The division of menopausal syndrome according to severity: causes, symptoms and treatment. Menopausal syndrome in women, symptoms, treatment

The body of a woman, in particular, her reproductive system, is distinguished by a number of features. Upon reaching the fair sex of 45-50 years, there is a gradual loss of childbearing function. This is a natural process that develops against the background of the restructuring of the work of the gonads and the central nervous system. All women experience menopause differently. Changes in the sexual cycle are gradual. After 55 years, the reproductive structures completely lose their natural function, physiological amenorrhea occurs.

In some cases, such restructuring is accompanied by unpleasant symptoms, which are combined into a climacteric syndrome. The natural transformations taking place in the body cause serious discomfort to patients. In addition to changes in the normal mental and emotional state, vegetative disorders also occur, as well as malfunctions in the cardiovascular and endocrine systems. Similar problems are diagnosed in 30-50% of women in menopause. It is important to distinguish normal clinical signs of menopause from pathological manifestations. To do this, you will need to visit a doctor and undergo a comprehensive examination.

Symptoms of the climacteric syndrome

The appearance of the restructuring of the work of the genital organs is accompanied by some features. All patients are prone to mood swings during this difficult period, which is associated with the influence of hormones on the psyche. However, not only the intensity of symptoms is important, but also their combination with vegetative manifestations. The clinical signs of menopausal syndrome in women include:

1. Sleep disorders, as well as cognitive problems, accompanied by memory impairment.
2. Anxiety, depression and the appearance of constant self-doubt.
3. Significant mood swings that are not associated with the phase of the cycle, exposure to stress and other environmental factors.
4. Fatigue, dizziness and migraines.
5. Changes in the genital organs are provided by the restructuring of the hormonal background. Frequent complaints of dryness of the mucous membranes of the vagina, itching and discomfort during intercourse.

Vegetative manifestations of pathology are considered the most significant and alarming. Premenopausal syndrome, that is, failures that occur at an early stage of restructuring, rarely lead to the appearance of such symptoms. Violations of the work of internal organs indicate a serious failure in the regulation of their activity by the central nervous system. The clinical picture in such cases includes:

1. The formation of vegetovascular dystonia (VVD), which is accompanied by pressure drops and unexplained pain in the chest.
2. Intense sweating and constant hot flashes. This sign also accompanies the normal course of menopause in some women, however, with pathological expression, it brings significant inconvenience.
3. Numbness of the fingers, a change in the nature of tactile sensations, convulsive contractions, which most often affect the muscles of the legs, and at night.

A peculiar classification of manifestations of VVD in case of illness has been adopted. It allows you to differentiate the severity of the pathological menopausal syndrome. The frequency of "hot flashes" in women per day is taken as the basis:

1. With a mild form, no more than 10 “attacks” are noted during the day. Half of women with this disease face a similar problem.
2. The second degree of severity is characterized by a greater intensity of clinical manifestations. There are from 10 to 20 "tides" within 24 hours. This form occurs in 30% of patients.
3. Severe menopausal syndrome is diagnosed in only 17% of women. It is accompanied by a high intensity of symptoms. The frequency of hot flashes reaches 20 per day.

Causes

The pathogenesis of the disease is associated with the development of hormonal changes in the body of a woman. The function of the sex glands is controlled by the hypothalamus - a special part of the brain that affects the pituitary gland. The latter produces protein compounds that stimulate the gonads. The ovaries normally respond by releasing hormones. In the process of aging, the work of the genital organs is restructured. At the same time, the hypothalamus is still trying to stimulate their natural function. The ovaries cannot produce the proper amount of biological compounds, which leads to the absence of menstruation and the loss of a woman's ability to bear children. However, in many cases, the onset of menopause occurs in a mild form. The following adverse factors contribute to the development of menopausal syndrome:

1. Constant exposure to stress negatively affects the functioning of the whole organism, including the function of the ovaries and the central nervous system.
2. Heavy physical activity also does not contribute to the reproductive health of women.
3. Endocrine disorders, such as diseases of the thyroid or pancreas, affect metabolic processes. This creates favorable conditions for further failures.
4. Inflammatory diseases of the pelvic organs in history. Pre-menopausal problems that affect the uterus, oviducts, or directly the gonads also contribute to the formation of menopausal syndrome.
5. Abuse of alcohol-containing drinks and smoking negatively affect many organs, including the genitals.

Diagnostic methods

As a rule, confirmation of the disease is not difficult. However, for correct treatment, a doctor's consultation is required. Diagnosis is carried out in a complex, on the basis of the collected anamnesis. Important parameters are the regularity of the sexual cycle, as well as the presence and frequency of menstrual bleeding. Confirmation of menopausal syndrome in women requires the exclusion of ailments similar in symptoms. This will require an examination of the patient, bacteriological tests and blood tests. Hormonal studies are most revealing in this case. Of great importance is the consultation of a psychotherapist, who will help to cope with possible cognitive impairment and sleep disorders.

Treatment of pathology

Since menopause is a natural process, therapy is limited to alleviating this condition and correcting symptoms. Changing the lifestyle of a woman is of great importance. Clinical recommendations include, first of all, the rejection of bad habits. Alcohol and cigarettes lead to an even greater imbalance in the work of the genital organs and the central nervous system. Moderate physical activity has a positive effect. They help prevent the development of complications associated with malfunctions of the cardiovascular system.

Recommendations for menopausal syndrome also apply to diet. The diet is required to include foods rich in fiber. This is due to their normalizing effect on the gastrointestinal tract. There is a direct link between the balance of microflora in the digestive system and the reproductive system. This is due to the peculiarities of their anatomical location in the fair sex. Exclusion from the menu of fatty, fried and salty foods will also have a beneficial effect on the course of menopause.

Medical support for women in this difficult period is reduced to the use of drugs based on estrogens and progestogens. They allow you to deal with the vegetative-vascular manifestations of menopausal syndrome, which are associated with hormonal changes. The use of these funds is possible only when prescribed by a doctor, since only patients with severe severity of the disease need to use medications. As a symptomatic therapy, various tranquilizers and antipsychotics are used, which help to improve the general condition of patients.

