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Menopause syndrome in women symptoms treatment. Premenopausal women. Methods of treatment and prevention of climacteric syndrome

Only with age can a woman appreciate the real taste of life. After 40, a woman achieves success in her career, brings up already matured children, has gone through all the periods of grinding in with her husband. After another ten years, a new round begins - children are independent, work priorities fade into the background, you can fully enjoy life.

At the same time, in addition to a wonderful period filled with self-awareness and joy from the experience of life, the lady expects a new transitional stage, called menopause. In women, this period causes fear and hostility in front of the incomprehensible and unknown. In addition, some who survived these manifestations are difficult, acquaintances talk about the horrors and unpleasant sensations in the premenopausal period and after. You should not unconditionally trust such statements, because official statistics say that about 50% of women over 45 go through this stage in their lives quite quickly and easily. Yes, the same statistics say about 10%, for whom menopause becomes a serious test, both physical and moral, women may experience painful conditions or it is difficult to experience the termination of the childbearing period. However, another 10% of the respondents experience, on the contrary, the rise and inspiration before a new stage in their lives.

The main factor that determines the condition of a woman in the premenopausal period is her readiness for the transition. It is necessary to study the theoretical calculations about the process, prepare yourself mentally and physically, take preventive measures to reduce the possible symptoms of menopause.

The term "climax" itself came into our everyday life from the Greek word "klimas", which means a ladder. In physiology, it denotes the transition to age when the adult becomes already non-reproductive. This period, when the reproductive system stops working, is the norm for all mammals. In Internet articles on this topic, the term menopause is also used in relation to women, but this designation is not entirely correct, since it is more correct to call the period when menopause disappears.

To understand the physiology of menopause, it is necessary to understand the work of the reproductive system in women. At about 12 years old, the girl begins her period. The figure is individual and can range from 9 to 15 years. The onset of menstruation means that the pituitary gland and hypothalamus of the brain are actively producing hormones that affect the functioning of the ovaries. Under the action of a hormone, a follicle begins to ripen in the ovaries, from which an egg will be released at the appointed time. If the egg is not fertilized after maturation, it is destroyed and released naturally. At the same time, endometrial cells lining the surface of the uterus are also destroyed and released. The process is accompanied by a violation of the blood vessels, so the discharge is accompanied by blood loss. At this time, the pituitary gland again gives a signal to the ovaries to start developing a new follicle. This description of the menstrual cycle is rather exaggerated, but gives a sufficient understanding of the physiology and sequence of the process.

Closer to forty years (the figure is again individual), the ovary ceases to respond to hormonal signals from the brain. In addition, the number of full-fledged follicles by this age is significantly reduced, because over the entire period of life, women have, on average, about 500 menstruation, and, accordingly, about 500 egg maturation. By this period, few high-quality reproductive structures remain in the ovaries, the follicles do not mature, and, accordingly, do not send a signal-response to the brain. The premenopausal period begins, the menstrual cycle fails. Over the course of several years, hormone production is significantly reduced, and menstruation stops completely. This stage is called menopause, the transition to quality new level... The process is not always easy and fast, some have a pain syndrome, others find it difficult to understand this period psychologically (this is where the analogy with a ladder comes from, where in order to climb higher, it is necessary to overcome a high step).

Transition types

According to the time of occurrence in women, the menopause is divided into several types. This division is rather arbitrary, because the onset of a new stage depends not only on biological age, but also on heredity, health status, living and working conditions.

There are such types of menopause:

• early - occurs before the woman's fortieth birthday. Such a process is considered a pathology and requires a gynecological examination. Constant stress, serious diseases of the body, and previous surgeries can cause pathology.
• premenopausal period - up to 45 years. The menstrual cycle may be regular, but the body is already preparing for a new stage.
• climacteric before the age of 52, hormonal changes occur female body, close reproductive function organism.
• late menopause - begins after the specified 52 years. Unlike the early one, it is not considered a pathology, on the contrary, it is considered an indicator of the excellent work of the body.

According to the presence of a leak, each of the types can be divided into pathological or normal (respectively, with and without deviations). In order to react in time to possible violations, it is necessary to closely monitor your health, and, if necessary, consult a doctor.

Climax is a natural natural process, for which a woman should be ready. And like any natural process, it does not occur instantly. The period that heralds the onset of menopause begins several years before the end of menstruation. At this time, the menstrual cycle is still regular and the woman may even become pregnant. True, such a pregnancy will require careful medical supervision.

During this period, the production of estrogen, which is vital for a normal cycle, already decreases. Lack of estrogen leads to:

• violation of the cyclicity of menstruation;
• an increase in body weight;
• deterioration of tissue elasticity;
• decreased sex drive;
• deterioration in emotional resilience.

The work of taste buds may also be disrupted, the fragility of bone tissue increases, it is difficult for a woman to control her emotions. All these signs appear on average from a year to three, and warn of an impending transition. In turn, this will allow the woman to prepare for the upcoming big changes.

