Climatic period in women and men. Menopause in women. What's this? How does the climacteric syndrome manifest itself?

This section is a sentimental story about a woman's autumn. Not only women though. We have somehow become accustomed, speaking of menopause, to mean exclusively the weaker sex. But menopause - the period of physiological extinction of the function of the reproductive system - happens, naturally, and at men.

In women, this period falls on the age of 45-55 years. There is also a later climax. This period of a woman's life, following the reproductive period, can last about 30 years.

Climax is a Greek word. Hippocrates' contemporaries did not put any medical meaning into it. In their time, that was the name of the staircase. But experts saw in this an undeniable similarity with a multi-stage series of hormonal changes occurring in the body during this period.

What are the phases in menopause?

These are: premenopause, menopause, postmenopause.

premenopause- this is the period from the beginning of the attenuation of ovarian function to the complete cessation of menstruation, which is characterized by a sharp decrease in the ability to conceive and a change in the nature of menstruation. This period usually begins at age 40-45 and lasts 2-8 years. In 60% of premenopausal women, there is a gradual lengthening of the intervals between menstruation, which become increasingly scarce. In 10% of women, there is a sudden cessation of menstruation. 30% of women may have acyclic uterine bleeding.

Menopause This is the last independent menstruation in a woman's life. The fact that it has come can be said no earlier than a year after the cessation of menstruation.

Postmenopause- this is the period from the last menstruation to the complete cessation of ovarian function, which precedes old age. The duration of postmenopause is 5-6 years. During this period, from time to time, a woman can still notice cyclic changes in the body, but menstruation does not come.

What is climacteric syndrome?

Female sex hormones affect all organs, including the central nervous system, blood vessels, heart, bones, mucous membranes, urinary system, skin, and others. Therefore, when the ovarian function is turned off, 40-80% of women may experience symptoms of menopausal syndrome.

This syndrome manifests itself in different women in different ways:
hot flushes to the head, neck and upper body,
periodic "jumps" in blood pressure,
palpitations,
insomnia,
increased sweating,
depression and irritability.

The severity of the menopausal syndrome is often determined by the frequency of "hot flashes". If there are no more than 10 of them per day, the climacteric syndrome is considered mild, if 10-20 “hot flashes” are of moderate severity, more than 20 are severe.

2-3 years after the onset of menopause, changes in the genitourinary tract may occur: dryness of the vaginal mucosa, itching, frequent or painful urination. 5 or more years after menopause, late metabolic disorders can occur - atherosclerosis and osteoporosis, which leads to an increased likelihood of many diseases - hypertension, myocardial infarction, bone fractures.

Often the thyroid gland suffers, metabolism can be disturbed, which will lead to obesity or weight loss. It is often during this period that diabetes develops.

The earlier menopause occurs (natural or surgical), the earlier late metabolic disorders may occur, due, along with age-related disorders, to the disappearance of the protective effect of estrogens on bones, heart and blood vessels.

Why does the ovarian function fail and unpleasant symptoms appear?

In the hypothalamus and pituitary gland, due to age-related changes, the process of regulating hormone formation is no longer so vigorously going on. They send too weak commands to the ovaries. And with a decrease in ovarian hormones, the mucous membrane of the uterus becomes thinner, and therefore menstruation stops.

The body suffers from a lack of progesterone and estrogen. Hence, many problems in the body. The fact is that estrogen is not only responsible for sexual functions, it is involved in thermoregulation, protects arteries from atherosclerosis, strengthens bones, and maintains skin elasticity.

The hypothalamus is responsible for the functioning of the heart, blood vessels, lungs and other internal organs. It is precisely because of the decrease in the activity of the hypothalamus and pituitary gland during menopause that many functions of the body are disturbed, new diseases may appear or old diseases become aggravated, and bone fragility increases.

The severity of all menopausal disorders is not the same in different women. Someone is incredibly tormented by these manifestations of menopause, and someone does not even notice it. Why? It all depends on the state of the body and lifestyle. If a woman has always led and leads an active life in all its manifestations, takes care of herself, controls her weight, goes in for sports and has not acquired any serious chronic diseases in her life, she will suffer less from the negative manifestations of menopause. But in women with an unstable nervous system, leading a sedentary lifestyle, during the menopause, existing diseases can worsen and new ones can join.

What drugs are indicated for menopausal disorders?

Drugs that are designed to alleviate menopausal syndrome contain natural (natural) analogues of female sex hormones - estrogen and progesterone. Such hormone replacement therapy drugs(HRT) are now popular all over the world. Thanks to them, millions of women in different countries safely pass the critical age.

These drugs include climonorm. It consists of estradiol and levonorgestrel and has a very mild effect on the body. Women taking this drug have a real opportunity to argue with the laws of nature and prolong youth. The drug takes control of the bone, nervous, cardiovascular and genitourinary systems. To a certain extent, it protects against cancer of the uterus and ovaries, polyposis, endometriosis.

