EpistemisCyclic mastalgia
Specialty: Gynecology and breast.
Why it occurs
- Physiological luteal hormonal fluctuations (relative estrogen predominance or progesterone deficiency)
- Fibrocystic breast disease
- Premenstrual water retention
- Mild prolactin disorders (subclinical hyperprolactinemia)
- Psychogenic stress and lifestyle (excess consumption of methylxanthines, saturated fats or caffeine)
Initial workup
Daily recording of breast pain for at least two consecutive cycles. Directed bilateral breast ultrasound if the patient is under 35 years of age; Bilateral mammography complemented by ultrasound if the patient is over 35 years of age. Determination of serum prolactin levels and thyroid profile (TSH, free T4) if underlying endocrinological alteration is suspected.
red flags
Strictly unilateral pain that persists after the end of menstruation, presence of a hard, fixed or palpable nodule with irregular contours, spontaneously appearing unilateral blood or serous telorrhea, skin retraction or retraction of the nipple-areola complex.
Standard management
- Diclofenac gel 1% — apply to the affected quadrant every 12 hours during the luteal phase, maximum 14 days per cycle
- Evening Primrose Oil 1000-3000 mg/day orally divided into two doses for a minimum of 3 continuous months
- Topical 1% micronized progesterone gel — apply to both breasts from day 15 to 25 of the menstrual cycle
- Tamoxifen 10 mg/day orally for a maximum of 3 to 6 months in cases of severe refractory mastalgia that seriously alters the patient's quality of life (note: under strict specialist control due to the risk of hot flashes and venous thromboembolism).
Educational guidance for study. It is NOT a prescription recommendation. The actual choice depends on the cause, the patient, and current guidelines.
- Area
- Gynecology and breast
- Listed causes
- 5
- Treatment options
- 4