Climacteric syndrome: symptoms, treatment and prevention. Premenopausal period (syndrome) Climatic disorders

Minasyan Margarita

Any age-related changes in the body cause excitement and alertness. With regard to menopause, this statement is all the more true, because, unfortunately, not the most pleasant manifestations accompany its arrival. Many of the fair sex, who have already gone through this path, talk about how difficult it was for them. Therefore, associations with the onset of menopause are often more than negative. Like any action conceived by nature, it does not begin suddenly. The main signs of the premenopausal period begin long before the full onset of menopause, if you properly prepare for them, you can significantly reduce the risks of adverse manifestations and maintain a high quality of life.

Features of the course of premenopause

The essence of menopause is to reduce the production of female sex hormones by the ovaries, the cessation of ovulation processes, which leads to the gradual disappearance of menstruation, and, consequently, the completion of reproductive function.
Menostasis itself is natural, but under the influence of certain factors, its symptoms can become excessively pronounced, significantly clouding life.
Climax does not come in one day, its onset can be divided into 3 stages:

Premenopause begins a few years before the complete cessation of monthly bleeding. This is the initial stage in which negative manifestations may already begin to make themselves felt. It is conditionally possible to call the age of 45-47 years the most characteristic for the onset of this phenomenon.
Menopause is characterized by the complete cessation of menstruation and the completion of reproductive function. Its onset is natural at the age of 50-52 years.
Postmenopause is a time that lasts until the end of life. As a rule, all the symptoms characteristic of the first two stages recede, but if the negative phenomena have managed to cause significant harm to health, then the consequences remain with the woman until the end of her life.

Premenopause begins at the moment when the production of female sex hormones gradually decreases, this is especially true for estrogens, since they are responsible for regulating many important physiological processes in the female body. In particular, they are responsible for:

stable menstrual cycle;
metabolism;
the formation of a figure according to the female type;
sexual desire;
maintaining timely renewal and moisture levels of the mucous membranes;
emotional stability;
for the complete absorption of calcium;
preservation of youth, since estrogens are involved in the synthesis of collagen fibers;
stimulating metabolic processes in the brain, maintaining memory, the ability to concentrate and perceive new information.

The premenopausal period is very important, it gives a kind of respite, time to prepare for the coming global changes. Its duration is on average determined by 4 years, but individual deviations from this indicator are possible. One thing remains unchanged: at this time you need to pay maximum attention to your well-being and not let the situation take its course.

The main signs of premenopausal changes

It should be noted that not every woman acutely feels the approach of menopause. Each organism is individual, and its reactions to any internal fluctuations are also different. To find out if the symptoms relate to the beginning of the menopause period, you can go through.

However, in medical practice, the following symptoms have been identified that distinguish the premenopausal period

One of the most significant external manifestations is a change in the nature of menstruation. If before they were regular, now characteristic failures in cyclicity can be observed. The essence can also change, they can become more scarce, then again take on a familiar character. Premenopause is characterized by the persistence of bleeding, but there is a tendency to stop them.
One of the most pronounced and most dangerous manifestations that this syndrome is marked with are malfunctions of the heart and blood vessels. This should include the appearance of hot flashes, attacks of palpitations, the development of coronary artery disease, atherosclerosis, angina pectoris, the diagnosis of frequent attacks of high blood pressure. Often, even with the slightest exertion and emotional stress, shortness of breath occurs. It is when all these signs of trouble are just emerging that timely treatment should be started and the achieved result should be maintained.
Also, sometimes there is excessive sensitivity of the mammary glands, if such a disease already exists. It should be borne in mind that many tumor diseases in this area are often hormone-dependent. Therefore, with the onset of menostasis, the number of oncological diseases increases sharply. And breast cancer is the leader among all types of oncology.
Fatigue, difficulty concentrating, memory loss may occur.
Against the background of a changing hormonal background, difficulties may arise in. A decrease in the concentration of estrogen can significantly reduce libido, provoke discomfort during intimate relationships. Find out which woman apply.
This syndrome does not bypass the emotional state. Sometimes even the most balanced women begin to notice heightened emotionality, unjustified outbursts of anger, loss of interest in previously beloved activities and things. This is easily explained by the fact that hormonal changes are invariably associated with the work of the central nervous system.
The premenopausal period may be accompanied by the appearance of sleep disorders. Appear, sleep becomes superficial, sometimes there are sweating, anxiety. These phenomena appear sporadically, but may already be the first "bells" of the impending deterioration of the situation.
Under the influence of hormonal changes, the manifestation of PMS can worsen, especially this problem will worsen in those women who regularly suffer from this disease.
In the premenopausal period, episodes often intensify.

Prevention of premenopause

May play a predominant role even before treatment. After all, the symptoms of trouble are not yet so pronounced, so there is time to influence their dynamics in more loyal and safe ways.

The syndrome of premenopause requires responsible preparation for it. Yes, there are hereditary factors that are very difficult to influence. If in the family all the representatives of the weaker sex had a hard time enduring the onset of menopause, then there is a certain risk of repeating this path. However, you should not write off everything on a fatal combination of circumstances. The development of pathological menopause is influenced by the lifestyle that accompanied a woman throughout her life until entering premenopause. Therefore, it is necessary to begin preparations for the onset of this stage by making adjustments in this direction. Ideally, of course, a healthy lifestyle should remain a faithful companion from childhood, but, as a rule, while a person is healthy, he wastes his health reserves aimlessly, and then tries to reverse the changes that have taken place. However, it is never too late to change circumstances in the direction of positive dynamics.

