Remove swelling of the mammary glands
It is known that this pathology suffersmost women, with a peak incidence observed in childbearing age (about 30 - 45 years). Fibrous-cystic mastopathy is considered one of the most common diseases in women, and its incidence is 30-40%, in the case of accompanying gynecological diseases in women, this pathology reaches 58%.
Fibro-cystic mastopathy orfibrocystic disease called benign dyshormonal pathology of the mammary glands, in which both proliferative and regressive changes in their tissues are noted, as a result of which a pathological ratio of epithelial and connective tissue components is formed.
Structure and regulation of mammary glands
The mammary gland refers to paired organs andis represented by three kinds of fabrics. The main one is the parenchyma or glandular tissue, in which ducts of various diameters pass, the glandular tissue is divided into lobes and lobes (about 15-20 of them). Slices and lobes are separated by stroma or connective tissue, which is the skeleton of the mammary gland. And the third type of tissue is fat, it is in it are embedded lobules, lobes and stroma of the breast. The percentage parenchyma, stroma and adipose tissue is directly related to the physiological state (age) of the reproductive system.
During gestation of the fetus, the mammary glandsreach morphological maturity. The dimensions and mass of them increase, the number of lobules and ducts increases, and the secretion of milk begins in the alveoli (morphomolecular unit of the breast). After giving birth due to the production of milk, the mammary glands are even more enlarged (milky sinuses are formed in the ducts of the lobes, in which milk accumulates). And after the cessation of lactation in the mammary glands, involution occurs, and the stroma is replaced by a fatty tissue. With age (after 40), the parenchyma is replaced by fat tissue.
Both growth and development of mammary glandsare regulated by numerous hormones. The main ones are estrogens. progesterone and prolactin. The role in regulating the development of mammary glands and growth hormone has also been proven. The main changes in the mammary glands under the action of hormones are parenchyma, and to a lesser extent the hormone is subjected to the stroma. The state of the mammary glands depends on the ratio of the content of the listed hormones. When the hormonal balance is violated, breast mastitis develops.
In modern medicine there is a large number of classifications of this disease. The most convenient in clinical work is the following:
- with predominance of the glandular component, they speak of adenosis;
- mastopathy, in which the fibrous component predominates (fibrotic mastopathy);
- mastopathy, in which the cystic component predominates;
- mastopathy of mixed form;
- a cyst of a mammary gland;
- intraprostatic papilloma (roughly speaking, a wart in the duct of the milk);
- hematoma of the breast;
In case of lesions of both mammary glands, they speak of bilateral fibrocystic mastopathy, and in the development of the process in one gland - about one-sided (for example, left breast cyst).
Depending on the severity of clinical manifestations, the disease can be mild, moderate and severe.
In addition, both diffuse and nodalmastopathy can be proliferating and non-proliferating form. Prognostically unfavorable is fibrocystic mastopathy (PKM) of the first form. In this case, proliferation of the epithelium of the milk ducts occurs, which leads to the formation of intraductal papillomas or proliferative changes in the epithelium of the inner walls of the cysts, which leads to the development of cystadenopapilloma.
All described changes are fraught with malignant degeneration and are dangerous for the occurrence of breast cancer.
There is also a special form of the mammary gland inend of the second phase of the cycle, which is called mastodynia or mastalgia. Mastodynia is caused by cyclic engorgement of the gland due to venous stasis and edema of the stroma, which leads to a sharp increase and morbidity of the breast (more than 15%).
