Fibrocystic mastopathy (FCM), a benign lesion of the mammary gland, is characterized by a spectrum of proliferative and regressive tissue changes with a violation of the ratio of epithelial and connective tissue components. In recent years, there has been a steady increase in this pathology throughout the world (A. G. Egorova, 1998; V. I. Kulakov et al., 2003). Mastopathy occurs in 30-70% of women of reproductive age; with gynecological diseases, its frequency increases to 70-98% (A. V. Antonova et al., 1996).

In premenopausal women it occurs in 20% of women. After menopause, new cysts and nodes, as a rule, do not appear, which proves the participation of ovarian hormones in the occurrence of the disease.

It is currently known that they occur 3-5 times more often against the background and in 30% of cases with nodular forms of mastopathy with proliferation phenomena. Therefore, in the anticancer fight, along with early diagnosis of malignant tumors, timely detection and treatment of precancerous diseases is no less important.

There are non-proliferative and proliferative forms of FCM. At the same time, the risk of malignancy in the non-proliferative form is 0.86%, with moderate proliferation - 2.34%, with pronounced proliferation - 31.4% (S. S. Chistyakov et al., 2003).

The main role in the occurrence of FCM is assigned to dishormonal disorders in a woman’s body. It is known that the development of the mammary glands, regular cyclical changes in them during puberty, as well as changes in their function during pregnancy and lactation occur under the influence of a whole complex of hormones: gonadotropin-releasing hormone (GnRH) of the hypothalamus, gonadotropins (luteinizing and follicle-stimulating hormones), prolactin, human chorionic gonadotropin, thyroid-stimulating hormone, androgens, corticosteroids, insulin, estrogens and progesterone. Any imbalance of hormones is accompanied by dysplastic changes in mammary gland tissue. The etiology and pathogenesis of FCM have not yet been definitively established, although more than a hundred years have passed since the description of this symptom complex. An important role in the pathogenesis of FCM is played by relative or absolute hyperestrogenism and progesterone deficiency. Estrogens cause proliferation of the ductal alveolar epithelium and stroma, and progesterone counteracts these processes, ensures differentiation of the epithelium and cessation of mitotic activity. Progesterone has the ability to reduce the expression of estrogen receptors and reduce the local level of active estrogens, thereby limiting the stimulation of breast tissue proliferation.

Hormonal imbalance in breast tissue towards progesterone deficiency is accompanied by edema and hypertrophy of intralobular connective tissue, and proliferation of ductal epithelium leads to the formation of cysts.

In the development of FCM, an important role is played by the level of prolactin in the blood, which has a diverse effect on the tissue of the mammary glands, stimulating metabolic processes in the epithelium of the mammary glands throughout a woman’s life. Hyperprolactinemia outside of pregnancy is accompanied by swelling, engorgement, pain and swelling in the mammary glands, more pronounced in the second phase of the menstrual cycle.

The most common causes of mastopathy are hypothalamic-pituitary diseases, thyroid dysfunction, obesity, lipid metabolism disorders, etc.

The cause of dyshormonal disorders of the mammary glands can be gynecological diseases; , hereditary predisposition, pathological processes in the liver and biliary tract, pregnancy and childbirth, stressful situations. FCM often develops during menarche or menopause. In adolescence and young women, the diffuse type of mastopathy with minor clinical manifestations, characterized by moderate pain in the upper outer quadrant of the mammary gland, is most often detected.

At 30-40 years of age, multiple small cysts with a predominance of the glandular component are most often detected; the pain syndrome is usually severe. Single large cysts are most typical for patients aged 35 years and older (A. L. Tikhomirov, D. M. Lubnin, 2003).

FCMs also occur in women with a regular two-phase menstrual cycle (L. M. Burdina, N. T. Naumkina, 2000).

Diffuse FCM can be:

• with a predominance of the ferrous component;
• with a predominance of the fibrous component;
• with a predominance of the cystic component.

Diagnosis of breast diseases is based on examination of the mammary glands, palpation, mammography, ultrasound, puncture of nodules, suspicious areas and cytological examination of punctate.

Examination of the mammary glands of reproductive age must be carried out in the first phase of the menstrual cycle (2-3 days after the end of menstruation), since in the second phase, due to engorgement of the glands, there is a high probability of diagnostic errors (S. S. Chistyakov et al., 2003) .

When examining the mammary glands, the appearance of the glands is assessed, paying attention to all manifestations of asymmetry (contours, skin color, position of the nipples). Then the examination is repeated with the patient's hands raised. After the examination, the mammary glands are palpated, first with the patient standing and then lying on her back. At the same time, the axillary, subclavian and supraclavicular lymph nodes are palpated. If any changes are detected in the mammary glands, mammography and ultrasound are performed.

Ultrasound of the mammary glands is becoming increasingly popular. This method is harmless, which allows the study to be repeated many times if necessary. In terms of information content, it is superior to mammography in the study of dense mammary glands in young women, as well as in identifying cysts, including small ones (up to 2-3 mm in diameter), while without additional interventions it makes it possible to judge the condition of the epithelium lining the cyst and carry out differential diagnosis between cysts and fibroadenomas. In addition, when examining lymph nodes and mammary glands with diffuse changes, ultrasound is the leading one. At the same time, with fatty involution of mammary gland tissue, ultrasound is significantly inferior in information content to mammography.

