Mastopathy is a benign disease of the mammary glands. Form of non-proliferative FCM. Non-steroidal anti-inflammatory drugs

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What it is? Fibrocystic mastopathy (FCM or fibroadenomatosis) is a pathological process that develops in the structural tissues of the female breast in the form of a rapid cellular proliferation of glandular tissue, forming cystic neoplasms (fluid-filled cavities) or nodular.

Included in the register of benign pathologies. It does not present difficulties in treatment with early diagnosis, but in advanced cases it can be an intermediate stage in the development of a cancerous tumor.

The disease affects almost half of the female population aged 30, 50 years. It develops against the background of hormonal destabilization, provoked by an imbalance of hormones (the predominance of estrogen over insufficient progesterone synthesis), excessive hormonal activity, or its sharp decline or rise, often changing their cyclic level for one reason or another. In connection with this feature, the pathology is also called dishormonal hyperplasia.

• Almost a quarter increases the risk of breast cancer in patients with a history of large cystic formations, the development of hyperplasia, adenosis, or proliferative mastopathy.

Forms and types of fibrocystic mastopathy (signs)

The clinic of mammary gland lesions in fibrocystic mastopathy can manifest itself in various forms: diffuse, having several subspecies, nodular and non-proliferative.

Features of diffuse manifestation

Diffuse lesion in FCM is due to the development of a pathological process that covers the entire chest, manifesting itself as a rather strong growth of connective (supporting) tissue structures, forming destructive foci of various shapes.

As a result of this dysfunction, processes develop that disrupt the structure of the ducts in the mammary glands and destruction in the alveolar-lobular tissues, contributing to the formation of small cystic-cavitary formations.

The genesis of diffuse mastopathy of a fibrocystic nature is associated with a genetic predisposition, and the development of the process is triggered by many negative factors - external, the influence of neurohumoral disorders and an imbalance in hormone synthesis. According to the nature of the structural lesion, several types of this form are distinguished:

• In the form of sclerosing adenosis - with excessive growth of the glandular component in the tissue structures and the alveolar-lobular structure of the breast, manifesting itself as a significant increase.
• With the dominant growth of fibrous components in the connective tissue structure of the breast (fibroadenomatosis).
• Pathology caused by a single or total lesion of the mammary gland in the form of fibrocystic formations filled with a liquid substance. Manifested by multiple tumor-like neoplasms.
• Mixed type - simultaneous damage to connective tissue structures, ducts and lobular alveoli with cystic and fibrous neoplasms. At its core, it is a consequence of a running process. With such a manifestation of the symptoms of fibrocystic mastopathy, treatment is a complex and lengthy process.

The severity of such clinical disorders is defined as minor, moderate, or severe. It is manifested by unilateral localization and bilateral - both mammary glands are simultaneously affected.

The disease itself is benign, but in the stage of neglect, turning into nodular pathology, there is a high risk of atypical cell formations and oncological degeneration.

Signs of nodular FCM

As a rule, the development of nodular FCM is preceded by a neglected and complicated diffuse process, manifested by single or multiple dense nodular formations. Sometimes, nodular FCM is called focal.

On palpation, densely elastic formations with clear contours are found, they are slightly painful and are not soldered to adjacent tissues. Soreness and swelling are acquired during menstrual flow.

A characteristic feature is that in the supine position, seals are very rarely palpable, or not palpable at all.

Nodes along the periphery of the chest usually do not tend to increase. Pain may be mild or not present at all. Pathology is detected, usually during a random examination. And its manifestation can be purely individual.

Form of non-proliferative FCM

This term refers to the pathology of the mammary glands, which does not have characteristic signs of excessive growth of glandular tissue in the breast with the formation of neoplasms and signs of intense cellular mitosis.

At the same time, no neoplasms are noted, a significant or localized swelling of the chest is possible. Non-proliferative diffuse cystic mastopathy, with proper therapy, is successfully treated.

The main symptoms of fibrocystic mastopathy of the mammary gland are manifested by sore seals and clear discharge from the ducts of the gland. Palpation and palpation of the chest reveals compacted areas with small and large formations.

Pain syndrome- differs in individuality, in each case. Pain occurs spontaneously, or manifests itself in response to touch. Unusual discomfort can be replaced by sharp pain even with a slight touch to the chest. The pain symptom of fibrocystic mastopathy is manifested by varying intensity - it is dull, shooting and twitching, accompanied by burdening, puffiness and a feeling of pressure in the chest.

It is not uncommon for pain to spread to nearby lymph nodes, causing their enlargement and tension. They can be local and give to the axillary and shoulder-scapular zones.

Characterized by an increase in pain during the "lunar cycle", which is due to hormonal surges. This symptomatology of breast mastopathy is not typical for all patients. For some, pain does not appear at all, for others it is noted only during menstruation.

In the presence of characteristic general signs of FCM, this phenomenon is explained by the difference in compression of nerve endings or is due to individual pain sensitivity. With the progression of the disease, the signs of fibrocystic mastopathy of the mammary gland are manifested by more pronounced seals and palpable pain, regardless of the critical days.

Discharge from the milk ducts- is an individual symptom and is not observed in all patients. In some cases, they may not appear at all, in others they may be very abundant (which sometimes allows you to independently identify the disease), or stand out from the nipples, with slight squeezing.

• The allocated secret does not differ in a special manifestation of smell. The color scheme ranges from whitish to dark shades, rather reminiscent of the first discharge of colostrum after childbirth.

Threatening symptom- brown and bloody discharge. Such a sign is noted in the oncological process, which destroys the circulation in the small vessels of the chest, and damages the vascular walls of the milk ducts.

With any signs of uncharacteristic discharge from the glands of the breast, and especially with a bloody admixture, it is necessary to quickly undergo an examination and begin immediate treatment of fibrocystic mastopathy of the mammary glands.

Treatment of fibrocystic mastopathy, drugs

The basis of the treatment of fibrocystic breast mastopathy is the restoration of hormonal failure. Therapeutic methods are compiled on the basis of diagnostic examination results that reveal hormonal imbalance. In accordance with which, drugs are prescribed to correct the hormonal background.

The treatment process includes puncture aspiration biopsy of the cyst followed by sclerotherapy. This technique is applicable to cystic formations without signs of malignant transformation and without symptoms of tumor development inside the ducts.

With multiple cysts, excessive tissue growth and with signs of malignancy, the technique of sectoral resection is used with the obligatory histological examination of the excised specimens.

Operative methods of treatment of FCM are carried out on the basis of reasoned indicators:

• analysis confirming the malignancy of the tumor;
• progression of increases in formations for 3 months;
• repeated relapses of nodular pathology due to sclerotherapy or drug therapy of the disease;
• with a large increase in cysts and fibroadenomas.

Operational techniques

Surgical techniques consist of:

• The method of sectoral removal of formations with a small area of ​​adjacent tissues.
• Cystic enucleation - removal of a cystic neoplasm by husking.

The operation is performed using local or general anesthesia. The duration of the operation is a little over half an hour.

Conservative treatment of FCM

With tumors and nodes of small size, quite often, drug treatment with periodic monitoring by a specialist is enough. In the treatment of fibrocystic mastopathy, the action of the drugs is aimed at stopping the causative factor of the disease, stabilizing immunity and eliminating background diseases that caused an imbalance of hormones (diseases of the thyroid gland and appendages).

The composition of drug therapy includes:

• Appointments of hormone preparations - in the form of "Duphoston" or "Progesterone", or "Urozhestan", "Progestogel", "Livial" and "Tamoxifen".
• Estrogen-gesta of gene contraceptives - "Marvelon" or "Zhanina", eliminating hormonal imbalance.
• To eliminate excessive hormonal secretion - "Parlodel" class of inhibitors.
• NSAIDs of the group that reduce pain symptoms - "Nimik", "Diclofenac" or "Nise"
• Immunomodulatory, anti-inflammatory, decongestant and analgesic enzyme agents such as Wobenzyma, Mulsala, Lidazy.
• Iodine-containing drugs that regulate thyroid function and reduce proliferation - drugs "Klamina", Iodomarin, Iodine asset.
• Compresses "Dimexide", as an anti-inflammatory agent. With severe pain, a tablet of "Analgin" and "Demidrol" is added to the drug diluted with water.
• To accelerate tissue regeneration and normalize metabolic processes, it is recommended to rub the Lekar gel or Api Bust cream into the mammary gland.
• Tonic and sedative tinctures - eleutherococcus, ginseng root, valerian, motherwort herb, vitamin therapy.
• Potent phytopreparations - Fitolon, Klamina and Mastodinon, which enhance the effect of medications.

Women over 40 are prescribed steroid drugs - Methyltestosterone, Methylandrostenediol and injections of hormones (testosterone or progesterone). The effectiveness of all these means is due only to the complex impact.