Stage symptomatology

In addition to the general signs of a lack of estrogen, the following features are characteristic of premenopause:

• change in the monthly rhythm. If at puberty the monthly cycle in a healthy woman is regular, and ranges from 21 to 35 days, then in this period the number of days of the cycle and the duration of each phase change. The duration of critical days and the number of secretions also become unstable - their duration and size changes from cycle to cycle.
• malfunctioning of cardio-vascular system. As a rule, heart palpitations are observed, atherosclerosis and angina pectoris may develop, seizures are frequent, in which blood pressure rises.
• the risk of breast cancer is significantly increased. The formation of a tumor in the mammary gland is a hormone-dependent process. Considering that hormonal imbalance begins at this time, the likelihood of developing the disease increases significantly. If mastopathy has already taken place, then it is more likely that it will also resume. The breasts as a whole become more sensitive.
• memory functions are impaired, ability to concentrate, it is difficult for a woman to keep attention for a long time even on important things.
• discomfort is experienced during intercourse. A decrease in estrogen levels affects not only sexual desires, but also the libido itself during intercourse.
• hormones in the body affect all moments of life, including the central nervous system. It is difficult for a woman, even the most balanced, to control emotions. Anger is especially common. Due to the dysfunction of the nervous system, insomnia or superficial, sensitive sleep may develop. It is at such moments that the systematic headache.
• the female body begins to react more sharply to premenstrual syndrome. The situation becomes especially complicated in those cases when it manifested itself in the established cycle.
• the so-called tides. The woman feels a sharp rush of heat, her cheeks turn pink for a while. And after the tide is over, the feeling of sweating comes on sharply. For a day, such manifestations of the syndrome can be from one to 30.

If the manifestation of these symptoms pass with the identified pathologies, then they talk about climacteric syndrome, which requires compulsory work with a doctor.

The climacteric syndrome can begin long before the onset of menopause, so any pathology can affect the body for several years. The situation is complicated if an adult woman has psychological problems, which over time can develop into neuroses. A deterioration in well-being and a growing lack of understanding in communicating with loved ones leads to various consequences.

Menopause syndrome can last for each woman in different ways, often stretching for a year or more. The duration of the stage depends on many factors - heredity, health status, stress resistance, socio-cultural ties, measures taken prevention.

In critical situations of the development of physiological pathologies and psychological disorders, the help of a specialist doctor is needed.

Help with exacerbations

Consultations with a doctor should begin immediately, as soon as the monthly cycle began to be disrupted or the woman felt the first rush or increased sweating. You should also contact the medical office if:

• lumps are found in the mammary gland (and every woman should regularly conduct breast self-examination);
• blood pressure fluctuates outside the normal range;
• there are violations on the side of the urinary-reproductive system.

While these signs should be a concern for an adult woman, heavy periods are not a cause for concern. The only exceptions are cases that are dangerous by the development of anemia, when it is necessary to call an ambulance.

For competent treatment of the condition, it is necessary to undergo examinations not only by a gynecologist, but also by a therapist, neuropathologist, and in some cases even by an endocrinologist. In most cases, the treatment of climacteric syndrome is complex and involves the use of medical hormonal drugs also conduct psychotherapeutic courses.

The premenopausal state is treated symptomatically. So, to combat neuroses, antipsychotics and bromides are used, sedatives are prescribed for insomnia, and the lack of hormones is treated with hormonal therapy.

Hormone therapy prescribed exclusively for mentally healthy people. Estrogen replacement therapy is actively used, during which the symptoms of a lack of female sex hormone (sweating, vaginal discomfort) are removed. Estrogen is also used to prevent disorders of the cardiovascular system, osteoporosis.

They also normalize the body's work with the help of gestagens. Gestagens are able to reduce the amplitudes of emotional fluctuations, but the premenopausal state of a woman whose symptoms speak of mental disorders ah, on the contrary, may intensify. Therefore, gestagens can be prescribed only after certain psychological studies.

Most often, a complex estrogen-progestogen therapy ... However, non-compliance with the regimen of drugs can stretch the entire climacteric period even longer. The dosage prescribed by the doctor should be strictly observed.

Mental disorders caused by the transition to a new physiological level, are treated with tranquilizers, nootropics and antidepressants. Psychotherapeutic sessions are mandatory. The course of hormonal and psychotropic drugs can be combined.

The main treatment procedures are influenced by the individual indicators of each woman - the symptoms manifested, the presence of hormonal or mental disorders, the transition period. In general, the prognosis for competent treatment is very favorable. With regular visits to the doctor, a woman will go through this natural process faster and more comfortable for herself and those around her.

Preventive measures

The climacteric syndrome in its acute manifestation can be prevented. The best preventive measure in this situation is considered healthy image life - moderate physical activity, proper nutrition enough sleep.

The premenopausal period passes faster if you get rid of nicotine addiction, stop drinking alcohol. It is also recommended to do regular exercises in the morning, and complement the hiking with jogging or swimming. It is useful to take a contrast shower.

Proper nutrition includes taking vitamins. Vitamins help to normalize the work of the cardiovascular system, strengthen the walls of blood vessels. The accompanying mineral complex is also useful in the prevention of climacteric syndrome. The use of vitamins B, C, E reduces the acute symptoms of the period.

When to be ready

At what age to start taking care of women's health to reduce the manifestations of a premenopausal state? The question is not entirely correct. After all, every girl, girl, woman should take care of her own health from early childhood.

At the same time, it is necessary to prepare for this stage of your life after 40 (do not forget that there is such a thing as early menopause). A woman should know the main signs and determine the beginning of the transitional stage in time. Attention to your health and timely visits to the gynecologist will allow you to go through this natural process quickly and as comfortably as possible for a woman.

