Mastalgia causes: Difference between revisions

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==Overview==
==Overview==
Two thirds of breast pains are cyclical and one third have non cyclical cause.
Two thirds of breast pains are cyclical and one third have non cyclical cause.<ref>Davies EL, Gateley CA, Miers M, Mansel RE. The long-term course of mastalgia. J R Soc Med 1998; 91:462. </ref>


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).
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 and during pregnancy and breastfeeding. Other causes of non-cyclical breast pain include alcoholism with liver damage (likely due to abnormal steroid metabolism), mastitis and some medications. Also, shingles can cause a painful blistering rash on the skin of the breasts.
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.


[edit]
==Causes==
=== Common Causes===
*[[Estrogen injection ]]
 
*Fibrocystic  changes
 
*[[Hormone replacement therapy ]]
 
*[[Medroxyprogesterone injection ]]
 
*[[Oral contraceptives]]
 
*[[Premenstrual syndrome]]
 
===Causes by Organ System===
 
{|style="width:80%; height:100px" border="1"
|style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" | '''Cardiovascular'''
|style="height:100px"; style="width:75%" border="1" bgcolor="Beige" | No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Chemical / poisoning'''
|bgcolor="Beige"| [[Alcoholism]]
|-
|-bgcolor="LightSteelBlue"
| '''Dermatologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Drug Side Effect'''
|bgcolor="Beige"| [[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]]
        |-
|-bgcolor="LightSteelBlue"
| '''Ear Nose Throat'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Endocrine'''
|bgcolor="Beige"| [[Diabetes mellitus]], [[Puberty]]
|-
|-bgcolor="LightSteelBlue"
| '''Environmental'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Gastroenterologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Genetic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Hematologic'''
|bgcolor="Beige"| [[Mondor's disease]], [[Thrombophlebitis]]
|-
|-bgcolor="LightSteelBlue"
| '''Iatrogenic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Infectious Disease'''
|bgcolor="Beige"| [[Shingles]]
|-
|-bgcolor="LightSteelBlue"
| '''Musculoskeletal / Ortho'''
|bgcolor="Beige"| Chest wall pain, [[Costochondritis]], Spinal and paraspinal disorders, Thoracic spine arthritis, [[Tietze's syndrome]]
|-
|-bgcolor="LightSteelBlue"
| '''Neurologic'''
|bgcolor="Beige"| [[Intercostal neuralgia]], Referred chest pain
|-
|-bgcolor="LightSteelBlue"
| '''Nutritional / Metabolic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Obstetric/Gynecologic'''
|bgcolor="Beige"| [[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
|-
|-bgcolor="LightSteelBlue"
| '''Oncologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Opthalmologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Overdose / Toxicity'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Psychiatric'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Pulmonary'''
|bgcolor="Beige"| [[Pleuritic pain ]]
|-
|-bgcolor="LightSteelBlue"
| '''Renal / Electrolyte'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Rheum / Immune / Allergy'''
|bgcolor="Beige"| Thoracic spine arthritis
|-
|-bgcolor="LightSteelBlue"
| '''Sexual'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Trauma'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Urologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Dental'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Miscellaneous'''
|bgcolor="Beige"| [[Caffeine]], Postthoracotomy syndrome, [[Trauma ]]
|-
|}
 
===Causes in Alphabetical Order===
*[[Alcoholism]]
 
*[[Antibiotics]]


==Causes==
*[[Antidepressants]]
=== Causes Related to the Breast===
 
* Fibrocystic changes
*[[Breast abscess]]
:* Increased number of cysts or fibrous tissue in otherwise normal breasts
 
:* Can be associated with pain or [[nipple]] [[discharge]] - [[fibrocystic disease]]
*[[Breast cancer]]
:* If fibrocystic changes are cause of pain- found in 50-90% asymptomatic  women
 
:* Hormonal etiology -  pain often cyclic; most severe during luteal phase
*[[Breast feeding]]
:* Tissue edema/water retention with dilated/blocked ducts - not proven
 
*[[Mastitis]] or breast abscess
*Breast fibroadenoma
:* Acute onset, usually due to Staphylococcus aureus (S. aureus) or streptococci
 
:* [[Erythema]], local [[tenderness]] induration
*[[Caffeine]]
:* Most common in lactating women
 
