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  • Mastopathy - Causes, symptoms and treatment. MF.

    Mastopathy is a benign dyshormonal disease of the mammary glands, characterized by pathological proliferative processes( proliferation) in the gland tissues.

    Causes of mastopathy

    Mastopathies are affected by women of reproductive age from 18 to 45 years, the peak incidence of mastopathy falls on the age of 30-45 years. From the point of view of female physiology, the appearance of mastopathy is easy to explain. Every month in the body of a healthy woman of reproductive age there are cyclical changes under the influence of hormones - estrogen and progesterone. These two hormones not only regulate a two-phase menstrual cycle, but also have a direct effect on the tissues of the mammary glands.

    Normally, under the influence of estrogens, which are formed in the first phase of the menstrual cycle, there are proliferative processes in the mammary glands, that is, the multiplication of cells. Progesterone, which forms in the second phase of the menstrual cycle, limits the action of estrogens, inhibiting proliferation.

    Under the influence of unfavorable factors, imbalance of hormones is formed - a deficiency of progesterone and an excess of estrogens, which leads to excessive proliferation of breast tissue, mastopathy occurs.

    Sometimes mastopathy develops due to excessive production of the hormone prolactin by the pituitary gland. Normally prolactin is produced in large quantities during pregnancy and lactation for the formation of mother's milk. But it happens that prolactin is excessively secreted and out of pregnancy, which is pathology and contributes to the appearance of mastopathy.

    In addition to hormonal disorders, the possible causes of mastopathy include:

    - tumors and inflammations of the ovaries;
    - diseases of the thyroid gland and adrenal glands;
    - liver disease;
    - psychological problems-stress, depression, neurosis;
    - irregular sexual life, absence of pregnancy and childbirth till 30 years;
    - frequent abortions;
    - hereditary predisposition;
    - injuries of the mammary glands, including wearing a tight bra on metal bones, which leads to microtraumas of the breast;
    - bad habits-smoking and alcohol;
    - deficiency of iodine in the body.

    There are two types of mastopathy:

    1. Nodular( or knotty) mastopathy with a single seal - a node in the gland. Nodular( or knotty) mastopathy is of two kinds - in the form of fibroadenoma( benign tumor) or cyst( fluid formation);With this form of mastopathy, the treatment is surgical.

    2. Diffuse mastopathy with multiple nodes in the mammary gland. Depending on the structure of the nodes, diffuse mastopathy can be:
    - mastopathy with predominance of the fibrous component;
    - mastopathy with a predominance of the glandular component;
    - mastopathy with predominance of the cystic component( when a number of cysts are found in the gland);
    - mastopathy of mixed form.

    Symptoms of mastopathy:

    Severity of symptoms of mastopathy depends on the type of mastopathy, on the psychological characteristics of a woman and on the concomitant mastopathy of diseases. More often mastopathy is expressed in the form of dull aching pains in the mammary gland on the eve of menstruation( "mastalgia" or "mastodynia").Characterization of engorgement and increase in the volume of the breast, which is associated with swelling of the connective tissue of the breast. These symptoms are most common for patients with mastopathy( about 90%), especially in the diffuse form of mastopathy, when chest pains can be intolerable.

    Less common with mastopathy can be discharge from the nipple. The separable can be white, transparent or greenish in color. In exceptional cases, the appearance of bloody discharge is possible, which is an alarm signal.

    When self-examining at home with a diffuse form of mastopathy, you can identify small nodular seals in the chest;with the nodular form of a single formation in the chest. In 10% of cases with mastopathy, lymph nodes in the axillary region increase, which can also be felt by self-examination.

    Breast self-examination

    Mastopathy, many women are confused with signs of PMS( premenstrual syndrome) and often these symptoms are perceived as given by nature. However, this is not the case. In the presence of the above-described symptoms of mastopathy or if any formation is found in the mammary gland, a full-time consultation of the mammologist is urgently needed!

    Diagnosis of mastopathy

    Diagnosis of mastopathy includes:

    - detailed survey and examination of the mammalian .The doctor performs a superficial and deep palpation( palpation) of the mammary glands both in standing and lying position, as some formations in the chest can be displaced when the position changes. Inspects the nipples, checks for any abnormal discharge from the nipples. In addition to examining the breast, the mammologist palpates the lymph nodes in the armpit, in the sub- and supraclavicular areas. Also palpation of the thyroid gland is performed to exclude its pathology;
    - mammogram - X-ray of the mammary glands - is performed on the 7-10th day of the menstrual cycle. The picture is taken in 2-projection - straight and oblique. Mammography allows you to determine the type of mastopathy and the severity of changes in the gland;
    - Breast ultrasound is a safer and easier method of diagnosis than mammography. Ultrasound of the breast can clearly determine the structure of education in the chest( cyst, fibroadenoma, etc.).Ultrasound is examined for mastopathy on the 5th-10th day of the menstrual cycle for greater informativeness;
    - if suspected of oncology, the biopsy is shown( using a thin needle take a piece of tissue from a suspicious area for histological examination);
    - hormonal studies - check the level of estrogens and progesterone, if necessary, examine the hormones of the thyroid gland and adrenal glands;
    - ultrasound of pelvic organs .When revealing the pathology of the ovaries is shown the consultation of the gynecologist ;
    - when a fibroadenoma is detected, advises the oncologist-mammologist .
    - liver examination is recommended and its pathology is excluded.

