The postmenopausal period is the final, third stage of menopause. He, in turn, is divided into early and late. After the extinction of the reproductive function, aging of the body becomes inevitable. It is accompanied by many unpleasant physiological and psychological symptoms that are more or less familiar to all women. Fortunately, this difficult condition can be alleviated with simple and effective methods.

The postmenopausal period (postmenopause) is recorded 12 months after the last menstruation, and it lasts for about a decade. There is no clear time frame, as well as a strict age norm for women. Individual characteristics and genetics largely determine these indicators.

The main signs of menopause begin to manifest themselves by changes in the body associated with a decrease in the functioning of the ovaries:

• with accompanying increased sweating;
• mood swings, unstable emotional state;
• , headaches and others.

The climacteric syndrome of the initial and final stages is different. In postmenopausal women, hormonal changes come to an end, and the amount of estrogen in the body becomes fixedly small, which affects literally all systems. In rare cases, when a woman's health is weak, they remain in the postmenopausal period.

Women's problems in postmenopausal women

The postmenapausal period is, first of all, aging. The body at this stage is tired, worn out, the spectrum of its abilities is significantly narrowed, the general state of health worsens. Such female hormones as estradiol, estrade and estriol, by the end of menopause, become less than male.

The bone, cardiovascular, nervous and excretory systems function normally with a sufficient number of them, respectively, during postmenopause, failures are observed in their work.

Typical problems that await a woman in the postmenopausal period:

1. The risk of osteoporosis. Due to the decrease in estrogen, the bone tissue becomes more fragile. This also explains the frequent bone fractures in women over 60.
2. The condition of hair, nails and teeth deteriorates.
3. Cardiovascular problems. The walls of blood vessels become thin and inelastic, which affects blood circulation and high blood pressure. A significantly slower metabolism affects the increase in cholesterol, which forms blood clots. The latter, in turn, can lead to ischemic diseases, angina pectoris, cardiac arrhythmias.
4. Vision decreases, hearing becomes worse.
5. Thought processes slow down, memory deteriorates.
6. Unstable emotional state, nervousness, tantrums.
7. ... Itching may bother you. Warts appear and hairiness on the face and body increases.
8. The reduced amount of secretion secreted by the genitals affects their microflora. In conditions of an insufficient amount of protective mucus, it is easier to get sick with genital infections or inflammatory diseases. Colpitis (vaginitis, inflammation of the vaginal mucosa) and cystitis are frequent companions of women at this time.
9. The presence at the final stage is a very alarming sign. They indicate a high level of estrogen in the body, which is considered an abnormality at this age. The most common cause of this phenomenon is the development of breast, cervical, or ovarian cancer. Any opaque, odorless discharge is also dangerous.
10. Urinary incontinence, which occurs for two reasons: prolapse of the pelvic organs and rapid weight gain.

Postmenopausal syndrome develops in different ways. It is most pronounced in women who are too thin or too overweight, who smoke or abuse alcohol, have physically or emotionally hard work, and experience frequent stress.

The most important thing a postmenopausal woman can do for herself is to comprehensively improve her lifestyle. To alleviate your condition, you must:

1. Follow an age-appropriate diet. This is a type of healthy balanced diet, the diet of which must necessarily include foods containing healthy omega acids: red fish, nuts, healthy vegetable oils, flax seeds, sesame seeds, chia. You also need dairy and fermented milk products, indispensable for maintaining the condition of bone tissue. To speed up metabolism, you need to eat fresh fruits and vegetables according to the season, and to build muscle tissue - lean meats, all types of sea fish, seafood. The diet includes cereals and whole grain flour products in limited quantities.
2. Use an additional source of essential micronutrients. Usually these are vitamin complexes with calcium and vitamin D. It is recommended to use it as directed by a doctor after examining blood tests.
3. Avoid nervous strain, hard work.
4. Provide yourself with healthy sleep and leisure full of positive impressions.
5. Introduce regular physical activity. Walking long walks, yoga, meditations, breathing complexes of exercises, aerobic exercise, if the state of health allows, would be ideal.
6. If necessary, initiate treatment with hormonal drugs. Doctors-gynecologists often prescribe them during menopause. These are estrogen substitutes that can be applied internally or topically. Taking these drugs orally helps to normalize hormones. External use is effective in eliminating itching in the genital area.

The presence of female problems characteristic of postmenopausal women should not affect the attitude towards life. It continues, and it makes sense to enjoy it, doing things for which there was not enough time before.

Catad_tema Menopause syndrome and hormone replacement therapy - articles

The climacteric period of a woman's life and modern possibilities of therapy

Menopause syndrome is the collective name for a number of interrelated health disorders that occur in women during menopause. In the absence of adequate treatment, climacteric syndrome can lead to serious diseases such as ischemic heart disease, dementia, type 2 diabetes, osteoporosis. Hormone therapy has long been used to treat menopausal disorders, but often produces unwanted side effects. The use of STEAR drugs (including tibolone) is a new approach to the treatment of menopausal disorders. The drugs of this group are characterized by a selective effect on various organs and tissues of the female body. The report on conference "Women's reproductive health: from abortion to contraception"held on September 15, 2011 in Samara, a doctor of the highest category, a gynecologist-endocrinologist Marina Vladimirovna Glukhova substantiated the need for widespread use of tibolone (including its equivalent - generic Ladybone) in the treatment of climacteric disorders.

