The climacteric period (Greek klimakter stage; age transition period; synonym: menopause, menopause) is the physiological period of a person's life, during which, against the background of age-related changes in the body, involutional processes in the reproductive system dominate.

Menopause in women. In menopause, premenopause, menopause and postmenopause are distinguished. Premenopause usually begins at the age of 45-47 years and lasts 2-10 years until menstruation stops. The average age at which the last menstruation (menopause) occurs is 50 years. Early menopause before the age of 40 and late - over the age of 55 are possible. The exact date of menopause is set retrospectively, not earlier than 1 year after the cessation of menstruation. Postmenopause lasts 6-8 years from the moment of cessation of menstruation.

The rate of development of the C. p. is determined genetically, but such factors as the state of health of the woman, working and living conditions, dietary habits, and climate can influence the time of the onset and course of different phases of the C. p. for example, women who smoke more than 1 pack of cigarettes a day go through menopause on average 1 year 8 months. earlier than non-smokers.

The psychological reaction of women to the onset of K. p. may be adequate (in 55% of women) with a gradual adaptation to age-related neurohormonal changes in the body; passive (in 20% of women), characterized by the acceptance of K. p. as an inevitable sign of aging; neurotic (in 15% of women), manifested by resistance, unwillingness to accept ongoing changes and accompanied by mental disorders; hyperactive (in 10% of women), when there is an increase in social activity and a critical attitude to the complaints of peers.

Age-related changes in the reproductive system begin in the central regulatory mechanisms of the pituitary zone of the hypothalamus and suprahypothalamic structures. The number of estrogen receptors decreases and the sensitivity of the hypothalamic structures to ovarian hormones decreases. Degenerative changes in the terminal areas of the dendrites of dopamine and serotonergic neurons lead to impaired secretion of neurotransmitters and transmission of nerve impulses to the hypothalamic-pituitary system. Due to a violation of the neurosecretory function of the hypothalamus, the cyclic ovulatory release of gonadotropins by the pituitary gland is disrupted, the release of lutropin and follitropin usually increases from the age of 45, reaching a maximum about 15 years after menopause, after which it begins to gradually decrease. An increase in the secretion of gonadotropins is also due to a decrease in the secretion of estrogens in the ovaries. Age-related changes in the ovaries are characterized by a decrease in the number of oocytes (by the age of 45, there are about 10 thousand of them). Along with this, the process of oocyte death and atresia of maturing follicles is accelerated. In the follicles, the number of granulosa and theca cells, the main site of estrogen synthesis, decreases. No dystrophic processes are observed in the ovarian stroma, and it retains hormonal activity for a long time, secreting androgens: mainly a weak androgen - androstenedione and a small amount of testosterone. The sharp decrease in estrogen synthesis by the ovaries in postmenopausal women is to some extent compensated by the extragonadal synthesis of estrogens in adipose tissue. Androstenedione and testosterone formed in the stroma of the ovaries in fat cells (adipocytes) are converted by aromatization into estrone and estradiol, respectively: this process is enhanced with obesity.

Clinically, premenopause is characterized by menstrual irregularities. In 60% of cases, there are violations of the cycle according to the hypomenstrual type - the intermenstrual intervals increase and the amount of blood lost decreases. In 35% of women, excessively heavy or prolonged periods are observed, in 5% of women, menstruation stops suddenly. In connection with the violation of the process of maturation of follicles in the ovaries, a transition is gradually made from ovulatory menstrual cycles to cycles with an inferior corpus luteum, and then to anovulation. In the absence of the corpus luteum in the ovaries, the synthesis of progesterone is sharply reduced. Progesterone deficiency is the main reason for the development of such complications of K. p. as acyclic uterine bleeding (so-called menopausal bleeding) and endometrial hyperplastic processes (see Dysfunctional uterine bleeding). In this period, the frequency of fibrocystic mastopathy increases.

Age-related changes lead to the cessation of reproductive and a decrease in the hormonal function of the ovaries, which is clinically manifested by the onset of menopause. Postmenopause is characterized by progressive involutional changes in the reproductive system. Their intensity is much higher than in premenopause, since they occur against the background of a sharp decrease in estrogen levels and a decrease in the regenerative potential of target organ cells. In the first year of postmenopause, the size of the uterus decreases most intensively. By the age of 80, the size of the uterus, determined by ultrasound, is 4.3´3.2´2.1 cm. years, the mass of the ovaries is less than 4 g, the volume is about 3 cm3. The ovaries gradually shrivel due to the development of connective tissue, which undergoes hyalinosis and sclerosis. 5 years after the onset of menopause, only single follicles are found in the ovaries. There are atrophic changes in the vulva and vaginal mucosa. Thinning, fragility, slight vulnerability of the vaginal mucosa contribute to the development of colpitis.

In addition to these processes in the genital organs, changes occur in other organs and systems. One of the main reasons for these changes is a progressive deficiency of estrogens - hormones with a wide biological spectrum of action. Atrophic changes develop in the muscles of the pelvic floor, which contributes to the prolapse of the walls of the vagina and uterus. Similar changes in the muscle layer and mucous membrane of the bladder and urethra can cause urinary incontinence during physical exertion.

