The climacteric period (Greek klimakter stage; age transition period; synonym: menopause, menopause) is a physiological period of human life, during which, against the background of age-related changes in the body, involutionary processes in the reproductive system dominate.
Menopause in women. The menopause is divided into premenopause, menopause and postmenopause. Perimenopause usually begins at the age of 45-47 years and lasts 2-10 years until the cessation of menstruation. The average age at which the last menstruation occurs (menopause) is 50 years. Early menopause is possible before the age of 40 and late menopause is possible after the age of 55. The exact date of menopause is determined retrospectively, no earlier than 1 year after the cessation of menstruation. Postmenopause lasts 6-8 years from the date of cessation of menstruation.
The rate of development of K. p. is determined genetically, but the time of onset and course of different phases of K. p. can be influenced by factors such as the woman’s health, working and living conditions, dietary habits, and climate. for example, in women who smoke more than 1 pack of cigarettes per day, menopause occurs on average at 1 year 8 months. earlier than non-smokers.
The psychological reaction of women to the onset of K. p. can be adequate (in 55% of women) with gradual adaptation to age-related neurohormonal changes in the body; passive (in 20% of women), characterized by the acceptance of K. p. as an inevitable sign of aging; neurotic (in 15% of women), manifested by resistance, reluctance to accept the changes taking place and accompanied by mental disorders; hyperactive (in 10% of women), when there is an increase in social activity and a critical attitude towards the complaints of peers.
Age-related changes in the reproductive system begin in the central regulatory mechanisms of the hypophysiotropic zone of the hypothalamus and suprahypothalamic structures. The number of estrogen receptors decreases and the sensitivity of the hypothalamic structures to ovarian hormones decreases. Degenerative changes in the terminal areas of the dendrites of dopamine and serotonergic neurons lead to disruption of the secretion of neurotransmitters and the transmission of nerve impulses to the hypothalamic-pituitary system. Due to a violation of the neurosecretory function of the hypothalamus, the cyclic ovulatory release of gonadotropins by the pituitary gland is disrupted; the release of lutropin and follitropin usually increases from the age of 45, reaching a maximum approximately 15 years after menopause, after which it begins to gradually decrease. An increase in the secretion of gonadotropins is also due to a decrease in the secretion of estrogen in the ovaries. Age-related changes in the ovaries are characterized by a decrease in the number of oocytes (by the age of 45, there are about 10 thousand of them). Along with this, the process of oocyte death and atresia of maturing follicles accelerates. In the follicles, the number of granulosa and theca cells, the main site of estrogen synthesis, decreases. No degenerative processes are observed in the ovarian stroma, and it retains hormonal activity for a long time, secreting androgens: mainly the weak androgen - androstenedione and a small amount of testosterone. The sharp decrease in estrogen synthesis by the ovaries in postmenopause is to some extent compensated by the extragonadal synthesis of estrogen in adipose tissue. Androstenedione and testosterone formed in the ovarian stroma in fat cells (adipocytes) are converted by aromatization into estrone and estradiol, respectively: this process is enhanced by obesity.
Clinically, premenopause is characterized by menstrual irregularities. In 60% of cases, cycle disorders of the hypomenstrual type are observed - intermenstrual intervals increase and the amount of blood lost decreases. 35% of women experience excessively heavy or prolonged menstruation, and 5% of women experience menstruation that stops suddenly. Due to disruption of the maturation process of follicles in the ovaries, a gradual transition occurs from ovulatory menstrual cycles to cycles with an inferior corpus luteum, and then to anovulation. In the absence of the corpus luteum in the ovaries, the synthesis of progesterone sharply decreases. Progesterone deficiency is the main cause of the development of such complications of uterine bleeding as acyclic uterine bleeding (so-called menopausal bleeding) and hyperplastic processes of the endometrium (see Dysfunctional uterine bleeding). During this period, the incidence of fibrocystic mastopathy increases.
Age-related changes lead to the cessation of reproductive function and a decrease in the hormonal function of the ovaries, which is clinically manifested by the onset of menopause. Postmenopause is characterized by progressive involutional changes in the reproductive system. Their intensity is much higher than in premenopause, since they occur against the background of a sharp decrease in estrogen levels and a decrease in the regenerative potential of target organ cells. In the first year of postmenopause, the size of the uterus decreases most rapidly. By the age of 80, the size of the uterus, determined by ultrasound, is 4.3´3.2´2.1 cm. The weight of the ovaries by the age of 50 decreases to 6.6 g, by 60 - to 5 g. In women over 60 years, the mass of the ovaries is less than 4 g, the volume is about 3 cm3. The ovaries gradually shrink due to the development of connective tissue, which undergoes hyalinosis and sclerosis. 5 years after menopause, only single follicles are found in the ovaries. Atrophic changes occur in the vulva and vaginal mucosa. Thinning, fragility, and slight vulnerability of the vaginal mucosa contribute to the development of colpitis.
In addition to the listed processes in the genitals, changes occur in other organs and systems. One of the main reasons for these changes is the progressive deficiency of estrogens - hormones with a wide biological spectrum of action. Atrophic changes develop in the muscles of the pelvic floor, which contributes to prolapse of the walls of the vagina and uterus. Similar changes in the muscle layer and mucous membrane of the bladder and urethra can cause urinary incontinence during physical stress.
Mineral metabolism changes significantly. The excretion of calcium in the urine gradually increases and its absorption in the intestine decreases. At the same time, as a result of a decrease in the amount of bone substance and insufficient calcification, bone density decreases - osteoporosis develops. The process of osteoporosis takes a long time and is unnoticeable. It can be detected radiographically if there is a loss of at least 20-30% of calcium salts. The rate of bone loss increases 3-5 years after menopause; During this period, bone pain intensifies and the incidence of fractures increases. The leading role of a decrease in estrogen levels in the development of osteoporosis in the breast is confirmed by the fact that in women who have been taking combined estrogen-gestagen drugs for a long time, the preservation of bone structure and the calcium content in them is significantly higher and the clinical manifestations of osteoporosis are less common.
During the menopause, immune defense gradually decreases, the frequency of autoimmune diseases increases, weather lability develops (reduced resistance to fluctuations in ambient temperature), and age-related changes occur in the cardiovascular system. The level of low and very low density lipoproteins, cholesterol, triglycerides and glucose in the blood increases; body weight increases due to hyperplasia of fat cells. As a result of disruption of the functional state of higher nerve centers against the background of a decrease in estrogen levels in the body, a complex of vegetative-vascular, mental and metabolic-endocrine disorders often develops (see Menopausal syndrome).