Forecast Options

Favorable prognosis is ensured by correctly performed diagnostics and timeliness.

Only adequate therapy of an initially benign neoplasm can prevent the growth and transition of a pathological diffuse state to a nodal stage and a malignant tumor.

Diffuse fibrocystic mastopathy is a benign oncological process that affects the breast tissue. With the development of mastopathy, the ratio between the epithelial and interstitial components is disturbed, since there are phenomena of proliferation and regression.

The relevance of this disease is due to the fact that it should be considered as a background against which malignant processes can develop. The frequency of degeneration into a malignant form depends on the severity of the proliferative process in mastopathy. So, with a pronounced proliferation, the risk of developing breast cancer is 32%, and with a mild degree of proliferation - only 1%

What it is?

Fibrocystic mastopathy is a violation of the ratio of the connective and epithelial components of breast tissues, accompanied by changes of a proliferative and regressive nature.

It is customary to distinguish two forms of the disease:

1. nonproliferative form. With this form of the disease, cysts of different sizes form inside the chest: from a few millimeters to several centimeters. At the initial stage of the development of the disease, the formation of structures resembling bunches of grapes occurs. As the pathology progresses, the process of increased collagen production starts, which leads to compaction of the connective tissue, its growth and scar formation. As a result, the lobules that represent the mammary gland are stretched and cysts are formed inside them. The non-proliferative form of the disease does not give a high risk of malignancy of the pathological process. It is no more than 0.86%.
2. The proliferative form is characterized by the start of the proliferation process, that is, the growth of epithelial and connective tissue by dividing their cells. With moderate proliferation, the risk of degeneration of the pathological process into a malignant one is 2.34%. With a pronounced degree of proliferation, these values ​​increase to 31.4%.

If we turn to the statistics of the disease in general, then among women around the world there is a tendency for an increase in pathology. In reproductive age, the disease affects up to 40% of women on average. If there are multiple gynecological diseases in the anamnesis, then the risk of encountering mastopathy is from 70 to 98%.

The high-risk group includes women who suffer from hyperplastic pathologies of the genital organs. During menopause, diffuse fibrocystic mastopathy is less common. It affects up to 20% of women. After menopause occurs, new cystic formations most often do not appear. This statistical fact is also another proof of the direct involvement of hormones in the development of the disease.

Causes of mastopathy

The main cause of mastopathy is hormonal imbalance, which consists in increased production of the hormone estrogen.

Also, hormonal disorders can be triggered by the following factors:

1. Multiple abortions, the consequence of which is always a severe hormonal disruption of the entire endocrine system of the body;
2. Gynecological diseases, both inflammatory (endometritis, adnexitis) and tumors (uterine fibroids, ovarian cysts, endometriosis);
3. Absence of pregnancies before 30 years;
4. The likelihood of mastopathy increases in the presence of endocrine diseases (thyroid dysfunction, diabetes mellitus), as well as diseases of the liver and biliary tract (hepatitis, cholecystitis, etc.)
5. Not breastfeeding or breastfeeding too short (less than 6 months). If a woman breastfeeds a child for more than 6 months, this reduces the risk of developing mastopathy by 2 times.

Other contributing factors:

1. Injuries of the mammary glands (blows, strong squeezing);
2. Psycho-emotional factors (depression, neurosis, stress, chronic fatigue syndrome);
3. hereditary predisposition;
4. Bad habits (smoking, alcohol abuse, tanning fashion).

Clinically, there are two main forms of mastopathy: diffuse and nodular.

Symptoms

According to experts, the diffuse form of the disease is its initial stage. That is why the symptoms of the disease in some patients are sufficiently lubricated, as a result of which women may not pay due attention to their condition for a long time. However, without treatment, the disease progresses.

There are certain signs that make it possible to suspect diffuse fibrocystic mastopathy in a patient:

1. Swelling of the mammary glands and an increase in their volume.
2. Chest pain. It has a aching dull character and disappears after the onset of menstruation. Over time, pain sensations become more intense and prolonged, they can be localized not only in the chest, but also give to the arm, shoulder or armpit. In some patients, even a light touch on the affected gland can cause pain. With the further development of the disease, the pain becomes less significant.
3. Enlarged lymph nodes located in the armpits.
4. Loss of sleep, the appearance of a feeling of fear and anxiety.
5. The appearance of discharge from the nipples. They are very different: abundant or scarce, bloody or colorless.
6. Changes in the skin on the nipples: the occurrence of cracks, retraction of the nipple or skin.
7. The appearance in the tissues of formations. They can be either multiple (resembling a bunch of grapes) or single. Such formations do not have clear boundaries and can be found in different places of the mammary glands.

The degree of manifestation of symptoms of diffuse mastopathy depends on the phase of the menstrual cycle: they make themselves felt most strongly in the second half of the cycle, and after the onset of critical days, the symptoms smooth out. For many women in the later stages of the development of the disease, pain and induration remain regardless of the phase of the cycle.

Why is mastopathy dangerous?

Diffuse fibrocystic pathology (FCM) is a benign process characterized by abnormal development of breast tissue. Some types of cells actively multiply (that is, proliferation occurs), others regress - as a result, the ratio of the connective tissue component and the actual active secretory tissue changes.

Despite the declared good quality of fibrocystic changes, mastopathy is a beneficial background for the development of malignant oncological diseases, therefore it refers to precancerous conditions. With active proliferation of cells of the affected gland, the risk of cancer reaches 32%. With less activity of the pathological process, the risk decreases to 1%, but this indicator cannot be neglected.

The vast majority of cases of diagnosis of fibrocystic pathology falls on women of childbearing age, whose mammary glands are active. In the period of perimenopause, there are significantly fewer such pathologies. Women almost do not pay attention to the primary signs of the disease, since they are not expressed by serious pain sensations and are perceived as temporary discomfort. However, with age, the disease progresses and can lead to dangerous consequences.

Diagnostics

Given the technical capabilities of diagnostic medicine, it is not difficult to identify diffuse cystic mastopathy. Screening or preventive examinations must be mandatory for all middle-aged women. From the age of 35, an ultrasound of the breast is done once a year, from the age of 40, an X-ray mammography is prescribed once a year.

If a woman has signs of diffuse fibrocystic mastopathy, then the methods of diagnostic studies are prescribed by a doctor. Possible options:

1. Endocrinologist and oncologist consultation.
2. Collection of anamnesis ─ general data, complaints, family history.
3. Examination of the chest, palpation.
4. Examination for gynecological diseases, taking smears.
5. Ductography is an x-ray examination of the milk ducts using the introduction of a contrast agent.
6. Ultrasound examination, in which benign and malignant formations are evaluated with high accuracy.
7. A biopsy of a seal or cyst is a histological examination of the tissues of the formation.
8. X-ray mammography is a study with a low radiation dose and minimal burden on the body.
9. MRI (magnetic resonance imaging) with contrast.
10. Blood tests for hormones: TSH, fT4, LH, FSH, prolactin, estradiol, progesterone.
11. Ultrasound of the thyroid gland and adrenal glands.
12. Microscopic examination of the detachable nipple

There is no degeneration of diffuse fibrocystic mastopathy into cancer. The danger lies in the fact that the disease prevents timely recognition of the presence of a malignant process in the breast.

Treatment

The chosen method of treatment of fibrocystic mastopathy depends on the stage of the disease. Basically, it is complex, that is, it is accompanied by taking medications, eliminating diseases that have become the precursors of this disease, as well as dieting and using folk remedies.

Treatment of diffuse fibrocystic mastopathy of the mammary glands is carried out with the help of non-hormonal medications.

Among them are the following:

• FCM treatment does not work without taking vitamin-containing drugs. In this case, you will need to take vitamins for a fairly long period of time. Particular attention is paid to vitamins of groups A, B, E and C.
• Preparations that contain a lot of iodine in their composition. Such are "Iodine-active", "Jodomarin", "Klamin". They help to restore the normal functioning of the thyroid gland. However, it is strictly forbidden to assign them to yourself.
• With a strong pain syndrome in case of breast disease, treatment is carried out using painkillers. For example, Diclofenac.
• Homeopathic remedies will help reduce the production of prolactin. Positive reviews have "Mastodinon", "Remens", "Cyclodinon". For the desired effect, it is necessary to take medicines for at least six months.
• To reduce nervous tension, the patient may need sedatives and sedatives. Tinctures based on motherwort, valerian and other medicinal plants help very well.

Diffuse fibrous disease of the mammary glands should include treatment that will be aimed at restoring the work of the hypothalamus-pituitary gland-ovaries. Most often, it is recommended to use hormonal agents for this. These include the following:

• Oral contraceptives Marvelon and Janine. The peculiarity of their reception lies in the strict observance of the instructions.
• Medications based on gestagens. These include Utrozhestan, Dufaston, Norethisteron. It is best to take them at the time of the second phase of the menstrual cycle. Otherwise, the effect will not be as strong.
• Women over the age of 45 should take androgens. These drugs include "Methyltestosterone", "Fareston" and "Tamoxifen". The duration of the course of treatment is set individually depending on each case of the disease.
• In advanced cases of the disease, it is advisable to use inhibitors for treatment that stimulate the production of prolactin. This is Parlodel.