But klimonorm, like all medicines, has its contraindications. These are oncological diseases, disorders of the kidneys, liver, pancreas, a tendency to thrombosis. Therefore, you must first talk with your doctor and decide whether or not to take this drug.

There are currently herbal preparations: klimadinon, remens, klimaktoplan.

MENOPAUSE(Greek, klimakter step, age-related turning point; synonym: climacteric, menopause) - the physiological period of transition from puberty to the period of cessation of the generative function.

menopause in women

The climacteric period in women covers a period of time from 45 to 60 years and is characterized by a gradual cessation of menstrual function, and then the hormonal function of the ovaries against the background of general age-related changes in the body. K. p. is inextricably linked with the aging process of both cortical nerve centers and hypothalamic structures that regulate the activity of the pituitary gland and ovaries.

In the first phase of menopause - in the phase of menopausal ovarian dysfunction, or premenopause - changes in ovarian function are characterized by irregular luteinization of the follicles, a decrease in the secretion of progesterone and estrogen, irregular menstruation is noted. The time after the last uterine bleeding due to the influence of ovarian hormones is called menopause. Its onset is preceded by a period of reduced ability of the female body to fertilize. The term "menopause" is also used to refer to the second phase of K. p. - postmenopause, when the function of the corpus luteum of the ovary completely stops, against the background of a significant decrease in estrogen production, their residual secretion in the ovarian tissue is noted, and menstrual function stops.

Changes in the neuroendocrine system of women in K. n. changes in the thyroid gland, dysregulation of autonomic centers, increased excitability of sympathetic centers and lability of the vasomotor system.

Duration of function of ovaries belongs to genetically programmed fiziol. processes. By the age of 40, 30,000-40,000 follicles remain in the ovaries, in the next decade their number decreases significantly. Dystrophic changes in the ovaries begin with a thickening of the basement membrane of the follicles, followed by its fibrous transformation.

The rate and degree of reduction in the number of follicles are individual; in the outcome of dystrophy, atresia of the follicles is observed with the filling of their cavity with connective tissue. In K. the item in ovaries follicles at different stages of development, fibrous and atretic bodies are found, the tendency to small-cystic degeneration of follicles is noted. 3-4 years after menopause, maturing and atretic follicles are less common. In the future comes the so-called. functional rest of the ovaries, their size decreases by 2 times. Sclerotic changes in the vessels of the ovaries, predominantly of medium caliber, are found after 30 years, long before the first wedge, manifestations of K. p., then they spread to larger vessels. The lumen of the vessels narrows, the inner shell thickens, the elastic membrane disappears, fatty and hyaline degeneration of the vascular walls occurs. The vascular network of the genital organs and especially the uterus is significantly rarefied. Its size undergoes great changes. Only in those women who suffer from menopausal bleeding due to increased secretion of estrogen, the uterus in premenopause increases. In postmenopause, its weight decreases to 30 g. The number of anastomoses between the branches of the vessels of the left and right half of the uterus decreases, and a seemingly avascular zone is found along the midline. Differences in the structure of the cervix and body of the uterus disappear, anteflexia is replaced by mild retroflexion. The vesicouterine and recto-uterine spaces are flattened. The endometrium acquires an atrophic structure: the stroma becomes fibrous, the glands are poorly developed, the spiral arteries become straight. The border between funkts, and a basal layer disappears; in the basal layer remains of the glands are preserved, often in a state of cystic atrophy. The epithelium of the cervix atrophies. The vagina unevenly narrows, especially in the upper third, the composition of the vaginal contents changes. In the area of ​​the external genitalia, subcutaneous adipose tissue disappears, the large labia become flabby, and the small ones decrease and depigment, the clitoris decreases. Involutional changes are also found in the mammary glands: glandular tissue disappears, the nipple loses pigmentation; sometimes the mammary glands increase significantly in size as a result of excess fatty deposits.

The first phase To. the item comes at the age apprx. 45 years. Carry its approach to 40-42 years to premature development To. the item, to late - after 55 years. In the presence of hypertension, the duration of premenopause increases to 3-3.5 years. A typical feature of changes in the menstrual function in this period are disturbances in the rhythm and duration of the menstrual cycle and a gradual transition from a two-phase (ovulatory) to a single-phase (anovulatory) cycle. After 43 years, the average duration of the menstrual cycle increases (see), a significant proportion of women have a single-phase cycle with a disturbed rhythm of menstruation. The time of onset of the second phase of K. p. varies over a fairly wide range even in perfectly healthy women (usually at 45-46 years old).

In most women, both phases of K. p. are expressed, and the period of menopausal changes in menstrual function precedes the onset of menopause: the intervals between menstruation gradually increase and the intensity of menstrual-like discharge decreases. Less often, changes in menstrual function are characterized by the appearance of irregular, profuse and prolonged menstrual-like bleeding. In a third of women, menstruation stops suddenly. Earlier cessation of menstrual function is facilitated by frequent repeated births, abortions, prolonged lactation, although in about half of women it is due to primary hypothalamic disorders. Menopause occurs later in patients with uterine myoma, hypertension, etc.