Alternative methods of treating menopausal syndrome are reduced mainly to the use of decoctions based on herbs that have a sedative effect. These include motherwort, valerian and mint. These plants allow you to deal with anxiety and stress, which women suffer during menopause.

To date, hormonal therapy for the manifestations of menopausal syndrome is the main option in the fight against the problem. Moreover, with a mild clinical picture, local remedies are used. For example, the use of vaginal suppositories and ointments to reduce the manifestations of atrophic changes in the mucous membrane shows good results. Such drugs do not have as many contraindications and side effects as systemic drugs.

However, despite all the benefits of hormone replacement therapy, there are alternative treatments for menopausal syndrome. They are often used as an adjunct to medical support. For example, red clover extract, which contains a large amount of isoflavones, is used as a source of estrogen. Soy has a similar therapeutic effect. Despite the widespread use of such methods, they have not been proven effective, although some women report relief of vaginal symptoms. If there are contraindications to the use of hormonal drugs to combat the vasomotor manifestations of menopause, agents from the group of serotonin reuptake inhibitors, such as Fluoxetine, are used.

Possible Complications

The unpleasant consequences of the disease most often include both significant damage to the genital organs and cognitive impairment. If the symptoms are ignored, women suffer from chronic insomnia, depression and severe stress, which only aggravates the course of menopause.

Prevention

Preventing the development of unpleasant symptoms comes down to following the principles of a healthy lifestyle. Regular visits to the gynecologist also contribute to the easy flow of menopause. Early detection of problems favors their faster and smoother flow. Self-medication is dangerous, therefore, if unpleasant symptoms appear, you should consult a doctor.

In the life of a woman, the following periods are distinguished: newborn (10 days after birth), childhood (up to 8 years), puberty (8-18 years), puberty, or reproductive (up to about 45 years) and menopause. The latter represents the natural or physiological process of the termination of childbearing function due to the extinction of ovarian function. With an average life expectancy of 75 years, it accounts for a third of a woman's life. Given the long duration, it is divided into several periods - premenopause, menopause and postmenopause.

premenopause begins at 45.5 - 47.5 years and lasts until menopause- the last menstruation, which occurs at 50 - 51 years. During this period, fewer eggs mature in the ovaries. Therefore, the onset of pregnancy in this period is theoretically possible, but unlikely. The date of menopause is considered true if there is no menstruation within 12 months. In some countries, menopause is considered the day 12 months after the last menstrual period. With the onset of menopause, the eggs in the ovaries do not mature. In the body of every woman, the time of menopause is genetically programmed. In addition to natural menopause, there can be artificial, caused by surgical shutdown of ovarian function, i.e. their removal due to various diseases in the reproductive period.

Next, postmenopausal period lasts until death. The main distinguishing feature of this period is the high level of gonadotropins (follicle-stimulating and luteinizing hormones produced by the pituitary gland) against the background of a sharp decrease in estrogen production by the ovaries.

The climacteric period can be asymptomatic or accompanied by a complex of manifestations that make up climacteric syndrome. This syndrome usually begins in the premenopausal period and may persist into the postmenopausal period. The duration of the syndrome varies widely: from several months to 5 years (in a third of patients), 5–10 years (in half), more than 10 years (rarely). In other words, the climacteric syndrome is a set of symptoms observed in the complicated course of the menopause. With its uncomplicated variant, one or two symptoms may be observed that do not disrupt the woman's performance, and she does not seek medical help. Thus, in one study it was shown that among women aged 45–54 years, 84% had at least one classic symptom, of which 45% noted that one or two manifestations of the climacteric syndrome were a serious problem for them. Usually, the manifestations of the climacteric syndrome are most pronounced within 12 months. before menopause, then in the next six months, the intensity decreases. Approximately 80% of women after 8-12 months. after menopause, the symptoms of menopausal syndrome disappear.

The life expectancy of the world's population continues to increase; while the proportion of able-bodied people is declining. In some countries, women's life expectancy has reached 80 years, by 2050 this figure may exceed 100 years. Given the desire of modern man for a high quality of life with a full working capacity, it becomes clear that this problem is acquiring not only a medical and personal nature, but also a social one. Suffice it to say that 9 out of 10 women take various drugs or alternative medicine to alleviate certain manifestations of menopausal syndrome.

There are several groups of disorders and disorders in menopausal syndrome:

1.Vegetative-vascular (vasomotor) disorders: hot flashes to the head, sweating, chills, palpitations, pain in the heart area, dizziness, numbness in the arms and legs, headache, changes in blood pressure (hypotension or hypertension).

2.Emotional and mental disorders: mood swings, insomnia, drowsiness, memory loss, tearfulness, irritability, forgetfulness, inattention, fear, anxiety, depression, fatigue with decreased performance, decreased sexual desire, suicidal thoughts, in severe cases - hallucinations.

3.Changes in the genitals and urinary system: dryness, itching and burning in the vagina, pain during intercourse, prolapse of the walls of the vagina and uterus, frequent urination, urinary incontinence, pain in the bladder, etc.

4.Changes in the skin and its derivatives: wrinkles, dryness, thinning and hair loss, brittle nails.

5.Late metabolic and endocrine disorders: obesity, atherosclerosis, osteoporosis, cardiovascular disease, Alzheimer's disease.

Below is a brief description of these symptoms and diseases associated with menopausal syndrome, in the order in which they are observed - from early to late.

tides- a typical, early and most constant complaint, which patients describe as a sudden sensation of heat in the face, neck, spreading throughout the body and usually lasting 1-3 minutes. As a rule, women experience hot flashes for 6 months to 2 years, but some have them for more than 10 years. Among patients with menopausal syndrome, hot flashes are observed in more than 90%. The frequency of hot flashes is considered as an indicator of the severity of this syndrome (mild form - up to 10 times a day, medium - 10–20, severe - more than 20). Usually, hot flashes are accompanied by sweating, palpitations, anxiety, suffocation, dizziness, chills. More often they occur at night, during emotional overstrain, in hot weather, after drinking hot drinks, spicy foods, alcohol, and even being in a warm room.

All of the above symptoms are due to estrogen deficiency and are observed in a variety of combinations. A wide range of changes is due to the presence of estrogen receptors in many organs and tissues: genitals, pelvic floor muscles, mammary glands, in the cells of the heart and blood vessels, brain, bones, in the larynx, oral and eye mucosa (conjunctiva).

