Early menopause is a complex of changes that occur with estrogenic insufficiency and are accompanied by early (up to 45 years) or premature (up to 40 years) termination of menstruation. The level of female sex hormones at a young age decreases with burdened heredity, injuries, inflammation and neoplasms of the ovaries, their removal, drug or toxic suppression of function. The early menopausal period can also be manifested by vasomotor, emotional and metabolic-trophic disorders. The diagnosis is based on typical complaints and laboratory-confirmed decrease in estrogen levels. The main method of treatment is hormone replacement therapy.
General information
The early onset of the menopausal period (early menopause or menopause) is a fairly rare condition, the prevalence of which has not yet been precisely established. It is observed in women under the age of 35-45 years with previously normal menstrual and reproductive functions. Some specialists in the field of gynecology call cases of premature loss of ovarian function, not related to their damage or removal, the syndrome of depleted ovaries. Although menopause is one of the physiological periods of a woman’s life, its early development in 60-80% of cases is accompanied by uncomfortable subjective sensations of varying severity and pathological changes in various organs and systems.
Causes of early menopause
Premature extinction of a woman’s reproductive function is associated with a decrease or cessation of the production of sex hormones. As a rule, early menopause leads to:
- Genetic abnormalities. Scientists have identified genes that prematurely terminate the functions of the ovaries or reduce their sensitivity to the action of follicle-stimulating hormone (FSH). The early onset of menopause due to ovarian exhaustion is also observed in a number of hereditary diseases (galactosemia, blepharophimosis, etc.).
- Ovarian tumors. Volumetric neoplasms with intensive growth can damage healthy follicular tissue.
- Ovarian surgery. Resection or removal of the ovaries is performed with their traumatic damage, surgical treatment of benign and malignant tumors, ectopic pregnancy.
- Intense radiation exposure. Receiving a total radiation dose of 6 Grays during radiation therapy of the pelvic organs or irradiation during an accident at an atomic facility causes irreversible damage to ovarian tissue.
- Chemotherapy. The production of estrogens can be disrupted in the treatment of tumors using drugs that suppress cell division. The treatment regimen for hormone-sensitive malignant neoplasms involves the appointment of drugs that inhibit the function of the ovaries.
- Autoimmune diseases. With autoimmune processes occurring in the genital glands, there is a replacement of follicles with scar tissue. Ovarian damage also occurs in Addison’s disease, insulin-dependent diabetes mellitus and some other diseases.
Pathogenesis
With early menopause, the number of follicles in the ovaries gradually decreases and, accordingly, the secretion of estrogens decreases. By the end of the third year of postmenopause, only single follicles can be identified, which subsequently disappear completely. Against the background of reduced estrogen levels, the pituitary gland secretes more FSH, which leads to hypergonadotropic hypogonadism. Since receptors for female sex hormones are found in most organs and tissues, the development of estrogen deficiency is accompanied not only by a violation of reproductive function (amenorrhea, uterine involution, etc. P.), but also changes in the limbic and other systems.
Classification
The classification of early menopause is based on the gradual nature of its development. The following phases are distinguished:
- Premenopause. The stage between the first symptoms and the last menstruation, lasting on average 6-8 years.
- Menopause. The period of 12-month absence of menstruation after the last menstruation, which passed independently as a result of the functioning of the ovaries.
- Postmenopause. The time interval after menopause is up to 65-69 years: early postmenopause – the first 5 years after menopause; late postmenopause – more than 5 years after menopause.
Signs of early menopause
The first sign of premature loss of ovarian function is a change in the menstrual cycle. The interval between individual menstruations usually lengthens to 35 days or more, less often it shortens. The discharge becomes abundant or, conversely, scarce. At the end of early premenopause, periods of secondary amenorrhea occur – the absence of menstruation for six months or more. A woman, as a rule, cannot get pregnant. Due to a lack of hormones, hot flashes are observed: fever is felt, the face turns red, and in some cases the upper part of the trunk, sweat is released abundantly, and shortness of breath attacks suddenly occur. The patient becomes irritable, tearful, her sleep is disturbed, her performance decreases, the performance of tasks related to memorizing and analyzing information worsens.
Dishormonal changes in the myocardium lead to shortness of breath when walking and physical activity, interruptions in the work of the heart. In the left half of the chest, discomfort and pain of a stabbing nature appear, not related to exertion, but sometimes quite intense and prolonged. Violation of vascular tone is accompanied by headaches, dizziness, sudden increase or drop in blood pressure. Due to the slowing down of lipid metabolism, body weight increases. Excessive hair loss occurs in the chin area and above the upper lip.
