Infectious and hormonal mastopathy of the mammary glands, treatment, symptoms, signs, causes. Cystic mastopathy: causes and treatment
Prolactin is a peptide hormone that is produced in the anterior pituitary gland. It belongs to the family of so-called prolactin-like proteins, including placental lactogen, somatotropin (growth hormone) and proliferin.
Prolactin is produced not only in women, but also in men. The exact effect of this substance in the body is still unknown, since receptors for prolactin are found in some parts of the nervous system, as well as in the liver, heart, pancreas, skeletal muscles, ovaries, testicles, adrenal glands, kidneys, thymus, lungs, skin and mammary gland .
What is known about prolactin today - During breastfeeding. It is believed that this hormone supports the formation of milk during breastfeeding, and during pregnancy it prepares the mammary gland, stimulating the growth of lobules of glandular tissue. By inhibiting ovulation, prolactin ensures the absence of menstruation in a nursing mother and thus protects the woman’s body from the onset of an early new pregnancy after childbirth. In the fetus. During pregnancy, prolactin “protects” the embryo from the effects of cells immune system the mother's body, and during the last trimester prepares the baby's lungs for the first full breath (participates in the production of a special substance - surfactant, thanks to which the newborn's lungs do not collapse back). Analgesic effect. It is believed that increasing the level of prolactin in the blood helps to lower the threshold of pain sensitivity. Providing orgasm during intercourse. Largest quantity Prolactin in the blood is recorded early in the morning or during REM sleep. Symptoms of elevated prolactin in women Increased levels of prolactin in the blood (hyperprolactinemia). Discharge of milk from the mammary glands (galactorrhea). Infertility. Violation of the monthly cycle. Hyperprolactinemia This is an increased concentration of prolactin in the blood. As a rule, at first a woman does not know that she has an excess of this hormone, but the following symptoms may indirectly indicate this condition: Violation menstrual cycle. Menstruation may become scanty and quite infrequent. Decreased sexual desire. Of course the work is hard physical activity, chronic lack of sleep can also reduce libido, but if all these factors are eliminated and the problem remains, hyperprolactinemia should be suspected. Growth of mammary glands with the formation of cysts, mastopathy. Osteoporosis (increased fragility, fragility of bones) with long-term hyperprolactinemia. Vaginal dryness, decreased genital hair growth. Galactorrhea It occurs with a significant increase in the level of prolactin in the blood and is manifested by the release of milk or colostrum from the mammary glands. May be accompanied by engorgement and breast tenderness. It should be remembered that a woman’s milk production is controlled by several hormones, so prolactin is not always to blame. To identify the exact cause, it is necessary to undergo a detailed examination by a gynecologist. Infertility In the case of excess prolactin, everything is very simple: the hormone delays ovulation indefinitely, and without it there can be no conception. As in the case of galactorrhea, it cannot be definitively concluded that unsuccessful attempts to conceive are always associated with prolactin. A timely examination by a gynecologist will in many cases help resolve this problem. Menstrual irregularities As mentioned above, elevated prolactin levels are characterized by scanty periods or their delay (something similar to what normally occurs in a breastfeeding woman during the first 3-5 months after childbirth). What to do Firstly, if you detect any of the above symptoms, you should consult a gynecologist. Secondly, don't panic. Thanks to the development of modern medicine, today in many cases hyperprolactinemia can be treated quite successfully. Thirdly, be sure to go through full examination prescribed by the doctor. If you need to determine the level of prolactin in the blood, remember that 2 days before the test you need to avoid sweets, physical activity, sex, and taking medications that can increase its level. Fourth, regularly take medications prescribed by your doctor (for example, Parlodel). Fifthly, if hyperprolactinemia is detected, do not provoke an increase in this hormone artificially. Remember that certain drugs can significantly increase the concentration of prolactin in the blood for a long time. medications(For example, hormonal contraceptives, s, antidepressants or tranquilizers) or drugs. Which doctor should I contact? If you have menstrual irregularities, you should consult a gynecologist. Additional assistance in diagnosis and treatment will be provided by a gynecologist-endocrinologist and mammologist.
Mastopathy- a benign disease that has developed as a result of an existing imbalance between hormones (progesterone, prolactin and estrogens) in the body. What leads to the growth of connective and glandular tissue in the mammary gland, which is why seals and/or cysts form in it different sizes.
Some statistics
In the world, 70 to 80% of women suffer from mastopathy. That is, 7-8 women out of 10. Moreover, women aged 30 to 45 years are most often affected by this disease.
Produced in the pituitary gland (located in the brain). Strengthens cell division in the mammary gland, stimulates the production of breast milk, increases the number of estrogen receptors in the mammary gland.
Normally, prolactin synthesis is suppressed by dopamine (a biologically active substance that transmits nerve impulses through nerve cells).
They regulate the metabolism of fats, carbohydrates and proteins, increase the production of prolactin, and also increase the sensitivity of mammary gland receptors to it.
Causes of mastopathy
In the formation of mastopathy, the main role is played by the hormonal imbalance between estrogen and progesterone, as well as prolactin. It develops as a result of various diseases.Causes of hormonal imbalance
The production of estrogen-binding protein is disrupted, so its (estrogen) activity increases significantly.
The production of thyroid hormones by the thyroid gland is reduced, so their level in the blood drops. As a result, the production of thyroid-stimulating hormone is stimulated in the pituitary gland, which activates the functioning of the thyroid gland. However, at the same time, the production of prolactin by the pituitary gland is also stimulated.
Note
- According to statistics, hypothyroidism is the most common reason increasing the level of prolactin in the body.
- With endemic goiter, mastopathy develops in 70% of cases. Because with a lack of iodine, the production of hormones in the thyroid gland decreases.
Eglonil and Cerucal (used to treat gastritis, stomach ulcers and 12 PCs), Reserpine (prescribed to lower blood pressure) - drugs central action(in the brain). They block the influence of dopamine - a biologically active substance, the deficiency of which increases the production of prolactin (normally, dopamine, on the contrary, reduces the synthesis of prolactin).
The production of hormones in the pituitary gland increases: FSH, LH and prolactin. Therefore, the synthesis of estrogen in the ovaries increases, and progesterone, on the contrary, decreases. Under the influence of estrogens and prolactin, breast cells begin to multiply intensively and the milk ducts begin to grow.
Partial synthesis of estrogens occurs in adipose tissue (cells). Therefore, the larger the subcutaneous fat layer, the more estrogen is produced.
Women whose close relatives (mother, grandmother) had breast or genital cancer are more likely to develop mastopathy. What is associated with the transmission of mutated (changed) genes from generation to generation.
Leads to poor circulation in the pelvis (blood stagnates). As a result, the functioning of the ovaries and their production of hormones are disrupted.
- Increased levels of aromatase (produced in the adrenal glands) - an enzyme that converts androgens (male sex hormones, which are Not large quantities synthesized in women) into estrogens.
- The number of receptors and/or their sensitivity to estrogen in the mammary glands is increased.
Types of mastopathy
The most widespread division of mastopathy according to radiological (detects changes in the structure of the mammary glands) and clinical (complaints and examination) signs.There are two main forms of the disease: diffuse and nodular mastopathy.
Diffuse mastopathy
Characterized by changes throughout the mammary gland. As a rule, it precedes the development of the nodular form. Types of diffuse mastopathy
Symptoms of diffuse mastopathy
- Breast engorgement, tenderness (mastalgia), swelling and tenderness of the mammary glands (mastodynia).
- When palpated, compaction of the entire mammary gland or only one area of it is noted. Or small-sized (about the size of a grain of rice) fine-grained foci of compaction are found, scattered in the mammary glands (mainly in the upper part).
- A clear or greenish-brown fluid may ooze from the nipple.
Nodular mastopathy
It is characterized by the formation in the parenchyma (body) of the mammary gland of cysts and nodes that have clear boundaries and are not fused to the skin and surrounding tissues. It can develop in one or both mammary glands.Fibrous mastopathy (fibroadenoma)
The glandular tissue (lobules) is replaced by connective tissue (it plays the role of a frame, but is not responsible for the function of the organs), which compresses the glandular duct, and therefore leads to its blockage over time. It is most common in young women aged 20 to 30 years. Signs
- Painful sensations and enlargement of the mammary gland
- A clear or greenish-brownish fluid discharges from the nipples
- When palpating the mammary gland, dense nodes are detected
Cystic mastopathy
Cavities appear, which are filled with liquid inside and surrounded on the outside by a dense shell (capsule). A form of mastopathy occurs in about 50% of women worldwide. Signs
- Painful sensations in the area of cyst formation
- The mammary gland increases in size and is painful
- Enlargement and soreness of the armpits lymph nodes, as well as swelling of the tissues around them
- Transparent selections from the nipples, and in case of infection - purulent.
- When palpating the mammary gland, elastic nodes of round or oval shape are determined
Fibrocystic mastopathy
Characterized by education dense foci in the parenchyma (body) of the mammary gland, which can degenerate into cysts, filling with fluid. It develops in approximately 50-70% of women with mastopathy, most often from the age of 30 until the onset of menopause. It has manifestations characteristic of both fibrous and cystic nodular forms of mastopathy.
When palpated, both areas of breast compaction and oval or round nodes with a loose and elastic consistency (soft to the touch) can be detected.
