Mastitis at menopause

Often, mastopathy phenomena alarm women because of possible malignant tumors, but one should not worry ahead of time, but rather undergo a comprehensive examination. Changes in the structure of milk ducts and the ratio of stroma to parenchyma can change with any hormonal changes, and especially during menopause. Mastopathy during menopause occurs very often, since hormonal changes affect not only the internal genital organs, but also other systems.

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Causes menopausal mastitis

When talking about the causes of menopause, it is necessary to understand the general hormonal changes in a woman's body during this period. During a normal menstrual cycle, there is a fluctuation of the main female steroid hormones, which change, and accordingly, these fluctuations cause changes in the entire body, including the work and structure of the mammary glands. In the first half of the cycle, progesterone predominates, which ensures the normal structure and functioning of the mammary gland outside the lactation period. When the level of estrogens increases, there is a slight increase in the volume of the stroma, which is sometimes felt as engorgement. But such a change occurs evenly and not intensively. During menopause, when there is no sufficiently constant concentration of hormones, such changes are slightly different.

There are some peculiarities in the development of the menopause period itself. This is explained by the fact that all changes must occur gradually with a change in the amount of hormones and corresponding reactions from the internal organs.

The climacteric period occurs in stages and is conventionally divided into:

1. premenopause – the period from 45 years to the onset of menopause;
2. menopause – the period of the last menstruation, average age is about fifty years;
3. postmenopause – the period from the last menstruation until the end of a woman’s life.

Each such period contributes not only to the involution of the uterus and ovaries, but also of the mammary gland. The mammary gland, as an organ, has a special structure. The parenchyma of the gland is represented by alveolar-tubular glands, which are collected in small particles. The entire parenchyma is in a connective tissue case, and when it comes to fibrocystic disease, that is, mastopathy, then in this case we are talking about connective tissue.

Premenopause is characterized by hormonal disorders, which are primarily of a central nature. There is an involution of the highest regulatory center - the hypothalamus, which is characterized by a gradual decrease in the sensitivity of the hypothalamus to the influence of estrogens, which disrupts its regulatory function according to the principle of feedback regulation. Normally, under the influence of pituitary hormones, proliferation of the epithelium of the mammary glands occurs, which in turn contributes to the normalization of the function and structure of the gland. With the involution of the menstrual dominant in the cerebral cortex, the production of oxytocin is suppressed, which is responsible for the proliferation of connective tissue, therefore, the process of normal differentiation of connective tissue elements is disrupted.

Another direct cause of mastopathy development is considered to be changes at the ovarian level. In this case, the most specific changes occur in the ovaries in the form of follicular atresia, destruction of membranes, death of oocytes and preservation of only the stroma. This, in turn, disrupts the feedback with the hypothalamus, which further increases the deficiency of estrogen and progesterone. Insufficient stimulation of the pituitary gland disrupts the secretion of follicle-stimulating and luteinizing hormones, which leads to a decrease in the amount of secreted estrogen. In addition to this, the number of sensitive special receptors to estrogens decreases in the stroma of the mammary gland, which contributes to the disruption of the processes of connective tissue proliferation. At the same time, the number of benign mitoses in the connective tissue cell increases, which leads to an increase in the volume and number of such cells. This process is called hyperplasia. In this case, if the influence of hormones is preserved, then this hyperplasia is uniform, that is, diffuse. If hormones act on certain sensitive receptors that still remain, then cell proliferation occurs in only one place, which causes nodular hyperplasia. This is the main pathogenetic mechanism for the development of these changes in the mammary gland, which determines the features of the clinical picture.

Thus, speaking about the cause and pathogenesis of mastopathy development during menopause, the initial role must be allocated to the hormone deficiency, which is observed during menopause. In addition, a vicious circle arises, in which the hormone deficiency is combined with a decrease in the sensitivity of receptors to it. Therefore, taking into account these factors, it is necessary to treat such pathology.

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Risk factors

It is also necessary to highlight the risk factors in which this pathology is observed more frequently during menopause. These include:

• Early onset of menarche in a girl.
• A large number of pregnancies.
• Late childbirth in a woman over thirty years of age, especially if this is her first pregnancy and childbirth.
• Lack of prolonged breastfeeding.
• Disorders of the ovariomenstrual cycle of any nature.
• Concomitant premorbid conditions such as excess weight or diabetes.
• Concomitant hyperplastic processes of the genital organs in the form of endometriosis, uterine fibroids, cervical polyps.