At the beginning of his speech, the head. Department of Gynecology "SDTs JSC", doctor gynecologist-endocrinologist of the highest category, Ph.D. M.V. Glukhova reported alarming statistics.

In the world, 25 million women annually undergo menopause, and only 10% of them have it without pathological manifestations. According to WHO forecasts, by 2015, 46% of women in the world will experience climacteric disorders of one degree or another. In Russia, nearly 40 million women have already reached menopause. And, as the gynecologist-endocrinologist of the highest category reported, by 2020 demographers expect an increase in this indicator by another 20 million. At the same time, Russia lags far behind countries with a high standard of living (Japan, Australia, Sweden, etc.) in terms of women's life expectancy. The climacteric period is a natural biological process of the transition from the reproductive period to old age. It is long-lasting and includes a gradual decline in ovarian function, the last spontaneous menstruation (menopause), and a decrease in estrogen levels. But climacteric syndrome should be distinguished from the climacteric period - a complex of pathological symptoms that accompany the climacteric period. “What are we afraid of in the 21st century? - asked a rhetorical question M.V. Glukhova. "We fear cardiovascular disease, dementia, type 2 diabetes and osteoporosis." All these diseases can arise as complications of climacteric syndrome. In the modern world, a woman's social and economic well-being largely depends on her health and good physical shape. “That is why we must choose this type of therapy to ensure the safety and optimal quality of life for our women,” M.V. Glukhova.

Menopause and climacteric syndrome

For the climacteric period, a decrease in the level of estrogen is characteristic. It begins after the age of 45, and by the age of 52-53 the estrogen content decreases to a minimum level, which remains in the future. Meanwhile, the physiological effects of estrogens are extremely diverse. They affect the central nervous system, heart and blood vessels, the condition of bone tissue, skin, mucous membranes and hair, the genitourinary system and mammary glands, and lipid metabolism in the body. Thus, a sharp decrease in estrogen production has a significant effect on many organs and systems. The climacteric period includes several phases. Premenopause usually occurs between the ages of 45 and 47, from the onset of the first symptoms of menopause until the end of spontaneous menstruation. Menopause is considered premature if it occurs at the age of 37-39 years, and early if it occurs at 40-45 years. The normal age for menopause is around 50. Allocate natural and artificial menopause, the latter may be associated with surgery, exposure to radiation, taking cytostatics and other reasons. Perimenopause is a period chronologically uniting premenopause and the first year of postmenopause. The allocation of this period is due to the fact that regular menstruation can sometimes appear after a significant period of time (up to 1-1.5 years) from the moment they stop. Menopause syndrome begins with neurovegetative and psychoemotional disorders, and in the long term, it can lead to osteoporosis, cardiovascular disease and Alzheimer's disease. To prevent such sad consequences, it is necessary to begin to deal with climacteric syndrome when its first symptoms appear, which include "hot flashes". During hot flashes, the body temperature can rise by 5 ° C in just a few minutes. The duration of the "tide" ranges from 30 seconds to 3 minutes, and their frequency can go up to 30 times a day. "Hot flashes" are accompanied by profuse sweating. Sympathoadrenal crises and fluctuations in blood pressure are common. According to the speaker, 75% of women suffer from "hot flashes" and other disorders within 3-5 years after the cessation of menstruation, about 10% - more than 5 years, and 5% of women "hot flashes" continue until the end of their lives.

There are a number of other symptoms of climacteric syndrome. The blood supply to the mucous membranes deteriorates, intercourse can become painful, urinary incontinence, frequent urination, and urgency may occur. Rarer symptoms include numbness and tingling in the extremities or their trembling, a feeling of creeping on the skin, muscle pain, shortness of breath and a feeling of lack of air, bouts of bronchospasm, a feeling of dryness or burning in the mouth, various unpleasant taste sensations, and also "dry" conjunctivitis, stomatitis and laryngitis.

In the future, more serious consequences can be expected: the development of osteoporosis, dyslipidemia and atherosclerosis, weight gain and redistribution of fat according to the male type, and a decrease in cognitive abilities.

Hormone therapy and its evolution

M.V. Glukhova sees hormone replacement therapy (HRT) as a very effective method of treating climacteric disorders. It simultaneously eliminates all the symptoms of climacteric syndrome, and the effectiveness of the prevention of osteoporosis in this way has been proven in randomized trials. HRT eliminates vasomotor manifestations, symptoms of depression, insomnia, and prevents the development of urogenital atrophy. This method of therapy has a positive effect on the connective tissue, which allows you to relieve joint and muscle pain in the back, to cure "dry" conjunctivitis, and has a positive effect on the skin. Prevention of osteoporosis allows not only to reduce the frequency of fractures of the spine and femoral neck, but also to reduce the phenomena of periodontal disease and associated tooth loss. The reduction in the incidence of colorectal cancer under the influence of HRT has also been proven.

The speaker described the evolution of treatments for menopausal disorders. In the 1920s. phytoestrogens were first used, in the 1940s - "pure" estrogens, in the 1970s combined therapy with estrogens and progestogens appeared, and in the 1990s - drugs of the STEAR group.