Symptoms of mastopathy
The disease can affect both mammary glands or one, and its symptoms depend on the type of mastopathy.| Symptom | Manifestations | Mechanism of occurrence |
| Diffuse mastopathy | ||
| Pain and feeling of fullness (swelling) in the mammary glands, as well as an increase in their size | At the beginning of the disease, symptoms are not pronounced; most often they occur a week before the start of menstruation. However, as the disease progresses, they become almost permanent. During menstruation itself, pain and swelling are somewhat less pronounced. | Estrogens promote the accumulation of sodium ions inside the cells of the mammary glands, which attract water molecules. Therefore, swelling of the breast tissue develops and pain appears. |
| Discharge from the mammary glands(transparent or greenish-brown) | They appear on their own (spots on the inside of the bra cup) or when pressure is applied to the nipples. | Prolactin promotes the development of milk ducts and their production of fluid, similar in composition to breast milk. |
| Areas of compaction | They are small, as a rule, located throughout the mammary gland. | Under the influence of estrogens and progesterone, the number and length of the milk ducts in the mammary gland increases, and connective tissue grows in it. |
| Nodular mastopathy | ||
| Fibrous mastopathy(fibroadenoma) | ||
| Breast tenderness, sensitivity to touch, and fullness | At the beginning of the disease, symptoms are most pronounced a week before the onset of menstruation. With the further development of mastopathy, they are present almost throughout the entire cycle. They can be aching and dull, but sometimes get worse even with a light touch. | Estrogen causes sodium to accumulate inside breast cells, which attracts water. In addition, the growing connective tissue puts pressure on the glandular tissue in the mammary gland. Therefore, swelling and pain intensify. |
| Discharge from the mammary glands(transparent to brownish-green) | At the beginning of the disease are not expressed. However, they intensify over time. They can appear independently (spots on the inside of the bra) or when pressure is applied to the nipples. | Prolactin increases the number of milk ducts, as well as their production of breast milk. |
| Formation of knots | When palpated, dense nodes are determined, which range in size from 0.2 to 5-7 cm. They have clear boundaries, they are mobile and not fused with the surrounding tissues. | The increased content of estrogen and prolactin leads to the growth of connective tissue, and the number of milk ducts increases. |
| Accession of infection(can be both with fibroma and cystic mastopathy) | Increased body temperature, redness of the skin of the breast, feeling unwell. The appearance of purulent or yellowish-green discharge from the nipples. | Swelling and stagnation of fluid in the mammary gland leads to impaired blood circulation in it, so infection easily occurs |
| Cystic mastopathy | ||
| Pain, swelling and burning in the breast | Most pronounced in the area of cyst formation. At the beginning of the disease, symptoms intensify as menstruation approaches. With a long course of mastopathy, they become almost permanent. The pain is mostly dull and aching, but sometimes quite pronounced, significantly intensifying even with a light touch. | Estrogens promote the penetration of sodium into cells, which attracts water. In addition, as the cyst grows, it puts pressure on surrounding tissues, increasing pain. If the cysts are small, then, as a rule, they do not cause any discomfort and there is no pain. |
| Discharge from the mammary glands | Transparent, greenish-brown, purulent (with infection). Discharge is more typical with multiple or large cysts Oh. Discharge can be random or appears when pressure is applied to the nipples. | Under the influence of prolactin, the number of milk ducts increases - and they begin to produce breast milk more intensively. |
| Breast enlargement | One or both depending on the location of the cyst or cysts. | The cyst puts pressure on the milk ducts, so fluid is retained, leading to the development of edema. |
| Lymph node changes(in 10-15% of patients) | They enlarge, become painful, and the tissue around them swells. | Most often, cysts are located in the upper and lateral lobes of the mammary glands, disrupting the outflow of lymph and leading to the formation of inflammation in them. |
| Cyst formation | Soft and elastic formations with clear boundaries, round or oval in shape, not fused with the surrounding tissues, ranging in size from 0.2 to 5-7 cm are palpated. The cyst can be a single formation or in the form of multiple foci. | Under the influence of estrogen and progesterone, one duct expands, and the fluid in it stagnates. Connective tissue then begins to form around the flow, forming a capsule. With the help of the capsule, the body tries to limit the dilated duct. Thus, fluid accumulates at the site of the dilated duct. |
| With this variant of the course of the disease, two forms of nodular mastopathy are combined: cystic and fibrous. As a result, both the formation of cysts in the mammary gland and areas of compaction occur. Therefore, signs of cystic and fibrous forms of mastopathy are observed simultaneously. | ||
Diagnosis of mastopathy
The reasons for the development of mastopathy are varied, so a thorough study is carried out to establish an accurate diagnosis.Which doctor should I contact if I have breast problems?
Three specialists are involved in the diagnosis and treatment of mastopathy: a gynecologist, a gynecologist-endocrinologist and a mammologist (identifies and treats only breast diseases). The ideal option is when all specialists take part in the treatment and monitoring of the patient. However, everything depends on the staffing of the diagnostic and treatment institution with these specialists.At the doctor's appointment
The doctor will conduct a short survey: he will clarify the details that are necessary to establish the correct diagnosis (when the first menstruation began, whether sexual activity is regular, and so on).This will be followed by examination and palpation (feeling) of the mammary glands, lymph nodes (axillary, cervical) and thyroid gland (located on the front of the neck).
If necessary, the doctor will order an ultrasound of the mammary glands, either mammography (x-ray of the mammary glands with a lower level of radiation), or even a biopsy (excision of a piece of altered tissue followed by examination under a microscope).
After receiving all the results of the study, the doctor will prescribe treatment, which can be carried out either conservatively (with the help of medications) or surgically (surgery).
Survey
Questions to answer in the doctor's office:
- How old are you?
- At what year of life did the first menstrual bleeding (menarche) appear?
- At what age did you have your first sexual intercourse?
- Is your sex life regular?
- Do you have menstrual irregularities?
- On what day of the menstrual cycle does the examination and consultation take place?
- How many pregnancies and births have you had? At what age?
- How many abortions and/or miscarriages have there been?
- What is the period breastfeeding?
- How is protection against unwanted pregnancy carried out?
- Do any close relatives (mother, sister, grandmother) have mastopathy or breast cancer?
- If there is no menstruation (menopause), then at what age?
- Do you have any chronic diseases? If so, what medications are taken to treat them?
Examination and palpation of the mammary glands by a doctor
It is carried out in a standing and lying position using the fingertips with sequential examination of each quadrant of the mammary gland: upper outer, upper inner, lower inner, lower outer.
During examination and palpation, the doctor asks the woman to either raise her hands or put them on her belt. Then he compares changes in both mammary glands, and also palpates the lymph nodes. Next, the doctor presses on the nipples, trying to squeeze out liquid from them.
The recommended timing of examination is from 5 to 9-10 days of the menstrual cycle (the most optimal is from 5 to 7 days). During menopause, the day does not matter.
Signs of mastopathy revealed during examination and palpation of the mammary glands:
- Soreness, swelling and increased sensitivity
- The presence of nodular seals in a certain area or throughout the mammary gland
- Detection of round cysts in various areas
- Discharge from nipples when pressing on them
- Presence of areas of skin or nipple retraction
- Formation of raised or depressed areas on the skin
- Marked unevenness of the mammary glands (slight asymmetry is the norm)
- Increased skin color of the nipple and peripapillary area
Mammography
A study used to diagnose breast diseases, which is informative even at the earliest stages of the development of the disease. There are several methods of mammography depending on the method: projection, digital and film.
However, the most commonly used is film X-ray mammography with minimal exposure to X-rays - the gold standard for diagnosing breast diseases. The procedure is performed using a special device - a mammograph, which makes it possible to obtain an image of the mammary gland in two projections (direct and lateral).
Indications for the use of film X-ray mammography
- Complaints of pain and enlargement of the breast
- Recession or bulging of breast skin areas
- Nipple discharge
- Presence of lumps in the mammary gland
- Women over 30 years of age who have received radiation therapy in the area chest regarding malignant neoplasm
- For preventive purposes, it is carried out annually for all women, starting from 40 years of age, and for women over 50 years of age - twice a year.
- Women who have close relatives with breast and/or ovarian cancer
Technology
The patient stands in front of the device, and the mammary gland is located between two dense holders (they compress the gland) in order to reduce the thickness of the tissues that absorb x-ray radiation. That is, the tighter the compression, the more informative the results. In some patients, the procedure may cause pain or discomfort, but such a reaction is acceptable.
Signs of mastopathy
Fibrous changes. There are clear and dense heavy shadows, which can be located both in individual areas (fibroadenoma) and spread throughout the mammary gland (diffuse mastopathy). In this case, connective tissue strands are located either along the glandular lobules, or along the milk ducts. While the contour of the lobules themselves is uneven. 
Overgrowth of glandular tissue of the mammary gland (adenosis). There are multiple small focal shadows of irregular shape and uneven edges - enlarged lobules. Sometimes these shadows completely merge with each other, forming foci of compaction of glandular tissue (lobules). 
Cystic changes. The general pattern of the mammary gland parenchyma is chaotic, and against its background there are formations of a round-oval shape of the same density. 
Mixed nature of changes in the mammary gland occurs most often. In this case, mammography shows both areas of compaction and cystic formations (nodular fibrocystic mastopathy).
Ultrasound of the mammary glands
Harmless and painless method, which is used to study the structure of the mammary glands and identify formations in them.The recommended timing for menstruating women is from 5 to 9-10 days of the menstrual cycle (the most optimal is from 5 to 7 days), since the condition of the mammary glands changes during the cycle under the influence of hormones. During menopause, the day does not matter.
