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| Menopause - symptoms and treatment!
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What is menopause? Causes of event, conclusion and strategies of treatment
Definition of the disease. Causes of the disease
Climacteric syndrome or menopause is a complex of symptoms (endocrine, vegeto-vascular,
psychoemotional disorders) that complicate the period of fading reproductive function in some
women.
At the heart of this pathological condition is an unsatisfactory adaptation of the body to a
decrease in the level of sex hormones, which are produced by the ovaries.
It is believed that about 30-60% of women are faced with manifestations of menopausal
syndrome. In each individual case, the set of symptoms, their severity and duration vary:
menopause manifestations can sometimes bother a woman for less than 5 years (35% of cases),
5-10 years (55%) and rarely over 10 years (10%).
In most cases, the full-fledged symptomatology is noted in the next 2-3 years after the cessation
of menstruation (menopause). Before this time - in premenopause - pathological manifestations
are 1.5-2 times less common.[1][2][3]
What determines the time of onset of menopause
The time of onset of menopause can be influenced by:
- Hereditary factor - women whose mothers and/or older sisters, grandmothers at one time had a
difficult experience of menopause, have a much greater chance of also facing menopause;
- The presence of concomitant pathology - in the presence of cardiovascular diseases
(arterial hypertension), endocrine disorders (diabetes mellitus, thyroid pathology and others),
disorders of the central and autonomic nervous systems;
chronic stress, physical and mental fatigue, lack of sleep, malnutrition, exhaustion;
- Bad habits, especially tobacco smoking;
diseases of the female genital sphere, abortions, pronounced premenstrual syndrome (PMS) in
the anamnesis;
abrupt cessation of ovarian function as a result of radical surgery (ovariectomy) or radiation
exposure.
What are hot flashes at menopause
Flushes of blood to the surface of the skin of the face, neck, chest, upper torso - one of the main
symptoms of menopause. Tides are accompanied by redness and a feeling of heat.
Is it possible to get pregnant at menopause
The probability of pregnancy at menopause is extremely low, but it is not completely excluded.
If menopause occurs before the age of 50, it is recommended to use contraceptive methods for
two years, if at the age of over 50 - for a year.
Symptoms of menopause
Symptoms of menopausal syndrome are conditionally divided into neurovegetative,
metabolic-endocrine and psychoemotional.
Neurovegetative:
one of the most characteristic symptoms - periodic flushes of blood to the surface of the skin of
the face, neck, chest, upper torso, which are accompanied by redness and a feeling of heat;
- Increased sweating;
- Sensation of cognition;
- Episodic fluctuations in blood pressure;
- Bouts of nausea, nausea, dizziness;
- Headaches;
- Discomfort in the heart area, chest pains, palpitations.
Metabolic and endocrine:
- Unexplained weight gain, edema;
- Elevated blood cholesterol;
- Decreased turgor (firmness, elasticity) and dry skin;
- Discomfort in the mammary glands - heaviness, engorgement, pain, aggravation of
pre-existing mastitis;
- Itching and burning in the area of the external genitalia, dryness and vulnerability of the
vaginal mucosa, which makes sexual intercourse painful;
- Ointment discharge outside of menstruation (before the onset of menopause), uterine
menopausal bleeding (sometimes they can be very profuse);
-Dysuric disorders - painful, frequent urination, including nocturnal, urinary incontinence
(irresistible urges, stress incontinence when laughing and coughing);
- The appearance of pain in the joints and bones, the initial manifestations of osteoporosis;
- Dryness of the mucous membrane of the eyes, conjunctivitis, blepharitis;
dysfunction of salivary glands, dry mouth, inflammatory changes of periodontium, atrophic
changes of gums, intense settling of the gingival margin, denudation of tooth necks.
Psychoemotional:
- Emotional lability (instability), unreasonable mood swings, tearfulness;
- Irritability, bouts of aggression;
- Decreased sex drive (libido);
- Increased anxiety;
- Bouts of apathy, depressive states;
- Problems with concentration, absent-mindedness, memory impairment;
- Sleep disorders - daytime sleepiness, insomnia, snoring, night apnea (stopping breathing in
sleep);
- Hard-to-explain unusual sensations - tingling, numbness, "goosebumps."
Often the abundance and diversity of manifestations are of psychosomatic origin. They largely
depend on the attitude of the patient herself to the changes occurring in her body (in particular,
from increased anxiety about it).