    Video for diagnosis of diseases of the breast

    Treatment of mastopathy

    Treatment of mastopathy is selected individually, depending on the type and cause of mastopathy. Treatment of mastopathy can be conservative or surgical, but you should start with a change in lifestyle and nutrition.

    Medical treatment of mastopathy

    Conservative treatment is indicated for diffuse forms of mastopathy and involves the use of hormonal and non-hormonal drugs. Treatment begins only after consultation of the oncologist, to exclude the need for urgent surgical intervention.

    Non-hormonal treatment of mastopathy

    Treatment of mastopathy with non-hormonal drugs is prescribed in combination with hormone therapy or separately. The drugs help to quickly stop the symptoms of mastopathy with mild manifestations of the disease, and if you follow a healthy lifestyle, you can achieve a complete cure.

    For non-hormonal treatment of mastopathy use:

    • Vitaminotherapy, appoint it for a long time. All patients with mastopathy are shown vitamins A, B, C and E.
    • iodine preparations( iodomarine, iodine, clamine) contribute to a decrease in proliferative tissue activity and regulate thyroid function. But before their appointment, an endocrinologist's consultation is always necessary to identify contraindications, such as hyperthyroidism, autoimmune thyroiditis.
    • When mastopathy caused by psychological problems, appoint sedatives( tinctures of motherwort, valerian, etc.), psychotherapy.
    • Non-steroidal anti-inflammatory drugs( such as Diclofenac) for rapid relief of the pain symptom in its presence.
    • Homeopathic remedies( Remens, Mastodinon, Cyclodinone).Their therapeutic effect is based on a decrease in the level of prolactin in the blood, which leads to the elimination of pathological processes in the mammary gland with hyperprolactinaemia. These drugs are prescribed for a long time.
    • Phytotherapy( used only as a supplement to the main treatment)
    • Enzyme preparations that possess anti-edematous, anti-inflammatory, secondary analgesic and immunomodulatory action.

    Hormonal treatment of mastopathy

    Hormonal treatment is prescribed to regulate cyclical changes in the hypothalamic-pituitary-ovary system. This normalizes the hormonal background, effectively affecting the tissue elements of the breast. For this purpose, the following preparations can be used:

    • gestagens( Duphaston, Utrozestan, Norethisterone. .. are prescribed in the second phase of the menstrual cycle, the Projeto externally for grinding the breast);
    • inhibitors of prolactin secretion( Parlodel) are taken with revealed hyperprolactinemia from the 10th to the 25th day of the menstrual cycle;
    • estrogen-gestagenic oral contraceptives( Jeanine, Marvelon) are prescribed for women under 35 years of age on a contraceptive scheme in the absence of ovulation and luteal phase disorder;

    Much less often with mastopathy, there is a need to use drugs:

    • antiestrogens( Tamoxifen, Fareston) are taken continuously for 3 months;
    • androgens( Methyltestosterone).This group of hormones mammologists are prescribed extremely rarely and only for women over 45 years due to unpleasant side effects.

    At any age, the hormonal treatment of any disease should be carried out only after a preliminary study of the hormonal status. After 40 years, due to the presence of concomitant diseases, many women have contraindications to hormone therapy.

    Surgical treatment of mastopathy

    Surgical treatment is used for nodular forms of mastopathy, mainly with fibroadenomas, extremely rarely with a cyst. With small sizes of fibroadenoma( up to 2 cm) from surgical treatment, you can also abstain - a dynamic observation is shown in the mammologist.

    There are 2 types of surgery for mastopathy - sectoral resection( together with the breast sector remove the tumor) and enucleation( vyluschivanie) of the tumor or cyst( remove only the tumor / cyst).

    Operative treatment of mastopathy is used according to strict indications:

    - for suspected breast cancer according to biopsy data( only in this case a sectoral resection is performed);
    - with the rapid growth of fibroadenoma( tumor increase by 2 times during 3 months);
    - if the cyst is single, the removal of the fluid is indicated by puncture( puncture of the formation), but with the recurrence of the nodular cyst, its excision is shown.

    Operation for nodular mastopathy is performed under general or local anesthesia and lasts an average of 30-40 minutes. The patient is discharged home the next day or the day of the operation. Postoperative sutures are removed on the 7-10th day after the operation.

