Cyclic mastalgia is treated symptomatically with lifestyle modification, analgesics, and hormonal therapy. In the last decade, case-control studies have reported that cyclical mastalgia could be. • ICD-9 code: 611. Breast pain, or mastalgia, affects up to 70%–80% of women during their lifetime (). On fifth and sixth visit, 46 patients reported with pain score 0, one with pain score of 2 and four with pain score of 6. Mastalgia is classified as cyclical, noncyclical, or. S. 1, 2 It can be sub-categorized as cyclic, non-cyclic and extra-mammary pain according to different onset time and area, with the first two types referred to as true mastalgia. Mastalgia is the second most common breast symptom leading to medical evaluation in the primary care setting. Mastalgia and breast cysts run a chronic relapsing course throughout life with improvement at menopause. The breasts are often painful, tender, and swollen at this time, but symptoms improve at other points in the cycle. The two most common concerns of patients presenting with mastalgia are: the fear of breast. Research criteria for the diagnosis of cyclic mastalgia are (1) pain severity greater than 4. Beles, C. Unfortunately, for some women the discomfort can begin around two weeks before her. 8% of woman had cyclical mastalgia which was closer to the results of Ader et al. Midrin. 9 This information is most accurate when obtained from a patient’s prospective breast painKeeping this in consideration, what is the ICD 10 code for breast pain? 2020 ICD-10-CM Diagnosis Code N64. It affects up to two-thirds of women, with one in ten women having moderate-to-severe pain. Treatment phase lasted 3 consequent menstrual cycles (2 x 30 drops/day = 1. In a prospective study by Plu-Bureau et al. Mastalgia ICD-10-CM Alphabetical Index. There is often a prodromal phase of nausea and pallor. This is cyclical premenstrual breast pain and by definition does not occur in post menopausal women. 4 Mastodynia. The rest result from benign ductal disorders (eg, intraductal papilloma, mammary duct ectasia, fibrocystic changes Etiology. This starter pack is exactly what every woman needs to bring her hormones back into balance!Cyclical mastalgia might last for more than 7 days in 11% of women . Fibrocystic Changes of the Breast: Radiologic–Pathologic Correlation of MRI. 1 Department of Radiology, Division of Breast Imaging, Penn State Health, Milton S. 22. ICD-10-CM Coding Rules. It affects both breasts and the armpit areas. This study evaluates the benefits and side-effects of two drugs (tamoxifen or danazol) used randomly in women with severe cyclical mastalgia. Cyclic Mastalgia (Nyeri Payudara Siklik) Nyeri payudara yang berkaitan dengan siklus menstruasi atau perubahan hormon wanita. Cyclical mastalgia ICD-10 code N64. 1 - other international versions of ICD-10 R59. Only a small proportion of patients seek medical advice from their general practice team • breast pain can be cyclical and non-cyclical and is most common between the ages of 30 and 50 years. Etiology of Mastalgia Localized breast pain is usually caused by a focal disorder that causes a mass , such as a breast cyst, or an infection (eg, mastitis , abscess). High level of estrogen, low level of progesterone, and imbalance in estrogen to progesterone ratio are assumed among its causes, as well. Studies have shown that those presenting with mastalgia are psychologically no different from women attending outpatients for other conditions. History will often reveal the temporal association of cyclical mastalgia with the menstrual cycle, but the best way to assess whether pain is cyclical is to ask the patient to complete a breast pain chart (Fig. 5%) did not have PMS. Cyclical mastalgia. Article preview. Tends to occur in both breasts, and sometimes the associated armpits and arms. Medicine. Localized breast pain is usually caused by a focal disorder that causes a mass , such as a breast cyst, or an infection (eg, mastitis , abscess). Sometimes the pain comes from the breast tissue in one or both breasts without any physical cause. doi: 10. 7 times as likely as asymptomatic young women to have had a mammogram. Breast pain is divided into two basic groups. The breast pain or mastalgia is the commonest presenting symptom to a breast clinic. Women <36 years old with cyclic mastalgia were 4. Young women (under 35 years) with mastalgia were more likely to have had a mammogram (20. It accounts for approximately 50% of referrals to a specialised breast clinic, two-thirds of patients having cyclical and one-third experiencing noncyclical mastalgia, or pain arising from the chest wall deep to the. Etiology of mastalgia is uncertain; various factors such as hormonal or dietary issues have been implicated [11,12]. 