The climacteric period (synonym: menopause, menopause, menopause) is a physiological period in a person's life, characterized by the reverse development (involution) of the reproductive system, occurring against the background of general age-related changes in the body.
Menopause in women
The onset of menopause in a woman is associated with functional changes in the system - the pituitary gland - the ovaries and is expressed in the gradual extinction of the menstrual function, and then the hormonal activity of the ovaries.
During menopause, there are two phases, or stages, of development. The first of them - the period of climacteric changes in menstrual function - occurs at 43-45 years old and later, lasts about one and a half to two years until the complete cessation of menstrual function (menopause). The most typical in the first phase of menopause is a violation of the rhythm of menstruation and the duration of the menstrual cycle. For most women, the intervals between periods gradually increase and the intensity of bleeding decreases. Less commonly, there is a shortening of intervals and increased bleeding. The onset of menopause ranges from 45-46 to 50 years. The duration of the second phase of menopause - the extinction of the hormonal activity of the ovaries after the cessation of menstrual function - is quite difficult to establish, but sometimes within 3-5 years (or more) after the onset of menopause, menstrual spotting may appear in older women and even occur. At the end of the second phase of menopause, the hormonal activity of the ovaries ceases and the so-called physiological rest of the reproductive system occurs.
Premature onset of menopause (up to 40 years) is observed in women who had unfavorable working and living conditions, after frequent childbirth and abortion, after massive blood loss during childbirth, in chronic infectious diseases. Late extinction of menstrual function (over 50 years old) is observed with uterine fibroids, with diabetes. Severe mental trauma, prolonged emotional stress in women of adolescence can contribute to the sudden cessation of menstruation.
Among the complications of menopause, climacteric uterine bleeding and the so-called climacteric syndrome deserve the greatest attention.
Menopause bleeding is caused by disturbances in the processes of growth, maturation and reverse development of follicles in the ovaries. Hormonal imbalances often cause overgrowth of the endometrium.
The detachment of the functional layer of the mucous membrane is also disturbed, as a result of which the patients develop prolonged irregular bleeding of varying duration and intensity. In some patients, bleeding occurs after a delay in menstruation.
To clarify the diagnosis, it is necessary to study the dynamics of ovarian function using a colpocytogram, the use of a test with crystallization of cervical mucus, measurement of basal (rectal) temperature (see). The most important is the diagnostic curettage of the mucous membrane of the uterus, which must necessarily precede the start of treatment. With a histological examination of scraping, it is possible to identify the nature of changes in the endometrium, and most importantly, to exclude the presence of a cancerous process.
The climacteric syndrome includes a kind of symptom complex, manifested by "hot flashes" to the head and upper half of the body, increased frequency, sweating, dizziness, sleep disturbance and working capacity. The diagnosis of climacteric syndrome is based on a typical clinical picture that develops at the end of the period of climacteric changes in menstrual function or at the beginning of menopause.
In the climacteric period, due to the unstable neuropsychic state of a woman, fluctuations in blood pressure are observed in some cases, typical forms of arthritis can develop, and the course of other diseases is aggravated.
Treatment... In the menopause, great attention should be paid to a rational general regimen, to establish a correct diet (increase the amount of vegetables in food, limit meat, meat soups), in order to avoid stagnation in the small pelvis, a woman should move more, do morning exercises, with constipation and obesity, it is recommended, ...
With climacteric bleeding, the diagnostic curettage performed before the start of treatment simultaneously has a therapeutic effect - in some patients, after curettage, the bleeding stops. In case of recurrent menopausal bleeding, the doctor conducts only after special functional studies. Women aged 45-47 years are prescribed preparations of the corpus luteum hormone - in tablets of 0.01 g 3 times a day under the tongue in the second half of the menstrual cycle. Older women, as well as with recurrent polypous growths of the endometrium, in order to suppress menstrual function, use drugs of male (androgens) hormones - methyl testosterone 0.01 g 3 times a day under the tongue for 1-2 months. or testosterone propionate (25 mg 2-3 times a week intramuscularly for 3-4 weeks) as directed by a doctor.
For the treatment of climacteric syndrome, sedative (sedative) drugs are recommended - valerian with bromides, (2-5 mg per night for 1-2 months), frenolone, etc., as well as small doses of hormonal drugs, also after a thorough special examination and only as prescribed by a doctor.
