Diffuse FCM with predominance. Fibrocystic mastopathy: what is it, scary or not. Diagnosis of diffuse mastopathy

Any pathology of the mammary gland is always an extremely unpleasant condition for any woman. Knowing about such a terrible disease as cancer, a woman experiences strong emotions with any change in her breast. Today we will tell you what diffuse fibrocystic mastopathy is, is it scary or not.

What is mastopathy

If the change in the gland does not progress and does not bother the woman, she often makes a big mistake by postponing the visit to the doctor indefinitely.

Mastopathy is a benign, hormone-dependent pathological change in the mammary glands. There are many variants of the course of such a disease. Therefore, sometimes it is difficult for an experienced general practitioner, surgeon, and even mammologist to establish the type of ongoing process and the reason for its development without special examinations. The treatment of such a disease is simple, but requires attention from the woman.

Fibrocystic mastopathy(Doctors may also use terms such as “Reclus disease”, “fibroadenomatosis”, etc.) is a pathological process of a benign nature that leads to a violation of the correct structure of the breast tissue. What happens in the glandular tissue (proliferation processes) leads to its growth along with the stroma (the connective tissue component of the gland) and blood vessels.

There are such forms of diffuse fibrocystic mastopathy:

• with a predominance of the fibrous component;
• mastopathy with a cystic component;
• mixed form with both fibrous and cystic components;
• bilateral form with a predominance of any component.

The term "diffuse" indicates that the process of changing the gland occurs throughout the organ, and not in a local area. The form of the disease is determined by the predominance of the pathological component.

Causes of mastopathy

The main pathological process that leads to the development of such a disease as diffuse fibrocystic mastopathy of the mammary glands is a persistent violation of the hormonal background of a woman.

It is worth noting that the glandular tissue of the breast is the target for all female sex hormones:

Diffuse fibrocystic mastopathy is a consequence of an imbalance in female sex hormones, which has been observed for a long time (usually more than 1 year). In turn, the causes of such disorders in the body can be provoked by such pathological processes:

The main impetus for the development of pathology is the long-term predominance of estrogen over progesterone. This condition can be observed with pathology of the ovaries and ovulation, frequent abortions.

With menopause, the opposite situation is observed: a sharp predominance of progesterone over other hormones. An increase in prolactin during a period not related to pregnancy and lactation is also often associated with the development of a disease such as diffuse fibrocystic mastopathy.

Symptoms of the disease

Almost a quarter of all women with this disease do not feel any symptoms from the chest. Fibroadenomatosis of the breast is then detected by palpation of the breast by a doctor or during a planned mammography or ultrasound of the mammary glands.

Otherwise, the patient may notice the appearance of one or more formations that become painful in the second half of the menstrual cycle. Such formations may resemble bunches of grapes and be concentrated in the upper chest.

Also, in parallel, some symptoms of the disease can be observed, which are of a general nature and cannot confidently indicate mastopathy:

Treatment of mastopathy

Any form of such a disease requires treatment without fail. The fibrous form, like the cystic form, often requires only conservative therapy by taking hormonal drugs. the main task such treatment - the normalization of hormonal levels.

When mastopathy is not combined with another endocrine pathology, a gynecologist treats a woman after a preliminary analysis of the hormonal background using laboratory research.

If the presence of diseases is detected during the diagnostic process endocrine system, treatment, along with a gynecologist, is also carried out by an endocrinologist. Drugs that are used for a disease such as diffuse fibrocystic mastopathy are hormonal agents. Therefore, the exact dosage and frequency of administration should be established only by a doctor.

Since mastopathy can mimic the symptoms of breast cancer, a detailed diagnosis of this disease is carried out. Hormonal treatment can be started only after any oncological disease has been excluded.

The cystic form of mastopathy requires surgical intervention if part of the altered mammary glands undergoes an infectious process (mastitis) or has an unaesthetic appearance due to illness. In this case, the pathological area of ​​the breast is excised, or a total resection of the mammary glands is performed (depending on the prevalence of the process). Next is hormonal treatment.

Summary

Diagnosis of a disease such as diffuse fibrocystic mastopathy in modern medical institutions is not very difficult.

The patient herself can often notice a change in the density and consistency of breast tissues during periodic self-examination. Conducting preventive mammography and ultrasound of the mammary glands allows you to identify the process at an early stage, as well as to conduct a differential diagnosis with a disease such as cancer.

Conservative treatment in the early stages allows you to achieve positive dynamics in any form of the disease. Normalization of the hormonal background of a woman allows her to eliminate negative symptoms before menstruation, normalize libido, and eliminate the unpleasant phenomena of the menopause period.

Unlike breast cancer, mastopathy in most cases has a favorable outcome, often does not cause significant discomfort to a woman and is successfully treated.

How to treat fibrocystic mastopathy - video

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

It is customary to distinguish two forms of the disease:

proliferative form characterized by the launch 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%.

Non-proliferative 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%.

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.

Symptoms of fibrocystic mastopathy

It is known that in Russia 90% of women independently detect breast pathology and only 10% of all cases are diagnosed by doctors.

Symptoms of the disease rarely occur hidden and it is quite difficult not to notice them:

Pain, with localization in the mammary glands. This pain is called mastalgia. She most often begins to disturb a woman in the second half of the cycle, or in its middle. The nature of mastalgia can vary from aching to stabbing and bursting. Possible irradiation of pain in the neck, hypochondrium, shoulder and back. When menstruation begins, the pain either significantly decreases or subsides altogether. After the end of menstruation, they disappear and the woman is not disturbed until the next middle of the cycle. However, as the disease progresses, the pains become more intense and do not go away after the end of the cycle, giving the woman discomfort throughout the entire time. Sometimes even a slight touch to the chest causes pain.

Breast tissue evenly compacted and swell.

During palpation, you can feel the granular structures of the gland.

If you press on the nipple, a discharge appears from it. They may be clear or resemble colostrum. During the premenstrual period, the discharge from the nipples increases. A woman can detect stains on the inside of her bra. If the discharge acquires a greenish or slightly yellow tint, then this indicates the addition of a secondary infection or the onset of an inflammatory process. In this case, it is strictly forbidden to postpone a visit to the doctor.

Enlargement and soreness of the lymph nodes located in the immediate vicinity of the mammary gland.

Carcinophobia is another common symptom of women with mastopathy. This is a pathological fear associated with the fear of getting cancer. It develops against the background of discomfort in the chest. Often, precisely because of cancerophobia, women postpone a visit to the doctor, fearing that their own fears will be confirmed. Often cancerophobia is accompanied by panic attacks, anxiety disorders, hypochondria.

Sleep disturbance due to pain. Insufficient night rest entails increased irritability, anxiety, nervousness, decreased performance.

Elevated estrogen levels and insufficient progesterone leads to the corresponding symptoms of hormonal failure. Menstrual irregularities, pronounced premenstrual syndrome, heavy bleeding, the occurrence of spotting between periods - all these signs often accompany mastopathy.

Often, during a comprehensive gynecological examination of women with diffuse fibrocystic mastopathy, ovarian cysts and uterine fibromas are found in them. Endometriosis and endometrial hyperplasia are also diseases adjacent to the pathology of the mammary glands.

Dryness of the skin, brittle nails and hair - all these are indirect signs indicating the pathology of the mammary gland of a fibrocystic nature.

It is also worth distinguishing the symptoms of various forms of cystic-fibrous mastopathy:

Mastopathy with a predominance of the fibrous component. With this form, fibrous changes occur in the connective tissue located between the lobules of the mammary gland. Often there is a proliferation of the intraductal epithelium, this causes either narrowing or complete fusion of the milk ducts. Women experience severe pain, seals are well palpable. Fibrous severity can have varying degrees of severity, depending on the stage of the disease.

Mastopathy with a predominance of the glandular component. This form of the disease is accompanied by the formation of small cysts. Women, as a rule, rarely pay attention to soreness and swelling of the breast, since the symptoms of the disease are mild. Most often, mastopathy with a predominance of the glandular component is diagnosed in patients aged 30 to 40 years.

