Relationship between depression and anxiety with the severity and length of cyclic mastalgia in women

Document Type : Original Article


1 Assistant Professor, Department of Midwifery, School of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran.

2 M.Sc. of Midwifery, Student Research Committee, School of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran.

3 PhD Student, Department of Epidemiology, Tehran University of Medical Sciences, Tehran, Iran.


Introduction: Mastalgia is one of the most common breast problems. Due to the lack of studies on the etiology of mastalgia and unknown etiology of this disorder, this study was performed with aim to assess the relationship between depression and anxiety with the severity and length of cyclic mastalgia in women.
Methods: This cross-sectional study was performed on 322 women aged 18-45 years old referred to Tabriz health and treatment centers in 2014-2015. The questionnaires of socio-demographic, Nominal Day Breast Pain (NDBP), and Hospital Anxiety and Depression Scale (HADS) were used for data collection. General linear model was used to estimate the effect of each of the independent variables (depression, anxiety and socio-demographic characteristics) on the dependent variable (severity of mastalgia). Data was analyzed by SPSS software (version 21), and Pearson test, t-test and ANOVA. PResults: According to the results of bivariate tests, there was a significant correlation between the length and severity of mastalgia with anxiety and depression (P<0.05). According to the general linear model, the scores of anxiety and depression were the predictors of length and severity of mastalgia.
Conclusion: Anxiety and depression are of the effective factors on the severity and length of cyclic mastalgia, therefore, psychological and emotional support for reducing the level of anxiety and depression should be included in the treatment protocol in this regard.


  1. Smith RL, Pruthi S, Fitzpatrick LA. Evaluation and management of breast pain. Mayo Clin Proc 2004; 79(3):353-72.
  2. Ader DN, South-Paul J, Adera T, Deuster PA. Cyclical mastalgia: prevalence and associated health and behavioral factors. J Psychosom Obstet Gynaecol 2001; 22(2):71-6.
  3. Kataria K, Dhar A, Srivastava A, Kumar S, Goyal A. A systematic review of current understanding and management of mastalgia. Indian J Surg 2013; 76(3):217-22.
  4. Parsay S, Olfati F, Nahidi S. Therapeutic effects of vitamin E on cyclic mastalgia. Breast J 2009; 15(5):510-4.
  5. Berek J, Novak E. Berek and Novak's gynecology. 15th ed. Philadelphia: Lippincott Williams & Wilkins; 2012. P. 654-6.
  6. Pirasteh A, Khajavi Shojaie K, Kholdi N, Davati A. Stages of change and predicting of self efficacy construct in breast self examination behavior among women attending at Tehran Health Centers, Iran, 2011. Iran J Obstet Gynecol Infertil 2013; 16(70):16-23. (Persian).
  7. Lotfi B, Esmaeil Nasab N, Aghaei A, Ahmadi Jouybari T. Evaluation of breast cancer in Iranian women in an ecological study based on latitude, sun exposure and vitamin D intake. Iran J Obstet Gynecol Infertil 2015; 17(129):17-25. (Persian).
  8. Preece PE, Mansel RE, Hughes LE. Mastalgia: psychoneurosis or organic disease? Br Med J 1978; 1(6104):29-30.
  9. Black WC, Nease RF Jr, Tosteson AN. Perceptions of breast cancer risk and screening effectiveness in women younger than 50 years of age. J Natl Cancer Inst 1995; 87(10):720-31.
  10. Rea N, Bove F, Gentile A, Parmeggiani U. Prolactin response to thyrotropin-releasing hormone as a guideline for cyclical mastalgia treatment. Minerva Med 1997; 88(11):479-87.
  11. Ramirez AJ, Jarrett SR, Hamed H, Smith P, Fentiman IS. Psychosocial adjustment of women with mastalgia. Breast 1995; 4(1):48-51.
  12. Armand A, Talaee A. Investigating the efficacyof cognitive-behavioral stress-management training on decreasing the psychological problems and symptoms of premenstrual syndrome of afflicted women. Iran J Obstet Gynecol Infertil 2012; 15(21):24-31. (Persain).
  13. Goyal A, Mansel RE. A randomized multicenter study of gamolenic acid (Efamast) with and without antioxidant vitamins and minerals in the management of mastalgia. Breast J 2005; 11(1):41-7.
  14. Mansel RE, Goyal A, Preece P, Leinster S, Maddox PR, Gateley C, et al. European randomized, multicenter study of goserelin (Zoladex) in the management of mastalgia. Am J Obstet Gynecol 2004; 191(6):1942-9.
  15. Fathizadeh N, Takfallah L, Ehsanpour S, Namnabati M, Askari S. Effects of evening primrose oil and vitamin E on the severity of periodical breast pain. Iran J Nurs Midwifery Res 2009; 13(3):90-3.
  16. Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta psychiatr scand 1983; 67(6):361-70.
  17. Montazeri A, Vahdaninia M, Ebrahimi M, Jarvandi S. The Hospital Anxiety and Depression Scale (HADS): translation and validation study of the Iranian version. Health Qual Life Outcomes 2003; 1:14-9.
  18. Borenstein J, Chiou CF, Dean B, Wong J, Wade S. Estimating direct and indirect costs of premenstrual syndrome. J Occup Environ Med 2005; 47(1):26-33.
  19. Smallwood JA, Kye DA, Taylor I. Mastalgia; is this commonly associated with operable breast cancer? Ann R Coll Surg Engl 1986; 68(5):262-3.
  20. Ader DN, Shriver CD, Browne MW. Cyclical mastalgia: premenstrual syndrome or recurrent pain disorder? J Psychosom Obstet Gynaecol 1999; 20(4):198-202.
  21. BeLieu RM. Mastodynia. Obstetrics Gynecol Clin North Am 1994; 21(3):461-77.
  22. Eberl MM, Phillips RL Jr, Lamberts H, Okkes I, Mahoney MC. Characterizing breast symptoms in family practice. Ann Fam Med 2008; 6(6):528-33.
  23. Colegrave S, Holcombe C, Salmon P. Psychological characteristics of women presenting with breast pain. J Psychosom Res 2001; 50(6):303-7.
  24. Chuong CJ, Dawson EB. Critical evaluation of nutritional factors in the pathophysiology and treatment of premenstrual syndrome. Clin Obstet Gynecol 1992; 35(3):679-92.
  25. Jarry H, Leonhardt S, Wuttke W, Spengler B, Christoffel V. Auf der Suche nach dopaminergen Substanzen in Agni-casti-fructus-Präparaten: Warum eigentlich? Z Phytother 1999; 20:150-2.
  26. Peters F, Pickardt CR, Zimmermann G, Breckwoldt M. PRL, TSH, and thyroid hormones in benign breast diseases. Klin Wochenschr 1981; 59(8):403-7.
  27. Mirghafourvand M, Mohammad-Alizadeh-Charandabi S, Ahmadpour P, Javadzadeh Y. Effects of Vitex agnus and Flaxseed on cyclic mastalgia: a randomized controlled trial. Complement Ther Med 2015; 24:90-5.
  28. Dennehy CE. The use of herbs and dietary supplements in gynecology: an evidenceā€based review. J Midwifery Womens Health 2006; 51(6):402-9.