The climacteric 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, psycho-emotional, metabolic-endocrine, neurovegetative, cardiovascular spheres. They develop in 30-60% of women in menopause.

How long can menopausal syndrome last?

Menopause in women is not a disease. This is a physiologically normal age (at 45-55 years of age) 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 the synthesis and secretion of gonadotropic hormones by the pituitary gland, the development of insufficiency in the functions of the sex glands.

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 menopausal syndrome during this period are observed in 38-70% of women;
• postmenopausal, characterized by estrogen deficiency, elevated levels of gonadotropic hormones and the final physiological morphological and functional restructuring of all systems and organs of the body, primarily reproductive.

Throughout, various pathological conditions arise, united by the term "menopausal syndrome". Its “early” manifestation is menopausal syndrome, which, as a rule, begins to develop gradually shortly before menopause (in premenopause) and lasts an average of 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 the climacteric syndrome, the main significance as a causative factor is given to age-related changes in the hypothalamic structures.

The hypothalamus is the main gland that regulates the cyclicity 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 the ovarian follicles and corpus luteum.

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

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

As a result, the function of the ovaries is gradually impaired, and they secrete into the blood not only directly functioning estrogen fractions (estrone, estradiol and estriol), but also intermediate components of their synthesis. In addition, the cyclical production of sex hormones is also disrupted. At a certain point, the ovarian sex hormones are no longer enough to have an inhibitory effect on the hypothalamus and pituitary gland. The 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 function of the latter - osteoporosis develops, the regulation of the cardiovascular and peripheral nervous system, metabolic processes, etc., is disrupted, which leads to the development of climacteric syndrome.

However, due to the fact that part of the sex hormones is produced by the reticular zone of the adrenal cortex, the latter take over part of the ovarian function during their extinction (according to the “feedback” principle). This contributes to the mild course of menopause in a certain percentage of women, as a result of which pathological symptoms do not occur.

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

1. Professional work in conditions of constant long-term and frequent physical and/or mental overwork.
2. Stressful conditions and dysfunction of the endocrine and central nervous system, dysfunction of internal organs by the time menopause begins.
3. Complications during pregnancy and childbirth, in the postpartum period.
4. Pelvic inflammatory disease, menstrual irregularities, major surgery.
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 the climacteric syndrome manifest itself?

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

The first ones include:

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

Vegetative manifestations of menopausal syndrome are usually accompanied by neuropsychiatric disorders and are expressed in:

• sensation of "tides" of heat to the face, head and upper half of the body;
• sudden redness of the skin of the face, neck and upper chest;
• dizziness;
• severe sweating, paroxysmal sweating, especially at night;
• numbness of the fingers, paresthesia, a feeling of "crawling" in the extremities, especially at night, convulsive contractions of the muscle fibers of the legs;
• a feeling of lack of air up to suffocation, tingling and inexplicable pain in the region of the heart, sometimes radiating to the neck, shoulder, shoulder blade, and subscapular region;
• palpitations and cardiac arrhythmias 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 enough be replaced by normal and even lowered and vice versa;
• persistent red or white dermographism.

Symptoms of VVD, as a rule, occur during periods of "hot flashes" and bouts of sweating. Some authors distinguish three forms of menopausal 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 joints, especially the femur, 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 general well-being. Among some women, episodes of sympathetic-adrenal crises are possible, accompanied by a feeling of fear of death, heart rhythm disturbances, as well as high blood pressure, allergic reactions, asthma attacks, hyper- or hypoglycemia in blood tests.
3. Combined, which develops among women already suffering from heart and vascular diseases, arterial hypertension, impaired liver and gallbladder function, metabolic and endocrine disorders, allergic diseases.

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

It consists in assessing the severity of the menopausal syndrome based on the determination of the frequency of "hot flashes":

• I degree of severity, or mild form, occurring 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 (in 35%);
• III degree, or severe menopausal syndrome - the number of hot flashes per day is more than 20. This form occurs on average in 18%.

According to studies, vegetative-vascular disorders occur in 13% of all women, and depressive states - 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 menopausal syndrome;
• an additional laboratory study of the hormonal status of the patient, as well as consultations with a therapist, an oculist (a study of the state of the vessels of the fundus), a psychoneurologist and an endocrinologist.

15-04-2019

Menopause- the physiological transition of the body from puberty to the cessation of the generative (menstrual and hormonal) function of the ovaries, characterized by the reverse development (involution) of the reproductive system, occurring against the background of general age-related changes in the body.

Menopause occurs at different ages, it is individual. Some experts call the numbers 48-52, others - 50-53 years. The rate of development of signs and symptoms of menopause is largely determined by genetics..

But the time of onset, the duration and characteristics of the course of different phases of the menopause are also influenced by such moments as, for example, how healthy a woman is, what her diet, lifestyle, climate, and much more.

Scientists have found that females who smoke more than 40 cigarettes a day, menopause occurs on average 2 years earlier than non-smokers.

The beginning of the menopause begins with a significant decrease in the production of female sex hormones. The fact is that over the years, the function of the ovaries gradually fades away, and may even stop altogether. This process can last from eight to ten years, and it is called menopause in women.

But do not forget what exactly during the premenopausal period, a woman is at risk for unwanted pregnancy. Pregnancy during menopause is very common, and therefore the number of abortions in this age category is very high.

The main signs of menopause

• Changes in the emotional sphere. Often a woman suffers from astheno-neurotic syndrome. She constantly wants to cry, irritability rises, the woman is afraid of everything, she cannot stand sounds, smells. Some women behave provocatively. They begin to color brightly.

• Problems with the autonomic nervous system- a feeling of anxiety, lack of air, sweating increases, the skin turns red, nausea is observed, dizziness. The woman is weakening. The respiratory rate and heart rhythm are disturbed. The patient has chest tightness, a lump in the throat.
• Constant severe headaches in the form of migraine, mixed tension pain. A person does not tolerate stuffiness, humid air, heat.
• With menopause, metabolic processes are disrupted calcium, minerals, magnesium, because the level of estrogen decreases.
• During sleep, there is a delay in breathing. The woman snores heavily. It becomes very difficult to fall asleep, thoughts are constantly spinning in the head and the heartbeat quickens.
• Menstrual disorders. One of the first signs of menopause is irregular menstrual bleeding. The abundance of blood loss and the intervals between menstruation become unpredictable.
• Dysfunctional uterine bleeding menopausal period are more common in women. First, delays in menstruation begin, and then sudden bleeding. Uterine bleeding in menopause is accompanied by weakness, irritability and constant headaches. As a rule, along with such bleeding in patients, the climatic syndrome is also noted.
• Often, premenopausal women complain of hot flashes. Quite suddenly, a feeling of intense heat sets in, the skin becomes red, and sweat appears on the body. This symptom is taken by surprise, often women wake up in the middle of the night from such heat. The reason is the reaction of the pituitary gland and a sharp drop in estrogen levels.
• Urination becomes more frequent, a small amount of urine is excreted. Urination is painful, burns strongly, cuts in the bladder. Nighttime urination is more frequent. A person walks more than once during the night, incontinence worries.
• Skin problems occur, it becomes thin, elastic, a large number of wrinkles, age spots appear on it. The hair is thinning on the head, much more appears on the face.
• Sudden pressure surges, pain in the heart.
• Due to a deficiency of estradiol, osteoporosis develops. During menopause, bone tissue is not renewed. A woman becomes noticeably stooped, decreases in height, is disturbed by frequent bone fractures, constant joint pain. There are unpleasant sensations in the lumbar region when a person walks for a long time.

The manifestation of clinical signs of menopause is individual. In some cases, it is not difficult to tolerate, in other cases, the symptoms are pronounced and torment a person for about five years. Climacteric symptoms disappear after the body adapts to new physiological conditions..

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Northern State Medical University

Department of secondary vocational education

on the course: Mature age

Topic: Menopause in men and women

Made by Lashina V.P.

student of the 1st year of the 2nd group of LD

Arkhangelsk 2014

Introduction

1. What is menopause?

Conclusion

Bibliography

Introduction

The climacteric period as a whole can be considered as a period of complex age-related restructuring, primarily of neurohumoral regulation associated with the extinction of reproductive function. Menopause occurs in both women and men, but in men it comes later, develops more slowly. In women, the climacteric period proceeds earlier more acutely, and is much more pronounced, which makes it convenient to study it.

