What is postmenopause - a phase for women. What is postmenopause in women? May be affected by postmenopausal women

Menopause– this is a physiological period in a woman’s life, during which, throughout the centuries, changes in the body are dominated by involutionary processes in the reproductive system. The words “climax”, “menopause” are similar to the Greek words kli-max – descend and klimakter – step.

• premenopausal period- from 45 years to menopause;
• perimenopausal period- Premenopausal and 2 years after menopause;
• postmenopausal period- begins after the onset of menopause and continues until the death of the woman.

Changes in the menstrual cycle can occur in women over 40 years of age, manifested by irregular menstruation. The sensitivity of follicles that are lost before stimulation by gonadotropins decreases, and the sensitivity of the hypothalamus to estrogens is advanced. Behind the mechanism of negative feedback, there is an increase in gonadotropins. FSH levels begin to rise in the blood after 40 years, LH levels – after 45 years. After menopause, LH increases 3 times, and FSH increases 14 times. During this period, the death of oo-cytes and atresia of primordial follicles accelerate. In follicles, the number of granulosa cells and theca cells, which are the main source of the synthesis and secretion of estrogens, changes. The hormonal activity of the ovarian stroma does not change - the secretion of androstenedione and a small amount of testosterone is observed.

The altered level of estradiol affects the secretion of pituitary gonadotropins. There is no ovulatory effect of FSH and LH, and ovulatory cycles change to cycles due to lack of body fluids, and then to anovulatory ones. Due to the lack of body fat, the synthesis of progesterone sharply decreases, which is partly the cause of endometrial hyperplasia and dysfunctional uterine bleeding (DUB).

The small number of mature follicles leads to increased intervals between cycles or cycles with oligomenorrhea.

The end of menstruation occurs when the amount of estrogens is insufficient to initiate proliferative processes in the endometrium and menstruation.

The hour at which menopause occurs depends on the number of eggs produced due to environmental and social factors. Pre-menopause is characterized by the manifestation of persistent amenorrhea in women aged 36-39, due to possible reasons: genetic diversity; lack of ovarian function as a result of the secondary autoimmune reaction in rheumatoid arthritis or the inflammatory response in mumps.

Early menopause occurs in women between 40 and 44 years of age. Rhubarb FSH, which is 30 µg/l, is a marker of menopause (Smetnik V.P., 2001).

Depending on the nature of the manifestation of guilt, pathological conditions are divided into 3 groups:

1st group. Early symptoms

Vasomotor: “flushing” of the scalp, increased sweating, headache, hypotension or hypertension, chills, palpitations.

Emotional and mental: twitchiness, drowsiness, weakness, restlessness, depression, forgetfulness, disrespect, decreased libido.

2nd group. Mid-hour symptoms

Urogenital: dryness of the liver, dyspareunia - pain with wear and tear, itching of the liver, urethral syndrome.

Skin and appendages: dryness, brittleness of nails, wrinkles, dryness and loss of hair.

3rd group. Exchange disruptions: osteoporosis, heart disease.

Otje, 1st group - Early symptoms are a typical manifestation of menopausal syndrome (CS), the frequency of which is 40-60%. According to the data of V.P. Smetnik (1999), in 37% of women, veins appear in the premenopausal period, in 40% they approach menopause, in 21% - 1.0-1.5 days after menopause, and in 2% - after 3-5 years after menopause. The most early and specific symptoms are “flushes” of the speck. “Flashes” are characterized by unsatisfying blackish skin of the head, neck and chest, which is accompanied by severe scalding and sweating.

The tides can last from a few seconds to a few seconds and occur more often at night or during a stressful situation. The tide rises, perhaps, with the cob of LH and is characterized by shifts in the level of LH, ACTH and TSH. The levels of FSH and prolactin do not change with the rising tide. However, since the levels of thyroid hormones do not change during the tide, the glucocorticoid and mineralocorticoid functions of the measles of the adrenal glands are constantly advancing. Vasomotor disorders in most women last 1-2 days, or can last up to 10 years (Savelyeva G.M. et al., 2002).

The number of tides indicates the severity of the menopausal syndrome (Vikhlyaeva E.M., 1966):

• mild form - up to 10 influxes per dose, zagalny stan and productivity are not damaged;
• moderate severity – 10-20 hot flashes, headache, confusion, pain in the heart, increased sleepiness and decreased productivity;
• Important form - over 20 tides per harvest, which means a complete waste of productivity.

“Tips” occur due to a decrease in the level of estrogen, which has previously established, and do not occur during hypoestrogenemia (for example, with gonadal dysgenesis) - through the low level of estrogen.

Other symptoms of CS include hyperhidrosis, changes in arterial pressure, advancement of arterial pressure (up to 60% of cases), headache, sleep disturbance, chills, sympathoadrenal crises. The etiology of this destruction has not been precisely established. However, it is accepted that estradiol deficiency leads to a change in the synthesis of cerebral catecholestrogens, which compete with catecholamines for the binding site in the hypothalamus. An important role is also played by the disruption of synthesis (3-endorphins in the brain and serotonin, which are responsible for mood (Smetnik V.P., 2002)). It is difficult to achieve this, but it is more pleasant in assessing the effectiveness of therapy and conducting scientific research (Pshenichnikova T.Ya., 1998).

Schematically, the symptom complex of the CS is divided into 3 groups (Savchenko O.M. et al., 1967).

Group 1- neurovegetative disorders: arterial pressure, headache, tachycardia attacks, chills, freezing, sympathoadrenal crises, sleep disturbance, “hot flashes”. Group 2- metabolic-endocrine disorders: obesity, changes in the function of the thyroid gland, dyshormonal hyperplasia of the mammary glands, pain in the meat, atrophy of the thyroid organs, osteoporosis, endocrine diabetes. Group 3 - psycho-emotional disturbances: decreased productivity, absent-mindedness, weakened memory, restlessness, tearfulness, disturbed appetite, impaired appetite, etc. Skin symptoms are assessed in points depending on the level of severity - from 0 to 3. Having manifested the CS, 10-20 points - mild level, 20-30 points - medium level, 30 or more - severe stage of CS severity .

Metabolic-endocrine and psychoemotional disturbances are assessed in the same way. MI, which is higher than 0, means no damage, 1-7 - mild injuries, 8-14 points - moderate, 15 or more - severe manifestations of the CS.

Druga group Porushen- Mid-hour disorders, stinks appear more often 3-5 years after the onset of menopause. The frequency of urogenital disorders becomes 30-40% (Savelyeva G.M. et al., 2002). Against the background of hypoestrogenia, the synthesis of glycogen in the cells of the mucous membrane of the liver decreases and the number of lactobacilli changes significantly, the pH of the midstream moves to 5.5-7.0. An infection often occurs, the growth of intestinal bacteria and staphylococcal streptococcus is especially activated. Persistent atrophic colpitis, itching of the vulvovaginal area, and dyspnea develop. Doctors have treated the drug, treatment is carried out with the addition of estrogenic drugs under the control of an increase in the indicators of the KPI to 50-60 and a decrease in pH to 4.5.

Atrophic changes in the urethra often cause recurrence of bacterial infection, which can lead to fibrosis and the development of “urethral syndrome,” which is characterized by partial, painful and fleeting discharge. Paraurethral bacterial colonization makes it easier to overcome cystitis and urethritis.

The following forms of urogenital disorders include:

1) mild form: atrophic vaginitis, dyspareunia, cystalgia, nocturia; The treatment is 100% effective;

2) middle stage: before the treatment of the body, an unbreakable section under stress is added; the effect of treatment is in 70% of cases, which means that illnesses develop within 3-5 years after the onset of symptoms;

3) important step: fleeting moment; The effect of treatment is up to 30% of cases.

Third group Porushen- Exchange disruptions. Primary, or involutional, osteoporosis is a systemic disease of the skeleton, or a syndrome of accelerated loss of bone tissue, which is characterized by further deterioration of laxity and deformity until fracture of the bones. Changes are observed in the lip parts of the axial skeleton: the thickness changes and the weight of the bone tissue decreases. Increased fluidity of cyst resorption is maintained for 3-7 years after menopause. Osteoporosis changes in place of estrone and androstenedione. Estrogen deficiency reduces the activity of osteoblasts and increases the sensitivity of bone tissue to parathyroid hormone, which regulates calcium metabolism in the bones.

There are two possible mechanisms for the development of osteoporosis: 1. Loss of spongiform integrity through increased activity of osteoclasts. Morphologically this is manifested by the destruction of the labial ligament.

2. Greater thinning of the cortical ball and a change in the mass of the labial cysts due to a decrease in the activity of osteoblasts.