* Pendulous breasts
*Cardiovascular agents
:* Pain due to stretching of Cooper’s ligaments
 
* [[Hidradenitis suppurativa]]
*Chest wall pain
:* Can involve the breast
 
:* Presents with painful breast nodules
*[[Chlorpromazine]]
 
*[[Costochondritis]]
 
*[[Cyclosporine ]]
 
*[[Diabetes mellitus]]
 
*[[Digitalis]]
 
*[[Duct ectasia]]
 
*[[Endometrial cancer]]
 
*[[Estradiol topical ]]
 
*Estradiol transdermal
 
*[[Estrogen injection ]]
 
*Estrogen vaginal
 
*Ethinyl estradiol and etonogestrel
 
*[[Etonogestrel]]
 
*[[Fat necrosis]]
 
*[[Fibroadenoma]]
 
*Fibrocystic changes
 
*[[Hidradenitis suppurativa]]
 
*[[Hormone replacement therapy ]]
 
*[[Intercostal neuralgia]]
 
*[[Intraductal papilloma]]
 
*[[Lactation]]
 
*Large pendulous breasts
 
*[[Lipoma]]
 
*Macrocyst
 
*[[Mastitis]]
 
*[[Medroxyprogesterone injection ]]
 
*[[Menopause]]
 
*[[Menstruation]]
 
*[[Methyldopa]]
 
*[[Mondor's disease]]
 
*Nodular sensitive breast
 
*[[Oral contraceptives]]
 
*[[Oxymetholone]]
 
*[[phylloides tumor]]
 
*[[Pleuritic pain ]]
 
*[[Polycystic ovary syndrome]]
 
*Postthoracotomy syndrome
 
*[[Pregnancy]]
 
*[[Premenstrual syndrome]]
 
*Prior breast surgery
 
*[[Puberty]]
 
*[[Ramelteon ]]
 
*Referred chest pain
 
*[[Shingles]]
 
*Spinal and paraspinal disorders
 
*[[Spironolactone]]
 
*[[Tamoxifen ]]
 
*Thoracic spine arthritis
 
*[[Thrombophlebitis]]
 
*[[Tiagabine]]


=== Causes Unrelated to the Breast ===
*[[Tietze's syndrome]]
* Trauma to chest wall
* Fat necrosis
:* Usually induced by trauma
:* Tender, firm mass, +/- calcification on mammogram
* [[Costochondritis]]
* [[Intercostal neuralgia]]
:* Usually due to a [[respiratory infection]]
* [[Pleuritic pain]] from underlying pulmonary/pleural disease
* Thoracic spine arthritis
* Referred chest pain
:* [[Gallbladder disease]]
:* [[Ischemic heart disease]]


===Flowchart===
*[[Trauma ]]
{{familytree/start}}
{{familytree | | | | | | | | | | | | A1 | | | | | | | |A1=Breast Pain}}
{{familytree | | | | | | | | | | | | |!| | | | | | }}
{{familytree | | | |,|-|-|-|-|-|-|-|-|+|-|-|-|-|-|-|-|-|-|.| }}
{{familytree | | | B1 | | | | | | |  B2 | | | | | | | |B3| |B1= Cyclic Pain|B2=Localized Tenderness|B3=Generalized Tenderness}}
{{familytree | | | |!| | | | | | | | |!| | | | | |,|-|-|-|^|-|-|-|.| | }}
{{familytree | | | C1 | | | | | | |  C2 | | | | C3 | | | | | | C4| |C1=Premenstural<br>Syndrome|C2=Trauma<br>Mastitis<br>Abscess<br>Herpes Zoster<br>Breast Fibroadenoma|C3= Fibrocystic Diseases<br>Pregnancy<br>Alcoholism<br>Caffeine|C4=Digitalis<br>Methyl-Dopa<br>Spironolactone<br>Chlorpromazine<br>Estrogens<br>Oral Contraceptives}}
{{familytree/end}}


==References==
==References==
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[[Category:Gynecology]]
[[Category:Gynecology]]
[[Category:Primary care]]
[[Category:Pain]]
[[Category:Pain]]
[[Category:Signs and symptoms]]
[[Category:Needs content]]
[[Category:Needs content]]
[[Category:Needs overview]]
[[Category:Needs overview]]
[[Category:Needs causes]]
[[Category:Needs causes]]

Latest revision as of 22:38, 29 July 2020

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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.