Often, the period of menopause in women is accompanied by rather unpleasant sensations that can disrupt her general condition or even lead to a malfunction. The concept of climacteric syndrome in women includes a symptom complex of neurovegetative, psycho-emotional and endocrine disorders with varying degrees of severity and duration during the period of age-related extinction of a woman's reproductive functions.
The regulation of the functioning of the cyclic process of the woman's reproductive system is based on the feedback of the main three links: hypothalamus - pituitary gland - ovaries. The hypothalamus produces releasing hormones that regulate the production of follicle-stimulating hormone and luteinizing hormone, which, in turn, regulate the hormone-producing function of the ovaries. And the ovaries, through the synthesis of estrogens, act on the hypothalamus and the chain is closed. Such phenomena normally occur in a healthy woman of the reproductive period. But with age, involutive changes occur in both the ovaries and the hypothalamus. And the reduced amount of estrogens produced by the ovaries is not enough for their perception by the hypothalamus. As a result, the production of follicle-stimulating hormone does not stop, but even increases, as a result, ovulation is inhibited, during which the woman's body loses its reproductive function. Thus, the menopause itself develops.
Gynecology considers climacteric syndrome from another angle. With a decrease in the synthesis of estrogens at an older age, the adrenal cortex partially takes over the function of producing sex hormones, as a result of which a woman's menopause proceeds quite smoothly without disturbances. If this does not happen, as a result of any violations of the functional state of the adrenal glands, the woman begins to have climacteric syndrome (code MKB10 N95). But the main role in the pathogenesis of climacteric syndrome is still played by involutive (age-related) changes in the hypothalamus.
How does climacteric syndrome manifest?
Clinical manifestations are due to a rather complex etiopathogenesis, which we will not go into, but consider in detail the possible manifestations characteristic of this difficult condition. The manifestations of climacteric syndrome can be of varying degrees.
The most common symptom in women is hot flashes, which occur as a result of a violation of the nervous regulation of vascular tone, which entails disturbances in the nervous regulation of the higher centers, as a result of which irritability, disturbances of night sleep, and a tendency to depressive conditions occur. This also includes the appearance of severe headaches, feelings of nausea, dizziness, which all arise for the same reason. Hot flashes are replaced by profuse sweating, and then chills.
How is the climacteric syndrome manifested in women on the skin?
As a result of a direct decrease in the synthesis of hormones, the skin suffers, its atrophic changes develop, elasticity decreases, recovery in case of damage takes much longer. Similar changes in the vaginal mucosa are associated with atrophy of the skin. It becomes dry, prone to damage (during intercourse, gynecological examination), itching and burning sensation appear. The local immunity in the vagina decreases, which can lead to the development of an infectious process.
Also, urinary incontinence occurs due to a weakening of the sphincter of the urethra, which again contributes to the addition of a secondary infection and the development of inflammatory processes of the urinary system.
All of the above complaints can also include the appearance of edema, thirst, bloating (flatulence), fluctuations in blood pressure.
Diagnosis of climacteric syndrome is based on the collection of complaints from a woman and a gynecological examination. In the future, the patient undergoes a full mandatory examination: consultations of related specialists, ECG, blood and urine tests, in order to clarify the severity and form of the disease in order to provide full assistance.
Depending on the frequency of the above manifestations in a woman, climacteric syndrome is divided into severity. Mild degree or form, which is characterized by the presence of hot flashes up to ten times a day, medium - from ten to twenty, and severe - from twenty or more. A severe degree is accompanied by a woman's disability and requires inpatient treatment and medical correction.
Also, two forms of climacteric syndrome are distinguished: not complicated, which proceeds in isolation and is due only to the presence of age-related changes in the reproductive system, and complicated, which is combined with other rather severe pathologies (diabetes mellitus, coronary heart disease, hypertension, osteoporosis, arthropathy, etc.) ... In view of this, the climacteric syndrome of the ICB 10 classification may additionally have other codes, depending on the concomitant pathology.
In any case, even if a woman has a mild climacteric syndrome and an uncomplicated form of its course, she needs to treat this condition. First of all, this is the regime. It includes proper nutrition, work and rest, exercise therapy, rejection of bad habits, spa treatment, the use of physiotherapeutic procedures (brain galvanization, electroanalgesia, etc.), massages. It is also possible to prevent climacteric syndrome, or rather its complications, with the help of vitamin therapy (A, C, E), which have a positive effect on the functioning of the brain, sedatives, herbal medicine (climadinon, etc.) or homeopathic therapy. And the most important stage in treatment is hormone replacement therapy, which is carried out in order to eliminate the lack of female sex hormones and the appearance of symptoms in a woman who disrupts her usual lifestyle.
Expert opinion There are basic strategies for the treatment of the syndrome: medication and non-medication. The second type of treatment includes diet, exercise, aromatherapy, massage and other treatments, folk remedies. This therapy is suitable for mild climacteric pathologies. The severe course of the syndrome involves the use of: hormonal, sedatives, antipsychotics, tranquilizers, vitamin complexes.
The climacteric syndrome involves a violation of the woman's condition against the background of the aging process of the female genital organs. With climacteric syndrome, clinical symptoms are observed, the main of which are hot flashes, increased sweating, chills, headache, dizziness, nausea, irritability, alternating with tearfulness, depressive conditions and much more. Let's take a closer look at the signs of climacteric syndrome.
Symptoms of menopause, climacteric syndrome in particular, includes vegetative-vascular manifestations, neuropsychic and metabolic disorders.
Vegetative-vascular or vaso-vegetative manifestations of climacteric syndrome are reflected in the form of a violation of the nervous regulation of vascular tone, which entails vegetative manifestations of climacteric syndrome. These changes are felt by a woman in the form of sweating and a feeling of hot flashes, which are subsequently replaced by chills. This occurs as a result of a decrease in the content of dopamine in the hypothalamus, which leads to vegetative crises, instability of blood pressure, more often to its increase. Feelings of hot flushes are caused by central hyperthermia, that is, an increase in temperature, which manifests itself about thirty minutes after capillary spasm and the development of venous stasis.
Against the background of the phenomena occurring in the brain on the part of the vascular tone, neuropsychic disorders appear. At first, a woman may notice a violation of predominantly night sleep, which in turn provokes sudden mood swings or increased excitability in a particular conflict situation. Then, these drops develop into outbursts of aggression, followed by crying, or, on the contrary, by the appearance of a depressive mood.
In women of menopause, the glands are disrupted, the production of sleep hormones decreases, but the amount of substances similar to adrenaline, which overexcites the nervous system, increases.
As for metabolic disorders, there is a direct dependence on the amount of estrogen synthesis. Due to a decrease in the concentration of this hormone, the digestibility of trace elements in bone tissue is impaired, which eventually leads to the development of osteoporosis, which is characterized by increased fragility of bones and pain. Also, estrogen deficiency leads to the development of cardiovascular diseases, the appearance of atherosclerotic plaques on the walls of blood vessels, thinning of the vascular wall, which can subsequently cause the development of a heart attack or stroke.