In case of osteoporosis caused by hypoestrogenia, the most common concerns are damage to the spine and fractures of the lower third of the forearm bones. Hypoestrogenia means an accelerated process of cyst resorption. Estrogen has a direct and indirect effect on the skeleton. There remains a decrease in the activity of parathyroid hormone, which results in decreased absorption of calcium into the intestine and its reabsorption by calcium. In case of hypoparathyroidism, the transformation of 25-hydroxy-tamine is activated D Its active metabolite is 1,25-hydroxyvitamin D, which blocks the absorption of calcium by the intestines. Calcitonin has a protracted effect, and it also reduces hypoestrogenism.

Officials with the risk of primary osteoporosis are often at a loss; In addition, there are factors associated with the characteristics of the family or particular anamnesis:

1) phenotypic signs (thinned, short woman with light skin, tendinous structure);

2) fractures in the mother;

3) menarche after 15 years of age;

4) menopause up to 50 years.

5) oligo-or amenorrhea;

6) anovulation and infertility;

7) more than 3 dimensions and beds;

8) duration of lactation;

9) lactation for 6 months.

Secondary osteoporosis is a multifactorial illness, in which the following factors play a role:

1) endocrine (hyperthyroidism, hyperparathyroidism, hypercortisolism, diabetes, hypogonadism);

2) deficiency of food and calcium;

3) excessive consumption of alcohol, coffee (more than 5 cups), nicotine;

4) taking medications: corticosteroids, heparin, anticonvulsants (over 4 years);

5) genetic factors: poor osteogenesis, low peak muscle mass;

6) other officials.

Before methods early diagnosis The mineral thickness of the bone tissue is determined by densitometry. As a screening method, ultrasound sonography is currently used, which indicates the level of elasticity and softness of the cystic tissue according to the division of ultrasound in the cystic tissue.

The diagnosis of osteoporosis can be made on the basis of radiography of the ridge - a decrease in the thickness of the bone due to the strengthening of the cortical contours is revealed. Such lesions can appear on radiographs using no less than 30% of cystic tissue. Wedge-like deformities and compression fractures on radiographs of the ridge may also indicate osteoporosis.

The assessment of the cystic tissue mass is carried out by computer tomography. The mineral strength of bone tissue (BMD) is determined using a monophotonic absorptiometer at the points of the bone tissue. They are analyzed as absolute values ​​of BMD (g/cm 2 ) and final indicators in hundreds of age-old norms, covered by age groups with a 5-point interval.

Valued instead of calcium and phosphorus in the blood and excretion in the section, then. phosphorus-calcium metabolism is not enough of a specific marker of cystic resorption, so there are a lot of factors involved (including diet, blood pH, protein storage, etc. .).

Disease of the cardiovascular system in the premenopausal period is a leading cause of death in high-frailty countries. While in the 40th century the frequency of myocardial infarction in men is significantly higher than in women, then in the postmenopausal period, especially up to 60 years, the frequency of myocardial infarction in men and women nok mayzhe however (Savelyeva G.M. and in., 2002).

It is important to note that endogenous estrogens play a significant role in the cardiovascular system. Estrogens reduce the level of atherogenic fractions of lipids (low and even low density lipoproteins), and also have a beneficial effect on hemodynamics, reducing the resistance of peripheral vessels and increasing blood flow in capillaries In addition, estrogens flow into local biochemical processes in the arterial walls (transfer of cholesterol to the intima of the arteries), synthesis of thromboxane, prostacyclin and other endothelial factors. U increased risk of heart-judgmental illnessesGut play the role of the group of factors(Koshtorisnik V.P., 2002):

1st group- Metabolic changes. 90-95% of women have dyslipoproteinemia, changes in glucose and insulin metabolism, changes in hemostasis and fibrinolysis.

2nd group- Non-metabolic changes: dysfunction of endothelial cells, caused by estrogen deficiency, which is associated with a decrease in endothelin-1 and thromboxane - A2, as well as decreased synthesis of nitric oxide and p I use prostacyclin; changes in heart function and hemodynamics.

Prevention and treatment of menopausal disorders. Hormone therapy is used as a method of treating climacteric syndrome and as a real prevention of osteoporosis and diseases of the cardiovascular system. In addition, hormone therapy is indicated when urogenital disorders appear, as well as trophic changes in the skin and mucous membranes - “dry” conjunctivitis, stomatitis, laryngitis, etc.

Non-steroidal estrogens (stilbestrol) and synthetic steroids (ethinyl-estradiol and mestic-ranol) have been widely used in the kidneys. The complications of this monotherapy were characterized by the appearance of hyperplasia of the endometrium in 7-15% of women and an increased incidence of endometrial cancer in 2-9 times in a similar population (Smetnik V.P., 200 2). In connection with this, the optimal regimens of hormone therapy and types of hormonal drugs to turn off negative effects were developed.

At this time, we will strictly accept the provisions about vikoristanya. natural estrogens for hormone therapy with obligatory ulcers adding low doses of gestagen (natural or synthetic). Although natural estrogens are not as active as synthetic ones, they have an important advantage against the stink. Odors are metabolized in the liver, like endogenous estrogens, which do not have such a pronounced effect on the liver, like synthetics, do not change coagulation factors, carbohydrate metabolism, and do not promote the synthesis of prolactin.

Estrogen is being used against estrogens estradiol, It is the main circulating estrogen in young women. Estron The form of conjugated estrogens is widely used in hormone therapy in postmenopause. The main component is estrone sulfate.

Estriol It is mainly found in the free form as es-triol succinate. Estriol is the least active estrogen, has a colpotropic effect, and is widely used vaginally for urogenital disorders.

There are two main ways of administering natural estrogens: oral and parenteral. Two important considerations between oral and parenteral estrogens:

1. Natural estrogens are often converted to estrone in the scolio-intestinal tract. Orally administered estrogens undergo primary metabolism in the liver in biologically inactive sulfate forms. Also, in order for physiological estrogens to reach target organs, their supraphysiological doses must be taken.
2. Parenterally administered estrogens reach target organs and have a therapeutic effect at lower doses, then. the primary metabolism of the liver is switched off.

When parenteral estrogen is prescribed, different methods of administration are used. The systemic action of estrogens is achieved through internal, transcutaneous (plaster), subcutaneous and scalp (ointment) administration.

The local effect is achieved with vaginal administration of estrogens in the form of ointments, suppositories, pessary rings for the treatment of urogenital disorders.

As it turns out, with chronic, continuous use of estrogens, there is an increased incidence of various types of hyperplasia and endometrial cancer. Therefore, at this time, with prescribed hormonal therapy, obligatory cyclic addition of progestogens to estrogen is taken over a period of 10-12-14 days. The use of natural estrogens and added progestogens made it possible to suppress endometrial hyperplasia. In women who enjoy this regimen, the incidence of endometrial cancer is lower, and lower in women who do not enjoy this regimen. Invariably, gestagens induce cyclic secretory transformation of the proliferating endometrium and thus ensure external destruction of the endometrium.

An additional component is the role of 17-OH progesterone. It has extremely low androgenic activity equal to its progestogenic activity and practically does not reduce the favorable influx of estrogens into the cardiovascular system. New generation progestogens (desogestrel, gestodene, norgesti-mate) also increase lipoprotein metabolism. Synthetic progestogens, when included in contraceptive pills, are administered in doses necessary to suppress ovulation. Progestogens can be administered orally or parenterally (internally, transcutaneously, vaginally - suppositories, capsules). Doses of oral progestogens are higher, lower parenteral. For example, the dose of norethisterone acetate for transdermal administration is 0.25 mg per dose. for 14 days, and for oral administration – 1.0-2.5 mg per dose. It has been established that reducing the incidence of endometrial hyperplasia is more important due to the greater ease of taking progestogens, the lower the dose given. Thus, supplementary administration of gestagen for 7 days reduces the incidence of endometrial hyperplasia to 4%, and for 10-12 days practically turns it off. Low doses of progestogens and cyclic administration of them allowed to minimize their negative effect on lipoproteins.

If uterine bleeding occurs, an ultrasound scan and diagnostic testing should be performed.

Investigations necessary before initiating hormone therapy:

• A medical history is contraindicated.
• Gynecological treatment with oncocytology.
• Ultrasound examination of the genitals (assessment of endometrial tissue.
• Investigation of mammary lumps - palpation and mammography.
• Changes in AT, growth, body weight, coagulation factors, blood cholesterol, as well as TSH, T3, T4; ECG recording, osteodensitometry in perimenopause.

