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The HRT follow-up consultation. What to do in case of breast pain. CNGOF and GEMVi clinical practice guidelines.

Carole Mathelin  1

Gynecol Obstet Fertil Senol.2021 Mar 20;S2468-7189(21)00079-9.doi:10.1016/j.gofs.2021.03.027. Ahead of print.

Breast pain is a concern in perimenopausal and postmenopausal women, quantifiable using validated tools, and may pre-exist or appear after initiation of a HRT. Objectives: A review of the literature was conducted to evaluate the frequency of breast pain, its evolution with age, its changes under HRT, its link with a possible risk of subsequent breast cancer, and the diagnostic (breast imaging) or therapeutic management modalities (pharmacological or other) in women taking HRT. Method: A review of the literature was carried out by consulting Medline, Cochrane Library data and international recommendations in French and English up to the end of 2019. Results: Published data confirm the importance of breast pain in relation to breast cancer risk. Women with breast pain prior to or related to the use of HRT have a significantly increased risk of breast cancer compared to women without breast pain. The risk is increased in cases of moderate to severe breast pain. In the presence of diffuse breast pain without abnormalities on clinical examination, it is not recommended to change the usual indications for screening, whether organized or individual. For focal breast pain, breast imaging (mammography and possibly ultrasound) is recommended. In the absence of abnormalities on breast imaging, a reassuring dialogue has to take place.

 With regard to HRT, doses of estrogens should be reduced until the breast pain decreases, or even stop the HRT if this symptom persists despite the use of low doses. Wearing a bra brassiere-type can also reduce breast pain.