In premenopause, the level of hormonal secretion in the residual ovarian follicles decreases, at the initial stages of age-related adjustment, the concentration of estradiol in the blood plasma decreases with unchanged production of progesterone by the corpus luteum, and later there is a decrease in the secretion of each of these hormones. The reserve of ovarian follicles capable of maturation is gradually depleted, and by the time of menopause, the level of excretion in the urine of total estrogens decreases to 20 mcg / day. Within the first year of postmenopause, cyclical fluctuations in the level of estrogenic influences are also noted, by the end of its level of estrogen excretion with daily urine is almost halved - to 10 mcg. This amount of estrogens is not enough for fiziol, stimulation of the endometrium, although the sensitivity of the latter to stronger endo- and exogenous hormonal stimuli persists for a rather long period. After a decrease and subsequent cessation of estrogen production in the ovarian follicular apparatus, extrafollicular production of steroid hormones persists in the female body for a long time and steroid hormones or their precursors in small quantities. With pronounced individual fluctuations, they continue to form mainly in the ovarian hilum, where hyperplasia of the cellular elements of the stroma with signs of enzymatic activity is often found. 6-10 years after the onset of menopause, a small part of estrogens is formed in the ovary, the rest is the product of aromatization of androgen precursors outside the ovarian tissue - in the subcutaneous tissue and the gastrointestinal-hepatic complex. The production of sex steroids by the adrenal cortex in adolescence remains unchanged for 10-20 years after menopause.

The progressive decrease in the formation of ovarian hormones, especially estrogen, in adolescence is accompanied by a violation of the influence of the latter on the hypothalamic-pituitary system. This is manifested by the cessation of the effect of ovarian steroids on the hypothalamic centers, increased cyclic production of hypothalamic releasing hormones and gonadotropic hormones in the anterior pituitary gland. The content of gonadotropins in the anterior pituitary gland increases 10 times; this is combined with an increase in the weight of this lobe and the content of basophilic elements in it. The content of luteinizing hormone (LH) in blood plasma, according to radioimmune determinations, increases from 30 ng / ml to 500 ng / ml, follicle-stimulating hormone (FSH) - from 20 to 760 ng / ml, and the LH / FSH ratio, equal in reproductive age 1.0, reduced to 0.4-0.7. The ratio of LH / FSH in plasma less than 0.7 is a sign of the onset of K. p. The maximum content of LH and FSH in the blood is observed in the 3rd year of postmenopause and persists for 10 years. With the onset of menopause, a decrease in estrogenic activity is observed in 50% of women, signs of moderate estrogenic influences are found in 33-40% of women, and 10-17% have signs of enhanced estrogenic influences.

Violations To. p. - climacteric dysfunctional uterine bleeding (see) and climacteric syndrome (see).

The state of estrogen deficiency, which usually develops in the later stages of the postmenopausal period, contributes to the development of atrophic changes in the vulva, vagina and urinary tract, atherosclerosis, systemic osteoporosis, and dystrophic arthropathy. While maintaining estrogenic influences in this period, there is a tendency to hypertension, diabetes, the development of hyperplastic processes in the endometrium and mammary glands.

In K. the item at many women obesity, development hron, constipations, the general weakening of an organism is observed. Walking, gymnastics, massage, limiting the amount of food, especially meat dishes, contribute to the prevention of these phenomena. Alcohol, spices, sharply stimulating the nervous system, should be excluded. The action of the bowels is best regulated by the appointment of an appropriate diet.

In K. p., practically healthy women should undergo a medical examination by a gynecologist at least 2 times a year. Serious attention and careful examination requires the appearance of unusual symptoms in this period.

Menopause in men

Menopause in men is determined by age-related involutional processes occurring in the gonads, and most often occurs at the age of 50 to 60 years. Atrophic changes in testicular glandulocytes (Leydig cells) in men of this age lead to a decrease in testosterone synthesis and a decrease in the level of androgenic saturation of the body. At the same time, the production of gonadotropic hormones of the pituitary gland tends to increase. The decrease in the endocrine function of the testicles plays the role of the so-called. trigger factor in violation of the mechanisms of regulation of the system hypothalamus - pituitary gland - gonads. As a result, there are complex neuroendocrine changes, including dysfunction of c. n. With. and defining the picture of male menopause. In the vast majority of men, the age-related decline in the function of the gonads is not accompanied by any clinical manifestations, although sometimes there are characteristic symptoms of menopause and in such cases, the course of K. p. is regarded as pathological.

Wedge, manifestations patol. To. the item at men are characterized by cardiovascular, psihonevrol, and genitourinary disturbances. Cardiovascular disorders are manifested by a sensation of flushing to the head, sudden redness of the face and neck, palpitations, pain in the heart, shortness of breath, excessive sweating, dizziness, etc. Sometimes there is intermittent arterial hypertension.