It is advisable to carry out therapy for fibrocystic mastopathy only after a thorough medical examination, which will establish a variety of forms of breast disease. When diagnosing a cystic variety of the disease, it will be necessary to puncture and cytological examination of breast tissues. In the case of establishing the presence of a tumor of a benign nature, it may be quite enough to carry out surgical intervention.

Treatment with folk remedies

Mastopathy is a disease known since ancient times, so there are a lot of folk recipes. But it is important to remember that in this way only the disease is cured in the early stages of its development and taking into account the recommendations of the doctor.

Tinctures. Prepared using herbs that are infused with alcohol. You can cook them yourself or buy ready-made in a pharmacy:

• alcohol tincture of boron uterus;
• pine nut shell tincture;
• propolis tincture.

Decoctions. They help to normalize the hormonal background, cope with tumors and get rid of associated inflammatory diseases that occur in the body. Herbs insist in boiling water and take orally. For the treatment of diffuse fibrocystic mastopathy, it is recommended to drink herbal decoctions:

• burdock root;
• boron uterus;
• red brush to regulate the functioning of the thyroid gland;
• yarrow;
• chaga.

Lotions and compresses. Herbal compresses should be applied all night to the chest for several weeks to achieve the result:

• a compress of burdock leaves;
• cabbage compress with honey;
• rye flour cake;
• pumpkin compress;
• a compress of grated beets with honey.

The use of folk methods for the treatment of fibrocystic mastopathy should also take place under the supervision of the attending physician. Phytotherapy implies the possibility of preparing decoctions from several herbs at once or using ready-made preparations that can be purchased at a pharmacy.

Diet

The therapeutic diet should contain products to stabilize the hormonal background. Food should be rich in fiber (greens, cereals).

It is important to take natural estrogen (legumes, cabbage of all varieties). Vitamin therapy strengthens the immune system and gives the body strength (citrus fruits, raw vegetables and fruits). Natural iodine is a cure for mastopathy. The use of fish, seafood, liver and sour milk will replenish the body with phospholipids. It is necessary to consume 2 liters of plain water, this will help the fastest recovery of metabolic processes.

Most often, to cure any ailment, it helps to abandon the usual wrong lifestyle. Fibrocystic mastopathy is easier to prevent, and this requires a timely visit to the doctor. At the initial stage of the disease, it is easier to defeat the disease.

Prevention and possible complications

Compliance with preventive measures reduces the risk of the disease and contributes to a speedy recovery if it is present. These include: giving up bad habits, avoiding stressful situations, choosing the right underwear, maintaining a mobile lifestyle, reducing salt intake, timely treatment of diseases of the pelvic organs.

Competent selection of hormonal contraceptives and regular visits to the oncologist and mammologist (at least 1 time per year) are important. Breastfeeding a child for more than 6 months reduces the risk of developing cancer by 2 times.

All women, including healthy ones, need to learn how to independently check the mammary glands. This advice is especially relevant in the periclimacteral period (after the age of 45). This is done by visually examining the chest in the mirror and feeling it in the prone and standing position. If any abnormal compaction is detected, a doctor should be consulted.

Despite the benign course, fibrocystic changes are a favorable background for the development of malignant diseases. With active proliferation (growth) of affected cells, the risk of cancer is 32%. With less activity of the pathological process, the risk decreases to 1%.

Mastopathy of the mammary glands cannot be eliminated on its own and almost always needs treatment. According to various statistics, in recent years, from 50 to 90% of women suffer from this disease, and the main danger of this breast disease lies in the ability of neoplasms to degenerate into a cancerous tumor. That is why any forms of this pathology are considered by mammologists as a precancerous condition and need constant monitoring and treatment. In this article, we will introduce you to the principles of treatment of mastopathy of the mammary glands. Once you have this information, you can ask your doctor if you have any questions.

The risk of tumor malignancy increases with the appearance of cystic formations. Of no small importance in tissue malignancy is the degree of growth (proliferation) of the epithelium of the mammary glands and the appearance of signs of calcification of neoplasms.

There is no single scheme for the treatment of mastopathy, its tactics depend on many factors:

• woman's age;
• form of mastopathy;
• character ;
• the presence of concomitant diseases: gynecological, endocrine, extragenital;
• the desire to preserve reproductive function or achieve a contraceptive effect.

In some cases, in women of reproductive age, according to the ANDI classification, some fibrocystic changes in the mammary glands may be normal. But in the presence of a significant deterioration in the quality of life, the presence of severe complaints and a high risk of malignancy (for example, in history), the approach to monitoring and treating such patients should be more thoughtful and comprehensive.

If mastopathy is detected in women by chance, as a concomitant pathology, and is not accompanied by complaints, then treatment is usually not prescribed. Such patients are recommended regular breast ultrasound or mammography (sometimes diagnostic puncture) at least once a year and observation by a mammologist.

If mastopathy is moderately cyclic or permanent and fibrocystic changes (without obvious microcysts) in the mammary glands are diffuse, then conservative therapy can begin with the correction of physiological cycles and the appointment of a diet. As a rule, this approach is allowed in the treatment of young and healthy women.

Patients with severe mastopathy, accompanied by persistent or cyclic pain, the presence of palpable changes in the structure of the gland or discharge from the nipples, treatment is always prescribed. With a diffuse form of this disease, a woman is recommended conservative therapy. The tactics of prescribing certain drugs in such cases depends on the data of a comprehensive examination of the patient. And if fibrocystic forms of mastopathy are detected, a woman can also be prescribed conservative treatment, but in some cases a surgical operation is necessary.

Conservative therapy

Non-hormonal agents

Diet

Many clinical studies on the treatment of mastopathy indicate the fact that there is a close relationship between the appearance of structural changes in the tissues of the mammary gland and the consumption of products containing methylxanthines (theophylline, caffeine and theobromine). That is why the rejection of products with a high level of methylxanthines (coffee, cocoa, chocolate, tea, cola) can significantly reduce the swelling and soreness of the mammary glands. Many experts always recommend such a diet correction in the treatment of any form of mastopathy.

Nutrition and this disease of the mammary glands has another relationship. Eating, which contributes to the development of chronic constipation and disruption of the intestinal microflora, also contributes to the development of mastopathy and. It is likely that this relationship is dictated by the reabsorption in the intestine of estrogens already excreted in the bile. That is why experts recommend that their patients introduce more fiber-containing foods into their daily diet and drink enough water (up to 2 liters per day).

Of no small importance for the normal functioning of the mammary glands is the state of the liver, since estrogen is utilized in this organ. That is why patients with mastopathy are advised to exclude from their diet any foods that adversely affect the functions of this organ. These include alcoholic beverages, fried and fatty foods, hepatotoxic substances. And to improve liver function, women are advised to additionally take B vitamins and dietary supplements based on them.

• fish (preferably sea);
• vegetable oils (linseed, olive, pumpkin, walnut);
• low-fat meats;
• dairy products: sour cream, cottage cheese, milk, cheeses, goat's milk;
• cereals: buckwheat, wheat, oatmeal, etc.;
• mushrooms;
• legumes;
• spinach;
• bell pepper;
• carrot;
• cabbage;
• beet;
• eggplant;
• zucchini;
• seaweed;
• nuts;
• fruits and berries.

• fatty meats;
• flour products;
• semolina;
• salty dishes;
• smoked meats;
• margarine;
• conservation;
• coffee;
• mayonnaise;
• ketchup;
• carbonated drinks;
• alcoholic drinks.

Choosing the right bra

Every woman should pay attention to the correct choice of a bra, especially for patients with mastopathy. Its wearing is recommended for all women with such a disease of the mammary glands.

The presence of a bra that does not fit or has an irregular shape leads to deformation of the breast and its compression. In addition, such a garment contributes to the overload of the ligamentous apparatus. This point is especially true for women with large and drooping breasts.

• the product must fully comply with the required size;
• preference should be given to natural or hygroscopic fabric;
• it is better to refuse the choice of models with a foam seal;
• the fabric should not shed;
• wear strapless products as little as possible;
• choose models with wide straps (especially with large breasts);
• after purchase, adjust the length of the straps;
• do not sleep in a bra;
• do not wear a bodice for more than 12 hours a day.

In some cases, choosing the right bra helps reduce or completely eliminate the symptoms of mastopathy.

Lifestyle change

Women suffering from mastopathy should make lifestyle changes:

• quitting smoking and drinking alcohol;
• balanced diet;
• sufficient motor activity;
• refusal to visit baths and saunas;
• exclusion of stress;
• rejection of natural and artificial tanning.

