Perimenopause (menopause) includes:

• premenopausal period (decay of reproductive system function);
• menopause - the last spontaneous menstruation;
• early postmenopause (1-2 years after the last menstruation).

The late postmenopausal period begins after perimenopause and continues until the end of a woman's life.

The premenopausal period is the period of a woman’s life from the end of the reproductive period until the onset of menopause. During premenopause, the function of the reproductive system fades, the number of follicles decreases, their resistance to the stimulating influence of pituitary hormones increases, anovulatory cycles predominate over ovulatory ones.

The gradual decline and complete extinction of reproductive function in women is called the menopause, which is accompanied by a number of symptoms and characteristic signs. Almost always, women during this period need support, both moral and professional.

When and how does menopause (menopause) begin in women?

The perimenopausal period occurs in women aged 45 to 51 years. Age boundaries may shift depending on the individual characteristics of the body. This is a rather difficult period, both physically and psycho-emotionally, when a woman needs not only the support and understanding of loved ones, but also special care for her health.

Menopausal syndrome: symptoms

Hot flashes are one of the characteristic signs of this period, which manifests itself in the form of increased sweating, short-term bouts of fever, rapid heartbeat and anxiety. But besides this, menopause (including early) in women has other symptoms and signs:

• change in psycho-emotional state: mood swings, excitability, insomnia, etc.;
• sometimes depression develops;
• body weight increases, etc.

Menopause is divided into several stages, each of which has its own characteristic features.

Postmenopause is when a woman has no more menstruation for a whole year after her last menstruation (menopause).

This period is characterized by:

• cardiovascular problems;
• arthritis and arthrosis;
• osteoporosis;
• dementia;
• high level of FSH;
• increased risk of osteoporosis;
• increased risk of cardiovascular diseases, as well as diabetes and obesity;
• dryness, itching and burning in the vagina;
• pain during sexual intercourse;
• frequent urge to urinate;
• wrinkles;
• dry and brittle nails;
• dryness and hair loss.

The time and age of the onset of a difficult period in the life of each woman depends on the individual characteristics of the body. During this period, you must consult a doctor (gynecologist and/or).

Premature ovarian failure syndrome: symptoms, signs and problems of menopause

Symptoms:

• unexpected and sudden changes in body temperature;
• sweating, especially at night;
• vaginal dryness;
• changes in hormone levels;
• changes in mood;
• menstrual irregularities, delays, etc.

Signs can appear all together or separately.

Premature ovarian failure syndrome: causes

The main reason for menopause is a decrease in hormone levels and the gradual cessation of the body's reproductive function. How quickly and intensively this process will take place depends on the individual characteristics of the female body and external factors. Thus, severe stress or nervous tension can aggravate both mood swings and the intensity of hot flashes.

What could cause:

• hereditary factor;
• disruption of ovarian function, premature decline or exhaustion;
• damage or surgical removal of the ovaries;
• aggressive drug therapy, etc.

Whenever the onset of menopause occurs, no matter how early its onset, the reasons may be different. Depending on these reasons, a complex of drugs is selected. For advice and help, you can contact the Energo medical center, where they provide comprehensive support and help to avoid serious problems.

Problems of menopause

The easiest way to avoid health problems and relatively calmly survive the restructuring of the hormonal system and the whole body is to come to an appointment with a gynecologist, who will prescribe a course of treatment.

Initial examination

Treatment of the syndrome is a difficult and delicate process, when the gynecologist must be very attentive and carefully analyze and evaluate the patient’s condition in order to select the necessary medications. In addition, treatment of menopause in women is not just an individually selected treatment regimen, but a whole range of measures and methods that include various medications (and not only).

Initial appointment

The initial consultation is very important: the doctor collects all the information about the patient and conducts the examination as delicately as possible. If necessary, consultations and examinations with other specialists can be prescribed.

What influences the choice of treatment regimen for menopause in women?

Firstly, it should be noted that menopause is not a disease, but a natural process of changes in a woman’s reproductive system. Therefore, the word “treatment” is applicable only in cases where there are any serious consequences or health problems caused by this period.