Methodology
The woman lies on her back with her hands behind her head. A transparent gel is applied to the skin of the examined area, which ensures tight contact of the ultrasound sensor. Next, the doctor presses a sensor to the skin, the waves of which penetrate the tissue at different angles and, reflected from them, are displayed on the monitor.
Indications for use
- Diagnosis of cysts or lumps identified by palpation of the breast
- Examination of the mammary glands in women under 30 years of age, as well as during pregnancy and breastfeeding
- Recommended for all women over 35 years old once every 1-2 years, over 50 years old - twice a year
- Enlarged axillary lymph nodes
Diffuse mastopathy
On ultrasound, there are numerous small compactions that correspond to the proliferation of connective tissue, or small cysts (cavities with fluid), which are located evenly throughout the mammary gland. 
Nodular mastopathy
Fibroadenoma It is represented by a limited area of compaction in the mammary gland, which has clear boundaries.
Cystic form of mastopathy manifests itself in the form of the formation of cavities filled with liquid, which change their shape when pressed.
Fibrocystic mastopathy characterized by both the presence of cavities filled with liquid and areas of compaction. Formations have clear boundaries.
Biopsy and morphological examination
Small samples of tissue are taken from the changed areas of the breast, which are then examined under a microscope.The method allows us to distinguish mastopathy from a malignant tumor of the mammary glands with great reliability. In 80-90% of cases, changes in the mammary gland are benign.
Indications for use
- The mamogram or ultrasound shows suspicious areas with altered breast tissue
- The presence of large cysts and/or areas of compaction of breast tissue (more than 1-1.5 cm), identified by palpation by a doctor
- The appearance of crusts, peeling or ulcers on the nipple, or bloody discharge from it
Most often used in mammology fine needle aspiration biopsy method: A piece of tissue is taken from the palpable formations of the mammary gland, then it is applied to glass, stained and examined under a microscope.
The puncture is carried out using a special disposable needle, which is attached to a puncture gun. During the procedure, the gun fires a knife, which cuts a thin column of tissue out of the mass. As a rule, the procedure is performed under local anesthesia.
Signs of mastopathy on biopsy
The cells are mononuclear, have normal size and color. They contain a normal amount of chromatin (located inside the cell nucleus and involved in the transmission of genetic information during division). There are no zones of coronal cell growth (increased cell growth at the edges of the formation). Calcium deposited in tissues may be detected (a sign of possible future degeneration of mastopathy into a malignant tumor).
Laboratory blood tests
Several hormones influence the mammary gland, but their levels vary throughout the cycle. Therefore, the hormonal status is determined in the first follicular phase- from 5 to 9 days or in the second luteal phase - from 20 to 22 days of the menstrual cycle. Blood is drawn from a vein. What hormones in the blood need to be determined?
- Estradiol produced in the ovaries and adipose tissue
- Thyroid hormones- thyroxine (T4) and triiodothyronine (T3)
- Thyriotropic hormone (TSH)(produced in the pituitary gland and stimulates the production of thyroid hormones)
- Follicle stimulating hormone (FSH) and luteinizing hormone (LH)(produced in the pituitary gland and regulate the functioning of the ovaries)
- Prolactin synthesized in the pituitary gland and regulates the production of breast milk in the mammary gland
Additional examination methods
They help determine the function of the organ that produces hormones: the presence of inflammation, adhesions, tumors, and so on. Since such changes can lead to disruption of their work and, accordingly, changes in hormonal levels. However, they are not mandatory.
Additional Research
Ultrasound of the pelvic organs prescribed to detect the presence of an inflammatory process or tumor in the ovaries, fallopian tubes ah, uterus.Ultrasound of the thyroid gland reveals the size of the lobes and isthmus, the presence of nodes.
CT (computed tomography) or MRI (magnetic resonance imaging) of the brain to detect tumors. For example, pituitary adenomas.
Others are appointed additional methods research, but as needed.
Treatment of mastopathy
It can be conservative (using medications) or operative (using surgery).Drug treatment of mastopathy
The goals are to suppress the effect of estrogen and progesterone on breast tissue, normalize the functioning of the thyroid gland and the immune system. Means for the treatment of mastopathy
| Drug groups | Representatives | How is it prescribed? | Mechanism of action |
| Hormonal drugs | |||
| Antiestrogens -drugs that reduce the effect of estrogen on the mammary gland | Tamoxifen, Toremifene | Long-term in injections and/or tablets twice a day. The dosage is determined by the doctor. Treatment continues another two months after the appearance of signs of reverse development of mastopathy. | The drug blocks receptors (specific areas on the cell membrane) of cells in the mammary gland that estrogens must contact. |
| Combined oral contraceptives (COCs) - oral contraceptive pills containing synthetic analogues of natural estrogens and progesterone | Ovidon, Diana - 35, Tri-regol, Regulon. Lindinet – 20 and others | It is taken long-term, starting from the first day of menstruation, usually for 21 days. This is followed by a break for 7 days. Then the drug is resumed. | Suppresses the production of LH and FSH hormones in the pituitary gland. Therefore, there is no change in the level of hormones in the body throughout the month. A sustainable effect is achieved with long-term use: from several months to 1-2 years. |
| Gestagens(progesterone) | For oral administration: * Utrozhestan - natural progesterone * Duphaston is a synthetic analogue of natural progesterone | Utrozhestan is prescribed ½-1 tablet twice a day, Duphaston - 1 tablet twice a day. Reception begins on the 14th day of the menstrual cycle and continues for 14 days. Then the drug is discontinued. The course is from 3 to 6 months. | Ovulation is blocked, and cyclic fluctuations in sex hormones are eliminated throughout the month. Therefore, increased cell division in the mammary gland and the growth of the milk ducts stop. |
| Externally: Progestogel | 1 dose is applied through the applicator to the skin of the breast. The drug is rubbed in until completely absorbed. Apply twice a day. | Blocks estrogen receptors. As a result, reverse development of the milk ducts occurs. In addition, the drug reduces swelling of the mammary glands and has an analgesic effect. | |
| Drugs that inhibit prolactin synthesis(prescribed only for elevated prolactin) | Parlodel (Bromocriptine), Dostinex | 1-2 tablets three times a day with meals. | Stimulates the production of dopamine in the hypothalamus, which, in turn, suppresses the synthesis of prolactin. |
| Gonadotropin-releasing hormone antagonists) | Diferelin, Zoladex, Buserelin | Zoladex - once every 12 weeks subcutaneously in abdominal wall. Diferelin - one injection once every three months. | Inhibits the release of gonadotropin-releasing hormone from the hypothalamus. As a result, LH and FSH are not produced in the pituitary gland. Thus, ovarian function and ovulation are inhibited. That is, temporary reversible menopause occurs, which contributes to the reverse development of mastopathy symptoms. |
| Synthetic analogues thyroid hormones | L-thyroxine, Euthyrox Used for hypothyroidism - insufficient production of thyroid hormones by the thyroid gland | In the morning on an empty stomach half an hour before meals. Dosage regimen: daily or with a two-day break, once a week. The dosage of drugs and the duration of treatment are determined by the doctor. | Increased production of thyritotropic hormone and prolactin by the pituitary gland is inhibited. |
| Non-hormonal drugs | |||
| Iodine preparations prescribed for thyroid deficiency | Iodomarin, Klamin (dietary supplement) | Iodomarin - 1-2 tablets per day after meals. Klamin - 2 capsules three times a day. Course - 2 months. It is repeated if necessary. | Iodine is involved in the synthesis and release of thyroid hormones. |
| Homeopathic medicines | Mastodinon | Take either 30 drops or one tablet twice a day. Course - 1.5-2 months. | Reduces the production of prolactin in the pituitary gland, normalizes the secretion of LH and FSH. As a result, the menstrual cycle is normalized, and the milk ducts undergo reverse development. |
| Mastopol | Dissolve one tablet under the tongue half an hour before meals three times a day. Course - 8 weeks. If necessary, treatment is repeated after 4-6 months. | Reduces swelling, inflammation and pain in the mammary glands. Improves supply nutrients and oxygen to all tissues, and also normalizes the functioning of the immune system. As a result, the milk passages undergo reverse development, and the menstrual cycle normalizes. | |
| Drugs plant origin | Mammoleptin | 5 capsules three times a day 30-60 minutes after meals. Course - 2 months | Reduces pain, swelling and tenderness of the mammary glands. Leads to reverse development of the milk ducts. |
| Vitamin complexes containing vitamin A or beta-carotene (precursor to vitamin A), C, E, D, P and selenium | Triovit, Aevit and others | 1 capsule 2 times a day. Course - 8 weeks. It is recommended to carry out up to 3 courses of treatment throughout the year. | Normalize estrogen levels, improve liver and immune system function. Stabilizes the walls of blood vessels, preventing the development of edema in the mammary glands (vitamin C). At long-term use prevent the transition of mastopathy to a malignant tumor (vitamins A and D, selenium). Slow down the aging of body cells and enhance the effect of progesterone (vitamin E and selenium). |
| Nonsteroidal anti-inflammatory drugs (NSAIDs) | Airtal, Indomethacin, Diclofenac and others | As a rule, 1 tablet is prescribed twice a day after meals. | Reduce pain, inflammation and swelling in the mammary glands. |
The listed drugs are used both for the treatment of diffuse and nodular forms of mastopathy. The course is from 2 to 4-6 months, depending on the severity of the disease.