The principle of modern HRT is to reduce possible risks from treatment, therefore, only natural estrogens (17- (3-estradiol) are used in the minimum effective doses, while the dose of the hormone decreases with the patient's age.In women with an intact uterus, estrogens are combined with progestogens (combination therapy) . The drug is selected individually. Before the appointment of therapy, a special examination is carried out, during therapy, annual control. In addition to women with climacteric disorders, HRT is recommended for patients with risk factors for osteoporosis or decreased bone density, women with premature menopause, women after removal ovaries and / or uterus. HRT is not prescribed for women over 65 years of age, and also solely for the prevention of cardiovascular diseases or Alzheimer's disease in the absence of menopause. There are a number of contraindications for HRT. It is not prescribed for breast cancer in history , at present or with suspicion of it, with estrogen-dependent malignant tumors (endometrial cancer or suspicion of this pathology), with bleeding from the genital tract of unknown etiology, with untreated endometrial hyperplasia. HRT is also contraindicated in deep vein thrombosis, pulmonary embolism, angina pectoris, myocardial infarction (all of these diseases, both at the time of the appointment of therapy and in the history are a contraindication to HRT), uncompensated arterial hypertension, liver diseases in the acute stage, allergies to active substances or to any of the excipients of the drug, porphyria cutaneous. Indications for the use of HRT are vegetative-vascular symptoms and psychoemotional disorders of mild to moderate degree in the pre- and postmenopausal period: hot flashes, excessive sweating, dizziness, headaches, sleep disturbances, increased excitability. Premenopause and early postmenopause (no later than 5-7 years after the last menstruation) are the "window" of the therapeutic possibilities of HRT. There are various types of hormone therapy: parenteral drugs - estradiol (patch) and estradiol (gel), topical drugs (for example, vaginal cream), but oral drugs are most often used - combinations of estradiol with dydrogesterone (Femoston), estradiol with levonorgestrel (Klimonorm) , estradiol with drospirenone (Angelique), and tibolone.

STEAR - a new approach to treatment

The main part of his report is a gynecologist-endocrinologist of the highest category M.V. Glukhova dedicated specifically to the drug Tibolone, including its generic equivalent Ladybone. Earlier - since 2003 - it was included in the group of drugs "other sex hormones", later - since 2009 - moved to the group of "other estrogenic drugs". Tibolone belongs to the STEAR group of drugs (Selective Tissue Estrogenic Activity Regulator). The use of STEAR drugs represents a fundamentally new approach to the treatment of climacteric disorders. The goal of this approach is not a total replacement of deficient hormones, but the selective regulation of estrogenic activity in tissues. Tibolone is a stimulant of estrogenic activity.

The principle of action of STEAR drugs is that estradiol or its analogs stimulate estrogen receptors (receptor level), and at the prereceptor level tissue enzymes activate or inhibit the synthesis of active forms of estrogens directly in the tissue. The metabolism of tibolone provides the effect of the drug on the sulfatase-sulfotransferase system of the body. “In young women, this system is in equilibrium, but in women of mature, climacteric age, the activity of the enzyme sulfatase predominates,” noted M.V. Glukhova. Metabolites block sulfatase and activate the sulfotransferase system. The clinical effects of the drug Tibolone are manifold. This is the therapy of symptoms of climacteric disorders, and a beneficial effect on the cardiovascular system, and the elimination of symptoms of urogenital atrophy, and the prevention of postmenopausal osteoporosis. An important effect of tibolone is to improve mood and libido. Unlike some other HRT drugs, it does not stimulate the mammary glands, does not increase mammographic density 1, does not stimulate endometrial proliferation 2. If two of the three metabolites of tibolone are stimulators of estrogenic activity, then the third metabolite (delta-4 isomer), which is formed in the endometrium, has an exclusively progestogenic effect. At the same time, there are no metabolites of tibolone in the endometrium that bind to estrogen receptors, which is explained by the already described activity of enzymes at the prereceptor level. In this regard, an important advantage of tibolone is the absence of bleeding.

Benefits of the drug Tibolone (Ladybone)

The main advantage of STEAR drugs (including tibolone) is that they have a selective effect on estrogenic activity in tissues (a fundamental difference between drugs in this group). As a result, favorable estrogenic effects are achieved in the central nervous system, bone tissue and the urogenital tract and there is no unwanted estrogenic effect in the endometrium and mammary glands, which avoids the risk of developing tumors (as you know, traditional HRT was sharply criticized for the fact that its use can increase the incidence of breast cancer glands), as well as engorgement and soreness of the mammary glands. With fibrocystic mastopathy and mastalgia, tibolone not only does not prevent healing, but also promotes it.

Hormone therapy of climacteric disorders improves the quality of life of a woman. “Of course, for women it is important to have a good mood and a positive effect of therapy on their appearance,” M.V. Glukhova. In terms of the quality of life of patients, treatment with tibolone is comparable to combined HRT. Taking tibolone improves the emotional background - in patients who have undergone a long course of treatment (10-12 months) with this drug 3, there is an increase in the level of (3-endorphins ("hormones of joy"). It has also been established that this drug has a positive effect on a woman's sex life, and under its effect increases both the frequency of initiative and satisfaction.In this respect, tibolone is more effective than traditional HRT.4 In addition, the drug has a positive effect on the appearance of patients.Tibolone increases bone and muscle mass, but at the same time reduces fat mass. the circumstance is very important, since it is the accumulation of fat that contributes to the development of various diseases in women who have reached menopause.Tibolone improves hydration of the body.Indications for the use of the drug tibolone are vegetative-vascular and psychoemotional disorders typical of mild and moderate climacteric syndrome: hot flashes, increased sweating, dizzy no, headaches, sleep disturbances, hyperexcitability.