The occurrence of menopause and the development of age-related pathological processes are associated with a cause and depend on common factors, i.e. united by one mechanism - the mechanism of aging. Despite the significant progress made in the study of the problem of aging, due to the great complexity of the problem, many unclear questions remain and there are still no generally accepted ideas about the patterns of age-related changes. Due to the common developmental mechanisms and the brightness of manifestations, the menopause is a convenient model for studying these patterns, an analysis of the processes occurring during the period of age-related adjustment allows us to establish why the body changes with age.

With age, both men and women experience menopause, I will tell about its causes, symptoms and treatment in my essay.

1. What is menopause?

Climax, menopause, menopause (from the Greek klimakter - step of the ladder, age-related turning point) - a period in the life of a biological individual, characterized by involution, the extinction of the function of the reproductive system, occurring in connection with age-related changes.

Menopause in men and women occurs differently: women: 40 - 50 years, men - 50 - 60.

In terms of severity, menopause occurs in both sexes in different ways, for women it is more painful. Women lose their reproductive function.

2. Menopause in men and women

2.1 Menopause in men

According to an andrologist, menopause is a natural stage in the life of every person. Due to the decrease in the level of the main male hormone - testosterone, there is a gradual transition from puberty to the extinction of sexual function. Doctors call it andropause, or male menopause. It starts around the age of 50-60.

With age, in the body of a man, natural changes occur in one of the most important parts of the brain - the hypothalamus. It is he who regulates the activity of the main endocrine gland - the pituitary gland. As a result, the production of hormones by the pituitary gland that stimulates the activity of the male gonads - that is, the testicles - is disrupted. They also age as the tissue is gradually replaced by connective and adipose tissue.

2.1.1 Causes of menopause in men

As a result of changes in the work of the sex glands in the male body, the function of producing the androgen hormone decreases. As a rule, menopause in men manifests itself at the age of 40 - 60 years. It can be recognized or not, but you can’t argue with nature - irreversible changes occur in the testicles.

Male menopause can be simply called the physiological process of aging. That is a natural process. You need to sound the alarm when the male menopause is accompanied by severe deterioration in health, if it occurs before the age of 45 (early) or after 60 years (late).

However, a late menopause is not scary, a man is even glad that he remains young for a longer time in every sense of the word. Of particular concern should be the pathological menopause, which is accompanied by changes in the work of the genitourinary and cardiovascular systems of the body. This condition can also be mixed with neurotic disorders.

Also, the male hormone testosterone has an important mission: it regulates the activity of the testicles, their appendages, seminal vesicles and the prostate gland. Stimulates sperm production and even determines libido, sexual arousal and orgasmic intensity.

Various diseases accelerate and complicate the anropause. With hypertension, atherosclerosis, sugar debit and alcoholism, old age catches a man unexpectedly and makes itself felt in full.

2.1.2 Symptoms of menopause in men

Symptoms of menopause in men and women are very similar. The main ones are: palpitations; dizziness; "tides", in which the skin of the face and hands turns red; drops in blood pressure are possible, which threatens the development of hypertension.

It should be noted that during physical exertion and psycho-emotional changes, all these symptoms appear brighter, their consequences can be more severe.

But the most important thing is that most men (up to about 90%) note a decrease in libido. In some men, potency gradually disappears, sexual intercourse becomes shorter, ejaculation occurs faster, sperm volume decreases. Representatives of the strong half of humanity endure all this very painfully. And, as you know, strong emotional experiences only aggravate the situation - at least, excessive excitement has not made any sexual intercourse better.

The manifestations of menopause can also include a change in the appearance of a man - the appearance of flabby skin and muscles, fat deposits on the hips and buttocks, sometimes even an increase in the mammary glands. But, of course, in all men, the symptoms of menopause appear very individually.

2.1.3 Treatment of menopause in men

The appearance of symptoms that signal the presence of menopause should provoke a man to think about a healthy lifestyle. It may sound trite, but adequate rest, an active lifestyle, movement, outdoor activities, proper nutrition and weight control all contribute to good health.

In addition, you need to be examined by a doctor. After all, the presence of unpleasant symptoms can signal not only problems in the sexual sphere. Diseases of the cardiovascular system should also not be left to chance.

In addition, the doctor may prescribe a special examination, in particular, an ultrasound of the prostate, as well as a blood test that reveals a prostate-specific antigen. According to the results of the examination, in addition to recommendations on the correct lifestyle, a man can be prescribed drug therapy, including antidepressants or sedatives, biogenic adaptogens and hormonal drugs.

2.2 Menopause in women

During menopause, the female body is functionally rebuilt in a new way: now the conception and birth of a child is no longer part of its “duties”, so the woman’s reproductive system is gradually fading away. The ovaries are preparing to lay down their powers, which is facilitated by hormonal changes in the body - less and less estrogen is produced. Once menopause is over, the chances of pregnancy will forever be a thing of the past. Therefore, many women endure it very hard.

Menopause is considered the beginning of aging and withering of a woman, which in reality is not entirely true. With the right approach and attitude to the issue, as well as advance preparation for the upcoming changes, a woman is able to feel at this time all the charm of life. The mental attitude plays a big role.

As a natural biological process, menopause is inevitable: any woman who has survived to this age is “doomed” to survive this time. But how to survive is a question that largely depends on each of us. And it is necessary to start preparing for the inevitable from a young age.

Menopause does not come suddenly, although it seems to many that it is. It develops and gains momentum gradually, passing from one of its manifestations to another.

Experts talk about 3 periods of menopause:

premenopause - when individual disorders and disorders begin to appear, one of the most indicative of which is a failure in the regularity of the menstrual cycle; childbearing function gradually fades away, but pregnancy is still possible, so you can not stop using protection;

Menopause - marked by the onset of the last menstruation in a woman's life. They say about menopause if no menstrual-like discharge is observed for 12 consecutive months;

· postmenopause - coming after menopause, that is, after a year from the last menstruation, and lasting until the complete cessation of the functioning of the ovaries.

The entire menopause lasts approximately 10-15 years.

In all women, menopause occurs at different ages and may have individual differences in manifestations and duration. However, for many centuries, medical scientists have noted that, on average, this turning point occurs between the ages of 45 and 55 years.

There is also a special type of menopause - artificial or surgical, due to the surgical removal of the ovaries and / or uterus at a young reproductive age.

2.2.1 Causes of menopause in women

From the moment of puberty to the moment of entering the menopause, the female body undergoes multiple changes every month. A follicle regularly matures in the female ovaries, from which an egg ready for fertilization is “born”, which enters the abdominal cavity in anticipation of a sperm cell. Up to this point, all the forces of the female body are directed to creating conditions favorable for the maturation of the egg: maintaining the optimal temperature regime, the required level of humidity, etc.

Simultaneously with ovulation, the body is reorganized to further protect the egg, theoretically fertilized after its release. Now conditions are already being created to maintain the vital activity of the fetal egg and provide it with the opportunity to make a successful landing in the uterine cavity. If the conception did not take place, then the female body receives the “hang up” command and starts preparing for the next cycle: menstrual bleeding begins, after which the attempt to be realized as a mother is repeated again.

All the described processes occur under the vigilant guidance of hormones and under their strict control.

It is simply amazing, but nature also provides for the natural completion of this persistent cyclical repetition: the birth of a child at a mature and advanced age is not only unnatural, but also unsafe - both for a woman and for offspring. That is why the ability to conceive and give birth to children (reproductive function) fades over the years, which is called the menopause.

The main reason for the onset of menopause is, perhaps, a decrease in the production of sex hormones and the resulting change in the hormonal background of a woman. This process begins from the departments of the central nervous system, where all natural processes are programmed.

The onset of menopause is genetically determined, but the course of this period depends very much on how a woman took care of her health throughout her life and what condition she was in when she entered the menopause.

2.2.2 Symptoms of menopause in women

The most pronounced and characteristic symptoms appear in the first phase of menopause - premenopause. These changes are not only on the physiological, but also on the mental level.

Everything can start with a general malaise, which is repeated with varying regularity and is manifested by a different set of symptoms. Headaches are noted, weakness and dizziness are felt, working capacity decreases, insomnia appears, jumps in blood pressure are observed, usually upward.

