Mastalgia causes

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Aditya Govindavarjhulla, M.B.B.S. [2] Hilda Mahmoudi M.D., M.P.H.[3]

Overview

Two thirds of breast pains are cyclical and one third have non cyclical cause.[1]

Cyclical breast pain is very often associated with fibrocystic breast changes or duct ectasia and believed to be caused by aberrations in dynamic hormonal changes mainly involving prolactin response to thyrotropin. Some degree of cyclical breast tenderness is normal in the menstrual cycle, and is usually associated with menstruation and/or premenstrual syndrome (PMS).

Noncyclical breast pain has various causes and is harder to diagnose.It is more likely to be unilateral and variable in its location in the breast.Some degree of non-cyclical breast tenderness can normally be present due to hormonal changes in puberty (both in girls and boys), in menopause, during pregnancy and breastfeeding. Other causes of non-cyclical breast pain include alcoholism with liver damage (likely due to abnormal steroid metabolism), mastitis, shingles and some medications.

Causes

Common Causes

  • Fibrocystic changes

Causes by Organ System

Cardiovascular No underlying causes
Chemical / poisoning Alcoholism
Dermatologic No underlying causes
Drug Side Effect Antibiotics, Antidepressants, Cardiovascular agents, Chlorpromazine, Cyclosporine , Digitalis, Drospirenone and Ethinyl estradiol, Estradiol topical , Estradiol transdermal, Estradiol valerate and estradiol valerate/dienogest, Estrogen injection , Estrogen vaginal, Ethinyl estradiol and etonogestrel, Etonogestrel, Hormone replacement therapy , Medroxyprogesterone injection , Methyldopa, Norethindrone acetate and Ethinyl estradiol, Norgestrel and Ethinyl estradiol, Oral contraceptives, Oxymetholone, Pramipexole, Ramelteon , Spironolactone, Tamoxifen , Tiagabine
Ear Nose Throat No underlying causes
Endocrine Diabetes mellitus, Puberty
Environmental No underlying causes
Gastroenterologic No underlying causes
Genetic No underlying causes
Hematologic Mondor's disease, Thrombophlebitis
Iatrogenic No underlying causes
Infectious Disease Shingles
Musculoskeletal / Ortho Chest wall pain, Costochondritis, Spinal and paraspinal disorders, Thoracic spine arthritis, Tietze's syndrome
Neurologic Intercostal neuralgia, Referred chest pain
Nutritional / Metabolic No underlying causes
Obstetric/Gynecologic Breast abscess, Breast cancer, Breast feeding, Breast fibroadenoma, Duct ectasia, Endometrial cancer, Fat necrosis, Fibroadenoma, Fibrocystic changes, Hidradenitis suppurativa, Intraductal papilloma, Lactation, Large pendulous breasts, Lipoma, Macrocyst, Mastitis,Menopause, Menstruation, Mondor's disease, Nodular sensitive breast, phylloides tumor, Polycystic ovary syndrome, Pregnancy, Premenstrual syndrome, Prior breast surgery
Oncologic No underlying causes
Opthalmologic No underlying causes
Overdose / Toxicity No underlying causes
Psychiatric No underlying causes
Pulmonary Pleuritic pain
Renal / Electrolyte No underlying causes
Rheum / Immune / Allergy Thoracic spine arthritis
Sexual No underlying causes
Trauma No underlying causes
Urologic No underlying causes
Dental No underlying causes
Miscellaneous Caffeine, Postthoracotomy syndrome, Trauma

Causes in Alphabetical Order

  • Breast fibroadenoma
  • Cardiovascular agents
  • Chest wall pain
  • Estradiol transdermal
  • Estrogen vaginal
  • Ethinyl estradiol and etonogestrel
  • Fibrocystic changes
  • Large pendulous breasts
  • Macrocyst
  • Nodular sensitive breast
  • Postthoracotomy syndrome
  • Prior breast surgery
  • Referred chest pain
  • Spinal and paraspinal disorders
  • Thoracic spine arthritis

References

  1. Davies EL, Gateley CA, Miers M, Mansel RE. The long-term course of mastalgia. J R Soc Med 1998; 91:462.

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