Principles of prescribing medications
- Diffuse forms of mastopathy
Treatment of adenosis, fibroadenomatosis, diffuse cystic and cystic fibrous mastopathy is carried out only with the use of medications (conservatively). They are prescribed depending on the stage and severity of the symptoms of the disease. For example, when initial signs Non-hormonal drugs (vitamins, iodine preparations, homeopathic remedies) are mainly used to treat the disease. Hormonal drugs are rarely used.
Whereas with severe symptoms diseases (especially in the diffuse fibrocystic form), hormonal drugs (gestagens, COCs, thyroid hormones, etc.) are often added to treatment. - Nodular forms of mastopathy
Treatment is long-term and complex, usually including both the use of medications and surgical treatment.
Treatment of fibroadenoma (nodular fibrous mastopathy)
Mainly carried out surgical treatment. However, if there are few nodes (one or two) and they are small in size (up to 1-1.5 cm in diameter), then it is possible to treat with medications: hormonal and homeopathic drugs, vitamins and others.
Treatment of nodular cystic mastopathy
Cysts up to 1.5-2 cm in size They are treated conservatively depending on the identified cause: vitamins, homeopathic medicines, hormones, iodine preparations and others are prescribed.
Cysts with a diameter of more than 1.5-2 cm, as a rule, are punctured using a thin needle. Next, treatment is carried out with medications (hormones, vitamins and others).
Treatment of nodular fibrocystic mastopathy
The most difficult and lengthy, since the mammary glands contain both areas of compaction and cysts. As a rule, seals are first removed and/or cysts are punctured, and then conservative treatment. However, if the size of the cysts and seals is small, then treatment with medications only is preferred.
When treating any form of mastopathy, the choice of medication (especially hormonal) always depends on the identified hormonal disorders (progesterone, estrogen, prolactin levels) and the presence of other diseases in the woman.
Surgical treatment of mastopathy
It is carried out for nodular mastopathy (cystic, fibrous and cystic fibrous forms) under general or local Indications for surgery
- The size of nodules and cysts more than doubles in three months
- Suspicion of a malignant tumor based on biopsy data, regardless of the size of the tumor
- Cysts whose size exceeds 1.5-2 cm
- Nodules larger than 1.5-2 cm
- Cysts are punctured using a thin needle and sucking out the internal fluid. Subsequently, the walls of the cyst are subjected to sclerosis (gluing the walls of the cyst by introducing special substances into the cavity). If cysts form repeatedly, their cavities are removed, but the surrounding tissue is preserved (if there is no suspicion of cancer).
- Nodes are removed and in severe cases (multiple and/or large nodes), sectoral (partial) removal of the mammary gland is performed. In this case, the gland tissue is removed, retreating from the edge of the tumor by 1-3 cm.
Rehabilitation after surgery
1.5-2 hours after surgery, a woman may feel pain and discomfort in the area of manipulation. As a rule, the sensations are not pronounced, so they do not require the use of painkillers. However, if necessary, painkillers are prescribed.
The woman is discharged home on the day of the operation or a few days later (it all depends on the extent of the intervention performed). Sutures are removed on the 7th day after surgery.
It must be remembered that surgery does not eliminate the cause of the disease. Therefore, after it, mandatory treatment of mastopathy with medications (hormones, vitamins, iodine-containing drugs, etc.) and the underlying disease (for example, hepatitis) is necessary. It is also important to choose the most optimal method of preventing unwanted pregnancy and follow a diet.
Diet for mastopathy
It is recommended to reduce fat intake and increase the amount of fiber (fresh vegetables and fruits, whole grains). As a result, the effect of estrogen on the mammary gland is reduced. It is advisable to limit sweets, flour, and fatty foods, since these foods lead to an increase in the subcutaneous fat layer (obesity), in which estrogens are produced.
It is better to eat foods rich in vitamins A, B, D, E (liver, yolk, milk, cottage cheese, cheese, vegetable oil, seafood, fresh vegetables and fruits of red or orange color).
It is important to replenish iodine deficiency in the body (seafood, iodized salt).
You should reduce your consumption of cocoa, chocolate, tea and coffee, as they contain methylxaptins - substances that can provoke the progression of the disease and increase pain.
Treatment with folk remedies
It is not an independent method of combating mastopathy, since it cannot influence all parts of the mechanism of development of the disease. However, when taken in combination with medications, they reduce the manifestations of mastopathy, promote recovery, and normalize the functioning of the body and immune system. | Name | How to cook | How to take | What effect to expect |
| Pine nut shell tincture | Pour half a glass of fresh pine nut shells or fresh walnut septum into half a liter of vodka. Then leave in a dark and warm place (near a radiator or stove) for 10 days. | Half an hour before meals, ½ -1 tablespoon during two female cycles. | Improves the functioning of the immune and circulatory systems, as well as the thyroid gland. Has antitumor effect. |
| Aloe Elixir | Wrap aloe leaves (age 3-4 years) in gauze and place in a plastic bag, but close it loosely (to allow air to flow in). Next, keep in the refrigerator at t + 4-8C for 2 weeks. Then pass the leaves through a meat grinder and squeeze out the juice. Then mix one part of aloe juice with two parts of liquid honey (1:2). | 1 tsp. 30 minutes before meals twice a day. Course - 30 days. | Improves the functioning of the immune system and has antitumor properties. |
| Burdock root decoction | 2 tbsp. add crushed burdock root to 3 cups of water, then boil and strain. | 50-60 ml 3 times a day half an hour before meals. Course - 1 menstrual cycle. | Reduces swelling and pain in the mammary glands, has antitumor properties. |
Prevention of mastopathy
What should I do?
Lead a healthy lifestyle and eat well
Consume foods rich in vitamins and microelements, as well as sufficient quantity Yoda. Introduce an active lifestyle, play sports, get enough sleep and rest (sleep duration is less than 7 hours a day). This will strengthen the immune system - the main defender against all ailments.
Have regular sex life
During sexual intercourse, a woman experiences orgasm, which improves blood circulation in the pelvis and the functioning of the ovaries. In addition, the seminal fluid contains biologically active substances that also improve the functioning of the ovaries.
Eliminate strong emotions
“All diseases come from nerves” is a true statement for mastopathy. Because stressful situations are a trigger for the development of the disease. While healthy sleep, eating delicious food, sexual satisfaction, positive emotions contribute to the production of dopamine, which blocks the increased synthesis of prolactin in the pituitary gland.
Conduct self-examination of the mammary glands
For a menstruating woman, monthly self-examination is recommended from days 5-6 to 9-12 of the cycle (most optimally on days 5-7), since on these days the mammary gland is in a relaxed state. During menopause - on the same calendar day.
Self-examination steps
Wear the right bra
Choose a bra that is the right size, non-stiff, does not press or chafe. Because the mammary gland is injured.
Undergo an annual medical examination (cancer examination)
The inspection includes:
- Examination of the skin and visible mucous membranes
- Examination and palpation of the mammary glands, thyroid gland and lymph nodes (axillary, cervical, inguinal)
- Gynecological examination and digital examination of the rectum
- Examination of a smear for vaginal flora and cytology (detection of cancerous or precancerous cells) from the cervical canal
Because it improves the functioning of the mammary glands and the course of mastopathy (though not always), leading to recovery. Breastfeeding is beneficial when it lasts up to one to two years (at least 6 months).
What should you avoid?
- Breast injuries.
- Contact with pesticides and chemicals that may be contained in food products. Because they enhance the production of aromatase, which increases the sensitivity of breast receptors to estrogen.
- Prolonged exposure to the sun during dangerous hours (from 11.00 to 16.00), since ultraviolet rays can provoke the development of mastopathy and/or cancer. While short sunbathing in the morning and evening hours is allowed.
- Smoking, abusing alcoholic beverages and taking drugs (even mild ones), as the body’s metabolism and the functioning of the immune system are disrupted.
Mastopathy or fibroadenomatosis is a fibrocystic disease of the mammary gland, which most often occurs due to a disturbed hormonal balance. The disease is characterized by the proliferation of connective and glandular tissue, leading to the formation of seals and cysts. The disease is diagnosed in 60-80% of women aged 18-45 years. It occurs infrequently during menopause.
Reasons for development
Mastopathy is a pathological process that can develop into malignant. The main function of the mammary glands is to produce breast milk to feed the baby. Every month they undergo cyclical changes, which are regulated by sex hormones. With their pathological relationship, proliferation of the epithelium occurs, which contributes to the appearance of fibroadenomatosis. First of all, hormones act on the parenchyma. During pregnancy, it is influenced by placental estrogens, lactogen, prolactin and progesterone. The stroma is subject to hormonal influence to the least extent, but hyperplasia can also appear in it.
Common causes of the disease:
In the absence of normal sleep and in stressful situations, there is a lack of dopamine, which prevents the excessive production of prolactin. In other words, when dopamine levels are low, prolactin is produced in the pituitary gland.
In addition, progesterone is synthesized in the ovaries in insufficient quantities, as a result of which estrogens begin to predominate. As a result, cells in the mammary gland rapidly divide, and the number of milk ducts increases.
Diets for weight loss can provoke mastopathy. If the body lacks certain necessary substances, the production of hormones and metabolism are disrupted.
Inflammatory processes of the ovaries and fallopian tubes lead to their insufficiency, which contributes to a decrease in the synthesis of estrogen. At the same time, production is also weakened.