The most striking symptom that accompanies menopause is the so-called hot flashes, when the skin of the upper body - the face, neck, chest, neck of a woman - suddenly turns red due to a sharp onset of heat. Hot flashes are accompanied by a rapid increase in body temperature (and then a decrease), chills, profuse sweating, migraines, shortness of breath, increased heart rate, and even attacks of panic and fear - this condition lasts for several minutes and just as suddenly disappears. Most of all, the tides that roll at night are frightening and exhausting. In general, they can occur several dozen times a day, in a real way, weakening a woman.

Among the most common companions of menopause, there are also a number of disorders, diseases and syndromes associated with the functioning of the limbs. Rheumatisms, arthrosis wake up, numbness, tingling, trembling or pain in the arms and legs is felt. In the longer term, osteoporosis awaits many women if they have not taken care of regular replenishment of calcium stores throughout their lives.

At the same time, the nervous system also suffers, and not only the lady, but also her entire environment. The well-established stereotype that a woman of menopause is characterized by increased irritability, anxiety, and often just unbearable nervousness and suspicion and is subject to sharp unreasonable mood swings has a well-founded background.

Changes in sexual life, of course, also do not pass by. First of all, transformations of the female genital organs are observed: the labia (like the entire mucous membrane) become thinner and dryer, the vagina narrows and itches, sexual intercourse becomes painful and often does not bring satisfaction, despite the fact that sexual desire during this period can noticeably increase . However, more often than not, a woman's sexual libido decreases rather than grows.

There are also genitourinary disorders: discomfort and pain in the bladder (in particular during urination), leakage and urinary incontinence, prolapse of the pelvic organs, and others.

On top of that, the woman begins to suffer from dramatic changes in her appearance. The skin seems to have withered and wrinkled in just one day, and the lifebuoy at the same waist grew in another. Some women also develop a mustache above the upper lip or acne on the face.

As long as there is a sufficient amount of female sex hormones produced, they support the preservation of the figure and ensure the distribution of fat according to the female type - with an emphasis on the chest and hips. Ironically, women do not appreciate this feature until the situation is turned upside down: when male sex hormones get the privilege, fatty tissue begins to redistribute along the male pattern, going to the sides and stomach. With the course of this process, not only the figure disappears, but also the chest along with it: the glandular tissue in it is replaced by connective and fatty tissue, due to which the chest loses its elasticity and noticeably falls off.

As for excess weight, during menopause it also appears due to changes in chemical reactions in the body. Due to the insufficiency of female sex hormones (estrogens), they have to be “extracted” from male ones (androgens), and this complex process can only occur in adipose tissue, which is why the “field for activity” in the form of fat deposits is being prepared so diligently.

2.2.3 Treatment of menopause in women

The most correct, of course, will be to prevent the severe course of menopause. This can be done, among other things, with the help of natural phytohormonal preparations or dietary supplements containing female plant hormones. But if it still came to a severe course of menopause, then a woman is unlikely to do without the help of doctors. Treatment of menopause will not only reduce the rapid manifestation of symptoms, but also help the body prolong the period of youth.

Doctors always emphasize that menopause is not a disease, but only a natural stage in the evolution of the female body, as inevitable as, say, a transitional adolescence. And yet, the treatment of menopause is a necessity, because the so-called climacteric syndrome (a set of signs characteristic of this period) significantly worsens the quality of a woman's life.

Treatment of menopause can and should only be carried out by specialists, since it is very specific and requires a special approach. A woman should certainly contact a gynecologist-endocrinologist, who deals with such issues, as well as a mammologist. This should be done already at the age of 40-45 for preventive examinations: the sooner a woman begins to take care of herself, the easier she will enter the menopause and survive it with minimal damage to health.

The main goal pursued by the treatment of menopause is to prevent a sharp drop in the level of sex hormones in a woman's body, otherwise a malfunction in the work of the main organs and systems cannot be avoided. It can be achieved only with the help of hormone replacement therapy (HRT), which is recognized as the gold standard in the world endocrine gynecology.

At the same time, auxiliary agents can be used to eliminate pronounced painful symptoms: headaches, nervousness, depression, insomnia, uterine bleeding, pain in the legs and others.

In complex treatment, physiotherapy also demonstrates a good effect.

Conclusion

Climax is not a sentence. Everyone goes through this period in life. At the end of the menopause, a new life begins. Women can devote more time to themselves, because the children have already grown up, the work experience has been worked out, the “home” does not go out, and men also have more time for their hobbies.

For a milder menopause in youth, you need to take care of your health: play sports, eat the right food, give up bad habits.

menopause sexual involution age

Bibliography

1. Physiology and pathology of women's menopause, L., 1965

2. Vikhlyaeva E.M., Menopausal syndrome and its treatment, M., 1966

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The site provides reference information for informational purposes only. Diagnosis and treatment of diseases should be carried out under the supervision of a specialist. All drugs have contraindications. Expert advice is required!

Climax- this is the depletion of the female sex glands - the ovaries, which every woman inevitably experiences. And although menopause is a completely physiological process, and not a pathology, every woman feels different symptoms, requires observation by her gynecologist and treatment.

All the rich symptoms of menopause are the result of a deficiency of female sex hormones, which play a huge role in a woman's life. There is probably not a single organ in the female body that does not involve sex hormones. Therefore, during menopause, changes affect the entire body as a whole, including appearance, psycho-emotional state and sexual life.

What happens in a woman's body?

Ovaries with menopause

The ovaries undergo irreversible changes during menopause. As it has already become clear, at all stages of menopause there is a change in their functions. The activity of the ovaries decreases premenopausal and stops completely postmenopausal.

In addition to functions, the ovaries change their shape, size and structure. At the initial stages, the ovaries slightly decrease in size; a small number of follicles can still be found in them. After the onset of menopause, they seem to wrinkle, their size decreases several times, follicles are not defined in them, and the ovarian tissue is gradually replaced by connective tissue - that is, tissue devoid of any function.

Changes in the uterus and endometrium with menopause

The uterus also responds to hormonal imbalances. During a normal menstrual cycle, physiological changes constantly occur in it, necessary to prepare for the fixation of the fetal egg. Particular changes occur in the inner layer of the uterus - the endometrium, it is updated monthly, rejected during menstruation and thickened after ovulation. And all this under the influence of estrogens and progesterone.

Involution in the uterus and in the fallopian tubes with menopause:

• Premenopausal the uterus increases somewhat in size, but becomes less dense.
• After menopause the uterus decreases in size several times.
• Myometrium , or the muscular layer of the uterus gradually atrophies, in postmenopause it is replaced by connective tissue - that is, it loses contractile functions.
• Even at the beginning of the climax uterine endometrium , or its inner layer gradually becomes thinner, by menopause it is also replaced by connective tissue - the inner cavity of the uterus overgrows.
• Cervix is also shortened, the cervical canal connecting the uterus with the vagina is significantly narrowed or completely overgrown. It also disrupts the functioning of the mucous glands located on the neck, which reduces the amount of vaginal mucus, or "lubrication".
• The fallopian tubes gradually atrophy, their patency disappears, they also overgrow with connective tissue over time.
• Weakened ligaments and muscles that support the uterus with appendages in the pelvis. As a result, the risk of prolapse of the vagina and uterus increases.

How does menopause affect the vagina and vulva?

Female hormones are responsible for the elasticity, firmness and moisture of the vagina, which is necessary for a normal sexual life and fertilization. With the extinction of the ovaries and estrogen deficiency, changes also occur in the vagina that bring women unpleasant discomfort.

Changes in the vagina with menopause:

• Gradual loss of elasticity and firmness of the vagina, thinning of its walls, as a result - it narrows and stretches poorly during sexual intercourse, bringing pain to the woman.
• Decreased secretion of vaginal secretions, or "lubrication". The vagina becomes dry, poorly lubricated during sexual arousal.
• The acidity of the vaginal mucus changes, which reduces local immunity, leads to a violation of the microflora (dysbiosis, thrush) and increases the risk of infection with sexually transmitted diseases.
• Fragility of the vessels that feed the vaginal wall is noted, which can be manifested by spotting.

With menopause, the appearance of the external genitalia also changes:

• the labia majora become flabby due to the loss of adipose tissue in them;
• labia minora gradually atrophy;
• thinning pubic hair.