In other cases, a corrective program is selected for each patient to alleviate symptoms. Moreover, the program can be of different intensity and with different components. If some pills and medications are suitable for one patient, for another they may be unacceptable or may not bring the desired results.

• assessment of clinical symptoms and collection of family and personal history information;
• assessment of hormonal levels;
• examination of the cardiovascular system;
• laboratory diagnostic methods (clinical blood test, biochemical blood test + coagulogram);
• osteodensitometry;
• consultation with a psychotherapist.

A detailed and thorough diagnosis is an opportunity to thoroughly study the patient’s condition, which is necessary and extremely important for the correct selection of methods and methods for alleviating the symptoms of menopause.

Contraindications

Contraindications in this case are individual intolerance to the components, age and stage of development of the menopause, allergic reactions and other reactions to treatment and selected therapy. Any changes in health or ailments must be reported to your doctor.

Repeated appointment

Based on the results of tests and examinations, drugs and medications for menopause are selected:

• hormone replacement therapy to relieve symptoms, support the condition of muscle tissue, skin and mucous membranes, and also to prevent osteoporosis;
• Herbal sedatives and homeopathic drugs and vitamins are also prescribed.

A diet is selected or nutrition is adjusted, physiotherapy and gymnastics are prescribed.

Depending on each specific case, the patient may be prescribed consultations or therapy with a psychotherapist. The doctor also draws up a plan for follow-up visits to monitor therapy and treatment.

If the chosen course of treatment does not reduce the intensity of symptoms, then it is possible to prescribe additional tests and select a new treatment regimen and therapy.

Control reception

A plan for visits and consultations with a specialist is assigned individually, and when the patient’s condition is stabilized, the doctor draws up a plan for follow-up appointments in order to adjust the treatment regimen if necessary.

Treatment result

The results of therapy and the timing of improvement depend entirely on the patient’s condition and the selected regimen for controlling menopausal syndrome.

Prevention

One of the best measures to prevent severe symptoms and complications during menopause is to visit a gynecologist. Of course, preventive examinations by a female doctor are desirable for everyone, and during menopause they are mandatory, since during this period:

• the skin ages and wrinkles quickly appear;
• age spots appear;
• breasts lose firmness and shape;
• excess weight appears, which is especially noticeable on the sides, hips, stomach and buttocks, etc.

More dangerous consequences include early heart attacks and strokes, atherosclerosis, cardiovascular disease, diabetes, tumor development and decreased bone mass density. All this and much more can be “contained” or the intensity of symptoms reduced if you visit in time.

Of course, seeing a doctor is not the only measure.

No less effective ways to reduce the impact of menopause on the body are:

• playing sports and living an active lifestyle to the best of your ability, that is, maintaining a work-rest regime;
• proper healthy eating;
• individual selection of cosmetics;
• taking medications during menopause (after consulting a doctor);
• if necessary, psychotherapy;
• physiotherapy;
• rejection of bad habits.

In addition, it is necessary to understand that menopause is a natural process that occurs in a woman’s body. And with the right set of means and methods, life will not lose its fullness, that is, the patient can be almost as active and have a sexual life.

If, upon the onset of menopause, unpleasant thoughts and signs of depression appear, then you can always seek psychological help and support from a specialist. In this case, a course of psychotherapy helps well.

With the end of the childbearing period of a woman's life, a new period begins - menopause. The terms “menopause” (from the gr. klimakteros - step), “menopause”, “menopause” are synonyms. This is a physiological period in a woman’s life, during which, against the background of age-related changes in the whole body, involutionary processes in the reproductive system predominate, characterized first by the cessation of childbearing and then by menstrual function. Is this autumn in a woman’s life?

No, it's not really autumn! It's the end of summer and just the beginning of autumn. At this time, a woman is characterized by: knowledge, the joy of creativity, experience. She is interested in everything at this age: politics and cosmetics. She has seen and learned a lot, raised children, sees herself in them, and the problem of youth is close to her. She also dreams of grandchildren, so that she can transfer her not completely wasted motherhood to them. This age is wonderful because a woman feels the truth of her worldview.