Given these factors, it is necessary to take into account any disturbances in the structure of the gland during menopause and conduct regular self-examination, since mastopathy has a benign course only at the beginning of the disease.

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Symptoms menopausal mastitis

Mastopathy is a benign process in the breast tissue. This pathology is also called fibrocystic disease or dysplasia. At the same time, the clinical picture of such a process often has no pronounced symptoms, which is accompanied by the fact that the risk of complications increases and the pathology is detected late. Therefore, you need to know the main signs of this disease in order to see a doctor in a timely manner, because, like any other pathology, mastopathy responds well to treatment in the early stages of development.

Often, the onset of mastopathy development is asymptomatic, since menopause hides many clinical manifestations that come to the fore. In premenopause, when there are still menstruations, but they become less regular, only then does the process of mastopathy development begin. At the same time, the woman does not feel any symptoms associated with breast dysplasia. When the changes are more pronounced, then symptoms may appear. A woman can accidentally detect the first signs of mastopathy during menopause during self-examination or during hygiene procedures. In this case, you can palpate a change in the structure of the gland in the form of small seals or point granular structures, and the node may also be larger in volume. Any such change causes concern and the woman consults a doctor.

Other symptoms of mastopathy may also appear over time. A feeling of heaviness in the chest very often accompanies this condition, as well as a feeling of engorgement of the glands. This occurs due to the fact that the volume of connective tissue increases, which presses on the milk ducts and nerve endings and causes such an uncomfortable sensation. The extreme degree of this symptom can be soreness of the gland. In this case, the pain is often diffuse, not local, and not constant, occurs during palpation. This also occurs due to compression of the nerve fibers of the mammary gland. Mastodynia is accompanied by other symptoms in the form of a high-intensity headache, swelling of the mammary gland, dyspeptic manifestations, anxiety, a feeling of fear.

Other symptoms that appear with mastopathy during menopause are the secretion of milk from the gland. There may be small drops of milk that are involuntarily secreted from the nipple, but this symptom must be carefully taken into account and differential diagnostics must be carried out with other possible more serious pathologies. Other symptoms are observed less often - an increase in the volume of the breast, its pastosity, darkening of the nipple. The secretion of milk from the nipples can also be the first sign of the disease, which often occurs due to hyperprolactinemia. An increase in body temperature with mastopathy is not typical, more often it is a sign of a secondary infectious process in the gland, so this symptom is an important diagnostic sign.

Forms

There are some features of the symptoms of different types of mastopathy. There are several main types - fibrous, fibrocystic and nodular forms. Fibrous mastopathy during menopause is characterized by uniform diffuse distribution of connective tissue. In this case, the entire mammary gland increases in size and becomes dense. Fibrocystic mastopathy during menopause develops as a result of a local disruption of the processes of proliferation of connective tissue cells, which is accompanied by local changes in the form of an increase in the mass of the interstitium with the simultaneous formation of cysts of varying size and quantity. Cysts are formed with local expansion of the milk ducts with the accumulation of fluid inside. In this case, this type of mastopathy manifests itself as a sensation of small bubbles against the background of compacted tissue or may be a nodule against the background of an unchanged gland.

It is important to know these basic symptoms, because when conducting a self-examination they can be very informative for establishing a diagnosis and promptly contacting a doctor.

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Complications and consequences

The consequences of mastopathy during menopause can be very serious, since it is a predisposing factor for the development of malignancy. Therefore, the severity of this condition and the importance of timely diagnosis increase. The risk of malignancy is especially high in nodular forms of mastopathy, so their treatment tactics are slightly different. Complications that can occur with mastopathy are mainly associated with possible secondary infectious lesions. Therefore, you should pay attention to the appearance of symptoms of intoxication and an increase in body temperature with mastopathy.

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Diagnostics menopausal mastitis

It is very important to establish a correct diagnosis of mastopathy in time with timely treatment of the pathology, while the treatment methods at the initial stage can still be conservative. Often, a woman seeks help herself when the first symptoms are detected. Therefore, it is necessary to note the important role of a preventive examination of a woman, which she should conduct herself, especially with the onset of menopause, when hormonal imbalance increases the risk of developing mastopathy. If a woman has come with specific complaints, then it is necessary to begin diagnostics with a thorough collection of anamnesis. It is necessary to find out when such symptoms first appeared and whether this is associated with a delay in menstruation. It is necessary to find out whether the symptoms changed depending on the situation and whether the breasts became larger or smaller, and also to detail the patient's complaints.