Mineral metabolism changes significantly. Gradually, calcium excretion in the urine increases and its absorption in the intestine decreases. At the same time, as a result of a decrease in the amount of bone substance and its insufficient calcification, bone density decreases - osteoporosis develops. The process of osteoporosis is long and unnoticeable. It is possible to identify it radiographically with the loss of at least 20-30% of calcium salts. The rate of bone loss increases 3-5 years after menopause; during this period, pain in the bones increases, the frequency of fractures increases. The leading role of lowering the level of estrogens in the development of osteoporosis in K. p. is confirmed by the fact that in women who have been taking combined estrogen-gestagen preparations for a long time, the preservation of the structure of the bones and the calcium content in them are significantly higher and the clinical manifestations of osteoporosis are less common.

In the menopause, the immune defense gradually decreases, the frequency of autoimmune diseases increases, meteolability develops (reduced resistance to temperature fluctuations environment), there are age-related changes in the cardiovascular system. The level of low and very low density lipoproteins, cholesterol, triglycerides and glucose in the blood increases; body weight increases due to hyperplasia of fat cells. As a result of a violation of the functional state of higher nerve centers against the background of a decrease in the level of estrogen in the body, a complex of vegetative-vascular, mental and metabolic-endocrine disorders often develops (see Menopausal syndrome).

Prevention of complications K. p. includes the prevention and timely treatment of diseases various bodies and systems - cardiovascular diseases, diseases of the musculoskeletal system, biliary tract, etc. Importance is attached to exercise, especially in the fresh air (walking, skiing, jogging), dosed in accordance with the recommendations of the therapist. Useful walking. In connection with meteorological lability and peculiarities of adaptation for recreation, it is recommended to choose zones whose climate does not have sharp differences from the usual one. The prevention of obesity deserves special attention. The daily diet for women in excess of body weight should contain no more than 70 g of fat, incl. 50% vegetable, up to 200 g of carbohydrates, up to 11/2 liters of liquid and up to 4-6 g of table salt with a normal protein content. Food should be taken at least 4 times a day in small portions, which contributes to the separation and evacuation of bile. To eliminate metabolic disorders, hypocholesterolemic agents are prescribed: polysponin 0.1 g 3 times a day or cetamiphene 0.25 g 3 times a day after meals (2-3 courses for 30 days at intervals of 7-10 days); hypolipoproteinemic drugs: linetol 20 ml (11/2 tablespoons) per day after meals for 30 days; lipotropic drugs: methionine 0.5 g 3 times a day before meals or 20% solution of choline chloride 1 teaspoon (5 ml) 3 times a day for 10-14 days.

In the countries of Europe and North America, estrogen-progestin preparations are widely prescribed to women in K. to compensate for hormonal deficiency and to prevent age-related disorders associated with it: uterine bleeding, blood pressure fluctuations, vasomotor disorders, osteoporosis, etc. Epidemiological studies conducted in these countries have shown that the risk of developing endometrial, ovarian and breast cancer in women taking estrogen-progestin drugs is lower than in the general population. In the USSR, a similar method of preventing the pathology of K. p. is not accepted, these funds are used mainly for therapeutic purposes.

The climacteric period in men occurs more often at the age of 50-60 years. Atrophic changes in testicular glandulocytes (Leydig cells) in men of this age lead to a decrease in testosterone synthesis and a decrease in the level of androgens in the body. At the same time, the production of gonadotropic hormones of the pituitary gland tends to increase. The rate of involutional processes in the gonads varies considerably; conditionally it is considered that K. the item at men comes to an end approximately to 75 years.

In the vast majority of men, the age-related decline in the function of the gonads is not accompanied by any manifestations that violate the general habitual state. In the presence of concomitant diseases (for example, vegetovascular dystonia, hypertension, coronary disease heart), their symptoms are more pronounced in K. p. Often, the symptoms of these diseases are mistakenly regarded as a pathological menopause. The possibility of a pathological course of K. p. in men is discussed. A number of researchers believe that with the exclusion of organic pathology to clinical manifestations pathological menopause can be attributed to certain cardiovascular, neuropsychiatric and genitourinary disorders. Cardiovascular disorders characteristic of pathological menopause include sensations of hot flashes to the head, sudden reddening of the face and neck, palpitations, pain in the heart, shortness of breath, increased sweating, dizziness, and an intermittent increase in blood pressure.

Characteristic neuropsychiatric disorders are irritability, fatigue, sleep disturbance, muscle weakness, headache. Depression, causeless anxiety and fear, loss of former interests, increased suspiciousness, tearfulness are possible.

Among the manifestations of dysfunction of the genitourinary organs, dysuria and disorders of the copulatory cycle are noted with a predominant weakening of erection and accelerated ejaculation.

A gradual decrease in sexual potency is observed in K. p. in most men and, in the absence of other manifestations of pathological menopause, is considered a physiological process. When evaluating sexual function in men in K. p., it is also necessary to take into account its individual characteristics.

