Climax

Menopause in women is a natural physiological stage in the life of every woman, when signs of involution of the reproductive system appear against the background of natural hormonal age-related changes. Contrary to the mistaken idea of ​​menopause common among women, it is completely incorrect to identify him and old age, as the hormonal function in women begins to fade long before the onset of genuine aging.

In fact, the meaning of menopause is only in the extinction of the hormonal function of the ovaries, and all the accompanying symptoms are associated with the processes of adaptation of the organism to this process.

The onset of menopause does not have a clearly defined "normal" age, as in different women the climacteric period begins in different ways. It is largely influenced by hereditary factors, gynecological and extragenital( especially chronic) diseases. As a rule, in most cases, the first signs of the onset of menopause are diagnosed in women over 45 years old.

According to age, when the onset of menopause is diagnosed, the early, physiological and late menopause are conventionally identified.

Climax is a long, multi-stage life span, during which all systems of the female body adapt to new conditions - they learn to function in conditions of severe estrogen deficiency. Sometimes this adaptation transition is accompanied by not very pleasant symptoms, but not always they mean pathology. To the body fully "learned" to live without estrogens, it needs at least 8-10 years.

There are several important periods in the climax:

- Premenopause. It begins when the first sign of menopause appears and lasts until the last menstrual bleeding.

- Menopause. Last menstruation. True menopause is considered in the event that after the last months during the year they were no longer there. Some experts consider it more correct to calculate menopause after 1.5 or even 2 years.

Women often identify menopause with menopause. Therefore, when studying the anamnesis, it is always necessary to specify what exactly the phrase "I have menopause after 50 years" or "menopause after 45 years" means.

- Perimenopause. Consolidates the two previous periods.

- Postmenopause. In fact, it starts with menopause and ends at 65 to 69 years. Isolate early( the first five years) and late( up to ten years) postmenopause.

This classification of menopause is conditional, because not all women have such a clear division into periods. However, it is important for clinical practice.

Sometimes patients ask if there are menstrual periods after menopause. Obviously, they mean menstruation after a long delay against the background of climacteric changes. According to the classification described above, the menopause ends in old age, so the menstrual period can not come after the menopause. Any separation of blood in postmenopause by menstruation is not and requires detailed study.

Pregnancy after menopause( similar to menstruation) is also not possible. However, hypothetically, it may well occur at the beginning of menopause, that is, until the moment of menopause, when menstruation is still going on, and there may be single spontaneous ovulation. This situation is unlikely, but it still requires the use of contraceptives until the menstrual function is completely extinguished. Questions related to contraception in women who entered the menopause are discussed with a specialist.

To navigate in a variety of terms and classifications, it is sufficient for patients to know that the final cessation of menstruation conditionally divides the menopause into two long time intervals, when initially the body gradually functions under estrogen deficiency conditions, and then, with the complete absence of estrogens.

So, the main "culprit" of menopause are disappearing estrogens, especially estradiol. Estrogens are mainly synthesized in the follicular apparatus of the ovaries and affect almost all systems and organs, namely:

- Stimulate the functioning of the glandular structures of the genital tract, affecting the secretion of cervical mucus and moisturizing the vaginal cavity.

- Affect the glandular tissue of the mammary glands, sebaceous glands of the skin.

- Maintain metabolic processes, accelerating the metabolism.

- Prevent the accumulation of cholesterol.

- Promotes the strength of bone tissue, as it controls the intake of calcium and phosphorus in the bone.

- Have a stimulating effect on the immune system.

- Affect the tone of smooth muscles, coagulation, digestive system and thermoregulation.

- Closely related to the psycho-emotional sphere.

When the amount of estrogen begins to decrease, the body responds with the appropriate symptomatology. Since climax affects almost all systems, the symptoms of its onset can be very diverse. Each woman has her own "climax" - a set of clinical signs associated with hypoestrogeny.

Climax is not a disease, just one of the periods of life that no woman can pass. However, it is not uncommon for women under this word to mean the pathological course of this period.

The clinic for menopause is very diverse and depends on how the ovaries complete their hormonal activity. If the decrease in estrogen occurs smoothly, the body gradually has time to adapt to the new condition, and the woman suffers this transition period easily. A sharp decrease in the concentration of estrogens, especially against the background of existing chronic diseases( both gynecological and extragenital), provokes the development of a pathological climacteric syndrome.

It should be noted that menopause can also be of an artificial nature, when the menstrual function stops not on the background of age-related changes, but because of external interference. Artificial menopause is used to stop the ovaries for therapeutic purposes in the treatment of endometriosis, fibroids, bleeding, oncology, and in preparation for artificial insemination. After surgical removal of the ovaries, menopause also develops.

