Mastodynia is cyclical or persistent pain in the mammary glands caused by fluctuations in hormone levels or pathological processes in the breast and other organs. It is manifested by pain, hypersensitivity, discomfort in the area of the mammary glands and their swelling. With symptomatic mastalgia, the symptoms of the underlying disease are determined. Ultrasound, mammography, and laboratory methods are used to make the diagnosis. Treatment of functional mastodynia involves the appointment of hormonal and hormone-like drugs, sedatives, analgesics, diuretics. In acyclic mastalgia, the choice of tactics depends on the leading pathology.
Breast tenderness (mastodynia, mastalgia) is one of the most frequent complaints of patients of reproductive age. At least once in her life, all women experience it, and every second one has painful sensations that lead to psychological and physical discomfort, occur monthly. The term “mastodynia” to denote cyclic pain and swelling of the mammary glands was first proposed by the German surgeon T. Billroth in 1880. Most often, the disorder occurs in patients 20-40 years old who have not yet given birth or had one birth, lead an irregular sex life, suffer from gynecological diseases. The appearance of complaints of chest pain in patients older than 40 years usually indicates diseases of the mammary glands or other pathology.
Mastalgia occurs both during physiological changes in the female body, and in the presence of various diseases of the reproductive organs, mammary glands, and other body systems. During puberty, pain is usually observed during the maturation of the mammary glands under the influence of estrogens. In most women of reproductive age, mastodynia is not associated with the development of pathological changes in the breast and is the result of hormonal influences. Its occurrence is caused by:
- Ovulation. Under the influence of female sex hormones, cyclical changes occur in the mammary gland, preparing it for possible conception, gestation and feeding of a child. Such sensations are physiological, although they may be one of the manifestations of premenstrual tension syndrome.
- Hormonal disorders. In some patients, the appearance of mastodynia or a change in its nature is a sign of a violation of the secretion of sex hormones. This occurs in diseases of the ovaries (oophoritis, cysts, endometriosis, cancer), pathology of the hypothalamic-pituitary region or endocrinopathies.
- Taking oral contraceptives. Mastalgia is one of the side effects of hormonal drugs that regulate the menstrual cycle. When they are taken in the breast, the same cyclic changes are observed as during ovulation. Usually in 2-3 months the body adapts, the pain disappears or weakens.
Pain syndrome is possible with a large size of the mammary glands, their compression with uncomfortable underwear, bruising. Pain is also one of the signs of inflammatory and neoplastic diseases of the mammary glands — mastitis, mastopathy and other benign tumors, sclerosing adenosis, cancer. Pain radiates into the chest with osteochondrosis, intercostal neuralgia, myalgia, Titze syndrome, heart and liver diseases. In the absence of a hormonal or organic basis for pain, mastodynia can be a manifestation of psychogenias, neurotic and mental disorders (hysteria, hypochondria, depression).
The mechanism of pain in physiological or dishormonal mastodynia is associated with changes occurring in the breast tissue under the influence of sex hormones, especially progesterone. In the luteal phase of the ovarian cycle, there is an active proliferation of breast epithelial cells, fluid is retained in the stroma. This leads to swelling of the mammary glands, compression of nerve endings and the appearance of pain. In the presence of organic changes in tissues, pain is caused by irritation of nociceptive receptors by metabolic products that are formed during inflammatory and necrotic processes, or by the pressure of a growing volume formation on the surrounding tissues.
When determining the variant of mastodynia, the frequency of pain occurrence and the causes that led to its appearance are taken into account. The choice of optimal medical tactics depends on the correctness of establishing the form of mastalgia. In addition, the distinction of individual categories increases oncological alertness when a patient complains of breast soreness. Specialists in the field of mammology distinguish the following types of mastodynia:
- Cyclic (functional, true), which occurs in the second phase of the menstrual cycle. It is observed with physiological ovulation, premenstrual syndrome, hormone-sensitive dysplastic processes in the breast (diffuse mastopathy, etc.), taking oral contraceptives.
- Acyclic (symptomatic), associated with various diseases of the mammary glands. Pain syndrome manifests itself regardless of the monthly cycle and indicates damage to breast tissue due to injury or surgery, inflammatory, tumor processes, sclerotic changes, developmental abnormalities.
- False (reflected, irradiating), caused not by functional or pathological changes in the mammary glands, but by disturbances in the work of other organs and systems. It develops more often with metabolic and dystrophic diseases of the spine, joints, heart diseases, radicular and myalgic syndromes.
The main manifestations of cyclic mastalgia are pain and discomfort in the mammary glands. Usually, patients characterize such sensations as pulling, pressing, aching. Sometimes they become sharper, stabbing and acquire a shingling character. The breast increases in size (swells), which is why the usual underwear may seem tight and squeezing. The tactile sensitivity of the nipple, areola, and skin of the mammary glands increases. When touching them, a woman experiences pronounced discomfort. A characteristic feature of true mastodynia is the occurrence of pathological sensations simultaneously in both mammary glands, and in the presence of an additional lobule of the breast — and in the armpit. Pain syndrome is clearly associated with the menstrual cycle, develops a few days before menstruation and passes within one day after the appearance of spotting.