Psychoneurol, disturbances in To. p, can be poorly or sharply expressed. Patients complain of mild excitability, fatigue, sleep disturbance, muscle weakness, headache. There is depression, unreasonable anxiety and fear, loss of former interests, increased suspiciousness, tearfulness.

Among the symptoms of dysfunction of the genitourinary organs, various degrees of dysuria are noted (see). Violations of sexual potency are observed in the vast majority of men (see Impotence). At the same time, all the components of the copulative cycle suffer, but there is a predominant weakening of erection and premature ejaculation.

Treatment at patol. To, the item at men includes normalization of a mode of work and rest, the dosed physical. load, creating the most favorable psychol, climate. An obligatory component of treatment is the psychotherapy (see). Drug treatment includes agents that normalize the function of c. n. With. (sedatives, psychostimulant antidepressants, tranquilizers, etc.), vitamins, biogenic stimulants, preparations containing phosphorus, antispasmodics. In some cases, the appointment of drugs of sex and gonadotropic hormones is shown in order to correct violations of endocrine relationships, as well as the use of anabolic hormones.

Bibliography: Arsenyeva M. G. Colpocytological studies in the diagnosis and therapy of endocrine gynecological diseases, p. 206, L., 1973, bibliography; Vikhlyaeva E. M. Menopausal syndrome and its treatment, M., 1066, bibliogr.; 3 m and n about v-s k and y Yu. f. Age neurophysiological features and climacteric disorders in women, M., 1975, bibliogr.; Malinovsky M. S. and C in e t - M about l d and in with to and I am V. D. Menopause and menopause, M., 1963, bibliogr.; Mandelstam V. A. Uterine bleeding in menopause, L., 1974, bibliogr.; Teter E. Hormonal disorders in men and women, trans. from Polish, Warsaw, 1968.

E. M. Vikhlyaeva; D. V. Kahn (Ural)

Climax is the physiological period of transition from puberty to the period of cessation of the generative function.

The climacteric period in women covers a period of time from 45 to 60 years and is characterized by a gradual cessation of menstrual function, and then the hormonal function of the ovaries against the background of general age-related changes in the body. The climacteric period is inextricably linked with the aging process of both cortical nerve centers and hypothalamic structures that regulate the activity of the pituitary gland and ovaries.

In the first phase of menopause - in the phase of menopausal ovarian dysfunction, or premenopause - changes in ovarian function are characterized by irregular luteinization of the follicles, a decrease in the secretion of progesterone and estrogens, irregular menstruation is noted. The time after the last uterine bleeding due to the influence of ovarian hormones is called menopause. Its onset is preceded by a period of reduced ability of the female body to fertilize. The term "menopause" is also used to refer to the second phase - postmenopause, when the function of the ovarian corpus luteum completely stops, against the background of a significant decrease in estrogen production, their residual secretion in the ovarian tissue is noted, and menstrual function stops.

Duration of function of ovaries belongs to genetically programmed fiziol. processes. By the age of 40, 30,000 - 40,000 follicles remain in the ovaries, in the next decade their number decreases significantly. Dystrophic changes in the ovaries begin with a thickening of the basement membrane of the follicles, followed by its fibrous transformation.

In most women, both phases are expressed, and the period of menopausal changes in menstrual function precedes the onset of menopause: the intervals between menstruation gradually increase, and the intensity of menstrual-like discharge decreases. Less often, changes in menstrual function are characterized by the appearance of irregular, profuse and prolonged menstrual-like bleeding. In a third of women, menstruation stops suddenly. Earlier cessation of menstrual function is facilitated by frequent repeated births, abortions, prolonged lactation, although in about half of women it is due to primary hypothalamic disorders. Menopause occurs later in patients with uterine myoma, hypertension, etc.

The state of estrogen deficiency, which usually develops in the later stages of the postmenopausal period, contributes to the development of atrophic changes in the vulva, vagina and urinary tract, atherosclerosis, systemic osteoporosis, and dystrophic arthropathy. While maintaining estrogenic influences in this period, there is a tendency to hypertension, diabetes, the development of hyperplastic processes in the endometrium and mammary glands.

In the menopause, many women experience obesity, the development of chronic constipation, and a general weakening of the body. Walking, gymnastics, massage, limiting the amount of food, especially meat dishes, contribute to the prevention of these phenomena. Alcohol, spices, sharply stimulating the nervous system, should be excluded. The action of the bowels is best regulated by the appointment of an appropriate diet.

Menopause in men is determined by age-related involutional processes occurring in the gonads, and most often occurs at the age of 50 to 60 years. Atrophic changes in testicular glandulocytes (Leydig cells) in men of this age lead to a decrease in testosterone synthesis and a decrease in the level of androgenic saturation of the body. At the same time, the production of gonadotropic hormones of the pituitary gland tends to increase. A decrease in the endocrine function of the testicles plays the role of the so-called trigger factor in the disruption of the mechanisms of regulation of the hypothalamus-pituitary-gonadal system. As a result, there are complex neuroendocrine changes, including dysfunction of the central nervous system and determining the pattern of male menopause. In the vast majority of men, the age-related decline in the function of the gonads is not accompanied by any clinical manifestations, although sometimes there are characteristic symptoms of menopause and in such cases the course of the menopause is regarded as pathological. Clinical manifestations of the pathological menopause in men are characterized by cardiovascular, neuropsychiatric and genitourinary disorders. Cardiovascular disorders are manifested by a sensation of flushing to the head, sudden redness of the face and neck, palpitations, pain in the heart, shortness of breath, excessive sweating, dizziness, etc. Sometimes there is intermittent arterial hypertension.