Examination of the mammary glands is of great importance in making a diagnosis. Palpation and examination of the mammary glands is carried out in three positions - lying on the back, lying on the side and in an upright position. During the examination, the symmetry of the mammary glands, their configuration, shape, contours, the presence of deformation, the color of the nipple and areola are determined. If the areola has a very intense brown color, this indicates a high level of estrogens, which rarely happens during menopause, but must also be taken into account when conducting treatment. If the nipple and areola are pale pink, this indicates a lack of estrogens during menopause. During examination, signs of mastopathy may be the position of the mammary glands at different levels, the presence of one or more compacted areas with clear contours. During palpation, the stringiness of the glandular tissue, fine granularity, and compactions of different sizes are determined. It is imperative to examine the regional lymph nodes, they are not changed in mastopathy. When examining the skin of the breast, its elasticity is revealed, there is no hyperemia.

During the examination by a gynecologist, specific signs of climacteric hypoestrogenemia are revealed, which confirms the etiology of mastopathy. At the same time, the mucous membrane of the genitals is dry, there is an insufficient number of folds on the vagina, and pigmentation is poorly expressed.

Such a comprehensive examination of a woman with palpation of the mammary gland in more than 80% of cases allows establishing a presumptive diagnosis. Further, it is necessary to conduct additional research methods.

The tests that are necessary to clarify the diagnosis are general clinical and special. General tests are blood tests, biochemical blood tests with lipidogram and kidney function indicators, and urine tests. This is necessary to exclude somatic pathology and monitor the patient's condition. Special tests are determination of the level of female sex hormones, which is necessary to prescribe treatment.

Instrumental diagnostics of mastopathy during menopause is widely used not only for diagnostics, but also for differential diagnostics. A mandatory research method is mammography. This method allows to establish a diagnosis with an accuracy of more than 95%. This research method is based on the X-ray principle of operation. In this case, in the case of mastopathy, it is possible to determine a violation of the normal pattern of the organ structure, alternation of areas of enlightenment and darkening of various shapes and sizes in conjunction with dense fibrous strands. In nodular forms, local nodular changes are determined on the mammogram. Ultrasound examination is also carried out among instrumental diagnostic methods, but it is inferior in information content to mammography. On ultrasound, diffuse or local changes can be seen, but if the process is localized behind the areola or deep in the retromammary space, then ultrasound is uninformative, although less harmful.

Sometimes it is necessary to conduct more informative research methods - this is a Doppler study, which allows you to determine the blood circulation in the gland tissue. In the case of mastopathy during menopause, namely its nodular form, the absence of vascularization of this focus is determined.

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Differential diagnosis

Sometimes, to verify the diagnosis and for the purpose of differential diagnostics, it is necessary to perform a puncture biopsy with cytological examination. In this case, the nature of the cells, the presence of atypia among them and the exact nature of the process are determined.

It is very important to conduct differential diagnostics of mastopathy during menopause with other malignant tumors of the mammary gland, so as not to be late with treatment. Differential diagnostics can be done without cytological examination. In this case, malignant tumors are detected during examination in the form of gross violations of the gland configuration, its unevenness, the skin can be changed, retracted or can look like lemon peel. In case of a malignant tumor, local pain is determined by palpation, the contours of the tumor are unclear, the lymph nodes are always involved in the process. The nipple or skin above the tumor is thickened, can be retracted. There are also differential signs of malignant tumors that can be identified by X-ray. In this case, the shape of the tumor is unclear, its contours are uneven, there may be small calcifications inside, the pattern of the entire mammary gland is atypical, there is a path to the nipple or skin, and vascularization may also be increased. Such signs allow for a clear differential diagnosis of mastopathy with malignant tumors of the mammary gland, and one should not forget the anamnestic data regarding the onset of the process and its connection with menopause.

Treatment menopausal mastitis

Treatment of mastopathy should be based on a clear clinical diagnosis, as well as anamnesis data, gynecological and hormonal examination. There are drug and non-drug treatments. Drug treatments should be aimed primarily at correcting hormonal disorders. Non-drug treatment also uses herbal preparations, folk remedies and homeopathic remedies, which are also aimed at normalizing the emotional state.

The pathogenetic approach to the treatment of mastopathy during menopause is the basis of the treatment plan. It involves the use of general recommendations and hormonal therapy. The goal of such treatment is to normalize metabolism, immune and hormonal status, as well as correct the accompanying symptoms of menopause. Long-term conservative therapy helps to significantly reduce the risk of malignancy.

The basic principles of drug treatment of this pathology are not limited to hormone replacement therapy alone, but it is also necessary to change your lifestyle.

