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Swelling of the mammary glands
Last reviewed: 23.04.2024
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Swelling of the mammary glands, that is, an increase in the volume of their cells or stroma, has both a physiological character and a pathological etiology.
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Causes of the swelling of the mammary glands
All the physiological processes that occur in the breasts are caused by the synthesis of hormones such as estrogens, progesterone, the pituitary-synthesized luteotropic hormone prolactin, and other steroid hormones that produce the hypothalamus, thyroid, and adrenal cortex.
But if the swelling of the breast is not associated with the natural metabolism of hormones, there remains the second option - pathology. And there are many versions of its development: from the excess (or lack) of cholesterol, which is the "raw material" for the biosynthesis of steroid hormones in the corresponding glands, to irregularities in the work of these glands or the deficiency of special enzymes necessary for steroidogenesis.
The main causes of swelling of the mammary glands, primarily in women, are caused by changes in the level of sex hormones.
Thus, swelling of mammary glands before menstruation, which is observed in most women, is caused by increased synthesis and emission of estrogens, estradiol, estriol and estrone, as well as progesterone, which are produced by the ovaries and adrenal cortex. Progesterone increases the volume of glandular cells in the mammary gland, and thanks to estradiol, the formation of connective tissue of the breast and an increase in the number of milk ducts. Therefore, swelling and soreness of the breasts is observed before the onset of menstruation.
But swelling of the mammary glands after menstruation, most often is a sign of mastopathy - fibrous, cystic, fibrous-cystic, focal or diffuse. Pain and swelling of the mammary glands with these benign neoplasms are caused by the growth of fibrous (connective) breast tissue, the epithelium of its ducts or alveoli, and the appearance of nodular or protruding lesions. There may be increased sensitivity and hyperemia of the skin on the chest, as well as discharge from the nipples.
For example, in non-pregnant women against a background of menstrual irregularity, swelling of the mammary glands can be accompanied by even the discharge of milk. This so-called hyperprolactinemia - increased synthesis of the hormone prolactin, the cause of which lies in the presence of a tumor (adenoma) of the pituitary gland. However, clinical practice shows that this pathology can be a consequence of ovarian cysts, liver cirrhosis, hypothyroidism, or brain tumors.
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Forms
Pregnancy and menopause
Swelling of the mammary glands during pregnancy occurs for natural reasons. By the method of feeding offspring, a person belongs to a mammal, and the nature of the intended use of the breasts is to feed the children until they have the ability to eat other food.
Therefore, this sign in pregnancy - an increase in glandular tissue, which will produce milk, the development of alveoli and excretory ducts - is the preparation for the upcoming breastfeeding of the baby. In addition to estradiol and progesterone, estriol, prolactin and a special hormone, synthesized by the surface layer of human embryo trophoblasts, are involved in this process - placental lactogen.
Women who have come out of childbearing age may have swelling of the mammary glands with menopause, which is associated with an increase in the volume of fatty and partly fibrous tissues, which, as a rule, displace glandular. It also occurs against the background of changes in the work of the hormonal system, moreover, cardinal ones.
The dominant physiological and biochemical component of hormonal processes during menopause is a decrease in ovarian activity, a sharp reduction in the synthesis of estrogen by follicular cells, and a complete cessation of estradiol production. This period is characterized by significant changes in lipid metabolism and an increase in the total level of cholesterol.
In addition, the menopause does not exclude mastopathy, in which the breasts are enlarged. Despite a significant reduction in estrogen production by the ovaries, the fat tissue is able to deposit estrogens, which during the menopause are synthesized from testosterone (it continues to produce adrenal cortex, although in much lesser amounts). These estrogens and destabilize the hormonal background, leading to various pathological processes in the breasts.
Swelling of mammary glands in a child and adolescent
Swelling of the mammary glands in a child occurs, mainly for physiological reasons. For example, in newborns (in the first month of life) - the result of the fact that maternal estrogen and progesterone enter the placenta and are in the blood of the fetus, and after childbirth - in the blood of the child.
This phenomenon is defined by pediatricians as a "hormonal crisis of newborns," which occurs on average in eight babies out of ten, of both sexes.
After a couple of weeks, swelling of the mammary glands in newborns (often - with secretions from the nipple) goes naturally. But if an increase is found that does not affect the nipple area, and the body temperature of the baby rises, then there is inflammation - infant mastitis, which can develop into a purulent mastitis. And then you need to use antibiotics.
Swelling of the mammary glands in girls, which begins after reaching eight or nine years, is an absolutely normal process associated with the onset of puberty. During this period, the body starts producing estrogen, in particular, estrone, responsible for the formation of secondary sexual characteristics. Their growth occurs gradually and continues throughout the puberty period.
If this sign in girls begins at an earlier age, then doctors state the fact of premature puberty, and in most cases, with the complete absence of other signs of the onset of puberty. The child should be shown to the endocrinologist, since everything speaks of hormonal pathology, which can be associated with the pituitary, hypothalamus, adrenal gland or thyroid gland.
It should be noted that a significant swelling of the mammary glands in adolescents (both girls and boys) is possible due to obesity, when fat deposits are concentrated in the chest and shoulder region.
By the way, this sign in boys can be observed in adolescence and is also due to entry into puberty. According to medical terminology, this is a juvenile or juvenile gynecomastia, the cause of which is the violation of steroidogenesis in the direction of female sex hormones.