In a woman, due to metabolic disorders, there are signs of increased gas production in the intestines, thirst, the appearance of peripheral edema due to a decrease in urine output, engorgement and pain in the mammary glands.
Atrophic phenomena develop on the mucous membrane of the vagina, skin, then accompanied by dryness, the appearance of wrinkles, due to a decrease in moisture and elasticity of the skin. Hair loss occurs, the structure of the nail plates is disrupted.
In addition, the lack of estrogen leads to a weakening of the sphincter of the urethra, which leads to urinary incontinence and the risk of an ascending urinary tract infection. Treatment of the syndrome is mandatory.
How to treat? Treatment of climacteric syndrome should be carried out by a qualified specialist on the basis of collected complaints, an objective gynecological examination, as well as after a number of clinical and laboratory, instrumental studies, consultations of related specialists in the presence of other somatic pathology, which also needs treatment and correction of the condition.
Comprehensive treatment of climacteric syndrome with folk remedies, herbal remedies, hormones or homeopathy is aimed primarily at eliminating or alleviating the course of symptoms, improving the quality of life of a woman, restoring her ability to work and an active lifestyle. First of all, it is necessary to determine the variant of the course of the climacteric syndrome, its form and the presence or absence of contraindications to this or that drug. Since the pathological process, which is the climacteric syndrome, is initially associated with the physiological phenomena of the body, it is not possible to achieve a complete cure and elimination of it at the root. This is due to the aging process of the body, and as you know, it is irreversible.
There are several treatment options for menopausal syndrome. One of the first, which is resorted to with a mild course of the syndrome, is diet therapy, physiotherapy, correction of the daily regimen. There is an opinion that it is enough only to correct the correct way of life, as a result of which the disturbances in well-being are practically eliminated. To do this, it is only necessary to adjust nutrition, give up bad habits, exclude the use of coffee, dark chocolate. Include physiotherapy exercises in the daily routine. In addition, to stabilize the condition of women, physiotherapeutic procedures are used (collar with novocaine according to Shcherbak, cerebral galvanization, electroanalgesia), spa treatment.
Infusions and tinctures of motherwort, hawthorn fruits, valerian rhizomes, which is an adaptogen and consists of powders of valerian rhizomes, lemon peel, etc., have a slight sedative effect.
Also, climacteric syndrome, a clinic (treatment) of which does not have pronounced manifestations, in addition to the above treatment method, includes drug correction of the condition. Vitamin therapy is used in the form of vitamins A, C, E, which improve the functioning of the brain and contribute to the attenuation of symptoms. With a mild and moderate degree of the syndrome, phytopreparations are used - non-hormonal therapy of climacteric syndrome. Herbal medicines contain estrogen-like substances that have effects similar to natural estrogens on the body. Such drugs include products containing cimicifuga extract: Tsi-klim, Estrovel, Klimadinon, Klimaktoplan, Remens and others. It is also possible to contain other estrogen-like herbal extracts, on which the treatment with traditional medicine is based. Such herbs used in the treatment of climacteric syndrome include boar uterus, red brush, hop cones, linden blossom. At the same time, climacteric syndrome (clinic, diagnostics, treatment) is rather well stopped with the help of only adjusting the regimen and phytotherapy. All of the above methods of treatment are used in a woman in case of refusal or in the presence of contraindications for the use of hormone replacement therapy.
When a woman has a pathological climacteric syndrome, treatment (drugs) is aimed at replacing the missing hormone in the body. This syndrome has a severe course, the presence of hot flashes for more than twenty episodes per day, impaired performance and general condition. Therefore, the main treatment for menopausal syndrome is hormone replacement therapy (HRT).
Before starting the use of hormonal drugs, the doctor carefully collects complaints, conducts a gynecological examination and prescribes a full examination in order to exclude the presence of another pathology, which may be a contraindication to hormone therapy. In addition, hormone therapy has a number of features of its implementation:
The indications for the appointment of HRT are the severe course of climacteric syndrome, the onset of metabolic disorders against the background of hypoestrogenism (osteoporosis, atherosclerotic plaques), the presence of atrophic changes in the vaginal mucosa, involuntary urination, the risk of developing depressive conditions, Alzheimer's disease.
Estrogen reduces the risk of and delays the onset and progression of Alzheimer's disease. Estrogen may also protect against dementia and other neurological disorders by decreasing inflammatory responses and increasing cell survival.
For the purpose of hormone replacement therapy, drugs containing natural estrogens and progestogens are prescribed. If the drug contains only estrogen, progestogens are added to therapy. Such products of the pharmaceutical industry include femoston with various dosages. In its composition, femoston contains estradiol and dydrogesterone, which are similar in their chemical and biological effects to similar hormones produced by the woman's body. The drug is low-dose and by its action eliminates all the effects of the absence of estrogen. Similar drugs for HRT, but with a different composition, include norgestrel, proginova, climonorm, klymen.
So, climacteric syndrome, treatment, presentation of drugs, needs careful monitoring and supervision by a qualified specialist.
Around the age of forty, most modern women begin to feel that they no longer belong to the young and cheerful, and begin to pay close attention to the impact that age has on them. At this time, subtle changes begin in their bodies, which are called preclimax.
The unexpected period that baffles many women, preclimax, begins when your ovaries' production of estrogen and progesterone - two of the main female hormones - begins to decrease significantly. It ends during pre-menopause with your last menstrual period. The natural physiological process, preclimax, signifies a new phase in physiological life, thus providing ample time to prepare for menopause and its possible effects on your emotions, skeletal system, heart, bladder, and even your sex life.
Most women begin to notice signs of premenopausal a year or two before their periods stop, although for some, the premenopausal period can stretch over several years, perhaps even up to eight to ten. The average age of a woman for the onset of menopause is 52 years, while its onset in the age range from 45 to 55 years is considered normal. But don't count on it. About eight out of a hundred women begin menopause at the age of 40, while others experience very early and unexpected "medical" menopause caused by external interventions such as surgery, radiation or chemotherapy. But on the other hand, five out of every 100 women continue to menstruate until almost 60 years of age.
Every woman will benefit greatly if she knows what is going on in her body and how best to prepare for these changes.
You can prepare for the future by eating healthy, exercising, getting regular medical check-ups, and killing bad habits such as smoking.
If you have not had regular comprehensive medical examinations and gynecological examinations for a long time, it is extremely important to do it right now. Schedule a comprehensive examination that includes a breast x-ray, breast exam, flora smear and analysis, cardiogram, stool analysis, bone density determination if you suspect osteoporosis (bone porosity), estrogen or hormone-stimulating measurement folliculin, a blood cholesterol test, and other blood and urine tests to determine a baseline against which subsequent changes can be compared. In most cases, for such an examination, you should consult a gynecologist, or at least a doctor with experience in the treatment of female diseases.
