Mastodynia: pathogenesis, diagnosis, and treatment

DOI

https://dx.doi.org/10.18565/aig.2022.6.33-39

Kulagina N.V., Odintsov V.A.
1) I.I. Mechnikov Northwestern State Medical University, Ministry of Health of Russia, Saint Petersburg, Russia; 2) Northern State Medical University, Ministry of Health of Russia, Arkhangelsk, Russia; 3) Odintsov Clinic LLC, Saint Petersburg, Russia

Mastodynia is observed in 70% of women in the population and it occurs more frequently at the age of 30 to 50 years. We reviewed the papers published in the PubMed and RSCI database in the period from 2000 to 2022 in order to systematize the variants of the clinical course, the mechanisms of mastodynia development and individual approaches to the management tactics of patients with breast pain. Mastodynia may be associated with premenstrual syndrome, benign breast dysplasia, mastitis. The risk of breast cancer is extremely low in a situation where the only symptom is mastodynia. The examination of patients with mastodynia includes history taking, physical examination, imaging techniques aimed at identifying functional and organic disorders of the mammary gland. After appropriate clinical evaluation, most patients with breast pain respond positively to non-medication and medication treatment. The results of the clinical studies show the effectiveness of medications containing a dry extract of the fruits of Vitex agnus castus in the treatment of mastodynia in patients with diffuse benign breast dysplasia and premenstrual syndrome.
Conclusion: It is necessary to conduct a thorough examination of women with mastodynia in order to exclude proliferative formations of the mammary glands and to identify the cause of breast tenderness. Mechanism-based mastodynia therapy helps to reduce episodes of pain and improve the quality of life while minimizing side effects.

mastodynia

benign breast dysplasia

premenstrual syndrome

Vitex agnus castus

Full text (in Russian)