Complete rest

One of the most important factors for the successful development of the scenario is the observance of a balanced regime of work and rest. There is a clear relationship between cause and effect here. As an example: systematic lack of sleep causes a feeling of depression, provokes bouts of irritability, as a result of which pressure jumps, there is concern for one's health, suspiciousness. And this whole chain of negative dynamics is complicated by hormonal "swings" that begin at this time. Therefore, for the normal functioning of all body systems, it is very important to have a good rest.

Mobility

The importance of physical activity should not be underestimated. Over the years, metabolic processes slow down, stagnant processes form in the body, muscle tone decreases, significantly affecting the shape of the body and an attractive appearance of the body. To counteract these unpleasant manifestations, you should include physical activity in your life. This will not only help prolong vigor and external beauty, but will also serve as a prevention of cardiovascular diseases and weight gain.

Proper nutrition

A balanced diet can also be a great help at the stage when it begins to show itself. Regular consumption of plant foods, lean meats, sea fish, dairy products - this is the basis of a healthy diet. To improve well-being, it is worth reducing the consumption of sugar, salt, fatty and fried foods, and “bad” carbohydrates.

It would be justified to take additional sources of vitamins and microelements in order to maintain the activity and resistance of the body to various negative factors.

Rejection of bad habits

It is very important to eliminate bad habits, if any. Nicotine and alcohol addiction are detrimental to any period of life, but during premenopause they can become provocateurs of heart disease, oncology, thyroid disease and other dangerous ailments.

calmness

Psycho-emotional state control is also an equally important factor. After all, the premenopausal period is characterized by a large number of vasovegetative symptoms, the formation of which is inextricably linked with the activity of the autonomic nervous system. Therefore, emotional well-being helps support the work of the central nervous system and slows down the development of adverse trends. To achieve a positive attitude, you should protect yourself from stress, emotional and physical overwork as much as possible, if this is not possible, then try to change your attitude to ongoing events and, possibly, resort to medical support for the work of the nervous system.

sexual activity

The presence of a full sexual life in premenopause has a positive effect on the general condition. Sexual energy has a positive effect on the production of hormones, the number of which has tended to decrease. In addition, blood circulation in the pelvic organs improves, stagnant processes are eliminated, and emotional manifestations are stabilized.

Therapy of premenopausal disorders

If the combination of preventive methods taken in premenopause does not bring a stable result, and pathological symptoms tend to progress, treatment should be supplemented with special drugs.

The first step towards developing the right treatment tactics is to contact a specialist. Ideally, it is he who should control the passage of the entire period of menopause.

Based on the collected history, the doctor will prescribe the necessary diagnostics, including:

direct examination by a therapist, gynecologist, mammologist;
passing urine and blood tests to assess the general condition of the patient;
blood sampling for analysis of hormone levels in order to determine the extent of the ongoing changes and select reasonable treatment;
Ultrasound of the pelvic organs and mammary glands;
mammography;
taking smears for infections;
conducting a cytological examination of the cervix;

Additional diagnostics is carried out on the basis of specific complaints of the patient. If there are any, the patient is referred to a specialized specialist and undergoes an appropriate diagnosis.

After collecting all the necessary information, a treatment tactic is prescribed, taking into account all contraindications and course features that distinguish the premenopausal period.

In premenopause, the most important direction of therapy is the stabilization of the hormonal background. The most significant effect on the condition of a woman is precisely the decrease in the amount of estrogen. Therefore, effective treatment should be based on compensating for the decrease in the production of these hormones.

Phytoestrogens

In order to prevent a sharp decrease in estrogen levels, they turn to pharmaceuticals containing phytoestrogens.

Phytoestrogens are non-steroidal hormone-like substances, similar in structure to one of the subspecies of natural estrogens - estradiol.

Taking plant estrogens has a positive effect on:

Activity of the cardiovascular system. Phytohormones strengthen the walls of blood vessels, increase their elasticity, provide adequate nutrition for the myocardium, prevent the development of atherosclerosis, thereby helping to avoid the development of hypertension, coronary artery disease, and also prevent heart attacks and strokes;
The work of the central nervous system. Estrogens enhance the adaptive ability of the central nervous system to various stressful situations, mental and emotional stress. In addition, they help regulate the interaction of the parasympathetic and sympathetic divisions of the autonomic nervous system, allowing you to streamline the change in the processes of activity and rest. Due to this, sleep is normalized, working capacity is increased, which is replaced by the natural onset of fatigue after the completion of labor-intensive processes, overexcitation is prevented, which does not allow a person to relax and fully rest;
external attractiveness. The action of natural estrogens is aimed not only at eliminating internal ailments, but also at maintaining the natural beauty of a woman. A decrease in the production of natural hormones leads to the launch of the aging process: the condition of the skin, hair, nails deteriorates sharply, the body is restructured according to the male type, and excess weight appears. The intake of phytoestrogens helps to resist the occurrence of these manifestations and push them to a later date.
absorption of calcium by the body. Phytoestrogens, together with vitamin D, help to fully assimilate this trace element from food and vitamin-mineral complexes, resisting the development of osteoporosis, a disease characteristic of this time, which manifests itself in increased bone fragility.

As a source of phytoestrogens, vitamin and mineral preparations supplemented with these plant substances are most often used. Examples of such complexes are:

Qi-Klim;
Klimadinon;
Estrovel;
menopace;
Remens;
Mense.

HRT

Hormone replacement therapy can be justified only if the syndrome develops too rapidly, and hormonal disruptions adversely affect the woman's health. In this case, delay can be dangerous, but becomes ineffective.

It is important to remember that HRT is an extreme measure, the use of which should be limited in time, and treatment should take place under the strict supervision of a specialist. Unfortunately, long-term treatment with hormonal drugs causes an increased risk of oncological diseases, for example, various types of cancer of the female genital organs and mammary glands.

