Event 3: Age Related Breast Pain

Age Related Breast Pain

1. Cyclic
2. Non-cyclic

Cyclic Breast Pain

• Most common type of breast pain
• Accounts for 67% of all breast pain
• Occurs in late luteal phase (days 14-28) of the menstrual cycle and during premenstrual syndrome
• Once menses occurs, the pain is usually relieved
• Occurs in women during their reproductive years
  • Approximately 2/3 of women with breast pain have cyclical pain 
• Some breast discomfort can be normal with menses, but cyclic breast pain can be intense and severe pain 
  • Disabling pain can last beyond the menses cycle
• Results from monthly fluctuations of the hormones, estrogen, and progesterone
  • Estrogen and progesterone increase the size and number of ducts and milk glands 
  • Retention of water 
    • This may result in breast pain  
• Characteristics: 
• Before menstruation, both breasts may swell and be tender, painful, and/or lumpy 
  • Pain is often bilateral, but may be more intense in one breast than the other
  • Pain can radiate to the armpit 
  • Pain often described as “dull, aching, heavy”

Reference

Santen RJ, 2000; Onstad M, & Stuckey A, 2013; Smith RL, Pruthi S, & Fitzpatrick LA, 2004; Chase C, Wells J, Eley S, 2011; Mastalgia (Breast Pain), 2016

Santen RJ, 2000; Onstad M & Stuckey A, 2013; Smith RL, et al., 2004; Chase C, et al., 2011

Breast pain, 2005; Chase C, et al., 2011

Treatment of Cyclic Breast Pain

Reference

Mastalgia (Breast Pain), 2016

Noncyclic Breast Pain

• Not associated with the menstrual cycle 
• Less common than cyclical breast pain
• The pain is present at all times and is more localized than cyclical breast pain
• Described as “burning, aching, sore” and as constant or intermittent pain 
• Typically occurs in 40-50 year old woman/postmenopausal women 
• Can be caused from some medications: 
  • Antidepressants 
  • Digoxin 
  • Thiazide-class diuretics 
  • Methyldopa
• Can also be associated with musculoskeletal issues with the chest wall-arthritis and costochondritis; or trauma – a blow to the breast

Reference

Amin, AL, et al., 2013; Chase C, et al., 2011; Smith RL, et al., 2004

Noncyclic Breast Pain Treatment

Treatment can be challenging

• Because it is not hormonal 
• Difficult to pinpoint the exact location of pain

Treatment Considerations:

• Age, current and past medical history
• Degree of the existing condition
• Tolerance for medications, procedures, and/or therapies
• Expectations for the condition
• Patient’s opinion and preferences

Treatment Steps for Non-Cyclic Breast Pain

History and Physical Exam

Physician may order mammogram

Biopsy of the area (if necessary)

If pain is caused by cyst, cyst is aspirated

Depending on location of pain, analgesics, anti-inflammatory drugs, and compresses may be prescribed