Climacteric disorders (menopause)

The clinical picture of menopause is very diverse. Initially, various vascular disorders are traditionally detected, manifested by rushes of blood to the head and upper half of the body due to a sudden short-term expansion of blood vessels. During the tide, the face, neck, and chest turn red sharply, and the temperature of the hyperemic areas rises. In many women, hot flashes are accompanied by sweating, dizziness, and tinnitus. Hot flashes appear at any time of the day and continue traditionally for several seconds or minutes. More often their appearance is promoted by nervous tension, excitement. Not infrequently, the climacteric syndrome is expressed by excessive sweating, short chills, fluctuations in blood pressure (usually a short-term or persistent increase), sometimes palpitations and pain in the heart area.

In addition to vascular disorders, various neuropsychiatric disorders are often noted. This is more common in women with an unstable psyche, especially in the presence of external factors that cause fear of impending old age and infirmity, fear of appearing changes in appearance, leading to the loss of former attractiveness. The climacteric syndrome in these women is often expressed by emotional instability with a tendency to depression, increased reactivity to somatic harm and mental trauma, a tendency to tearfulness, resentment, irascibility, sometimes, on the contrary, malice, intolerance to sensory stimuli (especially strong sound and light), sensation fears and anxiety (fear of death, fear of loneliness, etc.). Such nervous and mental disorders are almost always accompanied by flushes of heat.

Frequent symptoms of pathological menopause are endocrine disorders, expressed as violations of the function of the thyroid gland, the cortical substance of the adrenal glands, metabolic processes, etc. Particular importance is attached to the function of the thyroid gland in “stressed” conditions of the body, which is the menopause, when the body withstands great stress due to with restructuring in both the nervous and endocrine systems. At the same time, the function of the thyroid gland increases with an increase in basal metabolism, and in some patients a pronounced picture of thyrotoxicosis is observed. The content of iodine in the blood during menopause is almost always increased.

The function of the cortical substance of the adrenal glands is closely related to the function of the gonads, complementing and compensating for their function, so the nature and duration of menopausal disorders in women to a certain extent depends on the compensatory function of the cortical substance of the adrenal glands.

Some clinical symptoms of menopause (adynamia, arterial hypertension, asthenia, pain in the heart area, hirsutism, etc.) testify to a change in the function of the adrenal glands. In some patients, these symptoms are found in isolation, in others – in the aggregate, in the form of a syndrome.

Climacteric syndrome is observed during menstruation, before and at different times after menstruation, as well as during menopause. More often and more pronounced climacteric syndrome in the first phases of menopause.

A serious complication of menopause is dysfunctional uterine bleeding, which in women over 40 years of age account for 50-60% of all bleeding in this period of life.

The hormonal function of the ovaries with the onset of menopause does not stop immediately. Initially, the development of the follicle or corpus luteum is disrupted, which leads to the appearance of bleeding of a dysfunctional nature. Violation of ovulation and the formation of the corpus luteum is expressed by the persistence of the follicle. The corpus luteum does not appear, the menstrual cycle becomes anovulatory.

Violation of the maturation of follicles leads to a violation of cyclic changes in the uterine mucosa. Most often, endometrial hyperplasia is noted in the absence of secretory changes. Glandular cystic hyperplasia exists for a long time, since the absence of the corpus luteum and progesterone prevents the onset of the secretory phase. The pathologically altered endometrium undergoes extensive thrombosis, necrosis, and indiscriminate rejection accompanied by menstrual bleeding.

Menopausal bleeding begins most often after a delay in menstruation, less often bleeding is detected every day of the expected menstruation or even a little earlier, but almost always with subsequent prolonged bleeding of varying degrees, lasting several weeks and even months. In addition to the duration, a characteristic feature of menopausal bleeding is their tendency to recur, sometimes for 4-5 years. Bleeding in menopause is traditionally very abundant, sometimes life-threatening. More often, despite the duration of bleeding, patients do not develop significant anemia, except in cases of a combination of menopausal bleeding with uterine fibroids.

Diagnosis of pathological menopause often does not cause difficulties, since in most cases the characteristic symptoms are found at the age approaching menopause, and coincide in time with the menstrual cycle or the cessation of menstruation.

Diagnosis is complicated by all sorts of concomitant diseases that coincide in time with menopause or occur latently and manifest themselves only in the menopause. With menopause, somatic diseases are exacerbated, and the climacteric syndrome against the background of a somatic disease is characterized by a more severe course, not often with atypical manifestations.

To clarify the diagnosis, special research methods are needed to judge the functional state of the ovaries. The most commonly used histological examination of scrapings of the uterine mucosa and colpocytological examination of vaginal smears in dynamics. The presence of anovulatory cycles confirms the relationship of functional disorders with menopausal syndrome. The diagnosis of menopausal bleeding is confirmed by the absence of a secretory phase in the endometrium, single-phase rectal temperature, and the presence of an IV reaction of the vaginal smear. The cause of uterine bleeding in menopause and menopause can also be cancer of the cervix and body of the uterus, ovarian cancer with metastases to the uterus, uterine fibromyoma, endometriosis, polyps of the body and cervix, etc.

In some cases, the cause of bleeding in the menopause can be inflammatory diseases of the genital organs and the incorrect position of the uterus (fixed retroflexion), causing venous blood stagnation in the pelvis. There is evidence of the appearance of bleeding in menopause with long-term use of various hormonal products.

Since the pathological course of menopause is associated with age-related restructuring of the functions of many organs and systems, especially nervous and endocrine, then treatment should be focused on resolving their relationship.

After examination and diagnosis, the doctor prescribes general strengthening therapy, symptomatic, hormonal, physical methods, psychotherapy, etc.

With dysfunctional uterine bleeding in menopause, treatment is carried out in two stages: the first stage is to stop bleeding, the second is the normalization of menstrual function or its complete shutdown. The leading link in the complex of therapeutic measures is hormone therapy, which regulates the influence of both the endocrine and nervous systems. Along with hormonal therapy, physiotherapeutic methods of treatment (electrotherapy and ultrasound) are prescribed.

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