Withчины боли в молочных железах, диагностика иtreatment of pathological changes

Update: October 2018

The pain in the mammary glands in one degree or another worries
more than half of all women. She is варьируется от легкого
discomfort to painful burning and severity, reducing the quality
of life. Therefore very important найти причину болей, а затем и подобрать
эффективное treatment.

How are the mammary glands?

The female breast consists of a gland divided by ducts into
lobules, connective tissue and fat. Predominance of glandular or
fibrous (connective) tissue depends on age, hormonal
background, weight and characteristics of the body. But any breast
women – the body in which changes occur constantly
parallel with the menstrual cycle (see the causes of the violation
menstrual cycle). Hormonal transformations are as follows.
in the following way:

The first 14 days (with a 28-day cycle) in the ovaries are active
follicles mature. By the middle of the cycle, the follicle is torn and
releases an egg cell. This is combined with a peak estrogen release.
After the release of the egg on the place of the follicle forms a yellow body.
This phase is characterized by the production of progesterone. If not
conception occurs, the yellow body gradually fades away, and the level
both hormones by the end of the cycle is reduced. Menstruation occurs.

A great influence on the mammary glands has a female hormone –
estrogen. It causes an increase in the number of glandular cells,
connective tissue elements. These cells line all the ducts in
chest Excess estrogen can turn groups of glands into cysts. They
в большинстве случаев безопасны и не требуют treatment.

Progesterone, rising in the second half of the cycle, causes
swelling, improves blood circulation and leads to pain in
premenstrual period. This is due to the preparation of ferrous
breast cells to the possible release of milk after the onset
of pregnancy.

Cyclic pains (mastodynia) – pain before menstruation

Most of all complaints of chest pain are associated with
cyclical changes in the female body. For такого состояния
it is characteristic:

  • the onset of pain a few days before menstruation
  • pain subsides with the onset of menstruation, their disappearance after
    monthly
  • significant decrease or disappearance of pain during
    pregnancy and after menopause

Such complaints are found mainly in women from 17 to 40 years old, with
средним и большим размером chest Breast pain caused
which is ovulation, usually bilateral, most pronounced
in the upper outer quadrants of the chest

Pain as a sign of PMS

Cyclic pain that recurs every month can
be part of premenstrual syndrome. To other signs of this
unpleasant condition include:

  • Irritability and mood swings
  • Anxiety and anxiety
  • Increased appetite
  • Abdominal pain, bloating

The main feature of premenstrual chest pain is
complete absence of symptoms before ovulation. First half
the menstrual cycle is painless, and after 14 days
the above complaints are gradually increasing. Peak pain
приходится на 2-3 дня до monthly.

These or other signs of PMS mark up to 80% of women. Almost u
All of them breast tenderness is one of the main
symptoms. This condition does not pose a danger to life and
health There is a perception that women who suffer from monthly
breast pain and compaction, are at risk of cancer. AT
Currently, there is no evidence for the association of cyclic pains in
молочных железах и рака chest

Most often, pain occurs against a diffuse background.
fibrocystic mastopathy. This is not a disease, but a special condition.
female breast, in which there is a uniform growth
glandular or fibrous tissue. No consequences except
discomfort, it does not have.

Non-cyclic

  • with cysts in the chest
  • with benign and malignant tumors
  • with injuries and after surgery
  • when taking medication (hormones,
    antidepressants)

AT редких случаях боль не связана с менструальным циклом. Usually
discomfort occurs with cysts, tumors, injuries and
других патологиях в области mammary glands. Non-cyclic боли
often unilateral and localized. That is, a woman can clearly
show a place where there is discomfort (for example, localization
pain in the right breast near the nipple).

  • Nodal formations
  • Breast cysts
  • Fibroadenoma
  • ATоспалительные процессы
  • Implant response
  • Acute Mastitis
  • Lactocele
  • Malignant tumors
  • Paget’s Disease

Breast cyst

Breast cysts are cavities filled with fluid.
It is estimated that almost every woman has one or several
small cysts. They возникают в норме во время менструального
cycle. But sometimes cysts reach large sizes and cause
the owner of the inconvenience and pain.

If a careful examination and ultrasound revealed no threat of cancer,
small cysts usually do not touch, and the treatment prescribed is the same,
as with diffuse mastopathy. If cystic formations
suspicious (with a near-wall component, very big ones
inflamed) and cause severe pain, then carry out an operation on their
removal.