For patients taking a course of hormone therapy, the first control is scheduled after 3 months, and the onset - after 6 months. It is necessary to carry out once a day mamography, oncocytology, osteodensitometry for osteopenia and osteoporosis, ultrasound of the genitals.

If, at the time of ultrasound diagnostics, fibroids and endometrial hyperplasia up to 0.5 div are detected, replacement hormone therapy (HRT) may be prescribed; If the width of the middle structures is 05-06 cm, a test with progesterone is carried out, then ultrasound control is carried out if the size of the middle structures changes (M-moon), if it is more than 06 cm - padding (hysteroscopy).

However, on HRT, the echographic picture of nodules is being updated in the first few years and there is a possibility of an increase in myomatous (Zaidieva Ya.Z. et al., 2001), interstitial and interstitial-submucosal nodes. Lv. Atrophic processes in the mother can lead to an increase in centripetal tendencies and an increase in the submucosal component of the node, the possibility of bleeding (Savelyeva E. et al., 2002), which will require hydrosonography and hysteroscopy ї.

In case of diffuse mastopathy, HRT is not contraindicated; 2-phase drugs are preferred.

Contraindications for hormone therapy:

• swelling of the uterus, ovaries and mammary tracts;
• uterine bleeding of unknown origin;
• acute thrombophlebitis;
• thromboembolic disease;
• thromboembolic disorders associated with the intake of estrogens;
• nirkova and pechenkova deficiency;
• severe forms of diabetes;
• meningioma (Progestogens are contraindicated).

Caution is required for signs of illness, which may lead to disability (asthma, migraine, epilepsy), as well as for endometriosis, a history of depression, vaginitis, nitric deficiency no. Estrogen therapy may be prescribed when there is swelling or an increase in the size of the uterus.

Side effects of HRT: engorgement of breast tissue, decreased or increased body mass (by 4-5%), tiredness, pastyness, darkening of the abdomen, headache, visible cervical mucus, cholestasis, decreased or increased libido. In case of accumulation of mammary tracts, mastodinone or clamine is prescribed (Smetnik V.P., 2002).

Positive effects of HRT are characterized by changes in menopausal symptoms in 90-95% of women (Savelyeva E. and in., 2002; Koshtoris V.P., 2002; Sobolevska A.A. and in., 2001; Novikova O.V. and in., 2001; Zaidieva Ya.Z., 2001), reduction in depression, as well as in the tone of the flesh, skin, hair, changes in urogenital disorders (by 85%), the risk of fractures of the cervical neck (by 50%), ridges (by 60-70 %), reduced incidence of myocardial infarction (by 35-50%), Alzheimer's disease (by 30-60%) and the incidence of colon cancer (by 25-30%) (Smetnik V.P., 2002).

In the treatment of climacteric disorders, the only pathogenetically mediated and effective method of correction is replacement hormone therapy, against the progress of those who will require HRT and prevents the harm of the rest (Sav Eleva G.M. and in., 2002). On the one hand, there is a legacy of insufficient awareness of the population, on the other hand, there are scant reports about the risks associated with HRT. Thus, with the use of HRT, the risk of breast cancer increases; estrogens play the role of promoters in carcinogenesis (Savelyeva G.M. et al., 2002). Finally, data have emerged about an increased incidence of cardiovascular complications (thromboses, thromboembolism, strokes, heart attacks) during chronic HRT, in which the most unsafe is the first risk of taking the drugs. (Bashmakova N.V. and in., 2001; Mukhin I.B. and in., 2001; Savelyeva G.M. and in., 2002).

Basic principles of replacement hormone therapy and indications for its purpose:

• Use natural estrogens and analogues (the dose of estrogens is low).
• With an intact mother, estrogens and progestogens are combined; when the mother is removed, estrogen monotherapy is indicated in partial courses or in a continuous mode (Smetnik V.P., 2002).

With the help of prevention, the severity of HRT may become 5-7 years or more. For HRT, drugs are used to replace estrogens (monotherapy), a combination of estrogens with progestogens in different modes (cyclic or continuous), a combination of estrogens with androgens.

Combination therapy (estrogens with progestogens) in a cyclic regimen is recommended for women with visible uterus during perimenopause.

Biphasic drugs - in an intermittent cyclic mode are prescribed in perimenopausal women for the presence of the uterus (Divina, Divitren, Klimen, Klimonorm, Premella-cycle, cycloproginova) and in a continuous mode (Femoston).

Triphasic drugs are prescribed in a non-interruptible mode (trisequence).

Other drugs are Levial ​​(tibolone), which contains estrogenic, progestogenic and androgenic properties. Levial ​​does not have a stimulating effect on the endometrium and mammary glands (Genazzani A.R. et al., 1991; Rymer J. et al., 1994; Valdivia I. et al., 2002). Levial ​​2.5 mg per dose. After 28 days, it is not recommended to take the drug until 1 day after the end of menstruation.

Estrogen, what is there to vikorize? V HRT. Russia has registered drugs that act against 17-v-estradiol, estradiol-valerate, estriol, conjugated estrogens. Monotherapy with estrogens is indicated whenever the uterus is full. Estrogens have a positive effect on the metabolism of the endothelium of blood vessels, the lipid spectrum of the blood, activating the synthesis of nitrogen and prostacyclin. Ways of introducing estrogens:

1. Oral(estrophem, ovestin, progynova, estropheminal, premarin, hormoplex, presomen).
2. Vaginal(creams, candles – ovestine).
3. Nadshkirny(Plastiri, gels; climara, estraderm, dermestril, divigel, estral).

The main passage of the transdermal form of estrogens is due to their metabolism during the first passage through the liver; There is no stimulation of the renin system and the risk of hypertension is reduced (Karjalainen et al, 1997). In addition, a change in the level of fibrinogen and the activity of factor VII, which increases the concentration of triglycerides, has a positive effect on the risk factors of ischemic heart disease (Smetnik V.P. et al., 2000). The transdermal form is important in patients with diseases of the intestinal tract and liver.

Prevention and treatment of urogenital disorders (UTR). The most effective method is HRT. Any type of therapy (both systemic and local) has a positive effect:

• This results in the proliferation of turf epithelium.
• Under the influence of estrogens, the quantity of lactobacillus increases, glycogen production and the pH of the soil decreases, which improves the ecology of the soil (the normal pH is 3.5-4.5).
• It reduces the bleeding of all parts of the soil wall, increasing transudation, which promotes the woman’s sexual activity.
• With the influx of estrogens, the bleeding of all parts of the urethra improves, the mucus tone is restored, the urethral epithelium proliferates and the thickness of the urethral mucus increases.
• The internal urethral pressure is normalized, which prevents the development of stress tension.
• The trophism and the short-lived activity of the detrusor are growing.
• Estrogens reduce blood flow, trophism and short-term production of pelvic floor muscles, collagen fibers, thereby suppressing the morning secretions and changing the drooping walls of the stomach.

Estrogens stimulate the secretion of immunoglobulins in the paraurethral passages, which at the same time, due to the increased amount of urethral mucus, creates a barrier for the development of urinary infection. For mild forms of UGR, local therapy in the “Monday-Wednesday-Friday” mode is effective, which includes Ovestin (cream) + systemic drugs (estriol binds to receptors for 6 years and does not

gives systemic action, estradiol binds to receptors on the 24th year and gives systemic action).

Hormonal prophylaxis of cardiac and pulmonary diseases. A small amount of estrogens in the body leads to changes in blood composition, which reduces the elasticity of blood vessels, including coronary ones. The acidification of the heart tissue is destroyed, and there is a threat of myocardial infarction. In women who take HRT drugs during menopause, the levels of low-density lipoproteins (LDL) and serum cholesterol significantly decrease and the levels of high-density lipoproteins increase flatness (LPZSH). Respect that these changes contribute to the prevention of cardiovascular diseases and the prevention of atherosclerosis. The presence of estrogen receptor proteins in the tissues of arterial walls has been established. Therefore, estrogens act on the artery wall through the mechanisms of binding to hormonal receptors, vasoactive peptides, prostaglandins, and also directly acting on the artery wall in connection with the endothelium-generated relaxing factor. The heart rate increases, the speed of myocardium decreases, the arterial pressure stabilizes and the pain in the heart changes.

Thus, early use of HRT significantly reduces the risk of myocardial infarction and stroke, while in the short term the risk of cardiovascular disorders increases by 2%. Hormone therapy is indicated for 5-10 days.

For the prevention of cardiovascular disease in women during the postmenopausal period, HRT when indicated must be accompanied by courses of systemic enzyme therapy (bromelain, Vobenzym - 5 tablets 3 times a day 30 minutes before meals - 4-6 days. , complete repetition of courses 1-1.5 ms); for platelet hyperaggregation - vitamin E - 50 mg/dose, for a course of 2000 mg), for hyperlipidemia - lipostabil, cholestyramine), which normalize the rheological power of the blood.