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Estrogen is the main female hormone responsible for changes in the body during puberty, transforming a girl's body into that of an adult woman. Estrogen interacts with progesterone, the second most important female hormone, to prepare the body for fertilization and pregnancy. After puberty, tiny, fluid-filled sacs called follicles develop in the ovaries every month, which push the egg into the fallopian tube, from where it enters the uterus; this process is called ovulation.
At the same time, the inner walls of the uterus, under the influence of estrogen and progesterone, build up additional tissues, significantly thickening in order to be able to retain the fertilized egg and the developing embryo. If the egg is not fertilized and conception does not occur, progesterone stimulates the inner lining of these thickened internal uterine tissues - the endometrium (lining of the uterus) - to detach during the next menstrual period.
These cyclically recurring phenomena begin to undergo changes as the body approaches pre-climax. It resembles maturation in reverse. The ovaries still have a certain supply of follicles that ripen to the egg. In two or three years of the premenopausal period, their supply will be depleted and ovulation will stop. With a few viable follicles remaining, eggs in your body will be produced irregularly from time to time, and as a result of your body's decreased production of progesterone, your periods will become erratic and irregular. In some months you will have heavy menstrual flow, in others you will hardly have them. Sometimes they are absent for a month, two at a time, or they start too late or too early. Sometimes they are absent for several months, and then resume for several months. Without a regular supply of progesterone, the lining of the uterus exfoliates randomly and chaotically.
“I just don’t know what to expect. One month I have very heavy periods, and the next - almost nothing. In some months I have no period at all, or it starts too late, and sometimes lasts almost two weeks. Is this normal? "
Of course. Almost all possible variations are quite normal. Although for some women menstruation simply stops once and never comes again, most never know how it will happen in the future. This phase of instability can last only a few months, or it can drag on for several years. But its average duration is a year or two.
"I am worried if I am all right if I have unexpected bleeding, even though I have already reached climacteric age. What should I do?"
Check with your gynecologist. Spontaneous or any other type of bleeding should always be treated with attention. While they can often be caused by pre-climax, there is a possibility that they are not. Your gynecologist may suggest an endometrial biopsy, uterine curettage, or ultrasound to rule out the slightest chance of cancer, and then continue to monitor you for periodic examinations after your period ends. During this time, be sure to inform him of any new changes. The imbalance in your menstrual cycle is due to the fact that ovulation does not occur at all or only occurs from time to time and therefore your body no longer produces enough progesterone to stimulate regular monthly endometrium detachment. However, your body still continues to produce estrogen, which thickens the walls of the uterus, always in anticipation of a possible pregnancy.
"Is it possible to somehow influence the irregularity of the menstrual cycle, or is it better to just put up with it?"
Since the unexpected onset of your period can be very unnerving, you can bring your menstrual cycle back to a predictable schedule that is comfortable for you by supplying your body with the missing progesterone on a cyclic basis. You can do this by taking progesterone tablets in a dosage of 5 to 10 mg daily for ten or twelve days every four (or eight) weeks to keep your menstrual cycle in check and keep your period regular until you reach menopause. Your period will begin a few days after you take the last progesterone pill in your cycle.
In addition, the cyclic intake of progesterone ensures that the uterine lining is completely separated every month. Very often, due to a decrease in progesterone production during pre-menopause, the uterine lining does not peel off as thoroughly as it should. The second advantage is that you can avoid frequent biopsies this way. Since irregular discharge should always be monitored to ensure that nothing more serious is happening in addition to premenopausal events, your doctor will no doubt suggest that you do periodic biopsies of the endometrium (uterine lining) to examine these tissues for abnormal cells. However, when hormone therapy confirms that your erratic cycle is due to a lack of progesterone, you will not need to get a biopsy often because you will now have your period on a regular basis.
An alternative way to regulate your period is to take a low-dose oral contraceptive. These pills will not only restore your periods by returning them to a regular monthly cycle, but at the same time, they will ease pre-menopausal symptoms such as hot flushes and prevent the possibility of pregnancy. Newer oral contraceptives contain significantly lower doses of hormones than their predecessors and, unlike older versions, do not promote heart attacks or palpitations in healthy women. Most recently, they were approved by the US Department of Health for use by women in the 50s or so.
“I know that the menstrual schedule can jump if I enter menopause, but how can I know if I’m pregnant? For several months I have my periods like clockwork, and then they disappear for a month or two , or there are interruptions of six to seven weeks. Now I am 43, I have two grown children, and I absolutely do not want to have another child. "
There is always a small chance that the absence of menstruation means pregnancy. This happens to many 43-year-old women, but very few of them enjoy it. If you have the slightest reason to suspect this might be true, ask your doctor to test you for pregnancy. Even though the possibility of getting pregnant after forty is reduced to almost a minimum, you simply cannot know for sure that your body will not produce the last egg, and just one energetic sperm is enough to change your life in the most dramatic way. To eliminate the slightest chance of getting pregnant, continue to take birth control pills for at least six months after menopause.
"What is the best contraceptive for a premenopausal woman?"
You can choose from several methods to prevent unwanted pregnancies, but a cycle of low-dose birth control pills containing a small proportion of estrogen and progesterone may be the best solution to your problem if you do not smoke. This method, as we have already explained, will not only prevent pregnancy, but also regulate your menstrual cycle, and at the same time eliminate many of the unpleasant symptoms of the onset of menopause. You no longer have to wonder if a missed menstrual cycle means that you are pregnant, because you will no longer have any mishaps.
Now you have the last opportunity to strengthen your bones before the onset of menopause, during which you will begin to lose a significant percentage of bone mass. Here's how you can do it:
Get enough calcium (at least 1000 mg daily before menopause and 1500 mg after menopause) in food, vitamins, and supplements.
Get enough exercise to be able to support your own weight, which means at least half an hour of moderate physical activity three times a week.
If you do not want to agree to a course of hormone therapy after the onset of menopause, get tested for measuring the specific gravity of bones, so that you know the baseline with which you can compare the results of future measurements. Bone loss begins in the spine, sometimes even before menopause, so don't be content with just testing your cortical bones in your wrists or hips. Take another test a year after the onset of menopause. This will give you the ability to calculate the percentage of bone loss per year. Some women lose only 1 to 2% per year and most likely should not be afraid of developing osteoporosis, while others lose 8 to 10% of bone mass annually after the onset of menopause. If you are in the latter group, you must not let it go on like this. Refer to Chapter 4 for more information on bone preservation.
"I have obviously started preclimax because my period is very strange, but so far I do not feel any other symptoms of it. When do they usually start to appear?"
Many women do not experience typical menopausal symptoms such as hot flushes and palpitations during pre-menopause, but they usually become evident after estrogen levels in the body drop so much that menstruation stops altogether. However, in 15 - 20% of women, these symptoms appear earlier.
"I still have my period regularly, but I suffer a lot from hot flushes. What should I do?"
Try taking vitamin E daily to get rid of this phenomenon. Start with a 400-unit pill twice a day and if there is no improvement after a week, double the dose to 1600 units a day. You may not be able to get that much of this vitamin from your daily diet, so you will need to take it in the form of vitamins or supplements.