With age, hormonal changes inherent in nature occur in the female body. But many women are afraid of menopause, because there is an opinion that menopause is always malaise, hot flashes, loss of emotions from intimate relationships. Is it so? Or is menopausal simply the next stage in a woman's life and development? What is a woman's menopause, when it occurs and how it manifests 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 supply of eggs in the ovaries. The ovaries produce female hormones - estrogen and progesterone, which regulate female fertility, and as a result ovulation and menstruation occur cyclically every month. When the supply of eggs is used up, menstruation stops, the production of hormones is significantly reduced and the period of menopause begins.

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 people, in the office, etc. As a rule, they manifest themselves in a sensation of unexpected heat, which lasts for 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 the production of hormones. Well help relieve the attack of heat washing cold water, if this does not help, you need to choose a medicine with the help of a doctor.

Other possible signs of onset climacteric:

• irregular menstruation;
• uterine bleeding;
• sudden mood swings;
• heart rate increases;
• pressure surges;
• nausea;
• headache;
• joint and muscle pain;
• dryness of the vagina;
• decreased sex drive;
• fast fatiguability;
• sleep disorder;
• neurosis;
• depression may develop.

When comes

At what age and how does menopause begin? After 40 years in women, premenopause occurs: rare or frequent menstruation is observed, dysfunctional bleeding is possible, the development of climacteric cardiopathy, smearing between periods is possible. bloody issues... 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 will help confirm the onset of premenopause. A stable basal temperature also indicates the onset of menopause.

Nevertheless, there is no definite answer to the question of how old a woman starts menopause, because the onset of menopause is influenced by genetic factors, working conditions, climate, way of life, and the presence of bad habits. But in most women, climacteric changes begin after 45 years, if after 50 years it is a late menopause. Today, many specialists in gynecology are inclined to believe that late menopause should be called its onset after 55 years.

A frequent occurrence these days is early menopause. The causes of early menopause, which can begin even at the age of 30, are heredity, immunity disorders, or the results of medical intervention. In exceptional cases, premature menopause can occur even at the age of 25 as a result of damage to the ovaries after chemotherapy or surgical removal of the ovaries for medical reasons. But such a menopause is pathological and necessarily requires treatment in order to align hormonal disbalance the female body at a young age.

How long is the climacteric period

In the climacteric period, the phases of premenopause, menopause and postmenopause are distinguished. How long does hormonal changes in the body take?

• Premenopause lasts 2-10 years, until menstruation stops.
• Menopause occurs 1 year after the cessation of menstruation.
• The postmenopausal period begins with the onset of menopause and lasts 6-8 years, at which time the symptoms of menopause - for example, hot flashes - may persist, but go away more easily.

Treatment for menopausal syndrome

To alleviate the manifestations of menopause, you need to know what to take when a headache pesters, how to relieve hot flashes or other unpleasant symptoms, and stop uterine bleeding. One of the most commonly used drugs in the treatment of climacteric syndrome is the homeopathic tablets "Remens". A woman, after consulting a doctor, will be able to choose which means it is best for her to use.

Homeopathic remedies

Homeopathy for menopause offers remedies in the form of pills or drops. In the climacteric period, a whole complex of health problems manifests itself, which is based on vegetative-vascular symptoms - hot flashes, increased sweating, heart palpitations, and psycho-emotional - irritability, insomnia, increased fatigue. It is possible to solve a complex of problems with menopause due to the natural components in the composition of the Klimaktoplan preparation. 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 dispensed without a prescription, is well tolerated, and is produced in Germany.

Folk remedies

Recipes traditional medicine women are often divided among themselves, based on their experience. To maintain physical tone and Have a good mood water procedures are good - soothing herbal baths (Potentilla root, lovage). For the prevention of general health, teas and decoctions from medicinal plants are used: chamomile, mint, upland uterus, nettle, hawthorn. For optimal well-being during this transition period, you need to plan your daily routine, eat right, and get good rest.

Hormonal drugs

Hormone 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 the climacteric period, additional hormone intake is necessary. Doses of hormones, which are contained in the preparations "Klimonorm", "Femoston", "Kliogest", replace the lacking production of its own hormones by the body.

Phytopreparations

With menopause, use and medicines on a plant basis, 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 function 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

It is always pleasant for a woman to know that she is being taken care of. It’s even more pleasant to feel it. In the field of taking care of women's well-being, Lady’s Formula Menopause Strengthened Formula has proven itself ideally. A well-known complex of traditional vitamins, the most important minerals and rare extracts medicinal plants effectively helps women cope with the problems that arise during menopause. Thanks to an integrated approach to eliminating menopausal symptoms, delicate exposure and no side effects Biocomplex Lady's Formula Menopause Fortified 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 say no overweight and frequent urge to urinate. In addition, you will enjoy a healthy, fresh complexion and firmness of the skin, shine and strength of the hair.

Lady's Formula Menopause Fortified Formula will step by step restore high vitality, well-being and excellent appearance.

What is premenopause

The pre-clementeric period is the transition period to menopause, during which the level of estrogen produced by the ovaries decreases for several years in a woman. Harbingers of premenopause:

• delayed menstruation;
• exacerbation of premenstrual syndrome, sudden mood swings;
• painful tenderness of the mammary glands;
• itching and dryness of the vagina, discomfort during intercourse;
• decreased sex drive;
• frequent urination;
• incontinence when sneezing or coughing.

