Mastopathy with menopause

Often, the phenomenon of mastopathy alarms women because of possible malignant formations, but should not be experienced ahead of time, but should be examined in a comprehensive manner. Changes in the structure of the dairy duct and the relationship of the stroma with the parenchyma may change with any hormonal changes, and especially during the menopause. Mastopathy with menopause happens very often, because hormonal changes affect not only the internal sexual organs, but also other systems.

[1], [2], [3]

Causes of the mastopathy with menopause

Speaking about the causes of menopause development it is necessary to understand the general hormonal changes in the body of a woman during this period. During the normal menstrual cycle, there is a fluctuation in the main female steroid hormones that change, and accordingly these changes occur throughout the body, including the work and structure of the mammary glands. The first half of the cycle is dominated by progesterone, which ensures the normal structure and functioning of the mammary gland outside the lactation period. When the level of estrogen rises, there is a slight increase in the volume of the stroma, which sometimes feels like nagging. But such a change occurs evenly and not intensively. With menopause, when there is not enough constant concentration of hormones, such changes are slightly different.

There are some features in the development of the menopause itself. This is due to the fact that all changes should occur gradually with a change in the amount of hormones and the corresponding reactions from the internal organs.

The climacteric period proceeds in stages and is conditionally divided:

1. premenopause - the period from 45 years to the onset of menopause;
2. Menopause is the period of the last menstruation, the average age is about fifty years;
3. Postmenopause - the period from the last menstruation to the end of a woman's life.

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

Premenopause is characterized by hormonal disorders, which are primarily central. There is an involution of the higher regulatory center - the hypothalamus, which is characterized by a gradual decrease in the sensitivity of the hypothalamus to the effect of estrogens, which violates its regulatory function by the principle of reverse regulation. Normally, under the influence of pituitary hormones, proliferation of the mammary gland epithelium occurs, which in turn helps normalize the function and structure of the gland. With the involution of the menstrual dominant in the cerebral cortex, inhibition of the production of oxytocin occurs, which is responsible for the proliferation of connective tissue, and therefore the process of normal differentiation of connective tissue elements is disrupted.

Another direct cause of development of mastopathy is considered changes at the level of the ovaries. In the ovaries, the most specific changes occur in the form of atresia of the follicles, the destruction of the membranes, the death of oocytes and the preservation of only the stroma. This, in turn, disrupts the feedback from the hypothalamus, which increases the deficiency of estrogen and progesterone more. Insufficient stimulation of the pituitary gland disrupts the release of follicle-stimulating and luteinizing hormones, which leads to a decrease in the amount of secreting estrogen. In addition, the number of sensitive special receptors to estrogens decreases in the stroma of the mammary gland, which contributes to the violation of the proliferation of connective tissue. This increases the number of benign mitoses in the cell of connective tissue, which leads to an increase in the volume and number of such cells. This process is called hyperplasia. At the same time, if the influence of hormones is maintained, this hyperplasia is uniform, that is, diffuse. In the event that hormones act on certain sensitive receptors that are still there, then cells proliferate only in 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 of the cause and pathogenesis of the development of mastopathy in menopause, the initial role should be allocated to the hormone deficiency that occurs in menopause. In addition, there is a vicious circle, in which the hormone deficiency is combined with a decrease in receptor sensitivity to it. Therefore, taking into account these factors, it is necessary to conduct treatment of such pathology.

[4],

Risk factors

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

• Early offensive menarche at the girl.
• A large number of pregnancies.
• Late childbirth in a woman over the age of thirty, especially if this is the first pregnancy and childbirth.
• Lack of prolonged breastfeeding.
• Violations ovario-menstrual cycle of any nature.
• Concomitant premorbid conditions in the form of excess weight or diabetes.
• Concomitant hyperplastic processes of genital organs in the form of endometriosis, uterine myomas, cervical polyps.

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

[5], [6], [7]

Symptoms of the mastopathy with menopause

Mastopathy is a benign process in the breast tissue. This pathology still has the name of fibrocystic disease or dysplasia. In this case, the clinical picture of this process often does not have severe symptoms, which is accompanied by the fact that the risk of complications increases and pathology is detected late. Therefore, you need to know the main signs of this disease for a timely call to the doctor, because like any other pathology, mastopathy is well treatable at early stages of development.

