> 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 donšt 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 *********************************************** To temporarily stop your subscription: set lactnet nomail To start it again: set lactnet mail (or digest) To unsubscribe: unsubscribe lactnet All commands go to [log in to unmask] The LACTNET mailing list is powered by L-Soft's renowned LISTSERV(R) list management software together with L-Soft's LSMTP(TM) mailer for lightning fast mail delivery. For more information, go to: http://www.lsoft.com/LISTSERV-powered.html