Preclimax is an important preparatory stage for the restructuring of the female body. And although this phenomenon is exciting and, moreover, it is often accompanied by negative symptoms, it is important to consider it not only from a negative angle, but also from the side of opportunities that open up. As a rule, by this time, children no longer require as much attention as before, a woman has time to take care of herself and arrange her own leisure, her sexuality reaches its peak, and there is no need to worry about an unwanted pregnancy. Menopause is not the end of life, but a phenomenon provided for by nature itself, the course of which largely depends on the correct attitude and preventive measures taken.

Climacteric syndrome is a complex of clinical signs that complicates the course of the physiological transition period that occurs in the life of every woman. With age, the reproductive function fades, the glandular tissue of the ovaries undergoes reverse development, the secretion of sex hormones decreases, menstruation stops, the uterus decreases in size, and endometrial hypoplasia occurs. The well-being of women during menopause worsens, somatic, vegetative, metabolic, endocrine, urogenital, adaptogenic, vasomotor and mental disorders of varying severity develop.

Climacteric syndrome is otherwise called menopause, menopause or menopausal syndrome. This is a transitional phase, indicating the extinction of the reproductive function and the onset of old age. Menopause is not a pathology, but a normal state of the female body, characterizing a certain age period and developing under the influence of the restructuring of the central nervous system. The process of production of gonadotropic hormones by the pituitary gland is disrupted, which leads to dysfunction of the ovaries - the female gonads. Their follicular phase changes, the ovarian reserve is depleted, the number of follicles decreases. In the body there is a deficiency of sex hormones - progesterone and estrogen.

Menopause develops in 30-60% of women aged 45-55 years. This natural process of withering of the body is due to a decrease in the level of sex hormones in the blood. This phenomenon often manifests itself quite sharply and delivers a lot of discomfort. The main symptoms of the disease are: hot flashes to the body, pulsation in the head, hyperhidrosis, cardialgia, persistent rise in blood pressure, rapid and arrhythmic heartbeat, poor sleep. The syndrome has a code according to ICD-10 95.1 and the name "Menopause and climacteric condition in a woman."

Etiology and pathogenesis

The hypothalamus - pituitary gland - ovaries is an integral system, the work of which is carried out on the principle of feedback.

The hypothalamic structures lose their sensitivity to the normal concentration of estrogen secreted by the ovaries and involute. To restore balance, hyperfunction of the hypothalamus develops, which increasingly stimulates the pituitary gland. The latter secretes gonadotropic hormones in large quantities, especially follicle-stimulating hormones. Dysfunction of the ovaries develops, which begin to secrete not only functioning estrogen fractions, but also their intermediate components. Sex hormones are produced acyclically. Their number becomes insufficient to inhibit the work of the hypothalamus and pituitary gland. An excess of FSH in the blood leads to the cessation of ovulation and reproductive function.

The structures of the hypothalamic-pituitary region regulate all the basic functions of the body. If their work is disturbed, osteoporosis, metabolic disorders, dysfunctions of the heart, blood vessels and peripheral nerves develop, which leads to the development of menopause.

For some women, menopause is relatively easy. This is due to the ability of the adrenal cortex to partially produce sex hormones during ovarian involution. The mild course of the syndrome is due to the absence of pathological symptoms.

Factors leading to the development of the syndrome:

Heredity,
acute infections,
Operations
chronic somatic diseases,
Bad habits,
hypodynamia,
Excess weight,
Irrational nutrition,
Chronic poisoning of the body,
occupational hazards,
diseases of the central nervous system,
Psycho-emotional overstrain, stress,
Insufficient sleep
Negative environmental factors,
The number of births and abortions in history,
Long-term use of hormonal agents and cytostatics.

Pathogenetic processes in menopause: involution of the glandular tissue of the ovaries, reduction in the number of maturing follicles, rare ovulation, cessation of menstruation. The glandular tissue of the organ is gradually replaced by connective tissue fibers. Hypoplasia of the ovaries after 40 years is explained by the fact that white bodies remain in place of the corpus luteum, which do not completely resolve. The glands shrink due to the growth of fibrous tissue, and then undergoes irreversible dystrophic processes. Cardiovascular, respiratory, emotional, behavioral and temperature reactions are disturbed in the body.

Symptoms

The clinical picture of the climacteric syndrome includes signs of impaired autonomic regulation, hyperventilation syndrome, dysfunction of the genitourinary system, and slowing down of skin trophism.

Climacteric syndrome begins with pronounced neuropsychic manifestations and signs of vegetative-vascular dystonia. These include:

By the end of the second year of menopause, menstruation stops, and more pronounced symptoms occur. The following are added to the initial signs of the syndrome:

The occurrence of intermenstrual bleeding
Thinning and drying of the mucosa of the genitourinary system,
Dyspareunia - painful intercourse
Spontaneous excretion of urine
Atherosclerosis,
overweight,
Violation of carbohydrate metabolism with the development of diabetes mellitus,
Decreased visual acuity and hearing
Osteoporosis.

Forms of climacteric syndrome:

Typical - hot flashes to the head, hyperhidrosis, insomnia, emotional lability, migraine. The number of tides reaches 4-10 per day.
Atypical - excess adipose tissue on the body, swelling on the legs and face, arthralgia, myalgia, dysuria, vaginal dryness, fear of death, arrhythmia, hypertension, allergies, hyper- or hypoglycemia, epileptic seizures, hirsutism, nystagmus, visual hallucinosis.
Combined - develops in women with a history of signs of cardiac pathology, hypertension, dysfunction of the hepatobiliary zone, metabolic disorders.

tides- This is a specific clinical sign of menopause, which is an attack of heat localized in the head, neck and chest. It gives way to chills and icy sweat. At the same time, blood pressure fluctuates sharply, weakness occurs, patients lose consciousness. Hot flashes last from a few seconds to ten minutes.

