Climatic period in women. The use of hormones in the postmenopausal period. Why you need to see a doctor

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The climacteric period (menopause, menopause) is the physiological period of a woman's life, during which, against the background of age-related changes in the body, involutional processes in the reproductive system dominate.

Climacteric syndrome (CS) is a pathological condition that occurs in some women in menopause and is characterized by neuropsychic, vegetative-vascular and metabolic-trophic disorders.

Epidemiology

Menopause occurs at an average age of 50 years.

Early menopause is called the cessation of menstruation at 40-44 years. Premature menopause - the cessation of menstruation at 37-39 years.

60-80% of peri- or postmenopausal women experience CS.

Classification

In the menopause, the following phases are distinguished:

■ premenopause - the period from the appearance of the first menopausal symptoms to the last independent menstruation;

■ menopause - the last independent menstruation due to ovarian function (the date is set retrospectively, namely after 12 months of absence of menstruation);

■ postmenopause begins with menopause and ends at age 65-69;

■ perimenopause - the period that combines premenopause and the first 2 years after menopause.

The time parameters of the phases of the menopause are to some extent conditional and individual, but they reflect morphological and functional changes in various parts of the reproductive system. Isolation of these phases is more important for clinical practice.

Etiology and pathogenesis

During the reproductive period, lasting 30-35 years, a woman's body functions under the conditions of cyclic exposure to various concentrations of female sex hormones, which affect various organs and tissues, and are involved in metabolic processes. There are reproductive and non-reproductive target organs for sex hormones.

Reproductive target organs:

■ genital tract;

■ hypothalamus and pituitary gland;

■ mammary glands. Non-reproductive target organs:

■ brain;

■ cardiovascular system;

■ musculoskeletal system;

■ urethra and bladder;

■ skin and hair;

■ large intestine;

■ liver: lipid metabolism, regulation of SHBG synthesis, conjugation of metabolites.

The climacteric period is characterized by a gradual decrease and “turning off” of ovarian function (in the first 2-3 years of postmenopause, only single follicles are found in the ovaries, later they completely disappear). The resulting state of hypergonadotropic hypogonadism (primarily estrogen deficiency) may be accompanied by a change in the function of the limbic system, impaired secretion of neurohormones, and damage to target organs.

Clinical signs and symptoms

In premenopause, menstrual cycles can vary from regular ovulatory cycles to long delays in menstruation and/or menorrhagia.

In perimenopause, fluctuations in blood estrogen levels are still possible, which can be clinically manifested by premenstrual-like sensations (breast engorgement, heaviness in the lower abdomen, lower back, etc.) and / or hot flashes and other symptoms of CS.

According to the nature and time of occurrence, menopausal disorders are divided into:

■ early;

■ delayed (2-3 years after menopause);

■ late (more than 5 years of menopause). Early symptoms of CS include:

■ vasomotor:

Flushes of heat;

increased sweating;

Headache;

Arterial hypo- or hypertension;

Cardiopalmus;

■ emotional-vegetative:

Irritability;

Drowsiness;

Weakness;

Anxiety;

Depression;

Forgetfulness;

inattention;

Decreased libido.

2-3 years after menopause, the following symptoms may occur:

■ urogenital disorders (see the chapter "Urogenital disorders in menopause");

■ damage to the skin and its appendages (dryness, brittle nails, wrinkles, dryness and hair loss).

Late manifestations of CS include metabolic disorders:

■ cardiovascular diseases (atherosclerosis, coronary heart disease);

■ postmenopausal osteoporosis (see the chapter "Osteoporosis in postmenopause");

■ Alzheimer's disease.

Postmenopause is characterized by the following hormonal changes:

■ low serum estradiol levels (less than 30 ng/ml);

■ high serum FSH, LH/FSH index< 1;

■ estradiol/estrone index< 1; возможна относительная гиперандрогения;

■ low serum SHBG;

■ low serum levels of inhibin, especially inhibin B.

The diagnosis of CS can be established on the basis of the symptom complex characteristic of estrogen-deficient conditions.

Necessary examination methods in outpatient practice:

■ scoring of CS symptoms using the Kupperman index (Table 48.1). The severity of other symptoms is assessed on the basis of the subjective complaints of the patient. Next, the scores for all indicators are summarized;

Table 48.1. Menopausal index Kuppermann

■ cytological examination of smears from the cervix (Pap smear);

■ determination of the level of LH, PRL, TSH, FSH, testosterone in the blood;

■ biochemical blood test (creatinine, ALT, AST, alkaline phosphatase, glucose, bilirubin, cholesterol, triglycerides);

■ blood lipid spectrum (HDL-C, LDL-C, VLDL-C, lipoprotein (a), atherogenic index);

■ coagulogram;

■ measurement of blood pressure and heart rate;

■ mammography;

■ transvaginal ultrasound (the criterion for the absence of pathology in the endometrium in postmenopausal women is the width of the M-echo 4-5 mm);

■ osteodensitometry.

Differential Diagnosis

Menopause is the physiological period of a woman's life, so differential diagnosis is not required.

Since most diseases in the menopause occur as a result of a deficiency of sex hormones, the appointment of HRT is pathogenetically justified, the purpose of which is to replace the hormonal function of the ovaries in women who are deficient in sex hormones. It is important to achieve such levels of hormones in the blood that would actually improve the general condition, ensure the prevention of late metabolic disorders and do not cause side effects.

Indications for the use of HRT in perimenopause:

■ early and premature menopause (under age 40);

■ artificial menopause (surgical, radiotherapy);

■ primary amenorrhea;

■ secondary amenorrhea (more than 1 year) in reproductive age;

■ early vasomotor symptoms of CS in premenopause;

■ urogenital disorders (UGR);

■ the presence of risk factors for osteoporosis (see the chapter "Osteoporosis in postmenopause").

In postmenopausal women, HRT is prescribed for therapeutic and prophylactic purposes: for therapeutic purposes - for the correction of neurovegetative, cosmetic, psychological disorders, UGR; with prophylactic - to prevent osteoporosis.

Currently, there are no reliable data on the effectiveness of HRT for the prevention of cardiovascular diseases.

Basic principles of HRT:

■ Only natural estrogens and their analogues are used. The dose of estrogens is small and corresponds to that in the early and middle phase of proliferation in young women;

■ mandatory combination of estrogens with progestogens (with preserved uterus) prevents the development of endometrial hyperplasia;

■ All women should be informed about the possible impact of short-term and long-term estrogen deficiency on the body. Women should also be informed about the positive effects of HRT, contraindications and side effects of HRT;

■ To ensure optimal clinical effect with minimal adverse reactions, it is extremely important to determine the most acceptable optimal doses, types and routes of administration of hormonal drugs.

There are 3 main modes of HRT:

■ monotherapy with estrogens or gestagens;

■ combination therapy (estrogen-progestin drugs) in a cyclic mode;

■ combination therapy (estrogen-progestin drugs) in monophasic continuous mode.