Mammography - radiography of the mammary glands without the use of contrast agents, performed in two projections - is currently the most common method of instrumental examination of the mammary glands. Its reliability is very high. So, for breast cancer it reaches 95%, and this method allows you to diagnose non-palpable (less than 1 cm in diameter) tumors. However, this method is limited in application. Thus, mammography is contraindicated for women under 35 years of age, during pregnancy and lactation. In addition, the information content of this method is insufficient when studying dense mammary glands in young women.

Despite the universally recognized connection between diseases of the mammary glands and genitals, Russia has not developed the concept of an integrated approach to the diagnosis and treatment of diseases of the mammary glands and organs of the reproductive system. A comparison of changes in the mammary glands with and showed that the frequency of pathological changes in the mammary glands with uterine fibroids reaches 90%, nodular forms of mastopathy more often occur when uterine fibroids are combined with adenomyosis (V. E. Radzinsky, I. M. Ordiyants, 2003). Based on these data and the fact that more than half of women with benign breast diseases suffer from uterine fibroids and endometrial hyperplasia, the authors classify women with these diseases as a high-risk group for breast diseases.

In inflammatory diseases of the female genital organs, the frequency of benign diseases of the mammary glands was significantly lower - only in every fourth; nodular forms were not identified.

Consequently, inflammatory diseases of the genitals are not the cause of the development of FCM, but may be accompanied by hormonal disorders.

A mammological study of women of reproductive age with various gynecological diseases revealed a diffuse form of mastopathy in every third patient, and a third of women had a mixed form of FCM. The nodular form of mastopathy was determined in patients with a combination of uterine fibroids, genital endometriosis and endometrial hyperplasia.

Treatment of patients with nodular forms of benign diseases of the mammary glands begins with puncture with fine-needle aspiration. If cells with dysplasia in a nodular formation or cancer cells are detected during a cytological examination, surgical treatment is performed (sectoral resection, mastectomy) with urgent histological examination of the removed tissue.

Depending on the results of the examination, treatment of gynecological pathology, mastopathy, and correction of concomitant diseases is carried out.

Diet is important in the treatment and prevention of breast diseases: the nature of nutrition can affect the metabolism of steroids. An increased amount of fat and meat products is accompanied by a decrease in androgen levels and an increase in estrogen levels in the blood plasma. In addition, special importance is attached to a sufficient content of vitamins in the diet, as well as coarse fiber, since its anti-carcinogenic properties have been proven.

In recent years, the frequency of use of herbal medicines in the treatment of benign diseases of the mammary glands has increased.

Many studies are devoted to the treatment of this pathology, but the problem remains relevant today (L. N. Sidorenko, 1991; T. T. Tagieva, 2000).

For the treatment of mastopathy associated with mastalgia, various groups of drugs are used: analgesics, bromocriptine, night primrose oil, homeopathic drugs (mastodinone), vitamins, potassium iodide, oral contraceptives, herbal remedies, danazol, tamoxifen, as well as natural progesterone for transdermal use. The effectiveness of these remedies varies. Pathogenetically, the most substantiated method of treatment is the use of progesterone preparations.

Since the late 80s. last century, injectable (Depo-Provera) and implanted (Norplant) progestogens are widely used for therapeutic and contraceptive purposes (A. G. Khomasuridze, R. A. Manusharova, 1998; R. A. Manusharova et al., 1994). Long-acting injectable drugs include medroxyprogesterone acetate in the form of Depo-Provera and norethindrone enanthate. The mechanism of action of these drugs is similar to that of the progestin components of combined oral contraceptives. Depo-Provera is administered intramuscularly at 3-month intervals. The most common complications resulting from the use of Depo-Provera are prolonged amenorrhea and intermenstrual bleeding. Our research data showed that the drug does not have a negative effect on normal tissue of the mammary glands and uterus, while at the same time it has a therapeutic effect in hyperplastic processes in them (R. A. Manusharova et al., 1993). Long-acting drugs also include the implantable drug Norplant, which provides contraceptive and therapeutic effects for 5 years. For many years, it was believed that hormonal drugs should not be prescribed to patients with FCM from the time the disease is diagnosed until the indication for surgical treatment. At best, symptomatic therapy was carried out, consisting of prescribing a collection of herbs, iodine preparations, and vitamins.

