> A mother has approached me to find some information for her on mastitis
> post-weaning. This mother breastfed her child for just over a year. 7 months
> post-weaning she bought a new bra and developed mastitis (previous to this
> she did not believe that there was milk in her breasts). She took
> antibiotics (sorry don't know details of what she took or for how long) and
> mastitis subsided only to re-occur at the same time in her menstrual cycle
> as the first bout. Again she took anti-biotics. She's now coming up to the
> same point in her cycle again and is feeling like it is going to happen
> again.
> She had a couple of episodes of mastitis when she was breastfeeding but in
> the opposite breast to the one now having problems.
> 
> She has not worn the new bra since the first episode. I suggested to her
> that the new bra may well have been rubbing and that this may have been
> enough stimulation to raise her prolactin levels somewhat and result in some
> milk production. Any suggestions as to how she might deal with this? She's
> reluctant to just go on antibiotics every month (she wonders if she may not
> have been on them for long enough each time). Reasons why mastitis would
> occur at the same time in her menstrual cycle?

I think what you describe is probably not associated with prolactin or
stimulation of lactation but is a Non -lactational mastitis that is known as
periductal mastitis. Periductal mastitis  may result in periareolar breast
infection, abscess and mammary fistula. The mean age for women experiencing
this condition is 32-33 years (and they are often smokers (80%), or exposed
to cigarette smoke). In this condition there is squamous metaplasia  of the
cuboidal epithelium of major ducts which obstructs the ductal system causing
injury to the epithelial lining. This obstruction plus an alteration in the
bacterial flora results in periductal inflammation and mastitis. Where there
is resulting abscess from this infection, 40% will reoccur because the
underlying pathology remains  - and then surgical excision is considered the
most successful treatment. Mammary duct fistulas develop after this
treatment in one third of cases.  Antibiotic therapy is very important to
prevent abscess onset in periductal mastitis - so really I think she has
little choice with regard to this.

Of interest - Another post lactation problem (disorder of involution) that
can develop is cyst formation. This results from stroma disappearing early,
leaving epithelial acini unsupported which then form microcysts 9which can
become macrocysyts). These sometimes calcify, but are not associated with
inflammation. 

With regard to cyclical affects. Many things appear susceptible to this -
People report an increase in a wide range of conditions Eg:  episodes of
herpes recurrences, pimple outbreaks, mouth ulcers, boils etc. And
interestingly in mastalgia (which affects 70% of women at some time in their
lives and constitutes 50% of referrals to breast clinics) two thirds have
cyclical mastalgia (mean 34 years) and one third non-cyclical mastalgia
(mean 43 years).
First line treatment (there are 2nd and 2rd line treatments) for both types
of mastalgia includes evening primrose oil to treat reduced levels of 3
particular polyunsaturated fatty acids (dietary manipulation should also be
considered). This treatment alone results in a clinical improvement in 58%
of patients with cyclical mastalgia (and 38% with non cyclical). Returning
polyunsaturated fatty acid levels to normal is believed to dampen down the
hormone receptor interaction within the breast, sometimes several months of
treatment is required before an effect is seen.

Why I have digressed to this is because we know fatty acids play a
significant role in immune function and response. I don¹t know if
menstruation has been shown to affect fatty acid function but this could be
a possibility in the light of the success primrose oil has in treating
cyclical mastalgia. If so, disruption to fatty acid profiles may affect
immune function and make this woman at this time more susceptible to
infection. - just guessing though, haven't seen any literature to support
this theory.

However, whether menstruation affects immune response or not, supporting the
immune system generally, with basic dietary and life style changes (reducing
stress, quit smoking etc.) is probably an important contributing factor to
reducing any infections, such as these.

Regards
Cathy Fetherston CM MSc IBCLC
Perth, Western Australia

  

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