In addition, they are contraindicated in physiotherapy and massage.

vitamins

Reception of vitamin preparations for mastopathy:

• contributes to the normalization of metabolism and hormonal levels;
• has an antioxidant effect;
• strengthens the immune system;
• stabilizes the activity of the central nervous system;
• normalizes the functions of the thyroid gland, liver, ovaries and adrenal glands;
• normalizes reproduction and maturation of epithelial cells.

Diuretics

It is possible to weaken the manifestations of cyclic mastopathy that occurs with premenstrual syndrome and is accompanied by swelling of the feet and hands a few days before menstruation, using light diuretics. It is advisable to use diuretic medicinal herbs or preparations based on them for this. In addition, during this period, a woman needs to limit the amount of salt consumed.

Means to improve blood circulation

In patients with mastopathy, local changes in blood circulation in the mammary glands are often observed. They usually occur due to impaired venous outflow. To normalize it, many experts recommend that their patients take foods containing vitamin P (blackcurrant, citrus fruits, raspberries, cherries, rosehips, chokeberries), and preparations based on it (Ascorutin). Often, their use allows you to stabilize blood circulation, and with repeated thermographic studies, such violations are not detected.

Homeopathic preparations

To eliminate hyperprolactinemia, normalize the state of the ducts of the mammary glands and eliminate the pathological division of endometrial cells, women may be recommended to take drugs based on various medicinal plants (prune, cyclamen, tiger lily, iris and chilibukha). Mastodinone has become the most popular homeopathic remedy prescribed for mastopathy. In addition to it, the following tools can be recommended:

• Biocycline;
• Remens;
• Cyclodinone etc.

Non-steroidal anti-inflammatory drugs

In some cases, to reduce cyclic mastalgia, specialists prescribe non-steroidal anti-inflammatory drugs to their patients a few days before menstruation. For this can be used:

• Diclofenac;
• Nurofen;
• Nise and others.

However, such appointments cannot be long-term and permanent, and complex treatment of mastopathy is recommended to eliminate unpleasant symptoms.

Means for the normalization of the liver

Hepatoprotectors can be used to eliminate liver dysfunctions that affect the hormonal background and stabilize its functioning. A woman can be assigned:

• Essentiale;
• Legalon;
• Gepabene;
• Karsil and other drugs.

Adaptogens and iodine preparations

To normalize the functioning of the intestines, liver, thyroid gland and immune system in case of mastopathy, various iodine-containing drugs and adaptogens can be recommended:

• Klamin;
• Rhodiola extract;
• Eleutherococcus tincture;
• Iodomarin;
• Iodine active, etc.

Calming agents

In women, the state of the mammary glands is often influenced by the psycho-emotional background. Troubles in the family and at work, frequent depression, dissatisfaction with oneself - all these factors can contribute to increased pain. To eliminate them, experts often recommend that their patients take sedatives. Usually preference is given to the appointment of light drugs based on medicinal herbs:

• tincture of valerian, motherwort, peony;
• Persen;
• Alvogen Relax;
• Novo-passit;
• Sedariston;
• Dormiplant;
• Nervoflux and others.

Only if they are ineffective, stronger sedatives can be recommended to patients:

• Afobazole;
• Adaptol;
• Tenoten and others.

dietary supplements

To stabilize the menstrual cycle and hormonal levels, the normal functioning of the immune system, liver and intestines, various dietary supplements can be recommended:

• Indinol;
• Mastofit Evalar;
• Stella;
• Kelp;
• Diures;
• Garcizan;
• Lecithin Choline;
• Brest Care+;
• Biozyme;
• Indogreen;
• Citrus pectin, etc.

The choice of dietary supplements should be made only by a doctor, who is guided by data on the patient's health status obtained during the examination.

hormone therapy

The processes of development of mammary gland tissues, their differentiation, maturation and growth are fully coordinated by the interaction of the following hormones:

• estrogen;
• progesterone;
• prolactin;
• androgens;
• a growth hormone;
• thyroxine, etc.

Metabolism and the activity of the reticular formation and limbic system have a certain influence on these processes. Many facts indicate a significant influence of the hormonal background on the development of mastopathy:

• tissues of both glands undergo changes;
• the severity of symptoms depends on the phase of the menstrual cycle;
• pain decreases after menopause;
• mastopathy is often combined with other hormone-dependent diseases (, infertility);
• taking hormonal drugs affects the condition of the mammary glands.

Based on the above facts, the following hormonal agents can be used to treat mastopathy:

• antiestrogen;
• oral contraceptives;
• androgens;
• gestagens;
• prolactin inhibitors;
• LHRH (or analogues of gonadotropin-releasing factor).

Hormonal drugs can only be prescribed by a doctor who is guided by the results of the examination of the patient.

Antiestrogen drugs

Antiestrogens such as Tamoxifen and Fareston can be used to block estrogen receptors in breast tissue. With hyperestrogenism, these drugs do not allow estrogens to bind to receptors and reduce their effect on gland tissues.

Antiestrogens have been used to treat mastopathy since the 70s. First, Tamoxifen was used, which was effective in 65-75% of cases. 2-3 months after taking it, the patients showed a decrease in mastalgia (in 97% of cases), stabilization of the menstrual cycle and a significant decrease in blood loss during menstruation.

Sometimes at the beginning of the reception, patients noted an increase in sensations of breast swelling and pain, but over time, these adverse reactions decreased. In addition to these side effects, taking Tamoxifen can cause dizziness, nausea, increased sweating and hot flashes.

In a number of publications, data have appeared that this drug is capable of exerting a carcinogenic effect on endometrial tissues and leading to the development of its induced hyperplasia and cancer. That is why another antiestrogen drug, Fareston (ORION PHARMA INTERNATIONAL, Finland), was created. According to many experts, its active ingredient Toremifene is more effective and has fewer adverse reactions. The first therapeutic effects from taking this remedy appear within a month after the start of administration, and side effects are observed much less frequently.

Oral contraceptives

This group of hormonal agents is usually prescribed to women under 35 years of age. In addition to protecting against unwanted pregnancy, oral contraceptives contribute to the normalization of the menstrual cycle and reduce the manifestations of mastopathy already in the first 8 weeks after the start of administration. When properly prescribed, the drugs suppress ovulation, steroidogenesis, the synthesis of ovarian androgens and the synthesis of endometrial estrogen receptors. In some cases, with the wrong choice of an oral contraceptive in women, the signs of mastopathy increase, in such situations it is necessary to select another drug.

The following drugs can be used for treatment:

• Femodene;
• Marvelon (or Mercilon);
• Silest;
• Jeanine and others

When choosing an oral contraceptive, preference is given to means in which the content of estrogen is the lowest, and progestogen is higher. Drugs are prescribed for at least 3 months. For the treatment of mastopathy, the appointment of mini-pill oral contraceptives is not recommended, since the dose of hormones in them is extremely low to affect the disturbed hormonal background of a woman.

Gestagens

These drugs help suppress estrogen production and slow down the gonadotropic function of the pituitary gland. According to statistics, in 80% of cases they are effective in the treatment of mastopathy. The drugs are prescribed in courses with interruptions, the duration of which is determined by the doctor individually for each woman.

Previously, gestagens - testosterone derivatives - Danazol, Linestrinol and Norgestrel were used more often. However, now preference is usually given to derivatives of progesterone - medroxyprogesterone acetate. In addition, a topical progesterone-based drug such as Progestogel (gel) can be used to treat mastopathy. When using it, a woman does not have to experience the side effects that are observed when taking hormones orally.

Androgens

These drugs are estrogen antagonists and inhibit their activity. Usually, Danazol is prescribed for the treatment of mastopathy, which reduces the synthesis of gonadotropic hormone. As a rule, the therapeutic effect is observed in 2 out of 3 women - the structure of the breast becomes homogeneous, and the risk of cysts decreases.

When taking Danazol, the following side effects may occur:

• nervousness;
• weight gain;
• puffiness;
• sweating;
• vaginitis etc.

The doctor must warn the patient about their possible appearance. In addition, a woman should be made aware that the contraceptive effect of the drug is very low and unwanted pregnancy while taking it without additional methods of contraception can occur.

Prolactin inhibitors

Preparations of this group can be prescribed only with laboratory-proven prolactinemia. To obtain more accurate test results, it is recommended to administer a thyroid-stimulating hormone releasing factor (TRP test) before blood sampling.

With proven prolactinemia, patients with mastopathy may be prescribed such prolactin inhibitors:

• Bromocriptine;
• Parlodel.

After taking them, there is a decrease in the synthesis of prolactin, the balance between progesterone and estrogen normalizes, the menstrual cycle stabilizes, mastalgia and nodular formations in the tissues of the glands decrease.

