Volume 24, Issue 6 (Feb - Mar 2021)                   2021, 24(6): 566-581 | Back to browse issues page


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Ghodsi F, Olfati F, Bahrami N, Farhad M. Cyclic Mastalgia in Iranian Women: A Review. Journal of Inflammatory Diseases. 2021; 24 (6) :566-581
URL: http://journal.qums.ac.ir/article-1-2898-en.html
1- Schools of Nursing and Midwifery, Qazvin University of Medical Sciences, Qazvin, Iran.
2- Schools of Nursing and Midwifery, Qazvin University of Medical Sciences, Qazvin, Iran. , papoy6olfati@yahoo.com
3- Department of Surgery, Faculty of Medicine, Qazvin University of Medical Sciences, Qazvin, Iran.
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1. Introduction
astalgia is a common breast complaint and a well-known organ disorder that is classified into cyclic, non-cyclic, and extra mammary types based on its nature and response to existing therapies [1]. Various factors have been proposed in the etiology of mastalgia which are generally classified into three categories: hormonal, nutritional and psychological [7]. Hormonal factor is the most common cause [1, 8]. Five to 20 percent of patients with moderate to severe mastalgia require treatment with medication [3], while mild to moderate mastalgia can be treated with psychotherapy and diet control [3, 16]. Despite the high prevalence of cyclic mastalgia and disagreement with its treatment methods, it has not been addressed as much as other breast problems and there are many uncertainties about the cyclic mastalgia. The present study reviews the studies on cyclic mastalgia conducted in the past two decades. The aim is to classify the existing studies on issues related to mastalgia and draw a general conclusion on the extent and methodology used for filling possible research gaps. Studies were reviewed and evaluated under three main themes including: prevalence of cyclic mastalgia among Iranian women, factors affecting mastalgia (underlying and non-underlying factors), and most common interventions for mastalgia.
2. Materials and Methods
This is a narrative review. The search was conducted on related studies published from 1998 to 2018 in PubMed, Google Scholar, Science Direct, Scopus, SID, and Iran Medex databases by using keywords: Breast pain, mastalgia, mastodynia, and cyclic mastalgia. Initial search yielded 975 papers. Of these, 29 papers were finally selected for review after elimination of duplicates and considering inclusion and exclusion criteria. We selected quantitative or qualitative studies whose main purpose was the evaluation of cyclic mastalgia, published in reputable national and international journals. Papers, with unavailable full text and no clear sample size and implementation method, were excluded.
3. Results
It was found that 19 out of 29 studies were interventional and 10 were not interventional. Most studies reported a cyclic mastalgia prevalence of about 30% in Iran [5, 10, 29]. The minimum and maximum rates were 23.8% and 60% respectively [30, 31]. Age 30 was the most common age for cyclic mastalgia [3, 5, 10, 27, 28, 30, 34]. This pain was more common in married people than single ones [7, 10, 14, 29, 30, 31]. Most studies found a significant relationship between premenstrual syndrome and this pain [29, 30], but there was no significant relationship between the use of contraceptive pills and cyclic mastalgia [29, 30]. There were conflicting results regarding the duration of lactation and its possible effect on cyclic Mastodynia; some reported a significant correlation between them [29, 34], while others reported no correlation [30]. Several studies reported the significant positive relationship of length and severity of cyclic mastalgia with anxiety and depression [10, 30]. The results indicated that mastalgia could affect women’s quality of life since it had a negative effect on sleep, daily living activity, and sexual activity of Iranian women [5]. The Visual Analogue Scale was the most common tool for evaluating the pain severity [15, 19, 21, 23252627]. Most studies have reported that cancer was a major concern of women with mastalgia [5, 29, 30, 34, 38], while there was no significant relationship between the history of cancer in woman and their family and the incidence of cyclic mastalgia [29, 30, 34]. Intervention by using herbal remedies was the most common treatment method for cyclic mastalgia [39]. Vitagnus, evening primrose, nigella sativa (black caraway), and cinnamon were the most common plants for reducing the severity and duration of breast pain [3, 7, 22, 26, 41]. In this regard, administration of 40 mg vitagnus tablets per day had a greater effect on the severity and duration of mastalgia compared to evening primrose and vitamin E [7]. Intervention by using vitamins was the second most common method. Vitamins E and B6 were the most widely-used and effective vitamins in national studies [3, 7, 13, 15, 252628]. There were a few studies on chemical drugs, and only two studies compared them with herbal medicines, where it was found that Nigella sativa had a greater therapeutic effect than diclofenac [21, 32]. Counseling therapy was the least common type of intervention to control the cyclic mastalgia. Only a study was found whose results indicated that individual counseling therapy can be effective in reducing mastalgia [16].
4. Discussion and Conclusion
There are few studies on cyclic mastalgia in Iran and other countries. Given the high prevalence of this complication reported in various studies worldwide, and the lack of same treatment protocol and consensus, further research should be conducted on mastalgia for obtaining best evaluation and treatment. In Iran, most studies have focused on the treatment of mastalgia, but there are few studies on the identification of factors affecting the incidence and severity of mastalgia as well as its effect on women’s quality of life. Further studies are recommended to better identify the disease mechanism.

Ethical Considerations
Compliance with ethical guidelines

This study was approved by Ethics Committee of Qazvin University of Medical Sciences (Code: IR.QUMS.REC.1397.138).

Funding
This study was extracted from MSc. thesis of first author at Student Research Committee, School of Nursing & Midwifery, Qazvin University of Medical Sciences, Qazvin.

Authors' contributions
Data analysis, methodology, supervision, and project administration: Forouzan Olfati; Conceptualization and editing: Nasim Bahrami and Maryam Farhad; Writing and data analysis: Maryam Farhad; Data analysis: Fatemeh Ghodsi.

Conflict of interest
The authors declared no conflict of interest.

Acknowledgments
We want to thank the Qazvin University of Medical Sciences.


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Type of Study: Review article | Subject: Midwifery

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