Women often develop atrophic vaginitis during menopause. This is due to estrogen deficiency and slow synthesis of protective cells in the vagina. The number of lactic acid bacteria is reduced, vaginal discharge becomes abundant, alkalization of the medium occurs. This allows pathogenic and opportunistic microorganisms to actively grow and multiply in the vagina, causing acute inflammation. Urogenital symptoms of pathology - vulvar dystrophy, inflammation of the vagina, painful urge to urinate. These pathological changes are accompanied by itching, bleeding, profuse discharge, frequent urination.

During menopause, changes occur in the genitals: the uterus, fallopian tubes and ovaries decrease, their mucosa becomes thinner. The ligaments and muscles of the small pelvis weaken and stretch. They cannot fully hold the organs, which leads to their omission. Sexual intercourse becomes painful, accompanied by dryness and discomfort. Only hormonal drugs will help restore a full-fledged sex life and attraction to the opposite sex. Fibrous tissue grows in the mammary glands.

In women at this age, the amount of collagen in the skin decreases, which is manifested by its aging - the appearance of wrinkles and age spots. The hair on the head, pubis and in the armpits begins to fall out, the nails become brittle and soft.

Osteoporosis

Osteoporosis- a late complication of menopause, clinically manifested 3-7 years after the cessation of menstruation. Bone tissue loses its strength, fractures periodically occur. Women complain of frequent coldness of the legs, their numbness, tingling, crawling sensation.

The change in a woman's behavior is associated with the perception of menopause as a sign of aging. Some fall into depression, which is difficult to treat. In addition to therapeutic assistance, women at this time need the support of relatives. She should still feel desirable for her husband, loved by children, attractive to others. After all, menopause is not the end, but a new stage in life.

In men, menopause occurs somewhat later - after 50 years. The involution of the glandular tissue of the testicles leads to a lack of testosterone in the blood and an excess of gonadotropins. Such an imbalance is manifested by a violation of the joint work of the central nervous system and endocrine glands. Men rarely experience symptoms of the disease. It usually proceeds easily and painlessly. In some cases, the same clinic appears as in women: tachycardia, cardialgia, hypertension, migraine, sleep disturbance, inattention, decreased performance, progressive obesity, gout attacks, hyperglycemia, impotence.

Diagnostic methods

Diagnosis of pathology does not cause difficulties. Specialists evaluate the regularity of the menstrual cycle in accordance with age, study the clinical signs and complaints of patients, exclude concomitant diseases, and determine the hormonal status of the patient. In most cases, additional consultation of specialists in the field of ophthalmology, psychoneurology and endocrinology is required.

Doctors collect a hereditary and gynecological history, examine the woman's menstrual function, conduct a gynecological examination with a mandatory bimanual examination, and then refer the patient to donate blood for an analysis that determines the hormonal background. Additionally, the mammary glands are palpated.

Laboratory diagnostics:

Hemogram.
Definition of a hormonal background.
Cytological analysis of the cervix.
Blood biochemistry - enzymes and markers of basal metabolism.
Coagulogram.
Microbiological examination of the vaginal discharge for microflora.
Instrumental Methods:
mammographic study.
Ultrasound of the genital organs.
X-ray of the chest organs as indicated.

Therapeutic measures

Normalization of the regime of work and rest,
Proper low calorie diet
Taking vitamins and minerals
Fighting bad habits
Regular sex life preferably with one partner,
Periodic medical examinations
Optimal physical activity.

It is advisable to use special exercise therapy complexes. General massage and walks before going to bed improve the well-being of patients. Women with a mild form of the syndrome are recommended dietary nutrition. It is very important to pay attention to the calorie content of the food eaten. In menopause, people who neglect the principles of proper nutrition increase the amount of adipose tissue, which is deposited in excess on the back, sides, abdomen and hips.

The diet should be dominated by dairy products, lean fish and meat. It is necessary to limit pork, duck, smoked meats, marinades, spices, chocolate, strong tea and coffee, alcohol, carbohydrates. It is useful to use fresh salads that normalize intestinal motility, with a small amount of vegetable oil that protects cells from the negative effects of environmental factors.

Vitamin therapy - retinol, vitamin C, E and B; sedative herbal remedies - tincture of motherwort, hawthorn, valerian. Relax and improve well-being will help therapeutic massage and exercise therapy, physiotherapy, acupuncture, hydrotherapy, balneotherapy, aromatherapy. These techniques improve the psycho-emotional state of women in such a difficult life period.

Medical therapy

Moderate forms are treated with medications:

Phytoestrogens have a mild effect on menopausal processes in the body: they reduce the frequency of hot flashes, restore sleep, stabilize the psycho-emotional state, and minimize the severity of the main clinical manifestations. Such drugs are sold without a doctor's prescription and do not have the same side effects as real hormones.

In the absence of the effect of the listed drugs or in cases of severe course of the syndrome, hormone replacement therapy is prescribed with estrogen-gestagenic agents - Lindinet, Mercilon, Femoston.

Adequate drug correction makes the prognosis of the syndrome generally favorable. Psychoneurological disorders and depressive states are difficult to treat. If the disease is severe against the background of somatic diseases, serious complications develop from the heart, blood vessels and central nervous system. The treatment regimen is selected by a specialist individually for each patient, depending on the characteristics of the pathological process.

If menopause occurs before the age of 45, hormone replacement therapy is performed, which allows you to prolong the functioning of the ovaries. "Clinon" and "Climanorm" contribute to the appearance of menstruation and reduce the risk of developing endometrial hyperplasia.