In recent years, as a result of research, the need for active therapy, in which hormones play a leading role, has become obvious. With the accumulation of clinical experience in the use of Norplant, reports appeared about its positive effect on diffuse hyperplastic processes in the mammary glands, since under the influence of the progestin component in the hyperplastic epithelium, not only inhibition of proliferative activity consistently occurs, but also the development of decidual-like transformation of the epithelium, as well as atrophic changes in the epithelium of the glands and stroma. In this regard, the use of gestagens is effective in 70% of women with hyperplastic processes in the mammary glands. A study of the effect of Norplant (R. A. Manusharova et al., 2001) on the condition of the mammary glands in 37 women with a diffuse form of FCM showed a decrease or cessation of pain and tension in the mammary glands. During a control study after 1 year, ultrasound or mammography showed a decrease in the density of the glandular and fibrous components due to a decrease in areas of hyperplastic tissue, which was interpreted as regression of hyperplastic processes in the mammary glands. In 12 women, the condition of the mammary glands remained the same. Despite the disappearance of mastodynia, the structural tissue of the mammary glands did not undergo any changes. The most common side effect of Norplant, like Depo-Provera, is menstrual irregularity in the form of amenorrhea and intermenstrual bleeding. The use of oral gestagens for intermenstrual bleeding and combined contraceptives for amenorrhea (for 1 - 2 cycles) leads to the restoration of the menstrual cycle in the vast majority of patients.

Currently, oral (tablet) gestagens are also used for the treatment of FCM. Among these drugs, duphaston and utrozhestan are the most widely used. Duphaston is an analogue of natural progesterone, completely devoid of androgenic and anabolic effects, safe for long-term use and has a progestogenic effect.

Utrozhestan is a natural micronized progesterone for oral and vaginal use. Unlike synthetic analogues, it has beneficial advantages, which consist primarily in the fact that the micronized progesterone included in its composition is completely identical to the natural one, which leads to an almost complete absence of side effects.

Micronized utrogestan is prescribed 100 mg 2 times a day, duphaston 10 mg 2 times a day. Treatment is carried out from the 14th day of the menstrual cycle for 14 days, 3-6 cycles.

Combined oral contraceptives are prescribed to block ovulation and eliminate cyclical fluctuations in the levels of sex hormones.

Danazol is prescribed 200 mg for 3 months.

GnRH agonists (diferelin, zoladex, buserelin) cause temporary reversible menopause. Treatment of mastopathy with GnRH agonists has been carried out since 1990.

The first course of treatment is usually prescribed for 3 months. Treatment with GnRH agonists inhibits ovulation and ovarian function, promotes the development of hypogonadotropic amenorrhea and the reversal of mastopathy symptoms.

For cyclic hyperprolactinemia, dopamine agonists (parlodel, dostinex) are prescribed. These drugs are prescribed in the second phase of the cycle (from the 14th to 16th day of the cycle) before the onset of menstruation.

In recent years, various herbal remedies that have anti-inflammatory analgesic and immunomodulatory effects have become widespread. The fees are prescribed in the second phase of the menstrual cycle and are used for a long time.

One of the most effective means of treating mastopathy is a combined homeopathic drug - mastodinone, which is a 15% alcohol solution with extracts of medicinal herbs cyclamen, chilibuha iris, tiger lily. The drug is available in bottles of 50 and 100 ml. Mastodinon is prescribed 30 drops 2 times a day (morning and evening) or 1 tablet 2 times a day for 3 months. Duration of treatment is not limited

Mastodinone, due to its dopaminergic effect, leads to a decrease in elevated levels of prolactin, which contributes to the narrowing of the ducts, a decrease in the activity of proliferative processes, and a decrease in the formation of the connective tissue component. The drug significantly reduces blood flow and swelling of the mammary glands, helps reduce pain, and reverse the development of changes in the tissue of the mammary glands.

In the treatment of diffuse forms of mastopathy, the drug Klamin, which is a plant adaptogen with antioxidant, immunocorrective, hepatoprotective activity, has an enterosorbent and mild laxative effect, has become widespread. One of the most important characteristics of Klamin is the presence of iodine in its composition (1 tablet contains 50 mcg of iodine), which in areas with iodine deficiency completely covers its deficiency.

The drug phytolon, which is an alcohol solution of the lipid fraction of brown algae, has a high antioxidant and immunostimulating effect. The active principle is copper derivatives of chlorophyll and trace elements. The drug is prescribed orally in the form of drops or externally. Together with a complex of herbs it has a good absorbing effect.

If there are concomitant diseases, it is necessary to treat them. When diffuse FCM is combined with uterine fibroids, endometrial hyperplasia, adenomyosis, it is necessary to additionally add pure gestagens (utrogestan, duphaston) to the therapy.

We observed 139 women who complained of aching pain, a feeling of fullness and heaviness in the mammary glands, intensifying in the premenstrual days, sometimes starting from the second half of the menstrual cycle. The age of the patients ranged from 18 to 44 years. All patients underwent examination and palpation of the mammary glands, and attention was paid to the condition of the skin, nipple, shape and size of the mammary glands, and the presence or absence of discharge from the nipples. In the presence of discharge from the nipples, a cytological examination of the discharge was performed.

All women underwent ultrasound of the mammary glands, and in the presence of nodes, ultrasound and non-contrast mammography; according to indications, a puncture of the formation was performed, followed by a cytological examination of the obtained material. Using ultrasound of the mammary glands, the diagnosis of the diffuse form of FCM was confirmed in 136 cases.

The menstrual cycle was disrupted by the type of oligomenorrhea in 84 women, 7 of the observed patients had polymenorrhea, and in 37 patients the cycle was apparently preserved, but functional diagnostic tests revealed anovulation. In 11 women, the menstrual cycle was not disrupted, but they had pronounced symptoms of premenstrual syndrome, which were observed in every menstrual cycle and affected the patient’s quality of life.

