Surgical menopause is a symptom complex that develops in women of reproductive age against the background of medical termination of ovarian function. It develops with surgical removal of gonads, drug or radiation effects on ovarian tissue. The condition is manifested by hot flashes, psychoemotional instability, urogenital discomfort. Early onset of cardiovascular and metabolic pathologies is also characteristic. Diagnostics includes ultrasound of the pelvic organs, mammography, densitometry and a complete cardiological examination. Hormone replacement therapy is performed to correct the signs of surgical menopause.
ICD 10
N95.3 Conditions associated with surgical induced menopause
General information
Surgical induced menopause occurs in 80% of patients after ovarian removal operations (ovariectomy) and in every 3rd woman with supravaginal amputation of the uterus without appendages. Such pathology is possible at any stage of the reproductive period, even in 20-25-year-old girls with serious gynecological problems. The early onset of menopause is associated with severe stress for the female body, since the patient is neither physiologically nor psychologically ready for sudden changes.
Causes
Most cases of surgical menopause occur after ovariectomy, which is performed for oncogynecological diseases, extensive benign neoplasms. Premature menopause can be a consequence of removal of the ovaries in endometriosis, apoplexy, trauma and organ rupture. The cause of the symptom complex is a bilateral operation, when the ovarian function is completely turned off.
Specialists in the field of practical gynecology face the problem of surgical menopause after blocking ovarian function by radiation exposure, hormonal or cytotoxic drugs. Such treatment is prescribed to patients with oncopathology of the internal genitalia and breast cancer if it is impossible to carry out less radical therapy.
In rare cases, suppression of ovarian function occurs during isolated hysterectomy and is not associated with direct damage to ovarian tissue. Pathology is explained by a deterioration of blood flow in the pelvic organs, a violation of the functional activity of the ovaries, a decrease in the level of biogenic amines. A significant role is played by changes in the pituitary gland and hypothalamus, which produce regulatory sex hormones.
Pathogenesis
Sudden loss of hormonal activity of the ovaries causes complex and multi-stage disorders in the neuroendocrine system. With surgical menopause, the content of neurotransmitters in the subcortical nuclei decreases, against which there is a discoordination of vegetative, cardiorespiratory, temperature and other reactions. Therefore, the clinical manifestations are similar to the classic menopausal syndrome.
In the hypothalamus, the synthesis of regulatory neuropeptides decreases: lyuliberin, corticoliberin, thyrooliberin. Violations affect not only the reproductive organs, but also all body systems. After iatrogenic castration, androgens continue to be synthesized in limited quantities. They are the only source of estrogens, but this is not enough to fill the deficit.
Symptoms
Symptoms of surgical menopause occur 2-3 weeks after surgical treatment in gynecology or taking chemotoxic drugs. Manifestations reach their maximum intensity after 8-12 weeks, without treatment they progress and significantly complicate a woman’s life. The severity of the disease is determined by the frequency and severity of clinical signs.
Signs similar to physiological menopause develop, however, due to the young age of the patient and the suddenness of their appearance, they are more difficult to tolerate. The main complaint is hot flashes to the head, neck and upper half of the trunk. They are accompanied by redness of the skin, increased sweating, bursting headaches. During hot flashes, patients feel a strong and rapid heartbeat, a feeling of lack of air, a pre-fainting state.
Hot flashes are supplemented by signs of trophic changes in the vaginal mucosa. Women experience dryness and itching in the vagina, soreness during penetrating sexual intercourse. Characterized by vulvar kraurosis, chronic colpitis. Organic changes combined with a decrease in the hormonal profile cause a sharp drop in libido, anorgasmia. Dysuric phenomena, pain and discomfort in the pelvic region are possible.
Complications
A dangerous consequence of surgical menopause is the development of osteoporosis. It is formed due to the shutdown of the antiresorptive action of estrogens, it proceeds asymptomatically for a long time. Then there are complaints of pain in the bones of the extremities and lumbar spine, posture disorders, pathological fractures. The risk of spontaneous spinal injury in osteoporosis is 9 times higher than in healthy women of the same age.
