BREAST PAIN or MASTODYNIA
Breast pain is one of the leading complaints of women who apply to the outpatient clinic with breast-related complaints. Although it is seen more in women of childbearing age, it is also seen in women who have entered menopause. About one in every 10 women experiences moderate or severe breast pain lasting more than 5 days a month. Some women feel very severe pain, and this negatively affects their daily life, their work and their sexual activity. In addition to normal clinical and radiological findings, the factors affecting breast pain should be investigated and the right treatment should be chosen. Breast cancer that has not yet given any symptoms was detected in only 2-7% of women whose only history was pain. Pain due to breast cancer is typically in one breast and persistent. The risk of seeing breast cancer after a negative examination is 0.5%.
Cyclic mastodynia: it is generally seen in premenopausal women and is associated with the hormonal fluctuation of menstruation. The pain is typically in both breasts, especially in the upper-outer region. There are different approaches according to the prolactin measurement value. If prolactin is at a normal level, recommendations for the pain are made to the patient and drug treatment is started if necessary. If the prolactin level is high, a pituitary adenoma is suspected.
Non-cyclic mastodynia: It is generally seen in older and postmenopausal women. The pain is continuous or intermittent and is not related to the menstrual status. It is generally in one breast, especially in the lower-inner region. Recommendations are made to the patient and drug treatment is started if necessary.
Pain not originating from the breast: it may be caused by the heart, muscles or psychological factors; the patient is referred to an appropriate clinic such as cardiology, physical therapy or psychiatry.
Recommendations for mastodynia:
* Lifestyle changes are a good option for reducing breast pain; these include staying away from STRESS, quitting smoking, reducing caffeine, staying away from synthetic hormones, eating healthily, walking a lot and wearing a supportive bra without iron.
* Primrose oil: it may be effective for cyclic and non-cyclic pain by reducing sensitivity to hormonal effects.
*Danazol: it is the only pharmacological agent used in the treatment of breast pain. It has antigonadotropin activity and reduces pain in 75-92% of women. Its reported side effects are hair loss, acne, deepening of the voice, irregular menstrual bleeding and depression. Together with these, there is an increase in the incidence of thromboembolism.
* Bromocriptine: in some women with breast pain there is an increase in the secretion of the hormone prolactin. Bromocriptine reduces prolactin secretion and is particularly effective for cyclic pain. Side effects are dose-dependent, and nausea, vomiting, headache and dizziness are frequently seen.
*Tamoxifen is used in the prevention and treatment of breast cancer. It is 75-90% effective in relieving cyclic breast pain and 50-60% effective in relieving non-cyclic breast pain. It has side effects such as thromboembolic events and endometrial cancer. Hot flashes, nausea, menstrual irregularity and vaginal dryness are other side effects.
