Mastodynia , mastalgia or mammalgia are names for a medical symptom that means breast pain (from the Greek masto- , breast and algos , pain).

Pain can range from minor discomfort to severely incapacitating pain. Many women are more worried about a possible cancer risk than about the pain.

Breast pain during lactation or after weaning is not included into this definition but usually classified as breast engorgement or mastitis .

It can be classified into 2 main clinical patterns:

• cyclical when the pain intensity is changing during the menstrual cycle.

• non-cyclical when the pain remains essentially unchanged during the menstrual cycle. This type is less frequent.

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.

The causes for noncyclical breast pain are very varied and hard to establish. Noncyclical pain has frequently its root cause outside the breast.

Treatment depending on cause, see fibrocystic breast changes or duct ectasia. While in principle it is possible to predict which treatment will be most effective with a series of endocrinological investigations involving thyroid and complicated pituitary hormone testing , this is rarely done in practice.

Treatments which demonstrated some effectiveness:

• Vitex agnus-castus extract: there is convincing evidence that Vitex agnus castus is safe and efficient in the treatment of cyclical mastalgia. It is assumed, that like bromocriptine it works by reducing prolactin secretion from the pituitary gland.

• Topical and systemic NSAIDs, analgesics

• Progestin based birth control pills or topical progesterone application. This method is effective only in a minority of women but is often tried because of its well known safety profile.

• Dopamine agonists, best results with a better side effect profile than bromocriptine can be achieved with Dostinex.The older bromocriptine has been found very efficient with relatively good safety, is however associated with many unpleasant adverse side effects.

• Iodine: supplementation with supraphysiologic levels of iodine has been shown effective in the treatment of breast pain. Not yet widely recommended until the long term effects of supraphysiologic doses of iodine on thyroid health are better understood.

• Danazol: low dose danazol treatment has been found very efficient with modest side effects. The lowest dose tested in one trial produced the most favorable long term results and was associated with least adverse effects.

• Thyroid hormone supplementation, especially when hypothyroidism or subclinical hypothyroidism has been diagnosed. However even levothyroxin supplementation in normal patients has been shown effective.

• Tamoxifen has been shown effective but is very rarely used because of serious concerns about safety in premenopausal women.

Determining the appropriate treatment for noncyclical breast pain is more difficult, not only because it is hard to pinpoint where the pain is coming from, but also because the pain may not have hormonal causes and very often does not respond to hormonal treatment.

Great majority of breast cancer cases do not present with symptoms of pain.

Some epidemiological investigations suggest that women with symptoms of breast pain may have an increased risk of subsequently developing breast cancer and risk increases with duration of symptoms. This is consistent with the observation that a few special subtypes of fibrocystic breast changes exhibit increased breast cancer risk ??? see breast cancer risk of fibrocystic breast changes .

• Breast engorgement