Gonadotropin-releasing factor analogues (or LHRH)

Taking these drugs is usually recommended for severe mastopathy and the ineffectiveness of other hormonal agents. These drugs help lower estrogen and testosterone levels. However, LHRH preparations have a large number of side effects in the form of hot flashes, amenorrhea, dizziness and arterial hypertension. That is why their appointment should always be balanced and focused on a specific clinical situation.

Surgery

In recent years, most specialists have been wary of surgical methods for the treatment of mastopathy. Interventions do not completely eliminate the causes of the disease, and even after several operations, relapses are possible.

As a rule, surgical treatment of mastopathy can be recommended for some patients with a nodular form of this disease and a long absence of the expected effect from conservative therapy. In addition, the operation is indicated for accumulations of microcalcifications, intraductal papillomas, detection of epithelial growths during cytological analysis, and the presence of large cysts with hemorrhagic contents. Treatment of such patients should be carried out in an oncological hospital.

The extent of surgery may vary. A sectoral resection of the gland (i.e., removal of the affected area) is usually recommended. During the operation, an urgent histological examination of the removed tissues is performed, and if malignant cells are detected, the scope of intervention can be expanded.

With multiple cysts and nodes, intraductal papillomas, an extended resection of the gland is performed, and in some cases, its complete removal is performed. After such interventions, the patient may be recommended reconstructive plastic surgery - mammoplasty.

If solitary cysts are detected, the patient undergoes sclerotherapy of cysts.

After surgical treatment of mastopathy, dispensary observation is mandatory for all patients and a course of conservative therapy is prescribed, since the intervention allows you to eliminate only the foci of neoplasms, but not the cause of the disease. If atypical cells are detected during the histological analysis of the removed tissues, the patient is recommended a course of chemotherapy.

Can mastopathy be cured on its own?

Self-treatment of mastopathy is unacceptable, because it is impossible to identify the cause and form of the disease without a comprehensive examination and consultation with a mammologist. Many women try to treat this ailment on their own with the help of folk remedies, but such an attitude towards their health can cause the development of breast cancer, since mastopathy is considered by all experts as a precancerous disease.

Only long-term and complex treatment aimed at eliminating the causes of the disease will help get rid of mastopathy. In some cases, it can be supplemented with alternative methods, but their use should always be discussed with the doctor and combined with the main therapy.

Patients with mastopathy may be recommended sedatives, choleretic, diuretic and tonic herbal teas, which in some cases can be an alternative to pharmacological agents. Before using them, it is necessary to exclude all possible contraindications to their components.

Linseed oil

Flax contains substances that contribute to the normalization of hormonal levels, and Omega-3, which contribute to the activation of the body's anti-cancer defenses. Flaxseed oil can be administered in the form of capsules or in its pure form.

Infusion or decoction of cold Rhodiola (or red brush)

This medicinal plant has an anticarcinogenic effect and contributes to:

• normalization of estrogen and progesterone levels;
• restoration of the functions of the endocrine glands;
• elimination of inflammatory reactions in the mammary glands;
• strengthening immunity;
• removal of toxic substances from the body.

One or more courses of taking an infusion or decoction of the red brush helps to eliminate pain and swelling of the glands, stop discharge from the nipples and reduce the size of the nodes. In addition, taking this medicinal herb is recommended for concomitant diseases such as uterine fibroids, cervical erosion, inflammatory processes in the genitals and infertility.

Infusion of horse chestnut flowers

To eliminate inflammatory processes in the mammary glands and pain in mastopathy, it may be recommended to take an infusion of horse chestnut flowers. A teaspoon of vegetable raw materials is poured with a glass of boiling water and infused for half an hour. Strained infusion is taken in between meals 1/3 cup three times a day.

Compresses with cabbage leaves

Cabbage leaves can be used to reduce pain in mastopathy. They are superimposed on the chest in the evening or at night and are fixed with a bra. Instead of cabbage leaves, you can use burdock, and to enhance the effect, put a mixture of 3 parts of grated beets and 1 part of honey under the leaf.

Lotions with infusion of wormwood

You can eliminate mastalgia with the help of lotions from the infusion of wormwood. To do this, 5 tablespoons of vegetable raw materials are poured into 3 cups of boiling water and left to infuse overnight. After that, the infusion is filtered, a little warm water is added, a linen or cotton cloth is moistened in it and applied to the chest for 15 minutes three times a day.

Compresses of burdock leaves, honey and castor oil

Such compresses are prepared from crushed burdock leaves (100 g), two lemons, castor oil (100 g) and honey (100 g). The components are mixed, applied to a linen or cotton cloth and applied to the chest overnight.

Phytocollection of wormwood, nettle, sage and plantain

To prepare the collection, two parts of wormwood and one part of nettle, sage and plantain are taken. A tablespoon of the collection is poured into 220 ml of boiling water and left for an hour. The infusion is filtered and taken ½ cup 20 minutes after meals three times a day. The course of admission is 2 months. After 14 days, the course can be repeated.

Mastopathy refers to precancerous diseases and needs complex treatment from a specialist. The treatment plan may include non-hormonal and hormonal agents, the reception of which is aimed at eliminating the causes of the disease. In some cases, a woman may be recommended surgical treatment.

Which doctor to contact

If signs of mastopathy appear - periodic or constant swelling of the mammary glands, pain, discharge from the nipples, seals in the chest - you should definitely contact a mammologist. To draw up a plan for effective treatment of the patient, such diagnostic studies can be prescribed: ultrasound of the mammary glands, mammography, tests for hormone levels, biopsy with histological examination, etc.

Update: December 2018

It is known that most women suffer from this pathology, and the peak incidence is observed in childbearing age (about 30-45 years). Fibrocystic mastopathy is considered one of the most common diseases in women, and its frequency of occurrence is 30 - 40%, in the case of concomitant gynecological diseases in the fairer sex, this pathology reaches 58%.

Definition of the term

Fibrocystic mastopathy or fibrocystic disease is such a benign dyshormonal pathology of the mammary glands, in which both proliferative and regressive changes in their tissues are noted, as a result of which an abnormal ratio of epithelial and connective tissue components is formed.

The structure and regulation of the mammary glands

The mammary gland belongs to paired organs and is represented by three types of tissues. The main one is the parenchyma or glandular tissue, in which ducts of various diameters pass, the glandular tissue is divided into lobules and lobes (there are about 15-20 of them). The lobules and lobes are separated by stroma or connective tissue, which makes up the framework of the mammary gland. And the third type of tissue is adipose, it is into it that the lobules, lobes and stroma of the mammary gland are immersed. The percentage of parenchyma, stroma and adipose tissue is directly related to the physiological state (age) of the reproductive system.

During gestation, the mammary glands reach morphological maturity. Their size and mass increase, the number of lobules and ducts increases, and milk secretion begins in the alveoli (the morphomolecular unit of the mammary gland). After childbirth, due to the production of milk, the mammary glands increase even more (milky sinuses form in the ducts of the lobes, in which milk accumulates). And after the cessation of lactation, involution occurs in the mammary glands, and the stroma is replaced by adipose tissue. With age (after 40), the parenchyma is also replaced by adipose tissue.

Both growth and development of the mammary glands are regulated by numerous hormones. The main ones are , and . The role in the regulation of the development of the mammary glands and somatotropic hormone has also been proven. The parenchyma is subject to the main changes in the mammary glands under the action of hormones, and the stroma is subjected to hormonal effects to a lesser extent. The state of the mammary glands depends on the ratio of the content of these hormones. When the hormonal balance is disturbed, mastopathy of the mammary glands develops.

Forms of mastopathy

In modern medicine, there are a large number of classifications of this disease. The most convenient in clinical work is the following:

Diffuse mastopathy

Nodular mastopathy

• lipoma;
• fibroadenoma;
• breast cyst;
• lipogranuloma;
• intraductal papilloma (roughly speaking, a wart in the milk duct);
• hematoma of the mammary gland;
• angioma.

In the case of damage to both mammary glands, they speak of bilateral fibrocystic mastopathy, and with the development of a process in one gland, one-sided (for example, a cyst of the left mammary gland).

Depending on the severity of clinical manifestations, the disease can be mild, moderate and severe.

In addition, both diffuse and nodular mastopathy can be proliferating and non-proliferating forms. Prognostically unfavorable is fibrocystic mastopathy (FCM) of the first form. In this case, there is a proliferation of the epithelium of the lactiferous ducts, 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 the described changes are fraught with malignant transformations and dangerous occurrence.

A special form of the mammary gland is also distinguished at the end 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 soreness of the mammary gland (more than 15%).

