What is breast mastalgia? This concept is collective and it means a special condition of the mammary glands, characterized by pain and a feeling of discomfort. Such sensations are experienced by 80% of women at least once during their lives. It may indicate functional or organic disorders in the tissues of the mammary gland. Or exist as a symptom in other diseases that are not directly related to the breast. The problem of mastalgia is that it poisons a woman's life quite strongly, causing her anxiety and problems in family and sexual relations.
Mastalgia and mastodynia - is there a difference?
These 2 terms are synonyms, but mastalgia is used in a purely colloquial case, and mastodynia is indicated in the International Classification of Diseases (ICD-10 code - 64.4.) The term "mastalgia" is not in the ICD. The specified pathology is in the section "Other diseasesmammary gland".
Any of these 2 names can be used for varieties of mastalgia:
- single and double sided;
- local focal and diffuse;
- cyclic, acyclic, false;
- episodic or constant.
The term "mastodynia" was introduced into medicine in 1880 by the German surgeon T. Billroth and meant cyclic pain and breast engorgement. One more nuance can be noted: they speak of mastalgia in the absence of organic changes in the tissue of the glands, whether diffuse or focal. When violations occur in the gland itself, a more accurate term is used that indicates the real clinical picture. This term is mastodynia.
Causes of mastodynia
Symptoms and signs of mastalgia are common in young women, but can also occur before/after menopause. The first mention of mastalgia may occur already in puberty, when the mammary glands mature under the influence of estrogens.
Mastalgia of the mammary gland can manifest itself with physiological and pathological changes. Most often, in the fertile age, mastodynia is associated with hormonal imbalance. It can be, for example, ovulation - it is the growth of estrogen that gives the proliferation of cells in the breast and the appearance of pain in them. Such manifestations are considered physiological, may also indicate PMS syndrome - premenstrual.
Pain occurs 3-4 days before the onset of menstruation or during them. Also, mastalgia can occur whenwomen's pregnancy, especially in the first trimester.
Hormonal disorders can also occur with:
- ovarian pathologies: oophoritis, cysts, tumors;
- uterine pathologies - adenomatosis, endometriosis, cancer;
- pathologies of the hypothalamic-pituitary zone, diseases of the thyroid gland and adrenal glands;
- taking oral contraceptives.
This is due to the fact that many OCs often contain estrogen and progesterone. They cause the same cyclic changes that normally occur during ovulation.
This is not given attention, because usually in 2-3 months the body adapts to taking drugs and the pain may disappear. The reasons may also lie in inflammatory or other diseases of the breast - mastitis, sclerosing adenosis, mastopathy, breast cancer. If this is not the case, mastalgia can occur against the background of psychogeny - frequent and prolonged stress, neuroses, depression, hysteria, emotional overstrain, etc.
Purely mechanical causes - squeezing the wrong bra with a large breast size, blunt trauma, great physical stress.
There is also the concept of vertebrogenic mastalgia - irradiation of pain in the chest with cervicothoracic osteochondrosis of the spine, intercostal neuralgia, myalgia, Tietze's syndrome, chondropathy, in which 1 or 2-3 joints connecting the ribs to the sternum are aseptically inflamed.
Finally, mastalgia can be an echo of heart and liver disease. Provocative moments can be:
- woman's age;
- frequent births or abortions;
- gestation, especially in the first 3month;
- menopause;
- general and gynecological pathologies.
Pathogenesis
The mechanism of pain in hormonal failure is due to the fact that breast tissue has always been and remains hormone-dependent. In the luteal phase, proliferative processes intensify in the epithelial cells of the mammary glands, fluid is retained and accumulated in their stroma.
All this is a consequence of the growth of estrogens in the first phase of the MC. But in the second phase of the cycle, progesterone grows and it acts, for the most part, on the glandular tissue. Since it prepares a woman's body for pregnancy, when exposed to it, the breast enlarges and grows. Alveoli grow, receptors in the thickness of the glands, their sensitivity increases.
In addition, progesterone has the ability to directly affect electrolyte and water metabolism, provokes fluid retention in tissues, and, therefore, swelling. The tissues become hydrophilic, loose, compression of the nerve endings by edema occurs and pain in the chest appears. Therefore, the glands swell, the nerve endings are compressed, inflammatory mediators are activated and pain occurs. With organic changes in the tissues of the gland, nociceptive receptors (these are special receptors that are designed to perceive a damaging agent) are irritated by decay products due to inflammation, necrosis or tissue compression due to neoplasm growth.