For therapeutic purposes, HRT is prescribed for up to 5 years. With longer-term use in each case, the effectiveness (for example, reduced risk of fracture of the femoral neck due to osteoporosis) and safety (risk of developing breast cancer) of this therapy should be commensurate.

Monotherapy with estrogens and gestagens

Estrogens can also be administered transdermally:

Estradiol, gel, apply on the skin of the abdomen or buttocks 0.5-1 mg 1 r / day, permanently, or patch, stick on the skin 0.05-0.1 mg 1 r / week, permanently.

Indications for transdermal estrogen administration:

■ insensitivity to oral drugs;

■ diseases of the liver, pancreas, malabsorption syndrome;

■ disorders in the hemostasis system, high risk of venous thrombosis;

■ hypertriglyceridemia that developed before oral administration of estrogen (especially conjugated) or against its background;

■ hyperinsulinemia;

■ arterial hypertension;

■ increased risk of formation of stones in the biliary tract;

■ smoking;

■ migraine;

■ to reduce insulin resistance and improve glucose tolerance;

■ for a more complete implementation of the HRT regimen by patients.

Monotherapy with gestagens is prescribed in premenopausal women with uterine myoma and adenomyosis, in which surgical treatment is not required, with dysfunctional uterine bleeding:

Dydrogesterone inside 5-10 mg 1 r / day

from the 5th to the 25th day or from the 11th to

25th day of the menstrual cycle or Levonorgestrel, intrauterine

system1, insert into the uterine cavity,

single dose or medroxyprogesterone 10 mg orally

1 r / day from the 5th to the 25th day or from

11th to 25th day of the menstrual cycle or

Oral progesterone 100 mcg once daily from days 5 to 25 or from days 11 to 25 of the menstrual cycle or into the vagina 100 mcg once daily from days 5 to 25 or from day 11 to the 25th day of the menstrual cycle. With irregular cycles, gestagens can be prescribed only from the 11th to the 25th day of the menstrual cycle (for its regulation); with regular, both schemes for the use of drugs are suitable.

Combination therapy with two- or three-phase estrogen-progestin drugs in a cyclic or continuous mode

Such therapy is indicated for perimenopausal women with preserved uterus.

The use of biphasic estrogen-progestin drugs in a cyclic mode

Estradiol valerate orally 2 mg 1 r / day, 9 days

Estradiol valerate/levonorgestrel orally 2 mg/0.15 mg 1 r/day, 12 days, then break 7 days or

Estradiol valerate orally 2 mg, 11 days +

Estradiol valerate/medroxyprogesterone orally 2 mg/10 mg 1 r/day, 10 days, then break for 7 days, or

Estradiol valerate orally 2 mg

1 r / day, 11 days

Estradiol valerate / cyproterone inside 2 mg / 1 mg 1 r / day, 10 days, then a break of 7 days.

The use of biphasic estrogen-gestagenic drugs in continuous mode

Estradiol inside 2 mg 1 r / day, 14 days

Estradiol / dydrogesterone by mouth

2 mg / 10 mg 1 r / day, 14 days or

Estrogens conjugated orally 0.625 mg 1 r / day, 14 days

Conjugated estrogens / medroxyprogesterone orally 0.625 mg / 5 mg 1 r / day, 14 days.

The use of biphasic estrogen-progestin drugs with a prolonged estrogenic phase in continuous mode

Estradiol valerate inside 2 mg 1 r / day, 70 days

Estradiol valerate / medroxyprogesterone inside 2 mg / 20 mg 1 r / day, 14 days

The use of three-phase estrogen-gestagenic drugs in continuous mode

Estradiol inside 2 mg 1 r / day, 12 days +

Estradiol / norethisterone inside 2 mg / 1 mg 1 r / day, 10 days

Estradiol inside 1 mg 1 r / day, 6 days.

Therapy with combined monophasic estrogen-gestagen drugs in continuous mode

Indicated for postmenopausal women with preserved uterus. This HRT regimen is also recommended for women who have undergone hysterectomy for adenomyosis or cancer of the internal genital organs (uterus, cervix, ovaries) no earlier than 1-2 years after the operation (the appointment will be agreed with oncologists). Indications - severe CS after treatment of the initial stages of endometrial cancer and malignant ovarian tumors (cured cancer of the cervix, vulva and vagina is not considered a contraindication to the use of monophasic estrogen-progestin drugs):

Estradiol valerate/dienogest

Menopause is the next stage of physiological changes in a woman's body, associated with the extinction of reproductive function. The greatest probability of its onset falls on the age of 45-52 years. Depending on the characteristics of the organism, past diseases, living conditions, menopause may occur earlier or later. The ongoing hormonal changes gradually lead to the aging of a woman. If she leads an active lifestyle, pays the necessary attention to her appearance, takes care of her health, then the aging of the body slows down.

There are 3 stages of menopause:

1. Premenopause - the beginning of hormonal changes, in which the level of estrogen begins to decline, menstruation becomes irregular. The chance of conception is reduced.
2. Menopause is a period of 12 months from the start of the last menstrual period. If in the previous period a woman can still doubt the cause of menstrual cycle failures, then the absence of menstruation during the year is an accurate sign of the onset of menopause.
3. Postmenopause - the period after the end of menopause, is about 3-5 years. The level of estrogen reaches a minimum.

Video: Menopause and its types

Types of menopause and age of their onset

Symptoms of menopause in women depend on age. Treatment is also prescribed in accordance with the age of menopause, which depends on the characteristics of physiology, general health, conditions and lifestyle. There are several types of climax:

• premature (after 30 and before 40 years);
• early (from 41 years to 45 years);
• timely, considered the norm (45-55 years);
• late (after 55 years).

Premature and late menopause are usually a pathology. After examination and finding out the causes of deviations from the norm, treatment is prescribed. With the timely onset of menopause, in some cases, only the relief of accompanying symptoms is required.

Causes and effects of premature menopause

The onset of menopause at an early age is possible for several reasons. First of all, this is due to diseases of the ovaries, their removal or treatment with hormonal drugs. Sometimes premature menopause is caused by congenital genetic disorders. In this case, insufficient production of eggs occurs. This pathology is inherited.

One of the reasons is too early puberty of the girl. The usual age of the onset of the first menstruation is considered to be 13-14 years. But sometimes menstruation appears as early as 10-11 years.

Menopause comes too early for those who have had diseases of the thyroid gland, reproductive organs, immune system, liver. Radiation therapy in the treatment of tumors, chemotherapy can provoke the onset of menopause.

The emergence of early menopause is also facilitated by an unhealthy lifestyle and bad habits (smoking, alcohol abuse, drug addiction). The provoking factor is obesity, as well as passion for diets, prolonged fasting.

The onset of early menopause, as a rule, is associated with hormonal disorders in the body. A decrease in the level of female sex hormones leads to infertility and early aging. In addition, hormonal disorders increase the risk of tumors of the mammary glands, reproductive organs. It also increases the risk of heart attack, stroke and other cardiovascular diseases. Imbalance of hormones leads to diseases of the thyroid gland, the functioning of the genitourinary system is disturbed. Early menopause causes neurosis, depression.

