Managing breast pain
Mastalgia is generally defined as breast pain, and almost always manifests in women of reproductive age. Clinicians define three types of mastalgia: cyclical, noncyclical and extra-mammary mastalgia. All three have different etiologies and treatments.
Cyclical Mastalgia
Cyclical mastalgia, which is the most common type, is associated with the menstrual cycle. Pain usually begins a day or two before menstruation and increases until menstruation starts. The pain tends to fade after menstruation has begun, and often disappears after just a day or two. This type of cyclical mastalgia usually goes away following menopause. The etiology of the pain remains unknown, but it is almost certainly related to the estrogen cycle.
Noncyclical Mastalgia
Noncyclical mastalgia, which accounts for almost a quarter of the reported cases, is not well understood. There is rarely an identifiable precipitating incident, and the pain usually resolves itself spontaneously. The course of noncyclical mastalgia is not predictable, and can last from a few days to years.
Extra-Mammary Mastalgia
Extra-mammary mastalgia has numerous etiologies. Among the most common is Tietze's disease, an inflammation of the junctions of the chest wall; but referred pain from angina, pneumonia and oesophagitis also need to be ruled out.
Treatments for Mastalgia
The general experience is that that topical non-steroidal anti-inflammatory drugs are safe, effective and well-tolerated in relieving most kinds of breast pain. Tamoxifen or danazol should be considered if anti-inflammatories are ineffective and the pain is severe. While some health practitioners recommend evening primrose oil (EPO), there is no scientific evidence that it provides any benefit in reducing breast pain.
Non-Medical Techniques for Managing Mastalgia
There are a number of effective non-medical techniques for managing mastalgia, including but not limited to: wearing a comfortable bra that provides good support; limiting the intake of caffeine; weight loss; flaxseed as a dietary supplement; education and reassurance regarding the causes, course and treatments for mastalgia.
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