Kataria K., Dhar A., Srivastava A., Kumar S., Goyal A. A Systematic Review of Current Understanding and Management of Mastalgia. Indian J. Surg. 2014; 76(3): 217-22. https://dx.doi.org/ 10.1007/s12262-013-0813-8.
Goyal A. Breast pain. BMJ Clin. Evid. 2011; 2011: 0812.
Scurr J., Hedger W., Morris P., Brown N. The prevalence, severity, and impact of breast pain in the general population. Breast J. 2014; 20(5): 508-13. https://dx.doi.org/10.1111/tbj.12305.
Hafiz S.P., Barnes N.L.P., Kirwan C.C. Clinical management of idiopathic mastalgia: a systematic review. J. Prim. Health Care. 2018; 10(4): 312-23. https://dx.doi.org/10.1071/HC18026.
Grullon S., Bechmann S. Mastodynia. 2020 Jun 22. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan.
Протасова А.Э., Вандеева Е.Н. Диффузные заболевания молочной железы: новый вектор таргетной терапии. Гинекология. 2017; 2(19): 42-9. [Protasova A.E., Vandeeva E.N. Diffusive breast diseases: a new vector of targeted therapy. Gynecology. 2017; 2(19): 42-9. (in Russian)].
Eriksson M., Lindh., Uvnas-Moberg K., Hokfelt T. Distribution and origin of peptide-containing nerve fibres in the rat and human mammary gland. Neuroscience. 1996; 70(1): 227-45. https://dx.doi.org/10.1016/0306-4522(95)00291-p.
Peters M.T., Diemer P., Mecks O., Behnken L.L.J. Severity of mastalgia in relation to milk duct dilatation. Obstet. Gynecol. 2003; 101(1): 54-60. https://dx.doi.org/10.1016/s0029-7844(02)02386-4.
Алексеев Н.П. Физиология лактации женщины. М.: Издательство Юрайт; 2019. 300 с. [Alekseev N.P. Physiology of lactation of women. M.: Yurite Publishing House; 2019. 300 p. (in Russian)].
Smith R.L., Pruthi S., Fitzpatrick L.A. Evaluation and management of breast pain. Mayo Clin. Proc. 2004; 79(3): 353-72. https://dx.doi.org/ 10.4065/79.3.353.
Fentiman I.S., Hamed H. Assessment of breast problems. Int. J. Clin. Pract. 2001; 55(7): 458-60.
Contreras G.A., Rodríguez J.M. Mastitis: comparative etiology and epidemiology. J. Mammary Gland Biol. Neoplasia. 2011; 16(4): 339-56. https://dx.doi.org/ 10.1007/s10911-011-9234-0.
Fernández L., Langa S., Martín V., Maldonado A., Jiménez E. et al. The human milk microbiota: origin and potential roles in health and disease. Pharmacol. Res. 2013; 69(1): 1-10. https://dx.doi.org/10.1016/j.phrs.2012.09.001.
Hurtado J.A., Maldonado-Lobón J.A., Díaz-Ropero M.P., Flores-Rojas K., Uberos J. et al. Administration to Nursing Women of Lactobacillus fermentum CECT5716 Prevents Lactational Mastitis Development: A Randomized Controlled Trial. Breastfeed Med. 2017; 12(4): 202-9. https://doi.org/10.1089/bfm.2016.0173.
Çomçalı B., Kocaoz S., Özdemir B.A., Parlak Ö., Korukluoğlu B. Effects of sagging breasts and other risk factors associated with mastalgia: a case–control study. Sci. Rep. 2021; 11: 2620. https://doi.org/10.1038/s41598-021-82099-2.
İdiz C., Çakır C., Ulusoy A. İ., İdiz U.O. The role of nutrition in women with benign cyclic mastalgia: A case-control study. Eur. J. Breast Health. 2018; 14(3): 156-9. https://doi.org/10.5152/ejbh.2018.3827.
Altıntas Y., Bayrak M. Evaluation of 1294 Female Patients with Breast Pain: A Retrospective Study. Adv. Ther. 2018; 35(9): 1411-9. https://doi.org/10.1007/s12325-018-0769-y.
Koçoğlu D., Kurşun S., Akın B., Kamile K. Mastalgia and associated factors: a cross-sectional study. Agri. 2017; 29(3): 100-8. https://doi.org/10.5505/agri.2017.91069.
Hadi M.S. Sports brassiere: is it a solution for mastalgia? Breast J. 2000; 6(6): 407-9. https://doi.org/10.1046/j.1524-4741.2000.20018.x.
Радзинский В.Е., Ордиянц И.М., Масленникова М.Н., Павлова Е.А. Молочные железы и гинекологические заболевания: от общности патогенетических воззрений к практическим решениями. Репродуктивная эндокринология. 2014; 2(16): 72-80. [Radzinsky V.E., Ordiyants I.M., Maslennikova M.N., Pavlova E.A. Mammary glands and gynecological diseases: from the commonality of pathogenetic views to practical solutions. Reproductive Endocrinology. 2014; 2(16): 72-80. (in Russian)].