In 29 patients, mastopathy was combined with hyperplastic processes in the uterus (uterine fibroids, endometrial hyperplasia), in 17 - with adenomyosis, in 27 patients, along with mastopathy, there were inflammatory diseases of the genitals, in 9 women a pathology of the thyroid gland was detected. Those examined often had extragenital pathology, and 11 close relatives had benign and malignant diseases of the genitals and mammary glands.

Based on the examination results, gynecological pathology, mastopathy and other concomitant diseases were treated. For the treatment of mastopathy in 89 patients, progestogel, gel, 1% - natural micronized plant-derived local progesterone was used. The drug was prescribed in a dose of 2.5 g of gel on the surface of each mammary gland 1-2 times a day, including during menstruation. The drug does not affect the level of progesterone in the blood plasma and has only a local effect. The use of progestogen was continued for 3 to 4 months. If necessary, patients were prescribed a course of maintenance therapy: vitamins E, B, C, A, PP. In addition, sedatives (tincture of valerian, lemon balm, motherwort) and adaptogens (Eleutherococcus, ginseng) were prescribed.

In 50 women, mastopathy was treated with mastodynon, which was prescribed 1 tablet 2 times a day in two courses, 3 months each, with an interval between courses of 1 month. The main active component of the drug Mastodinon is Agnus castus extract, which acts on dopamine D2 receptors of the hypothalamus and reduces the secretion of prolactin. A decrease in prolactin secretion leads to regression of pathological processes in the mammary glands and relieves pain. Cyclic secretion of gonadotropic hormones with normal prolactin levels restores the second phase of the menstrual cycle. At the same time, the imbalance between the levels of estradiol and progesterone is eliminated, which has a positive effect on the condition of the mammary glands.

Ultrasound was performed 6-12 months after the start of treatment. Positive dynamics were considered to be a decrease in the diameter of the ducts, the number and diameter of cysts, as well as their disappearance.

After the treatment (for 4-6 months), all 139 women showed positive dynamics within 1 month, which was expressed in a decrease and/or cessation of pain and a feeling of tension in the mammary glands.

During control ultrasound 6-12 months after the end of treatment, a decrease in the density of the glandular and fibrous components was noted due to a decrease in areas of hyperplastic tissue, which was interpreted as regression of the hyperplastic process in the mammary glands. In 19 women with a diffuse form of FCM and in 3 with fibroadenoma, an objective examination and ultrasound revealed no changes in the condition of the mammary glands, however, all patients noted an improvement in their condition (pain, a feeling of tension and fullness in the mammary glands disappeared).

Side effects when using the drugs Mastodinone and Progestogel were not noted in any observation.

The use of these drugs is pathogenetically justified.

There is no treatment algorithm for the treatment of mastopathy. Conservative treatment is indicated for all patients with a diffuse form of mastopathy.

R. A. Manusharova, Doctor of Medical Sciences, Professor

E. I. Cherkezova, Candidate of Medical Sciences

RMAPO, Andrology Clinic, Moscow

The term “mastopathy” means the development of pathological formations and changes in the mammary gland. It is customary to use clarifying definitions for it. Thus, diffuse fibrous mastopathy is a disease that leads to changes in the structure of the mammary gland with the formation of fibrous foci throughout the mammary gland tissue.

The impetus for the development of pathological changes in breast tissue can be a variety of factors or their combination. Among these reasons, the most common are:

• dysregulation of hormonal metabolism;
• high levels of estrogen in the blood;
• low progesterone levels;
• genetic reasons;
• unfavorable gynecological history;
• somatic imbalances

Often, several provoking factors serve as the starting point. A woman’s body responds to diseases by changing the hormonal balance, which leads to the formation of diffuse fibrous mastopathy as one of the manifestations.

Dysregulation of hormonal metabolism

A normal balance of hormones in the female body ensures the full functioning of all organs and systems. The development of pathological fibrotic changes in women can occur due to imbalance of hormonal metabolism. The level of production of the estrogen component increases. A moderate increase in the hormone content in the blood results in minor mastopathy. The mammary glands are slightly enlarged. Their structure remains the same.

Diffuse fibrosis can be observed with a marked increase in estrogen in combination with an active decrease in progesterone. This imbalance is accompanied by an increase in the proportion of prolactin. Similar problems with the content of female hormones in the body can be observed with disorders of central regulation:

• brain pathologies;
• pituitary tumors;
• infectious meningitis.

Mastopathy can be caused by disorders that occur in the organs of the reproductive and endocrine systems:

• inflammatory diseases of the reproductive organs;
• injuries to the glands or genitals;
• endocrinological diseases;
• exposure to toxic factors;
• burdened gynecological history;
• genetic reasons.

Often, treatment of these painful conditions leads to side effects, and diffuse breast cancer develops.

Somatic diseases

Any unhealthy changes in the organs of the endocrine system lead to disruption of the female genital organs. This is explained by the fact that the body is a single system, hormonal regulation occurs centrally and any metabolic disorder almost permanently changes sexual regulation.