Treatment of pathological menopause is usually carried out by a therapist after a thorough examination of the patient with the participation of the necessary specialists and the exclusion of the connection of existing disorders with certain diseases (for example, cardiovascular, urological). It includes the normalization of the regime of work and rest, dosed physical activity, the creation of the most favorable psychological climate. Psychotherapy is an essential component of treatment. In addition, prescribe means that normalize the function of the central nervous system. (sedatives, tranquilizers, psychostimulants, antidepressants, etc.), vitamins, biogenic stimulants, preparations containing phosphorus, antispasmodics. In some cases, anabolic hormones are used; in order to normalize the disturbed endocrine balance, preparations of male sex hormones are used.

climacteric syndrome.

Endocrine and psychopathological symptoms that occur during the pathological course of menopause.

The reason for this condition is, firstly, a deficiency of estrogens (sex hormones) due to age-related endocrine changes in a woman's body. It should be noted that menopause (the last uterine bleeding due to ovarian function) occurs in all women, but not every one of them suffers from menopausal syndrome. It occurs in the case of a decrease in the adaptive systems of the body, which, in turn, depend on many factors. The probability of its occurrence increases in women with heredity, aggravated pathology of the menopause, cardiovascular diseases. The occurrence and further course of the climacteric syndrome are adversely affected by such factors as the presence of pathological character traits, gynecological diseases, especially uterine fibroids and endometriosis, premenstrual syndrome before the onset of menopause. Gkyakhosotsialnye factors are also of great importance: unsettled family life, dissatisfaction with sexual relations; suffering associated with infertility and loneliness: lack of job satisfaction. The mental state is aggravated in the presence of psychogenic situations, such as a serious illness and death of children, parents, husband, conflicts in the family and at work.

Symptoms and course. Typical manifestations of the pymacteric syndrome include hot flashes and sweating. The severity and frequency of hot flashes is different, from single to 30 per day. In addition to these symptoms, there is an increase in blood pressure, vegetative-spicy crises. Mental disorders are present in almost all patients with CS. Their nature and severity depend on the severity of vegetative manifestations and personality traits. In a difficult position of menopause, weakness, fatigue, irritability are observed. Sleep is disturbed, patients wake up at night due to strong hot flashes and sweating. There may be depressive symptoms: low mood with anxiety for one's health or fear of death (especially with severe crises with palpitations, suffocation).

Fixation on one's health with a pessimistic assessment of the present and future can become the leading one in the clinical picture of the disease, especially in people with an anxious and suspicious character.

During menopause, women may have ideas of jealousy, especially among those who in their youth were distinguished by a jealous character, as well as among persons prone to logical constructions, touchy, stuck, punctual. Ideas of jealousy can take possession of the patient so much that her behavior and actions become dangerous in relation to her husband, his "mistress" and to herself. In such cases, hospitalization is required to avoid unpredictable consequences.

Ideas of jealousy usually arise in women who do not receive sexual satisfaction. The fact is that during the period of premenopause (before the onset of menopause), many women have increased sexual desire, which, for various reasons (husband's impotence, sexual illiteracy, rare sexual relations due to objective reasons) is not always satisfied. In cases where rare marital relations are not associated with sexual violations of the husband, and there may be suspicion and thoughts of possible betrayal, which are supported by an incorrect interpretation of real facts. In addition to the ideas of jealousy, sexual dissatisfaction (with increased sexual desire) contributes to the emergence of psychosomatic and neurotic disorders (fears, emotional imbalance, tantrums, etc.). After the onset of menopause, in some women, on the contrary, sexual desire decreases due to atrophic vaginitis (vaginal dryness), which entails a decrease in interest in sexual activity and ultimately leads to disharmony of marital relations.

Climacteric symptoms in most women appear long before menopause and only a small proportion - after menopause. Therefore, the period of menopause is often stretched for several years. The duration of the course of the CS depends to a certain extent on personal characteristics that determine the ability to deal with difficulties, including diseases, and adapt to any situation, and is also determined by the additional impact of sociocultural and psychogenic factors.

Treatment. Hormone therapy should be prescribed only to patients without severe mental disorders and with the exclusion of mental illness. It is advisable to carry out replacement therapy with natural estrogens in order to eliminate estrogen-dependent symptoms (hot flashes, sweating, vaginal dryness) and prevent long-term effects of estrogen deficiency (cardiovascular disease, osteoporosis - bone thinning, accompanied by its fragility and fragility). Estrogens help not only reduce hot flashes, but also increase tone and improve overall well-being. Gestagens (progesterone, etc.) by themselves can lower mood, and in the presence of mental disorders they exacerbate the condition, so gynecologists in such cases prescribe them after consulting a psychiatrist.

In practice, combined estrogen-progestogen preparations are often used to avoid side effects pure estrogen. However, long-term, and sometimes unsystematic and uncontrolled, use of various hormonal agents leads, firstly, to the preservation of cyclic fluctuations in the state of the type of premenstrual syndrome (pseudo-premenstrual syndrome) and the formation of psychological and physical hormonal dependence and hypochondriacal personality development.