Prevention and treatment of osteoporosis. Preservation of the cyst oil – making it easier, less refreshing. Therefore, prevention of osteoporosis is very important and has several main goals:

1) formation of the bone mass and formation of the skeleton with maximum vitality until the period of state maturation;

2) an accelerated decrease in postmenopausal and age-old cyst mass loss;

3) swelling of the bones of the brush and movement of its muscles;

4) normalization of damaged processes of cyst remodeling and prevention of cyst fractures (Rozhinska L.Ya., 2002).

All methods of pathogenic therapy and prevention of osteoporosis, depending on the important mechanism of action, can be mentally divided into three groups:

1) it is important to suppress cystic resorption;

2) stimulating brush formation;

3) preparations of richoplanic acid.

Persha meta - blockade of bone tissue resorption reaches for estrogen levels (Vasiliev A.Yu. et al., 2001; Borovin O.V., 2001; Boldireva N.V., 2001) in women over 60 years of age. It is strictly advisable to use (if contraindicated) monophasic (two-component) drugs such as Cliogest or Levial, and in women with a distant uterus - monophasic estrogenic drugs, including for external stagnation (plasters, gels) (Dyakonova A.A. and in.) ., 2001; Koshtoris V.P., 2002).

In the search for the ideal estrogen, selective modulators of estrogen receptors were considered to be agonists of estrogen receptors in bone tissue and antagonists of estrogen receptors in relation to the uterus and mammary glands (Rozhinska L.Ya. , 2002). Such selective 2nd generation estrogen receptor modulators include raloxifene, keoxifene, and droloxifene.

Raloxifene at a dose of 60 mg, it significantly increases the mineral strength of the bone tissue in the spine, in the proximal parts of the spine and reduces the frequency of fractures of the bones of the spine by 30-40% (D elmas P.D. et al., 1997; Eftinger B. et al., 1, 19; N., 2001).

The 2nd group of drugs, which suppresses the activity of osteoclasts, thereby promotes galvanization of cystic resorption - calcium tonicity. These drugs have an analgesic effect, which is associated with an increase in the level of r-endorphins in the blood under the influence of calcitonin, an influx on the metabolism of serotonin and monoamines in the central nervous system (Rozhinska L.A., 2002).

Calcitonin is administered either in a continuous regimen of 100 OD internally or subcutaneously, or in the form of a course treatment (2 months of freezing, 2 months of break) for 2-5 days a day chronic intake of calcium and vitamin salts D.

The remaining hour increases the increase in salmon calcitonin - myocalcic in intranasal form at a dose of 200 OD (Karelina S.M. et al., 2001). The ritual lasts for 12 months. - two 3-month courses of therapy, intervals between courses - 3 months. Myocalcic is prescribed at a dose of 200 IU intranasally in the form of a spray 1 time per day. Calcitonin has a pronounced anti-resorptive effect, myocalcium stabilizes the mineral density of the cystic tissue in the proximal part of the sternum, including in the cervical cyst (Karelia on S.M. et al., 2001).

Bisphosphonates the most powerful inhibitors of cystic resorption. The leading antiresorbing activity of bisphosphonates is ethidronate (xydiphon, didronel), which is indicated in the form of cyclic therapy (400 mg per day for 2 days, then 10 days off) in combination ii with calcium and (or) vitamin preparations D.

Currently, olendronate (Fosamax) and long-acting dosage forms of aledronate and risedronate are available in the treatment of osteoporosis: 70 and 35 mg per 1 tablet. I will accept it 1 time per week.

In the prevention and treatment of senile osteoporosis, it is important to take vitamin preparations D. The essence of this biological activity:

• stimulation of absorption of calcium and phosphorus into the intestines;
• one-hour infusion on the process of resorption and formation to help block the secretion of parathyroid hormone;
• increased concentration of calcium and phosphorus in the matrix and stimulation of its maturation;
• influx on growth factors that alleviate the displacement of the bone tissue.

Selecting a vitamin dose D 3 carried out over the first 2 days under the control of the level of serum calcium, and then the necessary control instead of calcium 1 time every 2-3 months.

The importance of vitamin supplements has been established D(800 OD/precaution cholecalciferol or ergocalciferol supplemented with 1200 mg calcium) in elderly women for the prevention of cervical fractures (Chapuy M.C. et al., 1994). Trival therapy (more than 2 days) with active vitamin metabolites D(alpha-calcidol and calcitriol) does not provide a significant increase in cyst mass, but the frequency of new cyst fractures is significantly reduced (Rozhinska L.Ya., 2002).

It has now been established that calcium salts play an important role in the prevention of osteoporosis and should be included in the complex treatment of osteoporosis. The US National Institute of Health published it in 1994. Data indicate that the optimal calcium intake for postmenopausal women is 1500 mg, and for postmenopausal women who have taken off HRT - 1000 mg. You should ensure that the average calcium intake becomes 600-800 mg/day. To achieve a preventive effect, it is necessary to add calcium and salts. With age there is a progressive decrease in intestinal absorption of calcium and vitamins D, as well as vitamin supplementation D at the skin

The most pleasant benefits are the combination of calcium and vitamin preparations D, One tablet contains at least 500 mg of calcium and 200 mg of vitamin D. Examples of similar medicinal forms are cal-S-vita, calcium-D3 Nycomed, calcium.

For the treatment of osteoporosis, osteogenon is used, a drug that gives a secondary effect: anabolic - activation of osteoblasts and anti-catabolic - decreased activity of osteoclasts. It is best to mix both organic and inorganic components from the brushes. Organic components (osein) are represented by collagen and non-collagen peptides (proteins with growth factor and bone-specific proteins), the inorganic part replaces calcium and phosphorus in a physiological ratio of 2:1. Prescribe osteogenon for 1-2 tablets. 2 times a day. In case of complications, it is important to follow the hormonal therapy regimen, diet (vegetables, fruits, milk, cheese, vegetable fats), physical exercise, vicarious tranquilizers, IRT.

If HRT is contraindicated or intolerant, alternative therapy is prescribed: phytohormones and homeopathic medications.

Klimaktoplan- homeopathic medicine – prescribed 1-2 tablets. 3 times a day, 30 minutes before meals, course – from 4 to 12 days.

Climaxan- 5 tablets 1-2 times a day.

Mammosan - 5-7 tablets 3 times a day during the third hour, after the skin month - midday break. The drugs regulate hormonal balance, have angioprotective and anti-inflammatory effects.

Climadinon- a drug of rosemary, which interacts with estrogens, selectively reduces the concentration in the blood of pituitary LH; count as 1 table. 2 times or 30 drops 2 times a day without interruption for three hours.

Remens- its natural components regulate interactions in the hypothalamic-pituitary-ovarian system, promoting estrogen saturation, decreasing FSH levels, normalizing the LH/FSH ratio. Remens is prescribed for 15 drops 3 days a day 30 minutes before the end, the course is at least 1-3 months.

Fitovid- a natural preparation that consists of medicinal herbs from India; affecting the lipid spectrum of the blood (lowers cholesterol levels), activates metabolic processes in the brain, improves memory, and also has anti-stress and immunomodulatory effects. It is recommended to take 1 capsule daily for 1-3 months.

Turiplex Vikorist is used in cases of impaired function of the sechovogo mikhur (non-trimmable seche) during the perimenopausal period, 1 capsule 3 times a day. One capsule contains 122.5 mg of dry water extract.

Tourineirin- sedative extract of rosemary, one capsule containing 225-237.5 mg of dry herb extract infused with St. John's wort. Take 1 capsule 3 days a day, 1 hour a day.

Kal'kohel'- homeopathic remedy. It is recommended to treat osteoporosis during the postmenopausal period. It has metabolic and antispasmodic effects. Assign 1 table. under the language.

Osteoceaі calcitriol. These drugs stimulate the activity of osteoblasts, which contributes to the prevention of osteoporosis.

Hofitol It has an antioxidant effect, normalizes the exchange of cholesterol and lipid profile in the blood. The complex treatment scheme is based on 2 tables. 3 days here, lasting 6 months.

The method of extracorporeal hemocorrection, or plasmapheresis, is still being used. The essence of the method lies in the use of plasma. Plasma puffing is carried out with columnar and crystalline doses at a ratio of 1.0:1.1 or 1.0:1.2 - in proportion to the output hemodynamic indicators.