Classification
The correct definition of the variant of mastalgia is important for the choice of treatment and timely diagnosis in oncology. Mammologists identify the following causes and types of mastalgia:
- Cyclic.
- Acyclic.
- Extramammary.
Cyclic mastalgia - what is it? It is also called true or functional mastodynia. Most often this is a sign of PMS. Pain occurs 2-7 days before menstruation after ovulation, when the hormonal background changes. He also talks about possible FKM, long-term use of oral contraceptives.
Acyclic or symptomatic mastalgia is typical for people over 30 years of age. The pain syndrome can then be associated with damage to the breast tissues, complications after plastic surgery, inflammatory and tumor processes, anomalies in the development of the mammary glands, sclerotic changes and mastopathy. It no longer depends on the cycle.
False (reflected, radiating) mastalgia - occurs as a symptom of other pathologies of organs and systems not related to the chest. These are degenerative-metabolic disorders in the spine, joints, hepatic and cardiovascular diseases (angina pectoris, thrombophlebitis), endocrinopathy, esophageal pathology (diaphragmatic hernia), pleurisy, etc.
General symptoms of mastodynia
Usually, patients characterize the manifestations of mastalgia as pulling, pressing, bursting, aching pains. Sometimes they can be sharp, stabbing.
When the breast swells due to a hormone disorder, it is enlarged in size, the tactile sensitivity of the nipple and skin is increased. The pains are dull, bursting. Discomfort is usually bilateralassociated with the menstrual cycle. Pain does not require treatment and goes away on its own.
For acyclic mastalgia of the mammary gland, the symptoms are characteristic in the form of acute burning pains, do not depend on the cycle and are usually unilateral. Such mastalgias depend, for example, on stress. The pain can be episodic or constant, the intensity is different. It depends on the underlying pathology. Mastalgia is often combined with other manifestations of pathology - the presence of mass formation, changes in the shape and size of the glands, discharge from the nipple and its external defects, changes in skin color, local fever, enlarged axillary lymph nodes.
With false mastodynia (mastalgia), symptoms of damage to other organs can also always be detected. Most often, this tone of the spinal muscles is increased, thoracic pain along the nerves, changes in blood pressure and heart rate, etc.
Depending on the description, the symptoms and signs of breast mastalgia are grouped into 4 severity levels:
- No pain.
- Mild degree - the pain quickly disappears when taking 1 tab. analgesics.
- Medium degree - pain appears a week before menstruation, intensifies the day before and can be partially eliminated by taking an analgesic.
- Severe degree - the pain is constant, cannot be treated at home. Violates a woman's quality of life.
Symptoms of cyclic mastodynia
Symptoms of mastalgia of the mammary gland in this case often have the character of bursting and are almost always accompanied by edema. That's what they call it - dyshormonalmastalgia. The constantly occurring cyclic mastalgia of the mammary gland not only provokes severe pain, but also changes the mood of a woman - leads to depression, a decrease in the psycho-emotional background, and neuroses. With the normalization of the hormonal background, the condition noticeably improves.
The treatment includes not only hormones, but also physiotherapy, alternative means, mud therapy and spa treatment according to the profile. Of great importance in this case is the treatment of gynecological problems and the sanitation of foci of infection.
Symptoms of acyclic mastalgia
The degree of discomfort and pain is directly related to the existing pathologies. Additional symptoms and signs of non-cyclic breast mastalgia are, in addition to those listed above:
- cephalgia;
- fatigue;
- taste perversions;
- general weakness;
- the temperature may rise, the general condition may worsen.
This requires an urgent consultation with a mammologist.
Diagnosis
Lab tests:
- general blood tests, urine;
- biochemical blood test with indicators of liver function;
- determination of hormonal status.
When determining the hormonal status, the level of estrogen, progesterone, prolactin, FSH, LH, thyroid hormones and TSH is assessed.
Instrumental research:
- Ultrasound of the mammary glands and axillary lymph nodes;
- Mammography is the most effective method that allows you to determine the pathology in the initial stages; performed in 2-3projections and aiming.
- Puncture or fine needle aspiration biopsy under ultrasound guidance, followed by biopsy histology.
- Microwave radiothermometry (RTM) - captures body waves with a special device. This method is designed to detect pathologies in the early stages, when there are no clinical manifestations yet. It is used on other organs too. Its principle is that the diseased organ amplifies its radiation.
The level of the oncomarker CA 15-3 in the blood is also determined. This is especially true in cases where mastalgia first appeared in a woman during menopause. If there is a pathology of the spine, a consultation with a neurologist is required.