Because climax refers to natural processes, it is not necessary to treat it, and it is impossible. However, if a woman suffers this stage of life is difficult, it is necessary to correct the existing violations. Symptomatic therapy is often used. The pathological course of menopause is sometimes compensated by hormonal agents based on estrogens.

Causes at what age does the climax begin?

Climax begins as a result of a change in the hormonal function of the ovaries. The onset of menopause in time does not correspond to menopause, therefore its "normal" age indices are conditional. As a rule, the disappearance of menstrual function is preceded by a sufficiently long time interval, during which the reproductive system gradually completes its work, and the body adapts to such a process.

Most women for the starting point of the climacteric period is 45 years of age, coinciding with the appearance of the first clinical manifestations of menopause. As a rule, after three or five years( that is, by the age of 50), the menstrual function is finally completed, and the clinic for menopause becomes brighter.

These common age parameters are not absolute, because some menstrual function lasts a little longer, or ends earlier. In such situations, not so much the age of the woman as the cause of the early( up to 45 years) or late( after 55-year-old) menopause is important. In five of the 100 perfectly healthy women, the regular menstrual function continues after 55 years, and in 3% it ends before the age of 40.If the woman is healthy, the age of the onset of menopause is considered as an individual norm.

Often the onset of menopause is determined by heredity, when women in the family have early or late menopause. As a rule, a detailed examination of women with this predisposition does not reveal any pathological abnormalities.

Perhaps the onset of menopause depends to some extent on the age of the menarche. The later in the ovaries girls "turn on", the longer they function.

It is well known that if a woman smokes a lot, the onset of menopause occurs 1-3 years earlier than if she did not have a similar habit. Also, during the onset of menopause, severe infectious diseases, pronounced long-term stress, physical exhaustion.

The number of pregnancies and their outcome( labor, artificial or natural interruptions) do not affect the onset of menopause unless they are accompanied by serious complications.

Regardless of the age of the woman, menopause is provoked by ovarian dysfunction, namely, a decrease in the concentration of estrogens. The most active in the body has estradiol, its crucial amount is synthesized by the ovaries during the maturation of the follicle( the first phase of the cycle).Thanks to estrogens, not only the reproductive system functions normally, they also regulate the functioning of the urinary, digestive, musculoskeletal, cardiovascular systems. Estrogen receptors are located in the conjunctiva of the eyes, skin, and brain cells.

Ovarian estrogen secretion is controlled by the hypothalamus. It regulates menstrual function with the help of a pituitary mediator, which is able to influence the concentration of estrogens by producing follicle-stimulating( FSH) and luteinizing( LH) hormones. It is believed that the menopause is provoked by its physiological aging.

With a climacterium, the hormone ratio changes in such a way that against a background of estrogen deficiency, the level of hormones produced by the pituitary gland sharply increases. These changes begin in the pre-menopause. In the first year of menopause, the concentration of FSH exceeds the norm by more than 13 times, and the LH - by 3 times. Such hormonal dysfunction provokes structural and functional changes in the body, which tries to adapt.

Thus, menopause after 45 years, as well as menopause after 50 years, is a physiological norm and, if it is not accompanied by serious pathological symptoms, does not require any treatment.

Early menopause

The early onset of menopause is diagnosed up to 40 years. Premature termination of the hormonal function of the ovaries is almost always associated with pathological processes. The exception is a very small group of women, in whom too early menopause is inherited genetically.

Premature menopause occurs infrequently( 1-2%).Too early extinction of the hormonal function is not physiological, so the term "early climax" to designate this process has only a provisional value, because menopause does not belong to pathology. Therefore, if signs of extinction of menstrual function appear already by the 37th - 38th years, they speak of the syndrome of premature ovarian exhaustion.

In time, the climax comes in accordance with the processes of gradual aging of the body, which is preparing for hormonal changes and can compensate them with time, so often a timely menopause occurs with minimal negative symptoms that do not even require a medical correction. Unlike physiological menopause, which occurs in parallel with aging, the early menopause develops against the background of a normally functioning young organism that literally experiences a "shock" from sudden estrogen deficiency and is not yet ready for such changes and reacts to them with a vivid clinic.

The etiology of premature ovarian malnutrition has not been fully studied, but negative factors are known, the presence of which substantially increases the risk of developing this pathology. These include:

- Genetically determined predisposition to premature menopause. As a rule, the presence in the family of women with early menopause, especially against the background of endocrine disorders, increases the risk of its appearance in subsequent generations.