Often the onset of mastopathy is asymptomatic, as the menopause conceals behind it many clinical manifestations that come to the fore. In the pre-menopause, when there is still menstruation, but they become not so regular, only then does the process of development of mastopathy begin. However, the woman does not feel any symptoms associated with breast dysplasia. When the changes are more pronounced, then symptoms may appear. The first signs of mastopathy during menopause can be detected by a woman accidentally during self-examination or during hygienic procedures. In this case, it is possible to palpate the change in the structure of the gland in the form of small seals or dotted granular structures, and the node can also be of larger volume. Any such change causes anxiety and the woman turns to the doctor.

Other symptoms of mastopathy may also appear with time. The feeling of heaviness in the chest very often accompanies this condition, as well as the feeling of engorgement of the glands. This is 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 the soreness of the gland. In this case, the pain is more often diffuse, not local, and not constant, occurs when palpation. This also arises from the compression of the nerve fibers of the breast. Mastodinia is accompanied by other symptoms in the form of a headache of high intensity, swelling of the breast, dyspeptic manifestations, anxiety, a sense of fear.

Other symptoms that appear in mastopathy during the menopause are the discharge of milk from the gland. There may be small drops of milk that are involuntarily released from the nipple, but this symptom must be carefully taken into account and differential diagnosis performed with other possible more serious pathologies. Less common are other symptoms - breast enlargement in volume, her pastosity, darkening of the nipple. Isolation of milk from the nipple may be the first sign of the disease, which often occurs due to hyperprolactinaemia. The increase in body temperature with mastopathy is not typical, it is often 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 various types of mastopathy. There are several main types - fibrous, fibro-cystic and nodal form. Fibrous mastopathy in menopause is characterized by a uniform diffuse spread of connective tissue. Moreover, the mammary gland all increases in size and becomes dense. Fibrocystic mastopathy in menopause develops as a result of local disturbance of proliferation of cells of connective tissue, which is accompanied by local changes in the form of an increase in mass of interstitium with the simultaneous formation of cysts of varying size and quantity. Cysts are formed by local expansion of milk ducts with accumulation inside the fluid. In this case, this type of mastopathy manifests itself in the form of a sensation of small vesicles against the background of densified tissue, or it may be the nature of the node against the background of the unchanged gland.

It is necessary to know these basic symptoms, since during self-examination they can become very informative in order to establish a diagnosis and timely contact with a doctor.

[8], [9], [10], [11]

Complications and consequences

The consequences of mastitis in menopause can be very serious, as this is a predisposing factor in the development of malignancy. Therefore, the seriousness of this condition and the importance of timely diagnosis increase. Especially the risk of malignancy is high with nodal forms of mastopathy, so the tactics of their treatment are slightly different. Complications that may occur in mastopathy are mainly associated with possible secondary infectious lesions. Therefore, one should pay attention to the appearance of symptoms of intoxication and an increase in body temperature in case of mastopathy.

[12]

Diagnostics of the mastopathy with menopause

It is very important to correctly diagnose mastopathy with timely treatment of pathology in time, while the methods of treatment at the initial stage can still be conservative. Often a woman herself turns when she finds the first symptoms. Therefore, it is important to note the important role of conducting a preventive examination of a woman, which she must conduct herself, especially with the onset of menopause, when hormonal imbalance increases the risk of developing mastopathy. If the woman has addressed with concrete complaints then it is necessary to begin diagnostics with careful gathering of the anamnesis. It is necessary to find out when these symptoms first appeared and whether it is associated with a delay in menstruation. It is necessary to find out whether the symptoms varied depending on the situation and whether the breasts became larger or smaller, and also to detail the patient's complaints.

Inspection of the mammary glands is very important in determining the diagnosis. Palpation and examination of the mammary glands is carried out in three positions - lying on the back, lying on its side and in an upright position. When examined, the symmetry of the mammary glands is determined, their configuration, shape, contours, the presence of deformation, the color of the nipple and areola. If the areola has a very intense brown color, this indicates a high level of estrogen, which is rare in menopause, but it must also be taken into account in the course of treatment. If the nipple and areola are pale pink, this indicates the lack of estrogen in menopause. When examined, the signs of mastopathy can be the position of the mammary glands at different levels, the presence of one or several densified areas with clear contours. When palpation is determined by the tightness of the gland tissue, fine granularity, seals of different sizes. It is necessary to investigate regional lymph nodes, they are not changed during mastopathy. When examining the skin of the breast, its elasticity is revealed, there is no hyperemia.