Somatic diseases - what is it? These are diseases of the body organs. Those that significantly influence the development, treatment, and prognosis of fibrous mastopathy include: diabetes mellitus, thyroid disease, obesity, pancreatitis, and hepatitis. Treatment of these diseases can also lead to complications in female sexual regulation.

Gynecological history

Diffuse fibrous mastopathy of the mammary glands often occurs in those women who resorted to artificial termination of pregnancy, had a complicated birth, or incorrectly interrupted the process of breastfeeding a child. Also, a deviation from the norm can occur as a symptom of uterine fibroids.

Treatment of abnormal symptoms will be more successful the more accurately the cause of the development of painful reactions is established. As a rule, this is a combination of predisposing factors: genetic predisposition, concomitant diseases. The presence of toxic effects of smoking, alcohol, hazardous production, poisoning, stress.

Clinical manifestations

Diffuse mastopathy of the mammary glands with a predominance of the fibrous component is most often bilateral, that is, both organs are affected. Fibrous compactions are located evenly throughout the tissue of the organ, which is called diffuse. In this case, the woman subjectively feels pain, heaviness in the mammary glands, and discomfort when wearing underwear. Objectively, upon examination and palpation, dense formations of round or oblong shape can be detected. The consistency of these seals is hard, knotty, and elastic. The size of fibrous nodules ranges from a few millimeters to two to three centimeters in diameter.

Palpation of the formations is painful, the mammary gland can be enlarged, and with significant development of the process, fibrous nodules visually change the shape of the gland. Most often, the process of development of tissue changes is bilateral, but unilateral fibrous changes in the mammary glands occur. The increase or disappearance of subjective sensations may be associated with the phase of the menstrual cycle.

The woman feels pain that can radiate to the scapular region and armpits. Sometimes there is an increase in the size of the axillary group of lymph nodes on the corresponding side or on both sides. However, this symptom is quite rare. Pain is associated with the proliferation of fibrous tissues, which compress the nerve fibers of the corresponding loci, which provokes pain. The nodules themselves are not painful.

Diagnostics

A woman should periodically, approximately once every two weeks, conduct an independent examination and palpation of the mammary glands. This must be done in front of a mirror, preferably in the first half of the day, with a positive emotional mood. The discovery of any lumps is a reason to consult a doctor, which explains the examination in the morning. In order not to spend a sleepless night in restless thoughts, there is time to immediately go to the doctor.

The specialist will conduct examination and palpation in different positions for the most objective determination with further examination and treatment tactics. It is also necessary to undergo a mammography examination. With its help, the localization as well as the structural nature of changes in glandular tissue will be accurately determined.

Treatment

Any disease requires several treatment tactics. Thus, diffuse fibrous mastopathy can be cured or the patient’s condition can be significantly improved using therapeutic treatment tactics. The surgical method is chosen in the most severe or late diagnosed cases. Surgical intervention is justified in the case of significant proliferation of fibrous tissue, however, in fibrotic forms of mastopathy this method is practically not used. Fibrosis is distributed evenly throughout the mammary gland, so surgery will do more harm than good.

Hormonal and non-hormonal drugs are used. It all depends on how correctly the cause of the disease is identified. Medicines that do not contain hormones belong to different pharmacological groups:

• homeopathic remedies: mastodinon, remens, cyclodinone;
• sedatives for the neurological nature of the disease;
• anti-inflammatory non-steroidal drugs for significant pain;
• vitamin complexes as regulators of metabolic processes;
• iodine preparations, iodine-containing agents for thyroid pathologies.

Homeopathic remedies need to be taken for at least three to six months to achieve an effect, then for six months to stabilize the result. If homeopathic medicines are prescribed, you should be patient.

The use of hormone-containing drugs, for example, Yarin, is aimed at suppressing the activity of estrogen. The prescribed course of therapy depends on the initial stage of the process, age, concomitant diseases of the woman, her gynecological history and emotional status. Progestogen drugs, for example, Utrozhestan, Duphaston, also enjoy well-deserved authority. Suppression of the activity of the prolactin component can be achieved using parlodel.

Regulating your lifestyle has a healing effect. This includes giving up the harmful habits of smoking, drinking alcohol, and other mixtures that poison the body. Visiting solariums and prolonged exposure to direct sunlight negatively affects the dynamics of the development of mastopathy. Nutritional correction is necessary in favor of fish products, reducing the content of fats and easily digestible carbohydrates in the diet, and increasing the proportion of protein. It is necessary to wear the right lingerie that holds the breasts well, without deforming their shape at the same time. The cut of bras should suit your body type. Folk remedies are widely available for this diagnosis.

Prevention

Such measures include regular thorough examination and palpation of the mammary glands, examination by a gynecologist, treatment of concomitant diseases, adherence to the rules of a healthy sex life and reproductive function.

Changes in hormonal levels can provoke the development of diffuse changes in the mammary glands in a woman. As a result, the normal ratio of epithelial and connective tissue elements is disrupted. The disease causes soreness of the mammary glands, the appearance of discharge from the nipples, reminiscent of colostrum (secretion of the mammary glands). These symptoms cause a woman considerable discomfort, so it is worth understanding what diffuse mastopathy is, what its manifestations are and methods of treatment.

