gynecology and obstetrics
Mastalgia (Breast Pain)
Evaluation of Mastalgia
History of present illnessshould address the temporal pattern of pain and its nature (focal or diffuse, unilateral or bilateral). The relation between chronic or recurrent pain and menstrual cycle phase should be ascertained. Review of systemsshould seek other symptoms suggesting pregnancy (eg, abdominal enlargement, amenorrhea, morning nausea) or fibrocystic changes (eg, presence of many masses). Past medical historyshould cover disorders that could cause diffuse pain (eg, fibrocystic changes) and use of estrogens and progestins. Evaluation , looking for abnormalities such as mass, nipple inversion or discharge, skin changes including erythema, rash, eczematous appearance, edema, or dimpling (sometimes termed peau d’orange [orange peel]), and signs of infection, such as redness, warmth, and tenderness. The following is of particular concern: Signs of infection Mass, nipple inversion, or skin changes Absence of abnormal findings suggests that pain is due to hormonal changes or large, pendulous breasts. Pregnancy testing should be done if pain is unexplained and has lasted less than several months, particularly if other symptoms or signs are consistent with pregnancy. Other testing is indicated infrequently—only if breast examination detects abnormal findings. 