Doctors diagnose the premenopausal period based on the symptoms that a woman has, 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. Premenopause - a natural condition for women 40-50 years old, lasts until menopause, when the ovaries stop producing eggs.

Pregnancy with menopause

Is it possible to get pregnant during menopause? Yes it is possible. The reproductive function of a woman during the premenopausal period is significantly reduced, but the likelihood of pregnancy is there. If such a turn of fate is undesirable, you must continue to use contraception for 12 months after your last menstrual period. But sex after menopause is still able to bring bright colors to a woman's life, and sex life in no case should end in the postmenopausal period.

The climacteric syndrome is a symptom complex that develops during the period of age-related extinction of the function of the reproductive system of a woman and is characterized by neurovegetative, metabolic-endocrine and psycho-emotional disorders of varying degrees of intensity and duration.

Etiology and pathogenesis

The main regulating link in the menstrual cycle is the hypothalamus. It produces releasing hormones. It is currently believed that the hypothalamic regulation of the production of FSH and LH by the adenohypophysis is carried out by one hormone - gonadoliberin, produced by the hypothalamus. For many years, the hypothalamus-pituitary-ovarian system functions as a self-regulatory system according to the principle feedback ... However, with age, evolutive changes in the hypothalamus occur, which is manifested by an increase in the threshold of its sensitivity to the action of estrogens and an increased production of gonadotropic hormones, primarily follitropin. The cyclicity of their allocation is also violated. Due to the increasing stimulation of the ovaries from the hypothalamus, they secrete into the blood a large amount of not only the working hormones of estrogens, but also intermediate products of their synthesis. However, from a certain moment, the amount of hormones produced by the ovaries turns out to be insufficient to inhibit excited hypothalamic activity and high production of follitropin. A decrease in follitropin secretion does not occur, and therefore ovulation does not occur. With the cessation of ovulation, the corpus luteum does not develop, the reproductive function ceases. With age, there is a progressive decrease in the number of primordial follicles, although a small number can be found in postmenopausal ovaries. The most characteristic of this period is the resistance of such follicles to the action of FSH and LH, an increase in the level of which in the blood serum always occurs during menopause. Menopause is characterized by a violation of the secretion of many hormones, primarily gonadotropic and sex hormones. Despite the almost complete cessation of ovarian hormonal function, serum estrogen levels do not reflect this condition. This is due to the fact that androstenedione, which is converted into estrone in peripheral tissues, is an additional source of estrogens, mainly in the form of estrone. A decrease in the level of classical estrogens in the body contributes to the development of osteoporosis. Estrogen deficiency accelerates the development of atherosclerosis. An increase in the concentration of gonadotropins is likely to contribute to the development of ovarian cancer. A decrease in the content of dopamine in the hypothalamus leads to vegetative-vascular reactions, which is manifested by hot flashes, vegetative crises, and an increase in blood pressure. Feeling of heat is a consequence of paroxysmal vegetative sympathicotonic manifestations. Typical sensations arise as a result of central hyperthermia and appear 30-50 minutes later after the spastic state of the capillaries and the development of venous stasis. In the pathogenesis of climacteric syndrome, changes in the functional state of the hypothalamus matter. At birth, a girl has primordial follicles from 300 to 500 thousand. But gradually the number of primordial follicles decreases and by the age of 40 they remain from 5 to 10 thousand. Accordingly, fertility decreases, the secretion of estrogen changes, which decreases. In addition, the qualitative composition of the estrogen produced changes. The main active fractions of estrogens are estrone, estrodiol, estriol. In menopause, the most active is estriol. At an older age, the reticular adrenal cortex produces part of the sex hormones, and some women go through menopause very calmly and some women do not have any sensations and manifestations of menopause (since these women suffer the least from the adrenal glands during their life). The adrenal glands take over the function of the ovaries when the function of the latter fades away. In addition, the content of gonadotropin changes. If estrogens decrease, then gonadotropins increase (more than 10 times) to the feedback mechanism. The ratio of luteinizing hormone and FSH changes. At the reproductive age, this ratio is equal to unity, in the climacteric period, FSH is released more (ratio 0.43). The modern concept of the pathogenesis of climacteric syndrome attaches great importance to age-related changes in hypothalamic structures.

The most traditional classification is the division of the climacteric syndromeby the number of tides on: mild form - a disease with up to 10 hot flashes per day; medium form - a disease with 10-20 hot flashes per day and with other characteristic symptoms; severe form - a disease with more than 20 hot flashes per day and other symptoms in which a woman almost completely loses her ability to work Forms of climacteric syndrome: typical - uncomplicated complicated - in combination with ischemic, hypertension, diabetes mellitus, arthropathy, atypical osteoporosis - the prevailing symptoms are indicative of primary disorders in the hypothalamus, which is manifested by hypothalamic syndrome (most often with early menopause in young women)