Usually, from the age of 40, menstruation becomes longer or shorter, scanty or plentiful, irregular - more or less frequent. In rare cases, the rhythm and nature of menstruation is not disturbed until the menopause itself. Atrophic vulvovaginitis(or senile, senile colpitis) is accompanied by dryness, burning and itching in the vagina, pain during sexual intercourse. There comes atrophy of the external genitalia and mammary glands. Atrophic changes in the bladder and urethra lead to stress incontinence, pain in the bladder (cystalgia), painful and frequent urination. These changes in the genitourinary system in the absence of treatment progress. In postmenopause, the frequency of prolapse and prolapse of the genital and pelvic organs (the walls of the vagina, uterus, bladder, rectum) increases, which is also due to estrogen deficiency (uterine ligaments and pelvic floor muscles contain receptors for these hormones).

The skin contains a large amount of collagen, the amount of which decreases significantly in the peri- and postmenopausal periods. As a result the skin becomes thinner, becomes dry, wrinkles appear, especially on the face and hands.

Decreased estrogen during menopause increases the risk of cardiovascular disease, as evidenced by many observations. Men, whose estrogen content is very low compared to women, are several times more likely to suffer a myocardial infarction before the age of 50. By the age of 70, the incidence among both sexes is the same.

Osteoporosis represents a serious medical and social problem. Decreased bone density makes them more fragile. The disease is often asymptomatic and does not show up for years before the onset of postmenopausal fractures, usually in the hip, wrist, and vertebrae.

Development is associated with the menopause Alzheimer's disease, occurring in about 15% of people over 80 years of age, although the disease can begin in adults at any age. In Alzheimer's disease, atrophy of the cerebral cortex occurs, the death of neurons in the cortex and subcortical structures, which is accompanied by gradually developing memory loss, followed by slowly progressive dementia.

According to a number of studies, hormone replacement therapy in women (estrogens or their combination with progesterone) reduces the risk of postmenopausal coronary heart disease (by 30-40%), osteoporosis and Alzheimer's disease.

Diagnostics of the climacteric syndrome usually causes no problems. In some cases, it may be necessary to determine the blood follicle-stimulating hormone and estrogens, thyroid hormones (hypothyroidism can cause symptoms similar to those in menopausal syndrome). It is necessary to remember the importance of a gynecological examination at least once a year. It should not be in the premenopausal period to "write off the menopause" heavy uterine bleeding; in the postmenopausal period, there should be no bleeding from the vagina. They can occur with precancerous and malignant diseases of the female genital organs. In all these cases, as well as any changes in the nature of menstruation, you should consult a doctor. Delayed menstruation in the premenopausal period can be caused by pregnancy, but this is rare.

Non-drug treatment of menopausal syndrome

First of all, when any manifestations of the climacteric syndrome appear, one should not despair. Menopause does not mean the end of life, a third or half of your life is ahead of you. Menopause does not cancel femininity and sexuality. In case of severe manifestations of menopausal syndrome, you should immediately consult a doctor. The more effective the treatment of menopausal syndrome, the earlier started.

Treatment begins with the organization of a healthy lifestyle. To reduce the intensity of already existing manifestations and reduce the risk of late disorders associated with menopausal syndrome, it is necessary to stop smoking (aggravates all manifestations of menopausal syndrome), engage in or continue physical education. Daily 30-minute exercise has been proven to help prevent cardiovascular disease, diabetes, osteoporosis, obesity, and reduce stress. To reduce the number of hot flashes, yoga classes are useful, during which they are taught to control breathing, to relax.

Do Kegel exercises to strengthen your pelvic floor muscles. Their essence lies in the alternate contraction and relaxation of the muscles that raise the anus; exercises are performed 3 times a day; the number of repetitions is 15–20, the duration of muscle contraction is 5 s. These exercises are effective for stress urinary incontinence.

Food should contain fiber and fiber (wholemeal bread, bread with bran, whole grains, vegetables, fruits, legumes), vegetable fats. Limit carbohydrates.

It is necessary to normalize sleep by giving up drinks containing caffeine.

Effective physiotherapy, baths (pearl, foamy, oxygen, nitrogen, etc.).

Medical treatment of climacteric syndrome

It has been proven that estrogens alone or estrogens in combination with progestogens alleviate vasomotor (vegetative-vascular), emotional and mental disorders, as well as symptoms from the genitals and urinary system. However, only those women who have a severe menopausal syndrome need hormone replacement therapy (HRT). This is due to the serious side effects of this therapy: an increased risk of breast and uterine cancer, stroke and vein thrombosis. Therefore, before prescribing HRT, the benefits of it are carefully compared with possible complications. The patient is required to provide written informed consent for HRT. Be sure to perform a study of cytological smears, ultrasound of the genital organs and mammary glands, determine blood coagulation factors (coagulogram), cholesterol concentration, etc. The arsenal of hormonal preparations is quite wide, in each case they are selected individually. Women with a removed uterus are usually prescribed only estrogens, with a preserved uterus, progestogens are added to them to prevent hyperplastic processes and endometrial cancer. Hormonal preparations are prescribed orally and parenterally (intramuscularly, transdermally in the form of patches and gels, into the vagina in the form of suppositories, tablets and capsules). With topical application of estrogens, side effects are insignificant, so such forms can be prescribed to women with a preserved uterus without combination with progestogens. Combination with a progestogen is desirable when using uterine rings that release large amounts of estrogens. The symptoms of atrophic vulvovaginitis can be eliminated with the help of local (intravaginal) use of estrogens in the form of creams, tablets, uterine rings. This treatment leads to the elimination of some symptoms from the urinary system (see above).

The appointment of estrogens in the postmenopausal period reduces the breakdown of collagen in the skin.

For the treatment of menopausal syndrome and the prevention of osteoporosis, a new effective drug tibolone (Livial) has appeared, which is a synthetic steroid prohormone with estrogenic, progestogenic and androgenic activity. At a dose of 2.5 mg / day, it is prescribed to women after 12 months. after menopause. Livial does not have a proliferative effect on the mammary gland and endometrium, so it can be used in women with a preserved uterus. The possibility of its use in patients with breast cancer is being studied. However, despite the absence of many side effects of this drug, it should be taken only under medical supervision.