Prevention of complications of K. p. includes the prevention and timely treatment of diseases of various organs and systems - cardiovascular diseases, diseases of the musculoskeletal system, biliary tract, etc. Great importance is attached to physical exercise, especially in the fresh air (walking, skiing, jogging ), dosed in accordance with the recommendations of the therapist. Walking is useful. Due to weather instability and adaptation features, it is recommended to choose zones for recreation whose climate does not differ sharply from the usual one. The prevention of obesity deserves special attention. The daily diet for women who are overweight should contain no more than 70 g of fat, incl. 50% vegetable, up to 200 g of carbohydrates, up to 11/2 liters of liquid and up to 4-6 g of table salt with normal protein content. Food should be taken at least 4 times a day in small portions, which promotes the separation and evacuation of bile. To eliminate metabolic disorders, hypocholesterolemic drugs are prescribed: polysponin 0.1 g 3 times a day or cetamifene 0.25 g 3 times a day after meals (2-3 courses of 30 days at intervals of 7-10 days); hypolipoproteinemic drugs: linetol 20 ml (11/2 tablespoons) per day after meals for 30 days; lipotropic drugs: methionine 0.5 g 3 times a day before meals or 20% choline chloride solution 1 teaspoon (5 ml) 3 times a day for 10-14 days.
In Europe and North America, women in the CP are widely prescribed estrogen-gestagen drugs to compensate for hormonal deficiency and to prevent age-related disorders associated with it: uterine bleeding, blood pressure fluctuations, vasomotor disorders, osteoporosis, etc. Epidemiological studies conducted in these countries have shown that the risk of developing endometrial, ovarian and breast cancer in women taking estrogen-progestin drugs is lower than in the general population. In the USSR, a similar method of preventing pathology of the p. is not accepted; these drugs are used mainly for therapeutic purposes.
Menopause in men occurs more often at the age of 50-60 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 androgens in the body. At the same time, the production of gonadotropic hormones of the pituitary gland tends to increase. The speed of involutionary processes in the gonads varies significantly; It is conventionally believed that K. p. in men ends at approximately 75 years.
In the vast majority of men, age-related decline in the function of the gonads is not accompanied by any manifestations that disrupt the general habitual state. In the presence of concomitant diseases (for example, vegetative-vascular dystonia, hypertension, coronary heart disease), their symptoms are more clearly manifested in K. p. Often the symptoms of these diseases are mistakenly regarded as pathological menopause. The possibility of a pathological course of K. p. in men is debated. A number of researchers believe that, if organic pathology is excluded, clinical manifestations of pathological menopause can include certain cardiovascular, neuropsychiatric and genitourinary disorders. Cardiovascular disorders characteristic of pathological menopause include sensations of hot flashes to the head, sudden redness of the face and neck, palpitations, pain in the heart, shortness of breath, increased sweating, dizziness, and an unstable increase in blood pressure.
Typical psychoneurological disorders are increased excitability, fatigue, sleep disturbance, muscle weakness, and headache. Possible depression, causeless anxiety and fear, loss of previous interests, increased suspiciousness, tearfulness.
Among the manifestations of dysfunction of the genitourinary organs, dysuria and disorders of the copulatory cycle with a predominant weakening of erection and accelerated ejaculation are noted.
A gradual decrease in sexual potency is observed in menopause in most men and, in the absence of other manifestations of pathological menopause, is considered a physiological process. When assessing sexual function in men in K., it is also necessary to take into account its individual characteristics.
Treatment of pathological menopause is usually carried out by a therapist after a thorough examination of the patient with the participation of the necessary specialists and excluding the connection of existing disorders with certain diseases (for example, cardiovascular, urological). It includes the normalization of the work and rest regime, dosed physical activity, and the creation of the most favorable psychological climate. Psychotherapy is a mandatory component of treatment. In addition, medications are prescribed that normalize the function of the central nervous system. (sedatives, tranquilizers, psychostimulants, antidepressants, etc.), vitamins, biogenic stimulants, drugs containing phosphorus, antispasmodics. In some cases, anabolic hormones are used; In order to normalize the disturbed endocrine balance, medications of male sex hormones are used.
Menopausal syndrome.
Endocrine and psychopathological symptoms that occur during the pathological course of menopause.
The cause of this condition is, firstly, a deficiency of estrogen (sex hormones) due to age-related endocrine changes in a woman’s body. It should be noted that menopause (the last uterine bleeding caused by ovarian function) occurs in all women, but not all of them suffer from menopausal syndrome. It occurs when the body’s adaptive systems decrease, which, in turn, depend on many factors. The likelihood of its occurrence increases in women with heredity aggravated by the pathology of menopause and cardiovascular diseases. The occurrence and further course of menopausal syndrome is adversely affected by such factors as the presence of pathological character traits, gynecological diseases, especially uterine fibroids and endometriosis, premenstrual syndrome before the onset of menopause. Social factors are also of great importance: unsettled family life, dissatisfaction with sexual relationships; suffering associated with infertility and loneliness: lack of satisfaction in work. The mental state is aggravated in the presence of psychogenic situations, such as serious illness and death of children, parents, husband, conflicts in the family and at work.
Symptoms and course. Typical manifestations of cpymacteric syndrome include hot flashes and sweating. The severity and frequency of hot flashes varies, from single to 30 per day. In addition to these symptoms, there is an increase in blood pressure and vegetative-spucy crises. Mental disorders are present in almost all patients with CS. Their nature and severity depend on the severity of vegetative manifestations and personal characteristics. In severe cases of menopause, weakness, fatigue, and irritability are observed. Sleep is disturbed, patients wake up at night due to severe hot flashes and sweating. There may be depressive symptoms: low mood with anxiety about one’s health or fear of death (especially during severe crises with palpitations, suffocation).
Fixation on one’s health with a pessimistic assessment of the present and future can become a leading factor in the clinical history of the disease, especially in people with an anxious and suspicious character.
During menopause, women may experience ideas of jealousy, especially those who had a jealous character in their youth, as well as people who are prone to logical constructions, touchy, stuck, punctual. Ideas of jealousy can take such hold of the patient that her behavior and actions become dangerous towards her husband, his “mistress” and herself. In such cases, hospitalization is required to avoid unpredictable consequences.
Ideas of jealousy usually arise in women who do not receive sexual satisfaction. The fact is that during the premenopausal period (before the onset of menopause), many women have an increased sexual desire, which for various reasons (impotence in the husband, sexual illiteracy, rare sexual relations for objective reasons) is not always satisfied. In cases where rare marital relationships are not associated with sexual disorders in the husband, suspicion and thoughts of possible betrayal may arise, which are supported by an incorrect interpretation of real facts. In addition to ideas of jealousy, sexual dissatisfaction (with increased sexual desire) contributes to the emergence of psychosomatic and neurotic disorders (fears, emotional imbalance, hysterics, etc.). After menopause, some women, on the contrary, experience a decrease in sexual desire due to atrophic vaginitis (vaginal dryness), which entails a decrease in interest in sexual activity and ultimately leads to disharmony in marital relationships.
