Among all signs
and symptoms that characterize the premenstrual syndrome, mammary swelling,
engorgement and pain constitute some of the more frequent ones. Even many
women who do not complain from other premenstrual disturbances, often
report variable degrees of mammary congestion and/or pain on the days
that precede menstruation. Mammary congestion and engorgement is the most
frequent objective premenstrual manifestation and, therefore, the one
that is more easily verified at clinical examination. This happens because
the increase of density and volume of the mammary parenchyma thickenings
and nodules that characterize the so-called "functional mastopathies"
( or "benign functional alterations of the breasts" ) becomes
more evident in the premenstrual phase. In turn, this premenstrual increase
in the density and thickness of the mammary tissues is mostly due to the
premenstrual congestion and swelling of the breasts.
Even so, concerning
the precise etiology of this mammary congestion that frequently occurs
a few days or a week before the coming of the menses, we have to recognize
that it still remains obscure in the same way as that of the other
edemas and congestive phenomena that take place in other parts of the
female body along the premenstrual period. However, I would like to remark
once again that it is exactly in the breasts that the hydric retention
and the congestive phenomena that often precede menstruation become more
evident and easily detectable at clinical examination. In this way, besides
the probable action of local causative factors at the mammary level, there
are also indications suggesting the existence of a wider inter-relation
among all premenstrual edematous and congestive manifestations.
premenstrual engorgement of the breasts becomes clinically evident by:
1) a more or less diffuse increase in the volume and/or turgescence of
these organs; 2) an evident increase in the thickness and volume of their
glandular and ductal structures, as well as of the connective tissue that
surround them. As it is widely known, all these alterations often go along
with various painful phenomena that occur spontaneously or induced by
a simple touch or pressure. It is important to observe that considerable
variations in the intensity of all those manifestations can be found in
the same woman from one breast to the other a fact that demonstrates
the importance of the specific response of the "target" organ
in relation to the stimuli that cause the congestive reactions. In a similar
way to what happens to most of the other signs and symptoms that appear
on the days that precede the menses, this cyclical premenstrual mammary
congestion and pain also uses to reduce quickly with the beginning of
the etiology of this
premenstrual engorgement of the breasts, it is possible that, in this
phase of the cycle, there can be very specific reactions of the mammary
tissues to the estrogens and progesterone, to the interaction between
these hormones and/or to the fall in their respective levels. These very
specific reactions might give rise to a local formation of substances
capable of altering the permeability of the capillary vessels of the breast
tissues, resulting on the accumulation of interstitial fluid and the consequent
congestive phenomena. The already mentioned variations in the intensity
of these phenomena from one breast to the other in the same woman reinforce
this hypothesis. On the other hand, the mammary premenstrual congestion
can also be regarded as being only a more localized manifestation of the
systemic hydric retention that many women present on the days that precede
menstruation and that is part of the premenstrual syndrome *.
Also due to
this premenstrual mammary engorgement, women whose breasts present the
thickenings and increased nodularity that characterize the "functional
mastopathies" (or "benign functional alterations of the breasts")
often suffer from stronger premenstrual mammary pain and discomfort.
Over the last decades, several treatments have been used and proposed for this premenstrual mammary congestion and pain. The traditional treatments are commonly based on the use of hormones ( mostly progesterone and progestins ** ) and diuretics that cause the elimination of sodium and water, with a consequent reduction of the mammary edema. Other medicines have also been experimented in the last years, with uncertain results and many times controversial indications. Therefore, it is fundamental to emphasize that each case needs to be carefully analyzed individually so that the correct treatment can be prescribed.
Though there is no relation between the usual premenstrual mammary congestion and breast cancer, even so I would like to emphasize that the clinical management of all breast problems must necessarilly include, as a routine, full attention to the prevention and early detection of breast cancer.
Note 1: *Another more localized manifestation of these edemas that precede the menses is the premenstrual pelvic congestion. Though involving mostly the genitals, this congestive reaction also spreads to other near structures. Premenstrual pelvic congestion becomes clinically evident by a diffuse painfulness and sensation of "weight" and discomfort in the lower belly. Lumbosacral pain is also another frequent symptom.
Note 2: **According
to recent studies, some effects of progesterone and progestins ( synthetic
"progesterones" ) on the breast glandular structures are becoming
somewhat controversial. Even so, to my point of view, it is still too
early for radically changing the basic principles that rule the use of
these hormones for several mammary problems.