Кузнецова И.В., Бурчакова М.Н., Бурчаков Д.И., Хаджиева Н.Х., Филиппова Г.Г. Психогенные стресс-зависимые нарушения менструального цикла: роль негормональной коррекции. Медицинский алфавит. 2017; 2(10): 54-61. [Kuznetsova I.V., Burchakova M.N., Burchakov D.I., Khadzhieva N.K., Filippova G.G. Psychogenic stress-dependent disorders of menstrual cycle: role of nonhormonal correction. Medical alphabet. 2017; 2(10): 54-61. (in Russian)].
Yıldırım A.C., Yıldız P., Yıldız M., Kahramanca Ş, Kargıcı H. Mastalgia-Cancer Relationship: A Prospective Study. J Breast Health. 2015; 11(2): 88-91. https://doi.org/10.5152/tjbh.2015.2492.
Johnson K.M. Frequency of mastalgia among women veterans: association with psychiatric conditions and unexplained pain syndromes. J. Gen. Intern. Med. 2006; 21(3): 70-5. https://doi.org/10.1111/j.1525-1497.2006.00378.x
Srivastava V., Meena R.K., Ansari M.A., Kumar D., Kumar A. A Study of Anxiety and Depression in Benign Breast Disease. J. Midlife Health. 2020; 11(4): 200-9. https://doi.org/10.4103/jmh.JMH_85_20.
Kanat B.H., Atmaca M., Girgin M., Ilhan Y.S., Bozdağ A. et al. Effects of Mastalgia in Young Women on Quality of Life, Depression, and Anxiety Levels. Indian J. Surg. 2016; 78(2): 96-9. https://doi.org/ 10.1007/s12262-015-1325-5.
Katar M.K., Başer M. Relationship Between Mastalgia And Anxiety-Depression: An Observational Study. Cureus. 2021; 13(1): e12734. https://doi.org/10.7759/cureus.12734.
Mirghafourvand M., Ahmadpour P., Rahi P., Salehiniya H. Relationship between depression and anxiety with the severity and length of cyclic mastalgia in women. Iran J. Obstet. Gynecol. Infertil. 2016; 18: 1-7. https://doi.org/10.22038/IJOGI.2016.6559.
Noroozian M. Stein L.F. Gaetke-Udager K. Helvie M.A. Long-term clinical outcomes in women with breast pain in the absence of additional clinical findings: mammography remains indicated. Breast Cancer Res. Treat. 2015; 149: 417-24. https://doi.org/10.1007/s10549-014-3257-3.
Plu-Bureau G., Le M.G., Sitruk-Ware R., Thalabard J.C. Cyclical mastalgia and breast cancer risk: results of a French cohort study. Cancer Epidemiol. Biomarkers Prev. 2006; 15(6): 1229-31. https://doi.org/10.1158/1055-9965.EPI-05-0745.
Salman B., Collins E., Hersh L. Common Breast Problems. Am. Fam. Physician. 2019; 99(8): 505-14.
Jokich P.M., Bailey L., D'Orsi C., Green E.D., Holbrook A.I. et al. ACR Appropriateness Criteria® Breast Pain. J. Am. Coll. Radiol. 2017; 14(5): 25-33. https://doi.org/10.1016/j.jacr.2017.01.028.
Holbrook A.I., Moy L., Akin E.A., Baron P., Didwania A.D. et al. ACR appropriateness criteria: breast pain. J. Am. Coll. Radiol. 2018; 15(11): 276-82. https://doi.org/10.1016/j.jacr.2018.09.014.
Arslan M., Küçükerdem H.S., Can H., Tarcan E. Retrospective analysis of women with only mastalgia. J. Breast Health. 2016; 12(4): 151-4. https://doi.org/10.5152/tjbh.2016.2944.
Chetlen A.L., Kapoor M.M., Watts M.R. Mastalgia: imaging work-up appropriateness. Acad. Radiol. 2017; 24(3): 345-9. https://doi.org/10.1016/j.acra.2016.10.004.
Groen J.-W., Grosfeld S., Bramer W.M., Ernst M.F., Mullender M.M. Cyclic and non-cyclic breast-pain: A systematic review on pain reduction, side effects, and quality of life for various treatments. Eur. J. Obstet. Gynecol. Reprod. Biol. 2017; 219: 74-93. https://doi.org/10.1016/j.ejogrb.2017.10.018.
Peter C., Alec M., Botsikas D., Wegener S., Perbet E. Mastalgia: management and state of the art. Rev. Med. Suisse. 2022; 18(764-5): 83-7. https://doi.org/ 10.53738/REVMED.2022.18.764-65.83.
Cornell L.F., Sandhu N.P., Pruthi S., Mussallem D.M. Current Management and Treatment Options for Breast Pain. Mayo Clin. Proc. 2020; 95(3): 574-80. https://doi.org/10.1016/j.mayocp.2019.12.014.
Ngô C., Seror J., Chabbert-Buffet N. Breast pain: Recommendations. J. Gynecol. Obstet. Biol. Reprod. 2015; 44(10): 938-46. https://doi.org/10.1016/j.jgyn.2015.09.039.
Rosolowich V., Saettler E., Szuck B. Mastalgia. J Obstet. Gynaecol. Can. 2006; 28(1): 49-57. https://doi.org/ 10.1016/S1701-2163(16)32027-8.
Mansel R.E., Goyal A., Preece P., Leinster S., Maddox P.R. et al. European randomized, multicenter study of goserelin (Zoladex) in the management of mastalgia. Am. J. Obstet. Gynecol. 2004; 191(6): 1942-9. https://doi.org/10.1016/j.ajog.2004.06.100.