Psychoneurological disorders in menopause can be mild or pronounced. Patients complain of mild excitability, sleep disturbance, muscle weakness, headache. There is depression, unreasonable anxiety and fear, loss of former interests, increased suspiciousness, tearfulness.

Among the symptoms of dysfunction of the genitourinary organs, various degrees of dysuria are noted. Violations of sexual potency are observed in the vast majority of men.

Treatment for pathological menopause in men includes the normalization of the regime of work and rest, dosed physical activity, and the creation of the most favorable psychological climate. Psychotherapy is an essential component of treatment. Drug treatment includes drugs that normalize the function of the central nervous system (sedatives, psychostimulant antidepressants, tranquilizers, etc.), vitamins, biogenic stimulants, drugs containing phosphorus, antispasmodics. In some cases, the appointment of drugs of sex and gonadotropic hormones is shown in order to correct endocrine relationships, as well as the use of anabolic hormones.

Climacteric Syndrome (CS) - This is a kind of symptom complex that occurs against the background of age-related changes in the body, characterized by neuropsychic, vasomotor and metabolic-endocrine disorders that complicate the natural course of menopause.

The reasons for the development of CS are that the universal hormonal characteristic of postmenopause is an increase in the level of gonadotropins and estrogen deficiency. These changes occur in premenopause. In the reproductive period of a woman's life, estrogens constantly affect various organs and tissues, interacting with specific estrogen receptors, which are localized, in addition to the uterus and mammary glands, in the urethra, bladder, cells of the vagina and pelvic floor muscles, in the cells of the brain, heart and arteries. , bones, skin, in the mucous membranes of the mouth, larynx, conjunctiva.

In this regard, against the background of estrogen deficiency in menopause, pathological conditions of the above-mentioned organs and tissues may occur.

All the main clinical symptoms of menopausal disorders are divided into 3 groups:

TREATMENT of menopause complex and includes non-drug, drug and hormonal therapy.

Non-drug treatment involves morning exercises (15-20 minutes), therapeutic exercises in the "health" groups 2-3 times a week for 40-45 minutes, general massage, walks before bedtime. The diet should be dominated by fruits and vegetables, vegetable fats, carbohydrate restriction. Hydrotherapy at home is shown: dousing, washing, shower, baths (coniferous, sage, hot foot baths). Balneotherapy involves the use of mineral and radon waters, natural or imitating the corresponding natural factors in artificially prepared counterparts. Sanatorium-and-spa treatment is preferably carried out in the usual climatic zone or on the southern coast of Crimea (during the non-hot season).

In a typical form of KS (mild and moderate), pearl, oxygen, foamy and nitrogen baths are quite effective, and in patients with uterine myoma, endometriosis, mastopathy, thyrotoxicosis, radon or iodine-bromine baths.

Over the past decade, long-term hormone replacement therapy has been used to successfully treat menopausal syndrome. The choice of the method of hormone therapy is the prerogative of the obstetrician-gynecologist.

Patients with menopausal syndrome should be under dynamic observation. The gynecologist should examine the patient once every 3 months, the therapist - 2 times a year.

- a physiological period in a woman's life, characterized by the extinction of reproductive function due to hormonal changes in the body. It starts after 40 years and lasts about 10 years. Manifested by the gradual cessation of menstruation. May be accompanied by a complex of vegetative-vascular and endocrine disorders: sudden attacks of blood rush to the upper half of the body and face (“heat”), sweating, tearfulness, irritability, fluctuations in blood pressure, increased dryness of the skin and mucous membranes, sleep disturbance. May cause dysfunctional uterine bleeding, serious neuropsychiatric disorders.

General information

is a natural stage in a woman's life and is characterized by reverse changes in the reproductive system - the cessation of childbearing and menstrual functions. The word "climax" comes from the Greek "climax" - a ladder, expressing the symbolic steps leading from the flowering of specific female functions to their gradual extinction.

The life of a woman consists of several age periods, which have their own anatomical and physiological features:

• neonatal period - up to 10 days;
• childhood period - up to 8 years;
• puberty - from 8 to 17-18 years;
• the period of puberty (reproductive, or childbearing) - from 18 to 45 years;
• menopause (menopause), including:

1. premenopause - from 45 years to menopause;
2. menopause - cessation of menstruation (49-50 years);
3. postmenopause - from menopause - up to 65-69 years;

• old age - from 70 years.

With an average life expectancy for a woman of 75 years, a third of her life falls on menopause.