In recent decades, there has been a progressive increase in the average life expectancy of women. The number of older women significantly exceeds the number of older men. By 2000, according to World Health Organization forecasts, the average life expectancy of a woman in developed countries will be 75-80 years, and in developing countries - 65-70 years. Consequently, the so-called life hopes of 50-year-old women will amount to one third of life.

Menopause and old age are different concepts. Menopause is on the threshold of old age; it is only a symptom of beginning aging, but not old age. The duration of the menopause ranges from 3 - 5 to 8 years. Sex hormones (progesterone, estrogens) cannot prevent or eliminate old age. This is evidenced by the fact that with the onset of menopause and old age, the production of sex hormones continues, but at a different level.

Involutional changes occur in the body with age. Imperceptible at a young age, they gradually accumulate, turning into irreversible processes that are completed in old age. In the process of evolution, certain life spans have been formed for various biological species. The rate of development of aging processes is under genetic control. Of course, environmental factors (hunger, infection, stress), production factors can change or accelerate the aging process of individual human organs and systems.

It is impossible to answer unambiguously the question about the exact age of the onset of menopause and aging in each person. However, most physiological functions begin to weaken only from the age of 45. Apparently, this circumstance explains the existence of various classifications of periods of human life.

Thus, the ancient Greek thinker Pythagoras believed that the four seasons correspond to clear periods of human life, each equal to 20 years:

• formation period up to 20 years
• young man 20-40 years old
• a person in the prime of life 40-60 years old
• old man 60-80 years old

According to the ancient Chinese classification, human life is divided into the following periods:

• youth up to 20 years
• age of marriage up to 30 years
• age for performing public duties up to 40 years
• recognizing your own misconceptions before age 50
• the last period of creative life up to 60 years
• desired age up to 70 years
• old age after 70 years

Menopause and the physiological and morphological changes associated with it apply equally to female and male sexes. The different timing of the extinction of the generative function does not essentially change the situation. In women, the involutionary process begins from the genital area, and this gives the entire subsequent involution a more systematic character in relation to the general characteristics of ailments and illnesses caused by the loss of reproductive function and changes in the general hormonal state.

Menopause has two phases: premenopause and postmenopause, which are conventionally separated by menopause.

Perimenopause is a period of initial decline in ovarian function until the complete cessation of menstruation. It is characterized by a sharp decrease in the ability to conceive, a change in the nature of menstruation. The duration of premenopause varies from 2-6 to 8 years. In 60% of premenopausal women, menstruation is characterized by a progressive increase in the intervals between periods and a decrease in the amount of blood lost. In 10% of women, on the contrary, there is a sudden cessation of menstruation, especially if this was preceded by stress or climate change. This period begins at approximately 38-40-45 years. 30% of women experience acyclic bleeding.

Menopause is the last independent menstruation in life. Its exact date can only be established retrospectively, no earlier than a year after the cessation of menstruation.

Postmenopause is an extremely variable period of time - from the last menstruation (menopause) to the almost complete cessation of ovarian function. This phase precedes the onset of old age. The duration of postmenopause is 5-6 years. During this period of time, a woman often notices cyclical changes in the body, but menstruation does not occur.

The cessation of menstruation at the age of 40-45 years is usually regarded as early menopause; over 55 years old - late menopause. The age of 38-39 years is accepted as the lower limit of early menopause.

The cessation of menstruation in women under 36-37 years of age who have had normal reproductive and menstrual functions in the past, accompanied by hot flashes, increased sweating, irritability, and decreased ability to work, is regarded as ovarian wasting syndrome, but not premature menopause.

The average age of menopause in our country is 49.5-50 years, 50% of women experience menopause at 46-50 years, 17% at 41-45 years, 26% at 51-55 years. The remaining 7% are over 55 years old.