The climacteric period in such cases stretches for many years. Mental disorders are corrected with the help of psychotropic drugs (tranquilizers; antidepressants; neuroleptics in small doses such as frenolon, sonapax, etaperazine; nootropics) in combination with various types psychotherapy. Psychotropic drugs can be combined with hormones. The appointment of treatment in each case is carried out individually, taking into account the nature and severity of psychopathological symptoms, somatic disorders, the stage of hormonal changes (before menopause or after).

In principle, the climacteric syndrome is a transient, temporary phenomenon, due to the period of age-related neuro-hormonal restructuring in a woman's body. Therefore, in general, the prognosis is favorable. However, the effectiveness of therapy depends on the influence of many factors. The shorter the duration of the disease and the earlier treatment is started, the fewer various external influences (psychosocial factors, somatic illnesses, mental traumas), the better the treatment results.

Climacteric period. Vitamin E is also used in cosmetology for ... from the onset of puberty until menopausal period, but their number depends on...

"Climax" in Greek means "ladder". At some point, a woman, due to the reverse development of the reproductive organs, has to overcome this stage, leading to the extinction of the reproductive function. Hormonal changes that occur during menopause are a natural process, you do not need to be afraid of it.

Stages of menopause

Menopause is the period of life during which the functioning of the reproductive system stops.

There are three stages of menopause in women:

1. premenopause. It starts a few years before the full end of menstruation. The duration of the stage is from 1 to 3 years. The functions of the ovaries gradually begin to fade, ovulation ends, the process of conception becomes problematic. There are irregular periods. The interval between them increases, and the duration gradually decreases. The stage drags on.
2. Menopause. The period when a woman does not have menstruation during the year. At this time, a woman can gain a lot of weight, heart problems arise, and diabetes. Menopause most often develops between the ages of 45 and 50. The cessation of menstruation before the age of 45 is considered early menopause, and before the age of 40 - premature.
3. Postmenopause. Time from the end of menopause to 69-70 years.

It is often believed that menopause and menopause are one and the same. However, menopause is defined as the loss of childbearing function, and menopause is a year without menstruation.

There are times when menopause occurs unexpectedly, despite the fact that a woman planned to prepare for this stage. To avoid such a situation, you need to know the symptoms of approaching menopause in women.

Symptoms

The table shows the main signs of an impending menopause.

	signs
Menstrual irregularity	With the extinction of the hormonal function of the ovaries, the duration of menstruation changes. They run irregularly and poorly. There can be an interval of one to three months between periods, and sometimes more. After a certain time, menstruation stops completely.
tides	At such moments, the woman is thrown into a fever that spreads to the face, neck, chest and arms. At this moment, the temperature rises, sweating and lack of air occur. The skin becomes red or blotchy. These symptoms may be accompanied by dizziness, nausea and tachycardia. Hot flashes last from 30 seconds to 3 minutes.
Mood change	In the premenopausal period, women experience disturbances in the psycho-emotional state. They are expressed in aggressiveness, irritability, tearfulness, anxiety, restlessness. For most women, such changes in mood appear before menstruation.
Change in appearance	Hormonal imbalance in the body leads to skin laxity, hair loss. Nail plates become brittle, dry, begin to exfoliate.
Weight gain	Being overweight is not always a sign of menopause. Fatty high-calorie foods also affect weight gain. Insulin resistance may develop. With age, the muscles decrease, and the layers of fat increase.
Nocturnal hyperhidrosis	Manifested in heavy sweating during sleep.
Vaginal dryness	With the slowdown of metabolic processes in the body, there is a decrease in elasticity, moisture content of tissues. become loose, cracks appear. The pelvic organs may droop and prolapse.
Insomnia	Restful sleep depends on the balance of estrogen and progesterone. The lack of the first leads to sweating, the second - to insomnia.
Decreased libido	The first reason for a decrease in sexual desire is the discomfort that occurs during intercourse. The second is a decrease in the level of hormones responsible for sexual desire.
Problems with heart	Low estrogen levels cause the development of heart disease during menopause in women.
Osteoporosis	Most dangerous symptom. There are changes in the bone tissue, characterized by its rarefaction and increased fragility. Increased risk of bone fractures. The woman feels increased fatigue, weakness.
Urinary incontinence	deficit female hormones weakens the muscles of the pelvis and leads to relaxation of the sphincter Bladder
Muscle and headaches	During menopause, the tone of the blood vessels changes, resulting in headaches. Muscle pain appears when calcium metabolism is disturbed.
Memory problems	The reason is low estrogen levels. With the normalization of the hormonal background, the problem disappears.
Gynecological diseases	Influence the appearance of early menopause (primarily ovarian tumors).
Allergy	Its appearance is influenced by the connection between the endocrine and immune systems. Hormonal changes may cause allergic rhinitis, asthma, dermatitis.

There are many more signs of an upcoming female menopause, but a woman should not be scared and worried about this. Timely consultation with the doctor and the right selection medicines will help alleviate the condition.