The positive effect of the drug on the hormonal status of women after hysterectomy was also noted. Tibolone is recommended to be used in the early postoperative period - in the first three days after the operation. Therapy for 3 months after the operation led to a decrease in FSH by 1.31.6 times and an increase in E2 by 2.0-2.2 times. If you start therapy long after the operation, the effectiveness of tibolone decreases. In this case, significant changes in hormonal markers are achieved only after 6-12 months of therapy.

One of the main advantages of the Tibolone preparation is its positive effect on bone tissue. As shown by a British study, in patients taking tibolone for 10 years, bone mineral density (BMD) not only did not decrease, but even increased (both in the lumbar region and in the hip region). In contrast, in the control group, BMD steadily and significantly decreased with age 5.

Conclusion

Summing up his speech, M.V. Glukhova noted: a comparison of the use of tibolone and combined HRT indicates that these two types of therapy are equally effective for the treatment of climacteric syndromes and the prevention of osteoporosis. Tibolone is more effective for improving mood and libido, obtaining sexual satisfaction. Unlike combined HRT, this drug does not stimulate endometrial proliferation and does not cause bleeding. Thibo-lon also does not stimulate breast tissue, does not increase mammographic density, and does not promote engorgement of the mammary glands. When taking tibolone, the rate of refusal of patients from therapy due to side effects is much lower than when using combined HRT. The use of STEAR drugs (in particular tibolone) is the most physiological and therefore the safest means of treating menopausal disorders.
Answering questions from the audience, the speaker noted the complete equivalence of tibolone and the generic drug Ladybone, which has a similar therapeutic effect.

1 Lundstrom E., Christow A., Kersemaekers W., Svane G., Azavedo E., Soderqvist G., MolArts M., Barkfeldt J., von Schoultz B. Effects of tibolone and continuous combined hormone replacement therapy on mammographic breast density // Am. J. Obstet. Gynecol. 2002. Vol. 186. No. 4. P. 717-722.
2 Hammar M., Christau S., Nathorst-Boos J., Rud T., Garre K. A double-blind, randomized trial comparing the efects of tibolone and continuous combined hormone replacement therapy in postmenopausal women with menopausal symptoms // Br. J. Obstet. Gynaecol. 1998. Vol. 105. No. 8. P. 904-911.
3 Genazzani A.R., Pluchino N., Bernardi F., Centofanti M., Luisi M. Beneficial effect of tibolone on mood, cognition, well-being, and sexuality in menopausal women // Neuropsychiatr. Dis. Treat. 2006. Vol. 2. No. 3. P. 299-307.
4 Nathorst-Boos J., Hammar M. Effect on sexual life - a comparison between tibolone and a continuous estradiol-norethisterone acetate regimen // Maturitas. 1997. Vol. 26. No. 1. P. 15-20.
5 Rymer J., Robinson J., Fogelman I. Ten years of treatment with tibolone 2.5 mg daily: effects on bone loss in postmenopausal women // Climacteric. 2002. Vol. 5. No. 4. P. 390-398.

Menopause syndrome is a pathological condition associated with the climacteric period, complicating its course and characterized by disorders of body functions of varying duration and severity in the adaptogenic, psychoemotional, metabolic-endocrine, neurovegetative, cardiovascular spheres. They develop in 30-60% of women in menopause.

How long can climacteric syndrome last?

Menopause in women is not a disease. This is a physiologically normal age (at the age of 45 - 55) and genetically determined state of the body, which consists in the restructuring of the higher parts of the central nervous system. The result of this transformation is a decrease in the intensity and a change in the cyclicity of synthesis and secretion of gonadotropic hormones by the pituitary gland, the development of insufficiency of the functions of the gonads.

The climacteric period consists of three phases:

• premenopausal, preceding the cessation of menstruation and lasting from 2 to 5 years; pathological syndrome during this phase develops in 35% of women;
• , representing the final cessation of menstruation, which is estimated after 1 year of their complete absence; symptoms of climacteric syndrome during this period are noted in 38-70% of women;
• postmenopausal, characterized by estrogen deficiency, increased levels of gonadotropic hormones and the final physiological morphofunctional restructuring of all systems and organs of the body, primarily reproductive.

Throughout there are various pathological conditions, united by the term "menopausal syndrome". Its "early" manifestation is climacteric syndrome, which usually begins to develop gradually shortly before menopause (premenopause) and lasts on average 2-3 years. However, in some individual cases, its duration can be up to 10-15 years.

Pathogenesis and contributing factors

In the modern concept of the mechanisms of development of climacteric syndrome, the main importance as a causal factor is given to age-related changes in the hypothalamic structures.

The hypothalamus is the main gland that regulates the cycle of the menstrual cycle. It synthesizes the neurohormone gonadoliberin, or gonadotropin-releasing hormone (GnRH), under the action of which the adenohypophysis produces follicle-stimulating (FSH) and luteinizing (LH) hormones. They affect the maturation and function of ovarian follicles and corpus luteum.

The hypothalamus - the pituitary gland - the ovaries form an integral self-regulating system, the self-regulation of which is based on the principles of feedback. Age-related involutive changes in hypothalamic structures are the reason for a decrease in the sensitivity of the latter to the effects of a normal concentration of estrogens secreted by the ovaries.

In order to restore balance, the hypothalamus (by increasing the production of GnRH) in an excited state more and more stimulates the release of gonadotropic hormones by the pituitary gland, especially follicle-stimulating hormones.