When the first suspicions of a decrease in sexual activity of the body appear, you should consult a doctor. In case of doubt about the cause of the menstrual irregularity, an FSH (follicle-stimulating hormone) test is done. With menopause, its level rises and remains constantly high. If the disturbances are temporary, then the level of this hormone fluctuates.

Video: Hormone tests to determine the onset of menopause

Causes and complications of late menopause

As a rule, heredity is a factor in the onset of late menopause. If it does not occur before the age of 55, while there are no health problems, then late menopause plays only a positive role. The normal composition of bone and muscle tissue is preserved longer. Less problems with the work of the heart, blood vessels, brain.

However, in some cases, a serious gynecological disease or treatment with chemotherapy and radiation can be the cause of late menopause. In this case, a woman should be constantly under the supervision of a doctor, since an exacerbation or recurrence of diseases that caused a delay in menopause is possible. The irregular occurrence of bleeding of varying intensity sometimes masks the symptoms of diseases, including malignant tumors.

menopause symptoms

There are a number of signs by which you can determine that menopause has come.

tides- periodic sudden attacks, accompanied by a feeling of heat, as well as blood flow to the face. At the same time, the woman sweats a lot. After a few minutes, a state of chill sets in. Such hot flashes can last for years, appearing 20-50 times a day. In this case, the doctor will tell you how to reduce their number, alleviate the symptoms.

Headaches, dizziness usually appearing in the morning. A woman is forced to give up her usual activities, quickly gets tired. She experiences unreasonable anxiety, becomes irritable.

Sleep disorders. The tides that arise during the day and at night wake the woman. After that, it is difficult for her to sleep. Insomnia comes not only because of the hot flashes. The cause of sleep disorders can be neurosis, arising from the deterioration of the nervous system and brain. The inability to sleep normally deprives you of strength and causes even more anxiety and irritation.

Frequent mood swings. The woman becomes touchy, tearful. Cheerful mood is abruptly replaced by irritability and anger.

Lump in the throat. The reaction of the autonomic nervous system, in which there is a sensation of interference in the throat. There is a need to make swallowing movements. The woman does not experience pain or any discomfort. This condition usually resolves on its own. However, if the symptom does not disappear within a few months, pain appears, then it is necessary to consult an endocrinologist. Similar sensations occur in diseases of the thyroid gland.

Weakening of memory. During this period, most women complain of "sclerosis", absent-mindedness, inability to concentrate.

Dryness of the vagina. The symptom is usually accompanied by itching, is the cause of pain during intercourse. It occurs as a result of changes in the structure of the vaginal mucosa under the influence of hormones. At the same time, there is also a decrease in sexual desire.

Violation of the urinary organs. Violation of the composition of the vaginal environment makes the genitourinary system more vulnerable to infection. Often there are diseases of the kidneys, bladder, inflammatory diseases of the ovaries, uterus. Weakening of muscle tone leads to urinary incontinence.

Increased blood pressure, rapid heartbeat. This indicates changes in the structure of blood vessels and in the heart muscle. The risk of heart disease in women is significantly increased.

Joint diseases, bone fragility. This indicates a lack of calcium. With the onset of menopause, a woman's absorption of nutrients worsens. Insufficient calcium intake weakens the bones. In addition, nails become brittle, hair loss and deterioration of their structure are observed. Tooth enamel also becomes thinner, more often caries occurs.

Video: Symptoms of menopause, what determines their severity, how to treat them

Diagnosis in menopause. How to relieve symptoms

With the appearance of such signs as a violation of the menstrual cycle, a decrease or increase in the volume of secretions, a sharp change in body weight and other unexpected signs, a woman should definitely consult a doctor: a gynecologist, an endocrinologist, a mammologist. An examination using ultrasound, X-ray, as well as a biochemical blood test for hormones and tumor markers will allow timely detection of serious diseases that need to be treated urgently.

If a woman is healthy, unpleasant symptoms are associated with menopausal abnormalities, then she will be prescribed therapy to eliminate insomnia, taking sedatives and vitamins. Preparations containing calcium and silicon will help prevent osteoporosis. Means are used to enhance blood supply, eliminate high blood pressure.

The most effective method of getting rid of hot flashes and other symptoms of menopause is hormone therapy. Sometimes it is enough to choose suitable hormonal contraceptives with the help of a doctor. Candles containing hormonal preparations, special patches, intrauterine devices are also used. With the help of these funds, the level of estrogen increases, which allows you to slow down the onset of menopausal changes. Hormone replacement therapy is carried out for at least 1-2 years. To prevent osteoporosis, its use is sometimes required for several years after menopause.

Warning: Any hormonal drugs should be taken as prescribed by a doctor. Excess estrogen leads to weight gain, varicose veins in the legs, breast disease, uterine fibroids, and other serious health problems.

To gently reduce the symptoms of menopause, non-hormonal remedies based on herbal components are used, for example, the biologically active food supplement ESTROVEL® capsules - a complex of phytoestrogens, vitamins and microelements, the components of which act on the main manifestations of menopause.

Treatment with folk remedies for menopause

In the treatment of hot flashes, insomnia, headaches and other manifestations of menopause, traditional medicine is successfully used: decoctions of plants, herbal soothing baths. The lack of estrogens is replenished with the help of phytoestrogens, which include, for example, sage.

Infusion to eliminate sweating and relieve hot flashes

Mix sage, valerian root and horsetail in a ratio of 3:1:1. A glass of boiling water pour 1 tbsp. l. collection. This healing infusion is drunk every day in several doses.

Herbal infusion for high blood pressure, palpitations, sweating

1 st. l. mixtures of hawthorn, motherwort, cudweed, chamomile (4:4:4:1) insist in 1 cup of boiling water and drink the medicine 3-4 tablespoons several times a day.

15-04-2019

Menopause- the physiological transition of the body from puberty to the cessation of the generative (menstrual and hormonal) function of the ovaries, characterized by the reverse development (involution) of the reproductive system, occurring against the background of general age-related changes in the body.

Menopause occurs at different ages, it is individual. Some experts call the numbers 48-52, others - 50-53 years. The rate of development of signs and symptoms of menopause is largely determined by genetics..

But the time of onset, the duration and characteristics of the course of different phases of the menopause are also influenced by such moments as, for example, how healthy a woman is, what her diet, lifestyle, climate, and much more.

Scientists have found that females who smoke more than 40 cigarettes a day, menopause occurs on average 2 years earlier than non-smokers.

The beginning of the menopause begins with a significant decrease in the production of female sex hormones. The fact is that over the years, the function of the ovaries gradually fades away, and may even stop altogether. This process can last from eight to ten years, and it is called menopause in women.

But do not forget what exactly during the premenopausal period, a woman is at risk for unwanted pregnancy. Pregnancy during menopause is very common, and therefore the number of abortions in this age category is very high.

