Fibrocystic mastopathy: symptoms and treatment

What is it and how to treat it? For the first time fibrocystic mastopathy was described in 1829 by Cooper. However, there is still no single classification of this pathological process.

According to the views of the World Health Organization, fibrocystic disease is characterized by proliferative and regressive changes in breast tissue, with no normal relationship between epithelium and stroma.

These combinations can be very different, which can lead to the formation of nodes that are accessible by palpation.

It is therefore customary to isolate:

• diffuse fibrocystic mastopathy
  
• nodular fibrocystic mastopathy.

The first is classified into several species depending on the histological structure:

1. 1) The predominance of the glandular structure. Its second name is adenosis. Its main symptoms are pain, engorgement and diffuse or localized increase in mammary gland density.
   
2. 2) Prevalence of fibrous structure. In this case, complete narrowing of the ducts of the mammary gland can occur. As a result, this leads to pain and the appearance of taiga sites.
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3. 3) The predominance of cysts that are formed from lobules that have undergone atrophy, as well as from ducts enlarged in diameter.
   
4. 4) Mixed variant, which occurs most often.

It is also important to distinguish the degree of proliferation-proliferative and non-proliferating mastopathy. In the case of proliferation, small papillomatous growths appear that are localized in the ducts and / or cysts.

The danger of this type of mastopathy is that it is possible to develop atypia, which is already a precancerous process.

Causes of fibrocystic mastopathy

Why does fibrocystic mastopathy develop, and what is it? Mammary glands are target organs for female sex hormones. Thus, estrogens contribute to the development of proliferative changes that are observed at the end of the follicular phase.

Progesterone subsequently supports these changes, contributing to the development of glandular structures. Prolactin leads to the formation of milk, as well as an increase in the density of estrogen receptors.

Until now, there is no single etiological concept that would explain the causes and development of fibrocystic mastopathy. There is a causal relationship between the development of fibrocystic disease and the following factors:

1. 1) Conditions accompanied by a deficiency of progesterone
   
2. 2) Impaired normal functioning of the ovaries, accompanied by a relative or absolute increase in the level of estrogens in the blood.

On the basis of this at-risk group for the development of mastitis include patients with the following gynecological disorders:

• dysfunctional uterine bleeding
  
• infertility on the background of anovulation
  
• oligomenorrhea
  
• secondary amenorrhea
  
• polycystic ovarian
  
• uterine fibroids
  
• endometriosis
  
• ovarian cysts follicular

However, there are instances where breastdevelops in women with a normal state of the reproductive system. Also, hyperandrogenism does not exclude the possibility of developing this disease. All this again emphasizes the lack of a clear understanding of the etiology of this disease.

It should be noted that mastopathy is very often accompanied by diseases of the thyroid and liver. This is due to the fact that the thyroid gland is involved in the regulation of the ovarian-menstrual cycle, and the liver is the organ where sex hormones are metabolized.

Symptoms of fibrocystic mastopathy

The main symptoms that are typical for this type of mastopathy are:

1. 1) The appearance of breast tenderness, which can be at rest or observed only when palpation. Pain can be local or diffuse depending on the prevalence of the pathological process.
   
2. 2) Feeling of engorgement, which is associated with proliferative activity of mammary glands.
   
3. 3) Palpation of cords, which are most characteristic in case of proliferation of connective tissue.
   
4. 4) Palpation of cysts, which can have different densities and sizes. They are associated with atrophy of the lobules of the breast and blockage of the milk ducts.

However, all these clinical signs may not appear immediately. Therefore, for the early detection of a pathological process, a woman should perform self-examination of the mammary glands. In suspicious cases, always consult a doctor( mammologist, gynecologist or oncologist).

Diagnosis and methods of examination of mammary glands

The examination program for suspected fibrocystic mastopathy includes the following research methods:

1. 1) Palpation
   
2. 2) Mammography and its various modifications
   
3. 3) Ultrasound( ultrasound) to be used inof all women under 30 years of age, and also when the radiographic examination does not show any abnormalities( there may be deeply located pathological foci that are not available for mammogram(
   
4. ) 4) Diaphanoscopy - X-ray of the mammary glands
   
5. 5) Computer tomography
   
6. 6) Nuclear magnetic resonance
   
7. 7) Thermography
   
8. 8) Cytological examination of the nipple
   
9. 9) Biopsy, which is the "gold" standard for the diagnosis of cancer, andtheir risk in mastopathy is increased several times, especially if it is proliferative.

Treatment of fibrocystic mastopathy

Treatment of fibrocystic mastopathy should be systemic with the obligatory consideration of the cause that led to its development. It is carried out for a long time until the main factors facilitating proliferation in the mammary glands are eliminated.

It consists of two main stages:

• intensive therapy at the very beginning of drug therapy
  
• supporting courses that can last from several months to several years.

It pursues one main goal - to restore disturbed relationships in neuroendocrine regulation of the menstrual cycle. However, it is necessary to begin with the accompanying pathological processes that led to this.

Thus, the curative program of fibrocystic mastopathy is as follows:

• treatment from related specialists - it can be a gynecologist, endocrinologist and therapist( gastrologist)
  
• physiotherapy procedures
  
• normalization of a psychoemotional background of a patient
  
• psychotherapeutic methods of influence on the central nervous system
  
• drug therapy, which occupies the main place in the therapy of this disease.

In the treatment of fibrocystic mastopathy the following groups of pharmacological preparations are used:

• non-hormonal agents
  
• hormones, both female genital and thyroid, adrenal cortex
  
• antagonists or hormone synthesis stimulants.

The main drugs that influence the hormonal regulation of the functioning of the mammary glands are the following:

• antigonadotropins
  
• gonadoliberin agonists
  
• antiestrogens
  
• progestogens
  
• suppressing the secretion of prolactin( group of ergot alkaloids, quinagolin and cabergoline)
  
• hormonal drugs of the thyroid gland.

Also complex treatment includes the use of such drugs as:

• vitamins
  
• sedative
  
• hepatoprotectors
  
• enhancing the body's defenses( adaptogens)
  
• potassium preparations
  
• enzymatic agents and others.

Prevention

Preventive measures that to some extent prevent the development of fibrocystic mastopathy are as follows:

• regular visit to the gynecologist( at least once a year)
  
• regular self-examination of the breasts
  
• correction of menstrual disorders
  
• timely treatment of identified gynecological diseases
  
• laboratory control of thyroid function in endemic regions
  
• performing ultrasoundI have mammary glands and genital organs, if a woman is at risk.

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