2 Department of Radiology, Division of Breast Imaging, Penn State Health, Milton S. Because of that, it’s more. In our study Danazol at dose of 100 mg once a day was effective in 69%. The 2022 edition of ICD-10-CM N62 became effective on October 1, 2021. It often presents as diffuse bilateral pain but. Cyclical and non-cyclical mastalgia show some differences in their characteristics with substantial overlap, and studies of breast pain should include both groups to better understand and characterize these differences, particularly with regard to a possible connection with breast cancer risk. The content on the NICE Clinical Knowledge Summaries site (CKS) is the copyright of Clarity Informatics Limited (trading as Agilio Software Primary Care). However, the incidence of a breast malignancy associated with a presenting complaint of mastalgia is low. Dan adanya kondisi ini biasanya akan membuat seorang wanita merasa nyeri yang panas dan menusuk yang diikuti dengan dada yang terasa sesak. In single-blinded clinical study on 61 women suffering from cyclical mastalgia (18–40 years old), who were randomly divided in two groups of 3 g daily oral evening primrose oil (n = 31) or 600 mg daily oral vitamin E (n = 30) and were evaluated according to CBS and the severity of pain. Fibrocystic change of the breast is a nonspecific term, commonly understood as a continuum of physiologic. The exact cause is not fully understood — it is thought that hormonal changes affecting the breast tissue are involved. Cyclical mastalgia most common type of breast pain, there is an important correlation with the menstrual cycle (Grullon s. ICD-9-CM 611. Enrolled mastalgia patients were defined as those patients who were diagnosed with mastodynia (ICD-10-CM Code N64. Mastalgia and total body water. Breast pain can be cyclical or non-cyclical and is most common between the ages of 30 and 50 years. ICD-10 Diagnosis Codes . 59 - other international versions of ICD-10 N64. Approximately 8-10% of premenopausal women experience moderate to severe perimenstrual breast pain or cyclical mastalgia, monthly. If you have cyclical breast pain, your GP may reassure you that what you’re experiencing is a normal part of your monthly cycle. Thus, we carry out this study to determine the efficacy of evening primrose oil (EPO) for mastalgia treatment in women. Assessment of risk for the development of breast cancer is important and is useful in patient reassurance or to design risk. Epub 2014 Jul 15. 1 Approximately 60–70% of women suffer from moderate to severe breast pain in their lifetime among which 10–20% of the cases suffer from severe breast pain 2 who may need. Both surgery and radiation therapy for breast cancer can cause scar tissue formation. By definition, mastalgia is the breast tenderness before the menstruation cycle in the luteal phase []. 1 The episodes occur at variable intervals, with an average of 12 per year. Cyclical breast pain is related to the menstrual cycle. Pengobatan Mastalgia. If the pain is linked to the menstrual cycle, it is known as cyclical mastalgia (cyclical breast pain) (cyclical breast pain). Hormones are believed to play a causal role, but causes aren't fully understood. Browse for your desired term or condition, or search for a specific disease / condition. 2022 , Smith RL. The two most common concerns of patients presenting with mastalgia are: the fear of breast cancer and the. Raised PRL levels haveMastalgia can be separated into four main groups, cyclical mastalgia, non-cyclical mastalgia, chest wall pain, and non-chest wall pain [] (Table 4. (I A) 9. Cyclical mastalgia. Side effects at this low dose for 3 months are minimal and include irregular periods and hot flashes. mastalgia, that was often associated with tiny discrete lumps in the breast (fibroadenosis). Five women (15. In previous studies which were conducted to evaluate the effect of flaxseed on cyclic mastalgia, a specific amount of flaxseed powder (25–30 g/d) was administered for patients [6, 19, 20]. Breast pain (mastalgia) is common in women and occasionally occurs in men. Tamoxifen 10 mg daily or danazol 200 mg daily should beWhat is mastalgia? Mastalgia is breast pain and is generally classified as either cyclical (associated with menstrual periods) or noncyclic. It is not expensive and can be tried for two or three months to see if there is any benefit. 1185/030079904125003377. Cyclical mastalgia affects two-thirds of patients with true mastalgia. (I A) 8. It is most common. Cyclical mastalgia. These problems have been resolved in the new breast pain chart. 9%) reported epigastric pain and ten patients (19. 