In menopause and early postmenopause, the skin looks more dry and wrinkled, nails and hair become brittle, dull, their growth slows down. Typical urogenital disorders develop: imperative urge to urinate, urinary incontinence with sudden movements, during coughing and laughing. Due to the dryness of the mucous membranes of the external genitals and vagina, itching and burning appear. Sexual desire decreases. In the period of late postmenopause, memory, hearing and vision may be impaired, blood pressure may rise, there may be curvature and increased fragility of bones, bone and joint pain, impaired posture, arthritis.
Complications
Early menopause is complicated by dysfunctional uterine bleeding, infertility and diseases associated with a lack of estrogen. Without correction of disorders, osteoporosis with a tendency to pathological fractures, atherosclerosis with an increased risk of hypertension, myocardial infarction and stroke are significantly more common. Autoimmune processes occur or worsen – Hashimoto’s thyroiditis, autoimmune baldness, adrenal insufficiency, insulin-dependent diabetes mellitus. The risk of developing benign and malignant neoplasms of the mammary glands, ovaries, uterus increases.
Diagnostics
Timely detection of signs of early onset of menopause allows not only to prevent the development of quite serious diseases, but also to improve the quality of life of a woman. The comprehensive survey plan includes:
- Consultation of a gynecologist. When collecting anamnesis, typical symptoms are revealed, which is evaluated using the Kupperman index. When examined in dynamics, the symptom of the “pupil” always remains negative, and the index of tension of the cervical mucus is low.
- Hormonal studies. Already in the initial period of early menopause, the concentration of estradiol, inhibins (especially inhibin B), sex hormone binding globulins (SHBG) decreases. At the same time, the content of FSH increases. The ratio of follicle-stimulating and luteinizing hormone levels is disrupted. There may be both an increase and an insufficiency of androgens.
- Colpocytological examination. There is a shift to the left of the maturation index (IS) with an increased content of parabasal and basal cells of the vaginal epithelium.
- Study of lipid metabolism. The total level of cholesterol and low-density lipoproteins increases, the content of high-density lipoproteins decreases.
- Transvaginal ultrasound. There is a thinning of the endometrium, hypoechoic areas characteristic of fibrosis of the myometrium, in postmenopausal synechiae and a small accumulation of fluid in the uterus.
- Ultrasound Dopplerography. There is a decrease in blood flow in the muscular layer of the uterus.
In the postmenopausal period, an important role is played by studies to determine possible complications: osteodensitometry to detect osteoporosis, ECG to diagnose heart pathology, mammography and cytology of cervical scraping (PAP test) to detect neoplasms that occur against the background of hormonal imbalance. The severe course of early menopause must be differentiated from diseases of the adrenal glands, thyroid gland, hyperprolactinemia, pituitary and ovarian tumors. Consultations of an endocrinologist, oncologist, oncogynecologist, neuropathologist are shown.
Treatment
Since the clinical manifestations of menopausal syndrome are associated with estrogen deficiency, hormonal correction is indicated in its pathological course. For this purpose , the patient is assigned:
- Hormone replacement therapy (HRT). Female sex hormones are the most effective. Depending on the underlying disease that provoked the early development of menopause, estrogens, progestins, combinations of estrogens with progestins or androgens are used. Taking into account possible side effects from the use of hormonal drugs, the presence of absolute and relative contraindications to hormone therapy, a specific scheme should be selected by a gynecologist.
- Phytoestrogenic drugs. If there are contraindications to HRT or a woman refuses to take hormonal drugs, phytoestrogenic drugs are recommended. They are produced from plant raw materials containing nonsteroidal molecules with an estrogen-like effect.
- Local application of estrogen-containing drugs. The appointment of candles, creams, gels, etc. is justified with involutive changes in the mucous membrane of the cervical canal, vagina and external genitalia.
In order to prevent and treat possible complications, sedatives, drugs that improve cardiac and cerebral blood flow, vitamin and vitamin-mineral complexes, calcium preparations can be used. Therapeutic physical education is effective, aimed at maintaining the tone of the pelvic floor muscles and the functional state of the musculoskeletal system.
Prognosis and prevention
With the preservation of ovarian tissues, the appointment of hormone replacement therapy can reduce the typical menopausal symptoms in 92-95% of cases, reduce the severity of urogenital disorders in 85% of women, improve the condition of the skin and hair, and in some cases preserve and even restore menstruation (up to 10% of patients). In women who regularly take hormonal and hormone-like drugs, the risk of pathological fractures is reduced by a third. Taking into account the possible causes of early menopause, for its prevention it is important to lead a balanced lifestyle, monitor the health of the reproductive organs, visit an obstetrician-gynecologist at least once a year, avoid abdominal injuries, choose the least traumatic methods of surgical treatment (if indicated).