Etiological factors and the mechanism of developmentdiseases are caused by hormonal imbalance. The leading role in the formation of mastopathy is assigned to conditions in which there is a deficiency of progesterone, a violation of the function of the ovaries and / or absolute or relative hyperestrogenism. This is due to the fact that estrogens contribute to the proliferation of the epithelium in the alveoli, the milky way, increase the activity of fibroblasts, which causes proliferation and stroma. Also in the mechanism of the formation of the disease, hyperprolactinemia and excess prostaglandins are important (call mastodinia, and then mastopathy). To develop hormonal imbalance, the effect of provoking factors is necessary. But even with their existence, mastopathy does not develop immediately, because they need their long-term influence (several years) and "layering" of one factor on another. Such provoking factors include:
- early menarche (early puberty, up to 12 years, leads to rapid hormonal reorganization, which is reflected in the condition of the mammary glands);
- late menopause (discontinuation of menstrual after 55 years is also unfavorable for mammary glands due to prolonged hormonal effects on their tissues);
- abortion (a sharp hormonal decline after an abortion or miscarriage leads to hormonal disorders and the development of mastopathy);
- pregnancy and childbirth were absent altogether;
- short period of lactation or categorical refusal of lactation;
- heredity (benign and malignant breast diseases in women on the maternal line);
- age (over 35);
- stress as the cause of endocrine pathology;
- bad habits;
- trauma of mammary glands, compression of the breast with a tight and uncomfortable bra;
- inflammatory processes of the mammary glands;
- hormonal-dependent gynecological diseases (cycle disorders, anovulation and infertility, myoma, endometriosis);
- lack of iodine;
- liver pathology, thyroid gland;
- obesity (adipose tissue serves as a depot of estrogens, and their excess leads to hormonal disorders);
- tumors of the hypothalamus and / or pituitary gland (failures in the production of FSH and LH lead to hyperestrogenia);
- irregular sex life or dissatisfaction in sex, which contributes to the stagnation of blood in the pelvic organs and, as a result, causes abnormal ovarian function and hormonal imbalance.
When mastopathy symptoms and their severity depend onnot only from the form of the disease, but also from the emotional state and nature of the woman and from the existing accompanying pathologies. In the clinic of mastopathy, the following symptoms predominate:
- Mastodynia or tenderness of the chest
Pain syndrome can be of a different nature andintensity. In the initial stage of the disease, chest pains appear on the eve of menstruation, which many women regard as premenstrual syndrome. The pain can be blunt, aching or acute so that it is impossible to touch the breast. The pain syndrome is caused by the stagnation of blood in the veins and swelling of the tissues and is described by the patients as breast engorgement. Women also notice an increase in the volume of the mammary glands (swelling). After the menstrual period, the pain disappears, but as the pathology progresses, the pain becomes constant, only its intensity changes depending on the phase of the cycle. Expressed pains negatively affect the psychoemotional state of a woman. In addition to sleep disturbance, the lability of the psyche is noted, irritability, aggressiveness and tearfulness appear.
- Discharge from the nipple and the presence of seals / lesions in the chest
Isolation of the nipple is characteristic, but notan obligatory symptom of mastopathy. The severity and color of the discharge also varies. The detachable can be insignificant and appear only when the nipple is squeezed or appears on its own, as evidenced by stains on the underwear. The color of the discharge may be whitish or transparent, or greenish, indicating that a secondary infection is attached. The appearance of excretions from the breast indicates the involvement of the milky ducts in the process. A prognostically unfavorable sign is the appearance of brown or bloody discharge, which is inherent in malignant tumors.
It is more often diagnosed in young women, with palpation being determined by enlarged and painful mammary glands with coarse tautness and pronounced lobulation, as well as fine granularity.
Nodal is the next stage of developmenta disease that occurs when there is no treatment for a diffuse form of pathology. Palpation of the mammary glands allows you to feel the fingers of a separate or separate areas of compaction or a cyst. Foci of compaction are felt as dense nodes without obvious boundaries with pronounced lobulation. Nodes can reach impressive sizes (up to 6 - 7 cm). In the case of the formation of the breast cyst, elastic formations are rounded or oval with obvious boundaries that are not related to the surrounding tissues.
Diagnosis begins with the collectionanamnesis and complaints. After the survey, the sick doctor performs an examination and palpation of the mammary glands. When examined, the contours of the breast are clarified, the presence / absence of asymmetry of the mammary glands, the skin tone and venous pattern, the position of the nipples and whether they are deformed.