As a result, the function of the ovaries is gradually disrupted, and they release into the blood not only the directly functioning fractions of estrogens (estrone, estradiol and estriol), but also intermediate components of their synthesis. In addition, the cyclicity of the production of sex hormones is disrupted. At a certain point, the sex hormones of the ovaries are no longer sufficient to inhibit the hypothalamus and pituitary gland. Remaining high production of FSH leads to the cessation of ovulation and, accordingly, reproductive function.

Since the hypothalamic and pituitary parts of the brain are connected with the rest of the endocrine glands and the cerebral cortex, this also affects the functions of the latter - osteoporosis develops, the regulation of the cardiovascular and peripheral nervous system, metabolic processes, etc. is disrupted, as well as leads to the development of climacteric syndrome.

However, due to the fact that part of the sex hormones is produced by the reticular area of \u200b\u200bthe adrenal cortex, the latter take on part of the function of the ovaries during the period of their extinction (according to the principle of "feedback"). This contributes to a mild course of menopause in a certain percentage of women, as a result of which pathological symptoms do not arise.

The occurrence of a violation of the physiological course of menopause is facilitated mainly by factors such as:

1. Professional work in conditions of constant long and frequent physical and / or mental overwork.
2. Stress conditions and dysfunction of the endocrine and central nervous system, dysfunction of internal organs by the time of the onset of menopause.
3. Complications during pregnancy and childbirth, in the postpartum period.
4. Inflammatory diseases of the pelvic organs, menstrual irregularities, volumetric surgical interventions.
5. Infectious diseases and long-term pain syndromes of various origins
6. Increased body weight, even moderate.
7. Industrial hazards and abuse of smoking and alcoholic beverages.

How does climacteric syndrome manifest?

In the clinical course, especially at the initial stages, against the background of menstrual irregularities (1-3 months after their onset), neuropsychiatric disorders and vegetative-vascular dystonia (VVD), or vaso-vegetative manifestations are dominant.

The first are:

• various sleep disorders and short-term memory disorders;
• feeling of unexplained anxiety and obsessions;
• the appearance of depression and self-doubt;
• emotional lability, expressed in mood instability, unreasonable irritability and tearfulness;
• headaches, fatigue, decreased performance and ability to concentrate;
• depression and change (deterioration or, conversely, increase) of appetite;
• oppression, absence or increase in libido.

The vegetative manifestations of climacteric syndrome are usually accompanied by neuropsychiatric disorders and are expressed in:

• feeling of "hot flashes" to the face, head and upper body;
• sudden redness of the skin of the face, cervical region and upper chest;
• dizziness;
• severe sweating, paroxysmal sweating, especially at night;
• numbness of the fingers, paresthesia, a feeling of "creeping" in the limbs, especially at night, convulsive contractions of the muscle fibers of the legs;
• a feeling of lack of air up to choking, tingling and unexplained painful sensations in the region of the heart, sometimes radiating to the neck, shoulder, scapula, and subscapularis;
• attacks of palpitations and heart rhythm disturbances, unprovoked by physical exertion;
• instability of blood pressure - an increase in systolic A / D up to 160 mm. rt. Art. and higher, which can quickly be replaced by normal and even lowered and vice versa;
• persistent red or white dermographism.

The symptoms of VSD, as a rule, occur during periods of "hot flashes" and bouts of sweating. Some authors distinguish three forms of climacteric syndrome, depending on the nature and number of symptoms:

1. Typical - a feeling of "hot flashes" of heat to the head, face and cervical region, pathological sweating, sleep disturbances, dizziness and headache.
2. Atypical, which is characterized by both typical symptoms and uniform or regional deposition of adipose tissue, swelling of the lower extremities and face due to fluid retention in the body, pain in the bones and in the area of \u200b\u200bthe joints, especially the hip, dysuric phenomena, dryness of the vaginal mucosa, dyspareunia. Less common is a decrease in body weight against the background of a fairly rapid deterioration in overall health. Among individual women, episodes of sympatho-adrenal crises are possible, accompanied by a feeling of fear of death, heart rhythm disturbances, as well as high blood pressure, allergic reactions, attacks of bronchial asthma, hyper- or hypoglycemia in blood tests.
3. Combined, which develops among women already suffering from diseases of the heart and blood vessels, arterial hypertension, impaired liver and gallbladder function, metabolic endocrine disorders, allergic diseases.

However, in this classification there is no clear distinction between early and mid- and late-term manifestations of pathological menopause. Therefore, in practice, the traditional classification is mainly used, which was developed by Vikhlyaeva V.P. based on determining the severity of the current in accordance with the frequency of tides:

It consists in assessing the severity of the climacteric syndrome based on determining the frequency of "hot flashes":

• I degree of severity, or mild form, which occurs on average in 47% of women with this pathology - the number of hot flashes during the day is not more than 10;
• II degree of severity, or moderate form - from 10 to 20 hot flashes during the day (35%);
• III degree, or severe climacteric syndrome - the number of hot flashes per day is more than 20. This form occurs on average in 18%.

According to research data, vegetative-vascular disorders are found in 13% of all women, and depressive conditions - in 10%.

Diagnostics

Diagnosis of climacteric syndrome is not particularly difficult. It is based on:

• taking into account the regularity / irregularity of the menstrual cycle or the absence of menstrual bleeding in accordance with the age period;
• identifying a complex of the above symptoms;
• exclusion of concomitant diseases or, in the presence of the latter, determining their relationship with the existing symptoms of climacteric syndrome;
• additional laboratory research of the patient's hormonal status, as well as consultations of a therapist, an ophthalmologist (examination of the state of the vessels of the fundus), a neuropsychiatrist and an endocrinologist.