With cholecystitis and hepatitis, protein synthesis is disrupted, as a result of which estrogen becomes more active.
The disease is often caused local inflammation or hematoma. This can happen due to wearing uncomfortable bras or injury. Thus, in a sore spot, the processes of cell reproduction intensify, which leads to the appearance of a compaction.
Types of disease
There are different types mastopathy, each type is characterized by its own manifestations. There are two main forms of the disease: nodular (benign tumor or fluid formation) and diffuse (many nodules in the gland). The latter is of the following types:
Diffuse mastopathy is manifested by soreness of the mammary glands, sensitivity may increase, and sometimes swelling occurs. During palpation, a compaction is detected; there may be fine-grained foci scattered in the upper part. Often a colorless or greenish-brown fluid comes out of the nipple.
In nodular mastopathy, cysts and nodes are not fused to the skin and have clear boundaries. They may appear in one or both breasts.
Fibroadenoma most often occurs between the ages of 20 and 30 years. The glandular tissue is replaced by connective tissue, which begins to compress the duct, causing its blockage. When palpated, dense nodules are detected. The breasts may be enlarged and painful sensations are often observed.
Cystic mastopathy is characterized by the appearance of cavities with fluid surrounded by a dense capsule. 50% of women suffer from this form. In addition to the listed signs, it is also worth noting the enlargement of the axillary lymph nodes and swelling of nearby tissues. The nodes have an oval or round shape.
In the fibrocystic form, dense lesions, capable of degenerating into cysts. Most often it appears after thirty years of age. The nodes are characterized by a loose consistency and are soft to the touch.
Main features
Symptoms and treatment of mastopathy are determined by the form of the disease and the emotional state of the patient. In the first stage, a woman often feels pain in the chest before menstruation. The sensations can be so unbearable that it is even impossible to touch. Sometimes the pain radiates to the shoulder blade or arm; it appears due to stagnation of blood in the vessels and swelling, which makes the breasts enlarged in volume. Fibrous growths pressing on nerve fibers, also provoke discomfort.
When menstruation ends, the pain disappears, but as the disease develops, unpleasant sensations haunt the patient, worsening before menstruation.
In the second phase of the menstrual cycle, engorgement of the problematic mammary gland may occur. The breasts become harder, larger and heavier, which occurs due to stagnation of blood and swelling of the epithelium. One or more nodes are formed in it.
After pressing on the nipples, fluid of varying intensity may be released from them. Such discharge may be bloody, white, transparent, greenish, or brown. Sometimes a purulent secretion is produced. If fluid is released in the absence of pregnancy, there is a high probability that the pathological process has already developed.
Diagnosis of the disease
To make an accurate diagnosis and prescribe treatment for mastopathy, it is necessary to undergo an examination. The disease is diagnosed by three medical specialists: a mammologist, a gynecologist and a gynecologist-endocrinologist. Ideally, all doctors should be involved in the patient's treatment.
First, the doctor asks several standard questions about the first menstruation, regularity of sexual activity, etc. Next, it is necessary to feel the mammary glands, axillary and cervical nodes, and the thyroid gland. Then the doctor sends you for an ultrasound or mammogram. After receiving all the results, treatment is prescribed.
It is recommended to carry out the examination from the fifth to the seventh day of the menstrual cycle. During menopause, you can be examined at any time. Even in the absence of symptoms, women over 35 years of age are recommended to have their mammary glands examined every 1-2 years.
Surgery and rehabilitation
Surgical intervention is performed for nodular mastopathy of the mammary gland. Treatment is carried out under general or local anesthesia. Indications for surgery are:
Surgical treatment is not performed during pregnancy and breastfeeding, or if a woman is allergic to painkillers. Before surgery you must do:
- Breast ultrasound and mammography;
- urine and blood analysis;
- chest fluorography;
- heart electrocardiogram;
- Ultrasound of internal organs.
It is also necessary to obtain the result of a biopsy and consult with a physician to detect concomitant diseases. The doctor issues a conclusion indicating that the operation is possible. Surgical treatment is carried out in the following ways:
- Cysts are removed using a thin needle, internal fluid is sucked off. Next, their walls are glued together, for this purpose certain drugs are introduced into the cavity.
- The nodes are cut out, and in severe cases the mammary gland is partially removed (in case of numerous or too large tumors).
Removed tissues in mandatory sent for histological examination.
A couple of hours after surgery, a woman may experience pain and discomfort in the chest. Usually the pain is mild, so painkillers are not used. If necessary, such drugs are prescribed by a doctor. As a rule, the woman is discharged on the same day, the stitches are removed after a week. The cosmetic defect is minimal.
It should be understood that removing the tumor does not eliminate the cause of breast mastopathy. Symptoms often do not go away with treatment. In any case, after having surgery, it is important to continue taking the medications prescribed by your doctor. Usually these are iodine-containing and hormonal agents, vitamins. The underlying disease (for example, hepatitis) should also be treated.
Drug treatment
Before you start taking any medications, you should definitely consult a medical specialist.
Antiestrogens are hormonal agents that reduce the amount of estrogens in the body. They relieve pain, normalize the menstrual cycle, and reduce the likelihood of a benign tumor degenerating into a malignant one. The drugs have some side effects associated with decreased estrogen levels. This increased sweating, skin rash, depression, vaginal discharge, erythema. As a rule, doctors prescribe a course of treatment of 3-6 months. Among the popular remedies are Fareston and Tamoxifen.
Gestagens suppress estrogen synthesis and reduce the effectiveness of the pituitary gland's gonadotropic function. The use of these drugs normalizes hormonal balance; in 80% of cases of the disease they demonstrate high efficiency. Such products should not be used during pregnancy or cancer. “Pregnil” and “Norkolut” are among the most popular gestagens.
Oral contraceptives also help to cope with the problem. Hormonal contraception allow you to normalize the menstrual cycle, reduce pain during menstruation. Oral contraceptives interfere with the production of gonadotropins; among the most popular of them are Femoden, Silest, and Marvelon.
When treating mastopathy, the symptoms and signs of which can be quite different, secretion inhibitors are often prescribed. Such drugs normalize lactation, which is caused by high level prolactin. "Parlodel" and "Bromocriptine" help reduce compaction, reduce pain, improving reproductive function. Prolactin should not be taken if there are cancerous tumors.
Androgens are called estrogen antagonists, which they make less active. However, taking such drugs involves numerous side effects, including increased sweating, weight gain, amenorrhea, depression, swelling and other disorders of the endocrine system. Among the androgens, Danazol is the most widely used.
Non-hormonal therapy
Vitamin complexes enhance the functioning of the immune system, which is important for successful fight with pathology. In addition, additional use of such drugs reduces the side effects of products containing hormones. It is recommended to take vitamin A, B, E.
For severe pain, Nise, Nimesil, Ibuprofen and other painkillers are prescribed.
With mastopathy, hormonal imbalance often occurs, as a result of which the liver suffers. Hepatoprotectors help protect the organ from various toxins and restore its cells, including popular drugs A similar plan is worth highlighting: “Essentiale”, “Legalon”, “Karsil”. They normalize liver function and help achieve hormonal balance.
Enzymes improve the microflora of the stomach and intestines and relieve constipation. These drugs include Duphalac and Wobenzym.
Sedatives help get rid of increased nervousness, which often occurs against the background of hormonal imbalance and pain that accompanies mastopathy and menstruation. Sedative drugs suppress depression, among them are motherwort tincture, Valerian, and Persen.
The next group of drugs is diuretics. Diuretics help relieve swelling. Medical experts advise drinking rosehip tincture or herbal infusions.
While taking certain medications, you should never drink alcohol or smoke.
After removal of a cyst or node, you must adhere to special diet. You need to give up fatty foods, increase the amount of fiber (it is found in whole grains, fruits and vegetables). This will minimize negative impact estrogens. It is recommended to reduce the consumption of flour and sweet products, because they contribute to an increase in the subcutaneous fat layer, where estrogens are synthesized.
You can replenish the lack of iodine in the body through iodized salt and seafood. Many essential vitamins are found in egg yolk, cheese, cottage cheese, milk.
It is advisable to limit the consumption of chocolate, cocoa, tea and coffee: they contain methylxaptins, which contribute to the development of the disease and increase pain.
Folk recipes
Before using any folk remedy, you should consult a doctor.
Elderberry berries slow down the growth of nodes and help the body in the fight against cancer. You should take 1 tablespoon of juice on an empty stomach twice a day. The treatment course lasts several months.
Flax contains phytoestrogens that eliminate hormonal imbalances. For two weeks, you need to take two tablespoons of seeds with plenty of water. You can also add seeds to all kinds of dishes.
The kernels of apricot kernels contain amygdalin, this substance slows down the development of tumors. Every day you need to take 5-10 cores. Apricot can be replaced with cherries, plums, and grapes.
You can also prepare medicine from celandine. It is preferable to use self-dried plants; they are cut at the root in the morning and dried in their entirety. To obtain the medicine you will need one sprig of celandine, it must be crushed and poured into 0.5 liters of vodka. Next, the container is left in a dark place for two weeks, the grass should infuse. After this, the tincture is filtered through a thick cloth.
For the first three days, take 1 drop dissolved in 100 ml of liquid. For the next three days, 2 drops are diluted. So, gradually they reach 15 drops per day. Then you should stop taking the drug for a couple of months. The prepared tincture is stored in a cool, dark place. It is convenient to measure drops using a bottle of a particular medicine.