Complications of the menopause

Not in all cases, there is a normal course of menopause in women. Possible complications of this period:

• severe course of climacteric syndrome with impaired work gastrointestinal tract what causes the exhaustion of a woman;
• pathological fractures (a symptom of osteoporosis);
• breakthrough uterine bleeding due to hormonal disruptions;
• endometrial hyperplasia;
• development of uterine fibroids;
• mastopathy, tumor-like formations of the mammary glands.

Due to the large number possible complications regular preventive visits to the gynecologist are necessary.

climacteric syndrome

This is one of the common menopausal problems. Climacteric syndrome is expressed in the occurrence of a complex of endocrine and neurological disorders. Symptoms of this syndrome include:

• headaches, migraine, dizziness;
• flushes of heat to the head and upper body;
• sudden mood swings;
• insomnia;
• exacerbation of existing chronic diseases;
• disorders of the cardiovascular system;
• hypertension, etc.

In combination, these symptoms significantly worsen the quality of life of a woman, lead to a decrease in working capacity.

The severity of the menopausal syndrome depends on the frequency of hot flashes. A mild degree is characterized by the occurrence of hot flashes up to 10 times within 24 hours; medium - up to 20 times, severe - more than 20 times a day.

Causes of early menopause

Early menopause is called hormonal changes that began earlier than 45 years. This can be caused by a number of reasons:

• ovarian depletion associated with a genetic anomaly (defect of the X chromosome);
• inherited diseases (galactosemia, amenorrhea, blepharophimosis);
• the consequences of surgical intervention - removal of fibroids along with the uterus, oophorectomy;
• the effect of radiation and chemotherapy prescribed in the treatment of malignant neoplasms;
• decrease in immunity.

A woman should know which doctor to contact with early menopause. A professional gynecologist-endocrinologist will consult and prescribe treatment.

How to delay the onset of menopause?

Specialists have developed several methods to remove menopause. period most suitable for the application of deferral measures.

1. Hormone replacement therapy is prescribed by a doctor strictly according to indications. Estrogen preparations (Ovestin, Divigel, Klimonorm, Norkolut, etc.) can delay the onset of menopause.
2. The doctor may prescribe a long-term intake of phytoestrogens - plant substances similar in mechanism of action to natural estrogen. These drugs include Feminal, Estrovel, Femiwell, etc.
3. Phytotherapy - the use of decoctions and infusions of some medicinal plants (thyme, lungwort, sage, horsetail and many others). Effective for postponing menopause and Monastic tea.
4. In addition, for an effective result, you must adhere to the following rules:

• do not eat fatty, sweet foods; the diet should be dominated by fruits, vegetables, dairy products;
• play sports, thereby stimulating the production of biological substances that prolong youth;
• take care of women's health and regularly visit a gynecologist;
• avoid stressful situations;
• to refuse from bad habits.

By following these tips, a woman has the opportunity to delay the onset of menopause.

Diagnostics

Diagnosis of menopause includes consultations with a gynecologist, endocrinologist, cardiologist, neurologist. The functional state of the ovaries is determined using histological analysis and cytological examination of smears. If necessary, ultrasound of the breast, pelvic organs, mammography is performed.

Ways to eliminate the symptoms of menopause

Modern medicine offers the following methods to eliminate the unpleasant manifestations of the menopause period:

• Hormonal drugs (estrogen) are indicated for severe course menopause.
• Phytoestrogens are a mild option for the treatment of menopausal disorders.
• Physiotherapy - massage, physiotherapy exercises.
• Folk treatment.

By what means is the treatment of female menopause, shown in the video.

Menopause is an inevitable physiological process in a woman's life. Therefore, sooner or later she is forced to go through this period.

Menopause I Climacteric period (Greek klimakter stage; age transition period; synonym:, menopause)

the physiological period of a person's life, during which, against the background of age-related changes in the body, involutional processes in the reproductive system dominate.

Menopause in women. In menopause, premenopause, menopause and postmenopause are distinguished. Premenopause usually begins at the age of 45-47 years and lasts 2-10 years until menstruation stops. The average, in which the last () is noted, is 50 years. Early menopause before the age of 40 and late - over the age of 55 are possible. The exact date of menopause is set retrospectively, not earlier than 1 year after the cessation of menstruation. Postmenopause lasts 6-8 years from the moment of cessation of menstruation.

The rate of development of K. p. is determined genetically, but such factors as the state of health of a woman, working and living conditions, nutritional characteristics, can influence the time of onset and course of different phases of K. p. for example, women who smoke more than 1 pack of cigarettes a day go through menopause on average 1 year 8 months. earlier than non-smokers.

Age-related changes lead to the cessation of reproductive and a decrease in the hormonal function of the ovaries, which is clinically manifested by the onset of menopause. Postmenopause is characterized by progressive involutional changes in the reproductive system. Their intensity is much higher than in premenopause, since they occur against the background of a sharp decrease in estrogen levels and a decrease in the regenerative potential of target organ cells. In the first year of postmenopause, the size of the uterus decreases most intensively. By the age of 80, the size of the uterus, determined by ultrasound examination, are 4.3×3.2×2.1 cm. The mass of the ovaries by the age of 50 decreases to 6.6 G, by the age of 60 - up to 5 G. In women over 60, ovarian weight is less than 4 G, volume about 3 cm 3. The ovaries gradually shrivel due to the development of connective tissue, which undergoes hyalinosis and sclerosis. 5 years after the onset of menopause, only single follicles are found in the ovaries. There are atrophic changes in the vulva and vaginal mucosa. Thinning, fragility, slight vulnerability of the vaginal mucosa contribute to the development of Colpitis .