The postmenopausal period is accompanied by the extinction of ovarian functions. A decrease in estrogen in the blood causes a complete restructuring of the body, accompanied by the occurrence of unpleasant symptoms and diseases. A consultation with a doctor, the appointment of treatment will help a woman to survive this difficult time.

Postmenopausal women - what is it?

Changes in a woman's body are reflected both in her appearance and in her internal state. The development of possible diseases and the approach of old age causes fear.

With the onset of 45 years of age, a woman's reproductive function gradually fades away, menstruation disappears, and the size of the uterus and ovaries decreases. A decrease in estrogen levels, changes in the functioning of the hypothalamus lead to unpleasant neurovegetative and psychosomatic symptoms. The postmenopausal period begins from the moment there is no menstrual flow and ends after a full adaptation of the body. There is no clear time frame, genetics and individual characteristics determine this indicator. At this time, a woman is faced with hot flashes, increased sweating, insomnia, a violation of the psycho-emotional state, the occurrence of painful sensations in the extremities.

The period after menopause and hormones

The hormonal function of the ovaries begins to reorganize long before the last menstruation. Cyclic changes are caused by the development of follicular resistance to FSH with a decrease in inhibin secretion. In the postmenopausal period, women do not produce progesterone, the production of estrogen decreases, which is accompanied by hormonal imbalance. In some women, this stage is asymptomatic, while others have pain in the lower abdomen, dizziness.

The female body produces more than 70 types of hormones, estrogens are responsible for the restructuring in menopause.

During menopause, estradiol, estriol and estrone are synthesized in the adrenal glands and adipose tissue. After the onset of menopause, the amount of the former falls, and the latter increases, which leads to an increase in male hormones in the female body. When analyzing blood, the indicators should correspond to this level: the amount of estradiol 10-20 lg / ml, estrol 30-70 lg / ml, androstenedione 1.25 to 6.3 nmol / l, testosterone 0.13 to 2.6 lg / ml.

Postmenopausal period in women: symptoms and treatment of pathologies

Memory problems, dry skin, forgetfulness, and inability to concentrate are associated with a decrease in estrogen levels. Some symptoms can impair performance.

When menopause is reached, the restructuring of the hormonal background comes to an end, the number of estrogens becomes extremely small, which affects the functioning of all systems, is accompanied by the appearance of deep wrinkles, a violation of the hair structure, loss of tone and elasticity of the skin. Metabolic disorders, constipation, problems with motor coordination, difficulties with the thought process, nervousness, insomnia, depression in the postmenopausal period are symptoms that require a visit to a doctor.

Postmenopausal women: symptoms that indicate the development of diseases

Treatment in the postmenopausal period is required for:

• Increased risk of cardiovascular disease - rapid heartbeat, arrhythmias, high blood pressure (hypertension) vascular walls become thin and inelastic, which affects blood circulation; slow metabolism provokes an increase in cholesterol, which forms blood clots, so there is a chance of developing angina pectoris, coronary heart disease.
• Risks of osteoporosis - a decrease in the amount of estrogen affects the bone tissue; it becomes brittle and fractures are more frequent.
• The development of Alzheimer's disease, which is accompanied by a decrease in memory with subsequent progressive dementia.

Problems also arise in the gynecological area - in the postmenopausal period in women, discharge with blood is an alarming sign of an increased level of estrogen, which can lead to cancer of the breast, cervix, and ovaries. Any opaque discharge with a smell is also dangerous.

In case of minor deviations, it is necessary to consult a doctor, because many diseases at the initial stage are masked and are practically asymptomatic.

Postmenopausal period: treatment and elimination of symptoms

To reduce the intensity of symptoms, eliminate the likelihood of diseases, it is necessary to revise the diet and include yoga in the daily routine.

A complex change in life will help a woman to improve her condition during such a period. An age-appropriate diet must be followed. A balanced diet should include foods that contain beneficial omega acids. They are found in nuts, red fish, flax seeds, sesame seeds. To maintain bone tissue, you need to consume dairy and fermented milk products. Fresh fruits and vegetables will help speed up your metabolism. The diet includes cereals and whole grain flour products.

Avoiding stressful situations, avoiding overstrain at work will help ensure a healthy, sound sleep. Hiking, regular exercise, yoga, and breathing exercises can improve your well-being.

Quitting smoking can reduce the likelihood of breast cancer by 1/3.

If symptoms interfere with leading a full life, doctors prescribe hormone replacement therapy, with the help of which hormones are normalized.

Why see a doctor?

Menopause is not a disease, but a natural process in a woman's body. If symptoms occur, you need to see a doctor to get diagnosed and identify possible risks of disease. Gynecological examination, ultrasound will help determine the condition of the external genital organs, ovaries. As a result of hormonal studies, the doctor will determine the need for hormone replacement therapy. You can make an appointment for a consultation or a doctor's appointment.

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It is extremely important for women to know everything about their health - especially for the initial self-diagnosis. This rapid test will allow you to better listen to the state of your body and not miss important signals in order to understand whether you need to see a specialist and make an appointment.

- a physiological period in a woman's life, characterized by the extinction of reproductive function due to hormonal changes in the body. It starts after 40 years and lasts about 10 years. It is manifested by the gradual cessation of menstruation. May be accompanied by a complex of vegetative-vascular and endocrine disorders: sudden attacks of blood rush to the upper half of the body and face ("heat"), sweating, tearfulness, irritability, fluctuations in blood pressure, increased dryness of the skin and mucous membranes, sleep disorders. May cause dysfunctional uterine bleeding, serious neuropsychiatric disorders.