The main signs of menopause

• Changes in the emotional sphere. Often a woman suffers from astheno-neurotic syndrome. She constantly wants to cry, irritability rises, the woman is afraid of everything, she cannot stand sounds, smells. Some women behave provocatively. They begin to color brightly.

• Problems with the autonomic nervous system- a feeling of anxiety, lack of air, sweating increases, the skin turns red, nausea is observed, dizziness. The woman is weakening. The respiratory rate and heart rhythm are disturbed. The patient has chest tightness, a lump in the throat.
• Constant severe headaches in the form of migraine, mixed tension pain. A person does not tolerate stuffiness, humid air, heat.
• With menopause, metabolic processes are disrupted calcium, minerals, magnesium, because the level of estrogen decreases.
• During sleep, there is a delay in breathing. The woman snores heavily. It becomes very difficult to fall asleep, thoughts are constantly spinning in the head and the heartbeat quickens.
• Menstrual disorders. One of the first signs of menopause is irregular menstrual bleeding. The abundance of blood loss and the intervals between menstruation become unpredictable.
• Dysfunctional uterine bleeding menopausal period are more common in women. First, delays in menstruation begin, and then sudden bleeding. Uterine bleeding in menopause is accompanied by weakness, irritability and constant headaches. As a rule, along with such bleeding in patients, the climatic syndrome is also noted.
• Often, premenopausal women complain of hot flashes. Quite suddenly, a feeling of intense heat sets in, the skin becomes red, and sweat appears on the body. This symptom is taken by surprise, often women wake up in the middle of the night from such heat. The reason is the reaction of the pituitary gland and a sharp drop in estrogen levels.
• Urination becomes more frequent, a small amount of urine is excreted. Urination is painful, burns strongly, cuts in the bladder. Nighttime urination is more frequent. A person walks more than once during the night, incontinence worries.
• Skin problems occur, it becomes thin, elastic, a large number of wrinkles, age spots appear on it. The hair is thinning on the head, much more appears on the face.
• Sudden pressure surges, pain in the heart.
• Due to a deficiency of estradiol, osteoporosis develops. During menopause, bone tissue is not renewed. A woman becomes noticeably stooped, decreases in height, is disturbed by frequent bone fractures, constant joint pain. There are unpleasant sensations in the lumbar region when a person walks for a long time.

The manifestation of clinical signs of menopause is individual. In some cases, it is not difficult to tolerate, in other cases, the symptoms are pronounced and torment a person for about five years. Climacteric symptoms disappear after the body adapts to new physiological conditions..

The climacteric period (Greek klimakter stage; age transition period; synonym: menopause, menopause) is the physiological period of a person's life, during which, against the background of age-related changes in the body, involutional processes in the reproductive system dominate.

Menopause in women. In menopause, premenopause, menopause and postmenopause are distinguished. Premenopause usually begins at the age of 45-47 years and lasts 2-10 years until menstruation stops. The average age at which the last menstruation (menopause) occurs is 50 years. Early menopause before the age of 40 and late - over the age of 55 are possible. The exact date of menopause is set retrospectively, not earlier than 1 year after the cessation of menstruation. Postmenopause lasts 6-8 years from the moment of cessation of menstruation.

The rate of development of the C. p. is determined genetically, but such factors as the state of health of the woman, working and living conditions, dietary habits, and climate can influence the time of the onset and course of different phases of the C. p. for example, women who smoke more than 1 pack of cigarettes a day go through menopause on average 1 year 8 months. earlier than non-smokers.

The psychological reaction of women to the onset of K. p. may be adequate (in 55% of women) with a gradual adaptation to age-related neurohormonal changes in the body; passive (in 20% of women), characterized by the acceptance of K. p. as an inevitable sign of aging; neurotic (in 15% of women), manifested by resistance, unwillingness to accept ongoing changes and accompanied by mental disorders; hyperactive (in 10% of women), when there is an increase in social activity and a critical attitude to the complaints of peers.

Age-related changes in the reproductive system begin in the central regulatory mechanisms of the pituitary zone of the hypothalamus and suprahypothalamic structures. The number of estrogen receptors decreases and the sensitivity of the hypothalamic structures to ovarian hormones decreases. Degenerative changes in the terminal areas of the dendrites of dopamine and serotonergic neurons lead to impaired secretion of neurotransmitters and transmission of nerve impulses to the hypothalamic-pituitary system. Due to a violation of the neurosecretory function of the hypothalamus, the cyclic ovulatory release of gonadotropins by the pituitary gland is disrupted, the release of lutropin and follitropin usually increases from the age of 45, reaching a maximum about 15 years after menopause, after which it begins to gradually decrease. An increase in the secretion of gonadotropins is also due to a decrease in the secretion of estrogens in the ovaries. Age-related changes in the ovaries are characterized by a decrease in the number of oocytes (by the age of 45, there are about 10 thousand of them). Along with this, the process of oocyte death and atresia of maturing follicles is accelerated. In the follicles, the number of granulosa and theca cells, the main site of estrogen synthesis, decreases. No dystrophic processes are observed in the ovarian stroma, and it retains hormonal activity for a long time, secreting androgens: mainly a weak androgen - androstenedione and a small amount of testosterone. The sharp decrease in estrogen synthesis by the ovaries in postmenopausal women is to some extent compensated by the extragonadal synthesis of estrogens in adipose tissue. Androstenedione and testosterone formed in the stroma of the ovaries in fat cells (adipocytes) are converted by aromatization into estrone and estradiol, respectively: this process is enhanced with obesity.

Clinically, premenopause is characterized by menstrual irregularities. In 60% of cases, there are violations of the cycle according to the hypomenstrual type - the intermenstrual intervals increase and the amount of blood lost decreases. In 35% of women, excessively heavy or prolonged periods are observed, in 5% of women, menstruation stops suddenly. In connection with the violation of the process of maturation of follicles in the ovaries, a transition is gradually made from ovulatory menstrual cycles to cycles with an inferior corpus luteum, and then to anovulation. In the absence of the corpus luteum in the ovaries, the synthesis of progesterone is sharply reduced. Progesterone deficiency is the main reason for the development of such complications of K. p. as acyclic uterine bleeding (so-called menopausal bleeding) and endometrial hyperplastic processes (see Dysfunctional uterine bleeding). In this period, the frequency of fibrocystic mastopathy increases.

Age-related changes lead to the cessation of reproductive and a decrease in the hormonal function of the ovaries, which is clinically manifested by the onset of menopause. Postmenopause is characterized by progressive involutional changes in the reproductive system. Their intensity is much higher than in premenopause, since they occur against the background of a sharp decrease in estrogen levels and a decrease in the regenerative potential of target organ cells. In the first year of postmenopause, the size of the uterus decreases most intensively. By the age of 80, the size of the uterus, determined by ultrasound, is 4.3´3.2´2.1 cm. years, the mass of the ovaries is less than 4 g, the volume is about 3 cm3. The ovaries gradually shrivel due to the development of connective tissue, which undergoes hyalinosis and sclerosis. 5 years after the onset of menopause, only single follicles are found in the ovaries. There are atrophic changes in the vulva and vaginal mucosa. Thinning, fragility, slight vulnerability of the vaginal mucosa contribute to the development of colpitis.

