Menopause

Menopause (synonym: menopause, menopause, menopause) - physiological period in human life, characterized back development (involution) the reproductive system, taking place on the background of common age-related changes in the body.
Menopause in women
The onset of menopause in women is associated with functional changes in the system of the hypothalamus - pituitary - ovaries and is expressed in the gradual extinction of menstrual function, and then ovarian hormonal activity.
During menopause there are two phases or stages of development. The first is the climacteric period changes of menstrual function - due in 43-45 years later, lasts about one and a half to two years to complete cessation of menstrual function (menopause). The most typical in the first phase of menopause is a rhythm menstruation and menstrual cycle. Most women will gradually increase the interval between periods and decrease the intensity of bleedings. Rarely observed shortening of intervals and increased bleeding. The time of menopause varies from 45 to 46 to 50 years. The duration of the second phase menopause - fading ovarian hormonal activity after the cessation of menstrual function is quite difficult to install, but sometimes within 3-5 years (or more) after menopause in women of advanced age can appear spotting menstrual type, and even to attack pregnancy. At the end of the second phase menopause, ovarian hormonal activity ceases and there comes so-called physiological rest of the reproductive system.
Premature menopause (before 40 years) is observed in women with poor conditions of work and life, after frequent births and abortions, after massive blood loss during delivery, and chronic infectious diseases. Later the extinction of menstrual function (over 50) occurs when the uterine fibroids, hypertension, diabetes. Severe mental trauma, prolonged emotional stress in women puberty can contribute to the sudden cessation of menstruation.
Among the complications of menopause, the most noteworthy menopausal uterine bleeding and so-called climacteric syndrome.
Menopausal bleeding caused by violations of the processes of growth, maturation and reverse the development of follicles in the ovaries. Violation of hormonal balance often cause excessive growth of the endometrium.
Broken and detachment functional layer of mucous membrane, resulting in patients appear long irregular bleeding of different duration and intensity. Some patients with bleeding appear after a delay of menstruation.
For further diagnosis must study the dynamics of ovarian function with colpocytology, the application of the test with the crystallization of the cervical mucus, measuring basal (rectal) temperature (see the Menstrual cycle). The most important diagnostic scraping mucous membrane of the uterus, which must precede the beginning of treatment. Histological examination of a scraping able to reveal the character of changes of the endometrium, and the main thing - to exclude the presence of cancer.
To climacteric syndrome include a kind of symptoms, manifested by the "hot flushes" to the head and upper torso, rapid heartbeat, sweating, dizziness, sleep disorders and health. Diagnosis of menopause is based on a typical clinical picture that is emerging at the end of the period menopausal changes menstrual function or early menopause.
In climacteric period in connection with unstable nervous-mental state of women in some cases there are fluctuations in blood pressure may develop in a typical forms of arthritis, acute for diabetes and other diseases.
Treatment. In climacteric period great attention should be paid to the rational General regime, to establish the right diet (increase in the diet of vegetables, limit meat, meat soups), in order to avoid congestion in small pelvis woman should move more, to do morning exercises, for constipation and obesity is recommended physiotherapy, balneotherapy.
When menopausal bleeding produced before treatment diagnostic scraping has simultaneously and therapeutic effect - in some patients after scraping bleeding stopped. In recurrent menopausal bleeding only after special functional studies doctor conducts hormone therapy. Women aged 45 to 47 years prescribed drugs hormone yellow body - pregnin tablets 0.01 g 3 times a day under the tongue in the second half of the menstrual cycle. Women older, and in recurrent polypous endometrial growths with the purpose of suppression of menstrual function, use drugs male (androgens) hormones - methyl-testosterone 0.01 g 3 times a day under the tongue within 1-2 months. or testosterone-propionate (25 mg 2 to 3 times a week intramuscularly within 3-4 weeks) by a doctor.
For the treatment of menopausal syndrome recommended sedative (soothing) preparations of Valerian with bromides, triftazin (2-5 mg overnight during 1-2 months), phrenolon and others, as well as small doses of the hormone, also after careful special surveys and only by prescription.

This section presents modern concepts of physiological menopause and causes pathological course of climacteric period. The data about the characteristics of the course of somatic and gynecological diseases in menopause (diabetes, hypertension, metabolic disorders, cancer and inflammatory diseases of genital organs) and the tactics of treatment of patients. Considered are the issues of forecasting, detection and prevention of pathological climacteric.
Section designed for gynecologists, therapists, psihoneurologic, neuropathologists.

Preface

The problem of ageing of man from ancient times attracted the attention of the outstanding thinkers of mankind. In the second half of the XX century this problem has acquired particular importance in view of the fact that there have been significant changes in the age structure of the population, increased life expectancy. Therefore, increased duration of menopause. In this regard, clear all the increasing interest to this period of life, especially in terms of health.
Diagnosis and treatment of pathological conditions in menopause have specific character, which does not always take into account obstetricians-gynecologists. Features of this period are primarily in the fact that it was at this time that arise or occur many diseases, benign and malignant tumors, psychosis, neurosis, diabetes, obesity, disorders of the endocrine glands, vegetative-vascular disorders and other Clinical symptoms of these diseases can be similar to the symptoms of aging and abnormal flow of menopause, in other words, the nature of the manifestations of many diseases and age-related changes can be practically the same, while the methods of treatment should be totally different.
In this regard, the purpose of the present work was primarily the presentation of data on physiological and pathological age-related changes in the body of women, in particular reproductive system during the period of aging. High frequency of pathological course of menopause and diseases in this period of life obliges doctors to pay special attention to the prevention of pathological course of menopause. In connection with this seemed the most expedient to dwell on this aspect of the issue under consideration. Pathological processes developing in menopause, often caused by not always justified symptomatic therapy, so much attention is paid to the differential diagnosis and methods of pathogenetically substantiated therapy.
The section is written on the base of literature data, personal long-term experience of the author and of the results of research conducted by the author for 25 years in the endocrinology Department of the all-Union center for health protection of mother and child health Ministry of the USSR.


Table of contents

Chapter 1. General data about the physiological changes in menopause in women
Violations functions of the nervous system
Disorders of the cardiovascular system
Changes of hemostasis
Disorders of the endocrine glands
Violations of other organs
Changes in the skeletal system
Changes of connective tissue
Chapter 2. Physiological age-related changes of the reproductive system
Chapter 3. Pathological development of menopause in women
The typical form of climacteric syndrome
Atypical form of climacteric syndrome
Complicated, or combined, form of climacteric syndrome
Neuroendocrine disorders
Dishormonal menopausal cardiopathy
Pathology of endocrine glands
Pathology of mammary glands
Chapter 4. Dysfunctional menopausal uterine bleeding
A typical dysfunctional menopausal uterine bleeding
Bleeding in patients with primary neuroendocrine form hypothalamic syndrome and function disorders of the Central nervous system
Bleeding in patients with hyperplastic endometrium
Bleeding in patients with uterine myoma
Chapter 5. Diagnosis and differential diagnosis of menopause
History
Inspection
Examination of patients with the typical form of climacteric syndrome
Examination of patients with atypical form of climacteric syndrome
Chapter 6. Treatment of women in complicated cases menopause
Psychotherapy
Dietotherapy
Sedation
Physiotherapy
Hormone therapy
Hormone therapy in pre-menopausal women
Hormone therapy in postmenopausal women
Chapter 7. Prevention of pathological flow menopause
Chapter 8. Diagnostic and tactical mistakes
Conclusion
Selected bibliography