1. It is necessary to ensure mental and sexual comfort.
2. Diet correction – it is necessary to limit the intake of animal fats, extractive substances, coffee, strong tea. It is necessary to eat food of dairy and vegetable composition, the meals should be fractional, the daily volume of fruits and vegetables should be at least 300 grams and it is necessary to observe the drinking regime and drink clean water at least 1.5 liters.
3. Normalization of sleep by means of a regimen of rest – it is necessary to go to bed at about the same time, to sleep at least 8-9 hours a day. It is necessary to carry out hygienic measures in the room where the woman sleeps – wet cleaning, airing, fresh linen – all this contributes to the normalization of the level of hormones and its regulation by higher nervous activity.
4. Correction of the daily routine with normalization of the rest and work periods. It is necessary to precisely establish a rest regime after each work. This will help the body to distribute forces correctly and relieve stress while maintaining emotional stability and less pronounced symptoms.

One of the most important pathogenetic methods of treating mastopathy during menopause is the appointment of hormone replacement therapy. This should be done only after screening the hormonal background. The main drugs should be combined, since it is also necessary to take into account the state of menopause and correct its other symptoms.

1. Triziston is a complex hormone replacement drug. The principle of action is to regulate hormone levels, which in turn increases the regulation of connective tissue cell proliferation processes with normalization of the structure of the mammary gland. This drug is available in the pharmacological form of tablets of three colors, which are used in a special course every seven days a different tablet, then a break for a week. The course of treatment is at least three to six months. Contraindications for prescribing the drug are malignant tumors of any localization, vascular pathology in the form of thromboembolism in the past, hepatitis. It should be used with caution in diabetes mellitus, since the drug can change glucose tolerance, as well as in arterial hypertension. Side effects may appear in the form of cholestasis, liver dysfunction, embolism, as well as allergic and dyspeptic reactions.
2. Logest is a drug containing estradiol and gestagen, is a high-dose drug, due to which its preventive role is manifested not only in the correction of hormonal levels, but also in the prevention of oncological diseases of the female reproductive system, which further reduces the risk of malignant transformation. The drug helps to level out hormonal imbalance and due to this, diffuse involution of connective tissue in the stroma of the organ occurs. Logest is available in the pharmacological form of capsules, containing 21 pieces per package. The intake should be started on the first day of the cycle. You can start taking it on the fifth day of the menstrual cycle in case of menopause in a woman. The course of admission is one capsule per day for three weeks, then a break of seven days, then you need to resume taking it. Side effects are possible from the gastrointestinal tract in the form of stool disorders, nausea, a feeling of bitterness in the mouth, vomiting. There may also be asthenovegetative reactions, manifestations of hormonal treatment from the breast in the form of engorgement of the mammary gland, soreness, discharge, and increased vaginal secretion. Contraindications to the use of the drug for treatment are problems with blood clotting and a history of heart attack or stroke, malignant neoplasms, severe liver damage, pancreatic damage, and diabetes.

Drugs from other groups are also used.

Gonadotropin-releasing factor agonists, of which Diphereline or Triptorelin is a representative, are used from the 3rd day of the menstrual cycle for six months at 3.75 milligrams.

• Goserelin - is used for six months at 3.6 milligrams subcutaneously.
• Buserelin – 200 micrograms in the nose twice a day for a six-month course.
• Zoladex – from the 1st to the 5th day of the cycle by injection.

Gonadotropic hormone antagonists, a representative of which is the drug Danazol, are used at 400-800 milligrams per day, also with a course of treatment for six months.

Progesterone series drugs are various drugs that are able to regulate the ovariomenstrual cycle in case of insufficiency of its second luteal phase of the cycle. The main representatives of this series are:

• Norethisterone acetate – is used from the fifth day of the menstrual cycle, 5-10 milligrams twice a day for six months.
• Medroxyprogesterone acetate is used in the same dose and for the same course.
• The Mirena system is an intrauterine device that is inserted for five years with monitoring of its condition.
• Norcolut and Primolut are drugs that are used from the 16th to the 25th day of the menstrual cycle for three to six months.

Antiestrogenic drugs:

• Tamoxifen - taken 10 milligrams once a day, the course of treatment is 4-8 months
• Fareston is taken at 30 milligrams per day and has a pronounced proven effect in the treatment of proliferative forms of mastopathy.