- Autoimmune pathological processes in the thyroid gland( hypothyroidism).

- Any organic( tumors, traumatic injuries) or functional( stress, depression) changes in the brain( pituitary, hypothalamus), regulating hormonal function of the ovaries.

- Severe beriberi, including on the background of starvation.

- Operations on the ovaries, resulting in damage or removal of the follicular apparatus.

- Intrauterine pathology of fetal development, which provoked damage to the ovaries. A similar negative scenario is possible with severe gestosis. The most dangerous for the correct formation of the ovaries in the developing fetus are some aggressive viral infections( parotitis, rubella, influenza), often they lead to a partial replacement of the follicular apparatus with a dense connective tissue.

The clinic for early ovarian malnutrition is similar to that with the timely onset of menopause.

The first symptom of menopause in young women is menstrual dysfunction, after which the majority( 80%) have other symptoms.

Despite the lack of understanding of the causes of early menopause, it is reliably established that premature depletion of the ovarian function occurs almost always according to two main scenarios:

1. Fatal depletion of the follicular apparatus, when significantly reduced ovaries and absence of follicles are visualized during ultrasound scanning.

With this form of early menopause, there is a persistent lack of menstrual function and a rapid development of the symptoms of the pathological menopause against the background of pronounced estrogen deficiency. With ovarian exhaustion, the early menopause is more severe.

2. Syndrome of resistant( refractory, mute) ovaries. The word "resistant" very accurately conveys the meaning of this pathology: the ovaries have follicles, but "refuse" to respond to their own hormonal stimuli.

Ovaries also become slightly smaller in size, but follicles are periodically visualized in them, that is, estrogens are still synthesized, but they are not enough for the full functioning of the body. Menstrual function is impaired, but not absent: occasionally they can pass monthly.

Premature menopause on a background of resistant ovaries flows more gently. Episodes of activation of the function of the ovaries lead to an improvement in the status of patients and level the estrogen-deficient symptoms.

One of the serious consequences of early menopause is persistent infertility. In most still young patients, the natural onset of pregnancy after menopause becomes impossible, because damage to the follicular apparatus is not consistent with full ovulation. In a similar scenario for a woman with an early menopause, the only way to realize the reproductive function remains artificial insemination using the donor's egg.

Very rarely( 1-4%) in premature menopause, the function of the ovaries fades unevenly, and the probability of single spontaneous ovulation is maintained, which makes possible the maturation of a full ovum.

It should be noted that in addition to medical, in early menopause there is a pronounced psychosocial aspect: a young woman realizes that she is "aging", which causes her a wide range of neurological and psychiatric disorders.

Early menopause can be artificial, when the function of the ovaries is eliminated by medication or by surgery( removal of the ovaries).

Symptoms and symptoms of climax

Climax can proceed in different ways. After all, it affects almost all the most important body systems, and each of them "responds" to menopause in its own way. There is no asymptomatic menopause, but in healthy women all its manifestations are moderately expressed and do not disturb the habitual life rhythm.

Very often, menopause means climacteric syndrome - a set of pathological symptoms that reflect pronounced psychoemotional, vegetative, vascular and metabolic disorders. Contrary to the misconception of most patients, such disorders are not a physiological menopause, there are not every woman of menopausal age and should not be considered a "norm".

About 40% of women entering menopause carry their condition safely and do not need serious medication.

It can be said that the conditional boundary between "normal" and pathological climax is the self-esteem of one's condition by the woman herself and the degree of symptom severity of menopause.

In pre-menopause, the first symptoms of menopause appear, namely, menstrual dysfunction. Ovaries continue to function during this period, so estrogens are secreted, but not in a constant cyclic rhythm. Months gradually lose their habitual physiological parameters, become either extremely abundant or meager, and also may not arrive on time.

In perimenopause menstrual disorders are aggravated. Since fluctuations in estrogen levels are still possible, women note symptoms similar to premenstrual syndrome: heaviness in the lower segment of the abdomen, feeling of engorgement of the mammary glands, pain in the lower back and others. At the same time, the first well-pronounced "famous" tides appear.

Menopausal disorders according to the nature and timing of the offensive are classified into early, delayed and late.

• Early symptoms of menopause:

- Vascular( vasomotor): hot flushes, intense sweating, headaches and migraines, tachycardia and unstable blood pressure.

- Emotional and vegetative, that is, associated with changes in the reactivity of the central and / or peripheral parts of the nervous system. These include irritability, drowsiness, weakness, decreased memory and concentration of attention, unmotivated anxiety, depression.

