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At physiological menopause 45-50% of women in the beginning of premenopause submit complaints only on menstrual dysfunction. Childbearing is terminated before lasting cessation of menstruation, but in rare cases, the pregnancy can occur and to premenopausal. To illustrate, here is an example.
In outpatient departments Unitasker the USSR Ministry of health asked the woman, 47 years in the absence of menstruation for 1.5 years, the increase in the abdomen, the deterioration of the General condition, weakness, fatigue.
Menstruation with 13 years of regular. Sex life with 20 years of marriage first. Gynecological diseases was not. About the lack of pregnancies unsuccessfully treated up to 35 years with the help of various physical methods and hormonal drugs. The last 12 years at the gynecologist was not observed. At survey found an increase in the uterus to 26-27 weeks of pregnancy. The uterine appendages were not determined. The patient referred to the surgical Department for operative treatment with a diagnosis of uterine fibroids (fast-growing)". Hospital ultrasound diagnosis "pregnancy 26-27 weeks". At the 39th week of pregnancy was born normal girl (body weight 3 kg 800 g, height 50 cm).
Generally regressive changes in the ovaries occur before the onset of premenopause. About 30 years begin to discover sclerotic changes in the ovaries and blood vessels of medium caliber. The ovaries are shrinking. In 30-40 years weight of the ovary is equal to 9.3 g, 41-50 - 6.6 g in 51-60 - 4,96 g, 61 to 70 years -4, varies With age and morphological structure of the ovary. If during the reproductive period in the ovaries contain a large amount of primordial follicles in different stages of development, yellow and white body, with age, their number decreases: in the 18-25 years 150,000 follicles 40-44 years 8.000 to 9.000. Simultaneously with atresia of the follicle happen depletion and puckering of the cortical layer of the ovaries. Along with this, in the ovaries find hyperplasia stroma, the severity of which varies from point to proliferation in peripheral areas of the ovary to diffuse stromal hyperplasia of the entire ovary. In genitals noticeable change is not detected [Davydov I. Century, 1966]. Changes in hormonal ovarian function in premenopausal manifest violation of a natural cyclic processes, estrogennaya insufficiency of ovarian function and the yellow body, and then his absence.
The second option of course menopause - pathological. It differs from the first in pre-menopausal women in the sex organs symptoms of hyperestrogenemia, which are observed for a long time and can be detected during routine gynecological examination. The mucous membranes of the vagina and cervix long retain the color pink, there is a pronounced folding mucous membrane, from the cervical canal is almost always stands out mucus. The size of the uterus does not decrease, and sometimes even increasing, it is dense, may be rounded. Some patients may increase mammary glands. Under this option, usually occur uterine bleeding, found uterine fibroids and other tumors of the genital organs (scheme 3).
The second phase menopause - menopause - last uterine bleeding caused by hormonal function of the ovaries. Since it is difficult to establish whether uterine bleeding last, menopause determine retrospectively, after a year of existence of persistent amenorrhea. Studies to determine the age of menopause spent many authors. According to their data, it varies from 49 to 52 years [Vihljaeva E. M., 1959; Quater E. I., 1967; Smetnik B. N., 1980; Pressel J., 1982]. However, there are cases of an earlier onset of menopause (38-48 years old).