Processes in the mammary glands

The condition of the mammary glands directly depends on female sex hormones. They constantly undergo changes associated with the menstrual cycle and lactation. With menopause, as in the genitals, changes also occur in the mammary glands (involution, or reverse development), because there are few sex hormones, there is no menstrual cycle, and breastfeeding is no longer useful.

Physiological involution of the mammary glands with menopause:
1. Fat involution - replacement of the glandular component of the mammary glands with adipose tissue, which does not carry specific functions.
2. fibrous involution - replacement of glandular tissue with connective tissue. In this form, the reverse development of the mammary glands can be complicated by the formation of tumors and cysts, which are usually benign in nature, but always have a risk of malignancy. This process is called "fibrocystic involution".
3. Fibrofat involution The mammary gland is made up of fat and connective tissue.

What does the mammary gland look like after menopause?

• In premenopause, the mammary glands may thicken, swell, and slightly increase in size.
• After menopause, the mammary glands become soft, sag, change their size, in overweight women they increase in size due to excess fat, and in thin women, on the contrary, they decrease, they can completely atrophy.
• The nipple also changes, it sags, decreases in size, turns pale.

Skin in menopause. What does a woman look like after menopause?

Female hormones are the beauty of a woman, beautiful skin, hair, toned face and figure, attractiveness. And the saddest thing that happens during menopause is the appearance of age-related changes, that is, aging. Of course, the pace of aging is different for every woman. Everything is very individual. Some girls are already covered with wrinkles at 30, while other ladies at 50 even look very young. But with the onset of menopause, everything becomes very noticeable, because changes in the skin cannot be avoided.

What changes in appearance can appear in women after menopause?

1. Wrinkles, skin laxity. In the skin, the processes of formation of its own collagen, elastin and hyaluronic acid worsen, that is, the skin frame becomes loose and flabby. As a result - wrinkles, dry skin, sagging of the contours of the face and body.
2. Tired appearance, morning swelling. Under the influence of a lack of hormones and cardiovascular problems, the microcirculation of the skin is disturbed, which worsens the metabolic processes in it. The skin suffers from a lack of oxygen and nutrients, harmful compounds accumulate in it. Subsequently, the skin fades, turns pale, has a tired look. Red spots may appear associated with dilated blood vessels (rosacea). Morning swelling on the face and limbs is also associated with poor circulation.
3. Skin inflammation. Sex hormones regulate the work of the sebaceous and sweat glands, which protect the skin from negative environmental factors. Therefore, with a deficiency of female hormones, the skin becomes sensitive, easily irritated, various inflammatory dermatological problems appear. Seborrheic dermatitis may appear, as well as blackheads and acne, with which we are accustomed to associate adolescence.
4. Age age spots are more embarrassing for many than wrinkles and sagging skin. They cover not only the body, but also the face.
Causes of age spots after menopause:

• Violation of pigment metabolism, which probably involves sex hormones. In this case, the extra pigment melanin is not "utilized", but accumulates in the skin.
• The protective layer of the skin is weakened, so it is more susceptible to sunlight, which stimulates the production of excess melanin.
• By menopausal age, problems often appear with the liver, which is also involved in the exchange of pigments.
• Many experts believe that age spots are manifestations of atherosclerosis, and since this pathology often progresses with menopause, there are more and more spots.

Age spots on the skin can be in the form of ordinary dark spots that merge with each other (chloasma), freckles, which are more located on the hands, and also in the form of plaques (keratoma, xanthelasma), which are dangerous for the risk of malignancy.
5. Increased hair loss - they thin, become drier, stiffer, brittle, devoid of shine and natural color. Who has not yet turned gray before, gray hair appears. Thinning eyelashes and eyebrows.
6. May be noted hair growth in unwanted places , for example, antennae, individual hairs on the cheeks, back.
7. Shape changes associated with weight gain, sagging skin, redistribution of fat throughout the body. In addition, over time after menopause, posture changes and even a person’s height decreases, which is associated with age-related changes in the bones.

Why is menopause dangerous for bones?

Throughout life, there is a constant renewal of bone tissue, or, as experts call this process - remodeling. In this case, the bone tissue is partially absorbed and a new one (osteogenesis) is formed in its place. Remodeling is planned at the genetic level and is regulated by many metabolic processes and hormones, including sexual ones, this is a very complex process. Without a sufficient amount of estrogen during menopause, bone formation is disrupted, while the bone is gradually destroyed. Also, as a result of menopause, the absorption of calcium and phosphorus, minerals that are responsible for bone strength, is disrupted.

Such changes in the skeletal system lead to the slow destruction of bone tissue, or osteoporosis, to increased bone fragility and various degenerative processes in them.

Menopause, heart and blood pressure

Estrogens in childbearing age protect a woman from the development of cardiovascular diseases. But as soon as their level drops, the risk of developing atherosclerosis, arterial hypertension with all the consequences increases several times.

How does a deficiency of sex hormones affect blood vessels?

• With menopause, the metabolism of fats is disturbed. Excess fat, namely cholesterol, is deposited not only on the sides, but also on the walls of blood vessels, that is, atherosclerosis develops. Atherosclerotic plaques gradually increase and narrow the lumen of blood vessels, which leads to impaired blood circulation, increasing the risk of heart attack and stroke.
• Climax affects the processes of narrowing and dilation of blood vessels. These processes are necessary for the adaptation of the body during physical or emotional stress. Normally, vascular tone is regulated by the autonomic nervous system, and with a lack of estrogen, this regulation is disrupted, which leads to spontaneous vascular spasms or, conversely, to a decrease in vascular tone. This is manifested by jumps in blood pressure, the development of arterial hypertension, aggravation of atherosclerosis, the development of arrhythmias and coronary heart disease.
• Increases blood clotting. Estrogens thin the blood, and when they are deficient, the blood becomes thick, prone to the formation of blood clots and atherosclerotic plaques. As a result, an aggravation of the course of atherosclerosis, circulatory disorders and an increased risk of heart attacks, strokes and thromboembolism.

Menopause and thyroid gland

Thyroid and ovarian hormones are always interconnected. As with thyroid diseases, the reproductive function of a woman is disrupted, and with menopause, malfunctions in the thyroid gland can occur.

It's all about the hormones of the central nervous system that regulate the function of these organs, namely follicle-stimulating and luteinizing hormone (FSH and LH) and thyroid-stimulating hormone (TSH). They are very similar in their chemical structure. During the restructuring of the body at the beginning of menopause, the level of FSH and LH increases, they react to the lack of sex hormones and try to “spur” the ovaries to produce them. And with stress, which occurs during menopause, the thyroid gland may begin to perceive FSH and LH instead of TSH, which is more often manifested by an increase in its functions and the release of a large amount of hormones. This imbalance of thyroid hormones leads to metabolic disorders and requires urgent specific treatment.

Climax and nervous system

The nervous system during menopause suffers the most. In addition to the fact that female hormones are involved in various "nervous processes", menopause and aging for a woman is always stress, both somatic (bodily) and psycho-emotional. This is what exacerbates the development of nervous disorders.

What happens in the nervous system with the onset of menopause?

• Sex hormones affect the autonomic nervous system , which is responsible for the work of all internal organs, blood vessels and the adaptation of the body to various environmental factors, that is, to all internal processes. With an imbalance of estrogens and progesterone, the work of the autonomic nervous system is disrupted, as a result, a rich symptomatology of menopause: these are hot flashes, and a violation of vascular tone, the work of the heart and other organs.
• Influence of female hormones on the central nervous system. In the brain, the processes of excitation and inhibition of the nervous system are disturbed, this is manifested by increased emotionality, depression, emotional outbursts, sleep disturbance and other mental disorders. In addition, the lack of sex hormones affects brain structures such as the pituitary and hypothalamus, which are responsible for the production of many hormones, including serotonin, norepinephrine and endorphins - hormones of happiness.
• Mental disorders exacerbated by depression into which the woman "drives" herself. She realizes that she is getting old, it seems to her that she has become ugly, that she did not have time, did not achieve much. Besides, suffers and sex life , which, as you know, is an integral part of inner peace and satisfaction. Yes, and survive hot flashes and other unpleasant symptoms of menopause is also difficult.

Symptoms and manifestations of menopause in women

Deficiency of sex hormones during menopause affects many systems, organs and processes in the body. All these violations cannot pass without a trace, therefore, with the onset of menopause, various symptoms appear that bring discomfort and some women are driven to despair.