In some women, menopause has a physiological course and does not cause pathological disorders, in others, the pathological course of menopause leads to the development of the menopausal (climacteric) syndrome. Menopausal syndrome with 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 life and work capacity of a woman. The issues of the pathological course of menopause are of great social and medical importance in connection with the increased average life expectancy of a woman and her socially active behavior.

Causes of the menopausal syndrome

During menopause, changes occur throughout the body: immune defenses decrease, the frequency of autoimmune and infectious diseases increases, and aging processes progress. But the most active changes during menopause undergo the sexual apparatus of a woman. With menopause in the ovaries, the development of follicles stops, the eggs stop maturing and ovulating, and there is a decrease in intrasecretory activity. The follicles in the ovaries are replaced by connective tissue, which leads to sclerosis and a decrease in the size of the ovaries.

The hormonal picture in menopause is characterized by an increase in the level of gonadotropic hormones (follicle-stimulating and luteinizing) and a decrease in estrogen levels. Within a year after the onset of menopause, an increase in the level of follicle-stimulating hormone occurs 13-14 times, luteinizing hormone - 3 times, followed by some decrease.

During menopause, changes in the synthesis of estrogen hormones consist in the termination of the production of estradiol and the predominance of estrone. Estrogens have a biological effect on the uterus, mammary glands, urethra, bladder, vagina, pelvic floor muscles, brain, artery and heart cells, bones, skin, mucous membranes of the conjunctiva, larynx, mouth, etc., and their deficiency during the period menopause can cause various disorders in these tissues and organs.

Menopausal syndrome in menopause is a manifestation of estrogen deficiency and is characterized by vegetative-neurotic, urogenital disorders, dystrophic skin changes, a high risk of atherosclerosis and vascular ischemia, osteoporosis, and psychological disorders. With an increase in the average life expectancy of a woman, menopause lengthens and, accordingly, an increase in the period of estrogen deficiency, which increases the likelihood of developing menopausal syndrome.

Classification

According to its manifestations, the climacteric syndrome is divided into early-term, medium-term and late-term manifestations of menopausal disorders. The early manifestations of menopausal disorders in menopause include:

• vasomotor symptoms - a feeling of "hot flashes" of heat, headaches, increased sweating, chills, fluctuations in blood pressure, palpitations;
• psycho-emotional symptoms - weakness, anxiety, irritability, drowsiness, inattention, forgetfulness, depression, decreased libido.

Early manifestations during menopause capture premenopause and 1-2 years of postmenopause. Women with vasomotor and psycho-emotional symptoms during menopause are often treated by a general practitioner for hypertension, coronary heart disease, or by a psychoneurologist with diagnoses of neurosis or depression.

Medium-term manifestations of menopausal disorders in menopause include:

• urogenital symptoms - vaginal dryness, painful sexual intercourse, burning, itching, dysuria (increased urination and urinary incontinence);
• symptoms of the skin and its appendages - wrinkles, brittle nails, dry skin and hair, hair loss.

Medium-term manifestations during menopause occur 2-5 years after menopause and are characterized by atrophic changes in the skin and urogenital tract. As a rule, symptomatic treatment of urogenital and skin symptoms in menopause does not give the desired effect.

Late-term manifestations of menopausal disorders in menopause include:

• metabolic (exchange) disorders - osteoporosis, atherosclerosis, Alzheimer's disease, cardiovascular diseases.

Late-term manifestations during menopause develop after 5-10 years after the onset of menopause. Insufficient levels of sex hormones during menopause leads to a violation of the structure of bone tissue (osteoporosis) and lipid metabolism (atherosclerosis).

Symptoms of the menopausal syndrome

The development and severity of the course of the menopausal syndrome is influenced by hormonal, environmental, hereditary factors, the general condition of a woman by the period of menopause.

Vegetovascular (vasomotor) symptoms in the pathological course of menopause are observed in 80% of women. They are characterized by sudden "tides" with a sharp expansion of the capillaries of the skin of the head, face, neck, chest, an increase in local skin temperature by 2-5°C, and body temperature - by 0.5-1°C. "Hot flashes" are accompanied by a feeling of heat, redness, sweating, palpitations. The state of "tides" lasts 3-5 minutes with a frequency of 1 to 20 or more times a day, intensifies at night, causing sleep disturbance. A mild degree of vasomotor disorders in menopause is characterized by the number of "tides" from 1 to 10 per day, medium - from 10 to 20, severe - from 20 or more in combination with other manifestations (dizziness, depression, phobias), leading to a decrease in working capacity.

In 13% of women with a pathological course of menopause, asthenoneurotic disorders occur, manifested by irritability, tearfulness, feelings of anxiety, fear, intolerance to olfactory and auditory sensations, and depression. Psychoemotional symptoms in menopause develop before menopause or immediately after it, vasomotor symptoms last about 5 years after menopause.