In addition to these processes in the genital organs, changes occur in other organs and systems. One of the main reasons for these changes is a progressive deficiency of estrogens - hormones with a wide biological spectrum of action. Atrophic changes develop in the muscles of the pelvic floor, which contributes to the prolapse of the walls of the vagina and uterus. Similar changes in the muscle layer and mucous membrane of the bladder and urethra can cause urinary incontinence during physical exertion.

Prevention of complications K. p. includes the prevention and timely diseases of various organs and systems - cardiovascular diseases, diseases of the musculoskeletal system, biliary tract, etc. Importance is attached to physical exercises, especially in the fresh air (, skiing, jogging), dosed in accordance with the recommendations of the therapist. Useful walking. In connection with meteorological lability and peculiarities of adaptation for recreation, it is recommended to choose zones whose climate does not have sharp differences from the usual one. Obesity deserves special attention. The daily diet for women in excess of body weight should contain no more than 70 G fats, incl. 50% vegetable, up to 200 G carbohydrates, up to 1 1/2 l liquids and up to 4-6 G table salt with a normal protein content. Food should be taken at least 4 times a day in small portions, which contributes to the separation and evacuation of bile. To eliminate metabolic disorders, hypocholesterolemic agents are prescribed: polysponin 0.1 G 3 times a day or cetamiphene 0.25 G 3 times a day after meals (2-3 courses for 30 days at intervals of 7-10 days); hypolipoproteinemic drugs: linetol 20 ml(1 1/2 tablespoons) per day after meals for 30 days; lipotropic drugs: 0.5 each G 3 times a day before meals or 20% solution of choline chloride, 1 teaspoon (5 ml) 3 times a day for 10-14 days.

In Europe and North America, women in K. p. are widely prescribed estrogen-progestin drugs to compensate for hormonal deficiency and to prevent age-related disorders associated with it: uterine bleeding, fluctuations, vasomotor disorders, osteoporosis, etc. Epidemiological studies conducted in these countries have shown that the risk of developing endometrial, ovarian and breast cancer in women taking estrogen-progestogen drugs is lower than in the general population. In the USSR, a similar method of preventing the pathology of K. p. is not accepted, these funds are used mainly for therapeutic purposes.

Menopause in men occurs more often at the age of 50-60 years. Atrophic changes in testicular glandulocytes (Leydig cells) in men of this age lead to a decrease in testosterone synthesis and a decrease in the level of androgens in the body. At the same time, the production of gonadotropic hormones of the pituitary gland tends to increase. The rate of involutional processes in the gonads varies considerably; conditionally it is considered that K. the item at men comes to an end approximately to 75 years.

In the vast majority of men, the age-related decline in the function of the gonads is not accompanied by any manifestations that violate the general habitual state. In the presence of concomitant diseases (for example, vegetovascular dystonia, hypertension, coronary heart disease) their symptoms are more pronounced in K. p. Often, the symptoms of these diseases are mistakenly regarded as menopause. The possibility of a pathological course of K. p. in men is discussed. A number of researchers believe that with the exclusion of organic pathology, certain cardiovascular, neuropsychiatric and genitourinary disorders can be attributed to the clinical manifestations of pathological menopause. Cardiovascular disorders characteristic of pathological menopause include sensations of hot flashes to the head, sudden redness of the face and neck, pain in the heart, shortness of breath, increased, dizziness, and an intermittent increase in blood pressure.

Among the manifestations of dysfunction of the genitourinary organs, there are also violations of the copulatory cycle with a predominant weakening of erection and accelerated ejaculation.

A gradual decrease in sexual potency is observed in K. p. in most men and, in the absence of other manifestations of pathological menopause, is considered a physiological process. When evaluating sexual function in men in K. p., it is also necessary to take into account its individual characteristics.

Treatment of pathological menopause is usually carried out by a therapist after a thorough examination of the patient with the participation of the necessary specialists and the exclusion of the connection of existing disorders with certain diseases (for example, cardiovascular, urological). It includes the normalization of the regime of work and rest, dosed physical activity, the creation of the most favorable psychological climate. An obligatory component of treatment is. In addition, prescribe means that normalize the function of the central nervous system. (sedatives, psychostimulants, etc.), biogenic stimulants, drugs containing antispasmodics. In some cases, anabolic is used; in order to normalize the disturbed endocrine balance, preparations of male sex hormones are used.

Bibliography: Gynecological, ed. K.N. Zhmakina, p. 396, M., 1988; Gynecological disorders, ed. K.J. Powerstein, . from English, p. 510, M., 1985; Dilman V.M. Endocrinology, p. 140, M., 1983; Krymskaya M.L. Menopause, M., 1989; Smetnik V.P., Tkachenko N.M. and Moskalenko N.P. , M., 1988; Tiktinsky O.L., Novikov I.F. and Mikhailenko V.V. Diseases of the genital organs in men, L., 1985; Yunda I.F. and human health, Kyiv, 1985.