1). PMID: 15140333. In the patients the severity of pain may adversely impact the routine life. This is the American ICD-10-CM version of M77. It is most commonly minor or moderate and is accepted as part of the normal changes of the. Most frequently, nipple discharge has a benign cause (see table Some Causes of Nipple Discharge Some Causes of Nipple Discharge ). The effect of progesterone therapy on E2/P ratio changes during the luteal phase, and its consequences are on mastalgia and cyst, within a fibrocystic breast disease (FBD). Breast cysts are part of a larger benign disease process known as fibrocystic disease of the breast. The 2024 edition of ICD-10-CM N64. Stata Statistical. Mastalgia frequency was monthly in all of the cyclic mastalgia patients. Because of its selective antiestrogen action, centchroman has been used for treatment of mastalgia and fibroadenoma. Cyclic mastalgia is related to the. Although there is a difference in the etiology and treatment of non-cyclical and cyclical mastalgia, similar medical investigations are performed in the diagnosis process. Mastalgia is usually a benign disorder in young women due to hormonal imbalance during their menstrual cycle. 1 The episodes occur at variable intervals, with an average of 12 per year. 3 Approximately. 2. Cyclic mastalgia is breast pain that's related to the hormonal variations associated with the menstrual cycle, which affect how your breasts feel over the course of a month. The etiology of cyclical mastalgia is not known; however, since it starts in luteal phase, hormonal stimulation might be the cause. Two thirds of women with mastalgia have cyclical pain and the remaining third have pain which is non-cyclical. }, author={Sandhya Pruthi and Dietlind L. Cyclical mastalgia: prevalence and impact in an outpatient breast clinic sample. Intervention: Each of the Nigella sativa seed oil, diclofenac and placebo gels is separately applied 2 times daily to the site of breast pain in a group of 50 women with cyclic mastalgia. Mastalgia. Approximately 60 to 70 % of women experience some degree of breast pain at some stages of their lives, and in 10 to 20 % of cases, it is severe [2, 3]. This type of pain usually occurs in both breasts. Objectives Centchroman (Ormeloxifene) is a novel non-steroidal, selective antiestrogen. These patients were managed with various kind of medical agents. Cyclic vomiting syndrome (CVS) consists of recurrent paroxysms of severe nausea and vomiting separated by symptom free periods. Pak J Surg. Cyclical mastalgia: primary breast pain associated with the menstrual cycle menstrual cycle Postmenopausal hormone Oral contraceptive Noncyclical mastalgia:. Nyeri ini umum dialami oleh wanita menjelang haid dan selama menstruasi. Given the nature and its response to the treatment, Mastalgia is divided. 2%) than those without mastalgia (9. Severe mastalgia was the dominant feature in 10 women with diffuse fibrocystic disease of the breast as judged by palpation and mammography and verified histologically. The selective estrogen-receptor modulator tamoxifen is most widely known and used for its role in the adjuvant treatment of breast cancer, but it has also been studied for the management of breast pain at a dose of 10 to 20 mg daily. Cyclical mastalgia consisted of a 2-month run-in phase for pain severity has been estimated by population-based surveys to screening and baseline assessments, a 4-month treat- affect from 22% to 41% of women [2, 4–6], with higher ment phase, and an optional 2-month follow-up phase. 16). Gejala nyeri payudara siklik berupa: Terjadi sebelum atau selama. 71 should only be used for claims with a date of service on or before September 30, 2015. 78%), bilateral mastalgia (60%) and mastalgia with lumpiness (44. The average number of births was 1. 6%, respectively, while 47. Last revised in August 2021. Abstract: A randomized, double‐blind, placebo‐controlled, multicenter clinical trial was conducted with 111. Sieder. 4 ICD-10 code description. Often, cyclical mastalgia will settle over the course of a few months, returning to “normal” pre-menstrual breast discomfort without any specific treatment. As the most common breast symptom causing women to consult physicians, it may affect up to 70% of women in their lifetime [1,2]. Mastalgia tidak selalu berbahaya. It is often located in the upper outer quadrant of the breastThe ICD code N644 is used to code Breast pain. The patient is requested to record her pain experience in terms of VLA score of “0” to “10. The incidence of cyclical mastalgia in well women presenting for breast screening was 69 per cent. Granulomatous mastitis, left breast. Both cyclical and non-cyclical mastalgia have an approximate response rate [1,17,18]. The most affected ages are between 30–50 years . Mastodynia (Painful breasts) In: diseases of the Breast, 2nd Edition JB. Reduction in breast pain, heaviness, tenderness, and serum. Cyclical mastalgia has been estimated by population-based surveys to affect from 22% to 41% of women [2, 4–6], with higher prevalence rates seen in breast clinics (30–69%) [7–10]. Back to top. Patients with a mild degree of pain (visual analogue pain score (VAS) < 3 on a score of 0 to 10) are. Cyclical mastalgia is a common problem sometimes severe enough to interfere with normal activity levels, and it is related to excessive use of mammography among young women. 