Climax female
The female climax is the age-related physiological period of the involutionary restructuring of the gonads, as well as all other organs and systems. There are three phases of the climacteric period, usually occurring in women aged 45 to 55 years. In the first phase, a large amount is found in the body, in the second their content decreases, in the third there are no estrogens, but there are many gonadotropic hormones of the pituitary gland. Often in the climacteric period, women develop climacteric neurosis, which is a special neuroendocrine syndrome associated with age-related involution. Menopause disorders can appear with the onset of menopause, as well as long before it.
The syndrome is caused by complex changes in the central and autonomic nervous systems and the system of endocrine glands. It is characterized by hot flashes to the head and torso, sweating, dizziness, vasomotor lability, increased excitability, insomnia, a feeling of unreasonable anxiety, etc. There is an inferiority of the ovaries of a functional or structural order, atrophy of the uterus and external genital organs may develop, which does not depend on the content of estrogen in the body. The involution of the uterus and external genital organs precedes the age-related degeneration of the ovaries, the hormonal connection between these organs is disrupted. Often there is an increase in the thyroid gland, and sometimes an increase in its function. In connection with the hyperfunction of the adrenal cortex, male-type hair growth, coarsening of the voice, etc. may appear. The amount of 17-ketosteroids excreted in the urine increases. There may be some acromegaloid features of the face and extremities.
Treatment... Treatment with bromides is used (from 0.05 sodium bromide per dose twice a day; in the absence of an effect, the dose increases to 0.2-0.4 per day) until the disappearance or mitigation of neurotic phenomena. It is advisable to use preparations of rauwolfia, trioxazine, meprotan, andaxin, devinkan, etc.
Hormonal treatment of climacteric phenomena is carried out taking into account the phase of the climacteric period, the patient's age and the maintenance of menstrual function.
In the first phase of menopause, characterized by sufficient estrogenic saturation, in the presence of signs of neurosis, if the menstrual function is preserved, it is permissible to use small doses of estrogens (in accordance with the phase of the menstrual cycle). Estrogens act on the central nervous system, activating the inhibitory cortical process weakened in the climacteric period. In the first half of the intermenstrual period for 12-14 days folliculin is prescribed 1000 IU in the muscles daily or Octestrol one tablet (10000 IU) 1-2 times a day.
In the presence of functional uterine bleeding, progesterone, 5-10 U intramuscularly for 5-6 days, and testosterone propionate 25 mg intramuscularly 2 times a week (6-8 injections in total) or methyltestosterone 0.005 1-2 times a day can be used under the tongue for 10 days.
However, the use of progesterone and androgens requires special care, because it is known that there are psychoneurotic changes in women before menstruation, when the body is saturated with the corpus luteum hormone. In addition, this hormone, like androgens, has a virilizing property. Only in severe climacteric neurosis, when there is no effect from other measures of influence, it is possible to resort to these hormonal drugs, of course, with a complete cessation of their intake in case of signs of virilization.
In the second phase of menopause, when the hormonal level is sharply reduced and persistent menopause has begun, with severe autonomic-nervous disorders, the following drugs are recommended:
folliculin 1000 IU in the muscles (10-12 injections) or 3000 IU in the muscles every other day (a total of 8-10 injections);
estradiol-dipropionate 10,000 IU in the muscles 1-2 times a week (only 5-6 injections);
Octestrol or Sinestrol 1 tablet (10,000 IU) orally 1-2 times a day for 2-3 weeks.
The course of estrogen treatment can be repeated 2-3 times with intervals of 4-6 months. In the second phase of menopause, estrogens are prescribed to replace the missing follicular hormone.
In the third phase of menopause, estrogens are used to suppress the function of the pituitary gland and reduce the formation of gonadotropic hormones. Therefore, male and female sex hormones are combined according to the following scheme: testosterone propionate 25 mg intramuscularly three times a week (total 6-8 injections) or methyltestosterone 0.005 under the tongue 2-3 times a day for 3-4 weeks; it is also advisable to use methyandrostenediol 25 mg per day for 10-12 days; folliculin 3000 ME in the muscles 2 times a week (6-8 injections in total) or octestrol or sinestrol 1 tablet (10,000 ME) 1-2 times a day for 3-4 weeks.
During estrogen therapy, it is necessary to control the degree of saturation of the body with estrogens by changing the cytological picture of the vaginal smear or by another of the described tests.
If, before the end of the course of treatment, the symptoms of climacteric neurosis disappear, the dose of estrogen is reduced.
Contraindications to the use of sex hormones are neoplasms of the genitals and mammary glands (in the past or present), as well as recurrent uterine bleeding.