Fibroadenoma

Fibroadenoma – доброкачественная опухоль в молочной железе. She is
is a rounded chest, usually
painless, smooth and agile. But depending on
the location and size of this node can occur pain and unpleasant
sensations that lead a woman to a doctor.

There are fibroadenomas on the background of hormonal fluctuations,
more often in young women of childbearing age. Unlike
diffuse fibrocystic mastopathy, fibroadenomas require
biopsy. To exclude a cancer tumor injected into the site
a special needle and pump out some of the cells that study under
a microscope. After confirming the diagnosis, fibroadenoma is removed.
Along with her, pain and anxiety about oncology go away.

Lactocele

Lactocele – это киста в молочной железе, наполненная грудным
milk As a result of trauma, congenital abnormality or inflammation in
breast scar occurs, preventing normal lactation. Milk
stagnates, accumulates, forming a cyst. She is растет, вызывая
feeling sore and chest pain. In some cases it may
to cause its suppuration – abscess.

Lactocele представляет собой мягкое, подвижное образование. With
the puncture of the milk stands out. To relieve puncture pain happens
insufficient, requires a small operation to remove a cyst.

Lactostasis

The main cause of lactastasis, unlike lactosele, is
unsteady feeding rhythm. Increased milk secretion and
small consumption of his baby lead to stagnation in the chest.
Symptoms usually make themselves felt very quickly:

  • breast seal
  • tension and feeling
  • aching chest pain

In rare cases, a slight increase in pain may join.
temperature All these symptoms occur in the first 3-4 months after
childbirth, when mom and baby are not included in a single lactation rate.

The main method of treatment of lactostasis is considered active feeding.
The first portion of milk can be decanted to facilitate sucking. AT
the first months it is recommended to feed the child on demand, outside
depending on the time of day. If you stop feeding with lactostasis
affected breast, the amount of such valuable milk in it can
decrease, which will lead to problems in the future.

Mastitis

Mastitis – воспаление в молочной железе. Most common
lactation variant of the disease arising on the background of breastfeeding.
And in most cases, mastitis is preceded by lactostasis. Stagnation
milk in combination with cracks in the nipples allow bacteria
to multiply actively. AT результате молочная железа опухает,
it becomes red and hot to the touch, severe pain occurs.
General well-being is usually characterized by weakness in the background.
increase the temperature to 39 degrees.

Diagnosing mastitis is easy. Much harder it
cure while maintaining normal lactation. Drugs first
lines are considered antibiotics. They are prescribed only by a doctor after
inspection. With тяжелом состоянии и отсутствии эффекта от лекарств
an incision may be necessary to drain pus. AT любом случае
It is important to keep lactation at the recommended level.

Breast Injury

Breast injury is quite rare. Usually
bruises and abrasions after falls, road accidents and other
accidents. If a hematoma occurs as a result of a chest injury
(accumulation of blood, bruise), then after a considerable time
pain and discomfort appear. Therefore, all hematomas in dairy
glands require puncture and removal in order to avoid inflammatory
process.

Implant pain

Painful after reconstruction or breast augmentation surgery
sensations are the norm. It takes time to heal scars and
�”Addictive” to a new size. But sometimes the implant causes
chronic or acute inflammatory response or squeezes
nerve endings. AT этом случае нужно проконсультироваться с
plastic surgeon for reoperation.

Cracked nipples

Almost all women after childbirth experienced discomfort in
nipple area. Constantly hungry baby requires hourly
feeding, and milk is still very little. Friction leads to itchy skin,
burning and sore nipples. The most unpleasant sensations occur when
the appearance of cracks. ATысыхание кожи на груди приводит к растрескиванию
nipples – agonizing state. Sores and sores do not have time
heal between feedings, which delays recovery. AT таких
cases recommend frequent lubrication nipples Bepantenom,
Depantenol and other similar creams (see treatment of cracks
nipples). They do not harm the baby, but quickly heal cracks. With
severe infected wounds sometimes need to be limited
child stays “on the chest” before the symptoms subside.

Non-Breast Pain

  • межреберные невралгии (при ревматоидных болезнях, ОРATИ)
  • Tietze syndrome
  • postherpetic neuralgia

Tietze syndrome

Tietze disease is not very common, but still
sometimes found. This condition is manifested by pain and swelling in
area of ​​cartilage ribs. Withчины возникновения pathologies are unknown,
inadequate physical exertion can aggravate the condition and
stresses. In women, this syndrome is often disguised as pain in
mammary glands. Eliminating the disease is quite easy: enough
conduct a chest x-ray and pay special attention to
costal cartilage. Some specific treatment for Tietze syndrome
пока нет, при сильных болях используют стандартные НПATС. Pretty
often after a change in physical activity, the syndrome disappears itself
by myself.