What happens to menstruation before menopause
As a rule, menstruation becomes more scarce and shorter, and the intervals between them
increase until menstruation stops completely.
Signs of early menopause in your 30s and 40s and later in life
The signs of menopause are the same at any age - the cessation of menstruation and changes in
hormone levels. The only difference is that in 30-40 years of age, menopause should be more
carefully differentiated from other conditions accompanied by amenorrhea.
Pathogenesis of menopause
At the heart of the pathogenesis of menopause is the cessation of production of sex hormones by
the ovaries. It can be abrupt in the so-called artificial menopause or gradual with age-related
decline in the function of the sex glands.
The most clearly manifested deficiency of estrogens - the main female sex hormones. A marked
decrease in their production usually begins in premenopause - on average from about 45 years
old. The ovaries gradually decrease in size and shrink, glandular tissue is replaced by connective
tissue.
By the time of menopause (cessation of menstruation), the ovaries are no longer producing
estrogens. The only estrogens left in the body are those produced by the adrenal glands, which
are much less.
For some time the body tries to stimulate the declining ovarian function, for example, by
significantly increasing the secretion of follicle-stimulating hormone (FSH) in the anterior lobe
of the pituitary gland, but about a year after menopause, FSH production also begins to gradually
decline.
Estrogen-sensitive receptors are present not only in the uterus, vagina and breast tissue, but also
in the bladder, urethra, bone, muscle, skin, mucous membranes, heart and blood vessels. That
is why, in estrogen deficiency, changes are observed in these organs.
Gradually the body adapts to a decrease in estrogen levels, but under certain conditions, this
adaptation passes with violations, which is manifested by menopausal syndrome of varying
degrees of severity.
Some diseases that have not been noted before, debuted exactly in the menopause. This is due to
the cessation of the protective effect of estrogen. So, for example, happens with cardiovascular
diseases: women up to 50 years old have a significantly lower risk of their development than
men of the same age, but after reaching the age of 70, the chances are equalized.
Classification and stages of menopause
The three stages of menopause are:
Premenopause - the period several years before the last menstruation and one year after it. The hormonal
background during this period is unstable, so the symptoms are pronounced, menstrual cycles
are unstable.
Menopause - persistent cessation of menstruation, after a year without menstruation.
Postmenopause refers to the phase that occurs after the start of menopause.
According to the stages of development, early, delayed and late manifestations of menopause
are distinguished.
What signs appear first
To the early manifestations, which can sometimes begin 2-3 years before the onset of menopause, include symptoms of neurovegetative dysfunction, as well as some psychoemotional (emotional-affective) abnormalities:
- hot flashes, sweating;
- fluctuations in blood pressure;
- headaches;
- heart palpitations;
- irritability, tearfulness;
- loss of interest, apathy;
- sleep disturbances;
- decreased libido.
Delayed symptoms are more likely to occur 1-2 years after menopause and mainly affect the
urogenital area, but also concern the condition of the mucous membranes, skin and its
appendages:
- thinning, dryness and vulnerability of the genital and urinary tract mucosa;
painful sexual intercourse;
- increased frequency of urination, urinary incontinence;
- skin aging, dryness and flaking, decreased turgor, wrinkles, deterioration of hair and nails
(dullness, brittleness, stunted growth) due to decreased collagen synthesis;
- Dental problems (e.g., periodontitis) may appear at the same time.
Late symptoms develop 2-5 years after menopause. These include the following
endocrine-exchange disorders:
- accelerated development of atherosclerotic changes in the arteries;
changes in lipid metabolism, often increases the level of cholesterol in the blood, and the ratio
of so-called "good" and "bad" cholesterol is disturbed;
- disorders of carbohydrate metabolism, increasing the risk of diabetes mellitus;
- possible increase in blood pressure;
- problems with concentration, forgetfulness;
- progressive loss of bone (osteoporosis) and muscle mass.
There are various methods of determining the severity of menopausal syndrome, including the
Kupperman menopausal index and Green's menopausal scale, which take into account a whole
complex of symptoms at the same time. But most often doctors use a simplified scheme. It is
based on the number of arising hot flashes and distinguishes three degrees of severity of
menopause:
- mild - the frequency of hot flashes is up to 10 times a day;
- medium - occurrence of 10-20 hot flashes per day, accompanied by other symptoms;
- severe - hot flashes appear more than 20 times a day, accompanied by other symptoms and loss
of ability to work.
