Dear friends, good day!
Today we will continue the women's topic started last time, because you have received several requests to sort out menopausal disorders.
We will talk about what climacteric syndrome is, what processes occur in a woman’s body during menopause, what symptoms they manifest themselves in, is it worth throwing out all the mirrors in the house and doing hara-kiri for yourself?
And most importantly, what can you offer for menopausal syndrome from the over-the-counter products available in your range?
But first, I will tell you how the reproductive system of the female body works. It's MAGICAL!
Listen here.
Female reproductive system
It turns out that the period of physiological menopause for every woman is programmed long before her birth.
Already in the middle of pregnancy, a female fetus has tens of millions of eggs , surrounded by follicles. A follicle is a sac in which the egg will develop. We can say that this is a “house” for the female reproductive cell.
, 1-2 million remain in the girl’s body . Apparently, this could not have happened without natural selection.
By the beginning of puberty, there are already approximately 300 thousand of them.
During life, from year to year, the number of eggs decreases due to various unfavorable factors: poor environment, stress, radiation, drugs, smoking, alcohol, etc., etc. And, of course, due to their natural consumption by the body.
In some of the remaining eggs, chromosomal defects accumulate with age - all for the same reasons, and the likelihood of having a defective child increases.
Therefore, gynecologists have the concept of “old primigravida”. When I was in medical school, this name appeared in the birth stories of women starting at the age of 25. I wonder if anything has changed since then?
See how the female reproductive system works:
To fulfill our most important purpose, we women were given by the Creator the following vital organs:
The ovaries, which are located on either side of the uterus under the fallopian tubes. This is where the follicles with eggs inside are waiting in the wings.
The fallopian tubes, or fallopian tubes, through which every month the egg begins its final journey, hoping to meet the Love of your life. The wall of the fallopian tubes is designed in such a way that the egg does not get stuck anywhere along the way, but moves straight to the uterus. The length of the fallopian tube is approximately 10-12 cm.
By the way, the fallopian tubes perform another function: they create comfortable conditions for the fateful meeting and fertilization of the egg.
The uterus is a muscular organ that lies in the pelvic cavity between the bladder and rectum.
After the mature egg leaves its “house”, i.e. follicle, the uterus, like a real mother, “feels” in her heart that it’s time to prepare a “bed” for the newlyweds, and its inner shell begins to grow so that the fertilized egg is safely attached to it, and it feels soft and warm here.
The part of the uterus that protrudes into the vagina is called the cervix. It produces cervical mucus, the amount and consistency of which depend on the phase of the menstrual cycle. It becomes most abundant on the days most favorable for conception, in order to make it easier for sperm to reach their chosen one.
The same cervical mucus also rejects “suitors” like security at a checkpoint:
"Sober? Come on in! Did you get drunk? I won’t let you in!”
But seriously, it does not allow sperm that have certain abnormalities through the “passage” in order to reduce the risk of giving birth to sick offspring.
Normal menstrual cycle
The menstrual cycle is the period from the first day of one menstruation to the first day of the next.
The control center for a woman's entire reproductive system is located in the brain. There are structures called the hypothalamus and pituitary gland.
Neurohormones are released from the hypothalamus on certain days of the cycle, which act on the pituitary gland. After this, it begins to produce follicle-stimulating and luteinizing hormones.
At the beginning of the cycle, follicle-stimulating hormone rules the roost. Therefore, the first phase is called follicular.
I said above that in the ovary of a newborn girl there are already a lot of follicles with eggs.
But they are all in a sleepy state.
Follicle-stimulating hormone “awakens”, on average, 10 follicles per cycle. Under his strict guidance and with the support of luteinizing hormone, the eggs in the follicles grow and become more beautiful day by day.
Follicle cells produce estrogens necessary for the maturation of the egg (together with the above-mentioned hormones), as well as for our beauty, femininity and health.
But the rate of follicle maturation is different.
As a result, only one of them becomes dominant. Less often, two or three, and then after a few months twins or triplets are born.
Other follicles simply dissolve.
Around the middle of the cycle, the pituitary gland releases a lot of luteinizing hormone. This becomes a signal for the mature egg that it is time to leave its native land and go in search of a spouse.
The follicle bursts and the egg is released. This is called ovulation.