Doctors distinguish 2 degrees of pathology:

1. Diffuse fibrous mastopathy. The disease leads to the replacement of epithelial structures with connective tissue. The pathological process can be one- or two-sided. Pathology provokes the development of dysplasia, scarring, and the appearance of round or oval elastic seals. The disease is easily amenable to drug therapy, so a complete cure is possible.
2. Diffuse fibrocystic mastopathy (dfcm). The disease often develops against the background of menstrual irregularities and lack of ovulation. What is diffuse fibrocystic mastopathy? Pathology leads to the proliferation of glandular lobules with the formation of compactions with clear boundaries. The neoplasms are mobile upon palpation and gradually increase in size.

According to the modern classification, diffuse fibrous mastopathy is of the following types:

• fibroadenosis (diffuse fibrosis). This type is characterized by a predominance of fibrous changes;
• fibrocystic disease This is cystic mastopathy with a predominance of cavities filled with fluid;
• adenosis (glandular mastopathy) – mastopathy with a predominance of the glandular component;
• sclerosing adenosis;
• a mixed form of the disease, combining signs of several types of mastopathy.

Depending on the localization of pathological formations, there is unilateral and bilateral diffuse mastopathy.

Clinical picture

The following signs of diffuse mastopathy are distinguished:

1. Development of pain syndrome. The appearance of moderate pain during palpation is typical. The pain can be aching, bursting, tingling or radiating to the neck. Pain in the mammary gland is noted before the appearance of menstrual flow.
2. . Diffuse fibrous changes in the mammary gland provoke the appearance of round or oval-shaped lumps, which disappear by the end of menstruation. At the beginning of a new cycle, formations arise again. With diffuse fibrocystic mastopathy of the mammary glands, mobile formations filled with fluid appear.
3. Swelling and increase in the volume of the mammary gland.
4. Severe symptoms of premenstrual syndrome: constipation, increased gas formation, migraine-like headache, increased excitability, fear and anxiety.
5. The appearance of white, yellowish or pink discharge from the nipples. If the discharge is greenish in color, then an infection may be suspected.

There are also less common symptoms of diffuse mastopathy: weight gain, prolonged menstrual cycle, dysmenorrhea (heavy discharge or menorrhagia, amenorrhea, irregular cycle), dry skin, decreased performance.

Do you use folk remedies?

YesNo

Features of therapy for diffuse mastopathy

Many patients are interested in how to treat diffuse mastopathy. Therapy of the disease involves the use of conservative treatment methods (hormonal and non-hormonal drugs), traditional medicine recipes, and surgery may be prescribed for the treatment of diffuse cystic mastopathy.

Non-hormonal therapy

Diffuse mastopathy of the mammary glands involves the following treatment tactics:

Use of hormonal drugs

When fibrous mastopathy is detected, normalization of hormonal levels is required. For this purpose, the following drugs are widely used:

1. Gestagens (Duphaston, Utrozhestan, Norkolut, Primolut, Norethisterone). The drugs are prescribed in the second phase of the menstrual cycle.
2. Prolactin synthesis inhibitors (Parlodel). Prescribed for severe hyperprolactinemia. The drug is taken from 10 to 25 days of the cycle.

For diffuse fibrocystic mastopathy in women under 35 years of age, estrogen-gestagen contraceptives (Zanina, Marvelona) are used. The drugs will normalize the luteal phase and resume ovulation. If echo signs of diffuse fibrous mastopathy appear in patients over 45 years of age, then androgens (Methyltestosterone) or antiestrogens (Tamoxifen, Fareston) are used.
If therapy for diffuse nodular mastopathy is carried out against the background of endometriosis, then Danazol is indicated. The use of the drug leads to inhibition of the synthesis of pituitary hormones.

It is important to remember that before prescribing hormonal drugs, it is necessary to examine the patient’s hormonal status.

When is surgical treatment indicated?

If drug treatment for diffuse cystic mastopathy is ineffective for 6 months, they resort to surgical removal of the seals. The following indications for the operation are distinguished:

• development of intraductal adenoma;
• appearance;
• if it is actively developing and growing;
• nodular form of the disease;
• accumulation of calcifications in the gland.

During surgery, the following techniques can be used:

1. Sclerosis. The method involves the introduction of a sclerosing substance, which leads to the healing of defects in the mammary gland.
2. Resection. The operation involves excision of the affected area. The resulting tissue is sent for histological examination to rule out breast cancer.

Forecast

Diffuse mastopathy has a positive prognosis - the pathology is easily treatable with medication. However, in advanced cases, benign tumors may degenerate into cancerous tumors. Therefore, it is important to promptly begin therapy with a qualified mammologist if any form appears.

Prevention

Preventive measures include an annual examination by a mammologist. It is important to promptly treat any gynecological and extragenital pathologies in order to reduce the risk of developing hormonal disorders. Experts strongly recommend avoiding abortions, which are a serious stress for the body and increase the risk of developing mastopathy.

An important stage of prevention is monthly breast self-examination, which allows you to promptly identify minor lumps in the structure of the mammary gland. It is also necessary to minimize the risk of developing injuries and bruises to the chest, and give preference to comfortable bras.

