Menopause

Menopause is a physiological period in a woman’s life which is characterized by an extinction of a reproductive function due to hormonal changes in one’s obody. It starts after 40 years old and lasts about 10 years. Typical signal is phasing down of menses. Climax is also attended by a complex of vegetovascular and endocrine disorders: hot flash to a face, perspiring, tearfulness, irritability, blood pressure fluctuation, increased xerodermia, mucous membrane dryness, sleeping difficulty. It may cause dysfunctional uterine bleedings and serious neuropsychic disorders.  Read more…

Climax:

• Menopausal syndrome. Causes
• Types of menopausal disorders
• Symptoms of menopausal syndrome
• A diagnosis of menopausal syndrome
• Disorders treatment under climax
• Hormonotherapy regimen

Menopause is a natural stage in a woman’s life which is characterized by an extinction of a reproductive function – a stoppage of genital and menstrual functions.

A life cycle of a woman consists of several age periods to be characterized by anatomico-physiological peculiarities:

1. Neonatal period – up to 10 days;
2. Childhood period – up to 8 years old;
3. Pubertal period – from 8 to 17-18 years old;
4. Sexual maturity – (reproductive or genital) – from 18 up to 45 years old;
5. Climacteric period (climax):
   • Pre-menopause – from 45 years up to menopause;
   • Menopause – ischomenia (stoppage of menses) – (49-50);
   • Post-menopause – from menopause till 65-69 years old.
6. Old age period – from 70 years old.

Under average life expectancy (75 years), a third part of a woman’s life falls on climax. Some women do not suffer from any pathologic disorders caused by climax; unfortunately, climax may lead to climacteric syndrome development – 26-48% of women face a complex of different endocrine, nervous and cardiovascular systems to disrupt a normal vital activity and working capacity of a woman.

Questions of pathologic climax course have social and medical importance due to increased average time of a woman and her social-active way of life.

Causes of Menopausal Syndrome

Menopause provokes changes of the whole body of a woman: it weakens the immune system, increases possibilities to catch autoimmune and infectious diseases, it also progresses process of aging. The most active changes under menopause affect woman’s genitals as far as they stop follicles developing, egg cells, maturing and ovulating; endocrine activity is being reduced. Follicles in ovaries cells are replaced by a connective tissue to provoke sclerosing and decreasing of ovaries in size.

Hormonal phone under climax is characterized by a rise of level of gonadotropic hormones (follicle stimulating and luteinizing ones) and estrogen level fall. During the year, after menopause comes, the follicle, stimulating hormone level, increases by 13-14 times, luteinizing – by 3 times with the following certain decrease.

In case of climax, changes through a synthesis of estrogenic hormones consist of termination of an estradiol production and predominance of an estrone. Estrogens have biological effect on uterus, mammary glands, urethra, urinary bladder and vagina, muscles of pelvic floor, brain, arteries and heart cells, bones, skin, mucous membranes of conjunctivas, larynx, mouth and etcetera. Their deficit under climax may lead to different disorders in these tissues and organs.

Menopausal syndrome results in a lack of estrogens and it is characterized by vegetoneurotic, urogenital disorders, dystrophic skin modifications, high risk of atherosclerosis, vessels ischemia, osteoporosis and other psychological disturbances development.

Since woman’s average duration of life increases, climax also is prolonged. These factors extend estrogenic deficit period and provoke a menopausal syndrome development.

Types of Menopausal Disorders

A climacteric syndrome is subdivided into early-time, middling-time and late-time manifestations.

• Early-time manifestations

• Vasomotor symptoms-hot flushes, headaches, excessive sweating, chills, pressure oscillation, heartbeats.
• Psycho-emotional symptoms – weakness, stress, irritability, sleepiness, inattention, forgetfulness, depression and libido decrease.

In general, early-time manifestations during menopause cover pre-menopause and 1-2 years of post-menopause. Women with vasomotor and psycho-emotional symptoms usually pass a treatment course as to hypertension, ischemic heart disease, neurosis and depression during menopause.

• Middling-time manifestations of menopause include

• Urogenital symptoms – dry mucous membrane of vagina, painful intercourse, burning, itch, dysuria (frequent urination and urinary incontinence).
• Skin symptoms and its appendages – hair fallout, wrinkles, nails fragility, dry skin and hair.

Such symptoms are typical for the middling-time period during the menopause (2-5 years after menopause); they are defined by atrophic changes of a skin and urogenital tract. As a rule, symptomatic treatment of urogenital and skin symptoms under menopause is not effective.

• Late-time menopause disorders

• Metabolic disorders – osteoporosis, atherosclerosis, alzheimer’s disease, cardiovascular diseases.

Late-time manifestations during menopause start developing 5-10 years after menopause. Insufficient level of gonadal hormones during menopause period leads to bone tissue structure disruption (osteoporosis) and lipid metabolism (atherosclerosis).

Symptoms of Menopausal Syndrome

The development and severity of menopausal syndrome course are affected by hormonal, environmental, hereditary factors, and the general condition of a woman under menopause.

Vasomotor symptoms in case of pathologic climax course affect about 80% of woman. They are characterized by sudden hot flushes and sharp capillaries extension head skin, neck, face, thorax, increase of local skin temperature by 0,5-1°С. Usually, hot flushes are attended by fever, redness, perspiration and heartbeat. In general, hot flushes condition lasts 3-5 minutes, 1-20 times a day,  to be active especially at night. Unfortunately, it results in sleep disturbance. A mild case of vasomotor disorders under menopause is defined with 1-10 hot flushes a day, an average case – from 10 to 20, severe form – from 20 and more including other symptoms (dizziness, depression, and phobias). Surely, it leads to low working capacity.