Clinical picture General picture of the disease... In the early stages, symptoms of disorders associated with impaired nervous regulation of vascular tone appear - the so-called hot flashes and sweating. These symptoms are accompanied by significant disturbances in the higher nervous functions: sleep disorders, increased irritability and excitability, depression. In the future, symptoms arise associated with a decrease in the level of female sex hormones. Atrophy of the skin occurs (slow recovery of skin cells, its wilting), as well as the vaginal mucosa, which is manifested not only by unpleasant subjective sensations (primarily dryness and itching), but also fraught with the addition of infections of the genitourinary organs. There is an insufficiency of the sphincters of the bladder, which is manifested by involuntary urination (urinary incontinence). The clinic is diverse and manifests itself in neuropsychic, vegetative-vascular and metabolic disorders and is similar to diencephalic syndrome: neuropsychic manifestations: irritability, depression, tearfulness, aggressiveness, insomnia, headache, dizziness, nausea and vomiting, itching, vegetative chills vascular manifestations: sweating, heart pain, tachycardia (may be paroxysmal), lability of blood pressure, endocrine metabolic disorders - decreased urine output, thirst, edema, painful engorgement of the mammary glands, flatulence, etc.

Diagnostics Sort complaints into three groups: neurovegetative - hot flashes, sweating, dizziness, paresthesia, tingling in the heart, tachycardia. All this, as a rule, happens at the time of high tide. psycho-neurotic - impaired memory, sleep, bad mood up to depression. somatic - atherosclerosis, systemic osteoporosis, atrophic changes from internal organs In the first days of the examination, general analysis of blood, urine, TSH, study of the level of potassium, sodium in blood plasma, electrocardiography with physical activity (according to indications), X-ray examination of the chest organs. With pathological menopause, the electrocardiogram is normal or characterized by a pathology of the T wave in the form of its decrease, smoothing and transition to negative, a shift in the S T interval, especially in the right (V1 Vz), less often in the left (V5 V6) chest leads, without dynamic changes (in contrast from changes caused by ischemia), including after physical exertion. The test with nitroglycerin not only does not improve, but sometimes even worsens the ECG indicators and the well-being of patients.

Treatment Allocate drug, non-drug and hormonal treatment of climacteric syndrome.

The first stage is non-drug therapy: morning exercises physiotherapy exercises general massage proper nutrition (vegetables, fruits, vegetable fats should prevail in the diet) physiotherapy treatment (collar with novocaine according to Shcherbak, cerebral galvanization, electroanalgesia. procedures 7-8 times sanatorium treatment - hydrotherapy, balneotherapy , radon baths The second stage is non-hormonal drug therapy: vitamins A, C, E - improve the state of the diencephalon and help well when the first symptoms appear; antipsychotic drugs - drugs of the phenothiazine series - meterazine, ethaperazine, triftazine, frenolone; they act at the level of the interstitial brain, affect the subcortical structures and the Moscow school believes that they have a pathogenetic effect; start with small doses, and evaluate the effect after 2 weeks; tranquilizers - diazepam, elenium, if climacteric syndrome is combined with hypertension, then reserpine has a good effect in this case - pressure decreases, and gives an antipsychotic effect;

The third stage is hormone therapy Currently, the following basic provisions on the use of hormone replacement therapy have been developed.: using only analogs of natural hormones prescribing low doses of estrogens corresponding to the level of endogenous estradiol in the early phase of proliferation in young women, the combination of estrogens with progestogens, which makes it possible to exclude hyperplastic processes in the endometrium when the uterus is removed, estrogen monotherapy can be prescribed; duration of hormone prophylaxis and hormone therapy is at least 5- 7 years for the prevention of osteoporosis and myocardial infarction

Menopause syndrome is a pathological condition associated with the climacteric period, complicating its course and characterized by disorders of body functions of varying duration and severity in the adaptogenic, psychoemotional, metabolic endocrine, neurovegetative, cardiovascular spheres. They develop in 30-60% of women in menopause.

How long can climacteric syndrome last?

Menopause in women is not a disease. This is a physiologically normal age (45 - 55 years of age) and genetically determined state of the body, which consists in the restructuring of the higher parts of the central nervous system. The result of this transformation is a decrease in the intensity and a change in the cyclicity of the synthesis and secretion of gonadotropic hormones by the pituitary gland, the development of insufficiency of the functions of the gonads.

The climacteric period consists of three phases:

• premenopausal, preceding the cessation of menstruation and lasting from 2 to 5 years; pathological syndrome during this phase develops in 35% of women;
• , representing the final cessation of menstruation, which is estimated after 1 year of their complete absence; symptoms of climacteric syndrome during this period are ascertained in 38-70% of women;
• postmenopausal, characterized by a deficiency of estrogen, an increased level of gonadotropic hormones and the final physiological morphofunctional restructuring of all systems and organs of the body, primarily reproductive.

Throughout there are various pathological conditions, united by the term "menopausal syndrome". Its "early" manifestation is climacteric syndrome, which, as a rule, begins to develop gradually shortly before menopause (premenopause) and lasts an average of 2-3 years. However, in some individual cases, its duration can be up to 10-15 years.

Pathogenesis and contributing factors

V modern concept on the mechanisms of the development of climacteric syndrome, the main importance as a causal factor is given to age-related changes in the hypothalamic structures.

The hypothalamus is the main gland that regulates the cycle of the menstrual cycle. It synthesizes the neurohormone gonadoliberin, or gonadotropin-releasing hormone (GnRH), under the action of which the adenohypophysis produces follicle-stimulating (FSH) and luteinizing (LH) hormones. They affect the maturation and function of the follicles and the corpus luteum of the ovaries.

