Outcome of Medical Therapy in Patients Suffering from Cyclical Mastalgia—An Ambispective Cohort Study

Mastalgia is the most common presenting symptom for patients attending breast clinic. The etiology behind breast pain has been described because of the responsiveness of the terminal ducto-lobular unit to the estrogen and progesterone fluctuations in the body. There is a poor understanding of the nature of the disease and its management with medical therapy (antiestrogen drugs like centchroman or tamoxifen). Hence, this study was carried out to observe the outcome of medical therapy in patients suffering from cyclical mastalgia. In this ambispective cohort study, all women (aged > 14 years) having moderate to severe cyclical mastalgia with a pain score ≥ 5 on the visual analog scale were included. Patients were given medical treatment and followed up for 1 year. The effectiveness of the treatment was defined by a reduction in the severity of breast pain score < 3 following medical therapy. In this study, 100 patients with cyclical mastalgia were included and analyzed. The mean baseline pain score for all patients was found to be 6.5 ranging from 5 to 9. After 12 months of therapy with different modalities, the mean pain score reduced to 0.5 with 96% of patients showing treatment response. However, 8 out of 31 patients who were given centchroman experienced side effects like delayed menstruation, scanty menstruation, menorrhagia, and secondary amenorrhea. Among patients who took danazol, four of them experienced side effects like hirsutism (1/7, i.e., 14.2%), delayed menstruation (1/7, i.e., 14.2%), hot flushes (1/7, i.e., 14.2%), and nausea and vomiting (1/7, i.e., 14.2%). Few patients (2/7) discontinued treatment due to acne, hirsutism, and nausea and vomiting. Cyclical mastalgia can be managed safely and effectively with first-line therapy using reassurance, physical support, flax seeds, and oral and topical NSAIDs. Tamoxifen and centchroman therapy can be used as a safe alternative to non-responders of first-line therapy.