In addition to these processes in the genital organs, changes occur in other organs and systems. One of the main reasons for these changes is a progressive deficiency of estrogens - hormones with a wide biological spectrum of action. Atrophic changes develop in the muscles of the pelvic floor, which contributes to the prolapse of the walls of the vagina and uterus. Similar changes in the muscle layer and mucous membrane of the bladder and urethra can cause urinary incontinence during physical exertion.

Mineral metabolism changes significantly. Gradually, calcium excretion in the urine increases and its absorption in the intestine decreases. At the same time, as a result of a decrease in the amount of bone substance and its insufficient calcification, bone density decreases - osteoporosis develops. The process of osteoporosis is long and unnoticeable. It is possible to identify it radiographically with the loss of at least 20-30% of calcium salts. The rate of bone loss increases 3-5 years after menopause; during this period, pain in the bones increases, the frequency of fractures increases. The leading role of lowering the level of estrogen in the development of osteoporosis in K. p. is confirmed by the fact that in women who have been taking combined estrogen-gestagenic drugs for a long time, the preservation of the structure of the bones and the calcium content in them are significantly higher and the clinical manifestations of osteoporosis are less common.

In the climacteric period, immune protection gradually decreases, the frequency of autoimmune diseases increases, meteo-lability develops (reduced resistance to fluctuations in ambient temperature), and age-related changes occur in the cardiovascular system. The level of low and very low density lipoproteins, cholesterol, triglycerides and blood glucose increases; body weight increases due to hyperplasia of fat cells. As a result of a violation of the functional state of higher nerve centers against the background of a decrease in the level of estrogen in the body, a complex of vegetative-vascular, mental and metabolic-endocrine disorders often develops (see Menopausal syndrome).

Prevention of complications K. p. includes the prevention and timely treatment of diseases of various organs and systems - cardiovascular diseases, diseases of the musculoskeletal system, biliary tract, etc. Importance is attached to physical exercises, especially in the fresh air (walking, skiing, jogging ), dosed in accordance with the recommendations of the therapist. Useful walking. In connection with meteorological lability and peculiarities of adaptation for recreation, it is recommended to choose zones whose climate does not have sharp differences from the usual one. The prevention of obesity deserves special attention. The daily diet for women in excess of body weight should contain no more than 70 g of fat, incl. 50% vegetable, up to 200 g of carbohydrates, up to 11/2 liters of liquid and up to 4-6 g of table salt with a normal protein content. Food should be taken at least 4 times a day in small portions, which contributes to the separation and evacuation of bile. To eliminate metabolic disorders, hypocholesterolemic agents are prescribed: polysponin 0.1 g 3 times a day or cetamiphene 0.25 g 3 times a day after meals (2-3 courses for 30 days at intervals of 7-10 days); hypolipoproteinemic drugs: linetol 20 ml (11/2 tablespoons) per day after meals for 30 days; lipotropic drugs: methionine 0.5 g 3 times a day before meals or 20% solution of choline chloride 1 teaspoon (5 ml) 3 times a day for 10-14 days.

In the countries of Europe and North America, women in CP are widely prescribed estrogen-progestin drugs to compensate for hormonal deficiency and to prevent age-related disorders associated with it: uterine bleeding, blood pressure fluctuations, vasomotor disorders, osteoporosis, etc. Epidemiological studies conducted in these countries have shown that the risk of developing endometrial, ovarian and breast cancer in women taking estrogen-progestin drugs is lower than in the general population. In the USSR, a similar method of preventing the pathology of K. p. is not accepted, these funds are used mainly for therapeutic purposes.

The climacteric period in men occurs more often at the age of 50-60 years. Atrophic changes in testicular glandulocytes (Leydig cells) in men of this age lead to a decrease in testosterone synthesis and a decrease in the level of androgens in the body. At the same time, the production of gonadotropic hormones of the pituitary gland tends to increase. The rate of involutional processes in the gonads varies considerably; conditionally it is considered that K. the item at men comes to an end approximately to 75 years.

In the vast majority of men, the age-related decline in the function of the gonads is not accompanied by any manifestations that violate the general habitual state. In the presence of concomitant diseases (for example, vegetovascular dystonia, hypertension, coronary heart disease), their symptoms are more pronounced in K. p. Often, the symptoms of these diseases are mistakenly regarded as a pathological menopause. The possibility of a pathological course of K. p. in men is discussed. A number of researchers believe that with the exclusion of organic pathology, certain cardiovascular, neuropsychiatric and genitourinary disorders can be attributed to the clinical manifestations of pathological menopause. Cardiovascular disorders characteristic of pathological menopause include sensations of hot flashes to the head, sudden redness of the face and neck, palpitations, pain in the heart, shortness of breath, increased sweating, dizziness, and an intermittent increase in blood pressure.

Characteristic neuropsychiatric disorders are irritability, fatigue, sleep disturbance, muscle weakness, headache. Depression, causeless anxiety and fear, loss of former interests, increased suspiciousness, tearfulness are possible.

Among the manifestations of dysfunction of the genitourinary organs, dysuria and disorders of the copulatory cycle are noted with a predominant weakening of erection and accelerated ejaculation.

A gradual decrease in sexual potency is observed in K. p. in most men and, in the absence of other manifestations of pathological menopause, is considered a physiological process. When evaluating sexual function in men in K. p., it is also necessary to take into account its individual characteristics.

Treatment of pathological menopause is usually carried out by a therapist after a thorough examination of the patient with the participation of the necessary specialists and the exclusion of the connection of existing disorders with certain diseases (for example, cardiovascular, urological). It includes the normalization of the regime of work and rest, dosed physical activity, the creation of the most favorable psychological climate. Psychotherapy is an essential component of treatment. In addition, prescribe means that normalize the function of the central nervous system. (sedatives, tranquilizers, psychostimulants, antidepressants, etc.), vitamins, biogenic stimulants, preparations containing phosphorus, antispasmodics. In some cases, anabolic hormones are used; in order to normalize the disturbed endocrine balance, preparations of male sex hormones are used.

climacteric syndrome.

Endocrine and psychopathological symptoms that occur during the pathological course of menopause.

The reason for this condition is, firstly, a deficiency of estrogens (sex hormones) due to age-related endocrine changes in a woman's body. It should be noted that menopause (the last uterine bleeding due to ovarian function) occurs in all women, but not every one of them suffers from menopausal syndrome. It occurs in the case of a decrease in the adaptive systems of the body, which, in turn, depend on many factors. The probability of its occurrence increases in women with heredity, aggravated pathology of the menopause, cardiovascular diseases. The occurrence and further course of the climacteric syndrome are adversely affected by such factors as the presence of pathological character traits, gynecological diseases, especially uterine fibroids and endometriosis, premenstrual syndrome before the onset of menopause. Gkyakhosotsialnye factors are also of great importance: unsettled family life, dissatisfaction with sexual relations; suffering associated with infertility and loneliness: lack of job satisfaction. The mental state is aggravated in the presence of psychogenic situations, such as a serious illness and death of children, parents, husband, conflicts in the family and at work.