Complications of menopause
Climacteric syndrome itself complicates the normal course of the period of hormonal
restructuring in a woman. However, this syndrome can also take place with additional
complications.
Most often the period of menopause is accompanied by cardiovascular pathologies - coronary
heart disease (CHD) and arterial hypertension. Type II diabetes mellitus and osteoporosis may
also develop. Often these diseases in women are diagnosed in the menopausal period. In this
case, there is a possibility that the disease was already present, but in a blunt, asymptomatic
form, and hormonal imbalance only led to its progression and more obvious symptoms, which
served as a reason to consult a doctor.
The development of CHD contributes to the development of menopause is characterized by an
increase in cholesterol levels in the blood, as well as the acceleration of atherosclerotic processes,
including in the arteries that supply blood to the myocardium.
Arterial hypertension progresses against the background of atherosclerosis, excessive body
weight and impaired regulation of vascular tone. These points are usually present in menopausal
syndrome.
Impaired glucose tolerance (prediabetes) or the unfolding picture of type II diabetes mellitus is
usually first diagnosed in adulthood, especially if overweight. Sometimes insulin resistance,
overweight, hypercholesterolemia and arterial hypertension in a complex make up the so-called
metabolic syndrome, mutually exacerbating the manifestations of these conditions. Age close to
the onset of menopause is one of the risk factors for the development of this metabolic syndrome.
The development of osteoporosis is very closely related to the drop in blood estrogen levels,
but the rate of its progression and the severity of its manifestations largely depend on the initially
accumulated bone mass. If a woman has had an inadequate diet, a sedentary lifestyle or diseases
that prevent normal calcium absorption, the risk of critical loss of bone mass increases.
In particularly severe cases, the bones become so fragile that fractures may occur not only when
falling from the height of their own height, but also with an awkward movement.
Diagnosis of menopause
Suspect the presence of menopausal syndrome allows such criteria as female gender, age over 45
years and the appearance of complaints that can be attributed to the three groups listed above
(neurovegetative, psychoemotional, endocrine-exchange). However, in order to clarify the
diagnosis, a number of additional studies are required:
- general blood and urine analysis;
- biochemical blood analysis (glucose level, lipid profile, electrolyte balance in plasma) and
coagulogram (determination of blood coagulation);
- study of hormonal background (blood test for the level of estrogen, progesterone, FSH,
luteinizing hormone, gonadotropin, prolactin, testosterone, thyroid hormones, assessment of
the level of excretion of some hormones with urine);
- measurement of blood pressure and pulse, electrocardiography, if necessary - a test with
exercise and nitroglycerin, Holter monitoring;
- chest radiography and mammography;
- ultrasound of pelvic organs;
- osteodensitometry is performed to determine the state of bone tissue;
If necessary, hysteroscopy, diagnostic scraping, pipel-biopsy are indicated.
Of course, it is also necessary to perform a gynecological examination with cytology,
consultations with a neurologist, cardiologist, endocrinologist and other specialists
(eg, psychologist, ophthalmologist, dentist, urologist), depending on the present complaints
and clinical manifestations. These specialists will be able to determine whether the cause of the
ailment is the menopause or independent diseases that require separate treatment.
When talking with a specialist must clearly and truthfully answer all questions about the
features of menstrual function, the number, course and outcome of pregnancies, diseases,
surgical interventions, bad habits, taking medications.This largely determines the effectiveness
and safety of the prescribed treatment.
Treatment of menopause
Treatment of menopausal syndrome is usually required for moderate to severe course. It is
carried out in three directions: non-medicamentous, medication and hormonal.
Non-medicamentous treatment
At the first stage, treatment is mainly used:
Phytotherapy;
General strengthening exercises, massage, physical therapy - exercises to strengthen the pelvic
floor muscles, maintaining joint mobility and elasticity of ligaments, slowing the loss of bone
and muscle mass;
physiotherapeutic procedures - galvanization, electroanalgesia, electrophoresis with novocaine
on the collar zone and other techniques;
acupuncture;
spa treatment - climatotherapy, balneotherapy, hydrotherapy.
Psychotherapeutic techniques and relaxation methods will be useful to normalize the
psychoemotional state.
Nutrition and diet
It is recommended to limit the use of animal fats, simple carbohydrates, table salt and
caffeine-containing products, and enrich the diet with fiber, vegetable oils, fermented milk
products.