You may also want to start taking vitamins B and C, as although they are not scientifically proven to be beneficial, some women claim to feel a positive benefit from taking them.
The next step we generally recommend for healthy non-smokers is to switch to the newly developed low-dose birth control pill. This may be exactly what you need. Today, the attitude towards the question of the dangers or safety of taking estrogen before the onset of menopause has changed and, in addition, these pills are not at all like the old ones. In the past, the prevailing view was that it was dangerous to take any form of supplemental estrogen before menopause because it can dramatically increase blood pressure, promote excess uterine lining and create conditions for cancer.
But recent studies have shown that it is perfectly safe for women of premenopausal age to take estrogen in the form of low-dose birth control pills on a schedule, and the US Department of Health has recommended these drugs for women in their fifties. These pills can significantly alleviate this difficult period by eliminating the early symptoms of menopause. At the same time, they will keep your menstrual cycle regular and also solve the problem of unwanted pregnancy. However, these pills can also have side effects, such as causing pain in the chest area, weight gain, water retention and depression. If you come to the conclusion that they give you almost no trouble, consider that you have found the easiest way to avoid a lot of problems.
The recently introduced Depo Provera contraceptive is a second way to relieve hot flashes and other uncomfortable menopausal symptoms for women who cannot take estrogen or are not allowed to take these pills by their religious beliefs. Although sometimes it can even bring down the menstrual cycle even more and cause side effects similar to premenstrual syndrome.
All non-estrogenic progesterones should be injected every three months. Side effects from this can also appear for at least three months.
"I remember that in the past, some women could not take these pills because they contributed to the formation of blood clots. What has changed now?"
Now the estrogen content of these pills has become so low (although it is higher than dosages of hormone replacement therapy) that they are considered safe if you have not had thrombophlebitis and are not a heavy smoker. The latest data show that these pills reduce the likelihood of both uterine cancer and ovarian cancer. In addition, among those taking these pills, the percentage of those suffering from the formation of ovarian cysts, fibroids of the breast and dysmenorrhea (painful menstrual periods) is significantly lower.
"Why don't I get hormone replacement therapy instead of taking these pills?"
You can do this, but birth control pills will work better for you. During pre-menopause, hormone replacement therapy is usually given to women who have severe climacteric symptoms, have tried all other treatments, and cannot tolerate birth control pills. This is because during such a transitional period, your body can periodically produce a lot of its own estrogen and you do not need additional. In addition, one compact pill contains both estrogen and progesterone, which prevent pregnancy.
"If I take low-dose birth control pills and my period returns, how will I know if I am menopause?"
You won't know until you stop taking the pills and get your follicle-stimulating hormone levels measured. A simple blood test will determine the amount of this hormone, a substance whose content increases as estrogen levels decrease. But that doesn't really matter, as the hormones in the pill will protect you from osteoporosis and possibly cardiovascular disease, just like hormone replacement therapy would. At the age of fifty, you can either wait to see if you have hot flushes, or measure your follicle-stimulating hormone levels and then undergo hormone replacement therapy, if you wish.
If you smoke, do not use low-dose birth control pills or any other pills. These pills increase the already significant risk of arrhythmias and heart attacks for smokers.
"A friend of mine said that she had no problem with hot flushes because she drank the appropriate Chinese herbal tea. What is your opinion on this?"
Some women find that medicinal plants such as ginseng, fusanus pointed, spirulina, wormwood, wild yam, licorice, American laurel, and flaxseed can relieve hot flushes. And in fact, it is true that these herbs sometimes help relieve the manifestation of not too strong symptoms of menopause. Some of these herbs are actually potent sources of plant estrogen, and therefore actually serve as a kind of estrogen recovery therapy. Inadequate in their chemical formula to the hormones of the human body, but similar in structure, these plant estrogens, known as phytoestrogens, especially ginseng and fusanus pointed, can elicit an obvious biological response.
However, although these herbs are natural remedies, which in the eyes of many women make them far more preferable than chemically prescribed drugs, there is no way to control the estrogen levels they contain. Therefore, if not taken with progesterone to protect the walls of the uterus, there is a possibility that they will cause hyperplasia, that is, an overgrowth of this tissue, which can eventually lead to cancer. We advise you to use them as carefully as your doctor's prescription medications.
An alternative to the use of phytoestrogens as medicines is to increase the consumption of fruits and vegetables, many of which, especially soybeans and legumes, contain natural estrogen.
"Over the past few months, I have had PMS for the first time in my life. What happened?"
Premenstrual syndrome remains a mystery that has not been fully explored and understood by anyone. Sometimes women who have suffered from premenstrual syndrome all their lives find that premenstrual syndrome disappears completely during pre-menstruation. But for the rest during this transition period, it manifests itself much more strongly. And in that part of women who have never experienced it before, premenstrual syndrome first appears at this time.
We cannot say with certainty what exactly causes PMS, but it is likely related to ovarian hormones and possibly to the ratio of estrogen to progesterone. Research has shown that when estrogen levels fall below a certain level, anxiety and depression are common. Or it may be that the ovaries are now producing less estrogen than before, while you continue to ovulate and produce normal amounts of progesterone. Progesterone (and it is known for certain that it makes many women nervous, irritable and restless) can begin to prevail over the lack of estrogen and lead to pronounced premenstrual syndrome.
Try to drink plenty of fluids, cut back on salt, take vitamin B (no more than 500 mg per day) and natural diuretics. If you experience cyclical weight gain, bloating, or breast hardening, try aldactone, a mild medicated diuretic. Also, increase your calcium intake. Researchers have found that women who take at least 1,300 mg of calcium per day are significantly less likely to experience mood swings as well as pain.
Another, possibly effective, treatment is learning relaxation techniques, taking tranquilizers, and following a diet low in fat and sugar and high in fibrous and complex dietary carbohydrates.
Another solution is to take estrogen supplements within two weeks of your period. Most women feel better if their estrogen levels do not fall below a certain limit, usually around 50 grams per milliliter. Your gynecologist may also recommend other medications for you.
Finally, the answer to your question may be hormonal birth control pills. By substituting a specific daily dose of estrogen and synthetic progesterone for your monthly ovarian hormone production, they give you the opportunity to find an easy, low-cost way to get rid of PMS.
“My menstrual cycle is still regular, as I’m only 40, and I doubt that I’m starting to climax. However, I found that I had dryness in the vagina and sex began to cause me discomfort. Now, before intercourse, I use cream for lubrication. Can you suggest me something else? "
Vaginal dryness usually does not become a problem for several years after a woman's body stops producing estrogen, but everyone has it differently. First, you should try using effective vaginal lubrication gels such as Replen or Gin Moistrin, which moisturize the cells of the vaginal tissue, reducing dryness and soreness. Use the gel regularly, at least three times a week, it usually works quickly and effectively.
If moisturizing gels do not repair the vaginal tissue enough to stop sex being uncomfortable, the next step is to use a low estrogen vaginal cream several times per week. Although this is actually one of the ways to restore estrogen and can only be used as directed by a doctor, a very small fraction of the hormone enters the bloodstream, while the tissues of the vaginal walls restore their function.
