In premenopausal women, mastopathy occurs in 20 % of women. After the onset of menopause, new cysts and nodes usually do not appear, which proves the involvement of ovarian hormones in the occurrence of the disease.
Currently, it is known that malignant diseases of the mammary glands occur 3-5 times more often against the background of benign neoplasms of the mammary glands and in 30% of cases with nodular forms of mastopathy with proliferation phenomena. Therefore, in the fight against cancer, along with the early diagnosis of malignant tumors, timely detection and treatment of precancerous diseases is no less important.
There are non-proliferative and proliferative forms of mastopathy. At the same time, the risk of malignancy in the non-proliferative form is 0.86%, with moderate proliferation – 2.34%, with pronounced proliferation – 31.4%
The main role in the occurrence of fibrocystic mastopathy is assigned to dishormonal disorders in the body of a woman. It is known that the development of the mammary glands, regular cyclic changes in them in puberty, as well as changes in their function during pregnancy and lactation are influenced by a whole complex of hormones: gonadotropin-releasing hormone of the hypothalamus, gonadotropins (luteinizing and follicle-stimulating hormones), prolactin, chorionic gonadotropin, thyroid-stimulating hormone, androgens, corticosteroids, insulin, estrogens and progesterone.
Any disorders of the hormone balance are accompanied by dysplastic changes in the breast tissue. The etiology and pathogenesis of myopathy have not yet been definitively established, although more than a hundred years have passed since the description of this symptom complex. An important role in the pathogenesis is assigned to relative or absolute hyperestrogenism and progesterone deficiency. Estrogens cause the proliferation of the ductal alveolar epithelium and stroma, and progesterone counteracts these processes, ensures the differentiation of the epithelium and the cessation of mitotic activity. Progesterone has the ability to reduce the expression of estrogen receptors and reduce the local level of active estrogens, thereby limiting the stimulation of breast tissue proliferation.
Mastopathy – Hormonal imbalance
Hormonal imbalance in the breast tissues in the direction of progesterone deficiency is accompanied by edema and hypertrophy of the intra-lobular connective tissue, and the proliferation of the ductal epithelium leads to the formation of cysts.
In the development of mastopathy, an important role is played by the level of blood prolactin, which has a diverse effect on the breast tissue, stimulating metabolic processes in the epithelium of the mammary glands throughout a woman’s life. Hyperprolactinemia outside of pregnancy is accompanied by swelling, swelling, soreness and swelling in the mammary glands, more pronounced in the second phase of the menstrual cycle.
The most common cause of mastopathy is hypothalamic-pituitary diseases, thyroid disorders, obesity, hyperprolactinemia, diabetes mellitus, impaired lipid metabolism, etc.
The cause of dyshormonal disorders of the mammary glands can be gynecological diseases; sexual disorders, hereditary predisposition, pathological processes in the liver and bile ducts, pregnancy and childbirth, stressful situations. Often, mastopathy develops during menarche or menopause. In the adolescent period and in young women, the diffuse type of mastopathy with minor clinical manifestations, characterized by moderate soreness in the upper-outer quadrant of the breast, is most often detected.
At the age of 30-40, multiple small cysts with a predominance of the glandular component are most often detected; the pain syndrome is usually pronounced significantly. Single large cysts are most common in patients aged 35 years and older.
Fibrocystic mastopathy is also found in women with a regular two-phase menstrual cycle.
In recent years, as a result of the conducted research, the need for active therapy, in which the leading place belongs to hormones, has become obvious. With the accumulation of clinical experience with the use of norplant, there were reports of its positive effect on diffuse hyperplastic processes in the mammary glands, since under the influence of the gestagenic component in the hyperplastic epithelium, not only the inhibition of proliferative activity, but also the development of decidual-like transformation of the epithelium, as well as atrophic changes in the epithelium of the glands and stroma, consistently occurs. In this regard, the use of progestogens is effective in 70 % of women with hyperplastic processes in the mammary glands. The study of the effect of norplant on the condition of the mammary glands in 37 women with diffuse mastopathy showed a decrease or cessation of pain and tension in the mammary glands. In a control study after 1 year on ultrasound or mammography, there was a decrease in the density of glandular and fibrous components due to a decrease in the areas of hyperplastic tissue, which was interpreted as a regression of hyperplastic processes in the mammary glands. In 12 women, the condition of the mammary glands remained the same. Despite the disappearance of their mastodinia, the structural tissue of the mammary glands did not undergo any changes. The most common side effect of norplant, as well as depo-provera, is a violation of the menstrual cycle in the form of amenorrhea and intermenstrual spotting. The use of oral progestogens for intermenstrual spotting and combined contraceptives for amenorrhea (for 1-2 cycles) leads to the restoration of the menstrual cycle in the vast majority of patients.
Currently, oral (tableted) progestogens are also used for the treatment of mastopathy.
There is no treatment algorithm for mastopathy. Conservative treatment is indicated for all patients with diffuse mastopathy.