Mastopathy with a predominance of the cystic component. This form is characterized by the formation of single cysts, it is enough large sizes(they can reach 7 cm in diameter). This type of mastopathy is most often diagnosed in women aged 35 and older. Multiple small cysts may also be diagnosed. Pain intensifies at the time of the onset of menstruation. Large cystic formations have an elastic consistency. They are well palpated, as they are delimited from the surrounding tissues of the mammary gland. The higher the degree of proliferation of the ductal epithelium, the higher the risk of cyst formation.

Causes of fibrocystic mastopathy

In the occurrence of pathology, the main role of all scientists is given to dishormonal disorders occurring in the body of a woman. At the same time, not one, but a whole complex of hormones takes part, among which: gonadotropin releasing hormone of the hypothalamus, prolactin, gonadotropins, estrogens, progesterone, chorionic gonadotropin, thyroid stimulating hormone, androgens and some others. Violations of their balance leads to the fact that dysplastic changes are triggered in the tissues of the mammary gland. Against the background of an absolute increase in the level of estrogen and a fall in the level of progesterone, the process of pathological changes is gaining full strength. Estrogens stimulate the proliferation of the epithelium and stroma, and the critically low level of progesterone is unable to counteract this mechanism. As a result, the woman develops mastopathy.

The study of the hormonal status of a woman with fibrocystic disease most often shows: gestagenic insufficiency (absolute or relative), hyperestrogenism (absolute or relative), a violation of the ratio of FSH to LH and abnormal levels of gonadotropins.

Gynecological diseases. Diseases of the female genital area also negatively affect the condition of the breast tissue. Among such pathologies: oophritis (inflammation of the ovaries), adnexitis (inflammation of both the ovaries and appendages), ovarian dysfunction (violation of their hormonal function), etc.

The period of bearing a child. During pregnancy, it affects the hyperplasia of the mammary glands, hormones that are produced by the placenta.

Thyroid dysfunction. Currently, the relationship between mastopathy and thyroid pathologies is scientifically proven. This is primarily due to a drop in the level of corpus luteum hormones. In addition, the thyroid gland affects the thyrotropic and luteinizing function of the pituitary gland. This disrupts the ovarian cycle and leads to dyshormonal processes in the mammary gland.

Liver diseases. It has been established that a violation of its functioning causes multiple changes in the hormonal balance.

Adverse factors associated with the function of reproduction. Such factors include abortions suffered by a woman, as well as unsuccessfully completed pregnancies (miscarriages, premature births). Late onset of pregnancy, or its absence, also negatively affects the tissues of the mammary gland. In addition, infertility therapy, refusal to breastfeed, or a short lactation period may have an effect. It is a known fact that women who have interrupted the natural course of pregnancy more than three times are more prone to developing mastopathy. Their risk of pathology increases by 7.2 times.

Features of sexual development, the period of menopause. In this case, the greatest danger is the too early onset of puberty with menarche before the age of 12 years. If a woman's menstruation ends too late - over the age of 55, then this is also a risk factor that can lead to mastopathy.

Diseases. Some diseases can have an impact on the development of pathology, including: diabetes, arterial hypertension, diseases of the adrenal glands. With hypothyroidism, the risk of developing pathology increases by almost 4 times.

Overweight. The greater the weight of a woman, the more she has stocks of adipose tissue. It is known to be a depot for estrogens, and therefore there is always a risk of developing hyperestrogenism and mastopathy against its background.

exogenous reasons. Breast injuries, ionizing radiation, exposure to ultraviolet rays (obtained both from sunlight and in a solarium) on unprotected chest skin, and unfavorable environmental conditions in the area of ​​​​residence can negatively affect.

Features of sexual life. It is known that irregular sex life or its absence leads to stagnation in the pelvic area. This provokes diseases of the female genital area, disruption of hormone production and, as a result, mastopathy.

factor of heredity. Particularly attentive to the state of their own mammary glands should be those women whose closest maternal relatives have suffered breast diseases of benign or malignant origin.

stressful situations. The greatest danger is presented by severe and long-term continuing psycho-traumatic situations.

Is fibrocystic mastopathy dangerous?

Diffuse fibrocystic mastopathy is a dangerous disease. Doctors consider it precancerous, although it is benign. If the pathology is left untreated, then the next stage of mastopathy will come - nodular, with it the risk of malignancy increases several times.

So, the dangers of fibrocystic mastopathy are as follows:

The risk of malignancy of the process;

The development of an inflammatory reaction in the mammary gland, infection and suppuration of the existing formation;

Growth of cystic formation, deformation of the shape of the breast;

Violation of the integrity of the cystic formation.

In addition, the disease significantly reduces the quality of life of a woman. She constantly or periodically experiences discomfort and pain in the chest, which causes neurosis, psychosis, becomes the reason for the impossibility of proper rest, decreased performance, etc.

If mastopathy is suspected, a woman should seek advice from a gynecologist or mammologist. Timely treatment will allow you to get by with conservative methods and not resort to surgical intervention.

Treatment of fibrocystic mastopathy

The leading place in the treatment of diffuse fibrocystic mastopathy belongs to drugs of the hormonal group. Most often, oral gestagens are used for this purpose. Progestins are prescribed in the case when the patient's mastopathy is combined with hyperplastic processes in the endometrium, or progesterone deficiency is detected.

Widely used drugs such as:

Duphaston. It is an analogue of progesterone of natural origin. Therefore, it can be used without fear for the risk of developing side effects that occur when taking androgens. Even long-term treatment with Duphaston is safe and does not cause anabolic effects. Therapy allows you to achieve a progestogenic effect.

Utrozhestan. This drug is represented by natural micronized progesterone. It can be used both vaginally and orally. Micronized progesterone is absolutely identical to its natural counterpart and practically does not give side effects from taking the drug. This is one of the important differences between the natural progesterone contained in Utrozhestan and the synthetic hormone. As a rule, the full course of treatment takes up to six months.

Synthetic gestagen contains the drug Pregnin.

Regarding combined oral contraceptives, then the main purpose of their appointment is to block the ovulation process and eliminate the possibility of fluctuations in the level of sex hormones. Most often, drugs belonging to this group are prescribed to women of reproductive age. Among such funds: Silest, Femoden, Marvelon, Mercilon.

Antiestrogens can lower the level of estrogen in the body. However, when taking drugs from this group, it is worth remembering the side effects that they cause. First of all, these are violations caused by low levels of estrogen. Among these: excessive sweating, hot flashes, a feeling of heat, itching of the genitals, increased work of the sebaceous glands, dry skin, etc. In addition, their long-term use can provoke endometrial cancer, polyposis, cataracts, thrombophlebitis. Antiestrogen drugs are Fariston, Tamoxifen, Clomiphene, Torimifen, etc.

It is known that estrogen antagonists are androgens. Therefore, it is also advisable to use them for the treatment of mastopathy. Most often, doctors prescribe the drug Danazol. Treatment should last at least three months. This group includes drugs - Parlodel, Mercazolil.

GnRH agonists are such drugs as: Zoladex, Buserelin and Diferelin. They can cause temporary menopause, which is reversible. This will save the woman's body from hormonal fluctuations due to inhibition of ovarian function in combination with the caused hypogonadotropic amenorrhea, the symptoms of mastopathy will become reversible. The course of continuous treatment should last at least a month.

Homeopathic remedy Mastodinon deserves special attention. It is made on the basis of medicinal herbs- Chilibuhi iris, tiger lily and cyclamen. Its intake helps to reduce the level of prolactin, narrow the ducts of the mammary gland, and reduce the severity of proliferative processes. In addition, the blood supply and swelling of the chest decreases, and a reverse change in tissues occurs. The pain symptom is reduced.

Klamin is a herbal adaptogen. It allows you to increase the immune forces of the body, protect the liver from negative effects, acts as an antioxidant. Klamina also contains iodine, which, in the event of a deficiency of this microelement, completely covers the body's need for it.

From phytopreparations, Fitolon can be distinguished- a remedy of plant origin, which is based on the lipid fraction of brown algae dissolved in alcohol. The drug has a resolving effect, stimulates the body's immune forces and acts as an antioxidant.

Analgesic drugs used to relieve pain, which are quite pronounced. Such drugs can serve as drugs belonging to the group of NSAIDs.

Vitamin preparations also prescribed for the treatment of mastopathy. It can be Aevit, vitamin E, Decamevit, etc.

