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J Obstet Gynaecol Can. 2006 Jan;28(1):49-71; quiz 58-60, 72-4. Mastalgia.

Rosolowich V, Saettler E, Szuck B, Lea RH, Levesque P, Weisberg F, Graham J, McLeod L, Rosolowich V; Society of Obstetricians and Gynecologists of Canada (SOGC).

Breast Health Centre, Winnipeg Regional Health Authority, Winnipeg, Manitoba.

OBJECTIVE: To review the current management of women with breast pain. OPTIONS: The effect of various treatment modes and health practices, including medications, was considered for the management of both cyclical and noncyclical breast pain. OUTCOMES: Effective and timely management of the woman with breast pain and improved quality of...............................

RECOMMENDATIONS:

  • 1.

    Education and reassurance is an integral part of the management of mastalgia and should be the first-line treatment.

  • 2.

    The use of a well-fitting bra that provides good support should be considered for the relief of cyclical and noncyclical mastalgia.

  • 3.

    A change in dose, formulation, or scheduling should be considered for women on HRT. HRT may be discontinued if appropriate.

  • 4.

    Women with breast pain should not be advised to reduce caffeine intake.

  • 5.

    Vitamin E should not be considered for the treatment of mastalgia.

  • 6.

    There is presently insufficient evidence to recommend the use of evening primrose oil (EPO) in the treatment of breast pain.

  • 7.

    Flaxseed should be considered as a first-line treatment for cyclical mastalgia

  • 8.

    Topical non-steroidal anti-inflammatory gel, such as diclofenac 2% in pluronic lethicin organogel, should be considered for pain control for localized treatment of mastalgia.

  • 9.

    Tamoxifen 10 mg daily or danazol 200 mg daily should be considered when first-line treatments are ineffective.

  • 10.

    Mastectomy or partial mastectomy should not be considered an effective treatment for mastalgia. (III E).

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