Мастодиния: что означает боль в груди и как не пропустить осложнение

The most common complaint in the practice of a gynecologist is an indication of pain in the mammary gland on the part of the patient. Finding out the causes of such pain, it is necessary to collect a detailed anamnesis, not forgetting the need for oncological alertness, and carefully examine the patient in order to exclude a tumor in accordance with modern world standards.

Mastodynia can significantly disrupt the quality of a woman's life, be not only a consequence, but also a cause of stress, cause psychological, family and social maladaptation. Treatment should be pathogenetically substantiated and individualized as much as possible.

Diagnostics and rational treatment of diseases of the mammary gland (MG) – an integral part of women's health care. The breast is an organ of the female reproductive system, its development and functioning are closely related to the state of this system in different age periods. Numerous studies devoted to the study of this issue have shown that the breast is a target organ for more than 20 hormones, mainly sex hormones.

Pain in breast – one of the most common reasons why women, especially those of reproductive age, go to a doctor, primarily a gynecologist. It should be said that at least once in a lifetime pain in the breast was noted by approximately 70% of women.

Women's intimate problems

The concept of mastodynia, classification, pathogenesis, clinical manifestations

The concept of "mastodynia" or "mastalgia" implies the presence of pain in the breast. Mastodynia can be a symptom that accompanies the development of a pathological process in the breast, or it can exist independently without changes in this organ determined by objective methods. So, in the absence of objective changes in the breast, mastodynia can be classified as an independent diagnosis (in accordance with the ICD-10, code N64.4 and F45.4 – psychogenic mastodynia).

By the way, in ICD-10, non-tumor diseases of the breast, including mastodynia and mastopathy, are referred to the section "Diseases of the genitourinary organs", while in Ukraine traditionally, oncologists are most often involved in the diagnosis, treatment and follow-up of such patients.

Pain in the breast can be both a symptom of a tumor, an inflammatory process in the breast, and a variety of diffuse benign changes, usually combined with the term "mastopathy" or "dysplasia" in accordance with ICD-10. Among all clinical manifestations of a tumor, pain is the rarest. In most cases, the tumor compaction in the breast for a long time exists painlessly and is most often detected by palpation. As a rule, such detection of a tumor is not early.

Common signs of hormonal imbalance in women

Modern early diagnosis of breast tumors involves mammographic screening, which allows detecting a tumor of 1 mm in size at the preclinical stage. However, some categories of women (under the age of 40, pregnant, lactating) are not subject to such screening, so palpation of the tumor in them seems to be the only possible one. In addition, 20% of breast tumors are fast-growing and can develop over a very short period of time (several months).

Approximately 5-7% of breast tumors are X-ray negative. It should not be forgotten that in any study there is a human factor that affects a certain percentage of errors.

Mastodynia is classified into cyclic and non-cyclic. Such a division is pathogenetically justified, since non-cyclic mastodynia is not associated with MC and is most often a symptom of other diseases. However, sometimes non-cyclic mastodynia can also be caused by a pathological process in the breast. It is divided into chest pain itself and pain not directly related to the breast.

In addition to tumor, trauma and inflammation, non-cyclic thoracic mastalgia proper can be caused by Cooper's ligament sprain with large and saggy breast; in postmenopausal women with a large breast size, fatty necrosis occurs due to impaired microcirculation (more often in diabetics). In addition, non-cyclic pain may be experienced by patients after breast augmentation (enlargement) with implants, as well as some pregnant women due to rapid growth and severe breast engorgement. Sometimes uncomfortable underwear can also cause mastalgia.

In addition to a thorough mammological examination, in all cases of non-cyclic pain in the breast, a detailed history taking, a detailed assessment of the nature of complaints, a number of additional studies and consultations of related specialists are required. So, non-cyclic mastodynia, not directly related to the breast, can be caused by a chest injury, unusual physical activity, manifestations of intercostal neuralgia of various origins, fibromyalgia, Tietze's syndrome, arthritis of the shoulder joint. In addition, there may be secondary (radiating) pain of cardiac origin or as a manifestation of a stomach ulcer, gallbladder disease.

Cyclic mastodynia is pathogenetically associated with the cyclic functioning of the ovaries and the effect of sex hormones on the breast and is most often caused by the following reasons:

  • mastodynia as a symptom of premenstrual syndrome (PMS);
  • premenstrual engorgement and pain in the breast as an independent symptom in the absence of other manifestations of PMS;
  • as a manifestation of benign breast dysplasia (BDDM) (mastopathy);
  • against the background of the use of hormonal drugs, incl. hormonal contraceptives.