The egg enters the fallopian tube and moves along it towards the uterus, looking out for the prince in a white limousine along the way.
And at the site of the burst follicle, a corpus luteum is formed, which produces the hormone progesterone , which is necessary to prepare the uterus to welcome a fertilized cell. This is the luteal phase of the cycle.
If the egg in the fallopian tube does not meet anyone worthy of attention, it commits suicide.
The uterus, not waiting for the newlyweds, falls into hysterics.
She begins to “cry” :), rejecting the place prepared for them as unnecessary, i.e. its overgrown and unusable part of the mucous membrane.
Menstruation begins. And the whole cycle repeats.
By the way, the word “hysteria” is translated from Greek as “uterus”.
And if the egg in the fallopian tube meets a handsome gentleman, then fertilization occurs. It moves further into the uterus and attaches to the place prepared there for it. Pregnancy begins.
What do estrogens and progesterone affect?
So, the brain regulates the functioning of the woman’s reproductive system. But female sex hormones act locally: estrogens and progesterone (synonym for the latter: “gestagen”).
During a girl’s maturation, estrogens are responsible for the development of secondary sexual characteristics and genital organs. And later:
- promote the growth and development of follicles in the ovary,
- enhance peristalsis of the fallopian tubes during ovulation,
- prepare the uterus for pregnancy.
Plus, estrogens take part in 400 processes occurring in various organs and tissues that have estrogen receptors.
Such receptors are found in the cardiovascular, bone, immune systems, brain, skin, adipose and other tissues.
Therefore, estrogens do a lot of good things in the female body. And, above all, they protect us from atherosclerosis, heart attack, and stroke.
True, only before menopause.
Apparently, God had mercy on us and decided to give us a “bonus” for the pain, suffering, torment and other inconveniences that we experience in our lives, unlike the stronger half of humanity. I mean menstruation, the first “wedding” night, pregnancy, childbirth, menopause.
What do estrogens do?
- Prevents spasm of the arteries, which means an increase in pressure.
- Normalize blood clotting.
- Reduces cholesterol and “bad” lipids in the blood.
- They are responsible for the distribution of fat according to the female type and for female forms.
- Normalize blood glucose levels.
- Regulate the absorption of microelements, in particular magnesium and calcium.
- Promotes the absorption of calcium by bone tissue.
- Participate in the synthesis of collagen and elastin in the skin.
- Improves the condition of nails and hair.
- Provide balance to the autonomic nervous system.
- Participate in the metabolic processes of the brain, affect memory, thinking, learning ability, and emotional state.
- Stimulates sexual desire.
Now look at this list again and for each item imagine what will happen if there is a lack of estrogen.
What does progesterone do?
Progesterone ensures pregnancy and preparation of the mammary glands for lactation.
In addition, it controls weight, provides emotional balance, and restful sleep.
Prevention
No specific preventive measures have been developed.
Nonspecific prevention involves physical activity, proper nutrition and maintaining a healthy lifestyle.
Regular physical activity is recommended; the intensity of aerobic activity should take into account the physical condition of older people.
Weight loss is recommended for overweight or obese patients, as vasomotor symptoms worsen in parallel with an increase in BMI.
It is recommended to follow the principles of a healthy diet: several servings of fruits and vegetables daily, whole grains, fish twice a week and low total fat intake, limited salt intake, daily amount of alcohol should not exceed 20 g.
It is recommended to quit smoking.
It is recommended to follow the principles that promote the preservation of cognitive function in older age:
- improving brain health through the prevention and treatment of arterial hypertension, type 2 diabetes mellitus, dyslipidemia, obesity and smoking cessation;
- increasing cognitive reserve through cognitively stimulating leisure and high social activity;
- prevention of pathological changes characteristic of Alzheimer's disease.
Types and stages of menopause
The term “menopause” translated from Greek means “step, turning point.”
It has a synonym "menopause", but in fact, it is not always a "pause".
I'll explain now.
Firstly, menopause can be natural or artificial.
The natural one will come to all women: some earlier, some later.
On average, this occurs at 50 years of age.
It is considered normal if menopause occurs at 45-55 years of age.
Before 45 years of age – early menopause.
After 55 years - late menopause.
If menopause occurs in a woman under the age of 40, this is ovarian wasting syndrome.