Diffuse mastopathy provokes changes in the structure and functionality of the mammary gland. Therefore, when the first signs of the disease appear, you must contact a mammologist or gynecologist. This will allow the pathology to be identified in time and therapy to begin.

Mastopathy is associated with abnormal growth of mammary gland tissue. The development processes of these organs are regulated by female sex hormones. An unfavorable state of the endocrine system, in which the body's hormonal levels are disrupted, is called one of the main causes of breast diseases. Such pathologies are not uncommon, and no woman is immune from their occurrence. It is necessary for everyone to understand how important it is to independently monitor the condition of the glands, if mastopathy occurs, to notice its first symptoms in time.

Content:

Diffuse fibrous changes in breast tissue

Diffuse mastopathy is a disease in which many small foci of modified tissue are scattered throughout the gland. Sometimes they form separate groups (for example, they are located in the upper outer part of the gland). Such neoplasms are benign in nature, but in some cases they undergo malignant degeneration.

Diffuse fibrous mastopathy is a condition that is associated with the proliferation of fibrous tissue (the fibers that make up the frame of the mammary gland and the epithelium that covers the ducts and lobules). Improper formation of cell layers leads to the formation of scars in the connective (fibrous) fibers. So-called tissue fibrosis occurs.

The increased proliferation of connective tissue cells leads to the fact that they displace glandular tissue cells. At the same time, the number of ducts and lobules decreases. Fibrous mastopathy is characterized by the fact that the cells of the outer epithelium grow inside the ducts, can completely block them, and damage the lobules.

As a result, foci of tissue scarring form in the mammary gland, which are felt in the form of compactions of various sizes. In some of them small cysts appear. If there are so many such cysts that they occupy the largest part of the volume of the gland, then they speak of the occurrence of diffuse fibrocystic disease. Diffuse fibrous mastopathy (fibroadenomatosis) can be found in one breast or in both.

Mastopathy occurs in women at the age when they are most often exposed to adverse factors on the body that can affect hormonal levels (25-45 years). During the postmenopausal period, the level of sex hormones drops to a minimum, so this pathology does not occur in older women.

Video: Causes and diagnosis of mastopathy

Causes of mastopathy

The main cause of improper tissue development and fibrosis is a decrease in progesterone levels and an excessive increase in estrogen levels. The causes of hormonal disorders can be:

1. Improper production of sex hormones in the ovaries due to the occurrence of inflammatory processes in them and the formation of tumors.
2. Inflammatory diseases of other organs of the reproductive system that occur when they are damaged during operations, childbirth, or as a result of improper hygienic care. Such processes can quickly spread from the vagina to the uterus and ovaries. The same applies to infectious diseases that occur when the vaginal microflora is disrupted or pathogens penetrate the organs during sexual intercourse.
3. Disruption of the hypothalamic-pituitary system of the brain. The functioning of the ovaries depends entirely on the content of pituitary hormones (follicle-stimulating and luteinizing) in the body. Failure of this organ leads to diffuse fibrous mastopathy and other diseases of the mammary glands.
4. Prolactinemia is an increased level of prolactin (also a pituitary hormone). Prolactin is the main hormone responsible for the development of the mammary glands and their functioning.
5. Termination of pregnancy, refusal to breastfeed or its early cessation, lack of regular sexual activity, pregnancy and childbirth.
6. Metabolism and dysfunction of the thyroid and pancreas. Improper lipid metabolism leads to an increase in fat mass in the body. It is capable of producing estrogens, although not in such quantities as the ovary. Obesity leads to hyperestrogenism. Women with diabetes mellitus often suffer from mastopathy.
7. Use of hormonal medications with a high content of estrogen (in the treatment of infertility, amenorrhea, various menstrual abnormalities).

Factors that provoke the occurrence of diffuse fibrous mastopathy are nervous fatigue and depression. Ultraviolet radiation in a solarium or during prolonged exposure to sunlight has harmful effects. The disease occurs more often in women who smoke.

At risk are women who have a hereditary predisposition to diseases of this kind, as well as women with breast injuries and malignant tumors of the genital organs.

Symptoms of mastopathy

The first signs of diffuse mastopathy may be changes in the condition of the mammary glands a few days before menstruation. Even if a woman is healthy, swelling and mild pain in the breasts is normal for her. You need to pay attention to this sign if the breast enlargement is larger than usual (possibly asymmetrical enlargement of the glands), the pain is felt more strongly. A painful premenstrual symptom in many cases turns out to be a manifestation of diffuse mastopathy. Lumps during menstruation can decrease and even dissolve, and subsequently appear again, since the cause of the pathology remains.

During self-examination of the breast, a woman discovers small scattered lumps, changes in the shape of the breast, if a large number of nodules are grouped together. Sometimes there is a discharge of white or clear liquid from the nipple, which indicates the development of pathology in the lobules and milk ducts.

Depending on the severity of symptoms, the following forms of diffuse fibrous mastopathy are distinguished:

1. Expressed implicitly. The mammary gland contains a lot of fatty tissue, due to which fibrous compactions are difficult to palpate and are not very painful.
2. A state of moderate severity of symptoms. There is less adipose tissue, but still enough to mitigate the manifestations of the disease.
3. Severe fibrosis. Connective tissue predominates in the breast. Touching your breasts is very painful. The sensation of pain is constant and does not depend on the period of the menstrual cycle.