Surgical treatment is used in most cases of nodular mastopathy, since the risk of malignancy increases. The scope of surgical intervention depends on the size of the mastopathy and the localization of the node. Now they try to reduce the scope of surgical intervention and not perform sectoral resection, since this is a very traumatic operation. Therefore, in most cases, they limit themselves to excisional biopsy of the node without removing tissue, which allows for morphological verification of the diagnosis. Only after this is the issue of radical surgical intervention and the scope of the operation decided. Therefore, each case is discussed individually.

Traditional treatment of mastopathy during menopause

The use of folk methods of treating mastopathy during menopause is very widespread, but such treatment should be carried out in combination with the main methods, since its effect may be less useful than possible complications. Such methods can also be used after surgery to prevent relapses. The drugs that are used are aimed mainly at correcting hormonal homeostasis and the antiproliferative effect. For this, folk remedies and herbal treatment are used. The main folk methods are:

1. An effective way to normalize hormonal levels is to use walnut shells. Walnut tincture is prepared as follows: the membranes or shells are boiled for about five minutes in hot water, then the water is drained and half a glass of alcohol is poured in. This solution needs to be infused for about five to seven days, after which it can be taken one teaspoon twice a day, pre-diluted with boiled water in equal proportions. The course of treatment is three weeks.
2. Aloe contains a huge amount of vitamins B, C, A, E; amino acids; carotenoids; phytoncides; tannins; flavonoids; calcium, phosphorus, chlorine, magnesium, zinc, bromine, iodine. Aloe leaves, which have a pronounced anti-inflammatory, regenerating and antiproliferative effect, are squeezed into a glass and, having wetted a part of the gauze, make lotions or compresses at night, applying to the enlarged breast or to the node.
3. Honey has the ability to increase local immunity, stimulates tissue regeneration and helps reduce hyperplasia. To create a medicine from honey, you need to take a tablespoon of honey, add five drops of linseed oil and you can add aloe juice. Apply this solution to gauze and also make a compress at night, repeat for 10 days, after which mastopathy should decrease.
4. Herbal decoction of currant leaves, nettle, burdock and meadowsweet - take a tablespoon of each herb, steam in hot water and leave for 20 minutes. It is necessary to take such a decoction half a glass on an empty stomach every day for at least two months to get the effect. Such a drink reduces the number of proliferating stromal cells.

Homeopathic remedies are also used to treat this pathology. Their main effect is aimed at regulating normal hormonal levels, which helps reduce the size of mastopathy.

The main homeopathic remedies are:

1. Klimakt-Hel is a homeopathic remedy that has a composition similar to phytoestrogen drugs and helps to normalize hormonal levels during menopause. The drug also reduces proliferative processes at the cellular level. Klimaktoplan is used in tablets, one tablet before meals or an hour after three times a day. The course of treatment with the drug is long - about two months. No side effects have been identified. Contraindications to taking Klimakt-Hel are hypersensitivity to the components of the drug.
2. Gineko-Hel is a combined homeopathic remedy that has an effect on menopause disorders by normalizing the synthesis of estrogen and progesterone, which helps reduce the effects of deficiency of these hormones. The drug is available in drops and is dosed ten drops three times a day, can be dissolved in water or taken as a pure solution. Side effects are rare, but stool disorders, dyspeptic phenomena and allergic reactions may occur. No contraindications have been identified.
3. Cyclodinone is a combined homeopathic remedy that affects hormonal imbalances and restores estrogen deficiency. This drug is available in the pharmacological form of drops and tablets. You need to take one tablet per day, preferably in the morning, or 40 drops with the same frequency. The duration of treatment is about three months. Contraindications to taking Cyclodinone are acute infectious processes in the body.

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Prevention

Prevention of this disease consists of early diagnosis of the pathology and timely treatment with prevention of complications. Therefore, every woman should undergo screening at a women's mammology office. During the onset of menopause, you need to contact a gynecologist, and he will tell you about possible changes in the woman's body during this period and about the methods of diagnosing such conditions. It is very important to conduct self-examination of the mammary glands, especially after the onset of menopause. Also, as a screening, women after 35 years old need to undergo mammography.

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Forecast

The prognosis for recovery from mastopathy is favorable in case of detection of initial changes and early treatment. However, given the high risk of malignancy, it is necessary to monitor such patients and adjust treatment. In the presence of a nodular form of mastopathy, the risk of malignancy is higher, so the prognosis depends on timely surgical treatment.

Mastopathy during menopause is a very serious condition that can be asymptomatic, but there may be signs that should be taken into account. Treatment of this pathology can be conservative and surgical, depending on the form and extent of changes. The danger of malignancy of mastopathy proves the importance of timely treatment, but you should not be upset, because this diagnosis can be easily controlled.

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