To treat climacteric syndrome, use rheopoli-glucin and rheoglucan. The choice of crystalloids for plasma purge is determined by the indicators of the electrolyte depot of the blood.

The course of treatment with plasmapheresis consists of 2-4 sessions at intervals of 1-2 days. During the course of treatment, patients should eat a salt-free protein diet and take vitamins. The duration of remission ranges from 3 to 18 months. after plasmapheresis.

It's time to fly, and yesterday's high school student, named mother of an adult daughter, reveals that her body is beginning to work differently, but it started for the last 30-35 years. Another transitional age of a woman covers 1-2 rocks. And when postmenopause arrives, it becomes even more important to live in this period.

Read this article

Why can’t you be forever young?

Everything is developing alive in such a way that it becomes popular, gradually gains strength, then goes through a period of blossoming, then gradually fades away. It’s not the fault of the female body, which goes through a decade of equals. Postmenopause is one of them, which is residual.

This plant will recover from the remaining months. Since there is no risk, the entire period is postmenopausal. Vaughn is an absolutely natural place for a singer.

The causes of postmenopause lie in the natural development of the female reproductive system. It functions as a result of hormones produced by the pituitary gland, epithelium, and ovaries. Over the years, these authorities exhaust their resources, and the production of required speeches decreases.

The greatest peace is in vain. When the supply of vitamin cells runs out, estradiol stops vibrating, resulting in an increase in the concentration of FSH and LH. Progesterone also drops. All this is difficult is the renewal of the uterine mucosa. The beginnings of menstruation become more rare, then stop altogether.

Postmenopause can be distinguished from menopause, which is attributed to its manifestation. In some cases, this is entirely true, as it seems that it can be tolerated by a woman, but it is strong for several months or more.

This is mostly a sign of postmenopause – not without weakening menopause, plus other features:

• Body mass increases. This is due to the increase in fat cells, and the diet and lifestyle do not change. Needless to say, they are ironing not like cutlets, but like rocks, and they stink. Gain is compensation for the decreased level of estrogen. This is a natural process, but the body cannot replenish its reserve. The cream of the ovaries, which have begun their functioning, vibrate estrogen and produce adipose tissue;
• It becomes more important to rub the cut, otherwise the possibility of contracting urethritis increases. These symptoms of postmenopause in women are also caused by the loss of estrogen. Hormones were reducing the tone of the walls of the honeycomb, which is why the country did not go away without any help. Now the stench has weakened so much that minimal physical stress can cause rashes. This is also associated with loss of tissue elasticity;
• The mucous membranes of the organs become dry, and the organs themselves lose excessive tone. lead to destruction of collagen production, and therefore cervical and soil secretions. As a result, there is discomfort in the back of the stomach, and the walls may drop;
• And the emotional reactions that dominate the beginning of the menopausal period are preserved. Postmenopause symptoms are less pronounced. But the tide, the twitchiness, the twitchiness don’t go away;
• Calcium tissue loses excessive value due to calcium deficiency and folding due to its absorption. An unstoppable downfall or downfall, which would have previously ended in slaughter, can now lead to a turning point.

What are your visions like?

Changes that are observed in the organs of postmenopausal women

It is necessary to follow the rules for binding. After menopause, the work of the cervix changes, so it does not vibrate much mucus. A new store of hormones infuses the soil microflora. State organs become immune to infections.

As a result of state paths, colors are produced to disturb the itching of mucus, which is a sign of getting sick. It is growing and unsafe. On the mucous shell they can calm down, get out of their minds.

It is important to regularly monitor postmenopause; the norm meets the following criteria:

• Slime, prozor;
• Small in size;
• The consistency is similar to that of rice;
• Do not smell, do not cause unpleasant sensations.

An hour to extinguish reproductive function

Changes in a robot's reproductive system occur immediately, and may result in a sane character in the future. This manifests itself through stress and illness. This is not something that can be immediately determined when postmenopause occurs.

With this term, doctors call the period before 12 months after the completion of the remaining menstruation and beyond. The normal stage of postmenopause ranges from 45 to 55. Rarely, but it takes longer. This occurs through recessionary features or else. Illnesses may continue to plague doctors until the minds of menstruation are completely formed.

Before everyone, premenopause and menopause, as well as other transitional periods of women, postmenopause, which is now in the middle of 51 years, remains in this series.

How can you understand that postmenopause has arrived?

The woman's reproductive system is folded smoothly. As a matter of fact, the young woman, knowing her own characteristics and having reached the milestone, will never be able to understand what is happening. This is a long period of time, in which the function of the ovaries begins to fade away, until the great one.

For these reasons, it is necessary to diagnose postmenopause, as it is possible to differentiate natural processes in the reproductive organs from pathological ones. And the signs will become such that I will have to evaluate the risks of getting sick, and look for the possibility of avoiding it. Since a woman does not have a period, she can get it:

These methods are sufficiently informative to determine whether the postmenopausal period has begun. If you want to evaluate the damage it has caused to your body, you need help:

• External blood analysis;
• Ultrasound of the ventral emptying;
• Hysteroscopy;
• Mamography;
• Cytological examination of the mucous membrane of the cervix;
• Osteodensitometry, which determines the thickness of bone tissue.

Life after youth

Life after menopause for women never ends. Finally, there is an advantage: there is no need to be afraid, you can, with a clear conscience, give yourself more respect. Ale, madly, it is necessary to follow the singing rules of life:

• . The body not only does not need a lot of protein and fat, but it is harmful. There is high cholesterol, which promotes pressure and vagus. It is necessary to eat more fruits, vegetables, mature grains, and peas. Obviously in the diet fermented milk products are the best friends of brushes and enemies;
• Physically, it is important. Correction of postmenopause does not require the constant use of any activity through movement and the risk of fractures. However, reasonable physical attention is necessary. Eating meat preserves bone tissue and normalizes metabolic processes that are affected by hormonal deficiency. Walking, swimming, and other activities can help maintain tone and well-being;
• Have sex. By making love and being satisfied, you can relieve negative emotions and prolong your youth. And for sleep, to sleep.

In addition to the way of living, which requires a reasonable distribution of time and strength for work and repairs, consider what postmenopause in women is, symptoms and treatment. There are also other medications that can help support health during this difficult period.

Treatments for symptom relief

There are many ways to relieve postmenopausal symptoms. The doctor is responsible for identifying them, taking into account all the nuances of the body of a particular woman. An independent choice may turn out to be incorrect, causing negative signs to intensify, bleeding, and the development of already obvious illnesses.

Most scientists believe that a decrease in the amount of active substances is the main cause of this, such as postmenopause, medication, and drugs are responsible for replenishing their deficiency. And patients, for example, respect the unnecessary “to get hooked on hormones.” Of course, replacement therapy may be contraindicated:

• that of the uterine mucosa;
• Systemic autoimmune diseases;
• Serious problems with the liver and bile ducts.

But you will find more joy. Replenish estrogen deficiency without overinsurance.

Menopause is a natural process of going through age-related changes that occurs in a woman’s body after she reaches old age. It is associated with the vibration of hormones and affects, most importantly, the reproductive system, and, to a lesser extent, other organisms. It goes through three stages – premenopause, general menopause and postmenopause. The same phenomenon as postmenopause is discussed in this material.

Zgornuti

Viznachennya

What is postmenopause in women? In short, postmenopause in a woman is the stage that begins immediately after menopause. The final stage of active hormonal changes in the body has ended and, finally, menopause, postmenopause begins.

Regardless of the cause of menopause, the peculiarities of its transition or genetic depression, such a phenomenon occurs. Just as during menopause there is a significant decrease in the production of estrogen, progesterone and other hormones, in postmenopause it is essentially the same. The body begins to function in new minds and a new sense of self, and the patient’s body becomes brighter (there is a flush, etc.).

Features of the crossing

At this stage, the hormonal function of the ovaries is completely lost, and the body begins to function without participation. There is a need for further adaptation of systems and processes. Menopause is the last period of menstruation a woman has. If menstruation continues every day for 12 months, we can talk about postmenopause and the end of menopause.

How troubling is postmenopause? There are early and late postmenopausal periods. It will be early when one to five rocks have passed in the remaining months. Since up to 10 years have passed, then we are talking about the late period. After the end of the term, the term postmenopause in women may be used.

This stage is characterized by the occurrence of menstrual bleeding. Because the ovaries do not function. If bleeding appears, then we can talk about a serious pathology and the need to urgently go to the doctor.

Cause the development

Menopause and postmenopause most often develop due to natural causes. With age, the natural function of the ovaries decreases. The stench begins to emit less of the female hormones - estrogen and progesterone, and many others. As a result, significant changes occur in many systems of the body. It is also important that reproductive women experience menstruation and, apparently, the onset of pregnancy.