The reasons

Etiological factors and the very mechanism of the development of the disease are due to hormonal imbalance. The leading role in the formation of mastopathy is given to conditions in which there is a deficiency of progesterone, impaired ovarian function and / or absolute or relative hyperestrogenism. This is due to the fact that estrogens promote the proliferation of the epithelium in the alveoli, lactiferous passages, increase the activity of fibroblasts, which causes proliferation and stroma. Also, in the mechanism of the formation of the disease, hyperprolactinemia and an excess of prostaglandins are also important (they call for mastodynia, and then mastopathy). For the development of hormonal imbalance, the action of provoking factors is necessary. But even with their existence, mastopathy does not develop immediately, since their long-term influence (several years) and the “layering” of one factor on another are needed. These provoking factors include:

• early menarche (early puberty, up to 12 years, leads to rapid hormonal changes, which also affects the state of the mammary glands);
• late menopause (cessation of menstruation after 55 years is also unfavorable for the mammary glands due to prolonged hormonal effects on their tissues);
• termination of pregnancy (a sharp hormonal decline after an abortion or miscarriage leads to hormonal disorders and the development of mastopathy);
• pregnancy and childbirth were absent altogether;
• a short lactation period or a categorical refusal to breastfeed;
• heredity (benign and malignant breast diseases in women on the maternal side);
• age (over 35);
• stress as a cause of endocrine pathology;
• bad habits;
• mammary gland injuries, chest compression with a tight and uncomfortable bra;
• inflammatory processes of the mammary glands;
• hormone-dependent gynecological diseases (cycle disorders, anovulation and fibroids, endometriosis);
• lack of iodine;
• pathology of the liver, thyroid gland;
• obesity (adipose tissue acts 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 hyperestrogenism);
• irregular sex life or dissatisfaction in sex, which contributes to stagnation of blood in the pelvic organs and, as a result, causes ovarian dysfunction and hormonal imbalance.

Symptoms

With mastopathy, the symptoms and their severity depend not only on the form of the disease, but also on the emotional state and character of the woman and on the existing comorbidities. In the clinic of mastopathy, the following symptoms predominate:

• Mastodynia or breast tenderness

The pain syndrome can be of a different nature and intensity. In the initial stage of the disease, chest pains appear on the eve of menstruation, which many women regard as premenstrual syndrome. The pain may be dull, aching, or so sharp that it is impossible to touch the chest. The pain syndrome is caused by stagnation of blood in the veins and swelling of the tissues and is described by patients as breast engorgement. Women also note an increase in the volume of the mammary glands (edema). After menstruation, the pain disappears, but as the pathology progresses, the pain becomes constant, only its intensity changes depending on the phase of the cycle. Severe pain has a negative impact on the psycho-emotional state of a woman. In addition to sleep disturbance, mental lability is noted, irritability, aggressiveness and tearfulness appear.

• Discharge from the nipples and the presence of seals / formations in the breast

Discharge from the nipples is a characteristic, but not an obligatory symptom of mastopathy. The severity and color of the discharge also varies. The discharge can be insignificant and appear only when the nipple is squeezed or occurs on its own, as evidenced by spots on the underwear. The color of the discharge may be whitish or transparent, or greenish, which indicates the addition of a secondary infection. The appearance of discharge from the chest indicates the involvement of the milk ducts in the process. A prognostically unfavorable sign is the appearance of brown or bloody discharge, which is inherent in malignant tumors.

Diffuse mastopathy

It is more often diagnosed in young women, while palpation determines enlarged and painful mammary glands with coarse heaviness and pronounced lobulation, as well as fine granularity.

Nodular mastopathy

Nodular - is the next stage in the development of the disease, which occurs in the absence of treatment for the diffuse form of pathology. Palpation of the mammary glands allows you to feel with your fingers a separate or separate areas of compaction or cysts. Foci of compaction are palpated 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 a breast cyst, elastic formations are palpated, round or oval with obvious boundaries that are not connected with the surrounding tissues.

Diagnostics

Diagnosis of the disease begins with the collection of anamnesis and complaints. After the survey, the patient doctor examines and palpates the mammary glands. On examination, the contours of the breast, the presence / absence of asymmetry of the mammary glands, skin tone and venous pattern, the position of the nipples and whether they are deformed are specified.

Next, palpation of the mammary glands is carried out (mandatory in the first phase of the cycle) in two positions: standing and lying down, since some formations may not be palpable in one position. In addition, the doctor squeezes the nipples and determines the presence / absence of discharge from them, and also palpates regional lymph nodes (axillary, sub- and supraclavicular).

Instrumental methods for diagnosing mastopathy include:

• Mammography

The essence of this method lies in the X-ray examination of the chest. Mammography is indicated for women at significant risk for breast cancer, as well as for all women 35 years of age and older when undergoing medical examinations. inspection. An x-ray of the mammary glands is performed in the first half of the cycle (7-10 days) and always in 2 projections (direct and lateral). The advantages of mammography include high information content (up to 97%), the ability to detect non-palpable formations.

• Ultrasound of the mammary glands

This examination is indicated for women under 35 years of age, as well as for pregnant and lactating women. The 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, and the possibility of examining regional lymph nodes. Among the shortcomings of the method: it is impossible to examine the mammary gland as a whole, but only a “cut”, low information content in case of fatty degeneration of the breast, subjective assessment of the images (depending on the qualifications and experience of the doctor).

• Needle biopsy

If a suspicious area (seal or cavity formation) is detected, a fine-needle puncture of the pathological focus is performed, followed by a histological examination of the contents.

• Study of hormonal status

First of all, the level of estrogen and progesterone is determined, if hyperprolactinemia is suspected, the level of prolactin, and if necessary, adrenal and thyroid hormones are examined.

• Ultrasound of the pelvic organs

It is carried out to exclude diseases of the ovaries and uterus.

• Blood chemistry

Liver enzymes, blood sugar and other indicators are examined to exclude concomitant extragenital diseases.

In addition, of the additional methods for examining the mammary glands, ductography (examination of the milk ducts), pneumocystography (examination of abdominal formation), laser and digital mammography, thermography, and magnetic resonance imaging are used (if necessary).

Treatment

If mastopathy is detected, treatment should be carried out without fail and its tactics depend on a number of factors: the age of the patient, the form of the disease, the presence of concomitant pathology, interest in pregnancy or contraception. Fibrocystic mastopathy involves treatment both conservatively and surgically.

Conservative treatment patients are subjected only to a diagnosed form of diffuse mastopathy, and after consultation with a mammologist-oncologist. Conservative therapy is carried out with non-hormonal and hormonal drugs.

Non-hormonal treatments

• vitamins

Vitamin A is prescribed, which has an antiestrogenic effect, vitamin E, which enhances the action of progesterone, vitamin B6, reduces the content of prolactin, vitamins PP, P and ascorbic acid, which strengthen the vascular wall, normalize microcirculation and reduce swelling of the mammary glands. In addition, all of the listed vitamin preparations improve liver function, where estrogens are inactivated and, in general, have a beneficial effect on mammary gland tissues.

• Iodine preparations

Iodomarin, iodine-active are used, which normalize the functioning of the thyroid gland and participate in the formation of its hormones (see).

• Sedatives and biostimulants (adaptogens)

Purpose (motherwort, valerian, peony tincture) normalize the patient's psycho-emotional state, improve sleep and increase resistance to stress. Adaptogens (eleutherococcus, radiola rosea) stimulate the immune system, normalize metabolic processes in the body, improve the functioning of the liver and brain.

• Phytopreparations

Mastodinone, cyclodinone or remens are used, which have a beneficial effect on hormonal balance, eliminate pathological processes in the mammary glands, and reduce the concentration of prolactin.

The appointment of drugs such as indomethacin, nise, or not only reduce the pain syndrome by suppressing the synthesis of prostaglandins - "causative agents" of pain, but also relieve swelling and engorgement of the mammary glands.

• Diuretic

Diuretic drugs (lasix or: lingonberry leaf, kidney tea,) help to subside swelling in the mammary glands and reduce pain.

hormone therapy

This is the main link of conservative treatment, it consists in prescribing the following groups of drugs:

• Gestagens

Taking utrozhestan, dufaston, norkolut, pregnin and other drugs in the second phase of the cycle reduces the synthesis of estrogen and normalizes the level of progesterone, which favorably affects the course of mastopathy. The duration of taking progestogens is at least 4 months. It is also possible to use local progestogens (progestogel) - applying the gel to the surface of the mammary glands twice a day for at least 3-4 months, which contributes to the absorption of 90% of progesterone by the mammary gland tissues and eliminates side effects.

• Prolactin production inhibitors

Parlodel suppresses the secretion of prolactin and is prescribed for hyperprolactinemia.

• Androgens

Treatment with androgens (methyltestosterone, danazol, testobromlecid) is carried out for women after 45 years for 4-6 months continuously. Androgens inhibit the release of FSH and LH by the pituitary gland, suppress their action on the ovaries and inhibit the production of hormones by the ovaries.

• Antiestrogens

Tamoxifen and other drugs in this group are taken continuously for 3 months.