Video: doctor about the treatment of menopausal syndrome

Alternative treatment of the syndrome

The most common folk remedies to make the process of restructuring the female body less painful:

Spa treatment is indicated for women during menopause. After climate and balneotherapy, the general condition of the body improves, headaches, hot flashes disappear, working capacity is restored, sleep, pressure, gastrointestinal tract and kidneys normalize.

Climacteric syndrome is a condition that can be dealt with. Clinical recommendations of specialists, medicines and traditional medicine will help to do this. Menopause is an irreversible process, because time cannot be turned back. The climacteric syndrome is the transition of a woman from a young age to a mature one. Comprehensive treatment allows you to smooth out the course of this process and make it painless.

Video: lecture "Hot flashes and climacteric syndrome - modern tactics of management"

Climacteric syndrome is a symptom complex that develops during the period of age-related decline in the function of a woman's reproductive system and is characterized by neurovegetative, metabolic-endocrine and psycho-emotional disorders of varying degrees of intensity and duration.

Etiology and pathogenesis

The main regulating link of the menstrual cycle is the hypothalamus. It produces releasing hormones. Currently, it is believed that the hypothalamic regulation of the production of FSH and LH by the adenohypophysis is carried out by one hormone - gonadoliberin, produced by the hypothalamus. For many years, the hypothalamus-pituitary-ovarian system has been functioning as a self-regulating system based on the feedback principle. However, with age, involutive changes in the hypothalamus occur, which is manifested by an increase in its sensitivity threshold to the action of estrogens and increased production of gonadotropic hormones, primarily follitropin. The cyclicity of their selection is also violated. Due to the ever-increasing stimulation of the ovaries from the hypothalamus, they secrete into the blood a large amount of not only the working hormones of estrogens, but also the intermediate products of their synthesis. However, from a certain point on, the amount of hormones produced by the ovaries is insufficient to inhibit the excited hypothalamic activity and high production of follitropin. There is no decrease in follitropin release, and therefore ovulation does not occur. With the cessation of ovulation, the corpus luteum does not develop, reproductive function stops. With age, there is a progressive decrease in the number of primordial follicles, although a small number of them can be found in postmenopausal ovaries. The most typical for this period is the resistance of such follicles to the action of FSH and LH, an increase in the level of which in the blood serum always occurs during menopause. Menopause is characterized by impaired secretion of many hormones, primarily gonadotropic and sex hormones. Despite the almost complete cessation of the hormonal function of the ovaries, the level of estrogen in the blood serum does not reflect this condition. This is due to the fact that an additional source of estrogens, mainly in the form of estrone, in general, and especially in menopause, is androstenedione, which is converted to estrone in peripheral tissues. A decrease in the level of classical estrogen in the body contributes to the development of osteoporosis. Estrogen deficiency accelerates the development of atherosclerosis. An increase in the concentration of gonadotropins probably contributes to the development of ovarian cancer. A decrease in the content of dopamine in the hypothalamus leads to vegetovascular reactions, which is manifested by hot flashes, autonomic crises, and an increase in blood pressure. The feeling of heat is a consequence of paroxysmal vegetative sympathicotonic manifestations. Characteristic sensations arise due to central hyperthermia and appear 30-50 minutes after the spastic state of the capillaries and the development of venous congestion. In the pathogenesis of climacteric syndrome, changes in the functional state of the hypothalamus are important. At birth, a girl has primordial follicles from 300 to 500 thousand. But gradually the number of primordial follicles decreases and by the age of 40 they remain from 5 to 10 thousand. Accordingly, fertility decreases, estrogen secretion changes, which decreases. In addition, the qualitative composition of the produced estrogen changes. The main active fractions of estrogen are estrone, estradiol, estriol. In menopause, the most active estriol. At an older age, the reticular zone of the adrenal cortex produces part of the sex hormones, and some women go through menopause very calmly, and some women do not have any sensations and manifestations of the menopause (since these women suffer the least from the adrenal glands during their lives). The adrenal glands take over the function of the ovaries when the function of the latter fades. In addition, the content of gonadotropin changes. If estrogens decrease, then the feedback mechanism of gonadotropins increases (more than 10 times). The ratio of luteinizing hormone and FSH changes. In the reproductive age, this ratio is equal to one, in the menopause more FSH is released (ratio 0.43). The modern concept of the pathogenesis of climacteric syndrome attaches great importance to age-related changes in the hypothalamic structures.

The most traditional classification is the division of menopausal syndromeby the number of tides: mild form - a disease with up to 10 hot flashes per day; medium form - a disease with 10-20 hot flashes per day and with other characteristic symptoms; a severe form - a disease with more than 20 hot flashes per day and other symptoms, in which a woman almost completely loses her ability to work Forms of climacteric syndrome: typical - uncomplicated complicated - in combination with ischemic, hypertension, diabetes mellitus, arthropathy, osteoporosis atypical - symptoms prevail, indicating primary disorders in the hypothalamus, which is manifested by hypothalamic syndrome (most often with early menopause in young women)

Clinical picture General picture of the disease. In the early stages, symptoms of disorders associated with a violation of the nervous regulation of vascular tone appear - the so-called hot flashes and sweating. These symptoms are accompanied by significant disturbances in higher nervous functions: sleep disorders, increased irritability and excitability, and depression. In the future, there are symptoms associated with a decrease in the level of female sex hormones. Atrophy of the skin occurs (slow recovery of skin cells, its withering), as well as the mucous membrane of the vagina, which is manifested not only by unpleasant subjective sensations (primarily dryness and itching), but is also fraught with the addition of urinary tract infections. There is insufficiency of the sphincters of the bladder, which is manifested by involuntary urination (urinary incontinence). The clinic is diverse and manifests itself in neuropsychic, vegetative-vascular and metabolic disorders and is similar to diencephalic syndrome: neuropsychic manifestations: irritability, depression, tearfulness, aggressiveness, insomnia, headache, dizziness, nausea and vomiting, itching, vegetative vascular manifestations: sweating, heart pain, tachycardia (may be paroxysmal), arterial pressure lability; endocrine-metabolic disorders - decreased diuresis, thirst, edema, painful breast engorgement, flatulence, etc.