II Menopause

[Greek klimaktēr step (stairs), turning point; .: menopause, menopause] - the period of life during which the cessation of the generative function occurs.

Pathological climacteric period- K. p., accompanied by endocrine, vegetative and mental disorders (climacteric syndrome).

Climacteric period early- K. p., which develops in a woman under 45 years of age or in a man under 50 years of age.

1. Small medical encyclopedia. - M.: Medical Encyclopedia. 1991-96 2. First health care. - M.: Great Russian Encyclopedia. 1994 3. Encyclopedic dictionary of medical terms. - M.: Soviet Encyclopedia. - 1982-1984.

See what the "menopausal period" is in other dictionaries:

A period in a woman's life characterized by the cessation of menstruation. It comes about 45 years of life. Accompanied by a tendency to obesity. Depends on the cessation of maturation of eggs in the ovaries. Dictionary of foreign words included in the Russian ... ... Dictionary of foreign words of the Russian language

- (Greek klimakter stage, a turning point; synonyms for menopause, menopause), a physiological period in a person’s life, characterized by the reverse development of the sexual sphere (see. Sexual involution), occurring against the background of general age ... ... Sexological Encyclopedia

- (menopause) the period of life during which the cessation of reproductive function occurs, is characterized by a gradual cessation of menstrual function, and then the hormonal function of the ovaries against the background of general age-related changes in the body. ... ... medical terms

Menopause- (Greek klimakter - step, turning point). The period of life, characterized by the cessation of the generative function. In some cases, it proceeds with endocrine, vegetative-vascular and mental disorders (Kp pathological, menopausal ... ... Dictionary psychiatric terms

Menopause and menopausal syndrome: what happens in a woman's body? Harbingers, hot flashes, symptoms and manifestations, diagnosis of menopause (menopause). Diseases associated with menopause (uterine fibroids, endometrial hyperplasia, and others)

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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 no organ in female body, in the activity of which sex hormones would not participate. 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 fixation. gestational sac. 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 muscle layer uterus gradually atrophies, in postmenopause it is replaced by connective tissue - that is, it loses its 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.

Changes during menopause appearance external genitalia:

• 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 the set excess weight, with 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. Wherein bone partially absorbed and in its place a new one (osteogenesis) is formed. Remodeling is genetically planned and regulated by many metabolic processes and hormones, including sex hormones, 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, which 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, thyroid 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, suffering 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 eg 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 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 psychological state women, 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 drink: 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 migraine-like sharp 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, it 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 issues from the vagina can be associated with increased fragility of the vessels of the vaginal mucosa, in which case blood appears to a greater extent after intercourse, but blood from the vagina can also 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 diseases ( 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 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 research It has been 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 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 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 - benign tumor uterus, associated with a violation of the balance 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.	substitution 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 hormonal replacement therapy 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.	Cancer. Uterine bleeding may be a sign serious illnesses 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 uterus and appendages, especially inflammatory; lack of lactation or a short period of breastfeeding; no pregnancy before the age of 30; abortions and miscarriages; stress; excess weight; taking birth control pills 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 over 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 smears, bacterial culture from the vagina, cytological examination 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. They talk about severe menopause high performance FSH, as well as the LH / FSH ratio: the lower it is, the more difficult it is for a woman’s body to tolerate a lack of sex hormones and the more pronounced the symptoms and diseases associated with menopause will be.

Ultrasound examination for menopause

With the advent of menopause often come problems with women's health. 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?

Minasyan Margarita

Probably no other biological stage of life is met with such intense anticipation as menopause. The reason for this is the rooted associations that accompany this phenomenon: poor health, age-related ailments and the inevitable approach of old age. What is menopause really? And what to expect from her arrival?

What changes occur in the body during menopause?

Climax is not a synonym for old age, it is a gradual cessation of the reproductive function of the body, provided by nature itself.

First of all, the changes affect the ovaries. In them, the follicles stop developing and reaching the necessary maturity, which does not allow a full-fledged egg to mature and, therefore, ovulation does not occur. Gradually, these phenomena from periodic develop into permanent ones, menstruation completely stops, and then we can say that menopause has come.

At this time, changes occur not only in the functioning of the female organs, but also in their condition. The size of the ovary decreases by about 2 times, its parenchyma is filled with connective tissue.

The uterus and fallopian tubes also undergo changes. When the menopause is just beginning, the uterus has a slightly enlarged size and softened structure, then its fibers atrophy, the volume is reduced. In the fallopian tubes, muscle tissue is also replaced by connective tissue, the lumen of the tubes and their patency decrease. Atrophic phenomena also occur in the endometrium.

All these processes are accompanied by a decrease in the production of sex hormones. First, the synthesis of progesterone decreases, and after a while, estrogen.

Under the influence of these metamorphoses and makes itself felt.