The hypothalamus - the pituitary gland - the ovaries form an integral self-regulating system, the self-regulation of which is based on the principles of feedback. Age-related involutive changes in hypothalamic structures are the reason for a decrease in the sensitivity of the latter to the effects of a normal concentration of estrogen secreted by the ovaries.

In order to restore balance, the hypothalamus (by increasing the production of GnRH) in an excited state more and more stimulates the release of gonadotropic hormones by the pituitary gland, especially follicle-stimulating hormones.

As a result, the function of the ovaries is gradually disrupted, and they release into the blood not only the directly functioning fractions of estrogens (estrone, estradiol and estriol), but also intermediate components of their synthesis. In addition, the cyclicality of the production of sex hormones is disrupted. At a certain point, the sex hormones of the ovaries are no longer sufficient to inhibit the hypothalamus and pituitary gland. Remaining high production of FSH leads to the cessation of ovulation and, accordingly, reproductive function.

Since the hypothalamic and pituitary parts of the brain are connected with the rest of the endocrine glands and the cerebral cortex, this also affects the function of the latter - osteoporosis develops, the regulation of the cardiovascular and peripheral nervous system, metabolic processes, etc. leads to the development of climacteric syndrome.

However, due to the fact that part of the sex hormones is produced by the reticular area of ​​the adrenal cortex, the latter take on part of the function of the ovaries during their extinction (according to the principle of "feedback"). This contributes to a mild course of menopause in a certain percentage of women, as a result of which pathological symptoms do not arise.

The occurrence of a violation of the physiological course of menopause is facilitated mainly by factors such as:

1. Professional work in conditions of constant long-term and frequent physical and / or mental fatigue.
2. Stress conditions and dysfunction of the endocrine and central nervous system, dysfunction of internal organs by the time of the onset of menopause.
3. Complications during pregnancy and childbirth, in the postpartum period.
4. Inflammatory diseases of the pelvic organs, menstrual irregularities, volumetric surgical interventions.
5. Infectious diseases and long-term pain syndromes of various origins
6. Increased body weight, even moderate.
7. Industrial hazards and abuse of smoking and alcoholic beverages.

How is climacteric syndrome manifested?

In the clinical course, especially at the initial stages, against the background of menstrual irregularities (1-3 months after their onset), neuropsychiatric disorders and vegetative-vascular dystonia (VVD), or vaso-vegetative manifestations, are dominant.

The first are:

• various sleep disorders and short-term memory disorders;
• feeling of unexplained anxiety and obsessions;
• the appearance of depression and self-doubt;
• emotional lability, expressed in mood instability, unreasonable irritability and tearfulness;
• headaches, fatigue, decreased performance and ability to concentrate;
• depressive state and a change (worsening or, conversely, an increase) in appetite;
• oppression, absence or increased libido.

The vegetative manifestations of climacteric syndrome are usually accompanied by neuropsychiatric disorders and are expressed in:

• feeling of "hot flashes" of heat to the face, head and upper body;
• sudden redness of the skin of the face, cervical region and upper chest;
• dizziness;
• severe sweating, paroxysmal sweating, especially at night;
• numbness of the fingers, paresthesia, a feeling of "creeping" in the limbs, especially at night, convulsive contractions of the muscle fibers of the legs;
• a feeling of lack of air up to choking, tingling and unexplained painful sensations in the region of the heart, sometimes radiating to the neck, shoulder, scapula, and subscapularis;
• palpitations and irregularities heart rate unprovoked by physical exertion;
• instability of blood pressure - an increase in systolic A / D up to 160 mm. rt. Art. and higher, which can quickly be replaced by normal and even lowered and vice versa;
• persistent red or white dermographism.

The symptoms of VSD, as a rule, occur during periods of "hot flashes" and bouts of sweating. Some authors distinguish three forms of climacteric syndrome, depending on the nature and number of symptoms:

1. Typical - a feeling of "hot flashes" of heat to the head, face and cervical region, pathological sweating, sleep disturbances, dizziness and headache.
2. Atypical, which is characterized by both typical symptoms and uniform or regional deposition of adipose tissue, swelling of the lower extremities and face due to fluid retention in the body, pain in the bones and in the area of ​​the joints, especially the hip, dysuric phenomena, dryness of the vaginal mucosa, dyspareunia. Less common is a decrease in body weight against the background of a fairly rapid deterioration in general well-being. Among individual women, episodes of sympatho-adrenal crises are possible, accompanied by a feeling of fear of death, heart rhythm disturbances, as well as high blood pressure, allergic reactions, attacks of bronchial asthma, hyper- or hypoglycemia in blood tests.
3. Combined, which develops among women already suffering from diseases of the heart and blood vessels, arterial hypertension, impaired liver and gallbladder function, metabolic and endocrine disorders, allergic diseases.

However, in this classification there is no clear distinction between early and mid- and late-term manifestations of pathological menopause. Therefore, in practice, the traditional classification is mainly used, which was developed by Vikhlyaeva V.P. based on determining the severity of the flow in accordance with the frequency of tides:

It consists in assessing the severity of the climacteric syndrome based on the determination of the frequency of "hot flashes":

• I degree of severity, or a mild form, which occurs on average in 47% of women with this pathology - the number of hot flashes during the day is not more than 10;
• II degree of severity, or moderate form - from 10 to 20 hot flashes during the day (35%);
• III degree, or severe climacteric syndrome - the number of hot flashes per day is more than 20. This form occurs on average in 18%.