During intercourse, also use the latest proven lubricants such as jelly KJ. Never use lubricants (especially petroleum jelly) that are not intended for these purposes, because this can make things even worse: cause irritation or hardening of tissues, stop secretions from the glands of your body. And never use a vaginal moisturizer as a lubricant. First, it does not work very well as a lubricant to facilitate intercourse; and second, and more importantly, when used instead of lubricating just before intercourse, a vaginal moisturizer can cause severe irritation to delicate tissues in your partner.
"Is there any way to determine if the climax will begin soon?"
Yes, this can be done by measuring the level of follicle-stimulating hormone in the blood on the second or third day after the start of your period. The higher the level, the closer you are to menopause. There is a hormonal link between the pituitary gland, which produces follicle-stimulating hormone, and the ovaries, which produces estrogen. As soon as the ovaries reduce estrogen production, the pituitary gland senses this and releases more and more follicle-stimulating hormone into the blood, trying to get the ovaries to function again. The less estrogen, the more follicle-stimulating hormone.
So if you are really getting close to pre-climax and menopause is just around the corner, you will not only have lower estrogen levels, but also higher levels of follicle-stimulating hormone. In a healthy woman during pre-menopause, the level of follicle-stimulating hormone in the blood is usually on the order of 10 micrograms per milliliter (mcg / ml). If it rises to 20 or 25 mcg / ml, you are definitely in the premenopausal period. At 40 mcg / ml, you no longer have to puzzle yourself: your periods will stop and it will become obvious that you have reached menopause.
The level of follicle-stimulating hormone usually rises gradually and rarely decreases, so it is recommended to monitor it from time to time if you want to know about everything in advance. If, for example, today you have its level of 16 μg / ml, and next year it will be 30 μg / ml, most likely you will not have to wait long for menopause.
Determining the level of follicle-stimulating hormone is also necessary to determine the chances of pregnancy in women over forty who want to have a child. A follicle-stimulating hormone level of 20 mcg / ml or higher means pregnancy is unlikely. At a level above 25 μg / ml, its potential becomes close to zero. Since the level of follicle-stimulating hormone changes during the menstrual cycle, you will need to measure it during the first three days of your period, when estrogen levels are at their lowest.
"I have very large fibroids that cause severe bleeding, but I was told that now they should not be touched, because they will dissolve during menopause. Do you agree with that?"
It all depends on their size, the speed with which they develop, what force of bleeding they cause, what pressure they exert and how close you are to menopause, fibromas are tumors on the muscles of the uterus, which in 99 cases turn out to be benign, are most common in women after forty, although sometimes they develop earlier. If you are still far from menopause and your body is still producing enough estrogen, they will continue to grow. This is another reason to measure follicle-stimulating hormone levels.
If its level is low and shows that you are not expected to have menopause in the near future, fibroids will cause you a lot of problems, and you may have to agree to surgical removal of the fibroid itself or removal of the entire uterus. If the level of follicle-stimulating hormone is high, which means that menopause is just around the corner, and you are not losing a huge amount of blood, you may well wait and see if these phenomena stop when the level of estrogen decreases.
By the way, you might consider using a low-dose oral contraceptive regimen. Unlike pills of the past, containing a higher proportion of the hormone, modern pills often cause fibroids to be absorbed, reducing the severity of bleeding.
If you have not had a regular or erratic period for six full months, you can safely say that you have reached menopause. Your doctor will confirm this by measuring your follicle-stimulating hormone levels. If it is above 40 μg / ml (it can rise up to 1000), you will resolve all your doubts.
How can you improve your quality of life during this turbulent period for the female body?
Dominik Fraden-Reed, physician, specialist in the prevention of aging, explains what premenopause is, what are its main processes and phenomena, and how you can improve your quality of life during this troubled period for the female body.
Premenopause and menopause
Let's start with the terms. Menopause, also known as menopause, occurs when a woman has no periods all year round... This is preceded by a rather long period, which is characterized by the extinction of hormonal function and, often, by an imbalance between different hormones.
Premenopause begins, on average, between 45 and 50 years, while the average age of the onset of menopause is 51 years. However, I have been approached by women who developed premenopausal symptoms after 40 years.
Often premenopause makes itself felt by the irregularities of the menstrual cycle: too short, two in a month, or suddenly a month or two "drop out". Many women experience chronic fatigue, sleep problems, mood swings, or depression. What hormones are “not playing by the rules” and how do we feel about it?
Its number is increasing ... There are still eggs in the ovaries, but ovulation can be difficult- the body acts as if ovulation is normal and estrogen levels rise. During the first period of premenopause, estrogen remains at a good level, sometimes even too high.
Estrogen levels depend on the phase of the menstrual cycle. Usually, when a woman enters premenopause, its level is about 200-300 picograms per milliliter.... But as menopause approaches, estrogen levels crash. up to 20-30 pg / ml... This causes women to experience hot flashes. And when estrogen levels drop to 11, menopause ensues.
When there is no more ovulation, women’s progesterone levels also decrease. During the first few years of premenopause, you may have estrogen normal or too high, and progesterone low, in any case, the predominance of estrogen gives you the feeling that you are sexy, happy, full of life - and these sensations can go off scale.
But since at the same time you are experiencing a decrease in progesterone, the hormone responsible for a calm and relaxed state, the output can be nervousness, anxiety, and impatience.
The thyroid gland often creates problems when the sex hormones are imbalanced. Progesterone is the thyroid gland's best friend, so if your thyroid level goes down, your thyroid hormone levels go down as well. As a result, we have problems in the form of fatigue, hair loss, and skin problems.
Cortisol, or hydrocortisone, is a stress hormone that is produced in the body from progesterone at night... If your progesterone level decreases and, at the same time, you are in a state of stress, as often happens when children leave school, go to university, parents get old or get sick, your spouse is also going through his crisis, then you will have insomnia, because your condition is aggravated by the production cortisol.
There will be less and less estrogen in our bodies as there are fewer eggs in the ovaries.... During this period, symptoms of the second group begin to appear, which include hot flashes and profuse night sweats.
The earliest symptoms of premenopause are insomnia and fatigue. b, due to a decrease in progesterone levels.
Some women become very sensitive.... Some people tell me: “I have become terribly irritable, I cry over trifles - what's wrong with me? I have no patience, I am frustrated by my family. " I answer: "It's not you, it's your hormones."
Young women have a good balance of estrogen and testosterone, but this balance is disturbed with the onset of menopause., which leads to sudden mood swings.
Weight gain is another common symptom, especially in the abdomen and thighs.... It happens due to hormonal imbalance which leads to insulin resistance. It affects the body's ability to burn calories and leads to fat storage.
Elevated cortisol, the stress hormone, has the same effect.
Some women develop acne during the premenopausal period, even if they have never had a skin problem before. This is due to a decrease in female hormone levels and an increase in cortisol levels. Skin is also sensitive to blood sugar.