• Combined oral contraceptives

Taking Marvelon, Rigevidon and other contraceptives is indicated for patients under 35 years of age with anovulation and violation of the second phase of the cycle.

Surgery indicated in the detection of nodular mastopathy (fibroadenomas or cysts) and consists either in sectoral resection of the mammary gland (removal of the pathological focus along with the breast sector) or in enucleation (husking) of the tumor / cyst. The indications for surgery are: suspicion of cancer according to the histological examination of the punctate, rapid growth of fibroadenoma, recurrence of the cyst after a previous puncture.

Question answer

Is pregnancy allowed with mastopathy?

Pregnancy has a positive effect on the course of mastopathy, since the change (increased secretion of progesterone) during gestation not only stops the disease, but contributes to a complete cure.

Is it possible to breastfeed with mastopathy?

Not only possible, but necessary. Lactation is the prevention of breast diseases, and in the case of mastopathy, it contributes to the normalization of processes in the tissues of the mammary glands (the growth of the epithelium of the glandular tissue increases, which suppresses the reproduction of cells of the pathological formation).

Is it possible to use alternative treatment for mastopathy?

Yes, it is possible to use alternative treatment methods for this disease, but only when combined with drug treatment and after consulting a doctor.

What methods of alternative treatment are used for mastopathy?

One of the effective ways of folk therapy is the use of fresh cabbage. You can attach a fresh cabbage leaf with cut veins to your chest at night, wrapping it in a towel, or you can twist the cabbage and pumpkin (1: 1) through a meat grinder, evenly distribute the resulting mass over the mammary glands, wrap with polyethylene, and then with gauze and leave the compress for 2 hours . Such treatment relieves pain and inflammation, reduces swelling in the mammary glands and is carried out in courses of 7 to 14 days.

Why is mastopathy dangerous?

Complications of mastopathy include recurrence of the disease after drug treatment, which is possible with undiagnosed hormonal disorders, suppuration and rupture of the breast cyst and the degeneration of fibroadenoma into cancer (less than 1% with a non-proliferating form and reaches 32% with severe fibroadenoma proliferation). Therefore, nodular mastopathy must be treated without fail by surgery, without delay.

Is it possible to sunbathe with mastopathy?

Sunbathing, as well as other thermal procedures (visiting a bath or sauna) with this disease is prohibited. It should be remembered that with any form of mastopathy, a woman is at high risk for breast cancer, and insolation and any other type of "heating" of the breast contributes to the transition of diffuse mastopathy to nodular or malignancy of a benign breast tumor.

Is it necessary to follow a diet?

Yes, with mastopathy, one should adhere to the principles of therapeutic nutrition, which excludes the intake of chocolate, coffee, tea and cocoa due to the high content of methylxanthines in them, which not only increase 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, which improves bowel function), grains and bran products, dairy and seafood (sources of calcium and iodine), vegetable oils (vitamin E).

How to prevent disease?

To prevent the development of mastopathy, it is necessary to adhere to several principles:

• to refuse from bad habits;
• wearing comfortable underwear;
• refusal of abortions;
• avoid stress (if possible);
• adhere to the principles of breastfeeding;
• regularly carried out and checked by a doctor;
• avoid chest injury;
• adhere to a regular sexual life.

A common and dangerous disease of women is a malignant tumor. Its prevention is carried out in two directions:

• early diagnosis of malignancy;
• detection and treatment of precancerous diseases.

The most common precancerous diseases of the mammary glands are its dysplasia, in particular, mastopathy. In modern literature, you can find another term - "fibrocystic disease".

Why does the disease occur

Fibrocystic mastopathy - what is it? This is a set of processes of proliferation (reproduction, distribution) and regression of various tissues of the gland. This changes the balance between the epithelium, which forms the ducts and lobules, and the connective tissue, which forms the walls of the lobules and forms layers, partitions that support the shape of the gland.

As a result, fibrous, cystic, proliferative forms are formed. Fibrous are characterized by excessive formation of connective tissue strands, cystic - by the formation of cavities (cysts) in the gland tissue. Often these processes coexist.

Proliferation is the ability of cells to reproduce. Mastopathy with low proliferative ability rarely transforms into a malignant neoplasm, in about 9 patients out of 1000. If the tendency to proliferation is moderate, the risk of malignancy increases to 2%. The most dangerous form in this regard is mastopathy with a pronounced proliferation, it degenerates into cancer in a third of patients.

Microscopic analysis of the material of the gland found that cancer is combined with mastopathy in half of the cases.

The cause of mastopathy is a violation of the balance of hormonal regulators in a woman's body. The mammary gland develops and functions under the influence of a complex of hormones, which include:

• releasing factors secreted by the hypothalamus and activating the pituitary gland;
• gonadotropic hormones produced by the pituitary gland and affecting the sex and mammary glands (follicle-stimulating and luteinizing);
• prolactin (especially active during breastfeeding);
• chorionic gonadotropin (affects the mammary glands during pregnancy);
• thyroid-stimulating hormone secreted by the pituitary gland;
• androgens, estrogens, progesterone;
• glucocorticosteroids;
• insulin.

If any of the listed factors deviates from the norm, conditions are created for the development of fibrocystic and other forms of mastopathy. Such deviations can have a wide variety of causes, from genetic mutations to drug influences. Thus, mastopathy can develop under the influence of a variety of influences that cause hormonal imbalance in the body. However, the predominant disorder that can cause the development of the disease is a change in the ratio of estrogens and progesterone.

Of all the types of estrogens, estradiol has the strongest effect on the mammary gland. Its content in the tissues of the body is several times higher than in the blood. Effects of estradiol:

• stimulates the reproduction and maturation of epithelial cells lining the ducts;
• causes the formation of the lobules themselves;
• develops a vascular network in the tissues of the gland, increasing blood supply;
• increases the water content in connective tissue.

• inhibits the division of epithelial cells;
• reduces the permeability of small vessels - capillaries, preventing swelling of the connective tissue.

The lack of progesterone is accompanied by edema and an increase in the size of the connective tissue in the lobules. An increase in the content of estradiol causes an increase in the division of epithelial cells, which leads to the formation of cysts.

An additional pathogenetic mechanism is hyperprolactinemia. It causes engorgement of the glands in the second phase of the cycle.

The main causes of hormonal imbalance:

• stress, dissatisfaction with family life, conflicts at work and at home;
• reproductive factors - the number of pregnancies, childbirth, miscarriages, duration of lactation and others;
• inflammatory diseases of the female reproductive system;
• disruption of the endocrine glands, for example, the thyroid;
• pathology of the liver and gallbladder;
• hereditary predisposition.

Clinical picture

The disease can take the following forms:

• diffuse;
• diffuse-nodular;
• fibrocystic;
• nodal.

They can be stages of the process, replacing one another.

Diffuse fibrocystic mastopathy predominantly affects adolescents and young women. It is accompanied by minor clinical manifestations. Most often, patients complain of a slight pain in the upper outer quadrant of the gland.

In middle age, small cystic cavities predominate with a predominance of glandular structures. The signs of the disease are characterized by severe pain, aggravated in the second half of the cycle, an increase in the gland at this time.

Nodular fibrocystic mastopathy and large single cysts are more often observed in women of middle and older age.

Diagnosis of pathology

Diagnosis of fibrocystic mastopathy is based on examination, careful palpation of the glands, these additional methods. An ultrasound examination (ultrasound) of the glands or is performed. If seals or cystic formations are detected, a cyst or node puncture is prescribed, followed by a histological analysis of the resulting contents. It is studied especially carefully to exclude cancer of the gland.

Palpation of the mammary glands is most informative after the completion of menstruation. The study in the second phase of the cycle may be uninformative due to physiological changes in the mammary glands.

Initially, complaints are collected, the anamnesis and symptoms of fibrocystic mastopathy are specified.

The patient should undress from the top to the waist and turn towards the lamp. A mammologist examines the glands, evaluates their symmetry, skin changes and other signs. The patient is asked to raise her hands, a thorough examination is carried out again.

The glands are palpated with the patient standing and lying down. At the same time, axillary lymph nodes are evaluated, as well as their groups located above and below the collarbones.

If pathological changes are detected, an additional study is prescribed. Women under 40 usually have an ultrasound scan. After the age of 40, a woman should have an annual mammogram to screen for changes. The same X-ray method is also used to diagnose mastopathy at this age.

Mammography is a study using X-rays, carried out without contrast enhancement in frontal and lateral projections. This is a common method in the diagnosis of fibrocystic mastopathy. For example, mammography can detect a tumor up to 1 cm in size, which is not yet palpable on palpation. Mammography is contraindicated during pregnancy and breastfeeding. In young women, due to the high density of the tissue of the glands, it is of little information.