Menopausal symptoms appear in most women long before menopause and only in a small proportion after menopause. Therefore, the period of menopause often stretches for several years. The duration of the course of CS depends to a certain extent on personal characteristics that determine the ability to deal with difficulties, including diseases, and adapt to any situation, and is also determined by the additional influence of sociocultural and psychogenic factors.
Treatment. Hormonal therapy should be prescribed only to patients without severe mental disorders and when mental illness is excluded. It is advisable to carry out replacement therapy with natural estrogens in order to eliminate estrogen-dependent symptoms (hot flashes, sweating, vaginal dryness) and prevent long-term consequences of estrogen deficiency (cardiovascular diseases, osteopoprosis - loss of bone tissue, accompanied by its fragility and fragility). Estrogens help not only reduce hot flashes, but also increase tone and improve overall well-being. Progestogens (progesterone, etc.) themselves can reduce mood, and in the presence of mental disorders they aggravate the condition, so gynecologists in such cases prescribe them after consultation with a psychiatrist.
In practice, combined estrogen-progestin drugs are often used to avoid the side effects of pure estrogens. However, long-term, and sometimes unsystematic and uncontrolled, use of various hormonal drugs leads, firstly, to the persistence of cyclical fluctuations in a state such as premenstrual syndrome (pseudo-premenstrual syndrome) and the formation of psychological and physical hormonal dependence and hypochondriacal personality development.
The climacteric period in such cases extends for many years. Mental disorders are corrected with the help of psychotropic drugs (tranquilizers; antidepressants; neuroleptics in small doses such as frenolone, sonapax, etaprazine; nootropics) in combination with various types of psychotherapy. Psychotropic drugs can be combined with hormones. The prescription of treatment in each case is carried out individually, taking into account the nature and severity of psychopathological symptoms, somatic disorders, and the stage of hormonal changes (before or after menopause).
In principle, menopausal syndrome is a transient, temporary phenomenon, caused by a period of age-related neuro-hormonal changes in a woman’s body. Therefore, the overall prognosis is favorable. However, the effectiveness of therapy depends on the influence of many factors. The shorter the duration of the disease and the earlier treatment is started, the fewer various external influences (psychosocial factors, somatic diseases, mental trauma), the better the treatment results.
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The climacteric period (menopause, menopause) is a physiological period of a woman’s life, during which, against the background of age-related changes in the body, involutionary processes in the reproductive system dominate.
Climacteric syndrome (CS) is a pathological condition that occurs in some women during menopause and is characterized by neuropsychic, vegetative-vascular and metabolic-trophic disorders.
Epidemiology
Menopause occurs on average at around 50 years of age.
Early menopause is the cessation of menstruation at 40-44 years of age. Premature menopause - cessation of menstruation at 37-39 years of age.
60-80% of peri- or postmenopausal women experience CS.
Classification
The following phases are distinguished during the menopause:
■ premenopause - the period from the appearance of the first menopausal symptoms to the last independent menstruation;
■ menopause - the last independent menstruation due to ovarian function (the date is set retrospectively, namely after 12 months of absence of menstruation);
■ postmenopause begins with menopause and ends at 65-69 years of age;
■ perimenopause - a period that combines premenopause and the first 2 years after menopause.
The time parameters of the phases of the menopausal period are to some extent arbitrary and individual, but they reflect morphofunctional changes in various parts of the reproductive system. Distinguishing these phases is more important for clinical practice.
Etiology and pathogenesis
During the reproductive period, which lasts 30-35 years, a woman’s body functions under conditions of cyclical exposure to various concentrations of female sex hormones, which affect various organs and tissues and participate in metabolic processes. There are reproductive and non-reproductive target organs for sex hormones.
Target reproductive organs:
■ reproductive tract;
■ hypothalamus and pituitary gland;
■ mammary glands. Non-reproductive target organs:
■ brain;
■ cardiovascular system;
■ musculoskeletal system;
■ urethra and bladder;
■ skin and hair;
■ large intestine;
■ liver: lipid metabolism, regulation of SHBG synthesis, conjugation of metabolites.
The climacteric period is characterized by a gradual decrease and “switching off” of ovarian function (in the first 2-3 years of postmenopause, only single follicles are found in the ovaries, subsequently they completely disappear). The resulting state of hypergonadotropic hypogonadism (primarily estrogen deficiency) may be accompanied by changes in the function of the limbic system, impaired secretion of neurohormones, and damage to target organs.
Clinical signs and symptoms
In premenopause, menstrual cycles can vary from regular ovulation to prolonged delays and/or menorrhagia.
During perimenopause, fluctuations in estrogen levels in the blood are still possible, which can clinically manifest as premenstrual-like sensations (breast engorgement, heaviness in the lower abdomen, lower back, etc.) and/or hot flashes and other symptoms of CS.
According to the nature and time of occurrence, menopausal disorders are divided into:
■ early;
■ delayed (2-3 years after menopause);
■ late (more than 5 years of menopause). Early symptoms of CS include:
■ vasomotor:
Hot flashes;
Increased sweating;
Headache;
Arterial hypo- or hypertension;
Cardiopalmus;
■ emotional-vegetative:
Irritability;
Drowsiness;
Weakness;
Anxiety;
Depression;
Forgetfulness;
Inattention;
Decreased libido.
2-3 years after menopause, the following symptoms may occur:
■ urogenital disorders (see chapter “Urogenital disorders during menopause”);
■ damage to the skin and its appendages (dryness, brittle nails, wrinkles, dryness and hair loss).
Late manifestations of CS include metabolic disorders:
■ cardiovascular diseases (atherosclerosis, coronary heart disease);
■ osteoporosis in postmenopause (see chapter “Osteoporosis in postmenopause”);
■ Alzheimer's disease.
Postmenopause is characterized by the following hormonal changes:
■ low serum estradiol levels (less than 30 ng/ml);
■ high level of FSH in the blood serum, LH/FSH index< 1;
■ estradiol/estrone index< 1; возможна относительная гиперандрогения;
■ low level of SHBG in blood serum;
■ low levels of inhibin, especially inhibin B, in the blood serum.
The diagnosis of CS can be established on the basis of a complex of symptoms characteristic of estrogen deficiency conditions.
Necessary examination methods in outpatient practice:
■ scoring of CS symptoms using the Kupperman index (Table 48.1). The severity of other symptoms is assessed based on the patient’s subjective complaints. Next, the scores for all indicators are summed up;
Table 48.1. Kupperman menopausal index
■ cytological examination of smears from the cervix (Papanicolaou smear);
■ determination of the level of LH, PRL, TSH, FSH, testosterone in the blood;
■ biochemical blood test (creatinine, ALT, AST, alkaline phosphatase, glucose, bilirubin, cholesterol, triglycerides);
■ blood lipid spectrum (HDL cholesterol, LDL cholesterol, VLDL cholesterol, lipoprotein(s), atherogenic index);
■ coagulogram;
■ measuring blood pressure and pulse levels;
■ mammography;
■ transvaginal ultrasound (the criterion for the absence of pathology in the endometrium in postmenopause is an M-echo width of 4-5 mm);
■ osteodensitometry.