Due to changes in metabolism, premenopausal women often have high blood glucose levels, high blood pressure and high cholesterol, all of which can trigger acne.
During premenopause, hair follicles become very sensitive and may begin to fall out..
Joints
There is such a phenomenon as "cold shoulder" - female hormones are also responsible for the elasticity of the joint v. And now, when their level drops sharply, some women have a problem with the shoulder, most often the joint, it hurts and becomes inflamed.
Since hormones maintain a healthy state of the mucous membrane, a decrease in their level, respectively, leads to greater dryness and less reliability of the mucous membrane, a decrease in the amount of useful microflora, thus, the mucous membrane becomes vulnerable to pathogenic flora.
I must say right away that I do not prescribe synthetic progestins and always approach hormone therapy very carefully, prescribing minimal doses. I am a proponent of the natural approach and try to suggest natural remedies and supplements where possible.
You can improve your condition with supplements. The only thing I always advise is to contact good specialists, because self-medication can end badly. Medicines that contain both estrogen and progesterone can only be used when the levels of both hormones decrease, but in the first phase, you only need to take progesterone, because estrogen is already produced by the ovaries, it is not necessary to increase its level even more.
For example, to support progesterone, I recommend using evening primrose oil at bedtime, especially during the second half of your menstrual cycle. An excellent preparation is the Norwegian Serenol made from bee bread (bee bread) - it is very good for both mood swings and hot flashes.
There is also the supplement Cortisol Calm - a combination of Ayurvedic herbs. With menopause approaching and more and more symptoms appearing, I advise Relizen, a Swedish herbal remedy, about a million European women use it and 93% of them report improvement in their condition.
It is also helpful to support our neurotransmitters - substances that transmit impulses from neurons to neurons, because many symptoms are associated with mood. I recommend supplementing with theanine (L-theanine), an amino acid derived from the active ingredient in green tea that is responsible for relaxation.
Recent scientific studies have shown that theanine stimulates alpha brainwaves, promoting an active but calm state. I recommend theanine for those with sleep problems.
In our culture, menopause is something of a shame. I have been to other countries, for example, in Senegal, where this phenomenon is not treated with a negative attitude. Therefore, I think that attitudes towards menopause can and should be changed. We all need to learn to accept the normal changes that take place in our bodies as part of a full and healthy life. Published.
Dominic Fraden-Reed
You still have questions - ask them
P.S. And remember, just by changing your consciousness - together we are changing the world! © econe
The climacteric syndrome is a symptom complex that develops during the period of age-related extinction of the function of the reproductive system of a woman and is characterized by neurovegetative, metabolic-endocrine and psycho-emotional disorders of varying degrees of intensity and duration.
Etiology and pathogenesis
The main regulating link in the menstrual cycle is the hypothalamus. It produces releasing hormones. Currently, it is believed that the hypothalamic regulation of the production of FSH and LH by the adenohypophysis is carried out by one hormone - gonadoliberin, produced by the hypothalamus. For many years, the hypothalamus-pituitary-ovarian system functions as a self-regulating system based on the feedback principle. However, with age, evolutive changes in the hypothalamus occur, which is manifested by an increase in the threshold of its sensitivity to the action of estrogens and an increased production of gonadotropic hormones, primarily follitropin. The cyclicity of their allocation is also violated. Due to the increasing stimulation of the ovaries from the hypothalamus, they secrete into the blood a large amount of not only the working hormones of estrogens, but also intermediate products of their synthesis. However, from a certain moment, the amount of hormones produced by the ovaries turns out to be insufficient to inhibit excited hypothalamic activity and high production of follitropin. A decrease in follitropin secretion does not occur, and therefore ovulation does not occur. With the cessation of ovulation, the corpus luteum does not develop, the reproductive function ceases. With age, there is a progressive decrease in the number of primordial follicles, although a small number can be found in postmenopausal ovaries. The most characteristic of this period is the resistance of such follicles to the action of FSH and LH, an increase in the level of which in the blood serum always occurs during menopause. Menopause is characterized by a violation of the secretion of many hormones, primarily gonadotropic and sex hormones. Despite the almost complete cessation of ovarian hormonal function, serum estrogen levels do not reflect this condition. This is due to the fact that an additional source of estrogens, mainly in the form of estrone, in general, and especially in menopause, is androstenedione, which is converted into estrone in peripheral tissues. A decrease in the level of classical estrogens in the body contributes to the development of osteoporosis. Estrogen deficiency accelerates the development of atherosclerosis. An increase in the concentration of gonadotropins is likely to contribute to the development of ovarian cancer. A decrease in the content of dopamine in the hypothalamus leads to vegetative-vascular reactions, which is manifested by hot flashes, vegetative crises, and an increase in blood pressure. Feeling of heat is a consequence of paroxysmal vegetative sympathicotonic manifestations. Typical sensations arise as a result of central hyperthermia and appear 30-50 minutes later after the spastic state of the capillaries and the development of venous stasis. In the pathogenesis of climacteric syndrome, changes in the functional state of the hypothalamus matter. At birth, a girl has primordial follicles from 300 to 500 thousand. But gradually the number of primordial follicles decreases and by the age of 40 they remain from 5 to 10 thousand. Accordingly, fertility decreases, the secretion of estrogen changes, which decreases. In addition, the qualitative composition of the estrogen produced changes. The main active fractions of estrogens are estrone, estrodiol, estriol. In menopause, the most active is estriol. At an older age, the reticular adrenal cortex produces part of the sex hormones, and some women go through menopause very calmly and some women do not have any sensations and manifestations of menopause (since these women suffer the least from the adrenal glands during their life). The adrenal glands take over the function of the ovaries when the function of the latter fades away. In addition, the content of gonadotropin changes. If estrogens decrease, then gonadotropins increase (more than 10 times) to the feedback mechanism. The ratio of luteinizing hormone and FSH changes. At the reproductive age, this ratio is equal to unity, in the climacteric period, FSH is released more (ratio 0.43). The modern concept of the pathogenesis of climacteric syndrome attaches great importance to age-related changes in hypothalamic structures.
