Influence of parenteral progesterones on the prevalence and severity of mastalgia in premenopausal women: a multi-institutional cross-sectional study.

Abstract

More than 30 percent of women seen in surgical breast clinics suffer from mastalgia. Although the causes of mastalgia are poorly understood, imbalances in estrogen and progesterone effects in the breast have been implicated. Progesterones have been proposed as a treatment for mastalgia, but the literature supporting their use is conflicting and currently inconclusive. The prevalence and severity of mastalgia in women receiving parenteral progesterones for contraception was compared to that of a randomly selected, age-matched control group using a validated survey instrument. Surveys were completed by 671 case subjects and 1,433 randomly selected, age-matched control subjects. Nine percent of women using medroxyprogesterone acetate (Depo-Provera, Upjohn, Kalamazoo, Mich) reported frequent breast pain compared to 21 percent of control subjects (OR 0.220, p < 0.001). The prevalence of clinically significant breast pain was 2.3 percent in the progesterone group compared to 4.9 percent in the control group (p < 0.02). Focal, noncyclic mastalgia predominated in the progesterone group with continued breast pain (78.8 percent), while diffuse, cyclic breast pain was more common in the control group (67.7 percent, p < 0.001). Medroxyprogesterone acetate effectively suppresses cyclic mastalgia in reproductive-age women and warrants additional study as a primary therapy.