Hormonal treatment must be combined with the use of sedatives, elimination of all factors traumatizing the nervous system, if possible, observance of hours and days of rest, reasonable use of vacation, normal sleep, physiotherapy procedures, rational psychotherapy.
This section presents modern ideas about the physiological menopause and the causes of the pathological course of the menopause. The data on the peculiarities of the course of somatic and gynecological diseases in the climacteric period (diabetes, hypertension, metabolic disorders, tumor and inflammatory diseases of the genital organs) are given and the tactics of treating patients are determined. The issues of forecasting, diagnostics and prevention of pathological menopause are considered.
The section is designed for gynecologists, therapists, psychoneurologists, neuropathologists.
Foreword
The problem of human aging has attracted the attention of prominent thinkers of mankind since ancient times. In the second half of the 20th century, this problem has acquired particular relevance due to the fact that there have been significant changes in the age structure of the population - life expectancy has increased. Consequently, the duration of the climacteric period has increased. In this regard, the ever-increasing interest shown to this period of life is understandable, primarily in terms of maintaining health.
Diagnostics and treatment of pathological conditions in menopause have a certain specificity, which is not always taken into account by obstetricians-gynecologists. The features of this period are primarily in the fact that it is at this time that many diseases arise or manifest themselves: benign and malignant tumors, psychoses, neuroses, diabetes mellitus, obesity, dysfunctions of the endocrine glands, vegetative-vascular disorders, etc. Clinical symptoms of the listed diseases can be similar to the manifestations of the aging of the body and the pathological course of the climacteric period, in other words, the nature of the manifestations of many diseases and age-related changes can be practically the same, while the methods of treatment should be fundamentally different.
In this regard, the purpose of this work was, first of all, to present data on physiological and pathological age-related changes in the body of women, in particular, in the reproductive system during aging. The high frequency of the pathological course of menopause and diseases in this period of life obliges doctors to pay special attention to the prevention of the pathological course of menopause. In this regard, it seemed appropriate to dwell in more detail on this aspect of the problem under consideration. Pathological processes developing in the climacteric period are often caused by not always justified symptomatic therapy, therefore, the book pays great attention to differential diagnosis and methods of pathogenetically justified therapy.
The section is written on the basis of literature data, personal long-term experience of the author and the results of research conducted under the guidance of the author for 25 years in the endocrinology department of the All-Union Center for Maternal and Child Health Protection of the USSR Ministry of Health.
The time comes in the life of any woman when some changes begin to occur in her body. So that the inevitable problems of the climacteric life stage do not catch you by surprise, it is necessary to prepare in advance and adopt all the methods of treating its manifestations.
Why does the climacteric period occur in women?
The reason that triggers the climacteric process is a strong decrease in the production of a woman's sex hormones. The thing is that with age, the function of the ovaries begins to fade away a little, or may stop altogether. This action can last eight to ten years, it is he who is called the climacteric period in women. It should not be forgotten that during the premenopausal period, a woman is at risk for the possibility of an unwanted pregnancy. The occurrence of pregnancy is a very frequent occurrence, therefore, the number of abortions performed in this age category is extremely high. Carrying a fetus, however, like abortion, during the premenopausal period is much more difficult for women than at a young age, therefore, the issue of contraception must be taken very, very seriously.
In women, it is accompanied by a lot of symptoms, and it is not so easy to recognize them. Let us analyze the most important changes by which it is possible to establish the beginning of the climacteric period.
Symptoms of the onset of menopause
Violation of the menstrual cycle. One of the main symptoms of the onset of this period is irregular menstrual bleeding. The abundance of hemorrhages and the intervals between their onset become unpredictable. If such symptoms appear, you should immediately consult a doctor so that he can establish the exact cause.
Often during the premenopausal period, women complain of the so-called hot flashes. Suddenly, a feeling of intense heat rolls over, profuse sweat appears, and the skin becomes deep red. This symptom appears at any time of the day, even at night during sleep. The reason for this is the reaction of the pituitary gland and the drop in estrogen levels.
In addition, the symptoms of menopause include headaches and sleep disturbances. Trouble falling asleep, recurring hot flashes, and increased heart rate. Headaches are of a different nature, sometimes they are the result of depression. Depression is sometimes also a harbinger of the moment when menopause begins.
Dysfunctional climacteric character in women is more and more common. At first, menstruation begins to linger, and then sudden bleeding opens. They are accompanied by severe weakness, incessant headaches and causeless irritability.
Menopause in women: treatment
According to the observations of doctors around the world, in the past few decades, there have been trends in the rejuvenation of the onset of menopause, this phenomenon is called the early menopause in women. In any case, it is necessary to take up treatment only under the careful supervision of the attending physician and when the manifestations of menopause really complicate the woman's life. Most of the signs are accompanied by a lack of sex hormones, so experts advise switching to hormonal treatment. The preparations are selected purely individually. The daily regimen is very important during treatment. It is necessary to avoid stress, eat right, giving up all bad habits. Overwork or intense experience will again provoke headaches and sleep disorders in women during menopause. Nutrition in this period has its own individual characteristics. We need to eat more raw vegetables and fruits, dairy products and beef, buckwheat and oatmeal. It is necessary to give up the first and second courses containing a large amount of spices. In addition, sugar, salt and flour products should not be abused.
MENOPAUSE(Greek, klimakter stage, age turning point; synonym: menopause, menopause) - the physiological period of the transition from puberty to the period of termination of the generative function.
Menopause in women
The climacteric period in women covers a period of time from 45 to 60 years and is characterized by a gradual cessation of menstrual function, and then the hormonal function of the ovaries against the background of general age-related changes in the body. K. p. Is inextricably linked with the aging process of both cortical nerve centers and hypothalamic structures that regulate the activity of the pituitary gland and ovaries.
In the first phase of menopause - in the phase of climacteric ovarian dysfunction, or premenopause - changes in ovarian function are characterized by irregular luteinization of follicles, a decrease in the secretion of progesterone and estrogen, irregular menstruation is noted. The time after the last uterine bleeding due to the influence of ovarian hormones is called menopause. Its onset is preceded by a period of reduced ability of the female body to fertilize. The term "menopause" is also used to refer to the second phase of K. p. - postmenopause, when the function of the corpus luteum of the ovary completely ceases, against the background of a significant decrease in the production of estrogens, their residual secretion in the ovarian tissue is noted, and menstrual function stops.
Changes in the neuroendocrine system of women in K. p. Are characterized by a decrease in the reactivity of summer residents to gonadotropic stimuli from the hypothalamic-pituitary system, arising from a decrease in the estrogenic influences of the ovaries, funkts. changes in the thyroid gland, dysregulation of autonomic centers, increased excitability of sympathetic centers and lability of the vasomotor system.
The duration of ovarian function refers to genetically programmed fiziol. processes. By the age of 40, 30,000-40,000 follicles remain in the ovaries; in the next decade, their number decreases significantly. Dystrophic changes in the ovaries begin with a thickening of the basement membrane of the follicles, followed by its fibrous transformation.
The rate and degree of reduction in the number of follicles are individual; in the outcome of dystrophy, follicular atresia is observed with filling of their cavity with connective tissue. In To. The item in the ovaries follicles are found at different stages of development, fibrous and atretic bodies, there is a tendency to small-cystic degeneration of follicles. In 3-4 years after menopause, maturing and atretic follicles are less and less common. In the future comes the so-called. functional rest of the ovaries, their size decreases by 2 times. Sclerotic changes in the vessels of the ovaries, predominantly of medium caliber, are found after 30 years, long before the first wedge, manifestations of K. p., Then they spread to larger vessels. The lumen of the vessels narrows, the inner membrane thickens, the elastic membrane disappears, fatty and hyaline degeneration of the vascular walls occurs. The vascular network of the genitals and especially the uterus is significantly thinned. Its magnitude undergoes great changes. Only in those women who suffer from menopausal bleeding due to increased secretion of estrogen, the uterus in premenopausal women enlarges. In postmenopausal women, its weight decreases to 30 g. The number of anastomoses between the branches of the vessels of the left and right half of the uterus decreases, and a sort of avascular zone is found along the midline. Differences in the structure of the cervix and body of the uterus disappear, anteflexia is replaced by light retroflection. The vesicouterine and rectal-uterine spaces are flattened. The endometrium acquires an atrophic structure: the stroma becomes fibrous, the glands are poorly developed, the spiral arteries become rectilinear. The border between the funkts and the basal layer disappears; the remains of the glands remain in the basal layer, often in a state of cystic atrophy. The epithelium of the cervix atrophies. The vagina narrows unevenly, especially in the upper third, the composition of the vaginal contents changes. In the area of the external genital organs, the subcutaneous adipose tissue disappears, the labia majora become flabby, and the small ones decrease and become depigmented, the clitoris decreases. Involutional changes are also found in the mammary glands: the glandular tissue disappears, the nipple loses its pigmentation; sometimes the mammary glands grow significantly in size as a result of excess body fat.
The first phase To. The item comes at the age of apprx. 45 years. To premature development To. The item include its onset before 40-42 years, to late - after 55 years. In the presence of hypertension, the duration of premenopause increases to 3-3.5 years. A typical feature of changes in menstrual function in this period are disturbances in the rhythm and duration of the menstrual cycle and a gradual transition from a two-phase (ovulatory) to a single-phase (anovulatory) cycle. After 43 years, the average duration of the menstrual cycle increases (see), a significant part of women have a one-phase cycle with a disturbed rhythm of menstruation. The time of the onset of the second phase To. P. Fluctuates within fairly wide limits even in perfectly healthy women (as a rule, at 45-46 years).
In most women, both phases of K. p. Are expressed, and the period of climacteric changes in menstrual function precedes the onset of menopause: the intervals between menstruation gradually increase and the intensity of menstrual discharge decreases. Less commonly, changes in menstrual function are characterized by the appearance of irregular, heavy and prolonged menstrual bleeding. In a third of women, menstruation stops suddenly. An earlier termination of menstrual function is facilitated by frequent repeated childbirth, abortion, prolonged lactation, although in about half of women it is caused by primary hypothalamic disorders. Menopause occurs later in patients with uterine fibroids, hypertension, etc.
In premenopause, the level of hormonal secretion in the residual follicles of the ovary decreases, at the initial stages of age-related restructuring, the concentration of estradiol in the blood plasma decreases with unchanged production of progesterone by the corpus luteum, and later there is a decrease in the secretion of each of these hormones. The reserve of ovarian follicles capable of maturation is gradually depleted, and by the time of menopause, the level of total estrogen excretion in the urine decreases to 20 μg / day. Within the first year of postmenopause, there are also cyclical fluctuations in the level of estrogenic influences, by the end of the same, its level of estrogen excretion with daily urine is almost halved - to 10 μg. This amount of estrogens is not enough for fiziol, stimulation of the endometrium, although the latter's sensitivity to stronger endo- and exogenous hormonal stimuli persists for a rather long period. After a decrease and subsequent cessation of the production of estrogens in the follicular apparatus of the ovaries, the extrafollicular production of steroid hormones persists in the female body for a long time and steroid hormones or their precursors in small quantities. With pronounced individual fluctuations, they continue to form mainly in the area of the ovarian gates, where hyperplasia of the cellular elements of the stroma with signs of enzymatic activity is often found. 6-10 years after the onset of menopause, a small part of estrogen is formed in the ovary, the rest is the product of aromatization of androgenic precursors outside the ovarian tissue - in the subcutaneous tissue and the gastrointestinal-hepatic complex. The production of sex steroids by the adrenal cortex during transition remains unchanged for 10-20 years after menopause.
A progressive decrease in the formation of ovarian hormones, especially estrogens, in adolescence is accompanied by a violation of the influence of the latter on the hypothalamo-pituitary system. This is manifested by the termination of the effect of ovarian steroids on the hypothalamic centers, increased cyclic production of hypothalamic releasing hormones and gonadotropic hormones in the anterior pituitary gland. The content of gonadotropins in the anterior pituitary gland increases 10 times; this is combined with an increase in the weight of this fraction and the content of basophilic elements in it. The content of luteinizing hormone (LH) in blood plasma, according to radioimmune determinations, increases from 30 ng / ml to 500 ng / ml, follicle-stimulating hormone (FSH) - from 20 to 760 ng / ml, and the LH / FSH ratio is equal in reproductive the age of 1.0, decreases to 0.4-0.7. The ratio of LH / FSH in plasma less than 0.7 is a sign of the onset of K. p. The maximum content of LH and FSH in the blood is observed in the 3rd year of postmenopause and lasts for 10 years. With the onset of menopause, a decrease in estrogenic activity is observed in 50% of women, signs of moderate estrogenic influences are found in 33-40% of women, in 10-17% there are signs of increased estrogenic influences.
Violations To. The item - climacteric dysfunctional uterine bleeding (see) and climacteric syndrome (see).
The state of estrogen deficiency, which usually develops in the late stages of the postmenopausal period, contributes to the development of atrophic changes in the vulva, vagina and urinary tract, atherosclerosis, systemic osteoporosis, dystrophic arthropathy. While maintaining estrogenic influences in this period, there is a tendency to hypertension, diabetes, the development of hyperplastic processes in the endometrium and mammary glands.