Differential diagnosis
Menopause is a physiological period of a woman’s life, so differential diagnosis is not required.
Since most diseases during menopause occur as a result of a deficiency of sex hormones, the prescription of HRT, the purpose of which is to replace the hormonal function of the ovaries in women experiencing a deficiency of sex hormones, is pathogenetically justified. It is important to achieve such levels of hormones in the blood that would actually improve the general condition, ensure the prevention of late metabolic disorders and do not cause side effects.
Indications for the use of HRT in perimenopause:
■ early and premature menopause (under 40 years of age);
■ artificial menopause (surgical, radiotherapy);
■ primary amenorrhea;
■ secondary amenorrhea (more than 1 year) during reproductive age;
■ early vasomotor symptoms of CS in premenopause;
■ urogenital disorders (UGR);
■ the presence of risk factors for the development of osteoporosis (see chapter “Osteoporosis in postmenopause”).
In postmenopause, HRT is prescribed for therapeutic and preventive purposes: for therapeutic purposes - for the correction of neurovegetative, cosmetic, psychological disorders, UGR; with prophylactic - to prevent osteoporosis.
Currently, there is no reliable data on the effectiveness of HRT for the prevention of cardiovascular diseases.
Basic principles of HRT:
■ only natural estrogens and their analogues are used. The dose of estrogen is small and corresponds to that in the early and middle phase of proliferation in young women;
■ the mandatory combination of estrogens with progestogens (with a preserved uterus) prevents the development of endometrial hyperplasia;
■ all women should be informed about the possible effects of short-term and long-term estrogen deficiency on the body. Women should also be informed about the positive effects of HRT, contraindications and side effects of HRT;
■ to ensure optimal clinical effect with minimal side effects, it is extremely important to determine the most appropriate optimal doses, types and routes of administration of hormonal drugs.
There are 3 main modes of HRT:
■ monotherapy with estrogens or gestagens;
■ combination therapy (estrogen-gestagen drugs) in a cyclic mode;
■ combination therapy (estrogen-gestagen drugs) in a monophasic continuous mode.
For therapeutic purposes, HRT is prescribed for up to 5 years. With longer-term use, the effectiveness (for example, reducing the risk of femoral neck fracture due to osteoporosis) and safety (risk of developing breast cancer) of this therapy must be weighed in each specific case.
Monotherapy with estrogens and gestagens
Estrogens can also be administered transdermally:
Estradiol, gel, apply to the skin of the abdomen or buttocks 0.5-1 mg 1 time / day, constantly, or a patch, stick to the skin 0.05-0.1 mg 1 time / week, constantly.
Indications for transdermal administration of estrogens:
■ insensitivity to oral drugs;
■ diseases of the liver, pancreas, malabsorption syndrome;
■ disturbances in the hemostatic system, high risk of developing venous thrombosis;
■ hypertriglyceridemia that developed before or against the background of oral use of estrogens (especially conjugated ones);
■ hyperinsulinemia;
■ arterial hypertension;
■ increased risk of stone formation in the bile ducts;
■ smoking;
■ migraine;
■ to reduce insulin resistance and improve glucose tolerance;
■ for more complete compliance by patients with the HRT regimen.
Monotherapy with gestagens is prescribed in premenopausal women with uterine fibroids and adenomyosis, which do not require surgical treatment, with dysfunctional uterine bleeding:
Dydrogesterone orally 5-10 mg 1 time / day
from the 5th to the 25th day or from the 11th to
Day 25 of the menstrual cycle or Levonorgestrel, intrauterine
system1, insert into the uterine cavity,
once or Medroxyprogesterone orally 10 mg
1 r/day from the 5th to the 25th day or from
11th to 25th day of the menstrual cycle or
Progesterone orally 100 mcg 1 time / day from the 5th to 25th day or from the 11th to 25 days of the menstrual cycle or in the vagina 100 mcg 1 time / day from the 5th to 25th day or from the 11th to the 25th day of the menstrual cycle. For irregular cycles, gestagens can be prescribed only from the 11th to the 25th day of the menstrual cycle (to regulate it); For regular use, both regimens of drug use are suitable.
Combination therapy with two- or three-phase estrogen-progestin drugs in a cyclic or continuous mode
This therapy is indicated for perimenopausal women with a preserved uterus.
The use of biphasic estrogen-progestin drugs in a cyclic mode
Estradiol valerate orally 2 mg 1 time per day, 9 days
Estradiol valerate/levonorgestrel orally 2 mg/0.15 mg 1 time/day, 12 days, then a break of 7 days or
Estradiol valerate orally 2 mg, 11 days +
Estradiol valerate/medroxyprogesterone orally 2 mg/10 mg once a day, 10 days, then a break of 7 days or
Estradiol valerate orally 2 mg
1 day/day, 11 days
Estradiol valerate/cyproterone orally 2 mg/1 mg 1 time/day, 10 days, then a break of 7 days.
The use of biphasic estrogen-progestin drugs in a continuous mode
Estradiol orally 2 mg once a day, 14 days
Estradiol/dydrogesterone orally
2 mg/10 mg 1 time/day, 14 days or
Conjugated estrogens orally 0.625 mg 1 time per day, 14 days
Conjugated estrogens/medroxyprogesterone orally 0.625 mg/5 mg 1 time/day, 14 days.
The use of biphasic estrogen-progestogen drugs with a prolonged estrogen phase in a continuous mode
Estradiol valerate orally 2 mg once a day, 70 days
Estradiol valerate/medroxyprogesterone orally 2 mg/20 mg once a day, 14 days
The use of three-phase estrogen-progestin drugs in a continuous mode
Estradiol orally 2 mg 1 time / day, 12 days +
Estradiol/norethisterone orally 2 mg/1 mg once a day, 10 days
Estradiol orally 1 mg 1 time / day, 6 days.
Therapy with combined monophasic estrogen-progestin drugs in a continuous mode
Indicated for postmenopausal women with a preserved uterus. This HRT regimen is also recommended for women who have undergone a hysterectomy for adenomyosis or cancer of the internal genital organs (uterus, cervix, ovaries) no earlier than 1-2 years after surgery (the prescription will be agreed with oncologists). Indications - severe CS after treatment of the initial stages of endometrial cancer and malignant ovarian tumors (cured cancer of the cervix, vulva and vagina is not considered a contraindication to the use of monophasic estrogen-progestogen drugs):
Estradiol valerate/dienogest
Menopause in women is a natural physiological stage in the life of every woman, when, against the background of natural hormonal age-related changes, signs of involution of the reproductive system appear. According to different sources, menopausal restructuring lasts up to 10 years. Proper organization of life, a special diet, psychological assistance, and in some cases drug therapy, create a decent quality of life for a woman experiencing temporary difficulties.
