What is Mastodynia?
Mastodynia is the medical term for breast pain, a very common symptom affecting 70-80% of women at some point in their lives 1.
Definition and Clinical Significance
Mastodynia (also called mastalgia) refers to pain or tenderness in the breast tissue 1. It is the second most common breast symptom (after breast lumps) for which women seek medical attention 1.
Classification
Mastodynia is divided into two main types that must be distinguished 1:
Cyclical Mastodynia (Most Common)
- Accounts for up to 70% of breast pain cases 1
- Diffuse unilateral or bilateral pain that waxes and wanes with the menstrual cycle
- Most pronounced during the luteal phase (premenstrual period)
- Often accompanied by breast swelling
- Typically affects women in their third decade of life
- Hormonal in origin, though no consistent hormone abnormalities are found—likely represents increased sensitivity to normal hormone levels 1
- 14-20% resolve spontaneously within 3 months, but 60% recur within 2 years 1
Noncyclical Mastodynia
- Accounts for up to 25% of cases 1
- Predominantly inflammatory rather than hormonal
- Usually unilateral and focal (precisely localizable)
- No predictable pattern, though may worsen in cold weather
- More common in women in their fourth decade of life
- Often located in the subareolar area, nipple, or lower inner breast 1
- 50% resolve spontaneously 1
- May require additional evaluation to exclude underlying breast lesions
Etiology
The cause is multifactorial and not well understood 1. Possible mechanisms include:
- Disturbance of hypothalamic control
- Abnormal end-organ sensitivity to hormones
- Altered local hormone receptors
- Disorders of lipid metabolism or fatty acid levels
- Medications: hormone replacement therapy, oral contraceptives, SSRIs 1
- Duct ectasia with periductal inflammation (25% of noncyclical cases) 1
Important Clinical Pearls
Common misconceptions to avoid:
- No relationship exists between mastodynia and fibrocystic changes 1
- No relationship to total-body water retention 1
- Caffeine elimination has no significant effect on breast pain despite widespread belief 1
Cancer risk: