Comprehensive assessment of the state of the mammary glands in women with menstrual disorders of endocrine genesis

Abstract

The objective: to study the features of the pathological state of the mammary glands, depending on the nature of the menstrual cycle, the characteristics of the hormonal and immunological status in women with menstrual disorders of endocrine genesis.Materials and methods. For the study, a group of 130 patients (n=130) of reproductive age (mean age 27±2,3 years) was selected, who were divided into 2 subgroups by the nature of menstrual dysfunction: 1 subgroup (n=73) – women with secondary amenorrhea and oligomenorrhea background of chronic anovulation, 2 subgroup (n=57) – women with a regular rhythm of the menstrual cycle and insufficiency of the luteal phase (ILP). All patients complained about the absence of pregnancy for an average of 4±1,2 years.To assess the state of the reproductive system and hormone-dependent organs, women underwent complex clinical-hormonal, ultrasound, radiothermometric, X-ray and immunological examinations.Results. Menstrual irregularities in all patients are caused by endocrine pathology: secondary amenorrhea and oligomenorrhea against the background of chronic anovulation – 56,2%, regular rhythm in combination with ILP – 43,8%. When examining the mammary glands, 88,9% of patients were diagnosed with various variants of fibrocystic disease (FCD), underdevelopment of structural elements, involutive changes that do not correspond to age, focal formations.Thus, the frequency of FCD with anovulation is 1,3 times higher than with ILP (43,9% and 35,1%, respectively), while focal formations in the mammary glands of the type of fibroadenoma are 4 times more likely to be detected in patients with ILP than with amenorrhea (5,3% and 1,4%, respectively). With radiothermometry, in 13,4% of cases FCD was additionally diagnosed, which was not detected by ultrasound, while the coincidence of the results of both diagnostics was noted in 49,2%.In 1 subgroup, every 2nd patient (52,0%) was diagnosed with hyperprolactinemia. The hormonal parameters were characterized by a decrease in the level of FSH, LH, estradiol, and the degree of inhibition of the secretion of these hormones increased depending on the increase in the level of prolactin. In patients with hyperprolactinemia, different forms of FCD were detected 2,4 times more often. Hormonal and immunological examination revealed a decrease in the activity of T-helpers, immunoregulatory index, circulating immune complexes in both groups, while no significant differences were found between the groups.Conclusion. When studying the characteristics of the nature of the menstrual function of the patients, it was found that the majority of the subjects had latent disorders of the hypothalamic-pituitary-ovarian system, which were compensated until a certain point and manifested themselves under the influence of unfavorable factors. With ILP more often than with anovulation, mixed forms of FCD and diffuse forms with a predominance of the cystic component were diagnosed.Probably, these changes in the mammary glands can be explained by the insufficient effect of progesterone and a relative increase in the level of estrogens, which support the proliferation of the connective tissue and epithelial components of the mammary gland. As a result, obstruction of the ducts develops, which in some patients leads to an increase in alveoli and the formation of cystic cavities. Progesterone deficiency is also largely associated with changes in the immune status in patients with endocrine infertility, but immune disorders develop secondarily and are not specific for a particular pathology.