Let's take a closer look at what it is, at what age menopause occurs and what are the characteristic signs for it, as well as what is most often prescribed to a woman as a treatment to restore hormonal levels.
What is menopause?
Menopause is a natural physiological process of transition of the female body from the reproductive phase with regular menstrual cycles to the phase of complete cessation of menstruation. The word “menopause” comes from the Greek “klimax” - a ladder, expressing symbolic steps leading from the flowering of specific female functions to their gradual extinction.
On average, the onset of menopause in women occurs at the age of 40-43 years. However, there may be cases where they begin at 35 and 60 years of age. Therefore, doctors distinguish separately such concepts as “early menopause” and “late.”
In some women, menopause has a physiological course and does not cause pathological disorders; in others, the pathological course leads to the development of menopausal (menopausal) syndrome.
Menopausal syndrome during menopause in women occurs with a frequency of 26 – 48% and is characterized by a complex of various disorders of the functions of the endocrine, nervous and cardiovascular systems, which often disrupts the normal functioning and ability of a woman to work.
Periods of menopause
There are several important periods during menopause:
| Premenopause | It begins when the first sign of menopause appears and continues until the last menstrual bleeding. This stage occurs in women after the age of 40. It is characterized by a decrease in the body's production of estrogen, which manifests itself in the form of irregular menstruation, changes in the nature of discharge (they can increase or decrease). This stage does not cause any physical or psychological severe discomfort. It can last up to 10 years. |
| Menopause | Last menstruation. True menopause is considered if after the last menstruation there have been no more menstruation periods for a year. Some experts consider it more correct to calculate menopause after 1.5 or even 2 years. |
| Postmenopause | At the third stage, hormonal changes finally end, the ovaries completely stop producing hormones, the level of estrogen is steadily reduced by 50% of the level of the reproductive phase. The age-related involution of the body continues. This is early postmenopause (1 - 2 years). All organs whose functioning depends on sex hormones are subject to gradual hypotrophic changes. For example, it is noted:
|
Issues regarding the quality of life of women during menopause are quite acute and relevant. In this case, special attention is paid to the following parameters: physical and mental well-being, social and role functioning, as well as a general objective perception of the state of one’s health.
There are several types of menopause:
- premature (after 30 and before 40 years);
- early (from 41 to 45 years);
- timely, considered the norm (45-55 years);
- late (after 55 years).
Premature and late menopause are usually a pathology. After examination and clarification of the causes of deviations from the norm, treatment is prescribed. With the timely onset of menopause, in some cases, only relief of accompanying symptoms is required.
Causes
Menopause is a genetically programmed transformation of the female body, during which reproductive function declines. The ovaries rapidly reduce the production of sex hormones, the menstrual cycle is disrupted, and the likelihood of egg fertilization by sperm decreases every year.
For most women, the starting point for the onset of menopause is taken to be 45 years of age, coinciding with the appearance of the first clinical manifestations of menopause. As a rule, after three or five years (that is, by the age of 50), the menstrual function finally ends, and the menopause clinic becomes brighter.
Early menopause is the process by which menopausal symptoms begin to appear before the age of forty. It can occur either at fifteen or at thirty-nine. The main reason is impaired hormonal regulation, as a result of which menstruation is very irregular.
There are inherited and acquired causes of early menopause.
Genetic causes of early menopause:
- Defect of the female X chromosome.
- Shereshevsky-Turner syndrome.
- Ovarian dysfunction under the influence of the 3 X chromosome.
- Other hereditary disorders
Acquired causes of early menopause:
- Hormonal diseases (thyroid gland, others);
- Gynecological diseases, including infectious;
- Chemotherapy;
- Obesity;
- Attrition()
- Not rational hormonal contraception;
At what age do women begin menopause?
The timing of menopause varies from person to person; a woman’s last menstruation is called menopause, which occurs on average at the age of 50. If this occurs before the age of 45, menopause is considered early; before the age of 40, it is considered premature.
Each woman’s ovaries are genetically endowed with a certain number of follicles, and the time of onset of menopausal syndrome depends on this.
The fact is that female hormones have a beneficial effect on the entire body as a whole, and women with late menopause have a healthier heart and blood vessels, often smooth and clean skin, healthy hair and teeth.
But late menopause also has significant disadvantages. For example, in such women the risk of developing cancer is several times increased. They are advised to undergo examinations every six months for the presence of neoplasms in the body.
How menopause begins: the first signs
- Menstruation is often delayed and irregular. Their abundance and duration are several times stronger than usual.
- Sweat occurs too often and in large quantities, and there is a constant feeling of heat.
- There is discomfort and unpleasant dryness in the vaginal opening.
- Constant sleep disturbance.
- Mood changes dramatically, frequent depression.
- Feeling of restlessness and causeless anxiety.
- Blood pressure also changes sharply.
Symptoms of menopause in women
Menopause can occur in women at different ages. Moreover, if necessary, treatment is selected taking into account the symptoms, which can also be different and have varying degrees of severity.
Symptoms of menopause:
- Menstruation stops being regular, shorten and become less abundant in discharge in most cases; in a third of women, on the contrary, they become more intense.
- Unreasonable mood swings, tendency to irritability, depression, tearfulness, aggressiveness, negativism.
- Headaches: dull, present in the back of the head in the morning; migraine-like conditions; sharp and strong, localized in the temples and forehead.
- Tides. Impaired thermoregulation and increased feelings of heat are the main signs of menopause. At first, such complaints may last for a short period of time, but over time their appearance and intensity only increase.
- Sleep disturbance . Some women may experience insomnia, while others, on the contrary, may experience increased sleepiness. It is better not to solve sleep problems on your own with the help of medications, but to consult a doctor.
- Fluctuations in the level of female sex hormones during menopause are manifested by soreness of the mammary glands, pulling sensations in the lower abdomen and emotional swings.
- Metabolic and endocrine disorders. Women during menopause often experience a change in eating behavior, an improvement or deterioration in appetite, an increase in body weight, and fluid retention in the body, leading to the formation of edema.
- Chest pain. Pain in the mammary gland can be cyclical or non-cyclical. Cyclic pain coincides with the time of menstruation during the childbearing period. However, for women over 45, such pain is a sign of hormonal disorders.
- When the premenopausal period begins, almost all representatives of the fair sex complain of decreased sexual desire and libido, the inability to achieve orgasm, as well as dryness of the inner walls of the vagina. This process is naturally associated with the partial or complete disappearance of female hormones from the body.