In case of emotional and mental disorders, tranquilizers (tazepam), neuroleptics (frenolone), neurometabolic stimulants (aminalon, nootropil, etc.), herbal medicines (deprim contains an extract of St. John's wort) are prescribed. In addition, cinnarizine, belloid, bellataminal are prescribed.

To eliminate or reduce hot flashes, antidepressants (serotonin reuptake inhibitors) are used: paroxetine, sertraline (Zoloft), fluoxetine and venlafaxine. For this purpose, the anticonvulsant drug gabapentin and the antihypertensive clonidine (clophelin) are prescribed.

For the prevention of osteoporosis, it is justified to take vitamin D at a dose of 800 units. and calcium up to 1.5 g per day. Preparations from the group of bisphosphonates (alendra, bonefos, bonviva, etc.) successfully replace estrogens for the prevention of osteoporosis. Selective estrogen receptor modulator raloxifene increases bone mass, reduces calcium loss through the urinary system.

This information is provided for informational purposes only and should not be used for self-treatment.

Prevention of menopausal syndrome does not begin with the onset of menopause, but much earlier, from the reproductive period. This is, first of all, a healthy lifestyle and timely prevention and treatment of various diseases.

The cessation of menstruation in a woman indicates the onset of menopause and the physiological cessation of the female reproductive organs. The process begins a year later from the moment of the last menstruation. The last period in a woman's life is called menopause.

The onset of menopause is normally observed in women at 45 - 50 years of age. However, there is an early menopause on the background of gynecological diseases and iatrogenic (after surgical removal of the gonads in women).

Regardless of the beginning of the process in the body of a woman, the same changes occur:

• Changes in the hormonal background (increase in the concentration of follicle-stimulating and luteinizing hormones in the blood; decrease in estrogen levels).
• Stopping the maturation of eggs in the ovaries.

The climacteric syndrome manifests itself in all patients in different ways and changes begin in the premenopausal period. The final relief of all signs of the syndrome occurs in the postmenopausal period. The duration of menopausal syndrome in women varies individually: from 3 years to 10 years or more. In 50% of patients, the duration of symptoms is from 3 to 7 years.

There is an alternative point of view, confirmed by studies, according to which in 80% of patients in the postmenopausal period, all symptoms disappear completely.

Clinical manifestations

The climacteric syndrome is diverse in intensity and clinical symptoms. Rare lucky women can boast of a slight onset of menopause. The majority of women go to the doctor with the following complaints:

• hot flashes, sweating;
• feeling of heat;
• headache;
• sleep disorders;
• nervousness, depression;
• development of hypertension and hypertensive crises;
• interruptions in the work of the heart;
• chest pain;
• bone pain
• increased emotional sensitivity.

How does the climacteric syndrome proceed?

The course of the climacteric syndrome is divided into complicated and uncomplicated. In the first variant, several symptoms appear that do not violate the woman's habitual lifestyle and working capacity.

Symptomatic manifestations

Features of the clinical course of menopausal syndrome are divided into groups:

• Vaso-vegetative manifestations (disorders of the cardiovascular system, an increase or decrease in pressure, pain of various localization, hot flashes, sweating, a feeling of goosebumps all over the body).
• Disorders of the emotional and mental sphere (frequent mood swings, depression, constant fatigue, desire to sleep, insomnia, decreased performance, memory impairment, inability to concentrate, decreased sexual activity).
• Changes in the work of the genitourinary system and painful conditions (thrush, insufficiency of the function of producing protective mucus in the genital tract, pain during sex, increased urination, leakage of urine during physical exertion, weakening of the ligamentous apparatus of the uterus and vagina, pain during urination, urinary incontinence).
• Withering of the skin, changes in hair, nails (appearance of new wrinkles and deepening of existing ones, thinning and hair loss, delamination and wringing of nails).
• Metabolic changes (tendency to obesity, atherosclerosis, osteoporosis, cardiovascular disease and Alzheimer's disease).

The main reason for all pathological changes in a woman's body is a decrease, and then the cessation of estrogen synthesis. Such a clinical variety of symptoms is associated with the presence of receptors for female sex hormones in all tissues and organs.

tides

In order of manifestation, tides appear first. A characteristic feature of suddenness. The patient feels a sudden heat in the face, neck and then all over the body. The tide is accompanied by hyperemia (reddening of the skin), difficulty breathing, increased heart rate, sometimes chest pain and sweating, and this symptom occurs in 90% of cases. The period of manifestation of tides varies from six months to 10 years.

The severity of the clinical picture is determined by the frequency of manifestation:

• mild degree (1 - 10 times a day);
• medium degree (11 - 20 times a day);
• severe degree (more than 20 times a day).

Patients note the manifestation of the symptom mainly at night, in summer, in a well-heated room, when drinking strong drinks, spicy foods, tea, coffee.

Variations in the menstrual cycle

The next sign of menopause is cycle changes. After reaching the age of 40, the monthly cycle is shortened or lengthened, the discharge becomes less abundant. Increased menstrual flow is an alarming symptom and indicates the development of a pathological process in the female genital area.

The work of the genitourinary system

The main manifestation of inflammatory diseases of the genital tract against the background of mucosal atrophy (vulvovaginitis, colpitis) is the appearance of dryness, burning and itching in the vagina, dyspareunia (pain during sex). Secondary sexual characteristics atrophy.

Dystrophic processes of the urinary tract lead to leakage of urine during physical exertion, pain in the bladder (cystalgia), dysuria. Lack of adequate therapy leads to the progression of all symptoms.

A change in the elasticity of the ligamentous apparatus leads to prolapse and prolapse of the uterus, rectum.

Other manifestations of menopause

A decrease in estrogen synthesis entails a decrease in the amount of collagen fibers in the skin, resulting in the appearance and deepening of wrinkles. The skin itself becomes thinner, loses elasticity and dries out mainly on the face and hands.

In the postmenopausal period in women, the percentage of cardiovascular pathology is equal to that of men.