When does the camp come? This will become natural for women aged 40 to 50 years. Otherwise, it may be possible to attack much earlier, for example, at 20-25 roki. This is a pathological episode and will require special treatment. Therefore, such menopause, as a rule, is not accompanied by postmenopause, since progesterone and estrogen again move under the influence of treatment.

Symptoms and signs

The symptoms of menopause vary. The stench comes from impersonal systems, organs and processes in a woman’s body. The stench can have a negative impact on the harshness of life and sometimes it is important to tolerate it.

However, the symptoms of postmenopause are significantly less pronounced. Over time, the stench will pass on its own without rejoicing. However, in order to reduce its severity, postmenopausal therapy is also recommended.

Neurovegetative

These are the most characteristic signs of postmenopause in patients that can be detected before this stage. This heat is a body that feels intense heat in the upper part of the body. This is accompanied by sweating, and then changes to chills.

This phenomenon is associated with impaired thermoregulation. Nerves transmit a signal about changes in the middle cerebrum. And thanks to the help of hormones, they spread throughout the entire body, influencing energy, metabolic and other processes. When there is a lack of hormones, signals are transmitted in a hampered manner, resulting in an incorrect reaction in the body.

Urogenital

The reasons for such symptoms also lie with hormones. When there is a lack of estrogen and progesterone, the tone of tissues in the body decreases. Zokrema, sphincter and sechovogo mikhur. As a result, beware of accelerating the release of beans in small portions. Sometimes, insanity develops.

The side of the reproductive system during postmenopause may experience changes and damage. The lack of hormones leads to a structural change in the mucous membrane of the liver. She moans and the production of vaginal secretions decreases. The liver and dryness of the mucous membranes appear, and the severity of injuries increases.

Through such changes in the mucous membrane there is a significant increase in the prevalence of inflammatory or infectious processes (vaginitis, vaginosis, etc.). Therefore, careful hygiene and periodic cleaning play an important role.

Faraway

Because such symptoms characterize the cob stage. Over time, the severity of symptoms decreases without treatment. However, there are a number of long-term or delayed symptoms that can lead to discomfort several years after the end of menstruation. These are the signs like:

• Asthenic syndrome is a profound depression of self-esteem, which is expressed in increased fatigue, weakness, instability of the psychoemotional state, and so on;
• A decrease in lactobacilli in the soil microflora leads to various local disturbances. Fungi may also appear;
• In some episodes, uterine bleeding may occur, associated with the presence of either good or bad new developments;
• Because the hormonal function of the ovaries in postmenopausal women is suppressed, there is a risk of loss of appearance – decreased skin elasticity, hair fragility;
• Whenever you gain weight, adipose tissue often loses estrogen and the body, increasingly, tries to compensate for hormonal imbalance;
• Relax your hearing, memory, vision, estrogen flows into the nervous system;
• When postmenopause occurs, there may also be damage to the side of the cardiovascular system, which manifests itself in the form of hypertension (hypertension) and atherosclerosis.

In the event of an unpleasant situation, it is necessary to take medicinal drugs to preserve beauty and health. The stench has a positive effect on a woman’s body and helps her survive menopause as easily as possible.

Diagnostics

However, before taking any medications, it is necessary to conduct a thorough diagnosis. Especially when it comes to early menopause. The following investigations are considered:

1. Taking anamnesis and identifying symptoms;
2. Hormone analysis;
3. Ultrasound of pelvic organs, ECG and other investigations as necessary.

After this, one can already attribute the words. However, you cannot engage in self-medication and you must carefully follow all the recommendations of doctors.

I'll feel better

It is important that the country can be relieved with the help of people's welfare. Several plants grow in stock of phytohormones, which can often replace natural ones. The motherboard is particularly popular. Pour two tablespoons of dry cheese with half a glass of water. Drink half a bottle of this tea before every day.

It is recommended to take all necessary vitamins in sufficient quantity. The easiest way to do this is to take a multivitamin complex. Some doctors prescribe antidepressants to normalize the psychoemotional background, as well as to normalize the functioning of various organs and systems.

Way of living

The correct and healthy way of living is also to paint the building. Follow a few rules:

1. More physical attention, playing sports;
2. Healthy, rich in carbohydrates and balanced in vitamins and minerals;
3. Reduced stress;
4. Vidmova vid shkdlivikh zvichok.

It's all about getting over postmenopause.

Hormonal therapy

When the ovaries stop producing estrogen, a call is required. With such treatment, the norm for hormones will not be reached, otherwise the growth rate will decrease. It works in a number of ways:

1. Pure estrogens – drugs Klimara, Premarin, Estrfem, Proginova;
2. Combined estrogens with progesterones - drugs Klimonorm, Divina, Klimen, Cycloproginova, Femoston, Divitren, Trisequence, Cliogest;
3. Combined estrogens with androgens - such as Raloxifene, Draloxifene, Torimefen, Gedoxifen, Tamoxifen etc.

This treatment is often supplemented with the intake of vitamins. Then paint the mill in the same way.

Possible pathologies

During changes in the mucous membrane, inflammation, infectious and mycotic processes often develop. It is very important to be diligent about your hygiene, as well as your character. If the stench develops an unpleasant odor or an uncharacteristic yellow-green color, it is necessary to go to the doctor.

At this stage, the new creation may not be to blame, even though the smell is often hormonal in nature. However, the likelihood of developing a new creation of a different character in the breasts is high.

Heritage

Finally, the reproductive functions and functions of the body are affected. You can enhance the process and improve your appearance with the help of hormonal treatment. After menopause, rich women are also careful about increased libido. In general, the quality of life may not be as high as before menopause.

PERIMENOPAUSAL PERIOD honey.
The perimenopausal period is a period of a woman’s life, which is characterized by a natural decline in the function of the statistic system. Includes the premenopausal period, menopause and two postmenopausal periods. The terms of menopause and menopause rarely stagnate.
The premenopausal period is a period of 45 years before the onset of menopause.
Menopause - amenorrhea for 6-12 months in women over 45, which reflects natural secular changes in the statistic system; The end of menstruation in the middle occurs in 508 years.
The postmenopausal period is the period that begins after menopause and continues until the death of the woman.
Physiology of perimenopause and menopause. Changes in the menstrual cycle: irregularity after 40 years of age due to the onset of menstruation.
Accelerated death of oocytes and atresia of primordial follicles. The small number of mature follicles leads to increased intervals between cycles or cycles with oligomenorrhea. There is no ovulatory effect of FSH and LH, and ovulatory cycles change into cycles with a lack of body fluid, then into anovulatory ones.
Changes in hormonal regulation
A decrease in the production of estrogens, although estrogenic activity indicates a prolongation of many complications after menopause (estrogens mainly come from the supra-nervical cells, which means that a minority of them are produced by the ovarian stroma). It is important to note that with each step the absolute number of primordial follicles changes, so at the time of menopause the smell is almost daily, the development of the worm follicle increases or does not occur, which is accompanied by decreases or due to the absence of estrogen proliferation. Obese women have
stronger approval of estrone from its predecessor androstenedione
Increased production of gonadotropins through the mechanism of negative reversal (FSH 40 rokiv, LH 45 rokiv). After menopause, LH increases 3 times, and FSH increases 14 times
The hormonal activity of the ovarian stroma does not change - the secretion of androstenedione (a precursor to estrone) and a small amount of testosterone are observed.
The amount of estrogens is insufficient for proliferative changes in the endometrium, so menstruation occurs in women aged 50-52 years.
Due to the lack of fat in the body, the synthesis of progesterone sharply decreases. Progesterone deficiency is one of the causes of dysfunctional uterine bleeding (DUB) and endometrial hyperplasia.
Between 40 and 55 years of age, young women develop an excess of estrogen, which manifests itself as DUB. Excess estrogen is not associated with ovulation. Reasons for the increase in the level of endogenous estrogens:
Increased use of andro-stendione for functionally active and inactive endocrine swellings, liver disease and stress.
Increased vibrolysis in case of obesity, hyperthyroidism and diseased liver
Increased secretion of estrogens by ovarian tissues
Hypoprogesteronemia.
Response of target organs to reductions instead of estrogens
The soil becomes less stretchy, especially in the upper sections, the mucous membrane is pale, thin and dry.
Small lips look pale and dry, changing instead of fatty tissue in large lips
The muscles and ligaments of the small pelvis, which support the uterus and uterus, lose tone, which often leads to prolapse of the uterus.
The endometrium becomes plump, atrophic, with multiple petechial hemorrhages; The number of endometrial veins changes significantly. The myometrium atrophies, the uterus changes in size. Fibromyomas, because they stink, change in size, but are not known at all
The breast tissue loses its firmness and shape as a result of the deposition of adipose tissue and atrophy of the mucous tissue.
The femur gradually loses calcium, which results in osteoporosis, which is often accompanied by pain, crooked ridges and occasional fractures of the femurs.
Changing the type of hair to the human shell for the significant distribution of androgens.
Signs. Depending on the nature of the manifestations of menopausal disorders, they can be divided into several groups.
Vasomotor symptoms in most women last 1-2 days, or they can last up to 5 days.
Increase speck
The reddish skin of the face, neck and breasts are not suitable, which is accompanied by severe scalding and sweating. Thrilling from a few seconds to a few minutes. They are most likely to be upset and have greater expressions at night and during stressful situations.
The number of hot flashes indicates the severity of overcoming the climacteric syndrome: mild form - up to 10 hot flashes per day, the fire rate is not damaged; moderate severity - 10-20 hot flashes, headache, confusion, pain in the area
heart, despondency and decrease in productivity; Important form - over 20 tides per harvest, which means a complete waste of productivity.