- Vaginal dryness. The symptom is usually accompanied by itching and causes pain during sexual intercourse. It occurs as a result of changes in the structure of the vaginal mucosa under the influence of hormones. At the same time, there is also a decrease in sexual desire.
Other manifestations of menopause include:
- changes in taste preferences and sensations;
- dryness of the oral mucosa;
- pain in joints, bones and muscles;
- shortness of breath, tachycardia;
- migraine;
- visual disturbances (soreness and dryness in the eyes).
All unpleasant symptoms disappear after the immediate onset of menopause.
Menopause is not a quick process, it develops over a long period of time. Typically, menopause itself occurs only a couple of years after the first symptoms appear.
Diagnostics
Diagnosis of menopause occurs primarily on the basis of patient complaints, which appear as menopause approaches. The presence of any concomitant diseases complicates diagnosis, since under them the symptoms of menopause may not be recognized, and the health condition may worsen. Consultations with an endocrinologist, neurologist and, of course, a cardiologist are indicated.
During the consultation, the doctor will ask questions:
- age when menstrual irregularities began, when was the last menstruation, the nature of menstruation,
- what symptoms are bothering you?
- whether your close female relatives have had cancer of the breast or internal genital organs,
- undergone operations.
A mandatory gynecological examination and laboratory tests are carried out:
- Blood test for estrogen content,
- Study of follicle-stimulating and luteinizing hormone,
- Histological analysis of the endometrium of the uterus,
- Cytological examination of a vaginal smear,
- Basal temperature measurement,
- Detection of anovular cycles,
- Ultrasound examination of the pelvis and abdominal cavity.
Why is menopause diagnostics needed?
- Planning for late pregnancy;
- differential diagnosis of menopause and other diseases;
- identification of complications and diseases associated with menopause;
- examination before prescribing hormone replacement therapy and contraceptives.
Treatment
Menopause is a natural state at the appropriate age. But it is fraught with the threat of new diseases, including tumors, endocrine disorders, etc. However, when a woman has a hard time with menopause, treatment is necessary. Even if its manifestations do not cause much discomfort, regular visits to the gynecologist should be maintained.
Treatment may include the following:
- homeopathy;
- herbal medicine and traditional methods to stabilize hormonal levels;
- hormonal therapy;
- treatment of concomitant diseases, newly emerging or chronic in an acute form;
- the use of bioactive food supplements in the form of pills or tablets during menopause, for example, Bonisan.
- proper nutrition with plenty of fruits and vegetables (food fortified with vitamins);
- mandatory presence of dairy products in the daily diet (cottage cheese, yogurt, milk, sour cream, etc.);
- exclusion of fatty, spicy and salty foods;
- giving up bad habits (smoking, alcohol);
- fitness classes, gymnastics, recreational exercise or daily walks in the fresh air, on foot or by bike;
- reduce the consumption of tea and coffee, which are better replaced with herbal tea;
- take vitamins;
- wear clothes made from natural fabrics;
- observe the rules of personal hygiene.
Medicines for menopause
The first thing a woman needs to do during the menopausal period is to consult a local gynecologist for advice. After diagnosis, the specialist prescribes medications for menopause, which reduce the number of hot flashes, normalize the sleep phase, and remove increased irritability.
Hormone replacement therapy. According to experts, the most adequate method of treating menopausal syndrome is hormone replacement therapy. Its use is advisable if a woman during menopause begins to experience complications such as:
- cardiovascular pathologies,
- central obesity,
- pronounced,
- diabetes mellitus type II, etc.
Hormone therapy as a treatment for menopause pathology is contraindicated in patients suffering from:
- endometrial, ovarian, breast cancer;
- coagulopathy (blood clotting disorder);
- liver dysfunction;
- thromboembolism, thrombophlebitis;
- uterine bleeding of unknown cause;
- renal failure.
Non-hormonal agents(Qi-Klim, Estrovel, Klimadinon). If for some reason hormonal therapy is contraindicated for the patient, then drugs based on natural plant phytoestrogens are used. These are biologically active food additives. Their activity is significantly lower than that of hormones, but safety is higher and there are almost no side effects.
In addition to hormones, a number of other medications are prescribed: vitamins, herbal medicines, calcium preparations (for the prevention and treatment of osteoporosis), tranquilizers, antidepressants, biphosphates, nootropics and others. The advisability of using certain medications during menopause is determined by the attending physician.
Proper nutrition
Despite the unpleasant symptoms that accompany menopause in women, by prescribing the correct treatment and following the principles of a healthy lifestyle, the severity of the main symptoms can be significantly reduced. When reaching the age of menopause, attention should be paid to proper nutrition.
Proper nutrition during menopause is based on the following rules:
- it is necessary to reduce portions, but increase the number of meals up to 5-6 times;
- you should eat regularly at the same time;
- you need to drink up to two liters of clean water;
- dishes should be steamed, in the oven or stewed, but under no circumstances fried (a frying pan is taboo);
- as many vegetables and fruits as possible should be consumed raw;
- eliminate or minimize salt intake;
- exclude “harmful” foods from the diet and include a wide range of “healthy” ones.
When choosing foods for your diet, you need to ensure that your body gets vitamins and minerals. Especially vitamins A, E, D and C, group B, potassium, calcium and magnesium.
It is necessary to severely limit or remove the following foods and dishes from the diet:
- salt, sugar;
- semi-finished products, fast food;
- lard, fatty meat, lard, margarine, spread;
- alcohol;
- sausages, smoked meats, offal;
- coffee, chocolate, cocoa, sweets;
- hot spices;
- sweet soda, packaged juices.
Menu for the day
It is advisable to start the day with a cup of clean, cool water, drunk on an empty stomach. The menu of a woman who has entered menopause may look like this.
- Breakfast - oatmeal with bran and raisins.
- Second breakfast - salad with fruits and nuts.
- Lunch - chicken soup and seaweed salad.
- Afternoon snack - baked apples with low-fat cottage cheese.
- Dinner - boiled fish and vegetable salad.
In between meals, it is permissible to eat dried fruits and drink various juices.
Folk remedies
When treating hot flashes, headaches and other manifestations of menopause, traditional medicine is successfully used: plant decoctions, herbal soothing baths.
- Soothing herbal bath. 10 tbsp. l mixture of calamus root, thyme, yarrow, oregano, sage, pine buds is brewed in a bucket of water until cool, filtered and added to the container. A 10-minute procedure will be enough;
- Rhodiola rosea. Alcohol tincture (pharmacy) of Rhodiola is taken 15 drops, diluted in 20 ml of drinking water before breakfast and before lunch.
- To prepare an infusion of oregano 2 tablespoons of the plant are poured into 400 ml of boiling water and infused in a thermos. Take half a glass of the drink several times a day 30 minutes after meals. This decoction is especially effective for neuroses that arise during menopause.