The course of the menopausal syndrome with menopause can develop in the form of atypical forms:

• sympathetic-adrenal crises, characterized by a sharp headache, increased blood pressure, urinary retention, followed by polyuria;
• myocardial dystrophycharacterized by constant pain in the heart in the absence of ECG changes, ineffectiveness of conventional therapy;
• urticaria, vasomotor rhinitis, allergies to drugs and food, indicating a change in the body's immunological reactions, etc.

The course of menopause falls on a period of important events in a woman's life: growing up and marrying children, achievements at work, retirement changes, and menopausal disorders are superimposed on increased emotional stress and social problems. Almost 50% of women with a pathological course of menopause have a severe form of disorders, 35% of the disorders are moderately expressed, and only 15% of the menopausal syndrome has mild manifestations. A mild form of menopause disorders is usually found among practically healthy women, while women with chronic diseases are prone to atypical manifestations of the climacteric syndrome, a tendency to the crisis nature of the course, which disrupts the general health of patients.

The development of the menopausal syndrome in menopause is facilitated by genetic factors, endocrinopathy, chronic diseases, smoking, menstrual disorders during puberty, early menopause, physical inactivity, and the absence of a woman's history of pregnancy and childbirth.

Diagnostics

Diagnosis of the pathological course of menopause is based on the complaints of patients that appear at the age of approaching or onset of menopause. Exacerbation of concomitant diseases sometimes makes it difficult to diagnose menopausal syndrome in menopause, making it worse and causing the development of atypical forms. In the presence of concomitant diseases, a woman, in addition to consulting a gynecologist, is shown consulting other specialists: a cardiologist, a neurologist, an endocrinologist.

In order to correctly diagnose the complicated course of menopause, a study of the blood levels of follicle-stimulating and luteinizing hormones, estrogen is carried out. To clarify the functional state of the ovaries during menopause, a histological analysis of scrapings of the endometrium of the uterus and cytological studies of smears from the vagina in dynamics are carried out, and a graph of basal temperature is plotted. Identification of anovulatory ovarian cycles allows linking functional disorders with menopausal syndrome.

Treatment of disorders in menopause

Approaches to the problem of menopause pathology treatment accepted in modern gynecology are based on the reduction of its manifestations and symptoms. Reducing the severity and frequency of "hot flashes" in the pathological course of menopause is achieved by the appointment of antidepressants (venlafaxine, fluoxetine, paroxetine, citalpram, sertraline, etc.).

In order to prevent and treat the development of osteoporosis in menopause, non-hormonal biophosphonates (alendronic and risedronic acids) are used to reduce bone loss and the risk of fractures. Biophosphonates effectively replace estrogen therapy in the treatment of osteoporosis in menopausal women.

To reduce the manifestation of urogenital symptoms in the pathological course of menopause, local (vaginal) administration of estrogen in the form of a cream or tablets is recommended. The release of small doses of estrogen into the vaginal tissue reduces the sensation of dryness, discomfort during sexual intercourse and urination disorders.

The most effective method of treating menopausal syndrome with menopause is hormone therapy individually prescribed by a doctor. Taking estrogenic drugs well eliminates, in particular, "hot flashes" and discomfort in the vagina. For hormone therapy in the treatment of menopause pathology, natural estrogens (estradiol valerate, 17-beta-estradiol, etc.) are used in small doses in intermittent courses. For the prevention of hyperplastic processes in the endometrium during menopause, a combination of estrogens with gestagens or (less often) with androgens is indicated. Courses of hormone therapy and hormone prophylaxis are carried out for 5-7 years in order to prevent myocardial infarction and mammography, cytological analysis of smears discharged from the cervix, biochemical study of blood test parameters and coagulation factors (coagulogram).

Hormone regimen

The choice of hormone therapy regimen depends on the stage of menopause. In premenopause, hormone therapy not only compensates for the estrogen deficiency, but also has a normalizing effect on the menstrual cycle, therefore it is prescribed in cyclic courses. In postmenopause, when atrophic processes occur in the endometrium, for the prevention of monthly bleeding, hormone therapy is carried out in the mode of constant intake of drugs.

If the pathological course of menopause is manifested only by urogenital disorders, estrogens (estriol) are administered topically in the form of vaginal tablets, suppositories, creams. However, in this case, there remains a risk of developing other menopausal menopausal disorders, including osteoporosis.

The systemic effect in the treatment of the pathological course of menopause is achieved by the appointment of combined hormone therapy (for example, tibolone + estradiol + norethisterone acetate). With combined hormone therapy, hormones are combined with symptomatic drugs (hypotensive, cardiac, antidepressants, bladder relaxants, etc.). Combination therapy for the treatment of menopausal disorders is prescribed after consultation with narrow specialists.

Solving the problems of the pathological course of menopause is the key to prolonging women's health, beauty, youth, performance and a real improvement in the quality of life of women entering the beautiful "autumn" time of their lives.

"Climax" in Greek means "ladder". At some point, a woman, due to the reverse development of the reproductive organs, has to overcome this stage, leading to the extinction of the reproductive function. Hormonal changes that occur during menopause are a natural process, you do not need to be afraid of it.

