Menopause is a physiological period in a woman’s life characterized by the extinction of reproductive function due to hormonal changes in the body. It begins after the age of 40 and lasts for about 10 years. It is manifested by the gradual cessation of menstruation. It can be accompanied by a complex of vegetative-vascular and endocrine disorders: sudden attacks of a rush of blood to the upper half of the trunk and face (“heat”), sweating, tearfulness, irritability, fluctuations in blood pressure, increased dryness of the skin and mucous membranes, sleep disorder. It can cause dysfunctional uterine bleeding, serious neuropsychiatric disorders.
General information
Menopause is a natural stage in a woman’s life and is characterized by reverse changes in the reproductive system – the termination of childbearing and menstrual functions. The word “climax” comes from the Greek “klimax” – a ladder expressing symbolic steps leading from the flowering of specific female functions to their gradual extinction.
A woman’s life consists of several age periods that have their own anatomical and physiological features:
- newborn period – up to 10 days;
- the period of childhood – up to 8 years;
- puberty period – from 8 to 17-18 years;
- the period of puberty (reproductive, or childbearing) – from 18 to 45 years;
- menopausal period (menopause), including:
- premenopause – from 45 years to menopause;
- menopause – cessation of menstruation (49-50 years);
- postmenopause – from menopause – to 65-69 years;
- the period of old age – from 70 years.
With an average life expectancy of 75 years, a third of a woman’s 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 menopausal (menopausal) 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 violates the normal functioning and working capacity of a woman. The issues are of great social and medical importance due to the increased average life expectancy of a woman and her socially active behavior.
Causes of menopause
During menopause, changes occur throughout the body: immune protection decreases, the frequency of autoimmune and infectious diseases increases, aging processes progress. But the most active changes during menopause are exposed to a woman’s sexual apparatus. With menopause, the development of follicles in the ovaries stops, eggs stop maturing and ovulating, and there is a decrease in intersecretory activity. 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 during menopause is characterized by an increase in the level of gonadotropins (follicle-stimulating and luteinizing) and a decrease in the level of estrogens. Within a year after the onset of menopause, the level of follicle-stimulating hormone increases by 13-14 times, luteinizing hormone – by 3 times, followed by a slight decrease.
During menopause, changes in the synthesis of estrogenic hormones consist in the cessation of estradiol production and the predominance of estrone. Estrogens have a biological effect on the uterus, mammary glands, urethra, bladder, vagina, pelvic floor muscles, brain cells, arteries and heart, bones, skin, mucous membranes of the conjunctiva, larynx, mouth, etc., and their deficiency during menopause can cause various disorders in these tissues and organs.
Menopausal syndrome during menopause is a manifestation of estrogen deficiency and is characterized by vegeto-neurotic, urogenital disorders, dystrophic skin changes, high risk of atherosclerosis and vascular ischemia, osteoporosis, psychological disorders. With an increase in the average life expectancy of a woman, there is an elongation and, accordingly, an increase in the period of estrogen deficiency, which increases the likelihood of menopausal syndrome.
Classification
According to its manifestations, menopausal syndrome is divided into early-term, mid-term and late-term manifestations of menopausal disorders. Early manifestations of menopausal disorders during menopause include:
- vasomotor symptoms – a feeling of “hot flashes”, headaches, increased sweating, chills, fluctuations in blood pressure, palpitations;
- psychoemotional 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 psychoemotional symptoms during menopause are often treated by a therapist for hypertension, coronary heart disease or by a neuropsychiatrist with diagnoses of neurosis or depression.
The average manifestations of menopausal disorders during menopause include:
- urogenital symptoms – vaginal dryness, painful sexual intercourse, burning, itching, dysuria (increased urination and urinary incontinence);
- symptoms from the skin and its appendages – wrinkles, brittle nails, dry skin and hair, hair loss.
Mid-term manifestations are noted 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 during menopause does not give the desired effect.
Late–term manifestations of menopausal disorders during menopause include:
- metabolic (metabolic) disorders – osteoporosis, atherosclerosis, Alzheimer’s disease, cardiovascular diseases.
Late-term manifestations during menopause develop 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 menopause
The development and severity of the menopausal syndrome are influenced by hormonal, environmental, hereditary factors, the general condition of a woman by the menopause period.
Vegetative-vascular (vasomotor) symptoms are observed in 80% of women. They are characterized by sudden “tides” with a sharp expansion of the capillaries of the scalp, 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, increases at night, causing sleep disorder. Mild degree of vasomotor disorders during menopause is characterized by the number of “hot flashes” from 1 to 10 per day, average – from 10 to 20, severe – from 20 or more in combination with other manifestations (dizziness, depression, phobias), leading to a decrease in working capacity.