According to research data, vegetative-vascular disorders are found in 13% of all women, and depressive conditions - in 10%.

Diagnostics

Diagnosis of climacteric syndrome is not particularly difficult. It is based on:

• taking into account the regularity / irregularity of the menstrual cycle or the absence of menstrual bleeding in accordance with the age period;
• identifying a complex of the above symptoms;
• exclusion of concomitant diseases or, in the presence of the latter, determination of their relationship with the existing symptoms of climacteric syndrome;
• additional laboratory research of the patient's hormonal status, as well as consultations with a therapist, ophthalmologist (examination of the state of the vessels of the fundus), neuropsychiatrist and endocrinologist.

Menopausal Syndrome (climax , menopause ) - this is a period of physiological changes in a woman's life, which lead to a gradual extinction of the reproductive function. A similar restructuring in the body occurs under the influence of hormonal changes. As a rule, a woman's menopause begins after the age of forty and lasts for about ten years.

Signs of menopausal syndrome

The main symptom of menopause is the gradual cessation of menstruation. In addition, menopause is characterized by the manifestation of a whole complex of various disorders such as endocrine and vegetative-vascular nature ... Women during menopause often suffer from sudden "hot flashes", which are accompanied by a feeling of heat, blood flow to the face. In addition, at this time, a woman notes the manifestation of severe sweating, irritability, tearfulness, her can significantly decrease and increase, dryness of the mucous membranes and skin periodically manifests itself, insomnia worries. In some cases, during menopause, sudden mental and nervous disorders are possible, as well as the occurrence of dysfunctional uterine bleeding.

However, the symptoms of menopause listed above are not manifested in all women in menopause. In some women, the period of such a restructuring of the body of pathological manifestations does not provoke. However, another part of women notes the pathological course of menopause, leading to manifestations of climacteric syndrome. According to medical statistics, menopausal syndrome develops in 26 - 48% of patients. Sometimes the dysfunctions of various body systems during the development of this syndrome are so serious that a woman cannot work fully, and her quality of life is significantly reduced.

Causes of Menopausal Syndrome

The period when a woman's body enters the phase of withering of the functions of the reproductive system, many women are going through quite hard. Serious changes can affect almost the entire female body. A definite glitch gives work immune system , which, in turn, leads to an increase in the number of infectious and autoimmune diseases. The aging process of the female body at this time is also activated. However, the most striking changes at this time occur with the female reproductive system. During menopause, follicles no longer develop in a woman's ovaries, eggs do not mature, and ovulation does not occur.

During menopause, the content of the female body is significantly reduced, and at the same time the production of gonadotropic hormones increases. Due to the too low content of estrogen in the body, a woman may experience disorders in various organs. So with the menopausal syndrome, violations of the urogenital, vegetative-neurotic nature are possible. The risk of developing skin changes , ischemia of blood vessels , psychological disorders .

Features of menopausal disorders

Menopausal disorders, according to the degree of manifestation of climacteric syndrome, are manifested as early , mid-term and late manifestations.

As early manifestations, a number of vasomotor symptoms arise (hot flashes, chills, surges in blood pressure, periodic heartbeat). The so-called psychoemotional signs (a feeling of anxiety, weakness, mood swings, irritability, insomnia) are also distinguished. Sometimes a woman may even fall into a depressive state, note a decrease in libido. All these signs are characteristic of the premenopausal period, they can also occur in the first years of postmenopause.

Speaking about the average manifestations of menopause, doctors note some separate groups of symptoms. As urogenital symptoms the woman notes vaginal dryness, which leads to painful intercourse, itching and burning in the genital area, more frequent urination, sometimes the woman also suffers from urinary incontinence. The number of wrinkles on the skin gradually increases, nails can break intensively and hair fall out. Such manifestations occur in a woman about 3-5 years after the first manifestations of menopause. If a woman practices any methods of treating such symptoms, they do not bring the expected effect.

Late manifestations of disorders of the menopausal period are, first of all, disorders metabolism leading to atherosclerosis , osteoporosis , a number of cardiovascular disease ,. Such serious ailments develop 5-10 years after the first manifestations occur.

Menopausal metabolic syndrome

Diagnosis " menopausal metabolic syndrome "Is often given to women who had menopause several years ago. As a rule, patients after 60 years of age suffer from such a disorder. According to medical statistics, this syndrome affects about a quarter of all women. Until now, the reasons leading to the development of such a disorder have not been precisely established. But nevertheless, experts talk about the influence of hormonal imbalance, the presence of chronic diseases, and the absence in the body of some substances necessary for its functioning on the manifestations of the menopausal metabolic syndrome.

The main signs of this condition are obesity, an increase in glucose levels in a woman's blood, an increase in blood pressure, as well as the occurrence of diseases of the cardiovascular system. The combination of these factors can pose a serious threat not only to health, but also to a woman's life.

