N6637 Week 6 women's health - breast; Clinical Guide to
Mastalgia, Breast Disorders, and Hormonal Contraception:
Assessment, Diagnosis, and Management of Cyclic/Non-Cyclic
Breast Pain, Fibrocystic Changes, Nipple Discharge, Benign and
Malignant Breast Masses, Mastitis, Gynecomastia, Abnormal
Uterine Bleeding, Amenorrhea, and Contraceptive Options
Exam Questions Verified and Provided with Complete A+
Graded Rationales Latest Updated 2026
mastalgia
•A common reason for which women seek health care.
•Even though it's benign, it is a significant cause of anxiety and worry.
•Cyclic or non-cyclic depending on whether it's presence is related to the menstrual cycle.
•As many as 70% of women experience cyclic mastalgia, some can be severe.
•Non-cyclic mastalgia is less common.
•Can be caused by medications such as hormones, contraceptives, antidepressants, digoxin,
methyldopa, spironolactone, oxymetholone, and chlorpromazine.
•Can be related to fibrocystic breast changes.
cyclic mastalgia
•Usually begins in the luteal phase and subsides with menses.
•Bilateral
•Poorly localized
•Described as soreness or aching.
•Common in women age 30-50.
,non-cyclic mastalgia
•May be constant or intermittent.
•Unrelated to menstrual cycle.
•More likely to be unilateral.
•Localized pain that is sharp or burning in nature.
•More common in women age 40 years and older.
mastalgia assessment
•Determine if the pain is cyclic or non-cyclic.
•VAS to rate pain.
•Keep a daily diary to differentiate type of mastalgia.
•Ask about other breast symptoms and history of other breast disease or surgery.
•Do a review of medications.
•Ask about caffeine and fatty foods which lead to distention in the breasts.
•Get a family history.
mastalgia examination
•Perform a comprehensive examination of the breast including inspection and palpation, supine and
upright.
•Assess for skin changes, nipple discharge and breast masses.
•If pain can be reproduced, note it's location.
•Examine the chest wall for non-breast causes of the pain.
mastalgia diagnostic testing
Pregnancy test if the patient is of reproductive age and the history suggests a possibility of this. Breast
pain/tenderness can be an early sign of pregnancy.
, Ulltrasound
•In women younger than 30 for focal mastalgia
•Directed US may be used in conjunction with mammogram prn
Bilateral Mammogram: For who?
•Post menopausal women with noncyclic pain
•Women 30 years of age and up with family history of breast cancer or risk factors for breast cancer
mastalgia nonpharmacologic therapies
•Reassurance
•Wearing a supportive bra.
•Reduction in caffeine and fatty foods.
mastalgia pharmacologic therapies
•Modify the dose or route of hormone therapy*.
•Danazol, tamoxifen, and bromocriptine have been found to offer significant relief. Currently only
Danazol is approved in the US. These medications can have significant side effects!
•Oral and local NSAIDs.
mastalgia complementary/alternative theapies
•Evening Primrose oil: frequently recommended but may not be more effective than placebo.
•Agnus castus (chasteberry) appears to be effective for cyclic breast pain.
•Isoflavones - naturally occurring phytoestrogens, have shown to reduce pain.
Mastalgia, Breast Disorders, and Hormonal Contraception:
Assessment, Diagnosis, and Management of Cyclic/Non-Cyclic
Breast Pain, Fibrocystic Changes, Nipple Discharge, Benign and
Malignant Breast Masses, Mastitis, Gynecomastia, Abnormal
Uterine Bleeding, Amenorrhea, and Contraceptive Options
Exam Questions Verified and Provided with Complete A+
Graded Rationales Latest Updated 2026
mastalgia
•A common reason for which women seek health care.
•Even though it's benign, it is a significant cause of anxiety and worry.
•Cyclic or non-cyclic depending on whether it's presence is related to the menstrual cycle.
•As many as 70% of women experience cyclic mastalgia, some can be severe.
•Non-cyclic mastalgia is less common.
•Can be caused by medications such as hormones, contraceptives, antidepressants, digoxin,
methyldopa, spironolactone, oxymetholone, and chlorpromazine.
•Can be related to fibrocystic breast changes.
cyclic mastalgia
•Usually begins in the luteal phase and subsides with menses.
•Bilateral
•Poorly localized
•Described as soreness or aching.
•Common in women age 30-50.
,non-cyclic mastalgia
•May be constant or intermittent.
•Unrelated to menstrual cycle.
•More likely to be unilateral.
•Localized pain that is sharp or burning in nature.
•More common in women age 40 years and older.
mastalgia assessment
•Determine if the pain is cyclic or non-cyclic.
•VAS to rate pain.
•Keep a daily diary to differentiate type of mastalgia.
•Ask about other breast symptoms and history of other breast disease or surgery.
•Do a review of medications.
•Ask about caffeine and fatty foods which lead to distention in the breasts.
•Get a family history.
mastalgia examination
•Perform a comprehensive examination of the breast including inspection and palpation, supine and
upright.
•Assess for skin changes, nipple discharge and breast masses.
•If pain can be reproduced, note it's location.
•Examine the chest wall for non-breast causes of the pain.
mastalgia diagnostic testing
Pregnancy test if the patient is of reproductive age and the history suggests a possibility of this. Breast
pain/tenderness can be an early sign of pregnancy.
, Ulltrasound
•In women younger than 30 for focal mastalgia
•Directed US may be used in conjunction with mammogram prn
Bilateral Mammogram: For who?
•Post menopausal women with noncyclic pain
•Women 30 years of age and up with family history of breast cancer or risk factors for breast cancer
mastalgia nonpharmacologic therapies
•Reassurance
•Wearing a supportive bra.
•Reduction in caffeine and fatty foods.
mastalgia pharmacologic therapies
•Modify the dose or route of hormone therapy*.
•Danazol, tamoxifen, and bromocriptine have been found to offer significant relief. Currently only
Danazol is approved in the US. These medications can have significant side effects!
•Oral and local NSAIDs.
mastalgia complementary/alternative theapies
•Evening Primrose oil: frequently recommended but may not be more effective than placebo.
•Agnus castus (chasteberry) appears to be effective for cyclic breast pain.
•Isoflavones - naturally occurring phytoestrogens, have shown to reduce pain.