In To. The item at many women obesity, development hron, constipation, general weakening of an organism is observed. Walking, gymnastics, massage, limiting the amount of food, especially meat dishes, contribute to the prevention of these phenomena. Alcohol, spices that sharply excite the nervous system should be excluded. It is best to regulate bowel action by prescribing an appropriate diet.
In K. p. Practically healthy women should undergo a medical examination by a gynecologist at least 2 times a year. The appearance of unusual symptoms during this period requires serious attention and careful examination.
Menopause in men
The climacteric period in men is determined by age-related involutional processes occurring in the gonads, and most often occurs at the age of 50 to 60 years. Atrophic changes in testicular glandulocytes (Leydig cells) in men of this age lead to a decrease in testosterone synthesis and a decrease in the level of androgenic saturation of the body. At the same time, the production of gonadotropic hormones of the pituitary gland tends to increase. Decrease of the endocrine function of the testicles plays the role of the so-called. a triggering factor in the violation of the mechanisms of regulation of the hypothalamus - pituitary - gonad system. As a result, complex neuroendocrine changes occur, including dysfunction of c. n. with. and defining the picture of male menopause. In the overwhelming majority of men, the age-related extinction of the function of the gonads is not accompanied by any clinics, manifestations, although sometimes there are characteristic symptoms of menopause and in such cases, the course of To. Item is regarded as pathological.
Wedge, manifestations patol. To. P. In men are characterized by cardiovascular, psychoneurol, and genitourinary disorders. Cardiovascular disorders are manifested by a sensation of hot flashes to the head, sudden redness of the face and neck, palpitations, pain in the heart, shortness of breath, excessive sweating, dizziness, etc. Sometimes there is an unstable arterial hypertension.
Psychoneurol, disturbances in To. P, can be weakly or sharply expressed. Patients complain of mild excitability, rapid fatigue, sleep disturbances, muscle weakness, and headache. There is depression, causeless anxiety and fear, loss of previous interests, increased suspiciousness, tearfulness.
Among the symptoms of dysfunction of the genitourinary organs, there is a varying degree of dysuria (see). Violations of sexual potency are observed in the vast majority of men (see. Impotence). At the same time, all the constituent moments of the copulatory cycle suffer, but there is a predominant weakening of erection and premature ejaculation.
Treatment for patol. K, item for men includes the normalization of the mode of work and rest, dosed physical. load, creating the most favorable psychol, climate. An obligatory component of treatment is psychotherapy (see). Drug treatment includes drugs that normalize the function of c. n. with. (sedatives, psychostimulating antidepressants, tranquilizers, etc.), vitamins, biogenic stimulants, drugs containing phosphorus, antispasmodics. In some cases, the appointment of drugs of sex and gonadotropic hormones is shown in order to correct disorders of endocrine relationships, as well as the use of anabolic hormones.
Bibliography: Arsenyeva M.G. Colpocytological studies in the diagnosis and therapy of endocrine gynecological diseases, p. 206, L., 1973, bibliogr .; Vikhlyaeva E. M. Climacteric syndrome and its treatment, M., 1066, bibliogr .; 3 man about in-s to and y Yu. F. Age-related neurophysiological features and climacteric disorders in women, M., 1975, bibliogr .; Malinovsky MS and C in e t - M about l d and in with to and I VD Menopause and menopause, M., 1963, bibliogr .; Mandelstam VA Uterine bleeding in menopause, L., 1974, bibliogr .; Teter E. Hormonal disorders in men and women, trans. from Polish., Warsaw, 1968.
E. M. Vikhlyaeva; D. V. Kan (urol.)
The postmenopausal period is the final, third stage of menopause. He, in turn, is divided into early and late. After the extinction of the reproductive function, aging of the body becomes inevitable. It is accompanied by many unpleasant physiological and psychological symptoms that are more or less familiar to all women. Fortunately, this difficult condition can be alleviated with simple and effective methods.
The postmenopausal period (postmenopause) is recorded 12 months after the last menstruation, and it lasts for about a decade. There is no clear time frame, as well as a strict norm for a woman's age. Individual characteristics and genetics largely determine these indicators.
The main signs of menopause begin to manifest themselves by changes in the body associated with a decrease in the functioning of the ovaries:
- with accompanying increased sweating;
- mood swings, unstable emotional state;
- , headaches and others.