The most traditional classification is the division of the climacteric syndromeby the number of tides on: mild form - a disease with up to 10 hot flashes per day; medium form - a disease with 10-20 hot flashes per day and with other characteristic symptoms; severe form - a disease with more than 20 hot flashes per day and other symptoms in which a woman almost completely loses her ability to work Forms of climacteric syndrome: typical - uncomplicated complicated - in combination with ischemic, hypertension, diabetes mellitus, arthropathy, osteoporosis atypical - the prevailing symptoms are indicative of primary disorders in the hypothalamus, which is manifested by hypothalamic syndrome (most often with early menopause in young women)
Clinical picture General picture of the disease... In the early stages, symptoms of disorders associated with impaired nervous regulation of vascular tone appear - the so-called hot flashes and sweating. These symptoms are accompanied by significant disturbances in the higher nervous functions: sleep disorders, increased irritability and excitability, depression. In the future, symptoms arise associated with a decrease in the level of female sex hormones. Atrophy of the skin occurs (slow recovery of skin cells, its wilting), as well as the mucous membrane of the vagina, which is manifested not only by unpleasant subjective sensations (primarily dryness and itching), but also fraught with the addition of infections of the genitourinary organs. There is an insufficiency of the sphincters of the bladder, which is manifested by involuntary urination (urinary incontinence). The clinic is diverse and manifests itself in neuropsychic, vegetative-vascular and metabolic disorders and is similar to diencephalic syndrome: neuropsychic manifestations: irritability, depression, tearfulness, aggressiveness, insomnia, headache, dizziness, nausea and vomiting, itching, vegetative chills vascular manifestations: sweating, heart pain, tachycardia (may be paroxysmal), lability of blood pressure, endocrine metabolic disorders - decreased urine output, thirst, edema, painful engorgement of the mammary glands, flatulence, etc.
Diagnostics Sort complaints into three groups: neurovegetative - hot flashes, sweating, dizziness, paresthesia, tingling in the heart, tachycardia. All this, as a rule, happens at the time of high tide. psycho-neurotic - impaired memory, sleep, bad mood up to depression. somatic - atherosclerosis, systemic osteoporosis, atrophic changes in the internal organs In the first days of the examination, general analysis of blood, urine, TSH, study of the level of potassium, sodium in blood plasma, electrocardiography with physical activity (according to indications), X-ray examination of the chest organs. With pathological menopause, the electrocardiogram is normal or characterized by a pathology of the T wave in the form of its decrease, smoothing and transition to negative, a shift in the S T interval, especially in the right (V1 Vz), less often in the left (V5 V6) chest leads, without dynamic changes (in contrast from changes caused by ischemia), including after physical exertion. The test with nitroglycerin not only does not improve, but sometimes even worsens the ECG indicators and the well-being of patients.
Treatment Allocate drug, non-drug and hormonal treatment of climacteric syndrome.
The first stage is non-drug therapy: morning exercises physiotherapy exercises general massage proper nutrition (vegetables, fruits, vegetable fats should prevail in the diet) physiotherapy treatment (collar with novocaine according to Shcherbak, cerebral galvanization, electroanalgesia. procedures 7-8 times sanatorium treatment - hydrotherapy, balneotherapy , radon baths The second stage is non-hormonal drug therapy: vitamins A, C, E - improve the state of the diencephalon and help well when the first symptoms appear; antipsychotic drugs - drugs of the phenothiazine series - meterazine, ethaperazine, triftazine, frenolone; they act at the level of the interstitial brain, affect the subcortical structures and the Moscow school believes that they have a pathogenetic effect; start with small doses, and evaluate the effect after 2 weeks; tranquilizers - diazepam, elenium, if climacteric syndrome is combined with hypertension, then reserpine has a good effect in this case - pressure decreases, and gives an antipsychotic effect;
The third stage is hormone therapy Currently, the following basic provisions on the use of hormone replacement therapy have been developed.: using only analogs of natural hormones prescribing low doses of estrogens corresponding to the level of endogenous estradiol in the early phase of proliferation in young women, the combination of estrogens with progestogens, which makes it possible to exclude hyperplastic processes in the endometrium when the uterus is removed, estrogen monotherapy can be prescribed; duration of hormone prophylaxis and hormone therapy is at least 5- 7 years for the prevention of osteoporosis and myocardial infarction
Climacteric syndrome a complex of vegetative-vascular, mental and metabolic-endocrine disorders that occur in women against the background of the extinction of the hormonal function of the ovaries and the general age-related involution of the body. It is a complication of the natural course of the climacteric period (climacteric period) and is observed in 30-60% of women. Pathogenesis. In the pathogenesis of To. Page. the main role belongs to the mismatch of the activity of the hypothalamic structures of the brain, ensuring the coordination of cardiovascular, respiratory and temperature reactions with emotional and behavioral ones. The earliest and specific manifestation To. Page. - heat to the head, upper limbs and upper half of the body. These symptoms reflect disturbances in the central mechanisms that control the pulsating release of hypothalamic neuropeptides (luliberin, thyreoliberin, corticoliberin, etc.), which are involved in the regulation of the secretion of tropic hormones of the pituitary gland, the activity of the cardiovascular and respiratory systems, as well as in the regulation and formation of emotional behavioral reactions. With K. s. the previously existing violations are manifested in the higher regulatory centers, which is confirmed by the presence in a significant number of women of burdened heredity, concomitant extragenital pathology and paroxysmal autonomic disorders. The clinical picture. All symptoms To. Page. divided into three groups: vegetative-vascular, metabolic-endocrine and mental. The vegetative-vascular symptoms include hot flushes to the head, upper extremities and upper half of the body and increased, as well as tachycardia, head, sympathetic-adrenal and vagoinsular, which are found in most women (see.Hypothalamic syndromes) .
The group of metabolic endocrine disorders includes trophic changes in the skin, vulva, vagina and bladder, osteoporosis. occupy a large place in the clinical picture To. page. In their manifestations, they are very diverse and nonspecific. This is reflected in the terminology - "climacteric", "anxiety neurosis", "psychosomatic", "psychoendocrine climacteric". In all these cases, it is mainly about borderline mental (see. Neuroses ,
Psychopathy) and psychosomatic disorders; special climacteric psychoses do not exist. The main manifestations of mental disorders are affective shifts with a characteristic instability of the emotional sphere, pronounced fluctuations in mental activity and performance, drives, senestopathic disorders. Mood changes occur easily. For an insignificant reason, and sometimes without such, melancholy may appear with a loss of interest in the environment, a feeling of powerlessness and emptiness, or anxiety. Very often, a decrease is accompanied by dissatisfaction, pickiness, capriciousness. Much less often there are states of heightened mood with elements of exaltation and sentimentality. The instability of the mood and the corresponding patients sometimes resemble those of the hysterical. Mental activity and is also very labile. They can be normal, even elevated, but suddenly a feeling of fatigue may appear, accompanied by difficulty concentrating, inability to perform daily mental work. Attractions (, sexual feeling, etc.) are just as unstable. Sleep disorders are observed in many patients. Typical for K. with. vegetative disorders can be combined with senestopathies (Senestopathies)
(, tingling, vague sensations in different areas of the body). This kind of often causes the development of hypochondriacal ideas - for example, thoughts about cancer, tuberculosis or some other serious illness. The described mental disorders are based on the characteristic To. Page. endocrine shifts and concomitant secondary somatic disorders, primarily autonomic (for example, cardiovascular, gastrointestinal disorders), as well as psychogenic factors. With K. s. true psychogenic reactions may also arise, associated with feelings and thoughts about catastrophic aging and the expectation of the corresponding "consequences", primarily changes in family relations. Usually such reactions are characterized by anxiety-depressive mood. In these cases, it is necessary to bear in mind that the picture, reminiscent of psychogenic reactions at K. page, can begin and endogenous (see. Manic-depressive psychosis ,
Schizophrenia) .