10. Breast pain can range from mild to severe. (II-3 B) 3. Heavy breasts. Hormones are believed to play a causal role, but causes aren't fully understood. 19 It should be noted that the feeling of fullness and pain can occur only when the cerebral cortex of the woman receives nervous impulses from afferent receptors located in the inner part of the breast. 1 Description Intensity of mastalgia Timepoint before and after intervention Method of measurement Visual analogue scale (VAS) 2 Description Serum level of prolactin Timepoint before and after intervention. 18; vitamin E, p=0. cyclical mastalgia: Breast pain that occurs during each menstrual cycle. By definition, mastalgia is the breast tenderness before the menstruation cycle in the luteal phase []. 9 - other international versions of ICD-10 M83. Mastalgia is the most common breast symptom in patients attending a breast clinic []. Br J Cancer. The Alphabetic Index consist of a list of diseases and injuries and their related ICD-10 diagnosis code (s). The aims of the present study are to examine the effect of vitamin D supplementation on intensity of cyclical breast pain and prolactin level. The compliance rate (subjects reporting that they were ei- ther “complying fully” or “complying to some degree”) was 52. Cyclic mastalgia: Tends to be a feeling of soreness or heaviness. If she has no pain on next day, she fills a. 2 days of moderate-severe mastalgia monthly. and cyclical mastalgia in turkish women: Prevalans, risk factors, health-care seeking and quality of. Representative examples of non-neoplastic disorders include fibrocystic disease, gynecomastia, and. Nyeri Payudara (Mastalgia) Nyeri payudara atau mastalgia adalah rasa sakit yang muncul di payudara. ICD 10. Cyclical mastalgia (CM) or mastodynia typically occurs every month before the start of the menstrual period and is relieved within 7 days of the onset of menses. Effectiveness of Matricaria chamomilla (chamomile) extract on pain control of cyclic mastalgia: a double-blind randomised controlled trial. Diary cards are often helpful. It is possible that other foreign versions of ICD-10 N62. ↓ See below for any exclusions, inclusions or special notations. Section snippets Background. edu. I'm also concerned about the pain you say you feel. % of lactation history, while family. The 2024 edition of ICD-10-CM N60. Mastalgia pain is mostly mild, but some patients describe moderate or severe pain . Diagnosis often involves exclusion of other significant breast diseases. 4 ICD-10 code description Mastodynia Primary outcomes 1 Description severity of cyclic breast pain Timepoint at the begining of the study- at the end of first cycle of intervention- at the end of the second sycle of intervention Method of measurement visual analog scale 2 Description duration of the breast pain. This paper presents the first meta-analysis on the randomised trials published on the treatment of mastalgia. Data menunjukkan 70 persen wanita pernah mengalami mastalgia setidaknya satu kali seumur hidupnya. 2% (n = 85) with reassurance. 59 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. And given your age, it's highly unlikely this will be a concern. Breast pain during lactation or after weaning is. Objective: To evaluate the efficacy of Danazol and Oil of Evening Primrose (OEP) in the treatment of Mastalgia, and to note their undesirable effects during the course of. Complaints of mastalgia are more common in premenopausal women. Introduction. CAUSES OF MASTALGIA. Existing randomized controlled studies of tamoxifen showed efficacy in 71% to 96% of patients with cyclic breast. Ader and Craig D. The pain arises from the breast, but sometimes when it is referred from the chest wall it gets commonly mistaken as pain in the breast. Mastalgia, mastodynia, or breast tenderness is a common problem experienced by most women. Figure 1 shows that the CFA model had two factors, F1 and F2, which summarize the 10 PMS items. The pain can range from minor discomfort to severely. C84. Mastalgia is a common breast symptom that may affect up to 70% of women in their lifetime [ 1 ]. Careful examination can differentiate chest wall pain from true breast pain. 9 may differ. 