Complications
Physiological breast mastalgia does not pose a threat to a woman's life, but causes a decrease in the quality of life in the form of increased fatigue, irritability before menstruation, anxiety and tearfulness, bad mood, etc. Hypochondriacs may have cancerophobia syndrome.
Treatment of mastodynia
Special therapy for breast mastalgia begins only after the exclusion of organic and malignant breast diseases.
With cyclic mastodynia, dynamic monitoring is recommended with periodic examination by a mammologist and ultrasound.
The symptoms and treatment of mastalgia are closely related. Medical tactics for emotional disorders is aimed at improving the emotional background through the use of sedatives, antidepressants, tranquilizers,physiotherapy, psychotherapy. The combination of pathogenetic hormonal and non-hormonal treatment of mastalgia occurs most effectively.
Such patients are shown:
- Hormonotherapy - the choice is very wide, taking into account the level and type of hormone secretion and the severity of symptoms.
- For the treatment of breast mastalgia, COCs of the monophasic type ("Yarina", "Jess") or gestagens, antiestrogens, gonadotropin-releasing factor agonists are used.
- Targeted therapy - application of an ointment with progesterone ("Progestogel") to the chest, which has a targeted focus on breast tissue - relieves pain and swelling.
- Phyto- and homeopathic remedies - to correct dyshormonal disorders, plants containing phytoestrogens (evening primrose oil, sage, oregano, cumifuga oil) and homeopathic preparations containing them are used.
- Of the homeopathic preparations, one can note "Mastodinon", "Mamoklam", "Cyclodinone", etc. They should be prescribed by a homeopathic doctor for the best effect. Usually they are resorted to in case of refusal of patients to prescribe hormone therapy.
- Sedative drugs - SSRIs (Prozan, Paxil) are especially popular. In mild cases, "Magne B6" is recommended, herbal medicine - herbs of valerian, motherwort, peony; sedative fees.
- Analgesics - This includes NSAIDs (Ibuprofen, Diclofenca) and conventional analgesics.
- NSAIDs exhibit anti-inflammatory properties becauseinhibit the synthesis of inflammatory mediators of prostaglandins, preventing them from sensitizing pain receptors in the tissues of the mammary glands.
- Diuretics ("Furosemide", "Mannitol") - reduce swelling, and with them pain. Diuretics can significantly reduce the severity of pain. Usually, potassium-sparing diuretics are used (more often than others "Spironolactone"), which also have antiandrogenic properties.
Physiotherapy (electrophoresis, magnetotherapy, galvanization, balneotherapy) can also be added to the treatment complex. The use of vitamin-mineral complexes is also useful.
In case of acyclic mastodynia, treatment is carried out, first of all, of the underlying disease. If necessary, it is often necessary to apply surgical treatment, such as opening and draining mastitis, tumor enucleation, sectoral resection of the mammary gland or complete removal - mastectomy.
For mastitis and abscesses, antibiotic treatment will be mandatory.
Removing the ovaries or suppressing their activity with chemotherapy drugs or radiation therapy is very helpful in some conditions. Endocrine mastodynia is cured completely.
Forecast and prevention
With cyclic breast mastalgia, the prognosis is favorable, with acyclic and false it depends on the underlying disease that provoked the appearance of pain. But with all the favorable prognosis, self-treatment is completely excluded. Also, don't forget to check your glands monthly forthe appearance of knots and seals in them.
For the prevention of mastalgia caused by hormonal imbalance, mammologists advise adhering to the correct regime of work and rest. Workaholism should not exist. The diet should be adjusted to limit s alt, fluid-retaining foods (s alts, seasonings, sweets, fried foods, alcohol).
S alt slows down the metabolism and gives a tendency to edema. The diet should contain a sufficient amount of vitamins and minerals, enough fiber, more vegetables and fruits. If enough iodine, magnesium, selenium and zinc are supplied with food, then this has a positive effect on the general condition of the body.
An important place is given to the timely and complete treatment of gynecological pathologies, especially if they are accompanied by hormonal disorders. Prevention will also be a he althy lifestyle - moderate physical activity, the exclusion of physical inactivity, stress, the correct alternation of work and rest, the full value of sleep. An obligatory factor is the normalization of weight when it goes off scale.
Mammologists warn that obesity is a predisposing factor for mastalgia, because estrogen is synthesized and accumulated in adipose tissue. Coffee, chocolate and tea excluded.
You need to take care of the liver, its normal work is a reliable shield for hyperestrogenism. You should also choose the right underwear - so that it is not tight and does not squeeze the mammary glands. The ideal option is soft wide straps on a bra.