When examining a gynecologist, specific signs of climacteric hypoestrogenemia are revealed, which confirms the etiology of mastopathy. At the same time, the mucous membrane of the genital organs is dry, there are not enough folds on the vagina, and pigmentation is poorly expressed.

Such a comprehensive examination of a woman with palpation of the breast in more than 80% of cases allows you to establish a presumptive diagnosis. Further it is necessary to conduct additional methods of investigation.

Analyzes that are necessary to clarify the diagnosis are general clinical and special. General - a blood test, a biochemical blood test with a lipidogram and indicators of kidney function, urine analysis. This is necessary to eliminate somatic pathology and control the patient's condition. Special tests are the determination of the level of female sex hormones, which is necessary for the purpose of treatment.

Instrumental diagnosis of mastopathy with menopause has a wide use for the purpose of not only diagnosing, but also differential diagnosis. Conduct an obligatory method of research - mammography. This method allows you to establish a diagnosis with an accuracy of more than 95%. This is a research method 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 the areas of enlightenment and darkening of various shapes and sizes in conjunction with dense fibrous strands. With nodal forms on the mammogram, local nodal changes are determined. Also among the instrumental methods of diagnosis, ultrasound is performed, but it is inferior to mammography in informative value. On ultrasound, diffuse or local changes can be seen, but if the process is localized behind the areola or deep in the retro-matic space, then ultrasound is not informative, although less harmful.

Sometimes there is a need for more informative methods of research - this is a Doppler study that allows you to establish blood circulation in the gland tissue. In the case of mastopathy with menopause, namely its nodal form, the lack of vascularization of the focus is determined.

[13], [14], [15]

Differential diagnosis

Sometimes, in order to verify the diagnosis and for the purpose of differential diagnosis, it is necessary to perform a puncture biopsy with a cytological examination. This determines the nature of the cells, the presence of atypia among them and the exact nature of the process.

It is very important to conduct differential diagnosis of mastopathy with menopause with other malignant forms of the breast, so as not to be late with treatment. Differential diagnostics can also be performed without a cytological examination. At the same time, malignant formations are revealed in the form of gross violations of the gland configuration, its irregularities, the skin can be changed, retracted or may look like a lemon peel. At palpation in the case of malignant formation, local soreness is determined, the contours of formation are unclear, the lymph nodes are always involved in the process. The nipple or skin over the formation is thickened, can be retracted. There are also differential signs of malignant tumors that can be identified by X-ray. At the same time, the form of education is fuzzy, its outlines are uneven, there may be small calcifications inside, a drawing of the whole breast atypical, there is a path to the nipple or skin, and vascularization can be increased. Such signs make it possible to conduct a differential diagnosis of mastopathy with malignant formations of the mammary gland, as well as anamnestic data on the onset of the process and its connection with menopause.

Treatment of the mastopathy with menopause

Treatment of mastopathy should be based on a clear clinical diagnosis, as well as data of anamnesis, gynecological and hormonal examination. There are medicamentous and non-medicamentous methods of treatment. Medication methods of treatment should be directed mainly to the correction of hormonal disorders. Non-drug treatment also uses herbal remedies, alternative drugs and homeopathic remedies, which are also aimed at normalizing the emotional state.

The pathogenetic approach to the treatment of mastopathy in menopause is the basis of the treatment plan. It provides for the use of general recommendations and hormone therapy. The goal of such treatment is the normalization of metabolism, immune and hormonal status, as well as correction of concomitant symptoms of menopause. Long-term conservative therapy contributes to a significant reduction in the threat of malignancy.

The main principles of drug treatment of this pathology are not limited to hormone replacement therapy, but it is also necessary to change the way of life.