Next, palpation of the mammary gland(necessarily in the first phase of the cycle) in two positions: standing and lying, as some formations can not be probed in one position. In addition, the doctor compresses the nipples and determines the presence / absence of secretions from them, and also palpates regional lymph nodes (axillary, sub- and supraclavicular).
The instrumental methods of diagnosing mastopathy include:
The essence of this method ischest x-ray. The mammogram is shown to women from the group of significant risk for breast cancer, as well as to all women 35 and older in carrying out honey. inspection. Radiography of the mammary glands is performed in the first half of the cycle (7-10 days) and necessarily in 2 projections (straight and lateral). The merits of mammography include high information content (up to 97%), the possibility of identifying not probable formations.
This examination is shown to women younger than 35years, as well as in pregnant and breastfeeding women. Advantages of the method are harmlessness and safety, high resolution, the possibility of examining breast implants, or with existing trauma and / or inflammation of the breast, the possibility of examining regional lymph nodes. From the shortcomings of the method: it is impossible to examine the mammary gland as a whole, but only the "cut", low information content with fatty degeneration of the breast, subjective evaluation of the pictures (depends on the skill and experience of the doctor).
When a suspicious area (compaction or cavity formation) is identified, a thin needle puncture of the pathological focus is carried out, followed by a histological examination of the contents.
- Investigation of hormonal status
First of all, the level of estrogen and progesterone is determined, if the level of prolactin is suspected of hyperprolactinemia, and if necessary, hormones of the adrenal glands and thyroid gland are investigated.
- Ultrasound of the pelvic organs
It is carried out to exclude diseases of the ovaries and uterus.
- Blood chemistry
Hepatic enzymes, blood sugar and other parameters are investigated to exclude concomitant extragenital diseases.
In addition, from additional methodsBreast examinations are used (if necessary) for doktografiya (research of milk ducts), pneumocystography (study of cavity education), laser and digital mammography, thermography, magnetic resonance imaging.
In detecting mastopathy, treatment should bemandatory and its tactics depends on a number of factors: the patient's age, the form of the disease, the presence of concomitant pathology, interest in pregnancy or in contraception. Fibro-cystic mastopathy involves treatment both conservatively and surgically.
Patients undergo conservative treatmentonly with the diagnosed form of diffuse mastopathy, and after consultation of the mammalogist-oncologist. Conservative therapy is carried out nonhormonal and hormonal drugs.
Vitamin A is prescribed, which rendersanti-estrogenic effect, vitamin E, enhancing the action of progesterone, vitamin B6, reduces the prolactin content, vitamins PP, R and ascorbic acid, strengthening the vascular wall, normalizing microcirculation and reducing edema of the mammary glands. In addition, all the listed vitamin preparations improve liver function, where estrogen is inactivated and generally favorably affects breast tissue.
Yodomarin, iodine-active, normalizing the thyroid gland and participating in the formation of its hormones (see symptoms of iodine deficiency, drugs) are used.
- Sedatives and biostimulants (adaptogens)
The appointment of sedatives (motherwort,valerian, pion tincture) normalize the patient's psychoemotional state, improve sleep and increase resistance to stress. Adaptogens (eleutherococcus, radiola rosea) stimulate immunity, normalize metabolic processes in the body, improve the functioning of the liver and brain.
Used mastodinone, cyclodinone or remens, which have a beneficial effect on the hormonal balance, eliminate pathological processes in the mammary glands, reduce the concentration of prolactin.
The appointment of drugs such as indomethacin,najz or diclofenac not only reduce the pain syndrome due to the suppression of the synthesis of prostaglandins - "pathogens" of pain, but also relieve swelling and engorgement of the mammary glands.
Diuretics (lasix or plant diuretics, cranberry leaf, kidney tea, phytolysin) contribute to a decrease in swelling in the mammary glands and a reduction in pain.
This is the main link of conservative treatment, it consists in the appointment of the following groups of drugs:
Reception of utrozhestan, dyufaston, norkolut, prigninaand other drugs in the second phase of the cycle reduces the synthesis of estrogens and normalize the level of progesterone, which favorably affects the course of mastopathy. The duration of taking progestin is at least 4 months. Probably, the local application of gestagens (progestogen) is the application of the gel to the surface of the mammary glands twice a day for at least 3 to 4 months, which contributes to the absorption of 90% of progesterone by the tissues of the breast and eliminates side effects.