2021; 4 (1): p. Asthma is a Mastalgia is considered the most common benign breast disorder in women during the fertile period by a prevalence rate of about 65% [1–3]. Abstract Objective Different drugs are used to treat mastalgia, such as danazol and bromocriptine, and both are associated with side effects, due to which most of women. They're usually asymptomatic, but some people have swelling, tenderness, breast pain, or nipple discharge. 5% with mastalgia, 4. The 2020 version of ICD-10-CM N62 becomes effective on October 1, 2019, replacing the previous edition. There are multiple causes for breast pain, however a common way to categorise types of breast pain is as cyclical, non-cyclical, or extra mammary. A lady health worker provides the lady with explanation about filling the chart (Fig. 3 It may last > 5 days and ∼ 30% of. In routine- screening group breast cancer rate was 0. In randomized trials conducted in Great Britain, 4 58 percent of women with cyclic mastalgia and 38 percent of those with noncyclic mastalgia responded to treatment with evening primrose oil (γ. However, diffuse bilateral pain is very common in women. who also reported 30% of woman suffering from cyclical mastalgia. True non-cyclical mastalgia was commonly bilateral and located within the upper outer quadrant of the breast, whereas. Mastodynia Billable Code. Breast tenderness (mastodynia, mastalgia) is one of the most frequent complaints of patients of reproductive age. 2. It is more common in younger women and often stops after menopause. Applicable To. Kanker payudara ditandai dengan gejala, seperti benjolan atau penebalan pada payudara, keluarnya. Mastalgia is the most common breast symptom in patients attending a breast clinic []. Meskipun ditandai dengan rasa nyeri pada payudara, tetapi mastalgia tidak berkaitan dengan kanker payudara. Three patients of fibroadenosis were eventually operated, due to their clinical impression of fibroadenoma. In Vaziri and et al. Pain is usually at its worst 3 - 5 days before the first day of your period, and can vary from slight tenderness to more intense pain and aching. This clinical trial is conducted on 80 women suffering from cyclical mastalgia. 4 is a valid billable ICD-10 diagnosis code for Mastodynia . 0 cm measured on a 10. The most common form of mastalgia is cyclic mastalgia . About one third of women with breast pain have this type of pain. In population surveys, more than 60% of women report that they have experienced cyclical mastalgia which they grade as severe. Cyclical mastalgia: • varies with the menstrual cycle, increases progressively from mid cycle and is usually Localized breast pain is usually caused by a focal disorder that causes a mass , such as a breast cyst, or an infection (eg, mastitis , abscess). Most breast cancers do not cause pain. Pre-menstrual syndrome (PMS) refers to a set of menstrually related, chronic, cyclical, physical and emotional symptoms occurring in the luteal. an increase. MASTALGIA IS the most common breast-related complaint of patients seeking care at both primary care clinics and breast referral centers. N62 is represented as ICD-10-CM in the United States. 20 20 Gateley CA, Miers M, Mansel RE. Berikut ini penjelasannya: 1. ICD-10 code lookup — find diagnosis codes (ICD-10-CM) and procedure codes (ICD-10-PCS) by disease, condition or ICD-10 code. 4103/1735-9066. This type of breast pain is. Some natural substances and dietary practices show promise for efficacy in managing mastalgia, but they need further study. 05). [1] It is a structural disorder of the mammary glands due to different degrees of hyperplasia and subinvolution of the mammary parenchyma and stroma. 0-cm visual analog scale and (2) pain duration of at least 7 days per month. 9±11. Cyclical breast pain comes and goes regularly related to the menstrual cycle (monthly period). A total of 38 patients did not complain of any side. Most women require reassurance only and the. 3%) patient. Mastalgia ditandai dengan gejala nyeri tajam atau sensasi terbakar pada payudara, serta rasa kencang pada payudara. Results: Seventy-nine percent reported having regularly experienced cyclical breast symptoms; 48% have asked a health care provider about their mastalgia. 5% with recurrent fibroadenoma, 13. European multicentre trial of bromocriptine in cyclical mastalgia. 8% to 2% (12). 