Sedatives, and, if necessary, antidepressants are selected depending on the severity mental disorders. It can be: Azafen, Sibazon, Amizil, Amitriptyline, etc.

Diuretics help relieve swelling- Triampur, Aneroshpiron, Lasix.

With iodine deficiency, iodine-containing preparations are indicated, such as Iodomarin, Klamin, Potassium iodide, etc.

Special attention women with mastopathy should be given their own diet. Compliance with the dietary scheme of nutrition is not only a preventive, but also a therapeutic measure for mastopathy. It is known that an increased content in the daily menu of fats, as well as meat products, leads to an increase in the level of estrogen in the blood. At the same time, the amount of androgens decreases. In addition, a woman's diet should be enriched with vitamins and fiber as a source of coarse fiber. Fiber is a powerful anticarcinogen, which has been proven by many studies, which means it can have a beneficial effect on the course of the disease.

Proper nutrition will achieve weight loss in overweight women. This will make it possible to get rid of body fat, and hence from the supply of excess estrogens.

Increasing physical activity, exercise therapy, the use of physiotherapy techniques - all these procedures are applicable only with the permission of the attending physician. It is possible to undergo mud therapy, laser therapy, magnetotherapy, electrophoresis and other auxiliary methods of treatment. Any applications that are applied to the chest area with mastopathy should be cold or slightly warmed up.

The passage of preventive examinations by a gynecologist and a mammologist, the implementation of instrumental methods of examination will prevent the development of the disease and save women Health. In addition, the self-examination procedure is a significant measure for the prevention of mastopathy.

Education: completed residency at the Russian Scientific Cancer Center named after N.N. N. N. Blokhin” and received a diploma in the specialty “Oncologist”

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

One of the frequent options is diffuse fibrous mastopathy, characterized by the formation of a large number of seals of various sizes and shapes.

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

From the diet, it is necessary to exclude fatty meat, hydrogenated fats, fried, canned, smoked foods, as well as drinks containing caffeine.

Preference is given to whole grains, fish, poultry, dairy products, fruits and vegetables. Useful vitamin kits and herbal teas. Avoiding alcohol and smoking is required.

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

Relationship with oncology

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

Too much estrogen is a warning sign. Against its background, degeneration in the tissues of any organs of the female reproductive system is possible. Already existing fibromas do not regenerate, but malignant tumors may well form next to them.

Problem diffuse form the fact that there are a lot of neoplasms and not everything can be detected with a superficial examination. Therefore, you should be especially attentive to your condition, do all the necessary tests and follow the doctor's instructions exactly.

Diffuse fibrous mastopathy is a disease, the treatment of which can be successful only in the case of a complex effect and timely diagnosis. The therapy takes place under the supervision of specialists, only in this case a complete cure and the absence of relapses are possible.

You will be able to find Additional information on this topic in the section.

Fibrocystic mastopathy (FCM) occurs in 50% of women of childbearing age (25-40 years).

This disease develops for various reasons: stress, frequent abortions, inflammation of the appendages and others.

FCM is a disease of the mammary glands, which is characterized by the appearance of seals, tumors, growth of glandular tissue.

Mastopathy occurs most often in women who have given birth, who have been breastfeeding for a long time.

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What forms of mastopathy are there?

There are several forms of mastopathy:

1. Mastalgia. There are no seals at this stage. The thoracic ducts are clogged and inflamed. It causes pain.

   Due to pain, patients go to the doctor. Mastopathy at this stage is treated with antibiotics and painkillers.

2. Diffuse fibrocystic form. Tumors and cysts appear in the chest, they are well palpable on palpation. Treatment depends on the severity of the disease. In advanced cases, surgical intervention is required.

   Allocate:

   • mixed type;
   • the predominance of cysts;
   • the predominance of fibrosis;
   • the predominance of the glandular component.
3. Localized fibroadenomatosis. Neoplasms appear locally, do not spread. Their outlines and shape are clearly visible on x-rays or ultrasound.

FCM with a predominance of the fibrous component

What is FCM with a predominance of the fibrous component? This form of mastopathy is the most common. It is characterized by the appearance of neoplasms in the breast, but the fibrous component predominates. Fibrosis means:

• an increase in the volume of connective tissue, its growth in the gland;
• blockage of the ducts, up to the complete closure of the lumen;
• neoplasms in the interlobular space.

The patient is in severe pain. On palpation, the tumors are well palpable. Seals of a fibrous nature are visible on x-rays and ultrasound. The pictures clearly show the pattern of "frosted glass" (seals do not have clear outlines, they are teardrop-shaped.

Important! Any changes in the mammary glands can lead to breast cancer. With the appearance of pain and seals, you should immediately contact a mammologist or gynecologist.

Areas affected by fibrosis are slightly darkened. There is a feeling that you are looking at the picture through the "frosted glass" - hence the name).

Classification by the nature of neoplasms

FKM has several classifications. According to the nature of the neoplasms, they are distinguished:

Also, FCM can be proliferating and non-proliferating. Proliferation is the process of division and growth of cells with their subsequent change. Such cells are not cancerous, but differ in structure from normal ones.

According to the degree of severity, mastopathy is distinguished as mild, moderately pronounced and pronounced.

Fibrocystic mastopathy with a predominance of the fibrous component occurs in 30% of cases. It is dangerous because, apart from pain, there are no other symptoms. Tumors are poorly expressed, they can not be noticed immediately. Russian women, unfortunately, rarely conduct self-diagnosis, so mastopathy is detected at an advanced stage.

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Mastopathy of the mammary glands

Women in whom fibrocystic mastopathy was discovered by chance as a concomitant pathology without severe complaints, special treatment not required. Such patients should be examined (ultrasound and/or mammography and diagnostic puncture) and further observation can be continued at follow-up examinations by a gynecologist or surgeon at least once a year.

Women with moderate cyclic or permanent form of mastodynia and diffuse fibrocystic changes in the structure of the breast (without obvious macrocysts) are treated conservatively using both hormonal therapy and non-hormonal methods of treatment. Most often this applies to young practically healthy women.

Non-hormonal treatment of mastopathy

Diet correction

There is a close relationship between the use of methylxanthines (caffeine, theophylline, theobromine) and the development of fibrocystic mastopathy. These compounds contribute to the development of fibrous tissue and the formation of fluid in the cysts. Therefore, the restriction or complete rejection of products containing methylxanthines (coffee, tea, chocolate, cocoa, cola) can significantly reduce the pain and swelling of the mammary glands.

Both fibrocystic breast disease and breast cancer are associated with sluggish bowel activity, chronic constipation, altered intestinal microflora, and insufficient fiber in the daily diet. In this case, reabsorption from the intestine of estrogens already excreted with bile occurs. Therefore, patients with fibrocystic mastopathy need to eat food rich in fiber and adequate fluid intake (at least 1.5-2 liters per day). Since estrogen utilization takes place in the liver, any dietary disturbance that impedes or limits the normal activity of the liver (cholestasis, fat-rich foods, alcohol, other hepatotoxic substances) over time can affect the clearance of estrogen in the body. In turn. to facilitate and normalize liver function, an additional intake of vitamins B (especially B6), A, C and E is desirable - as food additives or even at therapeutic doses.

Diuretics

Cyclic mastopathy, as one of the manifestations of premenstrual syndrome, especially if it is accompanied by swelling of the hands and feet shortly before menstruation, can be stopped with mild diuretics (for example, herbal teas). It is also advisable to limit the use of table salt during this period.

Nonsteroidal anti-inflammatory drugs are recommended to reduce cyclic mastalgia a week or a few days before the next menstruation, when the most severe pain in the mammary glands appears, but this cannot be recommended as a permanent and long-term treatment.

Means that improve blood circulation

It is recommended to use vitamin P preparations (ascorutin) or products containing this vitamin (citrus fruits, rose hips, black currants, chokeberry, cherry, raspberry) to improve microcirculation and reduce local swelling of the mammary gland.

Complex, natural products

Currently, there are many different complex herbal remedies with vitamins, antioxidants and microelements for the treatment of both mastopathy and premenstrual syndrome, including cyclic mastalgia (Vetoron, Klamin).