Artificial menopause can occur at any age after removal of the ovaries.
Let's look at the stages of menopause.
- Premenopause, or menopausal transition. On average it lasts 2-5 years.
During premenopause, a woman's cycles become more and more anovulatory, during which the follicle matures, estrogens are released, the mucous membrane begins to prepare in the uterus, but the egg does not leave the follicle, i.e. ovulation does not occur. Consequently, the corpus luteum is not formed and progesterone is not released. And the follicle simply dissolves.
During this period, the duration of menstruation initially decreases. Then they become more scarce.
After some time, the cycle fluctuates for a week, both towards shortening and towards lengthening.
And approximately 1-3 years before the complete cessation of menstruation, there are delays of 1-2-3 months.
Already during this period, women may notice that they eat the same amount as before, but begin to gain weight as the amount of progesterone decreases. It does not have a direct effect on weight, but helps remove excess fluid. If there is not enough of it, fluid is retained in the body, and weight increases.
And anxiety also increases, sleep is disturbed, the woman more often loses her temper and then can’t get back together. Loss of interest in the opposite sex.
- Menopause. It is impossible to name the day and hour when menopause actually occurred. They talk about it only in retrospect, if there has been no menstruation for a year.
At this stage, 60% of women suffer most from hot flashes. These are attacks of sudden fever, accompanied by redness of the face, sweating, rapid heartbeat, nausea, headache, weakness, dizziness, and a feeling of lack of air.
Where do tides come from?
There is no progesterone, a tiny amount of estrogen is produced. According to the feedback principle, information goes to the hypothalamus, which is responsible for sleep, appetite, and body temperature. For some reason, during this period, he suddenly begins to perceive the actual body temperature as elevated, and tries to reduce it through vasodilation, sweating and rapid heartbeat.
- Postmenopause. The ovaries finally “retire.”
Osteoporosis and atrophic vulvovaginitis develop with its dryness, burning, discomfort in the vagina, and frequent urination.
Unimaginable things happen to the face: not only do wrinkles increase, but it also “floats” somewhere in breadth and downward, like a St. Bernard’s.
Some people are overwhelmed by depression, nothing makes them happy, and sometimes panic attacks occur.
Once again I will list the symptoms of menopause so that you can suspect it in the early stages and suggest the optimal set of remedies.
Rational psychotherapy, auto-training
Entering menopause, women are usually still in the prime of their creative powers, have extensive experience in production activities, and do a lot of work in the family. However, the painful sensations that accompany pathological menopause significantly worsen the general condition, leading to moral depression and premature decline in working capacity. Therefore, rational psychotherapy and auto-training play a big positive role. They help mitigate the unpleasant subjective manifestations of menopausal syndrome, normalize blood pressure in the initial stages of arterial hypertension, and eliminate cardialgia and cephalgia. Rational psychotherapy leads to an optimistic attitude towards the transition period in a woman’s life. During conversations with patients, the transient nature of subjective manifestations is explained, it is indicated that they do not pose a danger to life and do not lead to loss of ability to work. The autotraining technique is outlined in modern manuals on psychotherapy.
Menopausal disorders
Early symptoms
Autonomic: hot flashes, sweating, rapid heartbeat, headaches, dizziness, weakness, decreased or increased A/D.
Emotional: irritability, emotional instability, anxiety, depression, inattention, sleep disturbances, memory impairment, fatigue.
Other: decreased libido.
Medium-term symptoms
From the genitourinary system: dryness, itching and burning in the vagina, frequent urination, urinary incontinence, pain during sexual intercourse.
On the part of the skin and its appendages: dryness, decreased tone, the appearance of wrinkles, brittle nails, dryness and hair loss.
Late complications
Osteoporosis, cardiovascular diseases: atherosclerosis, arterial hypertension, heart attack, stroke; Alzheimer's disease.
Diagnostics
2.1 Complaints and anamnesis
Characteristic manifestations:
- vasomotor - hot flashes, increased sweating;
- psycho-emotional - depression, irritability, excitability, sleep disturbance, weakness, decreased memory and concentration;
- urogenital and sexual - itching, burning, vaginal dryness, dyspareunia, dysuria;
- musculoskeletal - osteopenia, osteoporosis; increased risk of fractures; sarcopenia
Many women experience more than one set of symptoms.