The above factors have a clear relationship. The manifestation is caused by natural weight gain during menopause under the influence of hormonal instability. It is important here to clearly adjust lifestyle and eating habits. However, sometimes women who suffer from recurrent depression start to eat too much junk food. As a result, the weight gradually increases. Obesity, in turn, leads to an increase in blood glucose and development.

The process of weight gain provokes the deposition of fat around the internal organs. Accordingly, the load on the heart increases significantly, which leads to cardiovascular diseases. Unfortunately, such processes can be irreversible.

Thus, if the doctor notes that the patient has several criteria during the period of menstrual pause (a sharp increase in body weight, increased pressure at rest, manifestations of irritability), then he has every reason to suspect menopausal syndrome.

Experts note that menopausal syndrome most often develops in women who have a hereditary tendency to severe menopause, as well as in the presence of chronic diseases, disorders monthly cycle during the reproductive period. Women who smoke, as well as those who had an early menopause, are more likely to suffer from a severe course of menopause. Menopausal syndrome is more common in nulliparous women.

Symptoms of Menopausal Syndrome

Both the process of development of menopausal syndrome and the severity of manifestations in menopause depends on several factors. These are hormonal disorders general state woman's health at the onset of menopause, genetic predisposition, environment.

If a woman's menopause is pathological, then in about 80% of cases there are vegetative vascular symptoms ... In this case, the so-called "hot flashes" should be noted: in this state, a woman's capillaries on the skin of the face, head, chest expand sharply, and the body temperature rises slightly. In this state, there is a strong influx of heat, the skin turns red, there is a strong heartbeat and sweating. These attacks can last for about five minutes. Different women have a different frequency of "hot flashes": from one to twenty such attacks per day can occur. Most often this happens at night, negatively affecting the sleep of a woman in menopause. In especially severe cases, the hot flashes of menopause are accompanied by a depressive state, phobias,.

In some women, the described symptoms of menopause are also accompanied by irritability, anxiety, tearfulness, and other psycho-emotional symptoms.

The pathological course of the climacteric period can also be manifested by sexual and urogenital disorders. Another alarming symptom is the development of osteoporosis, which significantly increases the risk of fractures.

Severe menopausal syndrome with menopause sometimes provokes the manifestation of sympatho-adrenal crises in a woman. With such an attack, the patient is worried about a sharp headache, surges in blood pressure, delayed urine separation, followed by polyuria ... With a severe course of menopause, the symptoms of menopause can also appear regularly, while ECG studies do not reveal changes. Possible allergic reactions that appear in response to previously well-tolerated foods and drugs. Such reactions are evidence of changes in the body's immune system. In general, changes in health that occur after menopause sometimes affect a woman's quality of life.

Diagnostics of the menopausal syndrome

When diagnosing menopausal syndrome, the doctor, first of all, carefully interviews the patient. Sometimes it is difficult to diagnose the pathological course of menopause due to exacerbated chronic diseases that take place in the patient. In this regard, the course of menopause is further aggravated, moreover, it can manifest itself atypically. Therefore, the doctor often recommends that the patient be examined by other doctors - a neurologist, cardiologist, endocrinologist. A blood level test is also done to confirm the diagnosis. Sometimes there is a need for a cytological examination of smears, as well as for a histological analysis of endometrial scrapings.

Menopausal Syndrome Treatment

Practicing the treatment of menopause, the gynecologist directs efforts to reduce the manifestations of menopause, which negatively affect the woman's condition. To alleviate the condition during hot flashes, as well as reduce their frequency, a woman is prescribed a course of antidepressant therapy.

In order to prevent the development and progression of osteoporosis, it is practiced to take non-hormonal drugs-biophosphonates, which do not allow intensive loss bone tissue... These drugs are sometimes prescribed instead of estrogens.

If a woman is very worried about urogenital symptoms, it is advisable for her to use the introduction of estrogen in the form of tablets or a cream vaginally.

However, the most noticeable effect in menopause is given by treatment with hormonal drugs. Treatment with medications containing estrogens can significantly reduce the frequency and intensity of hot flashes, eliminate discomfort in the genitals. Treatment with natural estrogens is mainly practiced. To prevent the development of hyperplastic processes in the endometrium, estrogens are combined with gestagens or with androgens ... Hormone therapy should last for several years in order to prevent a woman from developing serious diseases that provoke menopausal syndrome.

Taking hormonal drugs during a pathological menopause is not prescribed for women with oncological diseases organs of the reproductive system, as well as patients suffering from blood clotting disorder , impaired renal function or liver .

Before prescribing a course of treatment with drugs containing hormones, the doctor must conduct an ultrasound scan, cytological examination,

Hormone therapy is determined depending on what stage of menopause the patient has. If it comes about premenopause, then hormonal drugs are prescribed cyclically. In the postmenopausal period, due to atorophical changes in the endometrium, as well as other negative phenomena for the female body, hormones should be taken constantly.

With pathological menopause, systemic treatment with a combination of drugs containing hormones is the most effective. In addition, if necessary, other medications for treatment hypertension , cardiovascular diseases and other ailments associated with menopause.

Sometimes the attending physician also advises the patient to consult a dietitian in order to formulate the correct diet. In addition, a woman is advised to spend as much time as possible in the fresh air, fully sleep and rest, move more and avoid stress and negative emotions. Timely treatment of menopausal syndrome can significantly improve a woman's condition, her performance and health.