mastodynia

17 year old hispanic female with complaints of bilateral breast pain and tenderness since May 2010. She has been on Yaz for two years to help her dysmenorrhea. The patient denied nipple discharge, swelling, or the presence of any rashes. She denied excessive caffeine or chocolate intake. She also denied being sexually active. An ultrasound performed on June 14th did not reveal any underlying pathology/abnormalities. During the physical exam, her breasts were very sensitive to light touch. Other than that, the exam was completey normal. The only recommendation that my preceptor and myself could offer was to try changing her birth control to a progesterone only pill. The patient still wished to be on some sort of birth control because of her dysmenorrhea. The estrogen content in the Yaz could have possibly been the culprit in ther breast discomfort. We offered the patient the option to try Norethindrone, which is a progesterone only pill and does not affect the breasts like the estrogen containing pills do. The patient agreed to try this birth control option with the understanding that she had to take it the same time every day. Additional instructions that were given to this patient that might provide relief included taking naprosyn, wearing a well-fitted, sports bra, and starting vit E supplementation. The patient was aware to follow up within 3 weeks or sooner if the discomfort continues.

greg bellanca