A decrease in the calcium content in the bones of the skeleton leads to osteoporosis. With this disease, bone strength decreases and the slightest injury causes fractures, which is of great social importance. The course of the disease is asymptomatic for a long time and manifests itself directly with injuries. Typical fracture sites: femoral neck, vertebral bodies and forearm bones in a typical location (lower third).

Alzheimer's disease menopause can manifest itself from the defeat of the nervous system. With this nosology, the cerebral cortex atrophies, the neurons of the cortex and subcortical structures die. Clinically manifested by a gradual progressive deterioration of memory and the development of mental dementia.

It is possible to prevent the development of all pronounced and undesirable consequences for the patient's health with the help of replacement therapy (estrogen and progesterone).

Diagnostics of the menopausal syndrome

The diagnosis of "climacteric syndrome" is based primarily on clinical data. Laboratory confirmation consists in the study of the patient's hormonal background (follicle-stimulating hormone and estrogens, thyroid hormones).

All postmenopausal women should have an annual check-up with a gynecologist. The appearance of pathological spotting on underwear during premenopause, a change in the nature of menstruation should alert you to malignant diseases of the female genital organs. The absence of menstruation during this period in rare cases can be a sign of pregnancy.

Non-drug correction of climacteric syndrome

Remember that any change in the body is a way of life. Climax is no exception. Seeking specialist care early offers a better chance of preventing diseases and preventing their health consequences.

First of all, change your habitual way of life:

• Go in for fitness or yoga - physical activity reduces the risk of heart disease and blood vessels, obesity, diabetes. Cycling or cycling is a great way to strengthen your pelvic floor muscles.
• Drink more water, reduce the amount of carbohydrates consumed. Enrich your diet with fiber-rich foods.
• Take multivitamins.
• Avoid or reduce your intake of coffee and alcoholic beverages whenever possible.
• Get enough sleep (the normal duration of sleep for an adult is 8 hours).
• Start walking before bed.
• After consulting a physiotherapist, go through a general strengthening course of procedures.

In the case of the severity of the symptoms of menopausal syndrome, the attending physician will prescribe drug therapy.

Hormones in the treatment of menopause

Replacement therapy with a complex of estrogens with progesterone improves well-being, levels the manifestation of vegetative-vascular reactions, stabilizes the emotional and mental state and eliminates the symptoms of inflammatory and atrophic diseases of the genitourinary system.

Hormone replacement therapy is indicated for patients with severe menopause.

The risk of breast and uterine cancer, cerebrovascular accident and vein thrombosis are undesirable consequences of hormone replacement therapy.

The decision to use hormonal drugs is made by the doctor after a full examination, weighing the risks and informing the patient in detail.

The complex of examinations before prescribing estrogen and progesterone includes:

• detailed history taking;
• study of the cellular composition of smears;
• ultrasound examination of the organs of the reproductive system and mammary glands;
• mammography;
• bone densitometry;
• study of indicators of coagulogram and biochemical analysis of blood.

The number and composition of drugs that are prescribed to a woman are affected by surgical interventions on the organs of the reproductive system. For example, patients after a hysterectomy are prescribed exclusively estrogens. Progestogens with estrogens in the menopausal period are recommended for patients who have preserved all organs in order to prevent the development of malignant diseases.

Routes of drug entry into the body

The methods of administering hormonal drugs are diverse and you can choose the option that is optimal for the patient: intramuscular, dermal - patches and gels, vaginal - suppositories, tablets and capsules).

Manifestations of atrophic vulvovaginitis can be corrected by intravaginal administration of estrogens (creams, tablets, uterine rings).

Prevention of diseases of other organ systems

The intake of estrogens in a woman's body slows down the process of breakdown of collagen fibers and thus prevents skin atrophy.

Treatment and prevention of osteoporosis in menopausal syndrome is carried out with calcium preparations, vitamin D, bisphosphonates and a recently appeared synthetic steroid prohormone, which has an estrogenic, progestogenic and androgenic effect.

Correction of changes in the emotional and mental sphere is carried out with tranquilizers, antidepressants, sedatives.

To normalize the lipid spectrum, statins are prescribed, for obesity - drugs that affect metabolism, diuretics. A change in the patient's pressure requires the appointment of antihypertensive drugs.

The use of homeopathic preparations or the use of herbal teas, tinctures and decoctions of herbs (boron uterus, chamomile, red brush, etc.) is relevant.

Conclusion

Timely diagnosis, correction and prevention of menopausal syndrome helps to maintain a woman's health and high quality of life. Drug treatment (hormonal therapy) should be used according to strict indications, which are determined by the attending physician.

As women age, hormonal changes occur naturally. But many women are afraid of menopause, because there is an opinion that menopause is always malaise, hot flashes, loss of emotions from intimate relationships. Is it so? Or is the menopausal period just the next stage in a woman's life and development? What is the menopausal condition of a woman, when does it occur and how does it manifest itself, what treatment is indicated during menopause, read below.

What is menopause in women

Menopause is the natural state of a woman when she reaches a certain age. Every woman has a certain formed stock of eggs in the ovaries. The ovaries produce the female hormones estrogen and progesterone, which regulate female fertility, and as a result, ovulation and menstruation occur cyclically every month. When the supply of eggs is used up, menstruation stops, hormone production decreases significantly and menopause begins.

Symptoms

A woman should know information about how the menopause manifests itself, what hot flashes are. It is important to be able to get rid of hot flashes quickly so as not to feel discomfort in public, in the office, etc. As a rule, they manifest themselves in a feeling of unexpected heat, which lasts for several minutes and is replaced by a feeling of cold, perspiration appears on the woman's body - this is a reaction of the nervous system to a decrease in hormone production. Washing with cold water helps to relieve an attack of heat, if this does not help, you need to choose a medicine with the help of a doctor.

Other possible signs of the onset of menopause:

• irregular menstruation;
• uterine bleeding;
• sudden mood changes;
• heartbeat quickens;
• pressure surges;
• nausea;
• headache;
• pain in the joints and muscles;
• dryness of the vagina;
• decrease in sexual desire;
• fast fatiguability;
• sleep disorder;
• neurosis;
• depression may develop.