Diagnostics Complaints should be sorted into three groups: neurovegetative - hot flashes, sweating, dizziness, paresthesia, tingling in the heart area, tachycardia. All this, as a rule, happens at the time of high tide. psycho-neurotic - impaired memory, sleep, bad mood up to depression. somatic - atherosclerosis, systemic osteoporosis, atrophic changes in the internal organs During the first days of the examination, general analysis of blood, urine, TSH, the study of the level of potassium, sodium in the blood plasma, electrocardiography with physical activity (according to indications), x-ray examination of the chest. In pathological menopause, the electrocardiogram is normal or is characterized by the pathology of the T wave in the form of its decrease, smoothing and transition to a negative one, a shift in the S T interval, especially in the right (V1 Vz), less often in the left (V5 V6) chest leads, without dynamic changes (in contrast to from changes caused by ischemia), including after exercise. A test with nitroglycerin not only does not improve, but sometimes even worsens the ECG parameters and the well-being of patients.

Treatment Allocate drug, non-drug and hormonal treatment of menopausal syndrome.

The first stage is non-drug therapy: morning exercises physiotherapy exercises general massage proper nutrition (vegetables, fruits, vegetable fats should prevail in the diet) physiotherapy (collar with novocaine according to Shcherbak, galvanization of the brain, electroanalgesia. procedures 7-8 times spa treatment - hydrotherapy, balneotherapy , radon baths The second stage - drug non-hormonal therapy: vitamins A, C, E - improve the condition of the diencephalon and help well when the first symptoms appear; neuroleptic drugs - phenothiazine series drugs - meterazin, etaperazine, triftazin, frenolon; act at the level of the interstitial brain, affect the subcortical structures, and the Moscow school believes that they have a pathogenetic effect; start with small doses, and evaluate the effect after 2 weeks; tranquilizers - diazepam, elenium, if menopausal syndrome is combined with hypertension, then reserpine has a good effect in this case - pressure decreases, and gives a neuroleptic effect;

The third stage - hormone therapy Currently, the following main provisions on the use of hormone replacement therapy have been developed: the use of only analogues of natural hormones the appointment of low doses of estrogens, corresponding to the level of endogenous estradiol in the early phase of proliferation in young women, the combination of estrogens with progestogens, which makes it possible to exclude hyperplastic processes in the endometrium with a removed uterus, estrogen monotherapy can be prescribed; the duration of hormone prophylaxis and hormone therapy is at least 5- 7 years for the prevention of osteoporosis and myocardial infarction

Climacteric syndrome is a symptomatic complex that develops against the background of a decrease in the activity of the reproductive system, characterized by a whole complex of endocrine and neurological disorders. The clinic of this condition lasts about 2-5 years, but medicine knows cases of a more protracted menopausal syndrome - up to 10 years. Symptoms will depend on the severity of the development of this pathological process - there may be violations of not only the endocrine, but also the adaptogenic, psycho-emotional, cardiovascular system. Vasovegetative manifestations are not excluded.

This condition is observed in 80% of women aged 52–55 years, but men (45–70 years) are no exception in this case. Due to the specificity of the manifestation of the climacteric syndrome, problems with the diagnosis, as a rule, do not arise. However, laboratory and instrumental diagnostics will still be needed.

Treatment of menopausal syndrome is conservative and will include a whole range of therapeutic measures. In this case, it is important to consult a doctor in a timely manner, and not self-medicate or completely ignore the problem. Like any other pathological process, menopausal syndrome can cause serious complications.

Etiology

Menopausal syndrome in women develops due to a decrease in the amount and activity of a hormone such as estrogen. This process is not pathological, since the extinction of the reproductive function occurs as the body ages, that is, it is a natural physiological process.

However, there are a number of factors that can lead to the fact that the climacteric syndrome manifests itself in a more severe form.

These include:

the presence of infectious diseases, including STDs in a personal history;
genetic predisposition to the fact that a severe menopausal syndrome occurs;
the presence of chronic diseases that can recur in;
the presence of excess weight;
sedentary lifestyle;
malnutrition, constant overeating;
work in hazardous production;
frequent;
constant stress, nervous strain;
, lack of proper rest;
insufficient amount of sleep;
transferred operations;
lack of a stable sex life.

It should be noted that gynecology does not consider this process as a separate disease. In most cases, this is a natural reaction of the body to hormonal changes and changes in the functioning of some systems. But this does not mean at all that it is not necessary to treat the consequences of the syndrome, on the contrary, during this period one should be especially attentive to one's health.

Classification

The classification of the climacteric syndrome implies the division of this process according to several criteria - the features of the manifestation of the clinical picture and the severity of the course of the syndrome.

So, taking into account the time of manifestation of symptoms of menopausal syndrome, the following forms are distinguished:

early;
delayed - 1-2 years after the end of the menstrual cycle;
late - 2-5 years after the last menstrual cycle.

Climacteric syndrome according to severity is divided into such forms as:

light;
average;
heavy.

Determination of the severity of the course of the pathological process is determined by the Kupperman scale.

Climacteric syndrome in men has a slightly different classification by age:

early form - occurs at the age of 40-45 years;
common or medium - from 46 to 60 years;
late - after 60 years.