You can be treated for mastopathy with the help of sage, but it is important to know that it is taken only from the 6th to the 15th day of the menstrual cycle. A teaspoon of dried crushed plant is poured into a thermos and poured with a glass of boiling water. You need to let the sage brew for half an hour and strain it. The medicine is taken three times a day, 15 minutes before meals.
Rhodiola contains salidroside, which has an anti-inflammatory effect. Thanks to this and other substances contained in the plant, the decoction normalizes estrogen metabolism, the synthesis of prolactin and progesterone. Rhodiola is also called red brush. To prepare medicine from it, you will need to pour a glass of boiling water over a teaspoon of the dry plant and leave for 45 minutes, be sure to strain. The tincture is taken twice a day.
Preventive measures
Often girls and women are interested in what kind of lifestyle they should lead in order to avoid unpleasant disease. Prevention of mastopathy involves the following measures:
Stress is a trigger for the development of mastopathy. At the same time, healthy eating, sexual satisfaction and positive emotions provoke the synthesis of dopamine, which blocks the increased production of prolactin.
Every month, from the 5th to the 12th day of the cycle, a menstruating woman can conduct an independent examination. The mammary gland relaxes most on days 5-7; this time is ideal for examination.
If you want to prevent mastopathy, you need to be careful when choosing a bra: it should not press, rub or be too hard, otherwise it can damage the breasts.
Breastfeeding improves the functioning of the mammary glands. But it is only useful if it lasts for at least six months.
It is recommended to avoid prolonged exposure to open sun rays from 11.00 to 16.00, because at this time the sun poses the greatest danger, the risk of developing mastopathy is extremely high. It is also necessary to avoid contact with chemicals that may be in food. The fact is that they provoke the synthesis of aromatase, which makes the mammary gland receptors more sensitive to estrogen.
Thus, mastopathy does not go away on its own; in almost every case, this disease requires treatment. The main danger of the disease is the risk of the formations degenerating into a malignant tumor. Therefore, mammologists consider any degree of development of this disease as a precancerous condition that requires observation and treatment.
Of all breast diseases, fibrocystic disease, or fibrocystic mastopathy, is the most common. It occurs in almost 30% of all women, and in women under 30 years of age - in every fourth case of visiting an antenatal clinic. Among women suffering from chronic gynecological diseases, mastopathy was found in 30-70%.
What is mastopathy
The term “mastopathy” combines about 30 synonymous terms - mammary dysplasia, dyshormonal mammary hyperplasia, Schimmelbusch disease, chronic cystic mastitis, masoplasia, cystic mastopathy, mastodynia, etc.
All these and many other terms are used to designate those numerous changes of a morphological nature (proliferative, cystic, fibrous), which are often, but not necessarily, present simultaneously and are united by one common name.
In practical medicine, the term “mastopathy” is used in relation to many benign diseases of the mammary glands, differing in diversity clinical manifestations and, most importantly, the histomorphological structure, and united by the main reason for their occurrence - hormonal imbalances in the body.
Thus, mastopathy is a group of benign diseases, morphologically characterized wide range both regressive and proliferative processes, in which a pathological relationship between connective tissue and epithelial components mammary glands with the occurrence of cystic, fibrous and proliferative changes.
Why is mastopathy dangerous? Despite the fact that this disease is benign and is not considered directly a precancer, at the same time, breast cancer develops on average 4 times more often against the background diffuse diseases the latter and 40 times more often - against the background of cystic forms with signs of proliferation (proliferation) of epithelial cells. The risk of malignancy in non-proliferative forms of mastopathy is no more than 1%, with moderate proliferation of the epithelium - about 2.5%, and in the case of significant proliferation, the risk of breast cancer increases to 31.5%.
From this point of view, the prevention and treatment of mastopathy are at the same time the real prevention of malignant neoplasms. Unfortunately, 90% of pathological formations are detected by women on their own, and only in other cases are they discovered by medical workers by chance as a result of a preventive examination.
The combination of dishormonal hyperplasias with malignant neoplasms, identified in most studies, is explained by the common causes and risk factors, the identity of certain variants of mastopathy and malignant tumors, and similar hormonal and metabolic disorders in the body.
Types of mastopathy
Due to great variety morphological forms diseases, there are different classifications. In practice, depending on the predominance of certain changes identified during palpation (palpation) and/or mammography, as well as taking into account the results of histological examination, three main forms of the disease are distinguished, which some authors consider to be different stages of development of the same pathological process :
- Diffuse large- or small-focal, representing an early stage of the development of the disease. The histological picture is determined by areas of the organ with a normal structure, hyperplastic (enlarged) and atrophic lobules, dilated ducts and small cysts, coarsening and proliferation of connective tissue structures and collagen fibers.
- Nodular, characterized by a predominance of cystic elements and fibrous tissues, proliferation of gland lobules and epithelial cells that line inner surface cysts and milk ducts. The detection of individual atypical cells is a reason to characterize this form as a precancerous condition.
- Mixed, or diffuse nodular - nodular formations of more or less pronounced size are determined against the background of diffuse changes in the mammary glands.
In turn, diffuse and nodular forms are classified into types. The diffuse form is divided into:
- adenosis, in which the glandular component predominates;
- fibroadenosis - fibrous component;
- fibrocystic - cystic component;
- sclerosing adenosis - compact proliferation of gland lobules with preservation of the inner and outer epithelial layers and the configuration of the lobules, despite compression of the latter by fibrous tissues;
- mixed form.
In the nodal form, the following types are distinguished:
- adenomatous, which is excessively overgrown glandular passages with the formation of small adenomas, consisting of enlarged elements of the glandular structure located close to each other;
- fibroadenomatous, including leaf-shaped - a fast-growing connective tissue formation of a layered structure containing cellular elements, cysts and glandular ducts, which are lined with growing epithelial cells;
- cystic;
- intraductal papilloma, Mintz disease, or bleeding mammary gland; is an easily injured overgrown epithelium in the dilated excretory duct behind the areola or close to the nipple;
- lipogranuloma, or;
- hemangioma (vascular tumor);
- hamartoma, consisting of glandular, adipose and fibrous tissue.
Despite the fact that malignant tumors of the mammary glands are not necessarily the consequences of fibrocystic changes. However, their presence greatly increases the risk of developing cancer, which largely depends on the severity of epithelial proliferation inside the ducts and glandular lobules. In accordance with histological studies of material obtained during operations, in 46% malignant tumors are combined with diffuse tumors. This fact further supports the assumption that the prevention of mastopathy is also the prevention of breast cancer.
Causes of the disease and risk factors
The etiology and mechanisms of development of mastopathy have not been fully elucidated, but a direct connection has been established primarily between the development of this pathology and the state of hormone balance in the body. Therefore, the hormonal theory of the formation of diffuse fibrocystic disease was the basis for the name of the disease dishormonal mammary hyperplasia.
The latter are an organ that is highly sensitive to any changes in the level of hormones, especially sex hormones, and at any time in a woman’s life. The mammary glands are never in states characterized by functional rest. Their development and condition, physiological changes during menstrual cycles after puberty, activation of function during pregnancy and lactation are carried out and regulated through a whole hormonal complex.
These hormones include GnRH (gonadotropin releasing hormone) of the hypothalamic region of the brain, prolactin, luteinizing and follicle-stimulating hormones of the pituitary gland, thyroid-stimulating and chorionic hormones, glucocorticosteroids and insulin, and, most importantly, sex hormones (androgens, estrogens, progesterone).
Therefore, any hormonal imbalance, especially between progesterone and estrogens, among which estradiol has the maximum effect on the mammary gland, is accompanied by changes in the structure of its tissues and, as a consequence, the development of mastopathy. The differentiation (specialization) of cells, their division, development and proliferation of epithelial cells of the organ ducts depend on estradiol. This hormone also induces the development of the structural and functional unit of the gland (lobules), the development of the vascular network and the filling of connective tissue with fluid.
Progesterone prevents the division and proliferation of the epithelium of the milk ducts, reduces permeability small vessels caused by the action of estrogen. By reducing swelling of connective tissue, progesterone ensures lobular-alveolar separation and promotes the development of glandular tissues, lobules and alveoli.
The greatest importance is relative (in relation to estrogens) or absolute deficiency of progesterone. Its deficiency causes not only edema, but also an increase in the mass and volume of connective tissues inside the lobules, as well as growth of the epithelium of the ducts, leading to a decrease in their diameter, blockage and the formation of cysts. The hormone is able to reduce the degree of activity of estrogen receptors, reduce the local concentration of active estrogens, which helps limit the stimulation of the proliferation of glandular tissue.
An increased concentration of the hormone prolactin in the blood also plays a certain role in the development of mastopathy, which leads to an increase in the number of receptors in the tissues of the glands that perceive estradiol. This helps to increase the sensitivity of gland cells to the latter and accelerate the growth of epithelium in it. In addition, an increase in the level of prolactin is one of the reasons for the imbalance in the ratio of estrogen and progesterone, which is accompanied by corresponding symptoms in the second phase of the menstrual cycle - swelling, engorgement and tenderness of the mammary glands.
There are quite a few causative risk factors, but the main ones are:
- Late (after 16 years) or premature, inappropriate for age, onset of menstrual cycles (before 12 years), as a result of which the girl’s body does not have time to adapt to changes in the hormonal state, to which the mammary gland tissue reacts accordingly.
- Later (after 30 years) onset of sexual activity.