Stages of menopause

Menopause, like any phenomenon, has its own stages of development. In the absence of aggravating factors, hormonal restructuring of the reproductive system occurs gradually, in several stages.

1. The initial stage of menopause is premenopause. This is the time when the production of female sex hormones by the ovaries begins to decline. The optimal age for entering this stage is 45-47 years. On average, this period in women lasts about 4 years. This time is characterized by the appearance of failures in menstrual cycle, as well as not pronounced symptoms of menostasis.
2. The next stage can be called directly menopause, when menstrual bleeding subsides, and the symptoms are most acute. This usually age 50-52 years. Menopause is considered to have occurred if a year has passed since the end of the last menstruation.
3. Postmenopause is the time that comes after the complete completion of the reproductive function. It continues until the end of life. As a rule, the pronounced signs of menostasis are already receding, but in some cases they can accompany a woman for several more years.

The main problems of the menopause period

The symptoms that mark the menopause can be divided into several separate groups.

Vasovegetative signs

This group most strongly worries a woman about the frequency of her development, the intensity of manifestations and potential risks. One of the most characteristic manifestations of menostasis is hot flashes (rolling heat waves localized in the upper body). In addition, vegetative symptoms can be manifested by migraines, high or low blood pressure, heart failure, shortness of breath, tremors in the limbs, chills, loss of consciousness. These manifestations are dangerous not only in themselves, but also because they provoke serious complications: heart attacks, strokes, the development of hypertension, atherosclerosis.

Urogenital symptoms

A decrease in estrogen affects the condition of the mucous membranes of the genital organs, as well as the tone of muscle fibers. In connection with these changes, there is a feeling of dryness and discomfort in the intimate area. Often this is the cause of the onset of problems in sexual life, sex ceases to bring joy. In addition, a decrease in the muscle tone of the bladder can lead to.

Psycho-emotional changes

These signs are often pronounced. A woman becomes either overly emotional or deeply indifferent. She is tormented by bouts of anger, despair, depression. There is a decrease in working capacity, attention, ability to concentrate on the work being done.

Exchange disorders

Metabolism slows down under the influence of hormonal changes, the body changes its shape due to a lack of estrogen, extra pounds are added, muscle tone is weakened, bone tissue becomes more fragile.

Changes in appearance

All the same lack of sex hormones significantly affects the condition of the skin, hair, nails. The synthesis of collagen and elastin fibers is reduced, which leads to the appearance of wrinkles, loss of a clear facial contour, loss of skin elasticity. hair follicles weaken, appears, the nails become brittle.

To eliminate the symptoms are used, which will be discussed later.

Menopause diagnostics

Diagnosis of menostasis is not particularly difficult. According to the described symptoms, as well as the results, the doctor can easily determine the onset of menopause.

Here a natural question arises: which specialist should be contacted when concerns arise? The most reasonable would be to initially come to an appointment with a general practitioner or gynecologist. If the examination requires the help of specialized specialists, the attending physician will refer the patient to an appropriate consultation.

In order to make a correct diagnosis and develop justified tactics for supporting the body, the doctor will prescribe the following examination options:

• examination by a therapist, gynecologist, mammologist, endocrinologist;
• general and biochemical analysis blood;
• general urine analysis;
• taking swabs to test for infections;
• histological analysis of the cervix;
• Ultrasound of the pelvic organs, mammary glands;
• mammography;

This set of examinations will be enough to clarify the overall picture of the development of menopause.

The fight against the manifestations of menopause

The main direction of treatment that is used in menopause is the adjustment of the level of female sex hormones, as the main cause of symptomatic manifestations.

Phytoestorenes

The safest method of maintaining estrogen levels is considered to be taking preparations containing estrogen-like substances of plant origin, which are similar in structure to the female sex hormone estradiol.

The intake of phytoestrogens helps in the fight against the manifestations of menopause, without causing side effects possessed by hormone replacement therapy.

The most popular pharmaceuticals that have earned trust among women are: Qi-Klim, Mense, Klimadinon, Estrovel,.

Taking these drugs helps to significantly smooth out the onset of menopause and alleviate the general condition at this stage of life.

HRT

An emergency treatment option is hormone replacement therapy. It is used in cases where the climacteric syndrome manifests itself aggressively and poses a danger to the health and life of a woman. An example is, for example, the appearance of unscheduled bleeding (metrorrhagia in menopause), accompanied by profuse blood loss, pronounced pathologies of the cardiovascular system.

Healthy lifestyle

The basis for a beneficial fight against the negative manifestations of menopause can be a healthy lifestyle, which includes:

• balanced diet;
• elimination of bad habits;
• physical activity;
• proper hygiene;
• regular sex life;
• social activity and the presence of interesting activities and hobbies that help maintain the "climatic" balance of the psyche.

The arrival of menopause, many women meet on a minor note. The overabundance of negative information that surrounds this biological phenomenon is doing its job. However, do not forget that most often those women who survived the onset of menopause quite easily do not shout about it at every step - for them it is just a variant of the norm. And those who, in vivid colors, describe their suffering, may somewhat exaggerate the truth. And yet, the passage of this life segment, of course, requires careful attention and control.