Calming agents

The mammary glands are an organ that is very sensitive to psycho-emotional stress. Troubles at work or at home, chronic dissatisfaction, fatigue, anxiety, depression - all this can cause, maintain or increase pain. Depending on the psycho-emotional state of a woman, it is advisable to include sedatives in the scheme of complex treatment of mastopathy, at first preferring light drugs vegetable origin (tincture of motherwort, valerian, etc.), if necessary, more potent sedatives.

Choosing a bra

Women with a cyclic or permanent form of mastalgia should definitely pay attention to this item of women's toiletry, since both completely ignoring it and wearing a bra of an inappropriate shape or size can cause chronic breast deformity, compression or overload of the ligamentous apparatus, especially in women with large and drooping chest. Often, when these causes are eliminated, the pain in the mammary gland decreases or even disappears completely.

Breast massage for mastopathy

The female bust basically consists of glandular tissues, which are quite densely dotted with numerous blood vessels, the lymphatic system, sebaceous and sweat glands. Oddly enough, it is this area of ​​​​our body that is most protected.

Applying newfangled cosmetic products, antiperspirants of daily action, people do not even think that they clog exit pores for a long time. Therefore, the lymphatic system is not able to remove toxins, decay and processing products from the human body. But where do they go, naturally they begin to accumulate in neighboring tissues, that is, in the tissue structures of the chest. Often, such a development of events can lead to the formation of pathologies, one of which is quite capable of becoming mastopathy, the percentage of manifestations of which, today, is quite large.

Therefore, in order to reduce the risk of its development or, if it is diagnosed, a gynecologist or mammologist prescribes a breast massage for mastopathy, which is one of the methods of complex treatment that allows a woman to get rid of this problem.

This massage has a lymphatic drainage effect. This allows you to activate blood flow, lymph flow, preventing the appearance of congestion.

It is the stagnation of processes, in most cases, that is the catalyst for the formation of various kinds of neoplasms.

In the light of the development of the disease, normal lymph flow is especially important. After all, the lymph is the "vacuum cleaner" of the body, which cleans it, removing all the garbage, while simultaneously conducting disinfection. It is thanks to the lymph that our breasts are protected from invading flora and other negative influences.

As for mastopathy, then with this disease there can be no question of self-treatment. Therapy should be comprehensive and scheduled by a qualified specialist, after the woman has been examined and has a complete picture of the disease on her hands.

It is worth immediately reassuring women that this disease has been treated favorably for a long time. Therefore, the main thing is not to start the process and to carry out treatment in a timely manner, turning to a mammologist for help.

To date, there is no single system of therapy that would completely suit and satisfy the point of view of all doctors. Complex protocols for the treatment of this disease are also different, including medical and physiotherapeutic measures. This dispute also involves the method of massaging in the treatment of this pathology.

Therefore, today the use of massage in the treatment of mastopathy is controversial. Some experts believe that such an effect on the chest with existing mastopathy can become a catalyst for the degeneration of existing benign neoplasms into cancerous structures. And the risk is quite high. Therefore, they believe that they have no right to risk the health and life of a woman.

Others refute this judgment, proving the beneficial effect of physiotherapeutic measures on the relief of the problem associated with mastopathy.

It is worth recalling once again that the treatment of this disease should be comprehensive. At the same time, if the doctor has decided to assign massage to the treatment protocol, then you should not engage in amateur performances and self-treatment. Only a professional should do this treatment!

This therapy is long enough, therefore, to cope with the disease, you need to be patient. But it's worth it.

It is worth suggesting one of the massage methods that is acceptable in this situation. Sequencing:

• You need to sit down, relax, calm down, adjust your breathing and drive away any thoughts. Relaxation is an additional plus of this procedure.
• With the pads of the large, middle and index phalanx, it begins to make circular spiral movements, which first move clockwise and then in the opposite direction.
• At the same time, try to evoke love for yourself and direct it to the massaged area. Try not to lose this state for three to five minutes, during which massaging is carried out.
• In parallel, one should also imagine the fact that the disease leaves the body and recovery comes. Believe me, the result of such work will pleasantly surprise you.
• It is necessary to direct your appeal to the central part of the brain, where the pituitary gland is located, which controls the production of hormones, maintaining the hormonal background.
• Imagine light energy that penetrates and heals. Continuing to massage, it is worth directing this “solar stream” to the ovaries. Such activities will not be in vain. And soon it will be possible to notice a positive shift in the course of the disease.

It should only be noted again that self-medication should not be done, such an approach to therapy can bring a deterioration in a woman's health. The procedure should be done by a specialist, and the technique described above is allowed for use at home only with the permission of the attending physician.

Hormonal therapy of mastopathy

Hormone therapy is aimed at reducing the excessive stimulating effect of estrogens on breast tissue, less often at correcting dysprolactinemia or hypothyroidism.

Antiestrogens

To provide a stimulating effect, endogenous estrogens must bind to specific cell receptors. In the case of relative hyperestrogenism, antiestrogens (tamoxifen, toremifene), blocking estrogen receptors in target tissues (including in the mammary gland), do not allow estrogens to bind to receptors, reducing their biological activity.

In some patients, there may be an increase in pain and a feeling of breast swelling in the first weeks of treatment, which can be explained by the partial estrogenic effect of antiestrogens; in rare cases, because of this, it is necessary to interrupt treatment.

Oral contraceptives

Properly chosen and used oral contraception provides permanent suppression of steroidogenesis and ovulation, suppression of the synthesis of ovarian androgens, as well as estrogen receptors in the endometrium, alignment of excessive fluctuations in cyclic hormones, long-term protection against the development of ovarian and endometrial cancer. Symptoms of mastopathy often decrease or even completely disappear within the first two months, however, objective results can be expected no earlier than 1-2 years after the start of oral contraception. At the same time, in some women, during the use of oral contraceptives, pain in the mammary glands and other symptoms of mastopathy may even increase. Then you have to switch to another type of contraception or change oral contraceptives.

Gestagens

The therapeutic effect of gestagens in the treatment of premenstrual syndrome and fibrocystic mastopathy is associated with the inhibition of functional pituitary-ovarian connections and a decrease in the proliferation-stimulating effect of estrogens on breast tissue. V last years the use of progesterone derivatives - medroxyprogesterone acetate (MPA) has increased, as they have more pronounced progestogenic properties, moderate antiestrogenic activity and minimal or almost no androgenic effect. Gestagens are especially indicated for patients with established luteal phase insufficiency and the relative hyperestrogenism caused by this, anovulatory bleeding, and uterine myoma.

Androgens (danazol) as estrogen antagonists are used to treat mastopathy. The basis of the action of danazol is its ability to inhibit the synthesis of gonadotropic hormone (proven in experiments with laboratory animals) and some essential enzymes in ovarian steroidogenesis. The drug has a progestogenic and weak androgenic effect.

Prolactin secretion inhibitors

These drugs (bromocriptine) are prescribed only for patients with hyperprolactinemia.

Gonadotropin-releasing hormone analogs

As a result of the use of analogues of gonadotropin-releasing hormone (Gn-RH), the level of circulating estrogen and testosterone is significantly reduced. In addition, the presence of estrogen and progesterone receptors in breast cancer tissue suggests that GnRH specifically affects (autocrine or paracrine) the growth of breast tissue cells.

Conservative therapy of FCM requires long courses (3-6 months). However, already 1 year after the end of treatment, a relapse of the disease occurs in 60-70% of cases. Therefore, the search for new methods of prevention and treatment of this disease remains relevant.

Surgical treatment of mastopathy

In cystic-fibrous and other forms of nodular mastopathy, a sectoral resection of the mammary gland is indicated with an urgent histological examination of the node in order to immediately perform a radical operation if signs of malignancy are found in the removed preparation.

In cases where proliferating fibroadenomatosis is detected during cytological examination, a simple mastectomy is the method of choice. This form of mastopathy should be considered as an obligate precancer.

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Hyperplastic and dysplastic processes of the mammary gland (mastopathy). Clinic (symptoms), diagnosis and treatment of mastopathy

Mastopathy is a group of dyshormonal benign diseases of the mammary glands with hyperplasia of its tissue.

According to the WHO definition (1984), mastopathy is a fibrocystic disease with a wide range proliferative changes in breast tissue and pathological ratio of epithelial and connective tissue components.

Classification of fibrocystic mastopathy (FCM)

1. Diffuse FCM ♦ with a predominance of the glandular component (adenosis); ♦ with a predominance of the cystic component; ♦ with a predominance of the fibrous component;

♦ mixed form.