General information

is a natural stage in a woman's life and is characterized by reverse changes in the reproductive system - the cessation of reproductive and menstrual functions. The word "climax" comes from the Greek "klimax" - a ladder that expresses symbolic steps leading from the flowering of specific female functions to their gradual fading.

A woman's life consists of several age periods, which have their own anatomical and physiological characteristics:

• the neonatal period - up to 10 days;
• the period of childhood - up to 8 years;
• puberty - from 8 to 17-18 years;
• the period of puberty (reproductive, or childbearing) - from 18 to 45 years;
• menopause (menopause), including:

1. premenopause - from 45 years to menopause;
2. menopause - cessation of menstruation (49-50 years);
3. postmenopause - from menopause - up to 65-69 years;

• the old age period - from 70 years.

With an average life expectancy of a woman of 75 years, a third of her life falls on menopause.

In some women, menopause has a physiological course and does not cause pathological disorders, in others, the pathological course of menopause leads to the development of menopausal (climacteric) syndrome. Menopausal syndrome in women with menopause occurs with a frequency of 26 - 48% and is characterized by a complex of various disorders of the functions of the endocrine, nervous and cardiovascular systems, which often disrupts the normal life activity and working capacity of a woman. Issues of the pathological course of menopause are of great social and medical importance in connection with the increased average life expectancy of a woman and her socially active behavior.

Causes of menopausal syndrome

During menopause, changes occur throughout the body: immune defense decreases, the frequency of autoimmune and infectious diseases increases, and aging processes progress. But the most active changes during menopause undergo a woman's sexual apparatus. With menopause, the development of follicles stops in the ovaries, eggs cease to ripen and ovulate, and intrasecretory activity decreases. The follicles in the ovaries are replaced by connective tissue, which leads to hardening and a decrease in ovarian size.

The hormonal picture in menopause is characterized by an increase in the level of gonadotropic hormones (follicle-stimulating and luteinizing hormones) and a decrease in the level of estrogen. Within a year after the onset of menopause, an increase in the level of follicle-stimulating hormone occurs 13-14 times, luteinizing - 3 times, followed by a slight decrease.

During menopause, changes in the synthesis of estrogenic hormones consist in the cessation of the production of estradiol and the predominance of estrone. Estrogens have a biological effect on the uterus, mammary glands, urethra, bladder, vagina, pelvic floor muscles, cells of the brain, arteries and heart, bones, skin, mucous membranes of the conjunctiva, larynx, mouth, etc., and their deficiency during the period menopause can cause various disorders in these tissues and organs.

Menopausal syndrome with menopause is a manifestation of estrogen deficiency and is characterized by vegetative-neurotic, urogenital disorders, dystrophic skin changes, a high risk of atherosclerosis and vascular ischemia, osteoporosis, and psychological disorders. With an increase in the average indicators of a woman's life expectancy, an increase in menopause occurs and, accordingly, an increase in the period of estrogen deficiency, which increases the likelihood of developing menopausal syndrome.

Classification

According to its manifestations, climacteric syndrome is divided into early, medium and late manifestations of menopausal disorders. The early manifestations of menopausal disorders in menopause include:

• vasomotor symptoms - a feeling of hot flashes, headaches, increased sweating, chills, fluctuations in blood pressure, palpitations;
• psycho-emotional symptoms - weakness, anxiety, irritability, drowsiness, inattention, forgetfulness, depression, decreased libido.

Early manifestations during menopause include premenopause and 1-2 years postmenopause. Women with vasomotor and psychoemotional symptoms during menopause are often treated by a therapist for hypertension, coronary heart disease, or by a neuropsychiatrist diagnosed with neurosis or depressive state.

Moderate manifestations of menopausal disorders in menopause include:

• urogenital symptoms - vaginal dryness, painful intercourse, burning, itching, dysuria (increased frequency of urination and urinary incontinence);
• symptoms of the skin and its appendages - wrinkles, brittle nails, dry skin and hair, hair loss.

Medium-term manifestations during menopause are noted 2-5 years after menopause and are characterized by atrophic changes in the skin and urogenital tract. As a rule, symptomatic treatment of urogenital and skin symptoms in menopause does not give the desired effect.

The late manifestations of menopausal disorders in menopause include:

• metabolic (metabolic) disorders - osteoporosis, atherosclerosis, Alzheimer's disease, cardiovascular diseases.

Late manifestations during menopause develop 5-10 years later after the onset of menopause. An insufficient level of sex hormones during menopause leads to a violation of the structure of bone tissue (osteoporosis) and lipid metabolism (atherosclerosis).

Symptoms of Menopausal Syndrome

The development and severity of the course of menopausal syndrome is influenced by hormonal, environmental, hereditary factors, the general condition of a woman by the period of menopause.

Vegetovascular (vasomotor) symptoms in the pathological course of menopause are noted in 80% of women. They are characterized by sudden "hot flashes" with a sharp expansion of the capillaries of the scalp, face, neck, chest, an increase in local skin temperature by 2-5 ° C, and body temperature - by 0.5-1 ° C. "Hot flashes" are accompanied by a feeling of heat, redness, sweating, palpitations. The state of "hot flashes" lasts 3-5 minutes with a frequency of 1 to 20 or more times a day, intensifies at night, causing sleep disorders. A mild degree of vasomotor disorders in menopause is characterized by the number of "hot flashes" from 1 to 10 per day, medium - from 10 to 20, severe - from 20 or more in combination with other manifestations (dizziness, depression, phobias), leading to a decrease in working capacity.