Symptoms and course. Typical manifestations of the pymacteric syndrome include hot flashes and sweating. The severity and frequency of hot flashes is different, from single to 30 per day. In addition to these symptoms, there is an increase in blood pressure, vegetative-spicy crises. Mental disorders are present in almost all patients with CS. Their nature and severity depend on the severity of vegetative manifestations and personality traits. In a difficult position of menopause, weakness, fatigue, irritability are observed. Sleep is disturbed, patients wake up at night due to strong hot flashes and sweating. There may be depressive symptoms: low mood with anxiety for one's health or fear of death (especially with severe crises with palpitations, suffocation).

Fixation on one's health with a pessimistic assessment of the present and future can become the leading one in the clinical picture of the disease, especially in people with an anxious and suspicious nature.

During menopause, women may have ideas of jealousy, especially among those who in their youth were distinguished by a jealous character, as well as among persons prone to logical constructions, touchy, stuck, punctual. Ideas of jealousy can take possession of the patient so much that her behavior and actions become dangerous in relation to her husband, his "mistress" and to herself. In such cases, hospitalization is required to avoid unpredictable consequences.

Ideas of jealousy usually arise in women who do not receive sexual satisfaction. The fact is that during the period of premenopause (before menopause), many women have increased sexual desire, which for various reasons (husband's impotence, sexual illiteracy, rare sexual relations for objective reasons) is not always satisfied. In cases where rare marital relations are not associated with sexual violations of the husband, and there may be suspicion and thoughts of possible betrayal, which are supported by an incorrect interpretation of real facts. In addition to the ideas of jealousy, sexual dissatisfaction (with increased sexual desire) contributes to the emergence of psychosomatic and neurotic disorders (fears, emotional imbalance, tantrums, etc.). After the onset of menopause, in some women, on the contrary, sexual desire decreases due to atrophic vaginitis (vaginal dryness), which entails a decrease in interest in sexual activity and ultimately leads to disharmony of marital relations.

Climacteric symptoms in most women appear long before menopause and only a small proportion - after menopause. Therefore, the period of menopause is often stretched for several years. The duration of the course of the CS depends to a certain extent on personal characteristics that determine the ability to deal with difficulties, including diseases, and adapt to any situation, and is also determined by the additional impact of sociocultural and psychogenic factors.

Treatment. Hormone therapy should be prescribed only to patients without severe mental disorders and with the exclusion of mental illness. It is advisable to carry out replacement therapy with natural estrogens in order to eliminate estrogen-dependent symptoms (hot flashes, sweating, vaginal dryness) and prevent long-term effects of estrogen deficiency (cardiovascular disease, osteoporosis - bone thinning, accompanied by its fragility and fragility). Estrogens help not only reduce hot flashes, but also increase tone and improve overall well-being. Gestagens (progesterone, etc.) by themselves can lower mood, and in the presence of mental disorders they exacerbate the condition, so gynecologists in such cases prescribe them after consulting a psychiatrist.

In practice, combined estrogen-gestagen preparations are often used to avoid the side effects of pure estrogens. However, prolonged, and sometimes unsystematic and uncontrolled, use of various hormonal agents leads, firstly, to the preservation of cyclic fluctuations in the state of the type of premenstrual syndrome (pseudo-premenstrual syndrome) and the formation of psychological and physical hormonal dependence and hypochondriacal personality development.

The climacteric period in such cases stretches for many years. Mental disorders are corrected with the help of psychotropic drugs (tranquilizers; antidepressants; neuroleptics in small doses such as frenolon, sonapax, etaperazine; nootropics) in combination with various types of psychotherapy. Psychotropic drugs can be combined with hormones. The appointment of treatment in each case is carried out individually, taking into account the nature and severity of psychopathological symptoms, somatic disorders, the stage of hormonal changes (before menopause or after).

In principle, menopausal syndrome is a transient, temporary phenomenon, due to the period of age-related neuro-hormonal restructuring in a woman's body. Therefore, in general, the prognosis is favorable. However, the effectiveness of therapy depends on the influence of many factors. The shorter the duration of the disease and the earlier treatment is started, the fewer various external influences (psychosocial factors, somatic illnesses, mental traumas), the better the treatment results.

Climacteric period. Vitamin E is also used in cosmetology for ... from the onset of puberty until menopausal period, but their number depends on...

For citation: Serov V.N. Menopause: normal or pathological. breast cancer. 2002;18:791.

Scientific Center for Obstetrics, Gynecology and Perinatology, Russian Academy of Medical Sciences, Moscow

To Limacteric period precedes aging, and depending on the cessation of menstruation is divided into premenopause, menopause and postmenopause. Being a normal state, menopause is characterized by pronounced signs of aging. Climacteric syndrome, cardiovascular pathology, hypotrophic manifestations in the genitourinary system, osteopenia and osteoporosis - this is an incomplete enumeration of the pathology of the menopause, due to aging and the shutdown of ovarian function. Almost a third of a woman's life passes under the sign of menopause. In recent years, the possibility of significantly improving the quality of life during menopause with the help of hormone replacement therapy (HRT), allowing to cure menopausal syndrome, reduce cardiovascular pathology, osteoporosis, urinary incontinence by 40-50%.

premenopause precedes menopause by somatic and psychological changes due to the extinction of ovarian function. Their early detection can prevent the development of severe menopausal syndrome. Perimenopause usually begins after age 45. At first, its manifestations are insignificant. Both the woman herself and her doctor usually either do not attach importance to them, or associate them with mental overstrain. Hypoestrogenism should be excluded in all women over 45 who complain of fatigue, weakness, irritability. The most characteristic manifestation of premenopause is menstrual irregularities. During the 4 years preceding menopause, this symptom occurs in 90% of women.

Menopause- part of the natural aging process, in fact, is the cessation of menstruation as a result of the extinction of ovarian function. The age of menopause is determined retrospectively, 1 year after the last menstrual period. The average age of menopause is 51 years. It is determined by hereditary factors and does not depend on the characteristics of nutrition and nationality. Menopause occurs earlier in smokers and nulliparous women.

Postmenopause follows menopause and lasts an average of a third of a woman's life. For the ovaries, this is a period of relative rest. The consequences of hypoestrogenism are very serious, they are similar in health significance to the consequences of hypothyroidism and adrenal insufficiency. Despite this, doctors do not pay due attention to postmenopausal HRT, although it is one of the most important components of the prevention and treatment of various pathologies in older women. This appears to be because the effects of hypoestrogenism develop slowly (osteoporosis) and are often attributed to aging (cardiovascular disease).

