What is breast mastalgia? This concept is collective and it means a special condition of the mammary glands, characterized by pain and a sense of discomfort. 80% of women experience such sensations at least once during their life. It may indicate functional or organic abnormalities 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 with mastalgia is that it poisons the woman's life quite strongly, causing her anxiety and a problem 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 is 64.4.) The term "mastalgia" in the ICD is not. The specified pathology is in the section "Other diseases of the mammary gland."
Any of these 2 names can be used with varieties of mastalgia:
- single and double sided;
- locally 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 it meant cyclic pain and engorgement of the mammary glands. One more nuance can be noted: mastalgia is said in the absence of organic changes in the glandular tissue, whether diffuse or focal. When irregularities occur in the gland itself, a more accurate term is used, indicating the real clinical picture. This term is mastodynia.
Causes of mastodynia
Symptoms and signs of mastalgia are often characteristic of young women, but can also occur before / after menopause. The first mention of mastalgia can occur already in puberty, when the maturation of the mammary glands under the influence of estrogen occurs.
Breast mastalgia can occur with physiological and pathological changes. Most often, at a fertile age, mastodynia is associated with hormonal imbalance. This can be, for example, ovulation - it is the growth of estrogen that gives proliferation of cells in the chest and the appearance of pain in them. Such manifestations are considered physiological, may also indicate PMS syndrome - premenstrual.
Pain occurs 3-4 days before or during menstruation. Mastalgia can also occur when a woman is pregnant, 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 cyclical changes that normally occur during ovulation.
This is not given attention, because usually in 2-3 months the body adapts to taking medications and the pain can disappear. The reasons may 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, neurosis, depression, hysteria, emotional overstrain, etc.
Purely mechanical causes - squeezing with the wrong bra with a large breast size, blunt injuries, a lot of physical stress.
There is also the concept of vertebrogenic mastalgia - the irradiation of chest pain with cervicothoracic osteochondrosis of the spine, intercostal neuralgia, myalgia, Titz 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. Provoking moments can be:
- woman's age;
- frequent childbirth or abortion;
- gestation, especially in the first 3 months;
- menopause;
- general and gynecological pathologies.
Pathogenesis
The mechanism of pain during hormonal failure is associated with the fact that breast tissue has always been and remains hormone-dependent. In the luteal phase, proliferative processes in the epithelial cells of the mammary glands are strengthened, and fluid stays in their stroma and accumulates.
All this is a consequence of the growth of estrogen in the first phase of MC. But in the second phase of the cycle, progesterone grows and it acts, for the most part, on glandular tissue. Since it prepares a woman’s body for pregnancy, when it is exposed, the breast increases and grows. Alveoli, receptors grow 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 the tissues, and, therefore, edema. Tissues become hydrophilic, friable, compression of the nerve endings with edema occurs and chest pain 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 the growth of the neoplasm.
Classification
The correct definition of a mastalgia variant is important for the choice of treatment and timely diagnosis in oncology. Mammologists distinguish 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 FCM, prolonged use of oral contraceptives.
Acyclic or symptomatic mastalgia is characteristic for an age older than 30 years. Pain can then be associated with damage to breast tissue, complications after plastic surgery, inflammatory and tumor processes, abnormalities in the development of mammary glands, sclerotic changes and mastopathy. It no longer depends on the cycle.
False (reflected, irradiating) mastalgia - occurs as a symptom in other organs and systems that are not related to the breast and pathologies. These are degenerative metabolic disorders in the spine, joints, liver and cardiovascular diseases (angina pectoris, thrombophlebitis), endocrinopathy, esophageal pathology (diaphragmatic hernia), pleurisy, etc.
Common symptoms of mastodynia
Typically, patients characterize manifestations of mastalgia as pulling, pressing, bursting, aching pains. Sometimes they can be sharp, stitching.
With breast swelling due to hormonal imbalance, it is enlarged, tactile sensitivity of the nipple and skin is increased. The pains are dull, bursting. The discomfort is usually bilateral, clearly associated with the cycle of menstruation. Pain sensations do not require treatment and pass on their own.
For acyclic mastalgia of the mammary gland, the symptoms are characteristic in the form of acute burning pains, are independent of the cycle and are usually one-sided. Such mastalgia depends, for example, on stress. The pain can be episodic or permanent, the intensity is different. It depends on the underlying pathology. Mastalgia is often combined with other manifestations of the pathology - the presence of volumetric formation, changes in the shape and size of the glands, discharge from the nipple and its external defects, changes in skin color, local temperature increase, enlarged axillary lymph nodes.
With false mastodynia (mastalgia), symptoms of damage to other organs can also always be detected. Most often, thisonus 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 mastalgia of the mammary gland are combined in 4 degrees of severity:
- The absence of pain.
- Mild - the pain passes quickly when taking 1 tab. analgesic.
- Medium - the pain appears a week before menstruation, intensifies the day before and can be partially eliminated by taking an analgesic.
- Severe - the pain is constant, can not be treated at home. It violates the quality of life of a woman.