• Delayed symptoms of menopause( appearing in the first two years after the establishment of menopause):

- Urogenital disorders. Appear due to dystrophic and atrophic disorders in the lower segment of the genito-urinary tract, when atrophic vaginitis, cystitis, urethritis develops against a background of pronounced estrogen deficiency. Sometimes these disorders provoke the failure of the bladder sphincter and, as a consequence, urinary incontinence.

Pathological discharge after menopause, more precisely - after the onset of menopause, associated with nonspecific inflammation in the mucous membranes, deprived of the protective effect of estrogens. Often they are accompanied by unpleasant subjective sensations( itching, discomfort and the like).

Bloody discharge after menopause signal a possible serious problem, so require a visit to a specialist.

- Changing the structure of the skin and its appendages: dry skin, brittle nails and hair, wrinkles.

• Late clinical signs of menopause include metabolic disorders, which usually appear 3-5 years after persistent menopause.

- Postmenopausal metabolic syndrome: atherosclerosis, arterial hypertension, impaired synthesis and utilization of lipids and glucose.

- Neurological disorders of hearing, vision and memory.

- Changes in the structure of muscles and bones.

It should be emphasized that, in the normal course of menopause in a woman, the symptoms described above may not be expressed or expressed weakly.

In most( 75%) of men experiencing menopause, psychoemotional abnormalities predominate among complaints. They are not accompanied by a marked disruption of the activity of an organ, so women often experience them alone, which is not always beneficial. A woman's understanding of the onset of menopause is often incorrectly associated with her with old age, and this provokes changes in the emotional sphere and forms a negative attitude towards others, herself and her life. Meanwhile, nervousness in the menopausal period has a physiological basis, because the centers of the brain responsible for its psycho-emotional and physiological regulation are located side by side and affect each other.

Any woman experiencing climax should know that this period of life is experienced by everyone, but climacteric syndrome does not always develop. Adequate treatment of your condition and understanding that it is not a disease helps to survive this life stage with minimal side effects. If a woman has good health, has a favorite occupation, close people and many interests, she has all chances to overcome the menopause calmly, because all the emerging "terrible" symptoms are temporary and disappear after the menopause.

Climax without hot flashes

The most common first harbinger of the menopause is the so-called hot flashes. They occur so often that patients have an erroneous opinion that there are always hot flushes with menopause. Meanwhile, the climacteric period can proceed in such a way that other symptoms come to the fore, and the tides either flow in an erased form, and the woman does not accentuate them, or they rarely happen and disguise themselves under the manifestation of excitement, excessive physical stress or reaction toClimate change.

Tides reflect vegetative-vascular disorders in the body against a background of estrogen deficiency. Usually they start suddenly with a feeling of heat or heat in the body, especially in the upper part of the trunk( neck, head, back), and accompanied by intense sweating. The skin of the face turns red and sweat. The tide clinic is not the same for all women. Sometimes the tides are combined with a pronounced anxiety and even panic, palpitations, nausea, dizziness, pain in the projection of the heart.

Often intensified night sweats are also associated with hot flashes. Usually, when a woman wakes up, she does not feel the tide, but its effects in the form of sweat, especially on the back. If the tides cause a woman to wake up, she develops sleep disorders.

To provoke a rush can be spicy food, alcohol, high ambient temperature, severe excitement, physical stress.

On the appearance of menopause the body can respond in different ways, so the clinic of this period is ambiguous at all and depends on which system of the organism has reacted most sharply to the hormonal changes that have arisen. If the vegetative-vascular disorders are compensated by internal reserves, there will be no pronounced tides.

The number of tides per day is an important indicator of the severity of the climacteric period.

The mild form of the climax is accompanied by a small( less than ten) number of tides that do not affect the physical condition and vital rhythm of a woman.

If the number of tides fluctuates within 10-20 within a day, and they are accompanied by such unpleasant symptoms as dizziness and headache, heart pain, deterioration of well-being, the course of menopause correlates with the average severity.

The severe form of the climax is accompanied not only by frequent( more than 20 daily) tides, but also by other pathological symptoms that do not allow a woman to live a normal life.

Tides do accompany the menopause always, but often they run unnoticed or manifest unusually. For example, some women note that they do not have "classical" tides, but they periodically "freeze", there is increased sweating( especially at night), or they have become more difficult to tolerate hot weather and stuffy rooms.

Tides are the earliest precursors of menopause, sometimes they can begin long before the end of menstrual function and the onset of typical clinical manifestations. Thus, about 40% of patients with a normal menstrual cycle indicate the presence of hot flashes.