Клинические рекомендации «Доброкачественная дисплазия молочной железы». 2020. 77 с. [Clinical Guidelines "Benign Breast Dysplasia." 2020. 77 p. (in Russian)].
Souto E.B., Durazzo A., Nazhand A., Lucarini M., Zaccardelli M. et al. Vitex agnus-castus L.: Main Features and Nutraceutical Perspectives. Forests 2020; 11(7): 761. https://doi.org/10.3390/f11070761.
Seidlova-Wuttke D., Wuttke W. The premenstrual syndrome, premenstrual mastodynia, fibrocystic mastopathy and infertility have often common roots: effects of extracts of chasteberry (Vitex agnus castus) as a solution. Clinical Phytoscience. 2017; 3: 6. https://doi.org/10.1186/s40816-016-0038-z.
ЭльAкад Е.В., Сотникова Л.С., Тонких О.С., Оккель Ю.В., Федосова Л.Н. и др. Состояние гормональной регуляции при фиброзно-кистозной мастопатии. Мать и дитя в Кузбассе. 2011; 1: 342-6. [ElAkad E.V., Sotnikova L.S., Tonkikh O.S., Okkel Y.V., Fedosova L.N. et al. State of hormonal regulation in fibrocystic mastopathy. Mother and child in Kuzbass. 2011; 1: 342-6. (in Russian)].
Яворская С.Д., Сычева М.С., Кореновский Ю.В. Влияние лекарственного фитопрепарата на уровень гонадотропных гормонов и метаболитов эстрогенов у пациенток с доброкачественными заболеваниями молочных желез в сочетании с масталгией. Акушерство и гинекология. 2019; 1: 126-32. [Yavorskaya S.D., Sycheva M.S., Korenovsky Yu.V. Effect of an herbal medicine on the level of gonadotropins and estrogen metabolites in patients with benign breast diseases concurrent with mastalgia. Obstetrics and Gynecology. 2019; 1: 126-32. (in Russian)]. https://doi.org/10.18565/aig.2019.1.126-132.
Ашрафян Л.А., Бабаева Н.А., Антонова И.Б., Овчинникова О.А., АлешиковаО.И, Моцкобили Т.А., Кузнецов И.Н. Уровень баланса эстрогенных метаболитов при раке молочной железы и пути его коррекции. Опухоли женской репродуктивной системы. 2015; 11(3): 22-9. [Ashrafyan L.A., Babaeva N.A., Antonova I.B., Ovchinnikova O.A., Aleshikova O.I., Motskobili T.A., Kuznetsov I.N. The balance of estrogen metabolites in breast cancer and the ways of its correction. Tumors of female reproductive system. 2015; 11(3): 22-9. (in Russian)]. https://doi.org/
10.17 650/1994-4098-2015-11-3-22-29.
Сметник А.А., Сметник В.П., Киселев В.И. Опыт применения индол-3-карбинола в лечении заболеваний молочной железы и профилактике рака молочной железы. Акушерство и гинекология. 2017; 2: 106-12. [Smetnik A.A., Smetnik V.P., Kiselev V.I. Experience with indole-3-carbinol used to treat diseases of the breast and to prevent breast cancer. Obstetrics and Gynecology. 2017; 2: 106-12. (in Russian)]. https://doi.org/10.18565/aig.2017.2.106-12.
Ribat Z. W., Hayder B Sahib H.B., Khamees A.H., Al-Shammari A.M. Effect of vitex agnus castus fruits methanol extract against murine mammary adenocarcinoma cell line (amn3) and rat embryonic fibroblast normal cell line (ref). Int. J. Res. Pharm. Sci. 2019; 10(3): 1910-3. https://doi.org/10.26452/ijrps.v10i3.1393.
Bischoff-Kont I., Brabenec L., Ingelfinger R., Nausch B., Fürst R. BNO 1095, a Standardized Dry Extract from the Fruits of Vitex agnus-castus, Impairs Angiogenesis-related Endothelial Cell Functions In Vitro. Planta Med. 2021; 87(8): 611-9. https://doi.org/10.1055/a-1351-1038.
Kim Y.W., Byzova T.V. Oxidative stress in angiogenesis and vascular disease. Blood. 2014; 123(5): 625-31. https://doi.org/10.1182/blood-2013-09-512749.
Kikuchi H., Yuan B., Yuhara E., Imai M., Furutani R. et al. Involvement of histone H3 phosphorylation via the activation of p38 MAPK pathway and intracellular redox status in cytotoxicity of HL-60 cells induced by Vitex agnus-castus fruit extract . Int. J. Oncol. 2014; 45(2): 843-52. https://doi.org/10.3892/ijo.2014.2454.
Ahangarpour A., Najimi S.A., Farbood Y. Effects of Vitex agnus-castus fruit on sex hormones and antioxidant indices in a d-galactose-induced aging female mouse model. J. Chin. Med. Assoc. 2016; 79(11): 589-96. https://doi.org/10.1016/j.jcma.2016.05.006.
Ooi S.L., Watts S., McClean R., Pak S.C. Vitex Agnus-Castus for the Treatment of Cyclic Mastalgia: A Systematic Review and Meta-Analysis. J. Womens Health. 2020; 29(2): 262-78. https://doi.org/10.1089/jwh.2019.7770.