- Early (before 45 years) or late (after 55 years) menopause, which is associated with an early imbalance of sex hormones or longer exposure to estrogen.
- , absence of pregnancies resulting in childbirth or late (after 30 years) first pregnancy.
- Frequent abortions in adolescence or after 35 years. Three artificial abortions after 6 weeks of pregnancy, when the glandular tissue, are the triggering factor for the transformation of physiological proliferation into pathological one. Abortions during these periods increase the risk of developing mastopathy by 7 times due to the interruption of hormonal changes that occur during pregnancy.
- Absence, excessively short (less than 5 months) or excessively long breastfeeding.
- Hereditary predisposition and age after 45 years.
- Chronic inflammatory diseases female genital area (about 40-70%), which are not so much a provoking factor as a contributing factor or concomitant to endocrine disorders;
- Genital endometriosis (80%), (85%), whose hormones affect the mammary glands directly or through their influence on receptors that perceive other hormones.
- Ovarian tumors and menstrual irregularities (54%).
- Hormonal disorders of the hypothalamic-pituitary system, thyroid diseases (found in 40-80% of women with mastopathy), dysfunction of the adrenal cortex, hormonal imbalance in metabolic syndrome.
- Disposal violation steroid hormones, in particular estrogens, and their elimination as a result pathological changes or dysfunction of the liver, biliary tract and intestines.
- Prolonged psychological stress and chronic stress conditions, prolonged depression and sleep disorders, leading to a disorder of feedback between the cerebral cortex, hypothalamus and the rest of the endocrine and autonomic systems. Such disorders are present in almost 80% of women with mastopathy.
- Poor nutrition - excessive consumption of foods rich in fats, carbohydrates, animal proteins, and insufficient consumption of fruits and vegetables, as well as foods with dietary fiber.
- Nicotine intoxication and abuse of alcoholic and caffeine-containing drinks and products - strong coffee and tea, cola, energy drinks, chocolate.
- The negative influence of the external environment (chemical carcinogens and ionizing radiation) is often the impetus for the occurrence of mastopathy.
Mastopathy and pregnancy are to a certain extent related. If late or interrupted pregnancy, as well as infertility, are risk factors for the development of mastopathy, as mentioned above, then, accordingly, its presence, and even more so repeated pregnancies and childbirth, can be considered prevention of the disease. In addition, some authors believe that during pregnancy there may be a delay in the development of mastopathy and a decrease in the degree of its manifestations. This is explained high content progesterone in a woman’s body during pregnancy and lactation.
Symptoms of mastopathy
Diagnosis of any pathology is based on finding out the history of the disease during a conversation with the patient, his subjective feelings and external visual and palpation examinations. All this allows the clinician to choose further methods of instrumental and laboratory diagnostics in order to establish a diagnosis, provoking factors and concomitant diseases that influence the development of a specific pathology.
The main and most characteristic initial signs of mastopathy:
- Mastalgia, or pain in the mammary glands (85%) varying intensity forcing women to see doctors. They arise as a result of increased estrogen content and compression of the nerve endings of the edema connective tissue or cystic formations. Another reason is the involvement of nerve endings in tissues that have undergone sclerosis.
The pain is local, aching or dull, but sometimes intensifies with movement and radiates (gives) to the scapular and axillary regions, shoulder girdle, hand. They occur in the second half of the menstrual cycle - usually a week, and sometimes more, before the onset of menstruation. After the start of menstruation or after a few days, the pain disappears or its intensity decreases significantly. Severe pain leads to cancerophobia (a feeling of fear about a malignant tumor), anxiety or depression, and emotional imbalance.
- The most common concerns are sensations of discomfort, fullness, heaviness, engorgement (mastodynia) of the mammary glands and increased sensitivity. Sometimes these phenomena are accompanied by anxiety, irritability, headache, nausea and vomiting, discomfort and cramping abdominal pain (). They, as in cases of mastalgia, are associated with the menstrual cycle and arise as a result of increased blood supply and swelling of the connective tissue structure of the glands that form the stroma.
- Discharge when pressing on the nipples is transparent, whitish, brownish, greenish in color, or even mixed with blood. If there are a lot of them, they may appear on their own (without pressure). We should be especially wary spotting, also found in malignant neoplasms.
- The presence of one or more nodular formations of various sizes, detected by palpation and sometimes visually. More often they are determined in the upper outer quadrants of the glands, which are functionally the most active. External examination and palpation examination in horizontal and vertical (with arms lowered and raised up) are the main objective and easy available methods research that requires, at the same time, sufficient practical skills. They make it possible to determine the severity of the skin venous network, the consistency and boundaries of the compactions, fibrous cords and heaviness of the lobules, and their soreness.
It should be noted that enlargement of regional lymph nodes, their soreness and temperature during mastopathy are not signs of the latter. An increase in local and/or general body temperature, an increase in supra- and subclavian, axillary lymph nodes usually occur in the presence of inflammatory processes in the mammary gland (). In addition, when examining the mammary glands, the doctor always carefully checks the regional lymph nodes, which are the first site of metastasis of a malignant tumor.
Diagnosis of the disease
Easy accessibility of mammary glands for visual inspection and manual examination, the great similarity in different periods of their functioning of physiological changes with many forms of pathology often lead to erroneous interpretation of the examination results and are the cause of both over- and under-diagnosis.
Therefore, clinical examination data should be supplemented by such basic research methods as x-ray mammography and ultrasound diagnostics, which allow confirming, clarifying or rejecting the preliminary diagnosis.
The X-ray method is the most informative, allowing timely detection of gland pathology in 85 - 95% of cases. The World Health Organization recommends every 2 years any healthy woman after 40 years, and after 50 years - annually. The study is carried out from the 5th to the 10th day of the menstrual cycle in two projections (direct and lateral). If necessary, targeted (certain limited area) radiography is performed.
For women 35-40 years of age, pregnant and nursing mothers, it is recommended to carry out an echographic examination every six months. Its advantages are safety and high resolution. Ultrasound can accurately distinguish cavitary formations from solid ones, examine glands with high density (in young women, with tissue swelling as a result of injury or acute inflammation), and conduct targeted puncture biopsy. In addition, ultrasound makes it possible to visualize X-ray negative tumor formations located close to the chest wall and regional lymph nodes, and to carry out dynamic monitoring of treatment results.
Women with breast pathologies often need hormonal testing. These laboratory tests in some cases make it possible to determine the cause of the disease, risk factors, and adjust treatment in terms of the use of certain hormonal agents.
How to treat mastopathy
There are no generally accepted standard principles of therapy, despite the prevalence of the disease and its importance early detection and treatment for cancer prevention.
Treatment of women with nodular forms begins with a puncture (using a thin needle) aspiration biopsy. If signs of dysplasia (improper development of connective tissue structures) are detected in the node, surgical treatment is recommended - sectoral resection or complete removal organ (mastectomy) with mandatory emergency histological examination removed tissues.
Diet
Diet for mastopathy is of preventive and therapeutic importance, since nutrition largely affects metabolic processes sex hormones, especially estrogens. Recommended limited use carbohydrates and fats, meat products, which helps reduce the content of estrogens in the blood and normalize the ratio of androgens and estrogens. In addition, coarse fibers found in vegetables and fruits, especially some grain products, have also been shown to have anti-cancer properties.
It is important to eat food that contains large quantities of vitamins and microelements, especially iodine, zinc, selenium, magnesium, titanium, and silicon. To replenish them, it is advisable to take additional special food additives and vitamin-mineral complexes in dragees. One of these drugs is Triovit in peas, enclosed in capsules.
Taking hormonal medications
Because main reason Mastopathy is a hormonal disorder, the main goal of therapy is their correction. For this purpose, progestin hormonal drugs are most often used, the mechanism of effect of which is based on suppressing the activity of the pituitary-ovarian system, reducing the degree of stimulating effect of estrogens on breast tissue.
For these purposes, Utrozhestan, Duphaston and especially Progestogel Gel are used. The latter contains micronized plant progesterone, identical to endogenous and acting at the cellular level. At the same time, it does not increase the hormone content in the blood serum. It is applied to the skin for 3 months from the 16th to 25th day of the menstrual cycle or daily.
Homeopathy
IN recent years Homeopathy, based on the use of small doses of active components contained in plants, minerals, substances of animal origin, etc., has taken a certain place in the prevention and treatment of diffuse forms of mastopathy. They do not cause negative side effects. Their action is aimed at stimulating and maintaining the protective abilities of the body itself. Homeopathic remedies include tablets for mastopathy such as:
- Mastopol, prescribed for 2 months, 1 tablet three times a day, half an hour before meals or 1 hour after meals; it contains alkaloids of spotted hemlock, thuja, goldenseal and has sedative effect, significantly reduces the severity of mastalgia;
- Mastodinon, available in tablets and drops, is prescribed for use for three months twice a day, 1 tablet or 30 drops; it is a complex of products, the main ingredient of which is an extract from common twig (Abraham's tree, Vitex sacred).
Active substances help reduce prolactin synthesis by acting on the pituitary gland, thereby improving function corpus luteum ovaries and the ratio of estrogen to progesterone is normalized; this medicine leads to the elimination of signs of premenstrual syndrome, reduction or elimination of discharge from the nipples, normalization of the menstrual cycle, helps to reduce the intensity of proliferation processes in the mammary glands and regression of pathological processes in mastopathy;
- Cyclodinone, containing only an extract of the same plant, moreover, in a higher concentration;
- Klimadinon, the main component of which is an extract from the rhizome of black cohosh, or black cohosh; treatment of mastopathy during menopause is often highly effective, since black cohosh eliminates vascular-vegetative disorders well, being slightly inferior only to hormonal drugs; its mechanism of action is based on modulation of the function of estrogen receptors in the central nervous system, suppression of excessive secretion of luteinizing hormone involved in the mechanism of menopausal disorders and worsening the course of mastopathy among women 45–50 years of age.