Ultrasound of the mammary glands is a safe method, it does not carry radiation exposure. The study can be repeated several times. Ultrasound is more informative than mammography in young women under 35, and it also better detects cystic formations, including small ones. Ultrasound helps to evaluate the inner lining of the cyst and distinguish it from the gland - fibroadenoma. The method has proven itself well for diffuse changes in the glands. However, it is less informative for fatty degeneration of tissues that occurs in women older than 40-45 years.

If a suspicious formation is detected during mammography or ultrasound, it is punctured with a special needle under ultrasound control. The biopsy is examined under a microscope. If cells with signs of dysplasia or aplasia (precancer or cancer) are found in it, the woman is prescribed surgical treatment.

Treatment of fibrocystic mastopathy

Diet

The diet for fibrocystic mastopathy excludes foods rich in methylxanthines. These substances are found in large quantities in tea, coffee, cola, chocolate. They stimulate the formation of fibrous (fibrous) tissue and increase the accumulation of fluid in cystic cavities. Cessation of these foods in many patients results in a reduction in pain and breast engorgement. However, sensitivity to methylxanthines is individually variable; in some patients, psychological stress or physical activity is much more important.

Dishormonal diseases of the mammary glands, including mastopathy and cancer, occur against the background of sluggish bowel function, accompanied by intestinal dysbiosis. Therefore, patients must include vegetable fiber in their diet to stimulate peristalsis, as well as fermented milk products to restore microflora.

It is important to consume at least 1.5 liters of fluid per day. It also helps to restore bowel function and remove excess estrogen from the body.

The destruction of estrogen occurs in the liver. Patients with mastopathy should avoid any damaging effects on this organ, especially alcohol, excessively fatty and fried foods.

Choice of underwear

In addition to dietary nutrition, the right choice of a bra improves the well-being of patients: dense, but not squeezing, well supporting the chest, with wide straps. Free sagging of the gland increases pain and may contribute to the progress of the disease.

Surgical intervention

Treatment of fibrocystic mastopathy is determined by the form of the disease.

Women with nodular forms are observed and treated by oncologists. Nodular forms, especially with proliferation, immediately undergo surgical treatment. A sectoral resection of the gland is performed - the removal of part of its tissue in the form of a sector from the center to the periphery. The removed area is urgently examined, and if cancer cells are detected, the volume of the operation is increased, that is, the entire mammary gland is removed. To eliminate the cause of the disease, even after surgery, long-term drug treatment is carried out.

If a gland cyst is found, it is punctured (puncture) and the contents are removed, which is sent for histological examination. In the event that the doctor has a modern ultrasound scanner at his disposal, which allows him to assess the internal lining of the cyst, pneumocystography is not performed. If this is not possible, air is injected through the needle, the cyst cavity expands, and the surface can be assessed on a pneumocystogram (X-ray). If the cyst wall is smooth, there are no growths in it, conservative treatment is carried out for 6 months, and then the examination of the patient is repeated.

If after six months the walls of the cyst have fallen asleep, the cavity is obliterated (closed), continue to prescribe medications. If the cavity is filled with fluid again, a sectoral resection of the organ is performed with an urgent histological analysis.

If pathological outgrowths or an uneven inner surface are visible on the primary pneumocystogram or ultrasound after removal of the contents of the cyst, then they do not wait six months, but immediately perform an operation followed by drug treatment.

With multiple cysts, the scope of the operation can expand to a subcutaneous mastectomy. Often, after such an operation, a woman is placed in the breast with an implant that maintains the shape of the gland.

How to treat fibrocystic mastopathy conservatively?

The main goal of such treatment is the normalization of hormonal status. First of all, they treat inflammatory processes in the reproductive system, diseases of the liver and biliary tract, as well as correction of the thyroid gland.

Social, psycho-emotional factors are of great importance in the development of fibrocystic mastopathy. Therefore, it is necessary to direct efforts to normalize the work of the nervous system. The appointment of sedatives for a long period (Persen, valerian, motherwort, daytime tranquilizers), as well as vitamins A, B, E, C, P, nicotinic acid is shown. Vitamin A acts as an estrogen antagonist, reducing cell proliferation. Vitamin E enhances the effect of progesterone. B6 reduces the concentration of prolactin, P and C suppress swelling and improve microcirculation.

At the same time, stimulants are prescribed: Rhodiola rosea, Eleutherococcus, lemongrass. Sedatives, vitamins and stimulants are taken in a course of 4 months, then a two-month break is made, after which the course is repeated. The total duration of such therapy is at least 2 years.

In patients with a normally functioning thyroid gland, it is possible to use microdoses of iodine (Jodomarin), since this microelement normalizes the synthesis of female sex hormones. In case of liver diseases, hepatoprotectors are prescribed (Hofitol, Essentiale). These drugs have antioxidant activity, restore liver cells, improve fat metabolism, and also have a positive effect on the mood of patients.

In the second half of the cycle, before the onset of menstruation, many patients experience soreness and engorgement of the mammary glands. This sign is associated with a deficiency of progesterone or an excess of prolactin in the gland tissue, which cause swelling of the connective tissue. To combat edema and prevent it, a week before the expected onset of menstruation, you can start taking a decoction of lingonberry leaves, bearberry leaves, kidney collection, or medicines prescribed by a doctor - Furosemide, Hydrochlorothiazide or Triampur. Diuretics should be taken before the onset of menstruation.

Since the basis of fibrocystic mastopathy is an imbalance of hormones with a deficiency of progesterone, hormone therapy is recommended. In many cases, systemic use of hormones is contraindicated. Then the topical Progestogel will come to the rescue. This medicine is made in France, comes in the form of a gel and contains progesterone.

The advantage of the drug is its accumulation in the tissues of the gland. Less than 10% of the drug enters the systemic circulation. This does not affect the concentration of progesterone in the blood, so the drug does not cause any systemic effects.

Progestogel has an excellent analgesic effect for breast tenderness. It is recommended to apply it to the skin of each gland, 2.5 grams per day, daily or only in the second half of the cycle for 4 months. In this case, small cysts up to 2 cm in diameter can disappear completely. If fluid was removed from the cyst cavity, then under the influence of Progestogel, the number of relapses decreases.

If topical progesterone is not effective, progestogens may be given in the form of implantable forms or taken by mouth.

Depo-Provera contains progesterone and is administered intramuscularly once every 3 months. It effectively treats diffuse forms of mastopathy. However, the drug may cause the cessation of menstruation or the appearance of intermenstrual irregular uterine bleeding. Progesterone implants, for example, Norplant, also work for a long time. It also has a contraceptive effect.

A remedy such as intrauterine, releasing the progestogen levonorgestrel, is not used to treat mastopathy. The hormone secreted by it acts only in the uterus, is not absorbed into the bloodstream and does not affect the mammary gland in any way.

Many women can be advised to take progestogens in the form of tablets, such as Duphaston or Utrozhestan. These drugs have few side effects, they do not have an androgenic effect. Influencing the exchange of aldosterone, gestagens have a mild diuretic effect, preventing the development of edema in the legs, engorgement of the glands and other manifestations of premenstrual syndrome. For liver diseases, Utrozhestan can be used in the form of vaginal suppositories. Progestogens have a very good therapeutic effect in the case of a combination of mastopathy and endometrial hyperplastic processes.

Additionally, Danazol, gonadotropin-releasing factor agonists, dopamine agonists can be used. All these medicines have their own niches in the treatment of fibrocystic mastopathy, self-medication with them is unacceptable.

So, oral contraceptives are indicated for young women, especially with an irregular menstrual cycle. Gonadotropin-releasing factor agonists, on the contrary, are already used in mature women, since they cause artificial menopause and regression of changes in the mammary gland. Dopamine agonists are used for excess prolactin, which stimulates glandular tissue.

Treatment at home

It is carried out in addition to drug therapy. Usually, to relieve the symptoms of mastopathy, it is advised to put fresh cabbage leaves in a bra cup. There are recipes in which the leaves are first advised to grease with butter and sprinkle with salt.

You can make compresses with grated raw beets mixed with honey, put them on the chest during the night. To avoid allergies or skin irritation, it is recommended to first apply a compress during the day for several hours. With good tolerance, you can do the procedure at night.

For compresses, you can use a mixture of butter and garlic, honey and lemon, pumpkin pulp. Procedures are best done daily for at least a month.

With fibrocystic mastopathy, it is useful to take decoctions of medicinal plants - yarrow, mint, valerian, calendula, St. John's wort.

One of the widely used remedies is an alcohol tincture of walnut partitions. It is prepared within a week: partitions from 20-30 nuts are placed in a glass jar and poured with medical alcohol or vodka. After 7 days, you can start taking the liquid in a teaspoon three times a day.

For pain or tightness in the mammary gland, you should not start self-medication with folk remedies, you must first consult a doctor. So you can avoid advanced forms of malignant breast tumors and major surgery.