Likuvannya

estrogens reduce the frequency and severity of hot flashes
Other symptoms are hyperhidrosis, changes in blood pressure, headache, chills, heart palpitations.
Emotional and mental: twitchiness, drowsiness, weakness, restlessness, depression, forgetfulness, disrespect, decreased libido.
Dry skin, brittle nails, wrinkles, dryness and loss of hair.
Change of the menstrual cycle
Oligomenorrhea with progressive amenorrhea
If vaginal bleeding occurs after a 12-month period of amenorrhea, it is necessary to include endometrial pathology (polyps, hyperplasia and neoplasia).
Osteoporosis is dystrophy of bone tissue with a distorted structure, which is characterized by a change in the number of bone crossbars per bone volume, thinning, curvature and re-arrangement of parts of these elements, which develops advanced dexterity to fractures. Increased cyst resorption persists for 3-7 years after menopause.

clinical picture

Compression fractures of the ridge (most often - Th8-L3)
Fracture of the stigula with a characteristic localization in the cervical and intervertebral areas of the stegnosus
Fractures of the distal part of the promenian cyst and other cysts.

Frequency

Approximately 25% of women over 60 years of age who do not respond to replacement estrogen therapy develop compression fractures of the vertebrae.
Approximately 32% will experience one or more femoral fractures throughout their lives.
An average of 16% of women with stegnosus fractures die within 4 months after injury due to pneumonia or thromboembolism of the legen artery.
Atrophic changes
Atrophic vaginitis, itching of the vulvovaginal area, dyspareunia.
Dysuria, often and strong positivity to sechovyazanya, untrimmed seche
Cystitis.
If there is an excess of endogenous estrogens, blame
DMK
Neoplasia of the endometrium. In case of skin pathological bleeding in women over 35 years of age, it is necessary to perform an endometrial biopsy to exclude adenomatous hyperplasia and endometrial carcinoma.

Likuvannya:

Tactics

Hormonal therapy
Replacement therapy with estrogens is indicated for the skin of women during the intermittent period.
Sometimes progesterone is used in combination with estrogens.
Psychotherapy is indicated for all women, especially those who are pathologically going through the perimenopausal period.
Physical exercise, warm pine baths, walks in the fresh air, sanatorium-resort treatment
Diet - a necessary addition of hot and salty foods; green urchin (vegetables, fruits) is recommended.
Sedative therapy
Vitamin therapy
Prevention and treatment of osteoporosis, cardiovascular problems. Hormonal therapy.
Estrogen replacement therapy
Estrogen therapy reduces skin turgor (the skin looks
young), does not restore the tone of the mucous membranes and pelvic floor
Absolutely contraindicated
Gostry liver disease
Chronic liver dysfunction
Gostri thrombosis sudin
Neuro-ophthalmic vascular diseases
Uterine fibroids
Swollen and brushed ovaries
Cystic mastopathy
Recurrent endometrial polyposis
Evil new creations, be it any localization
Specific contraindications
Judicial Syndrome
Arterial hypertension
Low-grade hyperlipidemia
Migraine.
Hormonal therapy in patients after eyelid oophorectomy up to 40 years of age or with gonadal dysgenesis
Trivala cyclic therapy with small doses of estrogens (0.625 mg of estrogens daily from the 1st to the 25th day of the skin calendar month) and
progestin (medroxyprogesterone acetate) 10 mg daily from the 16th to the 25th of each calendar month.

Foreign calls

- Endometrial biopsy periodically throughout the course of treatment.
DMK at the hour of perimenopause
Cyclic progestin therapy is recommended to control excess estrogen in the endometrium; second visits - periodic endometrial biopsy
To treat vegetative-vascular manifestations in women with menstruation, which continue, use non-hormonal methods, and supplementary intake of estrogens can aggravate the endometrium.
Menopause
Consistent reduction of estrogens and progestin in menopausal women (as well as in women under 40). It is recommended to start with a low dose of estrogen and increase the dose as necessary to relieve symptoms; Progestin is taken from the 16th to the 25th of the calendar month
Combined regimen (0.625 or 1.25 mg of estrogens and 2.5 mg of medroxyprogesterone acetate from day 1 to 25)
Estrogen therapy relieves hyperplasia instead of HDL
Progestin therapy effectively reduces HDL concentrations.
Atrophy of the mucous membrane of the anterior cornea, cornea and cornea in late menopause can be effectively treated with the help of local treatments (estrogen cream) or low doses of oral estrogens.
Alternative to estrogen therapy. Medroxyprogesterone acetate is effective for relieving hot flashes, as estrogen is contraindicated. Prevention and treatment of osteoporosis Preventing osteoporosis is easier, less treatable. Medications can only increase the fluidity of bone loss, and are ineffective in renewing cystic speech.
Prevention - early replacement of estrogen therapy.
If the bath is repeated for 3 days after the end of menstruation, osteoporosis does not occur.
At the beginning of treatment 3 days after the end of menstruation, osteoporosis does not occur, but does not arise and the creation of new cystic tissue
Doses of estrogens
Horse estrogen 0.625-1.25 mg daily
Ethinylestradiol 0.025-0.05 g daily
Estron-sulfate 1-2 mg daily:
Calcium supplementation is prescribed at a dose of 1-1.5 g per dose.

Likuvannya

- Div.
Prevention of cardiac-vascular diseases. Rizik
IM in women before menopause is significantly lower, lower in men of the same age. Women after menopause have a risk of movement. Taking estrogens before menopause significantly reduces LDL, serum cholesterol and a higher concentration of HDL. Recommend the use of combination drugs to combine estrogens with gestagens
Proginova
Cycloproginova
Klimen
Gynodian depot.
Also, Vulvovaginitis is chromogen deficiency. Prolapse of the uterus and uterus
Short story. DUB - dysfunctional uterine bleeding Note. One can see a unique menopause - the addition of menstruation after any kind of treatment (for example, oophorectomy, removal of the uterus, X-ray examination, medicinal infusions) and a pathological menopause - the addition of menstruation, the formation of pathological process (swelling of the uterus). Possible causes: genetic diversity, ovarian failure as a result of the secondary autoimmune reaction in rheumatoid arthritis or the inflammatory response in mumps.

MKL

N95 Disorders of menopause and other disorders during the precopausal period

Dovidnik is ill. 2012 .

Most women suffer from nutrition: what is postmenopause and when it occurs, what are the symptoms, what is normal, and what signs may indicate the presence of pathology? It is necessary to know in advance what to prepare for, and then use some methods to lighten your camp.

Menopause is an inevitable process that occurs in a woman’s body. This is due to the end of the reproductive period and the progressive reduction in the production of state hormones. Many women experience menopause in old age, but this is far from the case, even though the menopause period lasts three decades and does not occur. Once you quickly recognize the beginnings of menopause, then by adjusting your lifestyle and eating habits, you can significantly reduce the symptoms of hormone deficiency.

Endocrine changes are mainly associated with the lack of vibration of estrogens - these are the main female state hormones. The particularity of estrogens and those that stink ensure the normal functioning of the body’s organs, and infuse the entire body:

• the waist of the skin is getting worse;
• the psychoemotional state is destroyed;
• obesity develops;
• Estrogens interfere with the level of cholesterol plaques in the blood;
• take the fate of the liver-contaminated blood throat factors.

Due to the lack of estrogen, women are afraid of unpleasant menopausal symptoms.