Received 06.06.2022

Accepted 14.06.2022

Natalya V. Kulagina, Dr. Med. Sci., Professor, Department of Obstetrics and Gynecology, I.I. Mechnikov NWSMU, Ministry of Health of the Russian Federation,
+7(812)303-50-00, dr.kulagina@mail.ru, https://orcid.org/0000-0002-9683-5963, 191015, Russian Federation, St. Petersburg, Kirochnaya str., 41.
Vladislav A. Odintsov, Dr. Med. Sci., Professor, Department of Radiation Diagnostics, Radiation Therapy and Oncology, NSMU, Ministry of Health of the Russian Federation; Chief Physician, Odintsov Clinic, +7(812)748-22-10, gec00@yandex.ru, https://orcid.org/0000-0001-7487-4219,
197345, Russian Federation, St. Petersburg, Touristskaya str., 22A.
Corresponding author: Natalya V. Kulagina, dr.kulagina@mail.ru

Authors’ contributions: Kulagina N.V. – developing the concept and design of the study, editing; Kulagina N.V., Odintsov V.A. – collecting and processing the material, writing the text.
Conflicts of interest: The authors declare that they have no competing interests.
Funding: The study was performed without external funding.
For citation: Kulagina N.V., Odintsov V.A. Mastodynia: pathogenesis, diagnosis, and treatment.
Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2022; 6: 33-39 (in Russian)
https://dx.doi.org/10.18565/aig.2022.6.33-39

Mastodynia: pathogenesis, diagnosis, and treatment

Kulagina N.V., Odintsov V.A.

Keywords

References

About the Authors

Similar Articles