Acyclic mastalgia is characterized by the appearance of periodic or constant pain of varying intensity, usually occurring in one breast and unrelated to the phases of the ovulatory cycle. The severity of pain depends on the type of underlying pathology. Pain is usually combined with other clinical manifestations — palpable volumetric formations, nipple discharge, changes in the shape and contour of the gland, skin color and structure, hyperthermia, lethargy, enlarged axillary lymph nodes. With false mastodynia, there are signs of damage to other organs: an increase in the tone of the muscles of the back, soreness along the intercostal space with vertebrogenic origin of pain syndrome, changes in pressure and heart rhythm in cardiac pathology, etc.
Physiological mastodynia does not pose a threat to a woman’s health, but it can lead to a deterioration in her quality of life — increased fatigue, the appearance of irritability, tearfulness, bad mood, anxiety and other emotional disorders on the eve of menstruation. In women with a hypochondriac type of reaction, carcinophobia may occur. More serious are the consequences of untimely detection of organic pathology that caused breast soreness. In such cases, the treatment is longer, and the prognosis of the disease worsens.
The main task of the diagnostic stage in case of suspected mastodynia is the exclusion of organic causes of chest pain. For this purpose, a full range of laboratory and instrumental studies and consultations are prescribed to detect breast diseases and other pathologies. The examination plan usually includes such methods as:
- Breast ultrasound. Sonography makes it possible to quickly assess the structure of breast tissues, identify bulky formations, clarify their shape, size, localization, and determine the enlargement of lymph nodes.
- Mammography. The most sensitive way to detect even small volume formations. It is performed in two or three projections. If necessary, a sighting shot is taken.
- Laboratory tests. A discharge from the nipple and a biopsy obtained by puncture or trepan biopsy are sent for cytological examination. The level of the cancer marker CA 15-3 in the blood is determined.
In the presence of appropriate equipment, radiothermometry of the mammary glands is used as a screening method. In complex diagnostic cases, CT, MRI, electroimpedance mammography, breast scintigraphy, assessment of the hormonal profile (content of estradiol, progesterone, free and bound testosterone, FSH, LH, thyroid hormones, etc.) are indicated. Differential diagnosis of physiological mastodynia is carried out with fibrocystic mastopathy and other benign tumors, various forms of breast cancer, mastitis, involutive changes, extra-mammary pathology. If necessary, the patient is examined by an oncologist-mammologist, gynecologist, endocrinologist, neurologist, cardiologist, therapist, psychiatrist.
Special therapy of mastalgia begins only after the exclusion of diseases of the mammary glands. With a slight pain syndrome and the absence of other disorders, women with true mastodynia are recommended to be monitored in dynamics with periodic examination by a mammologist and ultrasound or mammography. Medical tactics for severe pain and emotional disorders are aimed at reducing or eliminating subjectively unpleasant sensations in the chest that occur with fluctuations in the hormonal background. The combination of pathogenetic hormonal, non-hormonal medicinal and non-medicinal methods of treatment is considered the most effective. Such patients are shown:
- Hormone therapy. The choice of the drug is carried out taking into account the level of hormone secretion and the severity of symptoms. Combined oral contraceptives of monophasic type or releasing forms, progestogens, antiestrogens, gonadotropin-releasing factor agonists are used for treatment.
- Phytopreparations and homeopathic remedies. To correct dishormonal disorders, derivatives of plants with an estrogen-like effect (evening primrose, sage, oregano, tsimifuga) and homeopathic preparations are used, which they are part of. They are recommended when a woman refuses hormone therapy.
- Sedatives. In the presence of significant mood swings, a tendency to anxiety and hypochondria, selective norepinephrine and serotonin reuptake inhibitors are indicated. In milder clinical cases, magnesium preparations, sedative preparations and herbs (valerian, motherwort, peony) are effective.
- Analgesics. Women with severe pain syndrome are prescribed medications from the group of nonsteroidal anti-inflammatory drugs. NSAIDs stabilize cell membranes and inhibit the synthesis of prostaglandins, which reduce the threshold of pain sensitivity due to the sensitization of pain receptors to mechanical influences.
- Diuretics. Since one of the links in the pathogenesis of mastodynia is fluid retention in the tissues of the mammary glands, the use of diuretics can reduce the severity of pain syndrome. Potassium-sparing diuretics, which also have antiandrogenic properties, and phytopreparations are usually used.
Complex therapy of mastalgia can be supplemented with vitamin and mineral complexes and physiotherapy techniques (electrophoresis, magnetotherapy, galvanization, balneotherapy). In acyclic mastodynia, the treatment of the underlying disease is carried out with the use of appropriate drug therapy and surgical interventions (opening and drainage of mastitis, tumor enucleation, sectoral resection, mastectomy, etc.).
Prognosis and prevention
With cyclic mastodynia, the prognosis is favorable, with acyclic and false, it depends on the disease that provoked the occurrence of pain. For the prevention of pain syndrome associated with cyclical fluctuations in hormone levels, it is recommended to normalize sleep and rest, reduce workloads, correct the diet with a decrease in the amount of salt and limit foods that retain fluid in the body (smoked meats, pickles, fried foods, alcohol). Prevention and timely treatment of gynecological diseases accompanied by hormonal disorders plays an important role.