When it comes

At what age and how does menopause begin? After 40 years, women experience premenopause: rare or frequent menstruation is observed, dysfunctional bleeding is possible, the development of menopausal cardiopathy, spotting spotting is possible between menstruation. It is important to know why this period is dangerous: changes in the body can be symptoms of gynecological diseases, such as uterine fibroids. A menopause test will help confirm the onset of premenopause. A stable basal temperature also indicates the onset of a menopause period.

Nevertheless, there is no definite answer to the question of how old a woman begins menopause, because the onset of menopause is influenced by genetic factors, working conditions, climate, lifestyle, and the presence of bad habits. But in most women, menopausal changes begin after 45 years, if after 50 years it is a late menopause. Today, many specialists in gynecology are inclined to believe that late menopause should be called its onset after 55 years.

A common occurrence these days is an early menopause. The causes of early menopause, which can begin at the age of 30, are heredity, immunity disorders, or the results of medical intervention. Premature menopause in exceptional cases can occur even at 25 years of age as a result of damage to the ovaries after chemotherapy or surgical removal of the ovaries for medical reasons. But such a menopause is pathological and necessarily requires treatment in order to even out the hormonal failure of the female body at a young age.

How long is menopause

In menopause, the phases of premenopause, menopause and postmenopause are distinguished. How long does hormonal changes in the body take?

• Premenopause lasts 2-10 years, until menstruation stops.
• Menopause occurs 1 year after the cessation of menstruation.
• The postmenopausal period begins at the onset of menopause and lasts 6-8 years, during which time the symptoms of menopause - such as hot flashes - may persist, but are easier.

Treatment for menopausal syndrome

To alleviate the manifestations of menopause, you need to know what to take when a headache pesters, how to relieve hot flashes or other unpleasant symptoms, and stop uterine bleeding. One of the commonly used drugs in the treatment of menopausal syndrome is homeopathic tablets "Remens". A woman, after consulting a doctor, will be able to choose which means it is better for her to use.

homeopathic medicines

Homeopathy for menopause offers remedies in the form of tablets or drops. In the menopause, a whole range of health problems are manifested, which are based on vegetovascular symptoms - hot flashes, excessive sweating, palpitations, and psycho-emotional - irritability, insomnia, increased fatigue. It is possible to solve a complex of problems with menopause due to the natural components in the composition of the drug Klimaktoplan. The action of the drug is aimed at eliminating two main problems: manifestations of autonomic dysfunction and neuro-emotional discomfort. The drug is of European quality, does not contain hormones, is available without a prescription, is well tolerated, and is produced in Germany.

Folk remedies

Traditional medicine recipes are often shared by women based on their experience. To maintain physical tone and good mood, water procedures are good - soothing herbal baths (Potentilla root, lovage). For the prevention of general health, teas and decoctions from medicinal plants are used: chamomile, mint, pine forest, nettle, hawthorn. For optimal well-being during this transitional period, you need to plan your daily routine, eat right, and fully relax.

Hormonal drugs

Hormone therapy is used only after a medical examination of a woman and as prescribed by a doctor, since it has a number of contraindications. But if complications such as obesity, osteoporosis, cardiovascular diseases occur during the menopause, additional hormone intake is necessary. Doses of hormones contained in the preparations "Klimonorm", "Femoston", "Kliogest" replace the missing production of the body's own hormones.

Phytopreparations

With menopause, plant-based medicines are also used, for example, Inoklim, Klimadinon, Feminal, and in addition, vitamin-mineral complexes can be used alone or as part of hormone therapy. The composition includes phytoestrogens - substances similar in structure and function to female sex hormones, but phytohormones have a much less pronounced effect on the female body. Vitamins and trace elements have a strengthening function and help to remove the negative manifestations of age-related metabolic disorders.

vitamins

A woman is always pleased to know that she is taken care of. It's even nicer to feel it. In the field of women's well-being, Lady's Formula Menopause Enhanced Formula has proven itself ideally. A well-known complex of traditional vitamins, the most important minerals and extracts of rare medicinal plants effectively helps women cope with the problems that arise during the menopause. Thanks to a comprehensive approach to the elimination of menopausal symptoms, gentle effects and the absence of side effects, Lady's Formula Menopause Strengthened Formula biocomplex has become the drug of choice for many women to maintain a high quality of life during this period.

When you take Lady's Formula Menopause Enhanced Formula, you will no longer be bothered by hot flashes, tachycardia, irritability, insomnia, you will say "no" to excess weight and frequent urge to urinate. In addition, you will enjoy a healthy, fresh complexion and elasticity of the skin, shine and strength of the hair.

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What is premenopause

The premenopausal period is the period of transition to menopause, during which a woman's level of estrogen produced by the ovaries decreases over several years. Harbingers of premenopause:

• delayed menstruation;
• exacerbation of premenstrual syndrome, a sudden change in mood;
• painful sensitivity of the mammary glands;
• itching and dryness of the vagina, discomfort during intercourse;
• decrease in sexual desire;
• frequent urination;
• urinary incontinence when sneezing or coughing.

Doctors diagnose the premenopausal period based on the symptoms that a woman has and on the basis of a blood test for hormone levels, which must be taken several times due to unstable hormonal levels during this period. Premenopause is a natural state for women in their 40s and 50s, continuing until menopause, when the ovaries stop producing eggs.

Pregnancy with menopause

Is it possible to get pregnant during menopause? Yes it is possible. The childbearing function of a woman during the premenopausal period is significantly reduced, but there is a chance of pregnancy. If this turn of fate is undesirable, it is necessary to continue the use of contraceptives for 12 months after the last menstruation. But sex after menopause is still able to bring bright colors to a woman's life, and sex life should by no means end in the postmenopausal period.

Often, the period of menopause in women is accompanied by rather unpleasant sensations that can disrupt her general condition or even lead to impaired performance. The concept of climacteric syndrome in women includes a symptom complex of neurovegetative, psycho-emotional and endocrine disorders with varying degrees of severity and duration during the age-related decline of a woman's reproductive functions.