13% of women with pathologic menopause course suffer from asthenoneurotic disorders, such as, irritability, tearfulness, anxiety and fear sensation, intolerance of olfactory and sound sensations, depression. Psychoemotional symptoms are shown before menopause or after it, vasomotor ones continue for about 5 years after menopause.

Sometimes, pathologic menopause course acquires atypical forms:

• Sympathoadrenal crisis, to be characterized by sharp headache, increase of arterial pressure, urination delay with the following polyuria.
• Myocardiodystrophy, to be characterized by constant heart pains in case of none of visible changes at ECG, inefficiency of the current therapy.
• Hives, vasomotor rhinitis, allergy to medicines and foodstuffs to testify modifications of immunological body reactions and so on.

As a rule climax falls on important events in a woman’s life: maturation, children’s marriage, achievements at work, pensionary changes. Also, menopausal disorders appear through emotional stress, social problems. Almost 50% of women with pathologic course of climax face severe form of the disorder; meanwhile 35% of women have moderate dysfunctions, and only 15% suffer from mild syndrome of menopause; such disorder form reaches practically healthy women, while those, to have chronic diseases, are subject to acquire atypical form of the menopause which disrupts a general condition of patients.

A menopause syndrome development is usually provoked by genetic factors, endocrinopathy, chronic diseases and smoking, menstrual cycle disorder during sexual maturity period, early menopause, hypodynamia. Pregnancy and labor absence in past history also triggers off this syndrome.

A Diagnosis of Menopausal Syndrome

A diagnosis of pathologic climax course is based on patients’ complaints to arise at the age of menopause coming. Sometimes, sharpening of attendant diseases complicates a diagnosis of the menopausal syndrome and provokes atypical forms of development. In case of attendant diseases, a woman should apply to gynecologist, cardiologist, neurologist and endocrinologist.

For the purpose of the correct diagnosis of menopause course, one should undergo medical tests to detect follicle-stimulating and luteinizing hormones levels and estrogens.

In order to specify a functional condition of ovaries under the climax, it is necessary to carry out histological analysis of uterus endometrial and (interactive) cytological examination of vaginal smears, graphing of basal temperature. Detection of anovulatory ovarian cycles allows connecting functional disorders with menopausal syndrome.

Disorders Treatment Under the Menopause

Modern gynecological approaches to treat pathologies of menopause are based on its symptoms decrease.

Minimization of hot flushes frequency under the climax pathology is being achieved by antidepressant prescription: Venlafaxinum, Fluoxetine, Paroxetinum, Citalopramum, Sertralinum and other drugs.

With the view of prophylaxis and osteoporosis treatment, it is advisable to take non-hormonal bisphosphonates (Alendronate, Risendroantum) which reduce a lack of bone tissues and risk of fractures development. Bisphosphonates are substitutions of estrogen therapy under osteoporosis treatment. In order to reduce urogenital symptoms, it is recommended to apply local (vaginal) estrogen introduction in a cream or tablet form. Discharge of small doses of estrogen reduces dryness sensation, discomfort under sexual contacts and dysuria.

The most effective method of the menopause syndrome treatment is prescribed by a doctor individually. Estrogen drugs intake eliminates hot flushes and vaginal discomfort. For the purpose of hormonotherapy, natural estrogens are prescribed (Oestradioli valeras, 17-beta Estradiol) in a small dose by courses with certain intervals. In order to prevent endometrial hyperplasic processes under climax it is required to combine estrogens with gestagens (pousogest) or with androgens (more rarely). Hormonotherapy course of treatment in case of climax pathology is contra-indicated for those patients to suffer from:

• Endometrial, ovarian and mammary gland cancer;
• Coagulopathy, (blood coagulation disorder);
• Compromised liver function;
• Thromboembolism, trombophlebitis;
• Uterine bleeding of unknown reasons;
• Renal insufficiency.

Before a prescription of hormonal agents with climax pathology, it is necessary to carry out an examination: ultrasound of small pelvis, mammary glands and mammography, analysis cytologic analysis from neck of the womb (smears), biochemical investigation of blood test analysis and coagulated factors (Coagulation testing).

Hormonotherapy Regimen

A hormonotherapy regimen depends on the manopausal stage. In case of pre-menopause, the hormonotherapy fills in estrogens deficit and normalizes menstrual cycle. Thus, it is prescribes by courses.

When atrophic processes happen, it is necessary to carry out the hormonal therapy in order to prevent monthly bleeding.

In case a woman suffers from urogenital disorders only, a doctor prescribes estrogens (estriol) in a vaginal tablet, suppository or cream form. However, in this case, there is a risk of other menopausal climax disorders development, including osteoporosis.

A system effect in the pathologic menopause course treatment is reached by a combined hormonal therapy prescription (Ovestin+Estriol+Livial+ Kliogest). In the time of combined hormonal therapy, a doctor prescribes both hormones intake and symptomatic drugs: hypotensive, cardiac, antidepressants, urinary bladder relaxants and etcetera).

A combined therapy of menopauseal disorders is prescribed after specialists’ consultation only!

The pathological menopausal course and its treatment is a key to have strong women’s health, beauty, working capacity, this it leads to a real life quality improvement!