Gynecology and Mammology >>>> Treatment of mastopathy - what you need to know. Part 3

Treatment of mastopathy - what you need to know. Part 3.

There is no universal method of treating mastopathy due to the fact that each type of this disease requires an individual approach. It is the doctor who must diagnose the type of course of the disease and develop on this basis a set of treatment measures depending on age, concomitant gynecological diseases (uterine fibroids, endometriosis, endometrial hyperplasia, ovarian dysfunction), hormonal levels, the nature of the menstrual cycle, hypovitaminosis, as well as psycho-emotional state of a woman.

Several approaches to the treatment of mastopathy have been developed and they are all generalized into groups: non-hormonal and hormonal methods of treatment. The combination of these methods is called conservative treatment. And there is also a surgical method of treatment (operative).

Conservative treatment is indicated for patients in whom, using mammography, ultrasound, puncture biopsy of suspicious nodes, it is possible to exclude the malignant nature of the disease. It is aimed at correcting the identified hormonal imbalance and treating concomitant diseases.

Hormonal drug therapy includes drugs of different vectors of action:

Drugs that suppress sex hormones of the first phase of the menstrual cycle (estrogens), which affect tissue proliferation (proliferation). These drugs are called antiestrogens. The above drugs have side effects (carcinogenic effects of some of them on the liver and endometrium, thromboembolic complications) and should be prescribed with caution.
Drugs that suppress sex hormones of the second phase of the menstrual cycle (estrogens). These are progesterone-based drugs, their common name is progestogens.
Hormonal oral contraceptives containing high doses of gestagens and low doses of estrogens are prescribed for women under 35 years of age according to the scheme in the absence of ovulation and violation of the luteal phase. Usually, when making an appointment, one should be guided by several principles: the presence of concomitant diseases, identified hormonal imbalance, the severity of the symptoms of the disease.
Drugs that inhibit the synthesis of prolactin, a pituitary hormone responsible for milk synthesis. They are called prolactin secretion inhibitors.
Testosterone-based drugs suppress the synthesis of pituitary gonadotropic hormones. They are called androgens. This group is prescribed extremely rarely and only to women over 45 years old due to unpleasant side effects (increased vegetation on the body).
Enzyme therapy preparations.
The drugs are analogues of LGRF. These drugs, analogs of the released hormone gonadotropin, significantly reduce the level of estrogen and testosterone. The indication for the appointment of drugs of this spectrum is a severe form of fibrocystic mastopathy with painful mastodynia (pain in the mammary gland).
Iodine supplements play a critical role in the overall hormonal balance. By regulating the function of the thyroid gland, they help to reduce the proliferative activity of tissues.

The appointment of iodine-containing drugs must be carried out under the supervision of an endocrinologist, since there are contraindications for them.

Any hormone therapy, regardless of age, should be carried out after determining the level of hormones in the body at the time of treatment.

Non-hormonal treatment of mastopathy is combined with hormonal or considered as an independent one. It is carried out with the help of non-steroidal anti-inflammatory drugs, herbal remedies and vitamins.

Recently, research in the field of mastopathy treatment has focused on the use of herbal preparations containing extracts from a cruciferous plant, which have a pronounced antiproliferative effect by normalizing estrogen metabolism, blocking growth and regulating apoptosis processes.

For mild forms of mastopathy and mastodynia, drugs are used, made on the basis of an extract from the fruits of "Vitex sacred" ("Vitex Аgnus Castus" or "Prutnyak ordinary" ). They reduce the level of prolactin in the blood, regulate the menstrual cycle.

Since one of the causes of mastopathy can be unstable psychoemotional states, along with the above drugs, sedatives are also prescribed

Vitamin and mineral support is necessarily included in the general treatment regimen for mastopathy.

vitamin A has an antiestrogenic effect, reduces the phenomena of epithelial proliferation (beta-carotene)
vitamins P and C or products containing these vitamins (citrus fruits, fruits, rose hips, black currants, chokeberries, cherries, raspberries) to improve microcirculation and reduce local edema of the mammary gland.
vitamin E enhances the effect of progesterone

vitamin B6 reduces prolactin levels

phospholipids, selenium, zinc strengthen the structure of cell membranes.

The diet is seen as a necessary adjunct to conservative treatment. First, weight loss has a beneficial effect on hormonal balance, since adipose tissue serves as an additional source of estrogen production. It is also necessary to reduce calories by reducing the intake of carbohydrates (sugar, honey, jam, baked goods).

Secondly, since the utilization of estrogens occurs in the liver, and is excreted through the intestines, then the diet should have a sufficient amount of fiber (bran, vegetables, fruits, berries, herbs). Thirdly, if diseases associated with a lack of iodine are identified, it is necessary to include in the consumption of foods rich in iodine compounds (seafood, especially seaweed).

Surgical treatment of mastopathy

Surgical treatment is indicated in case of suspicion of a malignant tumor based on the results of a biopsy, the presence of nodular mastopathy with fibroadenomas of more than 2 cm, or in some cases with the formation of a large cyst. If the fibroadenoma is small, then constant monitoring by a mammologist is required.

With mastopathy, there are two types of surgical intervention: when only a node, cyst or tumor is removed (exfoliation), and when a tumor is removed with part of the breast (sectoral resection). With sectoral resection, a histological examination of the excised specimen is performed. If cancer is suspected, a subcutaneous mastectomy is performed.

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