The severity of menopausal symptoms is determined by the Greene scale.
2.2 Laboratory diagnostics
Hormonal examination (blood):
- FSH on days 2-4 of the menstrual cycle;
- Estradiol;
- AMH in women under 40 years of age with suspected premature ovarian failure;
- TSH for differential diagnosis of thyroid diseases;
- Prolactin for differential diagnosis of menstrual disorders
For signs of genitourinary syndrome:
- cytological examination: determination of the vaginal epithelial maturation index (VEMI);
- pH of vaginal contents.
If you have a history of fractures and risk factors for osteoporosis, determine your vitamin D level.
2.3 Instrumental diagnostics
Dimension:
- Blood pressure is an important risk factor for cardiovascular disorders;
- waist circumference (WC), a key factor in visceral obesity;
- weight, height and BMI are important risk factors for metabolic disorders.
Transvaginal ultrasonography to determine signs of ovarian “aging”: reduction in volume and measurement of the number of antral follicles.
Comprehensive urodynamic examination for urination disorders with determination of:
- bladder volume,
- maximum urine flow rate,
- maximum urethral resistance and its index,
- sudden increases in urethral and/or detrusor pressure,
- residual urine.
If there is a history of fractures and risk factors for osteoporosis, densitometry (dual-energy X-ray absorptiometry (DXA) of the lumbar spine and femoral neck.
Interpretation of DXA (according to WHO):
- normal—T-score from +2.5 to –1 standard deviations from peak bone mass;
- osteopenia—T-score from –1 to –2.5 standard deviations;
- osteoporosis - T-score –2.5 standard deviations and below;
- severe osteoporosis - T-score below -2.5 standard deviations with a history of one or more fractures.
If there are risk factors for osteoporosis in a postmenopausal woman over 50 years of age, an individual 10-year fracture probability assessment (FRAX) is performed.
Treatment of menopausal disorders
Since the cause of menopausal disorder is a lack of female sex hormones, the basis for the treatment of menopausal disorders should be hormone replacement therapy (HRT).
Unfortunately, our women have, to put it mildly, a wary attitude towards hormones. And if somewhere in America 40-50% of women of transitional age take them, then in Russia - only 4%.
Here are the most common horror stories: taking hormones is unnatural, you will become addicted to them, you will get fat from them, get cancer, damage your liver and generally die from thrombosis. And they will also increase the “shaggyness”. I mean hair growth.
Gynecologists deny all this. But nevertheless, against the background of hormone replacement therapy, you need to see a doctor once every six months.
They believe that modern hormonal preparations are as close as possible in their properties to natural estrogens and gestagens, contain low doses of hormones sufficient to restore order in a woman’s body, do not affect weight, and some even reduce it by removing excess fluid from the body. body, prevent cancer.
Now there are a lot of hormonal drugs in different forms: tablets, patches, suppositories, injections.
They are prescribed only by a doctor, depending on the stage of menopause, hormonal levels, symptoms of menopausal disorders, the results of other examinations, and concomitant diseases.
Some of them are taken according to the contraceptive regimen (Divina, Klimonorm, Cyclo-Progynova): 21 days of admission, then 7 days off. They are usually prescribed during the premenopausal stage. These drugs contain both estrogen and progestogen.
Others are taken constantly: Livial, Cliogest, Angelique. They also contain both components. But these drugs are prescribed after menopause, i.e. in postmenopause.
Still others are indicated when only estrogens are needed, for example, after removal of the uterus (Estrofem, Proginova). And if there is a problem with the liver, the doctor may prescribe a Klimara patch or a drug in the form of Divigel gel.
Before prescribing hormone therapy, a woman is prescribed the following examinations:
- Ultrasound of the pelvic organs.
- Mammography.
- Smears for oncocytology.
- Blood chemistry.
- Blood test for clotting.
- Hormonal status.
- If necessary, ultrasound of the liver and other organs.
Main contraindications to the use of HRT:
- Estrogen-dependent tumors of the uterus, mammary glands, ovaries.
- Uterine bleeding of unknown etiology.
- History of thromboembolism, deep vein thrombosis.
- Severe liver and kidney diseases.
And one more important point:
There is not much time to think about whether to take hormones or not.