One of the symptoms of mastopathy may be enlarged lymph nodes under the arms, in the area of ​​the collarbones. An advanced disease leads to the appearance of atypical cells in the breast tissue and the appearance of a cancerous tumor.

Diagnostics

A universal diagnostic method that can be used when examining women of any age, including pregnant women, is breast ultrasound. The method is safe and quite informative; it allows you to study the structure of tissues and notice the slightest compaction.

Mammography (breast x-ray) is also an important diagnostic method. It provides more detailed information about the condition of tissues and blood vessels. But there are contraindications to its use. The use of radioactive radiation does not allow its use for examining women under 35 years of age, pregnant or lactating women. It is also not suitable for women with small breasts.

Diagnosis using these methods is carried out immediately after the end of menstruation, when the chest is least tense. If suspicions arise about the nature of the lumps, a breast biopsy is performed. Tests of blood and fluid released from the nipple can determine the presence of inflammatory processes.

Video: Treatment of diffuse fibrous mastopathy

Treatment of fibrous mastopathy

Surgical treatment is performed only in extremely advanced cases, when the size of the lumps is more than 2 cm, and a biopsy shows that malignant degeneration has occurred. To eliminate compactions, a conservative treatment method is mainly used. Hormonal levels are restored and the functioning of the ovaries and pituitary gland is regulated with medications.

Drug treatment

Reducing estrogen levels is achieved by taking gestagens (progesterone-based drugs). These include duphaston and utrozhestan. For rubbing into the chest, progestogel is used - a gel with the same effect. They are taken in the second half of the cycle.

Drugs that suppress the production of prolactin (parlodel) are prescribed, which are taken in the middle and second half of the cycle, as well as antiestrogens (tamoxifen). Women under 35 years of age are prescribed oral contraceptives (Marvelon, Janine), which suppress ovulation. Women over 45 years of age are prescribed medications based on male sex hormones (methyltestosterone). Before prescribing such drugs, it is necessary to conduct a study of hormonal levels, and also study the general state of health (presence of liver, kidney, and blood diseases).

Iodine preparations (iodomarin) and drugs that replenish the lack of thyroid hormones (euthyrox) are prescribed. In the treatment of diffuse fibrous mastopathy, homeopathic herbal medicines, such as mastodinone and clamine, are also used.

To eliminate the causes of the disease, drugs that calm the nervous system, as well as vitamins and immunomodulators are prescribed. Painkillers and diuretics are used to remove fluid from body tissues and eliminate swelling.

Physiotherapeutic treatment is used (laser therapy, electrophoresis and others).

Warning: If you have diffuse mastopathy, you should not drink coffee, cola, eat chocolate, or eat hot spices. They contain substances that promote the development of fibrosis.

Any treatment should only be prescribed by a doctor. Hormonal medications are taken according to a specific schedule. Attempts to independently eliminate lumps and pain, including using folk remedies, can cause great harm and lead to a worsening of the condition.

Home Remedies

A temporary analgesic effect can be achieved by lubricating the mammary gland with burdock oil, applying a cabbage leaf, a compress of grated raw beets, or burdock leaves, which have a resolving effect. An infusion prepared from dill seeds, chamomile flowers, valerian root, and mint leaves is used as an auxiliary home remedy for mastopathy. Take 10 g of all components and brew with a glass of boiling water. It is necessary to drink 1 glass of warm infusion every day in 3 doses. After a few days, swelling and inflammation in the chest disappear.

Mastopathy can be expressed in different forms. They are divided into groups according to the nature of the neoplasms, their composition, and the characteristics of their occurrence.

One of the common options is diffuse fibrous mastopathy, characterized by the formation of a large number of compactions of different sizes and shapes.

In the article we will talk about diffuse mastopathy with a predominance of the fibrous component, what it is and what treatment methods are available.

It is necessary to exclude fatty meats, hydrogenated fats, fried, canned, smoked foods, as well as drinks containing caffeine from the diet.

Preference is given to whole grain cereals, fish, poultry, dairy products, fruits and vegetables. Vitamin kits and herbal teas are useful. Quitting alcohol and smoking is mandatory.

Nicotine and tar negatively affect hormonal levels, inhibiting the function of progesterone and causing an increase in the number of fibroids.

Connection with oncology

Doctors note a connection between the formation of benign fibroids and the possibility of breast cancer.

Excess estrogen is an alarming symptom. Against this background, degeneration is possible in the tissues of any organs of the female reproductive system. Already existing fibroids do not degenerate, but malignant tumors may well form next to them.

The problem with the diffuse form is that there are a lot of neoplasms and not all can be detected during a superficial examination. Therefore, you should be especially attentive to your condition, do all the necessary tests and strictly follow the doctor’s instructions.

Diffuse fibrous mastopathy is a disease, the treatment of which can only be successful in the case of complex treatment and timely diagnosis. Therapy is carried out under the supervision of specialists; only in this case is a complete cure and no relapse possible.

You can find additional information on this topic in the section.