Pathogenesis of the climacteric syndrome

The regulation of the functioning of the cyclical process of the reproductive system of a woman is based on the feedback of the main three links: the hypothalamus - the pituitary gland - the ovaries. The hypothalamus produces releasing hormones that regulate the production of follicle-stimulating hormone and luteinizing hormone, which, in turn, regulate the hormone-producing function of the ovaries. And the ovaries, through the synthesis of estrogens, act on the hypothalamus and the chain closes. Such phenomena normally occur in a healthy woman of the reproductive period. But with age, involutive changes occur in both the ovaries and the hypothalamus. And the reduced amount of estrogen produced by the ovaries is not enough for their perception by the hypothalamus. As a result, the production of follicle-stimulating hormone does not stop, and even increases, which subsequently inhibits ovulation, during which the woman's body loses reproductive function. Thus, the climax itself develops.

Gynecology considers climacteric syndrome from another angle. With a decrease in estrogen synthesis at an older age, the adrenal cortex partially takes over the function of producing sex hormones, as a result of which the woman's menopause proceeds quite smoothly without disturbances. If this does not happen, as a result of any violations of the functional state of the adrenal glands, the climacteric syndrome (ICB10 code N95) comes into effect in a woman. But the main role in the pathogenesis of menopausal syndrome is still played by involutive (age-related) changes in the hypothalamus.

Menopausal syndrome: clinic, diagnosis

How does the climacteric syndrome manifest itself?

Clinical manifestations are due to a rather complex etiopathogenesis, which we will not go into, but we will consider in detail the possible manifestations characteristic of this difficult condition. Manifestations of climacteric syndrome can be of varying degrees.

The most common symptom in women is hot flashes, which occur as a result of a violation of the nervous regulation of vascular tone, which entails violations of the nervous regulation of higher centers, resulting in irritability, night sleep disorders, and a tendency to depressive states. This also includes the appearance of severe headaches, feelings of nausea, dizziness, which all arise for the same reason. Flushes of heat followed by profuse sweating and then chills.

How does menopausal syndrome manifest itself in women on the skin?

As a result of a direct decrease in the synthesis of hormones, the skin suffers, atrophic changes develop, elasticity decreases, recovery in case of damage takes much longer. Similar changes in the vaginal mucosa join the atrophy of the skin. It becomes dry, prone to damage (during intercourse, gynecological examination), itching and burning sensation appear. Local immunity in the vagina decreases, which can lead to the development of an infectious process.

Urinary incontinence also occurs due to the weakening of the urethral sphincter, which again contributes to the attachment of a secondary infection and the development of inflammatory processes in the urinary system.

All of the above complaints can also include the appearance of edema, thirst, bloating (flatulence), fluctuations in blood pressure.

Diagnosis of menopausal syndrome is based on the collection of complaints from women and gynecological examination. In the future, the patient undergoes a complete mandatory examination: consultations of related specialists, ECG, blood and urine tests, in order to clarify the severity and form of the disease in order to provide full assistance.

Climacteric syndrome: severity

Depending on the frequency of the above manifestations in a woman, menopausal syndrome is divided into degrees of severity. Mild degree or form, which is characterized by the presence of hot flashes up to ten times a day, medium - from ten to twenty, and severe - from twenty or more. A severe degree is accompanied by a loss of a woman's ability to work and requires inpatient treatment and drug correction.

There are also two forms of menopausal syndrome: not complicated, which occurs in isolation and is caused only by the presence of age-related changes in the reproductive system, and complicated, which is combined with other rather severe pathologies (diabetes mellitus, coronary heart disease, hypertension, osteoporosis, arthropathy, etc.) . In view of this, the climacteric syndrome of the microbial classification 10 may additionally have other ciphers, depending on the comorbidity.

In any case, even if a woman has a mild severity of menopausal syndrome and an uncomplicated form of its course, she needs the treatment of this condition. First of all, this is the mode. It includes proper nutrition, work and rest regimen, physiotherapy exercises, giving up bad habits, spa treatment, the use of physiotherapy procedures (galvanization of the brain, electroanalgesia, etc.), massages. It is also possible to prevent menopausal syndrome, or rather its complications with the help of vitamin therapy (A, C, E), which positively affect the functioning of the brain, sedatives, herbal medicine (climadinone, etc.) or homeopathic therapy. And the most important stage in the treatment is hormone replacement therapy, which is carried out in order to eliminate the lack of female sex hormones and the appearance of symptoms in a woman who violates her usual lifestyle.

Expert opinion There are main strategies for the treatment of the syndrome: drug and non-drug. The second type of treatment includes diet, exercise, aromatherapy, massage and other treatments, folk remedies. This therapy is suitable for mild menopausal pathologies. The severe course of the syndrome involves the use of: hormonal, sedative drugs, antipsychotics, tranquilizers, vitamin complexes.

Symptoms of the climacteric syndrome

Climacteric syndrome involves a violation of the condition of a woman against the background of the aging process of the female genital organs. With menopausal syndrome, clinical symptoms are observed, the main of which are hot flashes, excessive sweating, chills, headache, dizziness, nausea, irritability, alternating with tearfulness, depression and much more. Let us examine in more detail the signs of the climacteric syndrome.

Pathological climacteric syndrome: symptoms

Symptoms of menopause, climacteric syndrome in particular, includes vegetative-vascular manifestations, neuropsychiatric and metabolic disorders.

Vegetative-vascular or vaso-vegetative manifestations of climacteric syndrome are reflected in the form of a violation of the nervous regulation of vascular tone, which entails vegetative manifestations of climacteric syndrome. These changes are felt by a woman in the form of sweating and feelings of hot flashes, which are subsequently replaced by chills. This occurs as a result of a decrease in the content of dopamine in the hypothalamus, which leads to autonomic crises, instability of blood pressure, more often to its increase. Sensations of hot flashes are due to central hyperthermia, that is, an increase in temperature, which manifests itself approximately thirty minutes after capillary spasm and the development of venous stasis.

Against the background of ongoing phenomena in the brain, neuropsychiatric disorders appear from the side of vascular tone. At first, a woman may notice a violation of predominantly nocturnal sleep, which in turn provokes sharp mood swings or increased excitability in a particular conflict situation. Then, these differences develop into outbreaks of aggression, followed by crying, or vice versa, the appearance of a depressive mood.

In menopausal women, glandular dysfunction occurs, the production of sleep hormones decreases, but the amount of substances similar to adrenaline, which overexcite the nervous system, increases.