It must be said that the male climacteric syndrome proceeds in a milder form, and the reproductive function is fully preserved, which cannot be said about women.

Symptoms

In men, the clinical picture of this process proceeds in a mild form:

decrease in sexual desire;
depressed mood;
irritability,;
decrease in performance.

The development of this syndrome in women is characterized by a more complex and pronounced clinical picture.

Early symptoms of this process include:

headaches;
mood swings;
fever, increased sweating;
decreased sex drive.

Symptoms of the delayed form are characterized as follows:

dryness and peeling of the skin;
pain during intercourse;
urinary incontinence;
hair loss;
appearance of wrinkles.

The clinical picture of late symptoms will be characterized as follows:

tendency to diabetes;
increase in the concentration of harmful fats in the blood;

Asthenoneurotic manifestations of climacteric syndrome include:

apathetic mood;
irritability, irascibility;
insomnia, sleep disturbance;
hypersensitivity to provoking factors;
unstable psycho-emotional background.

In addition, the overall clinical picture will include the following symptoms:

shivering and chills for no apparent reason;
exacerbation of existing chronic diseases;
disruption of the cardiovascular system;
headaches, dizziness;
frequent hot flashes - from 10 to 20 times a day, depending on the severity of the course of the pathological process.

In a complex manifestation, such signs lead to a significant deterioration in the quality of life of a woman, therefore, already at the initial stage of the development of such a pathological process, it is necessary to consult a doctor and begin treatment.

Diagnostics

Diagnosis of climacteric syndrome, due to the specificity of the manifestation of the clinical picture and the age category, is not something difficult.

First of all, the doctor conducts a physical examination of the patient, during which he finds out the following:

how long ago the first symptoms began to appear;
when the menstrual cycle ended;
is there a sexual life, how stable is it;
the patient's lifestyle - nutrition, daily routine, features of labor activity.

The Kupperman scale is used, which determines the severity of the syndrome.

The severity of the following clinical signs is taken into account:

the frequency of hot flashes;
sleep quality;
nervousness, mood swings;
weakness, fatigue;
heart rate;
blood pressure indicators.

In addition, the diagnostic program includes:

analysis of hereditary history;
gynecological examination;
examination and palpation of the mammary glands;
analysis of the menstrual cycle;
cytological examination of smears from the cervix;
blood test - general clinical, detailed biochemical and hormones;
mammography;
coagulogram;
Ultrasound of the pelvic organs;
densitometry.

Based on the results of the research, the tactics of treating menopausal syndrome will be determined.

Treatment

Treatment of menopausal syndrome is carried out using only complex measures - drug therapy is combined with psychotherapy, correction of the daily regimen and lifestyle. Folk remedies should also not be neglected, but only as additional therapeutic measures and in agreement with the attending physician.

Hormone replacement therapy with sex hormones may be prescribed:

estrogens - are prescribed to patients whose uterus has been removed;
gestagens - are prescribed with a personal history;
combined preparations - estrogens with gestagens.

Phytotherapy, a special diet are also prescribed.

Additionally, the pharmacological part of the treatment may include the following drugs:

neuroleptics;
tranquilizers;
sedatives;
antidepressants;
vitamin and mineral complexes.

to live an active lifestyle;
Healthy food;
exclude alcohol, since it is incompatible with the drugs taken during treatment;
normalize the mode of work and rest.

Provided that the therapeutic measures prescribed by the doctor are observed, the prognosis is positive. However, in the presence of chronic diseases, complications may develop.

Possible complications

There is a risk of developing the following pathologies:

atherosclerosis;
arterial hypertension;
development of cardiovascular diseases.

Therefore, it is necessary to consult a doctor in a timely manner and begin complex treatment.

Prevention

Prevention of menopausal syndrome is as follows:

maintaining a healthy lifestyle;
an exception ;
regular sex life;
moderate physical activity;
daily outdoor walks.

In addition, it is systematically necessary to undergo a comprehensive medical examination, to carry out the prevention of infectious diseases, including STDs.

Is everything correct in the article from a medical point of view?

Answer only if you have proven medical knowledge

Climax is a natural process of withering of the body. The normal age of menopause is 49-53 years. Menopausal syndrome in women has many manifestations. The totality of signs is studied by the science of gynecology.

Menopausal syndrome refers to vegetative-vascular, metabolic-endocrine and mental disorders that occur against the background of the extinction of the hormonal function of the ovaries. The age at which the menopausal period begins is affected by:

genetic predisposition;
environmental factors;
smoking;
the number of births in history;
nervous shocks;
concomitant diseases (diabetes mellitus, obesity, chronic diseases);
taking certain medications (chemotherapy, hormonal treatment);
age of onset of menstruation.

The ovaries of a newborn girl contain about 40 eggs. Under the influence of adverse environmental factors, their death occurs. Childbirth and breastfeeding, on the contrary, preserve the body's natural resources.

Mild form of climacteric syndrome

The prevalence of mild attacks of menopausal syndrome is 40-60%. Occurs in otherwise healthy women. This group includes a pathological complex of complaints:

flushes of heat in the head and neck;
headache;
dizziness;
sweating;
emotional instability;
sleep disturbance.

The appearance of these symptoms is a classic sign of the manifestation of menopausal syndrome. Most often, a mild form of menopause begins with hot flashes to the head. Hot flashes last from a few seconds to several minutes. The number of attacks is 4-10 per day.

Severe form of climacteric syndrome

Symptoms of a severe form of menopausal syndrome occur in 30% of cases. This type of menopause is characterized by a sharp hormonal depletion, which leads to the sudden cessation of menstruation.