- Inhibitors of prolactin production
Parlodel suppresses the secretion of prolactin and is prescribed for hyperprolactinemia.
Treatment with androgens (methyltestosterone, danazol,is administered to women after 45 years of age for 4 to 6 months in continuous mode. Androgens inhibit the release of FSH and LH by the pituitary gland, suppress their effect on the ovaries and inhibit the production of hominids by the ovaries.
Tamoxifen and other drugs of this group are taken continuously for 3 months.
- Combined oral contraceptives
Reception Marvelona, Rigevidona and other contraceptive medications is shown to patients under 35 years of age when anovulation and violation of the second phase of the cycle.
Surgical treatment is indicated upon detectionnodular mastopathy (fibroadenoma or cyst) and consists either in carrying out sectoral resection of the mammary gland (removing the pathological focus with the breast sector) or in enucleating the tumor / cyst. Indications for surgery are: suspicion of cancer according to histological examination of punctate, rapid growth of fibroadenoma, recurrence of cyst after previous puncture.
Is pregnancy possible with mastopathy?
Pregnancy favorably affects the coursemastopathy, since the changed hormonal background (increased secretion of progesterone) during the fetal gestation not only suspends the disease, but contributes to a complete cure.
Can I breast-feed with mastopathy?
Not only it is possible, but also it is necessary. Lactation is a prophylaxis of breast diseases, and in the case of mastopathy it helps normalize the processes in the tissues of the mammary glands (the growth of the epithelium of the glandular tissue increases, which suppresses the multiplication of cells of pathological formation).
Is it possible to use folk medication for mastopathy?
Yes, it is possible to use methods of folk medicine in this disease, but only when combined with drug treatment and after consulting a doctor.
What methods of folk treatment are used for mastopathy?
One effective method of folk therapyis the use of fresh cabbage. You can attach a fresh cabbage leaf with cut veins to your chest for the night, wrapping a towel, or you can twist cabbage and pumpkin (1: 1) through a meat grinder, spread the mass evenly over the mammary glands, wrap with polyethylene, and then gauze and leave the compress for 2 hours . Such treatment relieves pain and inflammation, reduces edema in the mammary glands and is carried out for 7 to 14 days.
Complications of mastopathy include relapsedisease after medical treatment, which is possible with undiagnosed hormonal disorders, suppuration and rupture of the mammary gland cyst and the degeneration of fibroadenoma into cancer (less than 1% with nonproliferative form and reaches 32% with severe proliferation of fibroadenoma). Therefore, nodal mastopathy must be treated without fail by an operative route, without delay.
Can I sunbathe with mastopathy?
Sunbathing, as well as holding otherthermal procedures (visiting a bath or sauna) for this disease is prohibited. It should be remembered that in any form of mastopathy a woman enters a high-risk group for breast cancer, and insolation and any other kind of "heating" of the breast promotes the transition of diffuse mastopathy to the nodular or malignant benign breast tumor.
Is it necessary to follow a diet?
Yes, with mastopathy should be adhered toprinciples of therapeutic nutrition, which excludes the intake of chocolate, coffee, tea and cocoa because of the high content of methylxanthines in them, which not only strengthen the pain syndrome, but also contribute to the progression of the disease. The diet should be rich in fresh vegetables and fruits (sources of vitamins and coarse fiber that improves bowel function), grains and bran products, sour-milk and seafood (sources of calcium and iodine), vegetable oils (vitamin E).
To prevent the development of mastopathy, several principles must be adhered to:
- to refuse from bad habits;
- wearing comfortable, according to the size of the laundry;
- avoid stress (if possible);
- adhere to the principles of breastfeeding;
- regular self-examination of the breast and checked by a doctor;
- avoid chest injuries;
- adhere to a regular sexual life.
Obstetrician-gynecologist Anna Sozinova