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. It is called - dishormonal mastalgia. Constantly occurring cyclic mastalgia of the mammary gland not only provokes severe pain, but also changes the background of a woman’s mood - it leads to depression, a decrease in the psycho-emotional background, and neurosis. With the normalization of the hormonal background, the condition improves markedly.
The treatment includes not only hormones, but also physiotherapy, alternative means, mud therapy and spa treatment according to the profile. Of great importance is the treatment of gynecological problems and the rehabilitation of foci of infection.
Symptoms of acyclic mastalgia
The degree of discomfort and pain is directly related to existing pathologies. Additional symptoms and signs of mastalgia of the mammary gland of the non-cyclic variant are, in addition to the ones listed above:
- cephalgia;
- fast fatiguability;
- taste perversions;
- general weakness;
- temperature may rise, deterioration in general condition.
This requires an urgent consultation with a mammologist.
Diagnostics
Laboratory research:
- general blood tests, urine tests;
- biochemical blood test with liver function indicators;
- determination of hormonal status.
When determining hormonal status, estrogen, progesterone, prolactin, FSH, LH, thyroid hormones and TSH are 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 2-3 projections and aiming.
- Puncture or fine-needle aspiration biopsy under the control of ultrasound, subsequent histology of the biopsy.
- Microwave radiometry (RTM) - captures the body waves with a special device. This method is designed to identify pathologies in the early stages, when there are no clinical manifestations. It is applied on other organs too. Its principle is that a diseased organ amplifies its radiation.
The blood tumor marker CA 15-3 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 neurologist consultation is required.
Complications
Physiological mastalgia of the mammary gland 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. Cancerophobia is possible in hypochondriacs.
Mastodynia treatment
Special therapy for mammary mastalgia begins only after the exclusion of organic and malignant diseases of the breast.
In cyclic mastodynia, dynamic observation is recommended with a periodic examination by a mammologist and an ultrasound scan.
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, and psychotherapy. The most effective combination of pathogenetic hormonal and non-hormonal treatment of mastalgia occurs.
Such patients are shown:
- Hormone therapy - the choice is very wide, made taking into account the level and type of hormone secretion and the severity of symptoms.
- For the treatment of mastalgia of the mammary gland, single-phase COCs (Yarina, Jess) or progestogens, antiestrogens, gonadotropin releasing factor agonists are used.
- Targeted therapy - applying an ointment with progesterone (Progestogel) to the breast, which has a targeted focus on the breast tissue - relieves pain and swelling.
- Phyto- and homeopathic remedies - plants containing phytoestrogens (evening primrose oil, sage, oregano, tsimifugi) and homeopathic medicines that they contain are used to correct dishormonal disorders.
- Of the homeopathic medicines, Mastodinon, Mamoklam, Cyclodinon, etc. can be noted. They should be prescribed by a homeopathic doctor for a better effect. Usually they resort to them in case of refusal of patients from the appointment of hormone therapy.
- Sedatives - SSRIs are especially popular (Prozan, Paxil). In mild cases, "Magne B6" is recommended, herbal medicine - herbs of valerian, motherwort, peony; sedative fees.
- Analgesics - this includes NSAIDs (Ibuprofen, Diclofenka) and conventional analgesics.
- NSAIDs have anti-inflammatory properties because they inhibit 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 the pain. Diuretics can significantly reduce the severity of pain. Typically, potassium-sparing diuretics (more often than others "Spironolactone"), also possessing antiandrogenic properties, are used.
Physiotherapy (electrophoresis, magnetotherapy, galvanization, balneotherapy) can also be added to the treatment complex. The use of vitamin-mineral complexes is also useful.
With acyclic mastodynia, treatment is performed, 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.
With mastitis and abscesses, antibiotic treatment will be mandatory.
It helps in some conditions, removing the ovaries or suppressing their activity by chemotherapy or radiation therapy. Endocrine mastodynia is completely cured.
Forecast and Prevention
With cyclic mastalgia of the mammary gland, the prognosis is favorable, with acyclic and false, it depends on the underlying disease, which provoked the appearance of pain. But with all the favorable prognosis, self-medication is completely excluded. In addition, do not forget to monthly examine your glands for the appearance of nodes and seals in them.
For the prevention of mastalgia caused by hormonal imbalances, mammologists are advised to adhere to the correct mode of work and rest. Workaholism should not take place. The diet should be adjusted with a restriction of salt, which retains fluid in the body products (pickles, seasonings, sweets, fried foods, alcohol).
Salt slows down the metabolism and gives a tendency to swelling. The diet should contain enough vitamins and minerals, enough fiber, more vegetables and fruits. If enough iodine, magnesium, selenium and zinc are supplied with food, then this positively affects the general condition of the body.
An important place is given to the timely and full treatment of gynecological pathologies, especially if they are accompanied by hormonal disorders. Healthy lifestyle is also a preventative measure - moderate physical activity, the exclusion of physical inactivity, stress, the correct alternation of work and rest, and full sleep. A mandatory 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 are excluded.
It is necessary 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 crush the mammary glands. Ideal option - soft wide straps on a bra.