Hormonal and metabolic changes occur gradually in premenopause. After a period of almost 40 years, during which the ovaries secreted sex hormones cyclically, the secretion of estrogens gradually decreases and becomes monotonous. In premenopause, the metabolism of sex hormones changes. In postmenopausal women, the ovaries do not completely lose their endocrine function, they continue to secrete certain hormones.

Progesterone is produced only by the cells of the corpus luteum, which is formed after ovulation. In premenopause, an increasing proportion of menstrual cycles become anovulatory. Some women ovulate but develop corpus luteum insufficiency, resulting in decreased secretion of progesterone.

The secretion of estrogen by the ovaries in postmenopause practically stops. Despite this, all women in the serum are determined by estradiol and estrone. They are formed in peripheral tissues from androgens secreted by the adrenal glands. Most estrogens are derived from androstenedione, which is secreted primarily by the adrenal glands and, to a lesser extent, by the ovaries. It occurs predominantly in muscle and adipose tissue. In this regard, with obesity, serum estrogen levels increase, which in the absence of progesterone increases the risk of uterine cancer. Thin women have lower serum estrogen levels and therefore have an increased risk of osteoporosis. Interestingly, menopausal syndrome is possible even with high estrogen levels in obese women.

In postmenopause, progesterone secretion stops. In the childbearing period, progesterone protects the endometrium and mammary glands from estrogen stimulation. It reduces the content of estrogen receptors in cells. In premenopausal and postmenopausal women, estrogen levels remain high enough in some women to stimulate endometrial cell proliferation. This, as well as the lack of secretion of progesterone, leads to an increased risk of endometrial hyperplasia, cancer of the body of the uterus and mammary glands.

Psychological consequences associated with aging are usually much more pronounced than those associated with the loss of childbearing function. In modern society, youth is valued more than maturity, so menopause, as a tangible proof of age, causes anxiety and depression in some women. The psychological consequences largely depend on how much attention a woman pays to her appearance. Rapid skin aging, especially in postmenopausal women, worries many women. The results of numerous studies confirm that age-related skin changes in women are due to hypoestrogenism.

In menopause, many women report anxiety and irritability. These symptoms have even become an integral part of the menopausal syndrome. It is generally accepted that they are associated with hypoestrogenism. Despite this, in none of the studies carried out, the relationship of anxiety with menopause and its disappearance during hormone replacement therapy has not been confirmed. It is likely that anxiety and irritability are due to various social factors. The doctor should be aware of these common symptoms in older women and provide appropriate psychological support.

tides- perhaps the most famous manifestation of hypoestrogenism. Patients describe them as a periodic short-term sensation of heat, accompanied by sweating, palpitations, anxiety, sometimes followed by chills. Hot flashes last, as a rule, 1-3 minutes and are repeated 5-10 times a day. In severe cases, patients report up to 30 hot flashes per day. With natural menopause, hot flashes occur in about half of women, with artificial - much more often. In most cases, hot flashes slightly interfere with well-being.

However, approximately 25% of women, especially those who have undergone bilateral oophorectomy, note severe and frequent hot flashes, leading to increased fatigue, irritability, anxiety, depressed mood, and memory loss. In part, these manifestations may be due to sleep disturbance with frequent nocturnal hot flashes. In early premenopause, these disorders may occur as a result of autonomic disorders and are not associated with hot flashes.

Hot flashes are explained by a significant increase in the frequency and amplitude of GnRH secretion. It is possible that increased secretion of GnRH does not cause hot flashes, but is only one of the symptoms of CNS dysfunction leading to thermoregulation disorders.

HRT quickly eliminates hot flashes in most women. Some of them, especially those who have undergone bilateral oophorectomy, require high doses of estrogens. In mild cases, in the absence of other indications for HRT (for example, osteoporosis), treatment is not prescribed. Without treatment, hot flashes go away after 3-5 years.

The epithelium of the vagina, urethra, and base of the bladder is estrogen-dependent. 4-5 years after menopause, about 30% of women who do not receive hormone replacement therapy develop its atrophy. Atrophic vaginitis manifested by vaginal dryness, dyspareunia, and recurrent bacterial and fungal vaginitis. All these symptoms completely disappear on the background of hormone replacement therapy.

Atrophic urethritis and cystitis manifested by frequent and painful urination, urge to urinate, stress urinary incontinence, and recurrent urinary tract infections. Epithelial atrophy and shortening of the urethra caused by hypoestrogenia contribute to urinary incontinence. HRT is effective in 50% of postmenopausal patients with stress urinary incontinence.

Menopausal women often report attention disorders and short term memory. Previously, these symptoms were attributed to aging or sleep disturbances caused by hot flashes. It has now been shown that they may be due to hypoestrogenism. Hormone replacement therapy improves the functions of the central nervous system and the psychological state of postmenopausal women.

One of the most interesting areas for future research is to determine the role of HRT in the prevention and treatment of Alzheimer's disease. There is evidence that estrogens reduce the risk of this disease, although the role of hypoestrogenism in the pathogenesis of Alzheimer's disease has not yet been proven.

Cardiovascular diseases There are many predisposing factors, the most important of which is age. The risk of cardiovascular disease increases with age in both men and women. The risk of death from coronary artery disease in women of childbearing age is 3 times less than in men. In postmenopause, it rises sharply. Previously, the increase in the incidence of cardiovascular disease in postmenopausal women was explained only by age. It has now been shown that hypoestrogenism plays an important role in their development. It is one of the most easily eliminated risk factors for atherosclerosis. In postmenopausal women receiving estrogens, the risk of myocardial infarction and stroke is reduced by more than 2 times. A doctor observing a postmenopausal woman should tell her about cardiovascular diseases and the possibility of their prevention. This is especially important if she refuses HRT for any reason.

In addition to hypoestrogenism, one should strive to eliminate other risk factors for atherosclerosis. Perhaps the most significant of them are arterial hypertension and smoking. Thus, arterial hypertension increases the risk of myocardial infarction and stroke by 10 times, and smoking by at least 3 times. Other risk factors include diabetes mellitus, hyperlipidemia, and a sedentary lifestyle.

It has long been known that menopause, natural or artificial, leads to osteoporosis. Osteoporosis is a decrease in density and restructuring of bone tissue. For convenience, some authors propose to call osteoporosis such a decrease in bone density, in which fractures occur, or their risk is very high. Unfortunately, the degree of loss of compact and cancellous bone in most cases remains unknown until a fracture occurs. The number of elderly women with fractures of the radius, femoral neck and compression fractures of the vertebrae due to osteoporosis is high. With an increase in the average life expectancy, it, apparently, will only increase.

Despite the fact that the rate of bone resorption increases already in premenopause, the highest incidence of fractures due to osteoporosis occurs several decades after menopause. The risk of hip fracture in women over 80 is 30%. Approximately 20% of them die within 3 months after the fracture from complications of prolonged immobilization. It is extremely difficult to treat osteoporosis already at the stage of fractures.