Swelling of mammary glands in adolescent boys has the appearance of a small increase in the pigmented area around the nipples (2-5 cm in diameter) with their increased sensitivity. As you grow older hormone production normalizes, and gynecomastia passes. And if about a year and a half or two years the increase does not go away, then maybe the boy has problems with the thyroid gland, liver or testicles. What exactly - the child endocrinologist should determine.
Swelling of mammary glands in men
Gynecomastia - proliferation of glandular tissue of the mammary glands - is also a result of hormonal disorders in the body. In particular, reduced testosterone production; insufficient synthesis of androgens (hypogonadism); excess progesterone and estrogens in hypercortisy (hyperfunction of the adrenal cortex); excess of the rate of pituitary hormone production; elevated levels of thyroid hormones (hyperthyroidism), etc.
These pathological abnormalities in the hormonal sphere are associated with both genetically determined features of the endocrine system and with tumor formations of one of the hormone producing organs - the testicles, the adrenal glands or the pituitary gland.
In addition, swelling of mammary glands in men can occur due to liver cirrhosis in alcohol-dependent, and after a long-term intake of estrogen-containing hormones and some antidepressants.
Not the least role in the development of this pathology is obesity, in which there is a so-called false gynecomastia or lipomastia - the growth of fatty tissue of the breast in parallel with the growth of fat subcutaneous accumulation in various areas of the trunk.
Diagnostics of the swelling of the mammary glands
Diagnosis uses a set of methods to determine the true cause of the pathology. Among them:
- Physical examination with palpation of the breast;
- X-ray of breasts (mammography);
- ultrasound examination (ultrasound) of the breast, thyroid, adrenal, pelvic organs;
- laboratory blood tests for the level of hormones (estradiol, prolactin, testosterone, luteotropin, thyrotropin, adrenocorticotropin, etc.);
- enzyme immunoassay;
- urinalysis (for urea, nitrogen, creatinine, hepatic transaminases);
- CT or MRI of the adrenal gland, as well as the brain.
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Treatment of the swelling of the mammary glands
Treatment depends on the causes of this pathology, but most often these are preparations containing hormones or their synthetic analogues.
So, the hormone preparation on the basis of progesterone Progestogen (for external use) is prescribed when women complain of severe swelling and tenderness of the mammary glands before menstruation.
In order to normalize the level of prolactin - with hyperprolactinaemia, Parlodel (Bromocriptine) is used: 1.25-2.5 mg three times a day (after meals).
In the case of diffuse forms of mastopathy, a drug with an antiestrogenic effect Tamoxifen (Toremifene) is effective enough - 20 mg per day. But you need to keep in mind that this drug is contraindicated in the presence of a woman with endometriosis and liver functioning disorders.
For treatment with menopause, the preparation-inhibitor of the synthesis of estrogens in fat tissues of Femar (1 tablet per day) is often recommended. But this drug gives side effects in the form of headache and joint pain, nausea and general weakness.
Treatment in men associated with hypogonadism (a deficit of androgens) is carried out by such drugs as anti-estrogens, such as Clomifene, Clomid or Serofen (inside 50 mg once or twice a day).
In cases where hormone therapy in men was unsuccessful, mastectomy is possible - surgical removal of the gland, and with false gynecomastia - liposuction.
Treatment of swelling of the mammary glands in children - with the premature development of girls, as well as in youthful gynecomastia in boys - clinical endocrinology has not been developed. It is only necessary to observe the doctor and at least once a year undergo a complete examination.
However, when the swelling of the mammary glands in boys reaches a considerable size and is not going to resolve, doctors prescribe the imposition of a tight bandage on the chest and the intake of hormonal drugs to reduce the production of sex hormones. One of the drugs in this group is Danoval (capsules); The recommended daily dose is 100 and 200 mg divided into three doses.
Prevention
Unfortunately, prevention of swelling of the mammary glands is almost not possible, since the synthesis of any hormones, including sex, is laid down in the individual genetic code of each person.
Nevertheless, medical science claims (and practicing doctors do not deny it) that trying to prevent some malfunctions in the hormonal system is quite possible if you eat properly and have a sufficient level of physical activity. For example, men who exercise and with carbohydrate metabolism are all right, and the level of the main male hormone testosterone is normal.
It is not necessary to create an additional threat to the normal hormonal metabolism by the abuse of products, in which there are many phytoestrogens - plant nonsteroidal compounds, in the structure and effects of human-like hormones. Such products include all legumes (especially soybeans), corn and wheat, sunflower and flax seeds, broccoli, asparagus and spinach, potatoes and carrots, dates and pomegranates, parsley and basil, hazelnuts, hard rennet cheeses, dark grape varieties and red wine, as well as beer produced with the use of hops ... In addition to hop, phytoestrogens are rich in such medicinal plants as ginseng, red clover, angelica, valerian, motherwort, sage, melissa, licorice, St. John's wort, geranium, rosemary.
It should be remembered that swelling of the mammary glands, which has no connection with physiological conditioned processes in the body and does not correspond to sexual characteristics or age norms, is pathology.
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Forecast
The prognosis is generally positive, but the hormonal system of a person is very vulnerable, so no one can guarantee that the occurrence of any complications (especially with mastopathy) and more serious diseases is excluded.