Mastalgia Breast Pain

Figure 25.2

Figure 25.2 is a flowchart outlining the treatment options for cyclical breast pain. Cyclical breast pain may be the only problem or it may be just one of several PMS symptoms. Some treatments are beneficial for cyclical mastalgia. These include:

  •   pyridoxine (vitamin B6).).

      bromocriptine (Parlodel).

Prolactin is the hormone particularly responsible for milk production after childbirth. Galactorrhoea (hyperprolactinaemia) tends to occur when prolactin levels are inappropriately elevated (hyperprolactinaemia Q6.10). For more than twenty years, bromocriptine (Parlodel - Novartis) has been the specific antidote for hyperprolactinaemia. It generally proves effective when other measures fail in the relief of cyclical mastalgia even in the absence of hyperprolactinaemia. Newer agents such as cabergoline (Dostinex Pharmacia and Upjohn) are more expensive. They may cause less side effects in some patients.

  • Oil of evening primrose will often prove effective and is readily available without prescription.
  • Danazol at a relatively low dose danazol (200mg daily) during the premenstrual phase of the cycle may improve cyclical breast pain but not other PMS symptoms.
  • GnRH to down-regulate the cyclical hormones may be helpful in severe situations which do not respond to these treatments. Add-back HRT may be required should menopausal symptoms occur (HRT-Add-Back).
  • Fluoxetine (Prozac Lilly) 20mg daily provides a new option for women with severe cyclical mastalgia. There is accumulating evidence that cyclical symptoms, including premenstrual mastalgia, may be related to abnormality in the release of serotonin which is an important neurotransmitter (a chemical released by brain cells to activate other brain cells).

A thirty-four year old lady presented with severe breast pain which had been slowly increasing. She had two children aged six and eight. She was taking no regular medication. A diuretic (encourages increased urine output) provided by her general practitioner had provided only temporary relief. On examination, her breasts were reminiscent of the engorgement encountered by women two or three days after childbirth. Investigations, including prolactin estimations demonstrated no abnormality. Over several years, a variety of treatments including Efamast, diuretics, Parlodel, Danazol, progestogens, and cabergoline individually and in combination have provided at best temporary relief. Down regulation with GnRH analogues and add-back HRT have proven to be effective.

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