2. Nodal FCM

FCM with a predominance of the glandular component is a highly differentiated non-encapsulated hyperplasia of the gland lobules with a smooth transition of seals into the surrounding tissues. This form occurs at a young age. The X-ray picture is characterized by the presence of multiple shadows of the correct form with fuzzy boundaries, which correspond to areas of hypertrophied lobules and lobes. Sometimes shadows capture the entire gland.

FCM with a predominance of the cystic component. There are multiple cystic structures of elastic consistency, clearly delimited from the surrounding tissue of the gland, formed from atrophied lobules and dilated ducts with fibrous changes in the interstitium. In the epithelium of cysts, proliferative processes can occur, leading to the appearance of papillary formations. This form develops in the perimenopausal period, mainly in postmenopause. X-ray picture: large-spotted pattern with numerous enlightenments and a clear contour. The color and consistency of the cysts are different. Sometimes there is calcification of the cysts.

FCM with a predominance of the fibrous component. Fibrotic changes in the connective tissue are noted in the presence of proliferation of the intraductal tissue with a narrowing of the lumen of the gland ducts up to their complete obliteration. This form is typical for women of premenopausal age. X-ray picture: dense homogeneous areas with pronounced heaviness ("frosted glass" appearance).

Mixed form of FKM. This form is characterized by: hyperplasia of the lobules, sclerosis of the intralobular and interlobular connective tissue, atrophy of the alveoli, expansion of the ducts and their transformation into cystic formations.

The nodular form of FCM is local changes in the form of individual or multiple nodes, morphologically similar to the corresponding diffuse variants of mastopathy.

All types of mastopathy are also divided into two types - with and without proliferation and atypia. The term "proliferation" refers to the active division of cells, the term "atypia" - the appearance of cells that differ from normal. These cells are not cancerous, but differ in structure from their predecessors.

There is a special form of mammary gland pathology - mastodynia or mastalgia - cyclic swelling of the gland associated with venous congestion, edema of the stroma and an increase in the size of the mammary gland.

Fibroadenoma is a benign breast tumor arising from the epithelium of the glandular lobules, which has a capsule and clear boundaries. Palpation is determined by a dense rounded mobile formation with smooth contours. It occurs during puberty, is a consequence of an excess of hormones and increased tissue growth rates. On radiographs, a regular oval or rounded formation with clear contours without a perifocal reaction is visualized.

The risk of developing breast cancer against the background of mastopathy increases by 4-37 times, and the frequency of malignancy increases with cystic changes, calcification, and also with proliferative processes in the epithelium lining the ducts and walls of cysts.

Etiopathogenesis of mastopathy.

An important role in the pathogenesis of FCM is given to relative or absolute hyperestrogenemia and progesterone deficiency.

Among estrogens, estradiol plays the most important role in the vital activity of the mammary gland. Its concentration in the connective tissue of the mammary gland is higher than in the blood serum. Estradiol stimulates the differentiation and development of the mammary gland ducts, enhances the mitotic activity of the epithelium, initiates the formation of acinus, stimulates vascularization and increases the hydration of the connective tissue.

Progesterone, counteracting these processes, prevents the development of proliferation, ensures differentiation of the epithelium, inhibits the mitotic activity of epithelial cells, prevents an increase in the permeability of capillaries caused by estrogens, and reduces swelling of the connective tissue stroma. Lack of progesterone exposure leads to proliferation of connective tissue and epithelial components of the mammary gland.

Breast adipose tissue contains many estrogen receptors and far fewer progesterone receptors. Adipocytes are depots of estrogens, progesterone and androgens. Under the influence of aromatase, androgens are converted into estradiol and estrone. This process increases with age, which becomes one of the factors that increase the risk of developing breast cancer.

A special place in the pathogenesis of hyperplastic processes in the mammary glands is assigned to prolactin, under the influence of which the number of estradiol receptors in the gland tissue increases. An increase in the level of prolactin, noted in the combined pathology of the uterus and mammary glands, also inhibits the production of progesterone, thereby exacerbating the pathological processes. Prolactin suppresses thyroid function. Thyroid hormones, which are modulators of the action of estrogens at the cellular level, can contribute to the progression of disorders in the histo- and organogenesis of hormone-dependent structures and the formation of endometrial hyperplastic processes.

In the pathogenesis of the disease, an increase in the level of cortisol plays a role, which contributes to the development of hyperplastic changes in the mammary glands, both directly through corticosteroid receptors in the mammary gland, and by increasing the number of prolactin receptors in this organ.

Under the influence of excess prostaglandins, the lumen of the vessels of the gland changes, the permeability of the vascular walls, hemodynamics and water-salt ratios are disturbed, which leads to tissue hypoxia. The level of Pg E2 in the blood of patients with FCM is 7-8 times higher than in healthy women.

The intrinsic risk factors contributing to the emergence and development of FCM and breast cancer include obesity, especially when combined with diabetes and arterial hypertension. Diseases of the hepatobiliary complex initiate the development of chronic hyperestrogenism as a result of delayed utilization of estrogens from the liver. It has been established that FCM is also associated with impaired intestinal activity, chronic constipation, altered intestinal microflora and an insufficient amount of fiber in the daily diet, it is possible that in this case reabsorption of estrogens already excreted by bile occurs in the intestine.

The main causes of dyshormonal disorders:

1. Hereditary (genetic) predisposition.2. Reproductive factors (a large number of pregnancies, childbirth, abortions, age during pregnancy and childbirth - up to 20 and after 30 years, the birth of a large fetus, long lactation, late menarche and menopause, menstrual dysfunction - hyperpolymenorrhea, etc.) .3. Gynecological diseases and, first of all, inflammatory processes in the small pelvis.4. Atypia of cells in the results of previous biopsy materials.5. Taking exogenous hormones: combined oral contraception or hormone replacement therapy.6. Endocrine disorders (diabetes, thyroid dysfunction) .7. Pathological processes in the liver and biliary tract, chronic colitis.8. Frustrating situations that are present in the life of every woman (dissatisfaction with marital status, as well as their position in society, domestic conflicts, conflict situations at work, mental stress, adverse sexual factors, etc.).

9. Abuse of alcohol and products containing methylxanthines (coffee, tea, chocolate, cocoa).

Clinic of mastopathy

Pain in the mammary glands that appear in the middle of the menstrual cycle and before menstruation, accompanied by compaction of the mammary glands, sometimes discharge from the nipples. The pain can be stabbing, shooting, sharp, radiating to the back, neck, resulting from compression of nerve endings by edematous connective tissue, cystic formations and their involvement in sclerotic tissues.

On palpation of the mammary glands, lobular seals with an uneven surface, tissue heaviness, and soreness are determined.

After menstruation with diffuse mastopathy, the pain is insignificant, the entire mammary gland is evenly compacted, heavy. With nodular mastopathy, single or multiple foci are determined; they are not painful, are not connected with the skin and with the nipple, are mobile, and are not palpable when the patient is lying down. There may be an increase in axillary lymph nodes, sensitive to palpation.

Mastopathy may be accompanied by galactorrhea, more often of the 1st degree (scanty secretions of gray fluid from the nipples during palpation).

There are 3 clinical phases of mastopathy:

1st phase: develops at the age of 20-30, is characterized by engorgement and soreness of the mammary glands a week before menstruation, their compaction and sensitivity to palpation; the menstrual cycle is regular, but often shortened to 20-21 days; 2nd phase: observed at the age of 30-40 years and manifests itself constant pain in the mammary glands, which occurs 2-3 weeks before menstruation, seals in them with cystic inclusions;

3rd phase: develops at the age of 40-45 years and is characterized by intermittent and less intense pain in the mammary glands with the presence of many cystic formations containing a brownish-green secret that is released when the nipple is pressed.

Diagnosis of mastopathy

1. Anamnesis (take into account risk factors).

2. Examination of the mammary glands is carried out in a bright room, the woman should be undressed to the waist, in a standing position with her arms lowered and tilted forward, with her arms raised in the supine position with a roller placed under the shoulder blades and lying on her side. This technique allows you to identify subtle symptoms.