The climacteric syndrome of the initial and final stages is different. In postmenopausal women, hormonal changes come to an end, and the amount of estrogen in the body becomes fixedly small, which affects the work of literally all systems. In rare cases, when a woman's health is weak, they remain in the postmenopausal period.
Postmenopausal women's problems
The postmenapausal period is, first of all, aging. The body at this stage is tired, worn out, the spectrum of its abilities is significantly narrowed, the general state of health deteriorates. Such female hormones as estradiol, estrade and estriol, by the end of menopause, become less than male.
The bone, cardiovascular, nervous and excretory systems function normally with a sufficient number of them, respectively, during postmenopause, failures are observed in their work.
Typical problems that await a woman in the postmenopausal period:
- The risk of osteoporosis. Due to the decrease in estrogen, the bone tissue becomes more fragile. This also explains the frequent bone fractures in women over 60.
- The condition of hair, nails and teeth deteriorates.
- Cardiovascular problems. The walls of blood vessels become thin and inelastic, which affects blood circulation and high blood pressure. A significantly slower metabolism affects the increase in cholesterol levels, which form blood clots. The latter, in turn, can lead to ischemic diseases, angina pectoris, cardiac arrhythmias.
- Vision decreases, hearing becomes worse.
- Thought processes slow down, memory deteriorates.
- Unstable emotional state, nervousness, tantrums.
- ... Itching may bother you. Warts appear and hairiness on the face and body increases.
- The reduced amount of secretion secreted by the genitals affects their microflora. In conditions of an insufficient amount of protective mucus, it is easier to get sick with genital infections or inflammatory diseases. Colpitis (vaginitis, inflammation of the vaginal mucosa) and cystitis are frequent companions of women at this time.
- The presence at the final stage is a very alarming sign. They indicate a high level of estrogen in the body, which is considered an abnormality at this age. The most common cause of this is the development of breast, cervical, or ovarian cancer. Any cloudy odorless discharge is also dangerous.
- Urinary incontinence, which occurs for two reasons: prolapse of the pelvic organs and rapid weight gain.
Postmenopausal syndrome develops in different ways. It is most pronounced in women who are too thin or too overweight, who smoke or abuse alcohol, have physically or emotionally hard work, and experience frequent stress.
The most important thing a postmenopausal woman can do for herself is to comprehensively improve her lifestyle. To alleviate your condition, you must:
- Follow an age-appropriate diet. This is a type of healthy balanced diet, the diet of which must necessarily include foods containing healthy omega acids: red fish, nuts, healthy vegetable oils, flax seeds, sesame seeds, chia. Also, dairy and fermented milk products are needed, which are indispensable for maintaining the condition of bone tissue. To speed up metabolism, you need to eat fresh fruits and vegetables according to the season, and to build muscle tissue - lean meats, all types of sea fish, seafood. The diet includes cereals and whole grain flour products in limited quantities.
- Use an additional source of essential micronutrients. Usually these are vitamin complexes with calcium and vitamin D. It is recommended to use it as directed by a doctor after examining blood tests.
- Avoid nervous strain, hard work.
- Provide yourself with healthy sleep and leisure full of positive impressions.
- Introduce regular physical activity. Walking long walks, yoga, meditations, breathing complexes of exercises, aerobic exercise, if the state of health permits, would be ideal.
- If necessary, initiate treatment with hormonal drugs. Gynecologists often prescribe them during menopause. These are estrogen substitutes that can be applied internally or topically. Taking these drugs orally helps to normalize hormones. External use is effective in eliminating itching in the genital area.
The presence of female problems characteristic of postmenopausal women should not affect the attitude towards life. It continues, and it makes sense to enjoy it, doing things for which there was not enough time before.
This section is a sentimental story about a woman's fall. Although not only women. We are somehow already accustomed, speaking of menopause, to have in mind the exceptionally weaker sex. But menopause - the period of physiological extinction of the function of the reproductive system - it happens, of course, in men.
For women, this period occurs at the age of 45-55 years. There is also a later menopause. This period of a woman's life, following the reproductive period, can last about 30 years.
Climax is a Greek word. Hippocrates' contemporaries did not put any medical meaning in it. In their time, this was the name of the staircase. But experts saw in this an undoubted similarity with a multi-stage sequence of hormonal changes occurring in the body during this period.
What phases are distinguished in the climacteric period?
These are: premenopause, menopause, postmenopause.