There is such a concept as the “Window of Therapeutic Opportunities for Hormone Replacement Therapy.” It “opens” during premenopause and “closes” 5-7 years after the last menstruation.
During this period, hormones will be effective.
It makes no sense to start taking hormones after the “window has closed”, since estrogen-sensitive receptors have atrophied.
And here you will only have to “treat” the consequences of hormone deficiency: osteoporosis, ischemic heart disease, atherosclerosis, etc. I put the word “treat” in quotation marks for a reason, since they are treated, but not cured.
And if hormone replacement therapy is started on time, it is currently believed that there are no restrictions on the duration of taking hormonal drugs.
What are the symptoms of menopause?
There are two periods of menopause:
1. The period of premenopause is characterized by the gradual cessation of ovarian function, the occurrence of vegetative symptoms and symptoms associated with ovarian hormone deficiency:
- menstruation becomes irregular, short, or with an increased duration between individual bleedings;
- cycles become non-ovulatory, the possibility of getting pregnant is significantly reduced. Some authors indicate a decrease in odds of 3% after exceeding the age of forty.
2. Postmenopausal period, during which a further decrease in hormone levels occurs, but these are no longer hormonal fluctuations, but systemic manifestations and symptoms associated with aging.
The most unpleasant are the so-called vasomotor symptoms characteristic of the onset of menopause. These are hot flushes to the head, palpitation (irregular, increased heartbeat in the absence of physical activity), excessive sweating, dizziness. They appear suddenly and last from several tens of seconds to three minutes. It may intensify in the evening and at night, causing insomnia and a feeling of chronic fatigue.
Dizziness
Undoubtedly, this group of symptoms is the cause of serious discomfort. The severity of vasomotor symptoms is very individual. Some women feel them several times a month, others several times a week, but there are those who experience attacks several times during the day.
Characteristic symptoms include excessive irritability of a woman, nervousness, a tendency to cry, mood swings, feelings of despondency or memory disorders. It has been established that the disease manifests itself more strongly in those women who were previously bothered by premenstrual syndrome, in smokers and obese women.
Over-the-counter remedies for menopause
In your assortment there are many over-the-counter drugs and dietary supplements that you can recommend on your own instead of hormones for women of “transitional age”.
They contain phytoestrogens, which are similar in structure to estrogens and have an estrogen-like effect. Their activity is significantly lower compared to hormonal drugs, so doctors recommend their use for mild and moderate forms of menopausal disorders.
Light form:
- Hot flashes up to 10 times a day,
- Not accompanied by sweating
- The general condition is not disturbed,
- Functionality has been preserved.
Moderate form:
- The frequency of hot flashes is 10-20 times a day,
- Sometimes accompanied by sweating
- Performance is reduced
- Headaches, sleep disturbances, and memory impairment are noted.
These remedies are also recommended for those women for whom hormones are contraindicated.
I will name a few of these means:
Homeopathic medicines
Remens - available in tablets (under the tongue) and drops (for those who find it difficult to take tablets).
Eliminates hot flashes and sweating, normalizes sleep, puts emotions in order, does not cause weight gain, addiction or withdrawal symptoms.
Take 3 times a day for at least 6 months.
Klimaxan - granules and tablets. Take either 5 granules 2 times a day, or 1 tablet 2 times a day. Recommend granules for those who have difficulty swallowing tablets.
Used for irritability, headaches, dizziness, sleep disturbances, sweating, hot flashes, palpitations.
Course – 6 months.
Klimakt-hel. The action is similar to the previous ones. Take 1 t. 3 times a day for a course of 1-2 months.
Caution with liver diseases.
Klimaktoplan is a drug in tablets, taken 1-2 tons 3 times a day. The course is not specified. The action is similar to those mentioned above.
I remind you that all homeopathic medicines are taken 30 minutes before meals or 1 hour after them.
If necessary, the doctor may prescribe repeated courses or increase the duration of taking the drug.
Herbal preparations
Klimadinon – available in drops and tablets, taken 2 times a day for 3 months. And if it is inconvenient to take 2 times a day, then there is Klimadinon Uno, which is drunk 1 time a day.
Caution with liver diseases.
The basis of all the above-mentioned drugs, with the exception of Klimakt-Hel, is black cohosh extract, which is considered a phytoestrogen.