3. Palpation of the mammary glands is performed in the position of the patient standing, lying on his back and side. The study begins with superficial palpation: the areola area is examined with the fingertips, then the peripheral sections of the mammary gland are sequentially starting from the upper outer quadrant (upper inner, lower inner, lower outer). In the same sequence, deep palpation is performed.

After examination and palpation of the mammary glands, palpate axillary lymph nodes subclavian and supraclavicular areas.

Clinical signs of malignancy: a tumor detected by palpation; retraction of the nipple or skin of the nipple; nipple asymmetry; erosion of the nipple; pain in the mammary gland; axillary lymphadenopathy; swelling of the upper limb; swelling of the skin of the breast - "lemon peel"; pain in the axillary region.

4. Mammography - X-ray examination of the mammary glands. On a special apparatus, radiographs are performed in two projections, if necessary, they are made with whole radiographs with magnification. The method allows to establish the presence of changes in the structure of the breast tissue, the presence of microcalcifications and changes in the axillary lymph nodes, to identify a tumor node with a diameter of 10 mm, i.e. a node of a size that the doctor, as a rule, cannot determine by palpation, especially if the node is located in the deep sections of the breast of a large size. The sensitivity of the method depends on the woman's age, size, and location of the tumor.

Classification of mammographic density of the mammary gland (Wolfe JN, 1987; Byrne C, Schairer C., 1995), according to which four types of mammograms are defined: N1 - the parenchyma is completely or almost completely adipose tissue, there may be single fibrous connective tissue strands; P1 - ductal structures occupying no more than 25% of the volume of the mammary gland; P2 - ductal structures occupy more than 25% of the volume of the mammary gland;

DY - very dense (opaque) parenchyma ("dysplasia"), which usually indicates connective tissue hyperplasia.

Establishing mammographic density has an important diagnostic and prognostic value: the risk of developing breast cancer in women with increased mammographic density is 3 times higher than in women with normal mammographic density.

5. Echography using a linear probe with a frequency of 7.5 MHz. The standard technique for examining the mammary glands is supplemented by measuring the thickness of the parenchyma (a layer of glandular tissue) in each sector of the mammary gland along imaginary lines converging to the nipple, and determining the echo density of the glandular tissue.

With age, there is a tendency to a decrease in the thickness of the layer of glandular tissue and an increase in echo density up to maximum values in women over 54 years of age. This dependence reflects the normal processes of age-related involution of the mammary glands. These processes are manifested by fatty transformation of the glandular tissue, which leads to a decrease in its quantity, as well as diffuse fibrosis of the breast tissue, which is manifested by an increase in echo density.

Sonographic symptoms of FCM

Glandular variant: ♦ glandular hyperplasia (thickening of the layer of glandular tissue from 15 to 33 mm); ♦ average echo density (28-30); ♦ absence of reverse involution phenomena. Cystic variant: ♦ thickness of glandular tissue layer 10 mm; ♦ increased echo density (37-35); ♦ presence of multiple small cysts. Fibrous variant: ♦ thickening of the layer of glandular tissue up to 16 mm; ♦ indicators of echo density are significantly increased (41-43). Mixed variant: ♦ thickening of the layer of glandular tissue up to 22 mm; ductectasia; ♦ there are no signs of age-related involution. Hyperplasia of the connective tissue of the mammary gland: ♦ the presence of stranded structures of irregular shape, high echo density, varying degrees of severity. Cysts are defined as echo-negative formations with clear contours, smooth edges, rounded shape,

homogeneous structure.

6. Puncture biopsy with cytological examination of aspirate is the main method for diagnosing the nature of breast neoplasms.

7. For special indications, a sectoral resection of the altered area and its histological examination are performed.

8. Thermography (thermal imaging). The method is based on the registration of infrared radiation using a special thermograph device (thermal imager). Thermography is used for differential diagnosis with palpable lesions. The temperature of the skin over a malignant tumor is 1.5-2.0 °C higher compared to the temperature of the skin over a benign formation and a symmetrical area of ​​the skin of a healthy mammary gland.

The scheme of management of patients with dishormonal dysplasia of the mammary glands

If a breast pathology is suspected, a further examination of the condition of the mammary gland is carried out. The most informative is a combination of diagnostic techniques called "triple test": clinical examination of the mammary glands; bilateral mammography; in the presence of volumetric formations, a fine-needle aspiration biopsy is performed under ultrasound control, followed by cytology.

Treatment of mastopathy

I. Conservative treatment.

They begin only after consulting an oncologist to exclude forms requiring surgical intervention (nodular form, the presence of calcifications in the gland tissue, proliferative changes in the epithelium of the mammary glands - after a puncture biopsy).

1. Gestagens are used to treat women of reproductive age, the course of treatment is 6-9 months. Gestagens regulate the conversion of active estradiol to less active estrone, inhibit proliferative processes by acting on growth factors, reduce cyclic edema of the connective tissue stroma of the breast by reducing capillary permeability. to the 25th day of the cycle; ♦ orgametril (linestrenol) 5 mg from the 16th to the 25th day of the cycle; ♦ pregnin 0.02 g (2 tablets) sublingually 3 times / day. from the 16th to the 25th day of the cycle;♦ progesterone: 1st treatment regimen: 10 mg (1 ml of 1% solution) IM from the 16th to the 25th day of the cycle (course dose - 100 mg) ; 2nd treatment regimen: 25 mg (1 ml of 2.5% solution) intramuscularly on the 21st, 23rd, 24th, 26th day of the cycle, (course dose 100 mg); ♦ 17-OPK- 125 mg (1 ml 12.5% ​​solution IM on the 17th and 21st days of the cycle (course dose 250 mg);

♦ utrozhestan - natural micronized progesterone for oral use. Apply 100 mg 2-3 times / day. from the 16th day of the menstrual cycle for 10-14 days 3-6 MC;

Algorithm for the treatment of women with benign diseases of the mammary glands

♦ duphaston (dydrogesterone) - an analogue of natural progesterone, does not have androgenic, thermogenic or corticoid activity; apply 20 mg from the 11th to the 25th day of the menstrual cycle; ♦ medroxoprogesterone acetate - 5-10 mg per day, from the 16th to the 25th day of the cycle;

♦ "Progestogel 1%" - a gel containing micronized progesterone is applied in 1 dose using a dispenser to the skin of the mammary glands 1 time / day. and rubbed until completely absorbed;

2. Antiestrogens The mechanism of action is based on competitive binding to estradiol receptors in breast tissue. ♦ Tamoxifen (Nolvadex) - prescribed 10-20 mg per day for 5-6 months;

♦ fareston (toremifene) - 10-20 mg per day for 3-6 months.

H. GtrH agonists cause a decrease in the frequency of pulsatile GnRH releases in the hypothalamus, have a direct effect on steroidogenesis in the ovaries, competitively binding a number of enzymes involved in the synthesis of steroid hormones, and inhibit the synthesis of LH and FSH in the pituitary gland. They are used after 45 years with combined endometrial hyperplasia, adenomyosis, uterine myoma.♦ Goserelin (zoladex). It is produced in the form of a special depot preparation - a rod (capsule) of a cylindrical shape, containing 3.6 or 10.8 mg of goserelin acetate, included in a polymer biodegrading matrix. Injected subcutaneously into the anterior wall of the abdomen - 3.6 mg 1 time per month for 2-4 months; ♦ triptorelin (decapeptyl, diferelin) - administered 525 mcg subcutaneously daily for 7 days, then at a maintenance dose (105 mcg) daily ♦ decapeptyl depot (1 syringe contains 3.75 mg triptorelin and a polymeric (depositing) filler) - administered subcutaneously or intramuscularly, 1 injection (3.75 mg) every 28 days; ♦ buserelin - administered subcutaneously 500 mcg 3 times / day, after 8 hours for 7 days. On the 8th day of treatment, they switch to intranasal administration of buserelin at a daily dose of 1.2 g (in 4 doses); ♦ nafarelin (sinarel) - spray for endonasal administration at a dose of 400 mg per day, in 2 doses;

♦ Leukoprolide (Lupron) - 3.75 mg IM once a month.

4. Dopamine receptor agonists The mechanism of action is based on the dopaminergic action of drugs, aimed at reducing the level of prolactin and regulating local hormone genesis in the tissues of the mammary glands. 4-6 cycles;

♦ dostinex - 1 tablet, 2 times a week, 3-6 months.