Treatment of prematurely onset menopause

Early menopause, as mentioned above, is always a pathological condition due to premature exhaustion of ovarian function. Like any other pathology, the early menopause can not be left without attention and therapy, because for young women this condition is always a strong emotional shock, not to mention the painful symptoms that it sometimes accompanies.

The early menopause can not be eliminated, since the extinction of ovarian function leads to irreversible consequences, namely the complete destruction of the follicular apparatus. However, it is possible to medically cope with the accompanying negative symptoms of early menopause.

Patients with prematurely onset menopause undergo a thorough examination. To determine the severity of hormonal dysfunction, necessary functional tests are performed( symptom "pupil", basal temperature, KPI), the concentration of the main sex hormones is determined, and hormone tests with progesterone, clomiphene, gonadotropins are carried out.

Ultrasound scanning determines the condition of the ovaries and uterus, and also allows to diagnose the concomitant pathology.

It is possible to directly examine the ovaries with laparoscopy, which allows you to take the material for subsequent histological examination.

The main goal of the therapy of premature ebullition of the ovarian function is the medical correction of the main cardiovascular, nervous, endocrine, immune and other systems involved in climacteric processes.

Early menopause starts in young women, whose body is not yet ready to grow old, because it has not worked out the resources it has put. To restore its normal functioning, it is necessary to artificially recreate the normal estrogenic effect. With this, hormone replacement therapy successfully copes. In order to artificially recreate the physiological effect of estrogens and prevent the development of negative consequences of the early menopause, hormonal drugs are prescribed in the contraceptive regimen, that is, with their help they imitate a normal menstrual cycle. The quantitative composition of hormones for replacement therapy is selected individually, but they always contain estrogen and progesterone( or their derivatives).As a rule, hormonal drugs must be taken before the woman reaches the age of onset of natural menopause, that is, 50 years.

As a monotherapy, hormone replacement therapy is not advisable. It must be combined with general therapy, physiotherapy.

Drugs and remedies for menopause

Climax "cure" is impossible, because it is not a disease, but represents a certain transitional life stage associated with the completion of the ovarian reproductive activity. If the climacteric period occurs in a natural, physiological, rhythm, and the woman calmly tolerates minor clinical symptoms, there is no need for a special curative program. However, this does not mean that the changes taking place in the body can be left without attention. Even the most healthy organism in the climax is experiencing serious stress and needs help.

First of all, it is necessary to revise the diet, enriching it with less caloric, but more useful food. A sufficient number of vegetables, fruits and sour-milk products in the daily diet will enrich the body with the necessary vitamins and biologically active compounds.

It is also important to pay more attention to the quality of physical activity. Exhausting physical activity should be replaced by regular outdoor walks and simple physical exercises. It is important not only the availability of time, but also the desire. Everyone, even the busiest woman, can walk to the house from work, do a spring cleaning, ignore the elevator and walk up the stairs.

Contrary to the prevailing opinion among women, severe climacteric syndrome accompanies menopause in a small number of patients. More often the menopause occurs in mild or moderate form, when the gradually fading function of the ovaries allows the body to gradually adapt to new conditions. In such a situation, therapy implies only symptomatic measures that eliminate violations of the vegetative-vascular, urinary, nervous and other systems. For each patient, the list of medications is individual and depends on what kind of negative symptoms of menopause it has.

To softly reduce the symptoms of menopause, nonharmonic agents based on herbal components are used, for example, a biologically active food additive. ESTROVEL® capsules are a complex of phytoestrogens, vitamins and microelements, the components of which act on the main manifestations of menopause. ESTROVEL® contains vitamin K1 and boron, which contribute to reducing the risk of osteoporosis.

For symptomatic therapy, phytotherapy and homeopathic remedies are also used.

Severe form of menopause( climacteric syndrome) requires mandatory complex therapy, the leading link in which is replacement therapy with hormones.

Hormonal drugs are prescribed only after a detailed examination to determine the extent of existing disorders and to exclude the presence of contraindications. The substitution hormonal treatment for menopause should strictly correspond to several principles:

- exclusively natural estrogens and gestagens are used;

- doses of hormones should be minimal, but sufficient;

- the duration of therapy is limited to two years, if the pathological symptoms recur, the treatment is resumed again.

Hormone replacement is carried out with the help of drugs from the following groups:

- "Clean" natural estrogens( shown in the absence of the uterus): Estrozel gel, Klimara plaster, Proginova, Estrofem and the like. Suitable as a permanent or intermittent reception.

- Combination of estrogens and progestins: Estrozel + Utrozhestan, two-phase preparations Klimen, Klimonorm, Divina and the like.

- Monophasic Femoston 1/5, Cliogest, Gynodian - depot and analogues.