If such a condition occurs against the background of hypertension and atherosclerosis, then the vegetative symptoms are much more pronounced. Acutely felt to the body, accompanied by a throbbing headache, tinnitus, profuse sweating, pain in the heart. Menopause implies a decrease in memory and sleep disturbances: drowsiness intersects with insomnia.

At the time of a vegetative attack of menopausal syndrome, blood pressure rises, the pulse accelerates. A hypertensive crisis may occur. After the end of the hormonal release, the pressure is kept at the usual level.

Clinical picture

The first manifestations of menopausal syndrome are observed already in the period of premenopause. They begin at the time of menstrual dysfunction. Most often presented vegetatively, in the form of hot flashes. This is the result of the absence of a hormonal effect on blood vessels, a restructuring in metabolism, and the body's adaptation to a new stage of life.

Violation of the hormonal constancy of the blood leads to the failure of the organs. The brain selects those biologically active substances that will help stabilize the general condition. The clinic of the climacteric syndrome is characterized by:

violation of autonomic regulation (a sense of anxiety, a feeling of sinking heart);
hyperventilation syndrome (shortness of breath, feeling short of breath);
violation of the genitourinary system (urinary incontinence, atrophic vulvovaginitis);
slowing skin trophism (fragility of nails, the appearance of wrinkles).

Symptoms of menopause last 1-2 years, but may be longer. It all depends on the body's ability to quickly adapt to new conditions and the severity of concomitant diseases.

Atrophic vaginitis

Against the background of a decrease in the amount of estrogen in menopausal syndrome, the synthesis of protective cells of the vaginal mucosa slows down. Accordingly, the number of lactobacilli is reduced. Happens. Vaginal mucus changes from acidic to neutral. The growth of the intestinal flora, streptococci and staphylococci is activated, which can be manifested by an inflammatory reaction. Persistent atrophic vulvovaginitis develops.

Atrophic changes in the ligamentous apparatus of the small pelvis

Stable menopause occurs against the background of hormonal deficiency. There are functional changes in the reproductive organs. The uterus and appendages are reduced in size. The fallopian tubes undergo reverse development: they become thinner, lose cilia, narrow.

The ligamentous apparatus of the small pelvis consists of connective tissue. In the absence of hormonal influence, the tone of muscles and tissues decreases. The ligaments weaken, stretch, and can no longer perform their function. There is omission of the genital organs.

Violation of the normal nutrition of the skin

Sex hormones play a key role in metabolic processes. The process of cell division slows down. Mutations accumulate, the amount of collagen decreases, which is very typical for menopausal syndrome. There is a gradual aging of the skin. The first wrinkles appear. Dry skin, hair, brittle nails are noted.

Due to hormonal imbalance and a relative increase in male hormones, hair growth appears on the face, thighs, and abdomen.

Osteoporosis and disorders of the cardiovascular system

Late complications of menopause include disorders of the cardiovascular system. They can appear 3-7 years after the cessation of menstruation.

Osteoporosis is a systemic bone disease characterized by loss of bone strength. The process is due to a decrease in the content of estrogen, which leads to a metabolic deficiency in bone tissue.

Violation of hormonal constancy increases sensitivity to parathyroid hormone, which causes a decrease in calcium absorption from the intestine and bone destruction. This accelerates the destruction of bone cells.

The condition is manifested by fragility and pathological fractures of bones. There is a feeling of coldness in the extremities, periodic numbness, crawling under the skin.

Vasovegetative manifestations are due to estradiol deficiency. Hormonal failure leads to a change in the release by the brain of substances responsible for vascular tone, mood, and emotional calm. At the peak of the release of hormones, there is a heartbeat, interruptions in the work of the heart, compressive pains behind the sternum, pressure fluctuations. The condition is accompanied by a slowdown in the conduction of the nerve impulse.

Menopause diagnostics

Diagnosis of climacteric syndrome is not particularly difficult. First of all, the doctor conducts a survey, finds out the time of occurrence and the nature of complaints.

Then a gynecological examination is required to exclude the organic pathology of the genital organs. After the examination, the patient is sent for a blood test that determines the hormonal background.

Combined clinical and laboratory diagnostics allows us to draw the right conclusion. Women suffering from vegetative and vascular disorders, due to their age, are registered with a gynecologist.

Treatment

With the onset of menopause, first of all, attention is paid to the mode and nature of nutrition, as well as the caloric content of the food eaten. It must be remembered that adipose tissue takes over the function of estrogen release. Therefore, it becomes more. With a high-calorie diet, the risk of fat deposition in the thighs, abdomen, and neck increases.

It is necessary to limit the consumption of fatty varieties of fish and meat. Preference should be given to a low-calorie diet. It is required to increase the intake of fermented milk products to maintain the natural microflora of the body.

Fresh vegetable salads with a small amount of vegetable oil normalize intestinal motility. The oil contains fat-soluble vitamins A and E, which protect against harmful environmental factors.

Treatment of menopausal syndrome is based on the use of such groups of drugs:

vitamins (Menopeice);
calcium (calcium gluconate, Calcemin);
magnesium preparations (Magnicum, Magne B6);
metabolic drugs (Riboxin, Pentoxifylline);
sedatives (Valerian, Sedavit, Novopassit);
homeopathic preparations (Remens, Klimadinon, Tsiklim);
hormone replacement therapy (Femoston, Gestagens).

In 70% of cases, menopausal syndrome is stopped without the use of hormonal treatment. But with severe forms and long-term consequences of menopause, they are simply necessary. The treatment plan is selected individually, depending on how the pathological process manifests itself.

Conclusion

Menopause is an irreversible change. It is impossible to turn back time. The climacteric complex of symptoms (syndrome) is the transition from a young age to a mature one. He is not a disease. However, only a doctor should observe and adjust the treatment. Early treatment can help avoid serious complications.

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