1. It is necessary to provide mental and sexual comfort.
2. Correction of the diet - you need to limit the intake of animal fats, extractives, coffee, strong tea. It is necessary to take milk and vegetable food, the food should be fractional, the daily volume of fruits and vegetables should be at least 300 grams and should be observed drinking regime and drinking clean water at least 1.5 liters.
3. Normalization of sleep by means of a rest - you need to go to bed at about the same time, sleep at least 8-9 hours a day. It is necessary to carry out hygiene measures in the room where the woman sleeps - wet cleaning, ventilation, fresh linen - all this contributes to the normalization of the level of hormones and its regulation by higher nervous activity.
4. Correction of the regime of the day with the normalization of the period of rest and work. It is necessary to establish exactly the rest regime after each labor. This will help the body correctly distribute forces and relieve tension while maintaining emotional stability and less severity of symptoms.

One of the most important pathogenetic methods of treatment of mastopathy in menopause is the appointment of hormone replacement therapy. This should be done only after screening for the hormonal background. The main drugs should be combined, because the status of menopause should be taken into account and other symptoms should be corrected.

1. Triziston is a complex hormone replacement. The principle of action is to regulate the level of hormones, which in turn increases the regulation of the proliferation of connective tissue cells with the normalization of the structure of the breast. This drug is released in pharmacological form of three colors tablets, which are applied at a special rate every seven days, a different tablet, then break for a week. The course of treatment is not less than three to six months. Contraindications for the prescription of the drug are malignant formations of any localization, the pathology of the vessels in the form of thromboembolism in the past, hepatitis. It should be used with caution in diabetes, because the drug can change glucose tolerance, as well as with hypertension. Side effects can appear in the form of cholestasis, impaired liver function, embolism, as well as allergic and dyspeptic reactions.
2. Logest is a preparation containing estradiol and gestagen in its composition, it is a highly dosed drug, due to which its prophylactic role is manifested not only in the correction of the hormonal background, but also in the prevention of cancer of the female reproductive system, which further reduces the risk of malignant transformation. The drug helps to equalize the hormonal inconsistency and due to this there is a diffuse involution of connective tissue in the stroma of the organ. Logest is produced in the pharmacological form of capsules, containing 21 pieces per package. The reception must start from the first day of the cycle. You can begin to receive and the fifth day of the menstrual cycle in the case of menopause in women. The course of admission is one capsule per day for three weeks, then a break of seven days, then you need to resume reception. Adverse events are possible on the part of the digestive tract in the form of a stool, nausea, a feeling of bitterness in the mouth, vomiting. There may also be asthenovegetative reactions, manifestations of hormonal treatment from the side of the breast in the form of engorgement of the breast, soreness, secretions, as well as an increase in the secretion of the vaginal secretion. Contraindication to the use of the drug for treatment - a problem with blood coagulability and a history of heart attack or a stroke, malignant neoplasms, severe liver damage, pancreatic damage and diabetes.

Also use drugs from other groups.

Gonadotropin-releasing agonists whose representative is Diferelin or Tryptorelin - the drug is used from 3 days of the menstrual cycle for six months at 3.75 milligrams.

• Goserelin - applied for six months to 3.6 milligrams subcutaneously.
• Buserelin - 200 micrograms in the nose twice a day for six months.
• Zoladex - from the 1st to the 5th day of the cycle injectively.

The antagonists of gonadotropic hormones, of which the drug Danazol is a drug, is used 400-800 milligrams per day, also with a six-month course of treatment.

Progesterone preparations are various drugs that are able to regulate the ovario-menstrual cycle in the absence of its second luteal phase of the cycle. The main representatives of this series are:

• Norethysterone acetate - applied from the fifth day of the menstrual cycle to 5-10 milligrams twice a day for six months.
• Medroxyprogesterone acetate is used in the same dose and the same course.
• The Mirena system is an intrauterine device that is placed for five years with a status check.
• Norkolut and Primoluth are drugs that are used from the 16th to the 25th day of the menstrual cycle for three to six months.

Anti-estrogen preparations :

• Tamoxifen - is 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.

Operative treatment is used in most cases with the nodal form of mastopathy, since then the risk of malignancy increases. In this case, the amount of surgery depends on the size of the mastopathy and site localization. Now the volume of surgical intervention is trying to reduce and not to carry out sectoral resection, since this is a very traumatic operation. Therefore, in most cases, limited excision biopsy of the site without removal of tissue, which allows for morphological verification of the diagnosis. Only then does the question of radical surgery and the scope of the operation be decided. Therefore, each case is negotiated individually.