There are many risk factors for osteoporosis. The most important of these is age. Another risk factor for osteoporosis is undoubtedly hypoestrogenism. As already noted, in the absence of HRT, postmenopausal bone loss reaches 3-5% per year. Most actively bone tissue is resorbed during the first 5 years of postmenopause. It is believed that during this period, 20% of the compact and spongy substance of the femoral neck lost during life is lost.

Low dietary calcium also leads to osteoporosis. Eating foods rich in calcium (especially dairy products) reduces bone loss in premenopausal women. In postmenopausal women receiving HRT, calcium supplements at a dose of 500 mg / day orally are sufficient to maintain bone density. Calcium intake in the indicated doses does not increase the risk of urolithiasis, although it may be accompanied by gastrointestinal disorders: flatulence and constipation. Exercise and smoking cessation also prevent bone loss and reduce the risk of osteoporosis.

In order to prevent complications of menopause is most effective hormone replacement therapy. Climacteric syndrome, most often observed in the perimenopausal period, is characterized by vegetative-vascular, neurological and metabolic manifestations. Hot flashes, mood instability, a tendency to depression are characteristic, hypertension is often aggravated, type 2 diabetes mellitus progresses, exacerbations of peptic ulcer and lung pathology occur. Hypotrophic processes of the vaginal mucosa, urethra, bladder gradually progress. Conditions are created for frequent urinary and vaginal infections, sexual life is disturbed. Atherosclerosis progresses, the risk of myocardial infarction and strokes increases. In late menopause, due to progressive osteoporosis, bone fractures occur, especially the spine, femoral neck.

HRT is effective in menopausal syndrome in 80-90% of cases , it halves the risk of myocardial infarction and stroke and increases life expectancy even in those patients in whom angiography is determined by the narrowing of the lumen of the coronary arteries. Estrogens prevent the formation of atherosclerotic plaques. The estrogens included in the combined preparations for HRT reduce bone loss and partially restore it, preventing osteoporosis and fractures.

HRT also has a negative effect. Estrogens increase the risk of hyperplasia and cancer of the uterine body, but the simultaneous administration of progestogens prevents these diseases. According to the literature, it is not possible to make a clear picture of the risk of breast cancer; many authors in randomized trials showed no increased risk, but in other studies it increased. In recent years, the beneficial effect of HRT against Alzheimer's disease has been shown.

Despite the clear benefits of HRT, it is not widely used. It is believed that only about 30% of postmenopausal women take estrogen. This is due to the large number of women who have relative contraindications and restrictions for HRT. In adulthood, many women have uterine fibroids, endometriosis, hyperplastic processes of the reproductive organs, fibrocystic mastopathy, etc. All this forces us to look for alternative methods of treating menopausal disorders (physical activity, limiting or quitting smoking, reducing the consumption of coffee, sugar, salt, balanced diet).

Long-term medical observations have demonstrated the high efficiency of a balanced diet and the use of multivitamin, mineral complexes, as well as medicinal plants.

climactoplane - a complex preparation of natural origin. The plant components that make up the preparation affect thermoregulation, normalizing the processes of inhibition in the central nervous system; reduce the frequency of sweating attacks, hot flashes, headaches (including migraine); relieve the feeling of embarrassment, internal anxiety, help with insomnia. The drug is used orally until complete resorption in the oral cavity half an hour before or one hour after meals, 1-2 tablets 3 times a day. There were no contraindications to the use of the drug, no side effects were detected.

Klimadinon is also a herbal preparation. Tablets of 0.02 g, 60 pieces per pack. Drops for oral administration - 50 ml in a vial.

A new direction in the treatment of menopause are selective estrogen receptor modulators. Raloxifene stimulates estrogen receptors while also having antiestrogenic properties. The drug was synthesized for the treatment of breast cancer, it is part of the tamoxifen group. Raloxifene prevents the development of osteoporosis, reduces the risk of stroke and myocardial infarction, and does not increase the risk of breast cancer.

For HRT, conjugated estrogens, estradiol valerate, estriol succinate are used. In the United States, conjugated estrogens are more commonly used, in European countries - estradiol valerate. The listed estrogens do not have a pronounced effect on the liver, coagulation factors, carbohydrate metabolism, etc. The cyclic addition of progestogens to estrogens for 10-14 days is mandatory, which avoids endometrial hyperplasia.

Natural estrogens, depending on the route of administration, are divided into 2 groups: for oral or parenteral use. With parenteral administration, the primary metabolism of estrogens in the liver is excluded, as a result, smaller doses of the drug are required to achieve a therapeutic effect compared to oral preparations. With parenteral use of natural estrogens, various routes of administration are used: intramuscular, cutaneous, transdermal and subcutaneous. The use of ointments, suppositories, tablets with estriol allows you to achieve a local effect in urogenital disorders.

Widespread throughout the world preparations containing estrogen and progestin. These include drugs of monophasic, biphasic and triphasic types.

Cliogest - monophasic drug, 1 tablet of which contains 1 mg of estradiol and 2 mg of norethisterone acetate.

For biphasic drugs supplied to the Russian pharmaceutical market currently include:

Divin. Calendar pack of 21 tablets: 11 white tablets containing 2 mg estradiol valerate and 10 blue tablets containing 2 mg estradiol valerate and 10 mg methoxyprogesterone acetate.

Clymen. A calendar pack of 21 tablets, of which 11 white tablets contain 2 mg of estradiol valerate, and 10 pink tablets contain 2 mg of estradiol valerate and 1 mg of cyproterone acetate.

Cycloprogynova. A calendar pack of 21 tablets, of which 11 white tablets contain 2 mg of estradiol valerate, and 10 light brown tablets contain 2 mg of estradiol valerate and 0.5 mg of norgestrel.

Klimonorm. Calendar pack of 21 tablets: 9 yellow tablets containing 2 mg estradiol valerate and 12 turquoise tablets containing 2 mg estradiol valerate and 0.15 mg levonorgestrel.

Triphasic drugs for HRT are Trisequens and Trisequens-forte. Active substances: estradiol and norethisterone acetate.

To monocomponent drugs for oral administration include: Proginova-21 (calendar pack with 21 tablets of 2 mg of estradiol valerate and Estrofem (tablets of 2 mg of estradiol, 28 pieces).

All of the above remedies suggest bleeding, reminiscent of menstruation. This fact confuses many women in menopause. In recent years, continuous-acting preparations Femoston and Livial have been introduced in the country, with the use of which bleeding either does not occur at all, or after 3-4 months the intake is stopped.

Thus, menopause, being a normal phenomenon, lays the foundation for many pathological conditions. The most noticeable change in menopause is the extinction of ovarian function. A decrease in estrogen levels contributes to aging. That is why the effect of hormone replacement therapy on the female body is being actively studied. It would be naive to think that all the troubles of aging can be eliminated by hormonal means. But it should be recognized as unreasonable to refuse the great possibilities of hormone therapy to preserve the health of women in menopause.