- Lemon. Grind the lemons (with peel) in a meat grinder. Grind the shells of 5 chicken eggs to a powder. Mix and let brew for 7 days. Take 3 times a day, 1 tbsp. spoon for a month.
- Hawthorn. 3 tbsp. Pour 3 cups of boiling water over spoons of hawthorn flowers. Take 1 glass 3 times a day.
- Teas will help relieve irritability and drinks based on mint, lemon balm, St. John's wort and oregano. These medicinal herbs have a powerful antidepressant effect and will help get rid of nervous tension.
- Valerian helps relieve emotional stress and improve sleep. The decoction is prepared according to the recipe given above. You need to take 100 ml in the morning and evening.
- Sage juice will help cope with high blood pressure. To do this, you need to take 20 ml three times a day for three weeks.
Diseases that occur during menopause
When discussing menopause in women, symptoms, age, treatment, we should consider in detail diseases that arise under the influence of changes in hormonal levels.
Estrogens are needed for more than just fertility. Throughout reproductive age, these hormones protect a woman from various diseases, strengthening almost all structures in the body. When estrogen levels begin to decline during menopause, many systems are affected.
| Osteoporosis | With this disease, bone density decreases, their microarchitecture is disrupted, fragility increases, as a result of which the risk of fractures significantly increases. Osteoporosis is caused by a change in the functioning of building cells, which occurs against the background of a change in the balance of hormones. |
| Diseases of the heart and blood vessels | Menopause has a serious impact on the circulatory system - all organs suffer, from the heart to the smallest vessels. After menopause, the risk of the following diseases increases:
Most often, menopause leads to an increase in blood pressure, which can become persistent and develop into hypertension. This is observed, along with various types of arrhythmias, in almost a third of women who have reached menopause |
| Myoma can be of different sizes, single or multiple. It often occurs against the background of menopause, and after menopause, small myomatous nodes are able to resolve on their own. | |
| During menopause, dermoid, endometrioid and other types of non-functional cysts often appear, as well as ovarian cysts. | |
| Frequent urination | The urinary system, which is connected by reverse processes with the reproductive system, is also susceptible to structural changes. Frequent urges at night, periodic infections, and other unpleasant pathologies will haunt a woman who does not care about preserving her own health. |
Prevention
Preventive measures aimed at preventing the early onset of menopausal changes include:
- Regular examination by relevant specialists - every 6 months.
- Timely treatment of pathological processes that arise in the endocrine and gynecological organ systems.
- Correct attitude towards taking hormone-containing drugs.
- General hardening.
- Balanced diet.
- Moderate physical activity.
- Regular sexual intercourse.
At the first signs of menopause, be sure to go to a gynecologist and endocrinologist for a consultation. Take care of yourself, we wish you good health and well-being!
With age, the female body undergoes hormonal changes inherent in nature. But many women are frightened by the menopause, because there is an opinion that menopause is always malaise, hot flashes, and loss of emotions from intimate relationships. Is it so? Or is menopause just the next stage in a woman’s life and development? What is a woman’s menopause, when does it occur and how does it manifest itself, what treatment is indicated during menopause, read below.
What is menopause in women
Menopause is a woman's natural state when she reaches a certain age. Each woman has a certain formed reserve of eggs in the ovaries. The ovaries produce female hormones - estrogen and progesterone, which regulate female reproductive function, and as a result, ovulation and menstruation occur cyclically every month. When the supply of eggs is used up, menstruation stops, hormone production decreases significantly, and menopause occurs.
Symptoms
A woman should know information about how the menopause manifests itself, what hot flashes are. It is important to be able to get rid of hot flashes quickly so as not to feel discomfort in public, in the office, etc. As a rule, they manifest themselves in a feeling of unexpected heat, which lasts several minutes and is replaced by a feeling of cold; perspiration appears on the woman’s body - this is a reaction of the nervous system to a decrease in hormone production. Washing with cold water helps relieve a hot flash; if this does not help, you need to find a medicine with the help of a doctor.
Other possible signs of the onset of menopause:
- irregular menstruation;
- uterine bleeding;
- sudden mood changes;
- heart rate increases;
- pressure surges;
- nausea;
- headache;
- pain in joints and muscles;
- vaginal dryness;
- decreased sex drive;
- fast fatiguability;
- sleep disorder;
- neurosis;
- Depression may develop.
When it comes
At what age and how does menopause begin? After 40 years, women enter premenopause: rare or frequent menstruation is observed, dysfunctional bleeding is possible, the development of menopausal cardiopathy is possible, and spotting is possible between menstruation. It is important to know why this period is dangerous: changes in the body can be symptoms of gynecological diseases, for example, uterine fibroids. A menopause test can help confirm the onset of perimenopause. A stable basal temperature also indicates the onset of menopause.
Still, there is no definite answer to the question at what age does a woman begin menopause, because the onset of menopause is influenced by genetic factors, working conditions, climate, lifestyle, and the presence of bad habits. But for most women, menopausal changes begin after 45 years, if after 50 years it is late menopause. Today, many specialists in gynecology are inclined to believe that late menopause should be called its onset after 55 years.
A common occurrence these days is early menopause. The causes of early menopause, which can begin at the age of 30, are heredity, immune disorders or the results of medical intervention. In exceptional cases, premature menopause can occur even at 25 years of age as a result of damage to the ovaries after chemotherapy or surgical removal of the ovaries for medical reasons. But such menopause is pathological and necessarily requires treatment in order to even out the hormonal imbalance of the female body at a young age.
How long does menopause last?
The menopausal period is divided into the phases of premenopause, menopause and postmenopause. How long does hormonal changes in the body last?
- Perimenopause lasts 2-10 years, until menstruation stops.
- Menopause occurs 1 year after the cessation of menstruation.
- The postmenopausal period begins from the onset of menopause and lasts 6-8 years, during which time the symptoms of menopause - for example, hot flashes - may persist, but pass more easily.
Treatment for menopausal syndrome
To alleviate the symptoms of menopause, you need to know what to take when you have a headache, how to relieve hot flashes or other unpleasant symptoms, and stop uterine bleeding. One of the frequently used drugs in the treatment of menopausal syndrome is homeopathic tablets "Remens". A woman, after consulting a doctor, will be able to choose which means are best for her to use.
Homeopathic medicines
Homeopathy for menopause offers remedies in the form of tablets or drops. During the menopause, a whole range of health problems appear, based on vegetative-vascular symptoms - hot flashes, increased sweating, rapid heartbeat, and psycho-emotional - irritability, insomnia, increased fatigue. A complex of problems during menopause can be solved using the natural components in the composition of the drug Klimaktoplan. The action of the drug is aimed at eliminating two main problems: manifestations of autonomic dysfunction and neuro-emotional discomfort. The drug is of European quality, does not contain hormones, is available without a prescription, is well tolerated, and is produced in Germany.