5. Androgens are used to treat women older than 45 years, the course of treatment is 8 months. ♦ Methyltestosterone 5-10 mg (1-2 tablets) from the 16th to the 25th day of the cycle;

♦ sustanon-250 (omnadren-250) - 1 ml intramuscularly once a month for 4-6 months.

6. Iodine preparations help to reduce the proliferative activity of tissues, have a positive effect on cysts and activate the function of the thyroid gland. They are used for a long time, 6-12 months with a break during menstruation. ♦ Potassium iodide - 10 ml of 0.25% solution 4 times / day; ♦ 5% tincture of iodine - 5 drops in milk 3 times / day; ♦ klamin (plant adaptogen, produced from the lipid complex of brown seaweed - kelp sugary and microcrystalline cellulose). One tablet contains 50 micrograms of iodine, 1 tab. 3 times / day;

♦ Iodomarin 200 mg 1 time / day.

7. Homeopathic preparations ♦ remens 10-15 drops in pure form or diluted in 1 tablespoon of water 3 times / day. before meals; ♦ mastodinone (15% alcohol solution with extracts from medicinal herbs: cyclamen, chilibukha, iris, tiger lily). Available in bottles of 50 and 100 ml. The mechanism of action is to reduce advanced level prolactin due to a dopaminergic effect. It is prescribed 30 drops in the morning and evening for at least 3 months without a break (regardless of the menstrual cycle);

♦ cyclodinone (17% alcohol solution with an extract from the fruit of the rod). Available in bottles of 50 and 100 ml. The mechanism of action is to reduce the elevated level of prolactin due to the dopaminergic effect and restore the balance of female sex hormones. It is prescribed 40 drops 1 time / day. (morning) for a long time.

8. Enzyme preparations have decongestant, anti-inflammatory, secondary analgesic and immunomodulatory effects, increase the production of α-interferon by leukocytes, have a resolving effect: ♦ Wobenzym - appoint 5 tablets. 3 times / day, 16-30 days;

♦ serta (serratiopeptidase) - 5 (10) mg, 3 times / day. after eating, without chewing. The course of treatment is from 2 to 4 weeks.

9. Phytotherapy in the treatment of mastopathy

Phytopreparation	Mode of application
Scarlet tree (agave)	Use aloe juice with honey in a ratio of 1: 2, 1 tsp each. 2-3 times / day.
Lesser duckweed	1 st. l. chopped herbs pour 1 cup boiling water, close, cool. Take V, glass 20-30 minutes before meals 3 times / day.
Veronica officinalis	Decoction: 2 tbsp. l. chopped herbs pour a glass of boiling water, cool. Take 1 tbsp. before meals.
Euphorbia Pallas	Alcohol tincture: 25-50 g of dry root pour 0.5 liters of vodka. Insist 3 weeks in a dark place. Take 7-10 drops 3 times / day. within 1-3 months.
Ferula Dzungarian	Tincture: 1 part root and 9 parts vodka. Insist 2-3 weeks in a dark place. Take 25-30 drops 3 times / day.
Kopeck tea	Tincture: 1 part crushed root and 9 parts vodka. Insist 2-3 weeks in a dark place. Take 20-30 drops 3 times / day.
Rhodiola rosea	Extract from roots and rhizomes (finished product). Assign inside 5-25 drops 2-3 times / day. 15-30 minutes before meals for 10-30 days
Aralia Manchurian	Tincture: Pour 1 part of the crushed root with 5 parts of boiling water, cool. Insist 3 weeks. Take 30 drops 3 times / day.
Calendula officinalis	Infusion: 1 tbsp. l flowers pour 1 cup boiling water, cool, take 1/3 cup 3 times / day.
pharmaceutical camomile	Infusion: 1 tbsp. l. flowers pour 1 cup boiling water, cool. Take 1/3 cup 3 times / day.
motherwort	Infusion: pour 15 g of flowers into 200 ml of boiling water, insist. Take 1/3 cup 3 times / day. 1 hour before meals.
Three-part series	Infusion: pour 10 g of herbs into 200 ml of water. Take 1/3 cup 3 times / day.
Eleutherococcus senticosus	Extract: (1 part of the rhizome and 1 part of 40% alcohol) - the finished product in 50 ml vials. Take 20 drops 30 minutes before meals.

Treatment of mastodynia

In the presence of mastodynia, the treatment of mastopathy should be supplemented with non-steroidal anti-inflammatory drugs (NSAIDs), diuretics and herbal remedies, starting from the 16th to the 25th day of the menstrual cycle.

The mechanism of action of NSAIDs is based on the inhibitory effect on the biosynthesis of prostaglandins, the stabilization of lysosomes.

Apply: indometaczh - 25 mg 3 times / day; ibuprofen (brufen) - 0.2 g 3 times / day; nimesulide - 100 mg 2 times / day, after a meal. The mechanism of action of diuretics is based on a decrease in the reabsorption of sodium and chloride ions in the proximal and distal parts of the convoluted tubules of the kidneys. .;♦ furosemide - 0.04 g 1 time / day. (in the morning).

Control examination after 3-6-12 months.

II. Operative treatment.

Fibroadenomas, intraductal papillomas and breast cysts are treated surgically. In case of fibroadenoma, it is necessary to perform a sectoral resection, and not exfoliation, since the excision of the tumor can lead to an increase in the proliferation process in the tissues adjacent to the fibroadenoma. Sectoral resection is aimed at removing fibroadenoma and mastopathy zone, which serves as a background.

Prevention of FCM

Primary prevention is to prevent smoking, alcohol consumption, overweight, physical inactivity, stressful situations, excessive solar exposure. The purpose of secondary prevention is the early detection of benign dyshormonal diseases of the mammary glands, timely correction of hormonal disorders.

Mastopathy is a dishormonal disease, which is characterized by pathological benign growth of breast tissue. It is of two types: nodular and diffuse. The first is diagnosed when a single seal (node) is formed in the mammary gland, and in the second, multiple nodes are formed with a predominance of a fibrous or cystic component. In this article, we will talk about diffuse form pathology.

Causes of the disease

Diffuse mastopathy of the mammary glands occurs as a result of a hormonal failure, in which there is an increased production of estrogens and a lack of progesterone in the female body. In order for the fair sex to be reproductively and physically healthy, hormonal balance must be observed. Violations occur due to many factors, the main of which are:

• pathology of the reproductive system (inflammation of the genital organs, especially infectious etiology);
• artificial termination of pregnancy (after conception, the glandular tissues of the mammary glands begin to prepare for feeding the child, and if this process is forcibly interrupted, then cystic or fibrous mastopathy will most likely develop);
• any endocrine pathologies (obesity, thyroid problems, diabetes mellitus);
• disorders of menstrual function, when the amount of hormones does not correspond to a certain phase of the cycle;
• forced cessation of breastfeeding;
• repetitive stress;
• drinking and smoking;
• sun tanning and tanning in a solarium, especially topless;
• hereditary predisposition.

Fibrous nature of the pathology

Diffuse fibrous mastopathy is an ailment in which fibrosis of the epithelial tissues of the mammary glands occurs and the formation of multiple intracanal tumors. In some cases, with this nature of the development of mastopathy, dysplasia and growth of the lobular structure of the mammary glands are possible, as well as the phenomena of fibrosis of the connective tissue, when cicatricial changes occur and seals form.

Fibrous mastopathy when probing the glands is characterized by severe pain. By palpation, seals can be detected in the form of small round or oblong formations of an elastic consistency. Signs of diffuse fibrous mastopathy, as a rule, appear with the onset of menstruation, and at its end they practically disappear. There may be constant discomfort, regardless of the phase of the cycle, as well as a feeling of fullness of the mammary glands, detection of uniform oblong seals when palpating the chest.

Fibrocystic nature of the pathology

Diffuse fibrocystic mastopathy is characterized by the growth of tissues of the glandular lobules and the formation of seals with clear boundaries within them. This form of the disease is most often found in women in one, or simultaneously in both mammary glands. Signs of fibrocystic mastopathy, as a rule, become noticeable after a hormonal disorder, as a result of which the periodicity of changes in the physiology of mammary gland tissues is disturbed. The disease can occur against the background of failures in the processes of menstruation and ovulation.