With the early onset of menopause, metabolic disorders inevitably occur: changes in lipid metabolism, hypercholesterolemia, metabolic syndrome and obesity. Clinical manifestations of dyslipidemia and atherosclerosis develop much earlier, other cardiovascular diseases – coronary heart disease, arterial hypertension — manifest and progress.
Surgical menopause is closely associated with asthenovegetative manifestations and chronic fatigue syndrome. Constant weakness and a sharp decrease in working capacity is accompanied by physical and social maladaptation of patients. Infertility is a significant psychosocial problem, especially for women who do not yet have children. The inability to realize the reproductive function leads to depression, difficulties in personal life.
Diagnostics
Women with surgical induced menopause are under the supervision of a gynecologist. The clinical examination of the patient includes an assessment of the frequency and severity of symptoms, determination of anthropometric indicators of the body, examination of the genitals on a gynecological chair. To assess the state of health and identify suspected menopausal complications, the following methods are shown:
- Ultrasound of the pelvic organs. With the help of sonography, the viability of postoperative sutures is assessed, the condition of the genitals after their drug or radiation blockade is studied. For a more informative diagnosis, transvaginal ultrasound is performed.
- Mammography. Patients receiving hormone therapy are at risk of developing breast cancer, so they are shown preventive examinations. The X-ray method visualizes breast tissue and identifies suspicious neoplasms.
- Bone densitometry. Measurement of bone tissue density is the main method of early detection of postmenopausal osteoporosis, assessment of its dynamics and effectiveness of treatment. To identify pathological fractures, radiography of the affected area is performed in several projections.
- ECG. Registration of a cardiogram in standard leads is necessary to assess the functioning of the cardiovascular system, to detect signs of ischemia, myocardial hypertrophy, and arrhythmia. If the results of electrocardiography indicate pathology, additional stress tests and echocardiography are performed.
- Laboratory diagnostics. All women are prescribed clinical and advanced biochemical blood tests, a study of the level of estradiol, prolactin and pituitary hormones (FSH, LH). The coagulogram evaluates blood clotting and the risks of vascular thrombosis. To exclude the pathology of the cervix, a PAP test is performed.
Treatmen
Hormone therapy
Hormone replacement therapy (HRT) is the main way to correct menopausal manifestations and improve the quality of life. For treatment, drugs with an optimal combination of estrogenic and gestagenic components are used, which reduce the frequency of hot flashes, increase mental and physical ability to work, and stop urogenital symptoms. HRT has a cardioprotective effect and prevents the development of postmenopausal osteoporosis.
In practical gynecology, oral estrogens are often used, which differ in the speed of pharmacological action and ease of use. The drugs have the effect of first passing through the liver, which allows you to control lipid and carbohydrate metabolism. The use of HRT during surgical menopause reduces the risk of death from cardiovascular diseases by 30-50%.
Other drug therapy
In addition to hormones, the following groups of drugs are used:
- Antidepressants from the SSRI group. The drugs effectively stop the psychoemotional and vasomotor symptoms of menopause, improve the patient’s well-being and mood.
- Polypeptides of the epiphysis. Medications are used as experimental therapy in addition to HRT. They significantly reduce the severity of menopausal manifestations without increasing the doses of hormone therapy.
- Extracts of cimicifuga. A safe herbal remedy affects the receptors of the brain, thereby reducing the intensity of vegetative manifestations of menopause. The effectiveness of the drug is lower compared to HRT.
Prognosis and prevention
Surgical menopause is an irreversible condition. Substitution therapy eliminates menopausal symptoms and improves the quality of life, but it is not able to restore the patient’s reproductive potential. Prevention consists in early diagnosis of gynecological and tumor diseases, selection of organ-preserving and minimally invasive methods of treatment, regular medical examinations of women even in the absence of complaints.