Folk remedies
Traditional medicine recipes are often shared among women based on their experience. To maintain physical tone and good mood, water treatments are good - soothing herbal baths (cinquefoil root, lovage). To prevent general health, teas and decoctions from medicinal plants are used: chamomile, mint, hogweed, nettle, hawthorn. For optimal well-being during this transition period, you need to plan your daily routine, eat right, and get proper rest.
Hormonal drugs
Hormonal therapy is used only after a medical examination of a woman and as prescribed by a doctor, since it has a number of contraindications. But if complications such as obesity, osteoporosis, cardiovascular diseases occur during menopause, additional hormone intake is necessary. The doses of hormones contained in the preparations “Klimonorm”, “Femoston”, “Cliogest” replace the missing production of the body’s own hormones.
Herbal medicines
During menopause, herbal-based medicines are also used, for example, Inoklim, Klimadinon, Feminal, and in addition, vitamin-mineral complexes can be used independently or as part of hormonal therapy. The composition includes phytoestrogens - substances similar in structure and functions to female sex hormones, but phytohormones have a much less pronounced effect on the female body. Vitamins and microelements have a strengthening function and help relieve the negative manifestations of age-related metabolic disorders.
Vitamins
A woman is always pleased to know that she is taken care of. It's even more pleasant to feel it. In the field of caring for women’s well-being, Lady’s Formula Menopause Strengthened Formula has proven itself to be ideal. A well-known complex of traditional vitamins, the most important minerals and extracts of rare medicinal plants effectively helps women cope with the problems that arise during menopause. Thanks to an integrated approach to eliminating the symptoms of menopause, gentle effects and the absence of side effects, the biocomplex Lady’s Formula Menopause Strengthened Formula has become the drug of choice for many women to maintain a high quality of life during this period.
When taking Lady’s Formula Menopause Enhanced Formula, you will no longer be bothered by hot flashes, tachycardia, irritability, insomnia, you will say “no” to excess weight and frequent urge to urinate. In addition, you will enjoy a healthy, fresh complexion and skin elasticity, hair shine and strength.
Lady's Formula Menopause Enhanced Formula will step by step restore high vitality, good health and excellent appearance.
What is perimenopause
The premenopausal period is a transitional period to menopause, during which a woman's level of estrogen produced by the ovaries decreases over several years. Harbingers of perimenopause:
- delayed menstruation;
- exacerbation of premenstrual syndrome, sudden mood changes;
- painful sensitivity of the mammary glands;
- itching and dryness of the vagina, discomfort during sexual intercourse;
- decreased sex drive;
- frequent urination;
- urinary incontinence when sneezing or coughing.
Doctors diagnose the premenopausal period based on the symptoms that a woman exhibits and on the basis of a blood test for hormone levels, which must be taken several times due to unstable hormonal levels during this period. Perimenopause is a natural state for women aged 40-50, lasting until menopause, when the ovaries stop producing eggs.
Pregnancy during menopause
Is it possible to get pregnant during menopause? Yes it is possible. A woman's reproductive function during premenopause is significantly reduced, but there is a possibility of pregnancy. If such a turn of fate is undesirable, it is necessary to continue using contraceptives for 12 months after the last menstrual period. But sex after menopause can still bring bright colors to a woman’s life, and sexual life should under no circumstances end in the postmenopausal period.
15-04-2019
Menopause- a physiological transition of the body from puberty to the cessation of the generative (menstrual and hormonal) function of the ovaries, characterized by the reverse development (involution) of the reproductive system, occurring against the background of general age-related changes in the body.
Menopause occurs at different ages, it is individual. Some experts call the numbers 48-52, others - 50-53 years. The rate at which the signs and symptoms of menopause develop is largely determined by genetics..
But the time of onset, duration and characteristics of the different phases of the menopause are also influenced by such factors as how healthy a woman is, what her diet is, lifestyle, climate and much more.
Scientists have found that females who smoke more than 40 cigarettes per day, menopause occurs on average 2 years earlier than in non-smokers.
The onset of menopause begins with a significant decrease in the production of female sex hormones. The fact is that over the years, ovarian function gradually fades away and may even stop altogether. This process can last from eight to ten years, and is called menopause in women.
But we shouldn’t forget what exactly During premenopause, a woman is at risk for unwanted pregnancy. Pregnancy during menopause is very common, which is why the number of abortions in this age category is very high.
Main signs of menopause
- Changes in the emotional sphere. Often a woman suffers from astheno-neurotic syndrome. She constantly wants to cry, irritability increases, the woman is afraid of everything, she cannot stand sounds and smells. Some women behave defiantly. They begin to paint brightly.
- Problems with the autonomic nervous system- feeling of anxiety, lack of air, increased sweating, reddened skin, nausea, and dizziness. The woman weakens. The breathing rate and heart rhythm are disturbed. The patient feels tight in her chest and has a lump in her throat.
- Constantly experiencing severe headaches in the form of migraine, mixed tension pain. A person cannot tolerate stuffiness, humid air, or heat.
- During menopause, metabolic processes are disrupted calcium, minerals, magnesium, because estrogen levels decrease.
- During sleep there is a delay in breathing. The woman snores heavily. It becomes very difficult to fall asleep, thoughts are constantly spinning in your head and your heart rate increases.
- Menstrual irregularities. One of the first signs of the onset of menopause is irregular menstrual bleeding. The amount of blood loss and the intervals between menstruation become unpredictable.
- Dysfunctional uterine bleeding menopause are becoming more common in women. First, delays in menstruation begin, and then sudden bleeding. Uterine bleeding during menopause is accompanied by weakness, irritability and constant headaches. As a rule, along with such bleeding, patients also experience climatic syndrome.
- Often, premenopausal women complain of hot flashes. Quite suddenly, a feeling of intense heat sets in, the skin turns red and sweat appears on the body. This symptom takes one by surprise; women often wake up in the middle of the night from such a fever. The cause is a reaction of the pituitary gland and a sharp drop in estrogen levels.
- Urination becomes more frequent and a small amount of urine is released. Urination is painful, severely burns, cuts in the bladder. Night urination becomes more frequent. A person walks more than once during the night and is worried about incontinence.
- Having skin problems, it becomes thin, elastic, a large number of wrinkles and age spots appear on it. The hair on the head is thinning, and much more appears on the face.
- Sudden pressure surges, painful sensations in the heart.
- Due to estradiol deficiency, osteoporosis develops. During menopause, bone tissue is not renewed. The woman becomes noticeably stooped, decreases in height, and is bothered by frequent bone fractures and constant joint pain. Unpleasant sensations occur in the lumbar region when a person walks for a long time.
The manifestation of clinical signs of menopause is individual. In some cases, it is not difficult to tolerate, in other cases the symptoms are severe and torment the person for about five years. Menopausal symptoms disappear after the body adapts to new physiological conditions.