    Treatment of mastopathy with folk remedies

    Treatment of mastopathy is carried out by means of regulating the menstrual cycle and, if necessary, the activity of the thyroid gland by hormonal means, vitamins and homeopathic preparations.

    For a quick recovery, the lifestyle during treatment is of fundamental importance.

    • It is advisable to limit the consumption of coffee, tea, cocoa and chocolate. The fact is that these products contain methylxaptytes, which can provoke the progression of diffuse mastopathy and enhance pain sensations.
    • It is necessary to abandon bad habits( smoking, alcohol) and lead a healthy lifestyle - to move more, to avoid stresses, to sleep at least eight hours a day;include in the diet of fish, boiled meat and products of plant origin.
    • The bra should be worn in the right size and shape - otherwise it can lead to chronic chest deformation or, conversely, to the overload of the ligament apparatus.
    • Any form of mastopathy is absolutely counter-indicative of thermal procedures - saunas, baths, long stay in the sun, solarium.

    Patients are encouraged to increase their intake of plant foods. Enrichment of the diet with vegetables, fruits, seafood in case of refusal of large amounts of tea, coffee, cocoa and chocolate can occur with mastopathy and prevention of relapses.

    When diffuse mastopathy is widely used funds from traditional medicine in the form of various compresses to stop the pain symptom. To this end, apply to the breast grated red beets, fresh pumpkin or warm rye bread in the form of compresses.

    However, it must be remembered that these remedies do not cure mastopathy, the effect of anesthesia on them is only temporary and is often based on self-hypnosis. Possible complications of mastopathies:

    - relapse of mastopathy after treatment. As a rule, this is due to undiagnosed hormonal disorders;
    - breast cancer. The risk of degeneration into cancer is higher in patients with fibroadenomas. With diffuse mastopathy, such a formidable complication is unlikely.

    Prevention of mastopathy:

    - Breast self-examination is the main method of preventing mastopathy and breast cancer, aimed at early detection of changes in the chest, which means that you can consult a doctor in a timely manner and not start the disease. After menstruation for approximately 5-7 days of the cycle, it is recommended that a woman should palpate both mammary glands in a prone and standing position. Palpation begins from the axillary region towards the nipple. Next, the chest is examined vertically from top to bottom with soft movements. If suspicious formations are found, it is urgent to see a doctor. The earlier treatment is started, the easier it will be to prevent the development of mastopathy and oncology;
    - pregnancy and lactation, refusal of abortions;
    - regular sex life;
    - reception of preparations of iodine in the autumn and in the spring, consumption of iodized salt( in the absence of contraindications from the side of the thyroid gland);
    is a healthy lifestyle.

    Questions and answers of obstetrician-gynecologist on the subject of mastopathy:

    1. I have chest pains. What is better to do an ultrasound or a mammogram?
    Up to 35-40 years of age, breast ultrasound is preferable, if you already have a 40-better mammography.

    2. I take birth control pills. Constantly I feel a pain in the right mammary gland. Could this be because of the pills?
    Yes, contraceptives are not suitable for you, but you can not exclude the formation of the mammary gland. Address to the expert.

    3. I was diagnosed with fibroadenoma during pregnancy. What to do, to be treated now or to wait until childbirth?
    It is necessary to carry out dynamic observation( ultrasound of the mammary glands).If the fibroadenoma will grow rapidly, then it should be removed before delivery.

    4. I have a big chest, I do not wear a brassiere at home, I only wear it when I get out. Can this provoke mastopathy?
    Yes, it can. A large load is placed on the ligament apparatus.

    5. Does the chest hurt when growing?
    No, most likely, it is mastopathy.

    6. Is it necessary to treat fibroadenoma if nothing disturbs?
    Required.

    7. I'm pregnant and I have mastopathy. Can I breastfeed my baby?
    You can.

    8. Can fibroadenoma occur again, after removal?
    Yes, but this happens rarely.

    9. Is it possible to treat nodal mastopathy with tablets so as not to go to surgery?
    No, this is inefficient. Only if the cyst is small, then you can try homeopathic medicines.

    10. I have fibro-kimstosis mastopathy for a long time already, during treatment cysts disappear, then again appear. I'm planning a pregnancy, will not it complicate her mastopathy?
    Pregnancy and subsequent breastfeeding have a beneficial effect on the condition of the mammary glands and the course of mastopathy. Another thing is that the causes of mastopathy, for example hormonal imbalance, do not prevent getting pregnant.

    11. Does mastopathy affect conception?
    Directly, mastopathy itself does not affect conception, but it can be caused by the same reasons that contribute to infertility - a lack of progesterone, an excess of prolactin, and as a result - the absence of ovulation or miscarriage. It is necessary to identify these factors and treat them. Mastopathy is just a beacon.

    Obstetrician - gynecologist, Ph. D.Christina Frambos