Chest pain associated with premenstrual syndrome

PMS – this is a complex symptom complex, which is characterized by a variety of psychopathological, vegetative-vascular and metabolic-neuroendocrine disorders, manifested in the luteal phase of the MC.

The pathogenesis of PMS is complex and poorly understood. There are many theories that try to explain the origin of this pathological condition. The frequency of PMS varies from 25 to 75% in various age and social groups, however, according to some authors, up to 95% of menstruating women experience some kind of premenstrual symptoms.

Mastodynia is explained by fluid retention (edema), compression of nerve endings, increased cell proliferation, the action of biologically active substances produced in high concentrations, in particular histamine, serotonin, prostaglandins and pain amines. Mastodynia as an independent premenstrual symptom occurs in approximately 10% of healthy women and, with a slight degree of severity, does not require drug therapy. Among patients with PMS, mastodynia occurs in more than 60% of cases.

Often cyclic mastodynia – one of the first and main manifestations of DMDM, disappearing when the disease takes on more pronounced forms – up to the transition to the nodal. The etiology and pathogenesis of DMDM ​​are complex and diverse. In each case, a thorough examination of the patient is required, an individualized assessment of the pathogenetic picture of the disease, risk factors, hormonal disorders and therapy options.

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Most often, DMDM ​​occurs precisely in the reproductive age of a woman, the peak incidence occurs at the age of 25-45 years. With the onset of menopause, the frequency of mastopathy decreases. The most common hormonal disorders in women of reproductive age, leading to the development of mastodynia, and later mastopathy, are the following:

  • absolute or relative estrogen dominance and progesterone deficiency;
  • hyperprolactinemia, incl. hidden and stressful;
  • hyperandrogenism.

In addition, the above hormonal imbalances may be secondary to diseases of the liver, thyroid gland, adrenal glands and other neuroendocrine pathologies.

One of the methods for correcting hormonal disorders in PMS, DMDM, MC disorders and others is the appointment of hormonal therapy – estrogens and progestins. The use of both synthetic and natural analogues of female sex hormones can lead to fluid retention in the body and manifest, in particular, mastodynia. The occurrence of painful cyclic breast engorgement also occurs when taking hormonal contraceptives with varying frequency (from 10 to 40%) depending on the composition of the drug, more often in the first months – during the so-called adaptation period.

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more about the most effective treatments PMS Subjectively, pain in the breast can be quite pronounced, cause significant anxiety, physical and psychological discomfort, or lead to refusal to take hormonal drugs prescribed for treatment or contraception.

Possibilities for correcting mastodynia, taking into account chest pain

Of course, treatment is indicated only after a thorough examination and clarification of the pathogenesis of mastodynia. In order to correct functional disorders, it is recommended to follow the principles of rational nutrition, to exclude products that contribute to fluid retention (salts, smoked meats, sweets), as well as containing various chemical flavors, dyes, preservatives. The amount of tea or coffee consumed should not exceed three cups per day.

The regime of the day is of great importance, it must necessarily include physical activity in the form of walking in the fresh air or any sports activities that bring positive emotions to a woman. Separately, mention should be made of the exclusion of bad habits – smoking and alcohol abuse. Particular attention should be paid to the selection of a bra. Underwear is recommended to choose from a soft, elastic fabric.

Mechanism of development and symptoms of menopause in women

Medication should be as individualized as possible. Of course, pathogenetically sound recommendations for the correction of hormonal disorders occupy a central place in the treatment of cyclic mastodynia. The groups of drugs used for this purpose include dopamine receptor agonists, antiestrogens, progestins, hormonal contraceptives. Considering the possible effect of fluid retention on the background of estrogen and progestogen drugs, preference should be given to the minimum effective dosages and the formulas as close as possible in terms of the spectrum of partial effects to natural hormones.

The treatment plan is selected individually after a thorough examination, taking into account hormonal disorders and the reproductive plans of each individual patient. Good results are given by the appointment of vitamin and herbal medicine. An important place is occupied by the use of drugs with decongestant, sedative action, as well as anti-inflammatory, vasoactive drugs.

Deficiency of what substances provokes the development of premenstrual syndrome Thus, despite the fact that mastodynia is not a condition that directly threatens the life and health of a woman, pain in the breast can be a sign of a number of serious diseases, up to a tumor. In addition, mastodynia can significantly impair the quality of a woman's life, be not only a consequence, but also a cause of stress, cause psychological, family and social maladaptation.

In all cases of pain in the breast, a detailed history is required, a detailed assessment of the nature of complaints, a thorough mammological examination, if necessary – a number of additional studies and consultations of related specialists. Treatment should be pathogenetically substantiated and individualized as much as possible.