Stages of menopause

Menopause is the period of life during which the functioning of the reproductive system stops.

There are three stages of menopause in women:

1. premenopause. It starts a few years before the full end of menstruation. The duration of the stage is from 1 to 3 years. The functions of the ovaries gradually begin to fade, ovulation ends, the process of conception becomes problematic. There are irregular periods. The interval between them increases, and the duration gradually decreases. The stage drags on.
2. Menopause. The period when a woman does not have menstruation during the year. At this time, a woman can gain a lot of weight, heart problems arise, and diabetes can develop. Menopause most often develops between the ages of 45 and 50. The cessation of menstruation before the age of 45 is considered early menopause, and before the age of 40 - premature.
3. Postmenopause. Time from the end of menopause to 69-70 years.

It is often believed that menopause and menopause are one and the same. However, menopause is defined as the loss of childbearing function, and menopause is a year without menstruation.

There are times when menopause occurs unexpectedly, despite the fact that a woman planned to prepare for this stage. To avoid such a situation, you need to know the symptoms of approaching menopause in women.

Symptoms

The table shows the main signs of an impending menopause.

There are many more signs of the upcoming female menopause, but a woman should not be scared and worried about this. Timely consultation with the doctor and the correct selection of medicines will help alleviate the condition.

Complications of the menopause

Not in all cases, there is a normal course of menopause in women. Possible complications of this period:

• severe course of menopausal syndrome with disruption of the gastrointestinal tract, which causes exhaustion of a woman;
• pathological fractures (a symptom of osteoporosis);
• breakthrough uterine bleeding due to hormonal disruptions;
• endometrial hyperplasia;
• development of uterine fibroids;
• mastopathy, tumor-like formations of the mammary glands.

Due to the large number of possible complications, regular preventive visits to the gynecologist are necessary.

climacteric syndrome

This is one of the common menopausal problems. Climacteric syndrome is expressed in the occurrence of a complex of endocrine and neurological disorders. Symptoms of this syndrome include:

• headaches, migraine, dizziness;
• flushes of heat to the head and upper body;
• sudden mood swings;
• insomnia;
• exacerbation of existing chronic diseases;
• disorders of the cardiovascular system;
• hypertension, etc.

In combination, these symptoms significantly worsen the quality of life of a woman, lead to a decrease in working capacity.

The severity of the menopausal syndrome depends on the frequency of hot flashes. A mild degree is characterized by the occurrence of hot flashes up to 10 times within 24 hours; medium - up to 20 times, severe - more than 20 times a day.

Causes of early menopause

Early menopause is called hormonal changes that began earlier than 45 years. This can be caused by a number of reasons:

• ovarian depletion associated with a genetic anomaly (defect of the X chromosome);
• inherited diseases (galactosemia, amenorrhea, blepharophimosis);
• the consequences of surgical intervention - removal of fibroids along with the uterus, oophorectomy;
• the effect of radiation and chemotherapy prescribed in the treatment of malignant neoplasms;
• decrease in immunity.

A woman should know which doctor to contact with early menopause. A professional gynecologist-endocrinologist will consult and prescribe treatment.

How to delay the onset of menopause?

Specialists have developed several methods to remove menopause. period most suitable for the application of deferral measures.

1. Hormone replacement therapy is prescribed by a doctor strictly according to indications. Estrogen preparations (Ovestin, Divigel, Klimonorm, Norkolut, etc.) can delay the onset of menopause.
2. The doctor may prescribe a long-term intake of phytoestrogens - plant substances similar in mechanism of action to natural estrogen. These drugs include Feminal, Estrovel, Femiwell, etc.
3. Phytotherapy - the use of decoctions and infusions of some medicinal plants (thyme, lungwort, sage, horsetail and many others). Effective for postponing menopause and Monastic tea.
4. In addition, for an effective result, you must adhere to the following rules:

• do not eat fatty, sweet foods; the diet should be dominated by fruits, vegetables, dairy products;
• play sports, thereby stimulating the production of biological substances that prolong youth;
• take care of women's health and regularly visit a gynecologist;
• avoid stressful situations;
• to refuse from bad habits.

By following these tips, a woman has the opportunity to delay the onset of menopause.

Diagnostics

Diagnosis of menopause includes consultations with a gynecologist, endocrinologist, cardiologist, neurologist. The functional state of the ovaries is determined using histological analysis and cytological examination of smears. If necessary, ultrasound of the breast, pelvic organs, mammography is performed.

Ways to eliminate the symptoms of menopause

Modern medicine offers the following methods to eliminate the unpleasant manifestations of the menopause period:

• Hormonal drugs (estrogen) are indicated for severe menopause.
• Phytoestrogens are a mild option for the treatment of menopausal disorders.
• Physiotherapy - massage, physiotherapy exercises.
• Folk treatment.

By what means is the treatment of female menopause, shown in the video.

Menopause is an inevitable physiological process in a woman's life. Therefore, sooner or later she is forced to go through this period.