In 13% of women with a pathological course of menopause, asthenoneurotic disorders are encountered, manifested by irritability, tearfulness, anxiety, fear, intolerance to olfactory and auditory sensations, depression. Psychoemotional symptoms in menopause develop before or immediately after menopause, vasomotor symptoms last about 5 years after menopause.

The course of menopausal syndrome with menopause can develop in the form of atypical forms:

• sympatho-adrenal crises, characterized by a sharp headache, increased blood pressure, urinary retention, followed by polyuria;
• myocardial dystrophy, characterized by constant pain in the heart in the absence of changes in the ECG, ineffectiveness of conventional therapy;
• urticaria, vasomotor rhinitis, allergies to drugs and food, indicating a change in the body's immunological reactions, etc.

The course of menopause falls on a period of important events in a woman's life: growing up and marrying children, achievements at work, retirement changes, and climacteric disorders are superimposed on increased emotional stress and social problems. Almost 50% of women with a pathological course of menopause have a severe form of disorders, 35% of the disorders are moderately expressed, and only 15% of menopausal syndrome is mild. A mild form of menopause disorders is usually found among practically healthy women, while women with chronic diseases are prone to atypical forms of menopausal syndrome, a tendency to a crisis nature of the course that disrupts the general health of patients.

The development of menopausal syndrome with menopause is facilitated by genetic factors, endocrinopathies, chronic diseases, smoking, menstrual irregularities during puberty, early menopause, physical inactivity, a woman's history of pregnancy and childbirth.

Diagnostics

Diagnosis of the pathological course of menopause is based on the complaints of patients who appear at the age of approaching or the onset of menopause. Exacerbation of concomitant diseases sometimes complicates the diagnosis of menopausal syndrome with menopause, making it worse and causing the development of atypical forms. In the presence of concomitant diseases, a woman, in addition to consulting a gynecologist, is shown consultation of other specialists: a cardiologist, a neurologist, an endocrinologist.

In order to correctly diagnose the complicated course of menopause, a study of the blood levels of follicle-stimulating and luteinizing hormones, estrogens is carried out. To clarify the functional state of the ovaries with menopause, a histological analysis of scraping of the endometrium of the uterus and cytological examinations of vaginal smears in dynamics are performed, and a basal temperature graph is plotted. Identification of anovulatory ovarian cycles makes it possible to associate functional disorders with menopausal syndrome.

Treatment of menopause disorders

The approaches adopted in modern gynecology to the problem of treating menopause pathology are based on reducing its manifestations and symptoms. Reducing the severity and frequency of "hot flashes" in the pathological course of menopause is achieved by the appointment of antidepressants (venlafaxine, fluoxetine, paroxetine, citalpram, sertraline, etc.).

In order to prevent and treat the development of osteoporosis in menopause, non-hormonal drugs-biophosphonates (alendronic and risedronic acids) are used, which reduce bone loss and the risk of fractures. Biophosphonates effectively replace estrogen therapy in the treatment of osteoporosis in women during menopause.

To reduce the manifestation of urogenital symptoms in the pathological course of menopause, local (vaginal) administration of estrogen in the form of a cream or tablets is recommended. The release of small doses of estrogen in the vaginal tissue reduces feelings of dryness, discomfort during sexual intercourse and urinary disorders.

The most effective method of treating menopausal syndrome with menopause is hormone therapy individually prescribed by a doctor. Taking estrogen drugs well eliminates, in particular, "hot flashes" and discomfort in the vagina. For hormone therapy in the treatment of menopause pathology, natural estrogens (estradiolvalerate, 17-beta-estradiol, etc.) are used in small doses with intermittent courses. For the prevention of hyperplastic processes in the endometrium with menopause, a combination of estrogens with gestagens or (less often) with androgens is shown. The courses of hormone therapy and hormone prophylaxis are carried out for 5-7 years in order to prevent myocardial infarction and mammography, cytological analysis of smears of discharge from the cervix, biochemical study of blood test parameters and coagulation factors (coagulogram).

Hormone therapy regimen

The choice of the mode of hormone therapy depends on the stage of menopause. In premenopausal women, hormone therapy not only replenishes the estrogen deficiency, but also has a normalizing effect on the menstrual cycle, therefore, it is prescribed in cyclic courses. In postmenopause, when atrophic processes occur in the endometrium, for the prevention of monthly bleeding, hormone therapy is carried out in the mode of constant intake of drugs.

If the pathological course of menopause is manifested only by urogenital disorders, estrogens (estriol) are prescribed topically in the form of vaginal tablets, suppositories, cream. However, in this case, there remains the risk of developing other menopausal menopause disorders, including osteoporosis.

The systemic effect in the treatment of the pathological course of menopause is achieved by the appointment of combined hormone therapy (for example, tibolone + estradiol + norethisterone acetate). With combined hormone therapy, hormone intake is combined with symptomatic drugs (antihypertensive, cardiac, antidepressants, bladder relaxants, etc.). Combination therapy for the treatment of menopause disorders is prescribed after consulting narrow specialists.

Solving the problems of the pathological course of menopause is the key to prolonging women's health, beauty, youth, performance and a real improvement in the quality of life of women entering the wonderful "autumn" period of their lives.