What is the cause and typical presentation of cyclic mastalgia?

Cyclic Mastalgia: Characteristics and Etiology

Cyclic mastalgia is caused by hormonal changes associated with menstruation (option C is correct), typically presents as diffuse bilateral or unilateral pain that waxes and wanes with the menstrual cycle, and most commonly affects women in their third decade of life rather than the 18-30 age range stated in option B.

Key Characteristics of Cyclic Mastalgia

Pain Pattern and Laterality

• Cyclic mastalgia is typically diffuse and can be either bilateral or unilateral (not specifically localized as suggested in option A), accounting for up to 70% of all breast pain cases 1, 2
• In one study, pain was unilateral in only 38% of cases, and among those with bilateral pain, 61% experienced more pain in one breast than the other (usually the breast with more parenchyma) 1
• The pain waxes and wanes with the menstrual cycle and is most pronounced during the luteal phase 1, 2

Age Distribution

• Patients with cyclic mastalgia are typically in their third decade of life (approximately 20-30 years old), not specifically the 18-30 range mentioned in option B 1
• Women who start having cyclical pain before age 20 usually have a prolonged course 1
• About 40% of women experience resolution of symptoms at menopause 1

Hormonal Etiology

Mechanism

• Cyclic mastalgia is most likely hormonal in origin, related to the menstrual cycle 1, 2
• The etiology involves several possible mechanisms including disturbance of hypothalamic control, abnormal hormonal response to stimuli, abnormal end-organ sensitivity, altered local hormone receptors, and disorders of lipid metabolism or fatty acid levels 1
• No consistent abnormalities in basal hormone levels have been found in most studies, suggesting increased sensitivity to normal hormone levels rather than absolute hormonal excess 1
• Research has shown that gonadotropin levels (not ovarian hormones) are significantly higher throughout the cycle in women with cyclic mastalgia 3

Distinction from Premenstrual Syndrome

• Most women with cyclic mastalgia do not meet the commonly accepted criteria for premenstrual syndrome, suggesting it is a distinct entity 1

Clinical Course and Prognosis

• Approximately 14-20% of patients experience spontaneous resolution within 3 months 1, 2
• Most patients have decreasing severity of pain over time 1
• However, at least 60% of cases recur within 2 years 1, 2
• Some women have increasing severity of symptoms until menopause 1

Important Caveats

• The likelihood of breast cancer is extremely low in the absence of other signs or symptoms 1
• Hormonal medications (hormone replacement therapy, oral contraceptives, infertility treatments) and selective serotonin reuptake inhibitors can cause or exacerbate breast pain 1
• There is no convincing scientific evidence that eliminating caffeine affects breast pain, despite widespread belief 1, 2