Main stages of menopause

Menopause cannot be combined with menopause - a trivial period that begins 5-7 days before the start of menstruation, and ends 10-15 days after the remaining menstruation. The severity and discomfort of menopause varies from person to person. However, these are statistically average hourly intervals that doctors compare to.

Premenopause

Premenopause – 45–50 years. This time is characterized by a decrease in the production of state hormones and disruption of the menstrual cycle. At this hour the woman can hear:

• flushing of blood to the point of exposure, fever, increased sweating. This occurs through changes in blood circulation in the body;
• psychoemotional changes, which may manifest themselves as increased restlessness, uncontrolled aggression, partial mood changes, tearfulness, emotional distress;
• Vaginal gain is achieved through an increase in fatty tissue and atrophy of meat tissue.

Proper hormonal correction and changes in the way of life during this period will help alleviate the symptoms of menopause and avoid more serious problems during menopause.

When a woman does not menstruate for 12 months, this is evidence that menopause has arrived. At this time, the main symptoms characteristic of premenopause remain, and may become new:

• decreased sexual desire;
• liver atrophy – appears dryness, liver, and may be inflamed;
• destruction of sechovipuskannya. Untrimmed cuts can be cut at night, or under strong mechanical pressure, for example, coughing;
• Obesity - tissues become sensitive to insulin, as a result of which the subcutaneous tissue begins to produce more insulin in order to maintain a normal level of glucose in the blood. And insulin is the hormone that burns accumulated fat, especially in the waist and abdomen.

Postmenopause

Postmenopause is a transitional period that begins after the residual addition of menstruation. The ovaries continue to lose their functions, acute hormone deficiency is avoided, which results in impaired functioning of estrogen-dependent organs:

• uterus;
• pikhvi;
• milk worms;
• vulva.

And also other systems:

• kistkovo-myazovy;
• heart-vessel.

Main signs of postmenopause

How can you understand, once postmenopause arrives, what the body will experience and what the symptoms will be? This is the kind of food that women crave after 40 years. The main sign that the postmenopausal period has arrived is the period of pregnancy, more than 12 months, or the number of menstrual periods. The woman should not miss this stage, before she will already be prepared both morally and physically, since she went through two periods of menopause.

Postmenopause can be divided into two stages:

• early – up to 55 years;
• late life – up to 65 years.

In the early stages, menopause may manifest itself in the following ways:

• urogenital disorders;
• change of skin covers.

Due to hormone deficiency, the mucous membrane of the penis and vulva becomes thin, leading to infectious aggression and various mechanical injuries, so a woman at this time may develop:

• vaginitis;
• urethritis;
• cystitis.

The absence of normal microflora can provoke local dysbiotic disorders, which lead to inflammation of the mucous membrane. In this case, a woman will often experience atypical symptoms of swelling, bleeding, and ichor.

In early postmenopausal patients, benign neoplasms are often diagnosed:

• polypi;
• uterine fibroids;
• serous cyst.

The culprit of such illnesses is due to hyperplastic changes in the endometrium - due to the growth of the inner uterus locally or along the entire perimeter.

In postmenopause, a woman's appearance changes: the skin loses collagen fibers and stops shading the middle, deep wrinkles appear, dry skin, and elasticity decreases. The skin, skin, and nails become thin and brittle, and the hair also becomes thin and falls out.

Symptoms of the late stage of postmenopause

The worst effects of menopause can occur in women after age 55. As a result of endocrine changes, the following develops:

• osteoporosis - loss of calcium from the brushes, the stench becomes loud, and the risk of fracture increases due to minor clotting. The most prominent place in the skeleton is the stag neck. And if they are removed, the fractures of the wrists will heal for a long time and painfully;
• heart-judgmental illness. Hypertension and ischemic heart disease can also develop in young adults, but such illness usually occurs in postmenopause;
• atherosclerosis – excessive accumulation of cholesterol on the walls of blood vessels. The lack of estrogens leads to the accumulation of cholesterol, which can accumulate in plaques and move through the bloodstream. Through the accumulation of plaques, the internal organs are unable to remove the necessary acidity, and their normal functioning is disrupted;
• an increase in vase is the most widespread symptom of postmenopause, which can lead to the development of diabetes;
• Impaired hearing, vision, memory and other illnesses in the neurological sphere result from a lack of estrogens. On this soil Alzheimer's disease can begin to develop.

It is important to note that women who care about their health and live the right way of life will experience menopause without serious consequences. Clearly expressed symptoms are avoided in less than 35% of women.

Early onset of menopause

If a woman begins menstruation at 40, then we can talk about the early onset of menopause. Since up to 40 years of age, menopause is approaching and is caused by genetic differences and autoimmune diseases. Such episodes are very rare, and it is important to correct them.

Reasons for early onset of menopause:

• gynecological operations of the ovaries, uterus, tubes and other pelvic organs;
• removal of ovaries as a result of injuries of the cervix and oncological swelling;
• Treatment with promenopausal therapy If the woman has experienced a dose of 6 Gray or more, her ovaries will be irrevocably damaged;
• treatment with chemotherapy drugs, which are prescribed at the time of diagnosis of oncological diseases of various organs. Such drugs interfere with the growth of cells, including follicles;
• autoimmune illness, when the body perceives the actions of the organs as third parties and directly directs all its forces to block their work.

Often the reasons for early onset of menopause are:

• incorrect food;
• obesity;
• smoking, drinking alcohol and drugs;
• parts of stress;
• daily healthy sleep.

In rich women, the causes of early menopause are unknown.

At the first signs of menopause, you should immediately contact a gynecologist-endocrinologist, who will conduct an examination and order the necessary tests to determine the causes of the early onset of menopause. Since the cause is hormonal imbalance, it is easy to correct it with replacement therapy and prolong a woman’s reproductive life.

Normal hormone levels during the postmenopausal period

There are no clear hormone standards that a woman can expect during postmenopause. Acute estrogen deficiency is indicated - the stench is now generated by the supraneural glands and the pituitary gland in some people. Hormones of the estrogen group are subject to their mutual reactions and are excreted in a transcellular way - in various tissues of the body. For example, estradiol is converted into estron and vice versa. The main source of estrogen in a postmenopausal woman is adipose tissue, which has accumulated these hormones before.

If during menopause the ovary has no follicles at all, then the increase in FSH and LH increases significantly. The level of follicle-stimulating hormone increases in 15–25 times, and of luteinizing hormone in 3–5 times. The unevenness of the increase in these hormones is explained by the varying periods of excretion from the body, and is due to the presence of an inhibitor - a peptide that suppresses the activity of FSH. The maximum amount of FSH and LH in a woman’s blood is observed in the first three years of menopause, then her volume gradually decreases.

Table of the normal levels of certain hormones in postmenopausal women, which are necessary for menopausal symptoms to be clearly expressed:

The level of human body hormones - androgens - decreases slightly, by about 15%, and in some cases an increase can be avoided. In this type of woman, signs of hirsutism appear:

• growth of hair on the body and appearance of a human type;
• deepening of voice;
• more sweating;
• disturbed sleep.

These illnesses can only be fought with the help of hormonal medications.

Treatment before postmenopause

As a result of the fact that postmenopause has been eradicated, let us look at ways to reduce the unpleasant symptoms of menopause.

There are a number of ways to improve the vitality of the body:

• non-hormonal drugs that restore the nervous system. These include neurotropic drugs and antidepressants;
• taking vitamin complexes Particularly necessary during the period are vitamins of group U, Z, E, D and calcium;

• taking phytohormones - these preparations, based on plant extracts, interfere with the synthesis of estrogens, for example Feminal, Estrovel, Klimaktoplan, Klimadinon, Remens;

• hormonal therapy. Treatment of menopause survivors with additional replacement therapy individually, the regimen is prescribed by an endocrinologist. The most commonly used drugs for therapy are Dermestril, Ovestin, Klimara, Divina, Levial, Klimonorm.

To relieve postmenopausal symptoms, there are many folk recipes that rely on taking infusions of herbs such as:

• St. John's disease (with strong and frequent tides);
• ginseng (for severe stress and emotional distress);
• licorice (for stimulating the metabolism of volatile estrogens);
• archery stable (rich in phytoestrogens);
• shavliya (to normalize heart rhythm);
• Turnera Rozloga (natural aphrodisiac).

To relieve the main symptoms of menopause, it is necessary to spend more time in fresh air, sleep at night, and eat properly. Include the following before the diet:

• flax and sesame seeds are rich in phytoestrogens;
• broccoli;
• green beans;
• wheat;
• pistachios;
• dried dates.

Extreme physical demands such as playing sports correspond to a decrease in the level of estrogens, so they need to be reduced.