1). The breasts may be described as "lumpy" or "doughy". Choe AI, Kasales C, Mack J, Al-Nuaimi M, Karamchandani DM. Young women (≤ 35 years) were more than three times as likely to have had a mammogram (75%) if they regularly experienced cyclical mastalgia than if they did not (24%; p < 0. Definition. Existing systematic reviews discuss dated treatment options that provide limited symptomatic. Published in British medical journal 29 November 1975. Mastalgia is one of the most common breast diseases complained by women and the leading reason to consult primary care doctors. The mean age of all participants was 31 ± 8. 8% and all of the patients with breast cancer in this group was postmenopausal. Most breast cancers do not cause pain. Certain hormonal factors underpin the function, evaluation, and treatment of this disease. Abstract. On the other hand, non-cyclic is more common in postmenopausal women as it. 71 should only be used for claims with a date of service on or before September 30, 2015. Key Words: Mastalgia, cyclic, non-cyclic, prevalence, reassurance. Cyclical mastalgia is a common problem sometimes severe enough to interfere with normal activity levels, and it is related to excessive use of mammography among young women. According to PSQI global score, overall sleep quality was significantly lower in the NCBP group compared to the control group (p. Pain can range from minor discomfort to severely incapacitating. When the lumps become significant enough to be called cysts, the condition is called fibrocystic. Last edited 4 Mar 2020. Young women (< or = 35 years) were more than three times as likely to have had a mammogram (75%) if they regularly experienced cyclical mastalgia than if they did not (24%; p < 0. To make a full assessment of the cause, all patients require a full history, examination and, sometimes, investigations. Mastalgia tidak selalu berbahaya. 3% with cyclical nodularity, 6. that is, (1) Cyclical mastalgia‑by definition having breast pain prior the menstruation in luteal phase and it relieved within 7 days of the onset of menstruation; (2) Noncyclical mastalgiaABSTRACT INTRODUCTION Idiopathic mastalgia (benign breast pain of unknown origin) is often poorly managed because of its subjective nature and unclear aetiology. J of Breast Imaging. N64. 0 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. During a menstrual cycle the breasts swell and become lumpy and tender. Previous Term: Mast Cell. Education and reassurance is an integral part of the management of mastalgia and should be the first-line treatment. 4 Mastodynia. Berikut beberapa gejalanya: Gejala mastalgia siklik: Perasaan payudara yang lebih berat dan nyeri. 7A - other international versions of ICD-10 C84. 0-cm visual analog scale and (2) pain duration of at least 7 days per month. The pain is often described as a dull, heavy ache, not focused on any specific spot. doi: 10. Introduction. 1997;185(5):466-70. Usually worsens the week prior to the onset of menstruation. Most breast cancers do not cause pain. Dysmenorrhea or painful menstruation is one of the most common problems of women. Because of that, it’s more common in 20-to-50-year-old women — and it’s particularly common. Thus, cyclical and non-cyclical mastalgia show some differences in their characteristics with substantial overlap. Mastalgia dapat terasa ringan hingga berat dan mengganggu aktivitas sehari-hari. In one survey, 69% of well women over 35 attending for breast screening reported cyclical mastalgia sufficient to cause. Diffuse bilateral pain may be caused by fibrocystic changes or, uncommonly, diffuse bilateral mastitis. Assessment of response to treatment was. 2001 Jun;22(2):71-6. In a study including 1,150 patients that investigated the causes of mastalgia, the rates of cyclic and noncyclic mastalgia were found to be 61. 2 ± 10. 4 - other international. • Justification of ordering additional data:Cyclic breast pain: Cyclic mastalgia affects women in their 20s, 30s, or 40s, while they are still menstruating. 5%, respectively . This is the American ICD-10-CM version of N61. N64. 4%). Prevalence and impact of cyclic mastalgia in a United States clinic-based sample. Lebih rentan terjadi pada wanita usia 20-30an. A topical preparation of this drug has recently been approved. 2%) were with cyclic pain and 15(28. 0 became effective on October 1, 2023. Management of the pain is often determined by the categorization of the pain. They're usually asymptomatic, but some people have swelling, tenderness, breast pain, or nipple discharge. Inclusion criteria: patients with cyclic mastalgia; regular menstrual cycles between 24-35 days; 4 or more mastalgia pain with VAS scale; age between 20-40 years old; not breast feeding; not to get pregnant; BMI between 19 to 29; no premature menopause; no history of breast and endometrial cancer or ovarian cancer; non family history of breast. This type of pain usually occurs in both breasts. mastalgia both cyclic and acyclic as 47. It is considered to arise from disturbed hormonal.