- Gelarium in tablets containing St. John's wort extract; it helps eliminate mild depression that accompanies premenstrual syndrome, normalizes sleep and appetite, and increases psycho-emotional stability;
- Femiglandin, which is obtained from evening primrose oil, contains vitamin “E” and polyunsaturated fatty acids;
- Femiwell - consists of soy isoflavonoids, mahogany extract and vitamin “E”
After consultation with the doctor, treatment of mastopathy at home can be carried out using infusions prepared independently from the above or other individual medicinal plants or herbal collections that are offered by the pharmacy chain.
Patients often ask the question, is it possible to do massage for mastopathy? Physiotherapy, ointments, massage, compresses not only in the area of the mammary glands, but also soft tissues in the area thoracic of the spine lead to the expansion of small and medium-sized vessels, increasing the volume of blood flowing to the tissues of the organ. This helps to increase tissue nutrition and accelerate metabolic processes, which stimulates the growth of existing tumor formations. Therefore, mastopathy is a contraindication for the use of such treatments for the named zones and areas.
For engorgement and swelling of the mammary glands, accompanied by pain, Dimexide can be used externally, but not as compresses or ointment, but in the form of 25 or 50% gel, produced in tubes. The drug has anti-inflammatory and moderate analgesic effects when applied to the skin of the mammary glands.
Conducted studies of women in reproductive age and suffering from various gynecological pathologies, revealed a diffuse form of mastopathy in an average of 30%, mixed (diffuse-nodular) in the same number of patients; nodular forms of mastopathy were usually combined with uterine myomatosis, endometrial hyperplasia and genital endometriosis. Thus, the choice of treatment methods depends on the form of the pathology, the presence of hormonal imbalance and concomitant diseases.
Even minor breast problems can develop into something serious and life-threatening. Therefore, all experts recommend that women the slightest symptoms consult a doctor.
The most common pathology of the female breast is mastopathy. More than 50% of women aged 25 to 45 face this problem. Every year the number of sick women increases. This phenomenon is associated with the modern way of life.
The mammary glands are highly dependent on various physiological processes occurring in the body. They undergo changes throughout a woman's life. As a result of exposure to various factors, mastopathy occurs. This is a disease in which, in the event of a hormonal imbalance, glandular tissue begins to grow and lumps appear in the breast.
Main causes of the disease:
- Ovarian dysfunction. The mammary glands are significantly influenced by the ovaries, which produce female hormones. Malfunctions in the functioning of these organs lead to an imbalance of hormones, which causes the entire reproductive system to suffer. But this is one of the options that cause mastopathy.
- Another factor that significantly influences hormonal balance is sex life women. Abortion, sexually transmitted infections, shortening the period of breastfeeding or complete failure from it, oral contraceptives, suppressive reproductive function, as well as stress - all this can cause mastopathy.
On initial stage Signs of the development of the disease cannot be noticed. The woman does not feel any discomfort and does not feel any changes. There are no symptoms, and pathology can be detected by early stage It is possible only with a routine ultrasound or mammography.
Signs of mastopathy can be noticed independently at the next stages of development. Women experience It's a dull pain in both mammary glands.
Most often, symptoms extend to top part breasts Not only does chest pain appear, discomfort can move to the arm and shoulder. Symptoms may occur intermittently or be present all the time.
In addition to painful sensations, women also experience:
- Nipple discharge. They are strong and weak. Their color can be greenish, brown, whitish and even bloody. Such symptoms signal the last stage of mastopathy.
- Swelling and feeling of heaviness in the chest. As the disease progresses, the symptoms become more pronounced.
- Tension increases before menstruation, and the size of the gland increases. Such symptoms may be accompanied by headaches and abdominal pain, nervousness and irritability.
A small percentage of women suffering from mastopathy also notice such signs as enlarged and painful lymph nodes in the armpits. Any symptoms of the disease should not be ignored.
Diagnostic and treatment methods
A mammologist treats women's breast problems. The first signs of mastopathy should prompt a woman to visit this doctor. After examination, the specialist must find out the causes of the disease. To do this, he asks about the regularity of the cycle, the number of abortions and births, and genetic predisposition.
After the doctor has studied the patient’s medical history, she should voice all the symptoms. Further examination consists of a manual examination, during which a specialist will determine the degree of formation of lumps, the size and condition of the breasts and nipples. Gland tissue can also be examined using ultrasound and mammography. Reviews of such examinations are positive, as they provide accurate information about the condition of the mammary glands.
When examining women for mastopathy, it is imperative to determine the level of sex hormones, especially estrogen and prolactin. After which the treatment of the pathology begins.
Mastopathy is not breast cancer, but it is with this pathology that it usually begins. Therefore, the disease must be treated correctly. Without proper therapy, benign neoplasms will quickly develop into malignant ones. It depends not only on the doctor, but also on the woman how successful the treatment will be.
After a comprehensive examination, the mammologist chooses a method of treating mastopathy. Since the disease is characterized not by one neoplasm, but by a group, there is no single treatment.
To choose the right therapy, consider:
- Form and prevalence of the disease.
- Duration of pathology.
- Concomitant diseases endocrine and reproductive systems.
- Woman's age.
Therefore, how to treat mastopathy is decided for each case separately.
Some women are prescribed hormonal drugs for treatment. These are drugs that inhibit the function of prolactin, as well as antiestrogens, androgens, and progestogens.
Most often, mastopathy is treated with progestogens. These drugs eliminate excess estrogen, which is unfavorable for this pathology. Treatment with antiestrogens is also successful. Sometimes such drugs are used for some stages of breast cancer.
Women aged 45 years and older are treated with male hormones androgens. Reviews about this treatment vary, since the drugs are quite serious and can significantly affect the entire body.
Self-treatment with hormonal drugs is not recommended. These drugs have serious side effects. Therefore, they are used only in severe cases of the disease, when other means do not help eliminate the signs and causes of the disease.
Those who have been helped by such methods leave good reviews, while other women try to protect others if it does not help them. But for every organism hormonal treatment works differently, so it is advisable not to pay attention only to reviews.
To cure mastopathy, herbal preparations are often used. Such remedies are called homeopathic. They are used in combination with other methods, since the disease affects the endocrine, vascular, reproductive and nervous system body.
Homeopathic remedies saturate the body biologically active ingredients, indispensable for its successful functioning. These drugs rarely have side effects and do not have a negative effect on the body, as they consist of natural ingredients.
Homeopathy treatment lasts from three months. They help regulate hormonal background, relieve inflammation, pain and swelling and reduce the risk of cancer.
Despite their benefits and safety, such drugs should only be prescribed by a mammologist. Self-medication can lead to sad consequences. Homeopathy always has good reviews. So Natalya, 39 years old, says: “Homeopathic medicines helped me not only get rid of mastopathy, but also had a positive effect on my overall health and strengthened my body.”
There is a wide range of methods for treating mastopathy. If the disease is caused by inflammatory gynecological diseases or occurs in the form of purulent mastopathy, antibiotics are prescribed.
Such products destroy pathogenic microorganisms. The drugs are administered into a vein or intramuscularly. The course must last at least five days.
But for the treatment to be successful, only antibacterial drugs won't be enough. Required integrated approach.
Local remedies
For local treatment of mastopathy in women, hormone-containing ointments and gels are used. They help cope with hormonal imbalances. Progesterone ointments are usually prescribed. They stop the growth of tumors, and also relieve swelling and pain.
Ointments penetrate deeply into the skin and act on the entire gland. Such remedies do not affect the general condition of the body in any way and act only at the local level. Ointments are effective only at the site of application.
Such products are usually sold with a spatula for ease of application. Ointments and gels should be rubbed into the skin until they are completely absorbed. Reviews about such products are positive. Anna, 28 years old. “The diagnosis of mastopathy was a shock for me. But she pulled herself together and began to heal. The doctor prescribed ointments along with other medications, and they quickly helped me get rid of chest pain.”
Other treatments
To eliminate the symptoms of mastopathy and completely get rid of the disease, treatment should also consist of:
- Vitamin preparations.
- Immunomodulatory therapy.
- Non-steroidal anti-inflammatory drugs.
- Sedatives.
You also need to adjust your diet. Tea, coffee, chocolate, and cocoa should be excluded from the diet. You need to eat more fruits, vegetables, fiber, and reduce your intake of fatty foods.
Some women use folk remedies to treat mastopathy. This method has positive reviews. Thus, Svetlana, 42 years old, says: “An ultrasound revealed mastopathy. They prescribed medications, but severe stress led to the fact that the drugs caused allergies. Then I decided to try folk remedies. I relied on my friend's reviews. A mixture of Kalanchoe and honey in a one to one ratio helped. Saw 1 tbsp. l. twice a day and the tumors began to shrink.”
Another woman used remedies such as beets and vinegar. Her reviews are also promising. You need to grind 200 grams of beets and heat them in a water bath. There you need to add 2 tbsp. l. vinegar and make a compress overnight. The procedure must be repeated at least 10 times.
Folk remedies are also effective only in combination with other methods.