Alternative treatment of mastitis in menopause

The use of alternative therapies for mastopathy in menopause is used very widely, 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 relapse. The drugs that are used are mainly directed to the correction of hormonal homeostasis and the antiproliferative effect. To do this, use alternative means and treatment with herbs. The main alternative methods are:

1. An effective way to normalize the hormonal background is to use a shell of walnuts. Tincture of walnuts is prepared as follows: membranes or shells are cooked for about five minutes in hot water, then drain the water and fill half a cup of alcohol. This solution should be infused for about five to seven days, after which it can be taken one teaspoon twice a day, previously diluted with boiled water in the same proportion. The course of treatment is three weeks.
2. Aloe contains a huge amount of vitamins B, C, A, E; amino acids; carotenoids; phytoncids; 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, wetting a piece of gauze, make lotions or compresses for the night, applying to an enlarged chest or knot.
3. Honey has the properties to increase local immunity, stimulates tissue regeneration and helps reduce hyperplasia. To create a medicine from honey, take a tablespoon of honey, add five drops of flaxseed oil and add aloe juice. This solution is applied to the gauze and also compress at night, which is repeated for 10 days, after which the mastopathy should decrease.
4. Herbal decoction of currant leaves, nettles, burdock and mallberry - take a tablespoon of each herb, steam it in hot water and insist for 20 minutes. It is necessary to take such a decoction of half a glass on an empty stomach every day for at least two months to obtain an effect. This drink reduces the amount of proliferating stromal cells.

To treat this pathology also use homeopathic remedies. Their main effect is aimed at regulating normal hormonal background and this contributes to a decrease in the size of mastopathy.

The main homeopathic remedies are:

1. Climact-Hel is a homeopathic remedy that has a composition similar to phytoestrogenic drugs and promotes the normalization of the hormonal background in menopause. The drug also reduces proliferative processes at the cell level. Applies Klimaktoplan in tablets one tablet before meals or an hour after it three times a day. The course of treatment with the drug is long - about two months. There were no side effects. Contraindications to taking Climact-Hel - this is hypersensitivity to the components of the drug.
2. Gineko-Hel is a combined homeopathic remedy that has an effect on the disturbances in menopause by normalizing the synthesis of estrogen and progesterone, which helps to reduce the effect of deficiency of these hormones. The drug is released in drops and dosed ten drops three times a day, can be dissolved in water or take a clean solution. Side effects are not common, but there may be stool disorders, dyspepsia and allergic reactions. No contraindications found.
3. Cyclodinone is a combined homeopathic remedy that affects hormonal disorders and restores estrogen deficiency. This drug is available in the form of pharmaceutical drops and tablets. Take one tablet a day, preferably in the morning or 40 drops with the same multiplicity. Duration of treatment is about three months. Contraindications to the use of Cyclodinone are acute infectious processes in the body.

[16], [17], [18], [19]

Prevention

Preventive maintenance of the given disease consists in early diagnostics of a pathology and timely treatment with the prevention of development of complications. Therefore, every woman should have a screening clinic for women. During the onset of menopause, you need to contact a gynecologist, and he will talk about possible changes in the body of a woman during this period and about methods of diagnosing such conditions. It is very important to carry out self-examination of the mammary glands, especially after the onset of menopause. Also, screening for women after 35 years of age requires a mammogram.

[20], [21]

Forecast

The prognosis of mastopathy for recovery is favorable in case of revealing initial changes and early treatment. But, given the high risk of malignancy, it is necessary to observe such patients and adjust the treatment. If there is a nodular form of mastopathy, the risk of malignancy is higher, so the prognosis depends on timely surgical treatment.

Mastopathy with menopause is a very serious condition that can have an asymptomatic course, but there may be signs that should be taken into account. Treatment of this pathology can be conservative and operative, which depends on the form and extent of the changes. The danger of malignization of mastopathy proves the importance of timely treatment, but one should not be upset, because this diagnosis can be easily controlled.

[22], [23]