Premenopause- This is the period from the beginning of the attenuation of the function of the ovaries until the complete cessation of menstruation, which is characterized by a sharp decrease in the ability to conceive and a change in the nature of menstruation. This period usually starts at 40-45 years old and lasts 2-8 years. In 60% of premenopausal women, there is a gradual lengthening of the intervals between menstruation, which are becoming increasingly scarce. 10% of women experience a sudden cessation of menstruation. 30% of women may have acyclic uterine bleeding.
Menopause- This is the last independent menstruation in a woman's life. The fact that it has come can be said no earlier than a year after the cessation of menstruation.
Postmenopause- This is the period from the last menstruation to the complete cessation of ovarian function, which precedes old age. The duration of postmenopause is 5-6 years. During this period, from time to time, a woman can still notice cyclical changes in the body, but menstruation does not come.
What is climacteric syndrome?
Female sex hormones affect all organs, including the central nervous system, blood vessels, heart, bones, mucous membranes, urinary system, skin, and others. Therefore, when the function of the ovaries is turned off, 40-80% of women may experience symptoms of climacteric syndrome.
This syndrome manifests itself differently in different women:
"Hot flashes" of heat to the head, neck and upper half of the body,
periodic "jumps" in blood pressure,
palpitations
insomnia,
increased sweating
depression and irritability.
The severity of climacteric syndrome is often determined by the frequency of "hot flashes". If no more than 10 of them occur per day, climacteric syndrome is considered mild, if 10-20 "hot flashes" are moderate, more than 20 are severe.
2-3 years after the onset of menopause, changes may occur in the genitourinary tract: dryness of the vaginal mucosa, itching, frequent or painful urination. After 5 or more years after menopause, late metabolic disorders may occur - atherosclerosis and osteoporosis, which leads to an increase in the likelihood of many diseases - hypertension, myocardial infarction, bone fractures.
Often, the thyroid gland suffers, metabolism may be disrupted, which will lead to obesity or weight loss. It is often during this period that diabetes mellitus develops.
The earlier menopause occurs (natural or surgical), the earlier late metabolic disorders may occur, due to the disappearance of the protective effect of estrogens on bones, heart and blood vessels along with age-related disorders.
Why does ovarian function decline and unpleasant symptoms appear?
In the hypothalamus and pituitary gland, due to age-related changes, the process of regulation of hormone formation is no longer so vigorously. They send too weak commands to the ovaries. And with a decrease in ovarian hormones, the lining of the uterus becomes thinner, in connection with which menstruation stops.
The body suffers from a lack of progesterones and estrogens. Hence, many malfunctions in the body. The fact is that estrogen is responsible not only for sexual functions, it participates in thermoregulation, protects arteries from atherosclerosis, strengthens bones, and maintains skin elasticity.
The hypothalamus is responsible for the functioning of the heart, blood vessels, lungs, and other internal organs. It is due to a decrease in the activity of the hypothalamus and pituitary gland during menopause that many functions of the body are disrupted, new or exacerbated diseases may appear, and the fragility of bones increases.
The severity of all climacteric disorders is not the same for different women. Someone is incredibly tormented by these manifestations of menopause, and someone does not even notice it. Why? It all depends on the state of the body and lifestyle. If a woman has always led and is leading an active life in all its manifestations, looks after herself, controls her weight, goes in for sports and has not acquired any serious chronic diseases during her life, she will suffer less from the negative manifestations of menopause. But in women with an unstable nervous system, leading a sedentary lifestyle, in the climacteric period, existing diseases may worsen and new ones join.
What drugs are indicated for menopausal disorders?
The drugs that are designed to alleviate the climacteric syndrome contain natural (natural) analogs of female sex hormones - estrogens and progesterones. Such hormone replacement therapy drugs(HRT) are popular all over the world today. Thanks to them, millions of women in different countries will safely pass the critical age.
Such medicines include climonorm. It consists of estradiol and levonorgestrel and has a very mild effect on the body. Women who take this drug have a real opportunity to argue with the laws of nature and prolong their youth. The drug takes control of the bone, nervous, cardiovascular and genitourinary systems. To a certain extent, it protects against cancer of the uterus and ovaries, polyposis, endometriosis.
But climonorm, like all medicines, has its own contraindications. These are oncological diseases, disorders of the kidneys, liver, pancreas, a tendency to thrombosis. Therefore, you first need to talk with your doctor and decide whether or not to take this drug.
Currently appeared herbal preparations: klimadinon, remens, klimaktoplan.
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