As for metabolic disorders, there is a direct dependence on the amount of estrogen synthesis. Due to the decrease in the concentration of this hormone, the absorption of microelements in the bone tissue is disturbed, which eventually leads to the development of osteoporosis, which is characterized by increased bone fragility and pain. Also, estrogen deficiency leads to the development of cardiovascular diseases, the appearance of atherosclerotic plaques on the walls of blood vessels, thinning of the vascular wall, which can subsequently cause the development of a heart attack or stroke.

In a woman, due to metabolic disorders, there are signs of increased gas formation in the intestines, thirst, the appearance of peripheral edema due to a decrease in diuresis, engorgement and pain in the mammary glands.

Atrophic phenomena develop on the vaginal mucosa, skin, which is accompanied by dryness, the appearance of wrinkles, due to a decrease in moisture and elasticity of the skin. Hair loss occurs, the structure of the nail plates is disturbed.

In addition, the absence of estrogen leads to a weakening of the urethral sphincter, which leads to urinary incontinence and the risk of ascending urinary tract infection. The syndrome must be treated.

Treatment of climacteric syndrome

What to treat? The treatment of menopausal syndrome should be carried out by a qualified specialist on the basis of collected complaints, an objective gynecological examination, as well as after a series of clinical and laboratory, instrumental studies, consultations of related specialists in the presence of another somatic pathology, which also needs treatment and correction of the condition.

Purpose of treatment

The complex treatment of menopausal syndrome with folk remedies, herbal remedies, hormones or homeopathy is primarily aimed at eliminating or alleviating the course of symptoms, improving the quality of life of a woman, resuming her ability to work and an active lifestyle. First of all, it is necessary to determine the course of the climacteric syndrome, its form and the presence or absence of contraindications to a particular drug. Since the pathological process, which is the climacteric syndrome, is initially associated with the physiological phenomena of the body, it is not possible to achieve a complete cure and eliminate it in the bud. This is due to the aging process of the body, and as you know, it is irreversible.

Menopausal syndrome in women - treatment

There are several treatment options for menopausal syndrome. One of the first to be resorted to with a mild course of the syndrome is diet therapy, physiotherapy, correction of the daily regimen. There is an opinion that only the correct adjustment of the lifestyle is enough, as a result of which the violations of well-being are practically eliminated. To do this, it is only necessary to correct nutrition, give up bad habits, and exclude the use of coffee, dark chocolate. Include physiotherapy exercises in the daily routine. Additionally, to stabilize the condition of a woman, physiotherapeutic procedures are used (a collar with novocaine according to Shcherbak, galvanization of the brain, electroanalgesia), sanatorium and resort treatment.

Infusions and tinctures of motherwort, hawthorn fruit, valerian rhizome, which is an adaptogen and consists of powders of valerian rhizome, lemon peel, etc., have a slight sedative effect.

Also, the climacteric syndrome, the clinic, (treatment) of which has no pronounced manifestations, in addition to the above method of treatment, includes drug correction of the condition. Vitamin therapy is used in the form of the use of vitamins A, C, E, which improve brain function and contribute to the attenuation of symptoms. With a mild and moderate degree of the syndrome, phytopreparations are used - non-hormonal therapy for menopausal syndrome. Herbal medicines contain estrogen-like substances that have effects similar to natural estrogens on the body. These drugs include products containing cimicifuga extract: Tsiklim, Estrovel, Klimadinon, Klimaktoplan, Remens and others. It is also possible to contain other estrogen-like herbal extracts, on which the traditional medicine treatment is based. Such herbs used in the treatment of menopausal syndrome include boron uterus, red brush, hop cones, linden blossom. At the same time, the climacteric syndrome (clinic, diagnosis, treatment) is quite well stopped by only adjusting the regimen and phytotherapy. All of the above methods of treatment are used in women in case of refusal or if there are contraindications for the use of hormone replacement therapy.

Hormonal therapy for menopausal syndrome

When a woman has a pathological climacteric syndrome, treatment (drugs) is aimed at replacing the missing hormone in the body. This syndrome has a severe course, the presence of hot flashes of more than twenty episodes per day, impaired performance and general condition. Therefore, the main treatment for menopausal syndrome is hormone replacement therapy (HRT).

Before starting the use of hormonal drugs, the doctor carefully collects complaints, conducts a gynecological examination and prescribes a complete examination in order to exclude the presence of another pathology that may be a contraindication to hormone therapy. In addition, hormone therapy has a number of features of its implementation:

• Individual approach in choosing a drug
• Selection of minimum dosages
• Accounting for risk factors and benefits that exceed these risks
• Constant monitoring of the woman's condition, preventive examinations once every half a year
• The use of two component treatment - estrogens along with progestogens, to prevent endometrial hyperplasia

Indications for the appointment of HRT are a severe degree of the course of the menopausal syndrome, the onset of the development of metabolic disorders against the background of hypoestrogenism (osteoporosis, atherosclerotic plaques), the presence of atrophic changes in the vaginal mucosa, involuntary urination, the risk of developing depressive states, Alzheimer's disease.

Estrogen reduces the risk and delays the onset and progression of Alzheimer's disease. Estrogen may also protect against dementia and other neurological disorders by reducing inflammatory responses and increasing cell survival.

• oncological process of the mammary glands at the moment or previously cured,
• estrogen-dependent tumors of the reproductive system,
• uterine bleeding,
• untreated endometrial hyperplasia,
• kidney and liver failure,
• the presence in the past or at the present time of deep vein thrombosis, thromboembolism,
• heart attack or stroke,
• as well as individual intolerance to the components of the drug.

How to treat climacteric syndrome

For the purpose of hormone replacement therapy, preparations containing natural estrogens and progestogens are prescribed. If the drug contains only estrogen, progestogens are connected to therapy. Such products of the pharmaceutical industry include femoston with different dosages. In its composition, femoston contains estradiol and dydrogesterone, similar in their chemical and biological action to similar hormones produced by a woman's body. The drug is low-dose and by its action eliminates all the effects of the absence of estrogens. Similar drugs for HRT, but with a different composition include norgestrel, proginova, climonorm, climen.

So, menopausal syndrome, treatment, presentation of drugs, needs careful monitoring and supervision by a qualified specialist.