Depending on the characteristics of clinical manifestations, there are three main forms To. Page: typical (uncomplicated), complicated and atypical. For a typical (uncomplicated) form, "hot flashes" and are characteristic. The complicated form includes cases of K. page, occurring against the background of diseases of the cardiovascular system, digestive organs (cholelithiasis, stomach and duodenum), which are often found in women over 40-15 years old, as well as other extragenital diseases (for example, hypothalamic syndrome, sugar, thyroid dysfunction). With a complicated form To. Page. there is an increase in the frequency and severity of "hot flashes", there are complaints of pain and a feeling of fading in the heart, disturbed sleep, memory. In the atypical form, along with "hot flashes" can be observed sympathetic-adrenal crises, allergic diseases (including),. In menopausal myocardial dystrophy, in contrast to coronary heart disease, changes are insignificant or absent, despite severe pain syndrome: there is a negative test with nitroglycerin, positive tests with obzidan and potassium preparations. The atypical form also includes the form in which the symptoms of To. Page. appear cyclically (at certain intervals) against the background of the absence of menstruation (cyclic form To. page); this form often occurs in women who have had premenstrual syndrome (PMS) during their reproductive years. The hyperprolactin form of K. is especially distinguished by the page, characterized by sympathetic-adrenal crises, the absence of a therapeutic effect from the use of estrogens and an improvement in the condition when prescribing bromocriptine (parlodel). Classification To. Page. by degrees of severity, in which all its manifestations would have been taken into account, is absent. The most common classification in clinical practice is E.M. Vikhlyaeva (1966), based on the determination of the severity of To. Page. by the number of "hot flashes", taking into account the general condition and performance of the woman. With climacteric syndrome I degree (mild), there are less than 10 "hot flashes" per day, the general condition and performance are not disturbed. II degree (moderate) is characterized by 10-20 "hot flashes" per day in combination with headaches, dizziness, pain in the heart, palpitations, decreased performance. With climacteric syndrome of the III degree (severe), the frequency of "hot flashes" is more than 20 per day, well-being and performance are significantly impaired. This classification is generally acceptable for the typical form of K. with. Polymorphism of clinical manifestations To. Page. it is often difficult to fit into the given scheme, and its severity is not always determined by the number of "tides". Based on the results of studying the state of the autonomic nervous system in patients with K. page, it is possible to characterize the features of the clinical picture depending on the type of autonomic reactions, which is important for the correct choice of therapy. When the sympathetic-adrenal part of the autonomic nervous system is activated, the arterial, which has developed in the climacteric period, increased heart rate and respiration at rest, predominance of complaints from the cardiovascular system (palpitations, pain in the heart) during the "tide". With the functional predominance of the parasympathetic division of the autonomic nervous system, arterial, vagoinsular crises of the type of fainting conditions, various allergic manifestations, and a decrease in breathing at rest are noted. "" Are accompanied by a feeling of sinking heart, lack of air, the appearance of profuse liquid sweat, nausea, dizziness, severe weakness. With prolonged severe course To. Page, especially in combination with hypertension, which developed at a young age, there is a dysfunction of both departments of the autonomic nervous system. At the same time, there are sympathetic-adrenal crises, attacks of paroxysmal tachycardia, pronounced autonomic shifts in the mental sphere. "Hot flashes" are combined with a feeling of severe discomfort, significant emotional disturbances. Diagnosis set on the basis of characteristic clinical manifestations. In the diagnosis of atypical forms To. Page. anamnesis data, indicating a connection between the onset of symptoms and the onset of menopause, the lack of effect from traditional therapy of existing disorders, and a positive effect against the background of treatment with sex steroids or parlodel (with a hyperprolacticemic form), help. Treatment is carried out by a gynecologist with the participation of a neuropsychiatrist, if necessary; it is carried out on an outpatient basis or in a hospital, depending on the severity of To. page. taking into account the type of vegetative reactions. They use non-drug, non-hormonal drug and hormonal therapy. With an easy current To. Page. you can limit yourself to non-drug therapy. Patients are recommended morning, classes in health groups 2-3 times a week, walks before bedtime, with a reduced content of animal fats and carbohydrates, limitation of broths, spices, coffee. Prescribe general, hydrotherapy (dousing, coniferous and sage, contrast foot baths), balneotherapy (pearl, oxygen, foamy and nitrogen baths, patients with K. with. In combination with uterine myoma, endometriosis, thyrotoxicosis - radon and iodine-bromine baths ( anodic galvanization of the brain, galvanization of the cervical-facial region, novocaine in the region of the upper cervical sympathetic ganglia in combination with massage of the collar zone, central electroanalgesia with frontal-mastoid electrodes) - 8-10 sessions of one of the above procedures every other day; very effective. For mental disorders, psychological correction can also be used. Treatment K. s. of moderate severity includes non-hormonal drug therapy aimed at normalizing the function of the c.ns. and the autonomic nervous system. When the sympathetic-adrenal link of the autonomic nervous system is activated, sympatholytic drugs are shown: reserpine 0.05 mg 1-2 times a day, obzidan 10 mg 1-3 times a day. In the case of the predominance of the influence of the parasympathetic division of the autonomic nervous system, anticholinergic drugs are prescribed: tavegil 1 mg or suprastin 25 mg 1-3 times a day, 5-10 drops of belladonna tincture 2-3 times a day. Patients with dysfunction of both parts of the autonomic nervous system are recommended to use the combined use of anticholinergic and sympatholytic agents (belloid or bellataminal 2-3 tablets a day, stugeron 25 mg 2-3 times a day). Regardless of the type of autonomic disorders, preparations of vitamins B 1 and B 6 are prescribed. Medication of mental disorders depends on clinical manifestations: in mild affective (depressive) states, the appointment of small doses of antidepressants and tranquilizers is indicated; with distinct senestohypochondriacal disorders, small doses of antipsychotics (in particular, triftazine) are added. In case of ineffectiveness of treatment To. Page. of moderate severity with non-hormonal drugs, as well as with severe K. page. held . Prescribe combined estrogen-gestagenic drugs (for example, non-ovlon, bisecurin) 1/3 - 1/4 tablets 1 time per day for 3 weeks, 3-4 courses with a break of 7 or more days. With pronounced hypoestrogenia, use 0.5 mg 1-2 times a day or microfollin at 0.025 mg 2 times a day orally or 0.1% solution of estradiol dipropionate, 1 ml intramuscularly 1 time in 3-4 days for 2 weeks, then within 7 days (pregnin 0.01 G 3 times a day under or norkolut 1 tablet a day); 3-4 courses are carried out with an interval of 7 days. In the case of a combination of K. with. with uterine myoma or mastopathy, gestagens are indicated (for example, norkolut). When prescribing hormone therapy using estrogens, it should be borne in mind that they are absolutely contraindicated in malignant neoplasms, thrombophlebitis, relatively contraindicated in case of changes in the hemostasis system (hypercoagulation), hypertension, diabetes mellitus, hepatitis.