Shingles

ATирус Herpes zoster, вызывающий при первом попадании в организм
chickenpox, leads to shingles (see herpes on the body).
This is quite a painful condition, accompanied by bubbly
rashes, burning pains and itching. Nerves are most commonly affected.
skin in the lumbar region (hence the name of the disease). If rash
appeared in the chest area, it is possible to confuse this itching and pain under
mammary gland with signs of mastopathy. Therefore very important
to inspect the chest for bubbles and redness.
Soreness of rash disappears in 2-3 weeks, condition
markedly facilitates antiviral therapy (acyclovir and other
drugs, see herpes ointment).

Mammary cancer

Breast cancer is considered the most formidable of all causes of chest pain.
glands. This is the tumor that ranks first among oncological
processes in women. Besides the high prevalence of this cancer
dangerous and high mortality, as many women delay
visit to the doctor to the last.

Breast Cancer Risk Factors

  • Early menstruation, late menopause, lack of childbirth and
    of pregnancies
  • Obesity
  • ATозраст более 60 лет
  • Previously transferred cancers of the breast, ovaries or
    intestines
  • Oncological processes of the above organs and the nearest
    relatives (mother, sister, grandmother)

Among all these factors, one dominates: impact
estrogen on the mammary gland. It must be remembered that the usual diffuse
mastopathy, cyclic chest pain before menstruation are not
risk factors and causes of cancer.

Heredity, burdened by cases of oncology, requires
attentive attitude to health. Up to 10% of breast cancers
considered a consequence of genetic damage. The presence of specific genes BRCA1
and BRCA2 increase the risk of cancer dozens of times. therefore
chest pain in a woman whose relatives had breast cancer
glands, requires special treatment and special studies.

Breast cancer symptoms

Small tumors without metastases, most often no discomfort
do not cause. Pain occurs only when the “unsuccessful” location
next to the nerve endings. therefore важным этапом ранней
diagnosis is self-examination of the mammary glands by a woman.

A special form of cancer is considered Paget’s cancer. It is localized in
the area of ​​the nipple, causing deformation and retraction, as well as pain
to the left or right of it.

Breast Cancer Treatment

In the initial stages of the disease, when the cancer has not gone beyond
breasts or the nearest lymph nodes, usually used complex
treatment. AT него входят операция по удалению рака, химиотерапия и
exposure. AT зависимости от типа опухоли могут применить
hormonal drugs. Sometimes too much swelling is reduced.
chemotherapy and then remove. Scope of surgery
in our country is usually great: clean the mammary gland, lymph nodes and
underlying muscles. AT странах Европы женщины выявляют у себя болезнь
much earlier, therefore, they use partial resection of the mammary
glands with cosmetic sutures.

Breast Examination Methods

With появлении болей в молочных железах нужно пройти ряд
research. They will help establish the cause of discomfort, eliminate
опасные для жизни состояния и подобрать адекватное treatment.

Breast self-examination

Lying – for examination of the right breast under the right
put a scoop pad, and the right hand is turned over by the head.
Fingers examine the entire breast in a circle, from the periphery to
pacifier Standing – surveys carried out in two positions: with lowered
and raised hands.

What to look for during the examination:

  • Consolidation of any shape and size. Especially: with uneven
    contours, motionless, large sizes.
  • ATтяжение соска
  • ATыделения из соска любого цвета (за исключением молока во время
    pregnancy and lactation)
  • Changes in breast size (asymmetry)
  • Lemon peel skin changes
  • Discoloration of the skin (redness, blue) and its
    temperatures
  • Feeling sore
  • The presence of ulcerations on the skin of the breast

ATсе вышеперечисленные признаки – это повод для обращения к
a specialist. This doctor may be a mammologist, gynecologist or
therapist. If the doctor has health concerns.
women, but he will send her for further examination and consultation to
oncologist Examination and probing of the breast by a woman helps to detect
early breast cancer. But in fairness it should be noted
that most of the neoplasms found by a woman
on their own. Are benign and do not even require
treatment.