Symptoms and manifestations of menopause are very individual. We are all unique, every fifth woman does not feel any changes in her health at all. Menopause is more easily tolerated by people who lead a healthy lifestyle, have interesting hobbies, are in demand in the family and are ready to adequately meet their interesting mature age.

Harbingers

Experts believe that the harbingers of menopause appear already at the age of 30-40 years or even earlier, long before the onset of premenopause, and these are:

• problems with conceiving and bearing a child or reduced fertility after 30 years;
• hormone-dependent gynecological diseases, for example, endometriosis, ovarian cysts;
• diseases of the mammary glands, mastopathy;
• menstrual irregularities, heavy or scanty periods, menstrual cycles without ovulation.

All these conditions are associated with an imbalance of female sex hormones and require mandatory treatment by a gynecologist-endocrinologist.

The onset and first signs of menopause, menstrual irregularities

Beginning menopause is always characterized by menstrual irregularities. Against the background of a failure of menstruation, other symptoms associated with a lack of estrogen gradually develop. All these manifestations are combined in climacteric syndrome, which each woman manifests very individually. Usually, one of the first symptoms of menopause are hot flashes and impaired psycho-emotional state.

The menstrual cycle is completely dependent on the hormones that are produced by the ovaries and the central nervous system (releasing hormones, LH and FSH). At the very beginning of menopause, the female cycle does not stop yet, but obvious failures are already noticeable, menstruation becomes irregular and completely unpredictable. Also, most menstruation passes without ovulation, that is, without the maturation of the egg.

In what form, and with what regularity menstruation will go, traditionally depends on individual characteristics. But it is possible to define some options for menstrual irregularities in premenopause:

1. Cycle lengthening (more than 30 days), scanty menstruation . This is the most common type of menstrual irregularity before menopause. In this case, the period between menstruation can be several months, and after 2-3 years menopause occurs, that is, the complete cessation of menstruation.

2. Abrupt cessation of menstruation one can say in one day. It doesn't happen very often. In this case, the development of two variants of the course of menopause is possible: a woman crosses this stage in her life almost without any discomfort, or menopause is more difficult, which is due to the fact that the body does not have time to adapt to a sharp change in hormonal levels.

Why do hot flashes appear during menopause?

The mechanism of tidal development is so complex and multicomponent that it has not yet been fully studied. But many experts believe that the main mechanism for the development of hot flashes is the “suffering” of the central and autonomic nervous system from a lack of sex hormones.

Modern research has proven that the main trigger in the development of hot flashes is the hypothalamus, a structure in the brain whose main function is to regulate the production of most hormones and control thermoregulation, that is, to maintain normal body temperature under the influence of various environmental factors. With menopause, in addition to the ovaries, the hypothalamus is also rebuilt, because it disrupts the production of releasing hormones that stimulate the pituitary gland and then the ovaries. As a result, thermoregulation is also disturbed as a side effect.

In addition, menopause affects the functioning of the autonomic nervous system, sweat glands and the cardiovascular system. Obviously, the complex of all these reactions of the body to the lack of sex glands manifests itself in the form of attacks of hot flashes.

What are the symptoms of hot flashes during menopause?

1. Not all women feel the harbingers of the tides, many attacks are taken by surprise. Before the onset of the tide, tinnitus and headaches may appear - this is due to a spasm of the cerebral vessels.
2. Throws into the heat - many describe the abrupt onset of the tide, the head and upper body seem to be doused with boiling water, the skin becomes bright red, hot to the touch. At the same time, the body temperature rises above 38 o C, but it will soon return to normal.
3. There is increased sweating, drops of sweat immediately appear, which quickly flow down in streams. Many women describe that their hair and things become so wet that "at least wring it out."
4. General well-being is disturbed - heartbeat accelerates, headache, weakness appear. Against this background, nausea and dizziness may appear. Severe attacks of hot flashes can even lead to short-term fainting.
5. The feeling of heat is replaced by chills - due to the fact that the skin becomes wet with sweat and thermoregulation is disturbed, the woman freezes, muscle tremors begin, which can persist for some time. After an attack, muscles may ache due to muscle tremors.
6. Violation of the psycho-emotional state - during the tide, an acute attack of fear and panic occurs, a woman may begin to cry, may feel short of breath. After that, the woman feels devastated, oppressed, and a pronounced weakness develops. With frequent hot flashes, depression can develop.

It is these symptoms that are described by women who have experienced severe attacks of hot flashes. However, not everyone tolerates the menopause. Hot flashes can be short-term, lighter, without disturbing the general and psycho-emotional well-being. Often, ladies feel only increased sweating and heat. Some women experience nocturnal hot flashes in their sleep, and only a wet pillow indicates a past attack. Many experts believe that the severity of hot flashes directly depends on the psychological state of the woman, but there are a number of factors that often provoke the development of hot flashes.

Irritant factors that provoke hot flashes:

• Stuffiness: poorly ventilated area, large crowds, high humidity on a hot day.
• Heat: prolonged exposure to the sun, out-of-season clothing, space heating with fireplaces and other heat sources, bath or sauna.
• Anxiety: stress, emotional distress, nervous exhaustion, fatigue and lack of sleep.
• Food and drinks: hot, spicy, sweet, too spicy food, hot and strong drinks, coffee, strong tea and overeating.
• Smoking, namely the very addiction to nicotine. Often the flush appears during a long break between cigarettes and with a strong desire to smoke.
• Poor quality clothes , poorly permeable to moisture and air, leads to overheating of the body, and wearing such things can provoke a rush.

In principle, if a woman avoids the effects of these factors, she can control hot flashes, and if good emotions are added to all this, then menopause will go much easier.

How long do hot flashes last during menopause?

The attacks of hot flashes themselves can last from a few seconds to several minutes, this is very individual. There may be no such attacks per day, or maybe several dozen.

Individually, and how much time they generally have to endure. Statistics show that almost all women experience hot flashes for at least 2 years (from 2 to 11 years). But some "lucky women" have to experience these hot flashes for many years after menopause and even for life. The duration and severity of hot flashes largely depend on when they began: with early menopause and a long period of premenopause, hot flashes last longer.

What do tides affect?

• Psycho-emotional state of a woman, self-confidence.
• Immunity - violation of thermoregulation reduces the body's ability to adequately respond to infections and other external factors.
• There may be fears of leaving the house so that people do not see her in this state.
• Prolonged depression against the background of severe hot flashes is not only a manifestation of psychological problems, but also increases the risk of developing other pathologies, such as psoriasis, diabetes, arterial hypertension, and many "mental" diseases.
• Some women have such a hard time with hot flashes that they even have to resort to emergency medical services.

It must be remembered that hot flashes and menopause itself are a normal reaction of the body, which is not any pathology, all the more something shameful and shameful. Moreover, many modern women are not only not shy about this, but are also ready to discuss it. It is important to prepare for menopause in advance, change your lifestyle, get everything from life, especially positive emotions, listen to your body. All this will not only alleviate the symptoms of menopause, but will also allow you to move on to a new stage of life with ease and dignity.

climacteric syndrome

As already mentioned, the climacteric syndrome in each woman proceeds differently. It represents a huge complex of symptoms and manifestations from various organs and systems. Many of these symptoms are still experienced by most women, to varying degrees and severity. Violation of the menstrual cycle and hot flashes are essential components of menopause. Other manifestations may be absent or unrecognized, often ladies associate poor health with fatigue or other diseases.

Symptoms depend on the phase of menopause. So, in premenopause, more vivid symptoms are observed, but after menopause, the risk of developing many diseases increases, which are often not associated with the manifestations of menopause.