13% of women with a pathological course have asthenoneurotic disorders, manifested by irritability, tearfulness, anxiety, fear, intolerance to olfactory and auditory sensations, depression. Psychoemotional symptoms in menopause develop before or immediately after menopause, vasomotor symptoms last about 5 years after menopause.
Quite often, the pathological course is characterized by urogenital and sexual disorders, as well as osteoporosis with the development of pathological fractures.
The course of menopausal syndrome during menopause can develop in the form of atypical forms:
- sympatho-adrenal crises characterized by a sharp headache, increased blood pressure, delayed urination, followed by polyuria;
- myocardiodystrophy, characterized by constant pain in the heart in the absence of ECG changes, ineffectiveness of conventional therapy;
- urticaria, vasomotor rhinitis, allergies to medicines and food products, indicating a change in the immunological reactions of the body, etc.
The course of menopause falls during the period of important events in a woman’s life: growing up and marrying children, achievements at work, retirement changes, and menopausal disorders are layered with increased emotional stress and social problems. Almost 50% of women have a severe form of disorders, 35% have moderate disorders and only 15% have mild menopausal syndrome. A mild form of menopause disorders is usually found among practically healthy women, while women with chronic diseases are susceptible to atypical forms of menopausal syndrome, a tendency to a crisis nature of the course that violates the general health of patients.
The development of menopausal syndrome during menopause is facilitated by genetic factors, endocrinopathies, chronic diseases, smoking, menstrual disorders during puberty, early menopause, inactivity, lack of a woman’s history of pregnancies and childbirth.
Diagnostics
The diagnosis is based on the complaints of patients who appear at the age of approaching or onset of menopause. Exacerbations of concomitant diseases sometimes complicate the diagnosis of menopausal syndrome during menopause, aggravating its course and causing the development of atypical forms. In the presence of concomitant diseases, a woman, in addition to consulting a gynecologist, is shown to consult 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, estrogens is carried out. To clarify the functional state of the ovaries during menopause, a histological analysis of the scraping of the endometrium of the uterus and cytological studies of vaginal smears in dynamics, plotting the basal temperature are carried out. The detection of anovulatory ovarian cycles makes it possible to link functional disorders with menopausal syndrome.
Treatment of disorders during menopause
The approaches adopted in modern gynecology to the problem of treating are based on reducing its manifestations and symptoms. Reducing the severity and frequency of “hot flashes” in the pathological course of menopause is achieved by prescribing antidepressants (venlafaxine, fluoxetine, paroxetine, citalpram, sertraline, etc.).
In order to prevent and treat the development of osteoporosis during menopause, non-hormonal drugs are used-biophosphonates (alendronic and rhizedronic acids), which reduce bone loss and the risk of fractures. Biophosphonates effectively replace estrogen therapy in the treatment of osteoporosis in women during menopause.
To reduce the manifestation of urogenital symptoms in the pathological course of menopause, local (vaginal) administration of estrogen in the form of cream or tablets is recommended. The release of small doses of estrogen in the vaginal tissue reduces feelings of dryness, discomfort during sexual contact and urination disorders.
The most effective method of treating menopausal syndrome in menopause is hormone therapy individually prescribed by a doctor. Taking estrogenic drugs well eliminates, in particular, “hot flashes” and unpleasant sensations 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. To prevent hyperplastic processes in the endometrium during menopause, a combination of estrogens with progestogens or (less often) with androgens is indicated. Hormone therapy and hormone prophylaxis courses are carried out for 5-7 years in order to prevent myocardial infarction, osteoporosis and stroke.
Hormone therapy as a treatment for this pathology is contraindicated in patients suffering from:
- cancer of the endometrium, ovaries, breast;
- coagulopathy (blood clotting disorder);
- impaired liver function;
- thromboembolism, thrombophlebitis;
- uterine bleeding of unknown cause;
- renal insufficiency.
Before prescribing hormonal drugs to patients with menopause pathology, it is necessary to conduct studies: ultrasound of the pelvic organs, ultrasound of the mammary glands and mammography, cytological analysis of smears of the discharge from the cervix, biochemical examination of blood analysis and coagulation factors (coagulogram).
Hormone therapy regimen
The choice of hormone therapy regimen depends on the stage of menopause. In premenopause, hormone therapy not only makes up for 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 medication.
If the pathological course is manifested only by urogenital disorders, estrogens (estriol) are prescribed locally in the form of vaginal tablets, candles, cream. 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 is achieved by the appointment of combined hormone therapy (as an example, tibolone + estradiol + norethisterone acetate). With combined hormone therapy, hormone intake is combined with symptomatic medications (hypotensive, cardiac, antidepressants, bladder relaxants, etc.). Combination therapy for the treatment of menopause disorders is prescribed after consultation with narrow specialists.
Solving the problems of the pathological course is the key to prolonging women’s health, beauty, youth, efficiency and a real improvement in the quality of life of women entering the wonderful “autumn” time of their lives.