Chest Examination for Pain

Mammography is an X-ray examination. mammary glands.
The method is the standard for diagnosing breast pathology in women.
over 40 years old. It allows you to assess the condition of the tissues of dairy
glands, the prevalence of pathology, the nature of tumor growth
process. But if the glandular dense component prevails in the chest,
mammography becomes uninformative. therefore молодым женщинам
It is recommended to conduct an ultrasound instead of x-rays.

Breast ultrasound – ultrasound examination of the breast is shown
in the following cases:

  • in pregnant and lactating women
  • in young women for the purpose of prevention
  • all women with complaints of pain (as an addition to
    mammography)
  • for differential diagnosis of cysts

CT and MRI of mammary glands – computer and magnetic resonance
tomography – additional methods of examination. With первом
contacting a doctor or not using them at all for prevention
of necessity. Usually к ним прибегают при неясном диагнозе, когда
mammography and ultrasound give a fuzzy picture. In addition, MRI and CT
help assess the state of the neighboring organs, even detect
distant metastases in malignant tumors.

Aspiration biopsy – for painful (or painless)
education in the mammary gland, especially in women in menopause and with
burdened with heredity, a single x-ray is not enough. For
making a diagnosis you need to study the formation cells for
malignancy. For этого чаще используют аспирационную биопсию.
AT некоторых случаях этот этап пропускают, прибегая сразу к удалению
tumor and subsequent examination of the material obtained.

With необходимости врач назначает дополнительные методы
examinations for the purpose of diagnosis.

Treatment of pain in the mammary glands

Treatment of pain syndrome directly depends on the reason
caused. therefore в первую очередь нужно обратиться к специалисту
for a thorough examination.

Treatment of cyclic pain

The so-called diffuse mastopathy with premenstrual pain
– safe and benign phenomenon. Inherently is
normal reaction to the normal ovulatory cycle. But if a woman
painful sensations bother, apply several methods.

  • Conversation with the doctor

Strangely enough, there is often a simple conversation with
specialist for complete withdrawal of symptoms. After clarifying about
the safety of mastopathy, the absence of cancer or the risk of its occurrence
The woman’s condition improves dramatically, and the pain subsides.

  • Choosing the right linen

Tight bra of the correct form and size allows to reduce
discomfort from cyclical pain

  • Aromatherapy, complete rest and dosed physical
    load at PMS
  • Limit fat foods and weight loss
  • Oral contraceptives

Withем комбинированных оральных контрацептивов – это временное
�”Turning off” ovulation. No ovulation means no hormone surges.
therefore дискомфорт и боль на фоне приема КОК обычно уменьшаются или
even disappear completely

  • Nonsteroidal anti-inflammatory drugs (ibuprofen,
    paracetamol and others)
  • Tamoxifen – a drug used in severe mastopathy with
    very bad pain. It has a number of side effects, therefore
    appointed strictly according to indications

ATажно помнить, что гомеопатические средства (мастодинон и
others), supposedly eliminating mastitis, are quackery. Effect
usually based on self-suggestion. therefore нет смысла применять
drugs with unproven efficacy and safety when
can be limited to a good rest, taking a bath or one
talk with the doctor.

Treatment of acyclic pains

With обнаружении кист, опухолей, воспалительных процессов
consultation of the doctor is necessary, careful diagnostics and in some
cases of surgery. After removal of a benign lesion
PMS treatment can be used. After treatment of malignant
neoplasms, many drugs are contraindicated. Cancer Pain
mammary glands with distant metastases are usually very strong,
мучительные, не снимаются НПATС. Sometimes for stopping cancer
pain has to use narcotic analgesics.

Treatment of non-breast pain

A competent doctor will determine the source and cause of the pain by prescribing
additional examinations. The treatment is chosen accordingly.
pathology.

ATопросы, которые может задать врач

Before visiting your doctor, you need to consider some questions that
sure to ask a specialist.

  • AT какой части груди чувствуется боль?
  • What is the nature of sensations? (aching, bursting, stitching
    pain?)
  • How long do pain bother you?
  • Rate the power of pain on a 10-point scale.
  • Does one or two breasts ache?
  • Is there a pattern in the occurrence of pain (menstruation,
    physical activity, breastfeeding, etc.)
  • Когда ATы проходили последнюю маммографию?
  • Are there any other symptoms? (breast lumps, discharge from
    nipple, etc.)
  • ATы беременны? Breastfeed? Was there a recent medical abortion
    or miscarriage?
  • Have there been breast injuries or dairy operations in the past?
    glands?
  • Did any of the closest relatives suffer from breast cancer,
    яичников или intestines?

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