Symptoms of the period of premenopause - from the first manifestations of menopause to 2 years of complete absence of menstruation

Symptoms	How do they appear?
tides	sudden feeling of heat; profuse sweating; skin redness; increase in body temperature; chills; severe weakness and disruption of the heart; psychoemotional disorders.
excessive sweating	may accompany hot flashes and be a separate manifestation of estrogen deficiency; often occurs at night; many women, because of this symptom, have to change clothes several times a day and use the most "powerful" antiperspirants.
Increased body temperature	fever may be associated with hot flashes or manifest as a separate symptom; during high tides, the temperature may exceed 38 o C; prolonged subfebrile condition or temperature up to 37 o C can be observed.
Discomfort in the mammary glands	swelling and puffiness; drawing pains in the chest; changes cease to depend on the phase of the menstrual cycle.
Insomnia and drowsiness	hard to sleep at night; during the day you constantly want to sleep; often women in menopause have bad dreams that are so vivid and realistic that they keep negativity for the whole day.
Headache	may be pronounced or aching; often develops for no apparent reason, at any time of the day, including in the morning and at night; often has the character of a migraine (acute pain in one half of the head); difficult to treat with conventional analgesics.
Weakness, increased fatigue	this symptom accompanies almost all women in menopause; often weakness and fatigue occurs already in the first half of the day, both after mental or physical exertion, and without it; working capacity decreases, memory, concentration and attention worsens, absent-mindedness appears.
Irritability , tearfulness, anxiety and a lump in the throat	even the most restrained women can break down on loved ones over trifles, often this symptom is accompanied by a fit of hysteria; ladies become touchy and impressionable, it seems to them that no one understands them; constant or sudden anxiety, many have bad "forebodings" of impending disaster, all this is accompanied by pathological fears; "pessimism" prevails over "optimism", and negative emotions over positive ones; a woman may stop enjoying life as much as before, but the interesting thing is that in the postmenopausal period, love and joy for life not only return, but also become much stronger than in her youth.
Depression, chronic stress	this is the result of not only a lack of hormones, but also an unwillingness to realize the fact of the onset of menopause; "fuel is added to the fire" nervous exhaustion due to fatigue, poor sleep, lack of sex, hot flashes and other manifestations of menopause.
Feeling the heartbeat	Most often, there is an increase in heart rate or tachycardia. Tachycardia usually occurs spontaneously and resolves on its own.
Urination disorder	increased risk of developing cystitis.
Sex, fertility and perimenopause	decreased sex drive (libido); there is a slight dryness in the vagina; sexual intercourse may become painful (dyspareunia); natural pregnancy is still possible.
Other manifestations	the first signs of skin aging: dryness, shallow wrinkles, decreased skin tone, etc.; fragility of hair and nails appears; blood cholesterol may increase; some women begin to gain weight.

Postmenopausal symptoms - 1 year after the last menstrual period and for the rest of life

Symptoms	How do they appear?
Hot flashes, sweating and psychoemotional disturbances	hot flashes usually become less frequent and easier, after a few years, most women have hot flashes completely; irritability, tearfulness, fatigue persist, but every month and year it becomes easier; insomnia and weakness persist for several more years, and some women do not get enough sleep for a long time.
Excess weight	many women gain weight, which is associated with a sedentary lifestyle, a slowdown in metabolism, and also with the fact that the body is trying to make up for the lack of estrogen by producing it with adipose tissue; the type of the figure also changes, there is a redistribution of fat in the abdomen and upper shoulder girdle, the skin sags, the posture changes.
muscle weakness	lack of hormones leads to weakening and flabbiness of muscle tissue, muscles sag, and their performance is significantly reduced; "Pumping muscle" with the help of sports becomes much harder than at a younger age.
Vaginal dryness	pain during intercourse; feeling of discomfort while wearing tight underwear and clothes; high risk of developing thrush and other inflammatory processes of the vagina.
Vaginal discharge, itching and burning	vaginal discharge is normal after menopause if it is: transparent, odorless and colorless, its amount is scarce and, most importantly, does not cause any discomfort and itching; the presence of itching, burning and unusual discharge indicate the presence of inflammatory and other problems, are not a normal condition, an appeal to a gynecologist is required; yellowish, odorless discharge, itching and discomfort during sexual intercourse indicate vaginal dysbiosis - the most common condition of the genital organs after the onset of menopause; cottage cheese discharge with a sour smell indicates vaginal candidiasis (thrush); secretions with a specific odor indicate the attachment of various pathogenic infections, including sexually transmitted ones; brown and bloody vaginal discharge may be associated with increased fragility of the vessels of the vaginal mucosa, in which case blood appears to a greater extent after intercourse, but also blood from the vagina can be a sign of tumors in the uterus and appendages, including malignant ones.
Urination disorder	the urge to urinate is significantly increased; a very high risk of developing urethritis and cystitis, as a result - the risk of developing inflammation of the kidneys (pyelonephritis); some women may experience urinary incontinence, especially when exercising, and the saying "you can stop laughing" is not so funny anymore.
Sex and fertility	libido continues to decline, although some women, on the contrary, have a special interest in sex, one that was not even in their youth; pain increases during sex due to vaginal dryness and poor elasticity of its walls; natural pregnancy is no longer possible.
Skin, hair and nails	there is a noticeable aging of the skin, it becomes dry, flabby, sags, deep age wrinkles appear, and not only on the face; the natural blush disappears, the skin of the face grows dull, looks tired, there are problems with acne, acne; often there are swelling of the eyelids; the hair splits, becomes thin, dull, turns gray, and there is also an increased loss of hair, over time the braid becomes much thinner; growing nails for a beautiful manicure is becoming increasingly difficult, they are brittle, often lose their color.
High risk of developing various diseases	osteoporosis - deformation of bone tissue; cardiovascular pathologies (arterial hypertension, atherosclerosis, arrhythmia, angina pectoris and others); diseases of the uterus and appendages (myoma, ovarian cysts, polyps, oncological diseases), prolapse of the vagina and uterus; pathologies of the mammary glands (mastopathy, cancer); diabetes mellitus, pathology of the thyroid gland and adrenal glands; diseases of the nervous system (vegetative-vascular dystonia, strokes, mental disorders and diseases); diseases of the digestive system (cholelithiasis, constipation, hemorrhoids); urinary tract infections and others.

Diseases with menopause

One of the manifestations of menopause after menopause is the risk of developing various diseases. This does not mean that all women in the period of menopause should suddenly begin to suffer from all diseases. Everything largely depends not so much on the level of hormones as on lifestyle, genetic predisposition and many environmental factors. In addition, many of these diseases can develop without menopause at a younger age. Yes, and men who are not so dependent on estrogens also suffer from these ailments. But many scientific studies have proven that it is the deficiency of sex hormones that is the trigger for the development of many of the "age-related" pathologies. Let's consider some of them.

Diseases associated with menopause:

Disease	Factors and causes that increase the risk of developing the disease	Main symptoms	What is dangerous?	How to reduce and prevent manifestations of the disease?
Osteoporosis- a decrease in bone density, a lack of calcium, phosphorus and other minerals in them, leads to the gradual destruction of bone tissue.	heredity; smoking; alcohol; sedentary lifestyle; excess weight; rare exposure to sunlight; unbalanced diet; diseases of the digestive and endocrine systems.	bone pain, especially "for the weather"; movement disorder in some joints; weakness, decrease in physical strength, sluggishness; spinal deformity, manifested by a violation of movements and posture, pain and a decrease in growth; deformation of the fingers and toes and other bones; fragility of nails, diseases of the teeth and hair loss.	Pathological bone fractures that can occur even with the slightest injury and simply unsuccessful movements. Fractures are difficult to grow together and can permanently chain a woman to a bed. Violation of cerebral circulation as a result of osteochondrosis of the cervical and / or thoracic spine.	Right way of life; food rich in calcium and phosphorus; moderate sunbathing; moderate physical activity, the correct mode of work and rest; fight against excess weight; avoid falls, injuries, awkward movements; hormone replacement therapy with sex hormones reduces the manifestations of osteoporosis; taking calcium supplements: Calcium D3, Ergocalciferol and many others.
Uterine fibroids is a benign tumor of the uterus associated with an imbalance of sex hormones. Myoma can be of different sizes, single or multiple. It often occurs against the background of menopause, and after the onset of menopause, small myomatous nodes are able to resolve on their own.	Abortions and operations on the uterus; lack of childbirth; endometriosis; irregular sex life; chronic stress; early menarche (first menstruation); excess weight; abuse of animal food; alcohol abuse; heredity; late pregnancy can exacerbate the growth of fibroids.	Prolonged, frequent and profuse menstruation; bleeding that is not associated with the monthly cycle; an increase in the volume of the abdomen; frequent urge to urinate; constipation; pain during intercourse.	Uterine bleeding, including massive. Pelvioperitonitis associated with torsion of the leg of the myoma node requires surgical intervention. Cancer is the malignancy of a tumor.	Replacement hormone therapy; healthy lifestyle; regular sex; prevention of venereal diseases; fight against excess weight; regular follow-up with a gynecologist.
ovarian cysts- benign cavity formations. With menopause, dermoid, endometrioid and other types of non-functional cysts often occur, as well as polycystic ovaries.	Endocrine diseases of the thyroid gland, adrenal glands, brain; abortions and operations; inflammatory diseases of the pelvic organs; sexually transmitted infections; genetic predisposition; taking contraceptives and hormone replacement therapy with sex hormones.	Pain in the abdomen, in the lower abdomen or in the lower back, aggravated by physical exertion and sexual intercourse; violation of urination and constipation; asymmetric enlargement of the abdomen; spotting spotting; painful menstruation in premenopause.	Cancer - non-functional cysts have a high risk of malignancy. Cyst rupture, ovarian rupture, and torsion of the cyst pedicle are conditions that require urgent surgical treatment.	Annual examination by a gynecologist and timely treatment of gynecological problems; if necessary, surgical treatment; prevention of venereal infections; healthy lifestyle and "no" to carcinogens.
Uterine bleeding- spotting from the vagina of a different nature, associated or not associated with menstruation.	In premenopause, bleeding is often associated with hormonal changes in menopause and menstrual irregularities; endometriosis; uterine fibroids; uterine polyposis; pathology of the cervix; polycystic and other ovarian cysts; spontaneous abortions.	Options for uterine bleeding in the premenopausal period: prolonged and heavy menstruation (more than 6 pads per day and more than 7 days); periodic spotting spotting, not associated with menstruation; the presence of large blood clots, lumps during or between periods; frequent periods (more than every 3 weeks); spotting that appears after intercourse; prolonged spotting of varying intensity (more than 1-3 months). After the onset of menopause, any spotting should alert.	Crayfish. Uterine bleeding can be a sign of serious illness, including cancer. Anemia - with prolonged and heavy bleeding, lead to loss of blood. Hemorrhagic shock - can develop with massive uterine bleeding, requires urgent resuscitation, surgery and transfusion of blood products.	Timely access to a doctor to determine the causes of bleeding and their correction; food rich in protein and iron; control over the amount of blood lost.
Mastopathy- a benign tumor of the mammary glands.	Involution of the mammary glands associated with hormonal changes; early onset of menstruation and early puberty; various diseases of the uterus and appendages, especially inflammatory ones; lack of lactation or a short period of breastfeeding; no pregnancy before the age of 30; abortions and miscarriages; stress; excess weight; taking contraceptives and other hormonal drugs in large doses; endocrine pathologies. heart attack; heart failure.	Proper lifestyle and nutrition; Regular physical activity; fight against excess weight; control of diabetes; regular intake of drugs containing aspirin; control of blood pressure; timely access to a doctor and compliance with his recommendations.

Diseases associated with menopause can be prevented not only by hormone replacement therapy, often recommended during severe menopause, but also by the right lifestyle and regular examinations by your gynecologist.

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Menopause diagnostics

Menopause is not a disease and, it would seem, why diagnose it, because everything is clear anyway - hot flashes, menstrual irregularities, the onset of menopause and the body getting used to living on small doses of sex hormones. But there are situations when it is simply necessary to know whether menopause has begun, and at what stage it is.

Why do we need menopause diagnostics?

• differential diagnosis of menopause and other diseases;
• identification of complications and diseases associated with menopause;
• examination before prescribing hormone replacement therapy and contraceptives.

What is included in the examination plan for menopause?

1. Analysis of life history and complaints (time of onset of menarche, presence of pregnancies, abortions, regularity of the menstrual cycle, etc.).
2. Examination by a gynecologist, taking swabs, bakposev from the vagina, cytological examination of smears from the cervix. Examination of the mammary glands.
3. Blood test for sex hormones.
4. Ultrasound of the uterus and appendages.
5. Breast ultrasound or mammography.
6. Osteodensitometry - measurement of bone density.
7. Electrocardiography (ECG)
8. Biochemical blood test: glucose, triglycerides, cholesterol, lipoproteins, blood clotting factors, calcium, phosphorus, etc.
9. Analysis for HIV and syphilis.

Sex hormones (estrogens, progesterone, FSH and LH) in a blood test with menopause:

Period of a woman's life	Indicators of the level of gomons in the blood, norm *
	Estradiol, pg/ml	Progesterone, nmol/l	FSH(follicle-stimulating hormone), honey/ml	LG(luteinizing hormone), honey/ml	LH/FSH index
Reproductive period before menopause: 1. Follicle maturation phase (1-14th day of the menstrual cycle).	less than 160	up to 2.2	to 10	less than 15	1,2-2,2
2. Ovulation (14-16th day).	over 120	to 10	6 – 17	22 – 57
3. Luteal phase (16-28th day).	30 – 240	over 10	up to 9	less than 16
premenopause	Female sex hormones gradually decrease**, menstrual cycles are observed without ovulation.		over 10	over 16	about 1
Postmenopause	5 – 30	less than 0.6	20 - 100 and above	16 - 53 and above	less than 1

* All normal values ​​are approximate. Each laboratory has its own reference (normal) values, which are usually indicated on the answer sheet. This is due to the various methods and test systems that are used in the process of laboratory research. Therefore, it is necessary to take into account those reference values ​​that the laboratory gives.

** Interestingly, at the beginning of premenopause, progesterone deficiency is especially pronounced, and not estrogen. And by the time of menopause, progesterone is formed in very low doses, and estrogen is only half as much as in childbearing age.

Hormonal background each woman is very susceptible to environmental factors, emotional state and various diseases, so the level of hormones in the same woman is variable.

When to take a blood test for sex hormones?

An analysis for sex hormones during the premenopausal period, that is, with saved menstruation, must be taken at certain periods of the menstrual cycle, accurately indicating the day from its beginning. Usually, FSH and LH are recommended to be taken on the 3-5th day from the onset of menstruation, and estradiol and progesterone on the 21st day. After the onset of menopause, the analysis can be taken any day.

Preparing for a blood test for sex hormones:

• the analysis is given strictly in the morning on an empty stomach, in the evening a light dinner;
• before the analysis, you should stop taking alcohol, coffee and drugs, do not smoke;
• when taking contraceptives, the results are adjusted taking into account their doses;
• the day before blood donation, it is recommended to give up sex and heavy physical exertion;
• before donating blood, you must completely relax, sit quietly for at least 10 minutes.

With the help of a blood test for sex hormones, the doctor can detect the onset of menopause or the onset of menopause, whether pregnancy and its bearing are possible. Also, depending on the level of hormones and the severity of symptoms, you can determine the severity of menopause. Severe menopause is indicated by high FSH levels, as well as the LH / FSH ratio: the lower it is, the more difficult the woman’s body tolerates the lack of sex hormones and the more pronounced the symptoms and diseases associated with menopause.

Ultrasound examination for menopause

With the advent of menopause, women's health problems often come. These are, first of all, various tumor-like formations, both benign and malignant. It is for their detection and observation that ultrasound diagnostics of the pelvic organs is necessary, and annually. In addition, ultrasound helps to diagnose the onset of menopause and determines the possibility of late pregnancy.

Ultrasound signs of the upcoming menopause:

• Ultrasound can detect the presence or absence of follicles in the ovary and their number. The closer to menopause, the fewer follicles, and the less chance of getting pregnant. After menopause, the follicles in the ovaries are not determined.
• The ovaries gradually decrease in size , they lose their echogenicity. After menopause, they may not be detected at all.
• The uterus is shrinking , becomes denser, small fibroids can be observed, which after menopause most often resolve on their own. The location of the uterus in the small pelvis also changes, it shifts somewhat.
Uterine fibroids and its treatment with ultrasound therapy
• Life after menopause - what is it like? Sex and sexual relations. Is it possible to get pregnant with menopause? Nutrition advice for women before and after menopause. Do men have menopause?