Non-hormonal medicines
At the second stage, non-hormonal medicines are connected:
- vitamin complexes containing vitamins A, C, E, D and B vitamins;
- phytopreparations containing substances similar to female sex hormones;
- sedatives, neuroleptics, tranquilizers;
- symptomatic agents;
- medicines for the treatment of concomitant diseases.
Hormonal treatment
The third stage is hormonal treatment. The main principles of hormone replacement therapy:
- only analogs of natural female hormones are used;
- low doses of estrogens in combination with progestagens are used (in case of removed uterus
isolated use of estrogens - monotherapy is possible);
- duration of treatment with hormones - at least 5-7 years.
Different hormonal preparations are designed for different stages of menopause:
- for early menopause in relatively young women, the preparations model a menstrual-like
response;
- for older women who do not wish to resume menstrual discharge, medications that contain a
much lower dosage of hormones are indicated;
- for women who have been in menopause for at least a year and a half, prescribe drugs that are
aimed at preventing osteoporosis, cardiovascular disease, inflammatory processes of the
urogenital tract and alleviate vasomotor symptoms.
Methods of administration of hormones can vary: oral (orally in the form of tablets), vaginal,
intrauterine, external (in the form of patches or gels) and injectable.
In each case, individual selection of the drug by a doctor is necessary, taking into account the
individual characteristics of the patient and contraindications.
Combating vaginal dryness at menopause
At any stage of menopause, it is possible to use means that improve the condition of the external
genitalia and vaginal mucosa. They are indicated for women who have pronounced signs of
atrophic changes in the skin and mucosa of the genitals, accompanied by itching, a sense of
dryness, significant difficulties in sexual intercourse (up to their impossibility) and urinary
incontinence (in the early stages). It is a local application of preparations of hyaluronic acid,
which moisturizes the skin and mucous membranes to deep layers, increases elasticity and
elasticity, improves appearance.
Also in recent years, the so-called laser vulvovejuvenation is used - the effect of a special type
of laser irradiation, which improves trophic processes in the skin and mucosa, and eliminates the
feeling of dryness and discomfort.
Treatment of hot flashes at menopause
In addition to hormonal drugs prescribed by a doctor, the following can help with hot flashes:
- Avoid provoking factors, such as bright light or emotional overload;
- reduce the temperature of the environment by using an air conditioner or fan;
- choose clothing that can be easily removed when needed.
Treatment of hypertension during menopause
Treatment of hypertension occurs in conjunction with a cardiologist, who prescribes appropriate
medications.
Therapy for osteoporosis in menopause
All postmenopausal women are recommended to undergo screening for osteoporosis. Patients are
managed in conjunction with an endocrinologist.
Tobacco cessation
One of the important components of the successful fight against the negative manifestations of
menopausal syndrome is the complete cessation of tobacco smoking.[4] In women who smoke,
menopausal syndrome often proceeds especially severely and at an earlier age, and hormone
therapy against the background of smoking can lead to severe side effects.
Prognosis. Prevention
In general, menopausal syndrome has a favorable prognosis for life, although it can significantly
worsen its quality (with a severe course - up to complete disability).
Worsen the prognosis of menopause such disorders as cardiovascular disease and osteoporosis,
which adversely affect the course of the syndrome.
Significantly improves the prognosis of timely appointment of hormone replacement therapy. It
should be carried out under constant medical supervision with clear compliance with i
ndications and contraindications. Treatment with hormonal drugs can smooth out typical
symptoms in the vast majority of women (90-95%), approximately 85% of patients significantly
reduces the manifestations of urogenital disorders, 30% reduces the risk of fractures
(femoral neck, spine) associated with osteoporosis.
Can menopause be prevented from occurring?
Completely prevent the development of menopausal syndrome, unfortunately, it is unlikely to be
possible, since it largely depends on the individual congenital and hereditary characteristics of
the woman. However, there are measures to prevent its severe and complicated course. They
should be undertaken long before the onset of menopause (ideally - from early childhood) and
involve:
- leading a healthy lifestyle - a rational diet, motor activity, maintaining optimal weight, regular
hardening, adequate rest;
- prevention and timely treatment of chronic infections;
- avoidance of abortions, competent contraception, prevention and treatment of sexually
transmitted infections;
- regular visits to a gynecologist, timely treatment of gynecological diseases;
- leisure activities that promote training of memory, attention and preservation of cognitive
functions;
- formation of positive thinking;
- avoidance of bad habits (smoking and alcohol abuse).