September 23, 2022 Author : Sílvia Alexandre Silva Mastalgia is breast pain without a specific pathological connotation. It is a frequent symptom, about 70% of women will report it throughout their lives. It happens both before and after menopause. Breast pain causes anxiety in women, both because of the fear that it may be associated with breast cancer, and due to the impact on quality of life, interfering with physical, work, sexual or social activities. Thus, breast pain is a very frequent cause of seeking medical consultations, including breast and general and family medicine consultations. It is important that breast pain complaints are evaluated by a physician to determine whether they are related to physiological (normal) changes or to some pathological process, including breast cancer, although they are not a frequent symptom of this disease. Types of breast pain Mastalgia can be divided into two groups: Cyclical breast pain; Noncyclical breast breast. Cyclical breast pain Cyclical breast pain is the most frequent type. It is related to the menstrual cycle , in particular to ovulation. Usually appears 1-2 weeks before menstruation. In general, it is bilateral, that is, it affects both breasts. Pain may be diffuse or more localized in the upper and outer quadrants of the breast, and may radiate to the axilla and inner side of the arm. Many women experience discomfort a few days before menstruation that spontaneously improves after it. The difficulty is to perceive when one goes from a normal to a pathological situation. Noncyclical mastalgia Non-cyclical breast tenderness is not related to the menstrual cycle and usually appears in women in the fourth and fifth decades of life . It can be unilateral or bilateral; Pain is more localized. Causes of mastalgia Cyclical breast pain The causes of cyclical breast pain are not completely understood, but the hormonal environment related to the menstrual cycle is the most important factor. Noncyclical mastalgia Noncyclical breast pain is not usually due to hormonal issues. It is related to anatomical issues , resulting, for example, from: Trauma; Inadequate support; Benign solid or cystic tumors; Ductal ectasia or mastitis; Pregnancy; Effects of some medications. Breast cancer is an uncommon cause of breast pain, but this possibility should always be excluded. There is also extra-mammary pain to be considered, a pain interpreted as being in the breast and having other origins, such as: Cardiac; Gastrointestinal, for example in gallstones or gastroesophageal reflux; Chest wall, both with muscular origin and in inflammatory problems of the costal cartilages (Tietze syndrome). Evaluation and treatment of breast pain Interventions for treating cyclical and non-cyclical breast pain overlap. Its success is greater in cyclical breast pain , with a response in 92% of patients, compared to 64% in the case of non-cyclical breast pain. A specialized medical evaluation, complemented, whenever indicated, by an imaging study, allows to exclude with high probability malignant breast pathology and ensures peace of mind for patients. In many cases, no treatment is even necessary. Non-pharmacological therapy Some non-pharmacological measures, although with limited scientific evidence, can be adopted mainly in cases of mild to moderate breast pain , with good results: Women with breast pain often have high levels of anxiety and emotional stress, which can exacerbate the pain. Strategies to address stress and relaxation may benefit women with mild or moderate breast tenderness; Use an adequate breast support adapted to the type of breast; Avoidance of consumption of methylxanthines present in coffee, tea, chocolate, and soft drinks; Nutritional supplements : Vitamin E and B6 for their antioxidant effects; Primrose oil, rich in gamma-linoleic acid, can reduce the hypersensitivity of the breast epithelium to circulating hormones and to prolactin via prostaglandins; Flaxseeds (25 g/day) for their anti-inflammatory effects. Pharmacological treatment Pharmacological therapy, always prescribed by a doctor , most often includes: Oral or topical non-steroidal anti-inflammatory drugs , which have no relevant side effects; Drugs with hormonal activity , which should be reserved for cases of severe breast pain with a significant impact on the woman quality of life. The duration of treatment can be a few months and about half of the women experience a recurrence of symptoms, although they are usually milder. The content published in the Health Guide is intended for the general public and is provided for informational and educational purposes only. It does not replace individual medical assessment, diagnosis, or personalized clinical advice from a qualified healthcare professional. The content is produced or reviewed by physicians and other healthcare professionals at Hospital da Luz and is based on the knowledge available at the time of publication or the most recent update, as indicated at the beginning of each item.