Diffuse fibrocystic mastopathy is manifested by the formation of tumors of various sizes in the glandular tissues (from 0.2 to 2-3 centimeters in diameter), which can be located locally or at a distance from each other. These seals are not soldered to the surrounding tissues, they are somewhat mobile on palpation. At the end of menstruation, cystic formations, as a rule, do not disappear, tumors increase in size from time to time and bring more and more discomfort.

Common symptoms of diffuse mastopathy

The main manifestations of the pathology are discharge from the nipples, pain in the mammary glands, the presence of seals in them and their increase in size. Painful sensations are usually aching or dull, can be given to the arm or under the shoulder blade. The nature of the pain can be constant or intermittent. In the premenstrual period, as a rule, the discomfort increases. In some women, pain may be absent, but when palpating the mammary glands, all the same signs are observed as in women who experience pain. In general, discomfort is caused by compression of diffuse formations and the involvement of nerve endings in the process of tissue sclerosis.

A woman may suspect that she has diffuse mastopathy during self-examination, when during palpation of the mammary glands, areas of seals with clear or fuzzy contours are felt. It is possible to increase the lymph nodes in the armpits and increase their sensitivity to pressure, but this symptom is not found in all women suffering from mastopathy.

Often, in the presence of a disease, the mammary glands increase in volume, which is caused by swelling of the connective tissue. At the same time, the increase can be very significant: by fifteen or more percent. This symptom is often accompanied by mastodynia and mastalgia.

Diffuse mastopathy can also be manifested by other signs, namely discomfort in the abdomen (flatulence, constipation, feeling of fullness), migraine-like headaches, fear, nervous irritability, anxiety. The complex of such changes is called premenstrual syndrome. As a rule, with the onset of menstruation, these symptoms disappear.

Another sign of mastopathy is scanty or copious discharge from the nipples that appears when pressed. Their color can be whitish, greenish, brown. There are clear discharges. It is most dangerous if blood is mixed with them - this indicates that diffuse fibrous mastopathy has been developing for a long time and is in an advanced stage.

Diagnostics

First, the doctor visually examines and palpation examines the mammary glands. Such an examination is best done in the first phase of the cycle, when menstrual flow stops, since the second phase is aggravated by premenstrual syndrome, and at this time false symptoms may occur. During an external examination, the specialist evaluates the symmetry of the mammary glands and the uniformity of the skin integument. Visual examination is carried out in a standing and lying state from different angles. The doctor should pay special attention to the peripheral lymph nodes.

Diffuse fibrous mastopathy of the mammary glands can be detected by ultrasound or mammography. With the cystic nature of the pathology, such diagnostic methods can also be useful. Ultrasound examination allows you to evaluate the tissue structure of the mammary glands and determine the type of formations, their location and size. Also, by means of ultrasound, nearby lymph nodes can be simultaneously examined.

Mammography involves taking x-rays of the mammary glands from different angles. This is a fairly effective diagnostic method, however, patients may have contraindications to it, for example, breastfeeding, pregnancy, young age of the subject. This procedure is not recommended to be performed more than once every two years.

Only after a comprehensive examination can a woman be diagnosed.

Diffuse mastopathy: how to treat?

Fibrous mastopathy, as well as fibrocystic, is treated with conservative methods. Doctors resort to surgical intervention only in the most advanced cases. Therapy begins with dietary and lifestyle changes. Various medications are also prescribed.

Non-hormonal treatment

To cure a disease such as diffuse mastopathy, use:

• Iodine-containing products, such as "Iodine-active", "Iodomarin", "Klamin". They reduce the proliferative activity of tissues and regulate the functioning of the thyroid gland. However, before using such drugs, you should always consult with an endocrinologist for contraindications (autoimmune thyroiditis, hyperthyroidism).
• Vitamin therapy. All patients, and especially those diagnosed with diffuse fibrocystic mastopathy, are shown to use vitamins of groups A, B, C, E for a long time.
• Calming agents, if the illness was caused by psychological problems. These include tinctures of motherwort, valerian and other plants.
• Non-steroidal anti-inflammatory drugs, for example, Diclofenac. They allow you to quickly eliminate the pain symptom, if any.
• Homeopathic remedies such as Mastodinon, Remens, Cyclodinon. When they are used in the blood, the level of prolactin decreases, due to which pathological processes in the mammary glands are eliminated. As a rule, such drugs are used for a long time.

hormone therapy

If diffuse-fibrous mastopathy is detected, treatment should be aimed at regulating changes in the cyclic nature in the hypothalamus-pituitary-ovaries system. By acting on the tissues of the mammary glands, it is possible to normalize the hormonal background. For these purposes, the following means are assigned:

• Gestagens. These include drugs "Utrozhestan", "Dufaston", "Norethisterone" and others. Such medicines should be taken in the second phase of the menstrual cycle. You can also use the external agent "Progestogel" for rubbing the chest.
• When hyperprolactinemia is detected, inhibitors of prolactin secretion are used, for example, Parlodel. They should be taken from the 10th to the 25th day of the cycle.

Women under 35 years of age with a fibrocystic nature of the pathology in violation of the luteal phase and the absence of ovulation can be prescribed oral estrogen-gestagenic contraceptives such as Marvelon, Zhanina (they must be taken according to the contraceptive scheme).

Diffuse fibrous mastopathy in women over 45 can be cured with the help of androgens, for example, the drug "Methyltestosterone", as well as antiestrogens, such as "Fareston", "Tamoxifen" (used for a three-month course in continuous mode). We must not forget that hormone therapy can only be started after a study of the hormonal status. Women after 40 years of age (and they are most often diagnosed with diffuse fibrous mastopathy) may be contraindicated in taking hormonal drugs.

Surgery

Surgical intervention in the fibrous nature of the pathology is almost never used. In some cases, it has to be resorted to with fibrocystic mastopathy. There can be two treatment options: sectoral resection, when the tumor is removed along with the breast sector, and enucleation, in other words, husking, when only the cysts themselves are removed.

Lifestyle

In addition to taking hormones, homeopathic remedies and vitamins, for recovery, women suffering from mastopathy should change their habitual lifestyle.

• Give up bad habits such as drinking and smoking.
• Limit consumption of tea, coffee, chocolate, cocoa. These products contain methylxaptins, which increase soreness and provoke the progression of the disease.
• Avoid stress, move more, sleep at least eight hours a day;
• include boiled meat, fish, vegetable products in the diet;
• Choose bras that are the right shape and size. Otherwise, chronic deformation of the mammary glands is possible.
• Refuse to visit the sauna, bath, solarium, prolonged sunbathing.

Diffuse mastopathy: treatment with folk remedies

Various means can be used to relieve the pain symptom. traditional medicine in the form of compresses. So, applying fresh cabbage leaves, grated red beets, burdock leaves to the chest will be effective. Such procedures help to ensure that the formations dissolve faster.

The pronounced pain that diffuse fibrous mastopathy provokes can be reduced by lubricating the mammary glands with burdock oil. The recipe is simple: you should take one part of the ground burdock root, combine it with three parts of olive oil, leave the mixture for ten days in a warm place, and then strain and use. The product can be stored in the refrigerator.

Many women say that drinking hemlock tea helps them get rid of the manifestations of mastopathy. Another proven remedy is an infusion of dill seeds, valerian root, chamomile flowers and peppermint. All ingredients are combined in equal parts (ten grams each) and poured with a glass of boiling water. Take this decoction three times a day for half a glass.

Please note that all of the above folk remedies the fight against mastopathy produce only a temporary analgesic effect. To eliminate the very cause of the development of the disease, you should undergo a course of drug treatment under the supervision of a specialist.

Prevention

The main method of preventing pathology is self-examination of the mammary glands. If you regularly palpate in the supine and standing positions, you will be able to detect changes at an early stage, contact a specialist in a timely manner and not start the disease. Self-examination is recommended to be performed approximately on the fifth or seventh day of the menstrual cycle. You need to start palpation from the axillary areas towards the nipples. Then examine the mammary glands from top to bottom (vertically). Carry out the palpation with soft movements. If during such manipulations you find any suspicious seals, immediately consult a doctor. Remember: the sooner treatment of mastopathy is started, the less significant its negative consequences will be.