Catad_tema Menopausal syndrome and hormone replacement therapy - articles

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

Published in:
EF. Obstetrics, gynecology. 4/2011

Menopausal syndrome is a general name for a number of interrelated health disorders that occur in women during menopause. In the absence of adequate treatment, menopausal syndrome can lead to such serious diseases as coronary heart disease, dementia, type 2 diabetes, and 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. This group of drugs is characterized by a selective effect on various organs and tissues of the female body. In a report on Conference "Women's Reproductive Health: From Abortion to Contraception", held on September 15, 2011 in Samara, a doctor of the highest category, gynecologist-endocrinologist Marina Vladimirovna Glukhova substantiated the need for widespread use of tibolone (including its equivalent, generic Ladybon) in the treatment of menopausal disorders.

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

Worldwide, 25 million women go through menopause every year, and only 10% of them have it without pathological manifestations. According to WHO forecasts, by 2015, 46% of women in the world will experience menopausal disorders of varying severity. In Russia, almost 40 million women have already reached menopause. And, as the gynecologist-endocrinologist of the highest category reported, by 2020 demographers expect this figure to increase by another 20 million. At the same time, Russia in terms of women's life expectancy lags far behind countries with a high standard of living (Japan, Australia, Sweden, etc.). Menopause is a natural biological process of transition from the reproductive period to old age. It is long in time and includes the gradual extinction of ovarian function, the last independent menstruation (menopause), a decrease in estrogen levels. But from the menopause should be distinguished menopausal syndrome - a complex of pathological symptoms that accompany the menopause. What are we afraid of in the 21st century? - M.V. asked a rhetorical question. Glukhov. “We fear cardiovascular disease, dementia, type 2 diabetes and osteoporosis.” All these diseases can occur as complications of menopausal syndrome. In today's 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 of our women,” emphasized M.V. Glukhov.

Menopause and climacteric syndrome

Menopause is characterized by a decrease in estrogen levels. It begins after 45 years, 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 state 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 impact on many organs and systems. The climacteric period includes several phases. Premenopause usually occurs at the age of 45-47 years - from the onset of the first symptoms of menopause to the cessation of independent menstruation. Menopause is considered premature if it occurs at the age of 37-39 years, and early if it occurs at the age of 40-45. The normal age for menopause is around 50 years old. There are natural and artificial menopause, the latter may be associated with surgery, exposure to radiation, the use of cytostatics and other reasons. Perimenopause is a period that chronologically combines 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. Climacteric syndrome begins with neurovegetative and psycho-emotional disorders, and in the long run it can lead to osteoporosis, cardiovascular pathology and Alzheimer's disease. To prevent such sad consequences, it is necessary to begin to deal with menopausal syndrome when its first symptoms appear, which include "hot flushes". During hot flashes, 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 reach up to 30 times a day. Hot flashes are accompanied by profuse sweating. Often there are sympathoadrenal crises, fluctuations in blood pressure. 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 life.

There are a number of other symptoms of menopausal syndrome. The blood supply to the mucous membranes worsens, sexual intercourse can become painful, urinary incontinence, frequent urination, and urgent urges may occur. Less common symptoms include numbness and tingling or trembling in the extremities, goosebumps, muscle pain, shortness of breath and feeling short of breath, bouts of bronchospasm, a feeling of dryness or burning in the mouth, various unpleasant taste sensations, and "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 cognitive decline.

Hormone therapy and its evolution

M.V. Glukhova sees in hormone replacement therapy (HRT) a very effective method of treating menopausal disorders. It simultaneously eliminates all the symptoms of menopausal syndrome, and the effectiveness of preventing osteoporosis by this method 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, 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 effects of periodontal disease and the associated loss of teeth. It has also been proven to reduce the incidence of colorectal cancer under the influence of HRT.

The speaker described the evolution of methods for the treatment of menopausal disorders. In the 1920s phytoestrogens were first used, in the 1940s - "pure" estrogens, in the 1970s there was a combination therapy with estrogen and progestogens, 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 are used (17-(3-estradiol) in the minimum effective doses, while the dose of the hormone decreases with the age of the patient. In women with an intact uterus, estrogens are combined with progestogens (combination therapy) In addition to women with menopausal disorders, HRT is recommended for patients with risk factors for osteoporosis or reduced 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 exclusively for the prevention of cardiovascular diseases or Alzheimer's disease in the absence of menopausal disorders. There are a number of contraindications for HRT. It is not prescribed for women with a history of breast cancer , currently or if it is suspected, with estrogen-dependent malignant tumors (endometrial cancer or suspicion of this pathology), with bleeding from the genital tract of unclear etiology, with untreated endometrial hyperplasia. HRT is also contraindicated in deep vein thrombosis, pulmonary embolism, angina pectoris, myocardial infarction (all of the listed diseases, both at the time of the appointment of therapy and in 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, cutaneous porphyria. Indications for the use of HRT are vegetative-vascular symptoms and mild to moderate psychoemotional disorders in pre- and postmenopause: hot flashes, excessive sweating, dizziness, headaches, sleep disturbance, irritability. Premenopause and early postmenopause (no later than 5-7 years after the last menstruation) is a "window" of therapeutic possibilities of HRT. There are various types of hormone therapy: parenteral agents - estradiol (patch) and estradiol (gel), topical drugs (for example, vaginal cream), but most often oral drugs are used - combinations of estradiol with dydrogesterone (Femoston), estradiol with levonorgestrel (Klimonorm) , estradiol with drospirenone (Angelik), as well as tibolone.

STEAR - a new approach to treatment

The main part of his report, gynecologist-endocrinologist of the highest category M.V. Glukhova dedicated specifically to the drug tibolone, including its generic equivalent, Ledibon. Previously, since 2003, it was included in the “other sex hormones” group of drugs, later, in 2009, it was moved to the “other estrogen drugs” group. Tibolone is part of the STEAR (Selective Tissue Estrogenic Activity Regulator) group of drugs. The use of STEAR preparations represents a fundamentally new approach to the treatment of menopausal disorders. The goal of this approach is not the 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 analogues stimulate estrogen receptors (receptor level), and at the prereceptor level, tissue enzymes activate or inhibit the synthesis of active forms of estrogen 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 balance, but in women of mature, menopausal age, the activity of the sulfatase enzyme predominates,” noted M.V. Glukhov. Metabolites block sulfatase and activate the sulfotransferase system. The clinical effects of the drug tibolone are diverse. This is the treatment of symptoms of menopausal 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 , and does not stimulate endometrial proliferation 2 . If two of the three metabolites of tibolone are stimulants 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 tibolone metabolites 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 Tibolone (Ladybon)

The main advantage of the drugs of the STEAR group (including tibolone) is that they have a selective effect on estrogenic activity in tissues (the fundamental difference between the drugs of 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 undesirable estrogenic effect in the endometrium and mammary glands, which avoids the risk of developing tumors (as you know, traditional HRT has been sharply criticized because 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 interfere with the cure, but also contributes to it.

Hormone therapy of menopausal disorders improves the quality of life of a woman. “Of course, a good mood and a positive effect of therapy on appearance are important for women,” M.V. Glukhov. 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"). A positive effect of this drug on a woman's sexual life has also been established, and under its effect increases both the frequency of manifestation 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.Last this 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 body hydration.Indications for the use of the drug tibolone are vegetative-vascular and psycho-emotional disorders typical of mild to moderate menopausal syndrome: hot flashes, excessive sweating, dizzy ie, headaches, sleep disturbances, irritability.

A positive effect of the drug on the hormonal status of women after hysterectomy was also noted. Tibolone is recommended to be used already in the early postoperative period - in the first three days after surgery. Therapy for 3 months after surgery led to a decrease in FSH by 1.3-1.6 times and an increase in E2 by 2.0-2.2 times. If you start therapy in the long term after surgery, then 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 drug tibolone is a 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 femoral neck). On the contrary, in the control group, BMD steadily and significantly decreased with age 5 .

Conclusion

Summing up his speech, M.V. Glukhova noted that a comparison of the use of tibolone and combined HRT indicates that these two types of therapy are equally effective for the treatment of menopausal syndromes and the prevention of osteoporosis. To improve mood and libido, to obtain sexual satisfaction, tibolone is more effective. Unlike combined HRT, this drug does not stimulate endometrial proliferation and does not cause bleeding. Tibolone also does not stimulate breast tissue, does not increase mammographic density, and does not contribute to breast engorgement. When taking tibolone, the frequency of patients refusing therapy due to side effects is much lower than when using combined HRT. The use of STEAR preparations (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 Ledibon, 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, randomised trial comparing the effects 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.