On age of menopause or cessation of menstruation is influenced by such unfavorable factors as prolonged nervous experiences, infectious diseases, chronic diseases.

It has been established that the age of first menstruation and the number of uncomplicated births do not have a significant effect on the age of menopause. In women living above 2000-3000 m above sea level, menopause occurs 1-1.5 years earlier than in those living below 1000 m.

Smoking reduces the age of menopause; those who smoke more than 15 cigarettes per day experience menopause 1.8 years earlier than non-smokers.

Women's reactions to the complete cessation of menstruation vary. This depends on the type of nervous system, but the importance of factors such as material wealth, family situation, presence of children in the home, health of parents and husband, ability to still do regular work and compete with young people should not be underestimated. There are 4 types of women's reactions to menopause.

Passive reaction(in 15-20% of women) is characterized by submissive acceptance of menopause as an inevitable phenomenon. This type of reaction is more common among women in rural areas.

Neurotic reaction observed in 8-15% of women. This is a kind of “resistance” to the aging process, an unwillingness to accept it. With this type of reaction, the clinical picture is dominated by neuropsychiatric symptoms.

Hyperactive reaction observed in 5-10% of women. Women with this type of reaction refuse to accept the changes taking place in them. They try to block the symptoms that arise by more actively participating in social life, work, elegance, fashion. They keep their emotions to themselves, are critical of the complaints of their peers, and have wide contact with young people.

Adequate reaction observed in 60-70% of women. These women adapt relatively well to hormonal and social changes; they tend to have happy family lives and interesting jobs. The role of social factors and the ability to still perform complex intellectual work should not be underestimated. At the same time, worries arise in connection with children leaving home and creating a new family; parents pass away.

A study of age-related changes in the central nervous system using electroencephalograms showed that at the age of 49-54 years, the nature of the electrical activity of the brain does not differ from that in young women. Age-related restructuring of the central nervous system begins to appear only at the age of 55-60 years.

The reactions of the cardiovascular and respiratory systems to physiological and mental stress correspond to those of a young woman, but still the magnitude of the changes is less pronounced, but sufficient to ensure adaptive behavior of the body.

During menopause, the ovaries are the first to begin, to a certain extent, to leave the “ensemble of endocrine glands.” Sclerotic changes in the blood vessels of the ovaries begin after 30 years.

In the ovaries of young women, as mentioned earlier, the cortical and medulla layers are distinguished. The cortex contains many follicles with eggs, which are constantly depleted throughout life and are not renewed. Follicles become the main source of female sex hormones.

With the onset of menopause, a certain number of follicles with eggs remain in the cortical layer of the ovaries, which are completely depleted only after 3-5 years of postmenopause.

Why don’t the remaining follicles mature and postmenopausal pregnancy occur?

If eggs matured in postmenopause, then the most highly organized biological species, man, would be under the threat of degeneration. The fact is that an aging female body cannot create full-fledged offspring. The “bank” of eggs in a woman’s ovaries exists throughout her life; over the years it is depleted, but not restored. All the unfavorable factors that the female body encounters throughout life (radiation, stress, infection, chemicals) have a negative effect on highly sensitive eggs. Therefore, after the age of 40, the risk of having unfavorable offspring increases many times.

In the process of evolution, special mechanisms have been created that block the maturation of eggs in an aging body.

However, cases of pregnancy and childbirth in postmenopause are extremely rare.

How can we explain the cases of pregnancy, childbirth and periods of restoration of regular menstrual cycles in postmenopause? The source is precisely the small number of follicles with eggs remaining in the cortical layer of the ovaries, which, as a rule, are depleted after 3-5 years of postmenopause. This also explains the cyclical changes in the body noted by many women and even premenstrual tension throughout the body, despite the absence of menstruation.

As the follicles are completely depleted, the ovaries become smaller and shrink.

For a long time it was believed that such an ovary loses its biological role. Therefore, among many doctors, especially oncologists, there was a point of view about the need to remove intact ovaries in postmenopause in case of surgery in the pelvic cavity. This was regarded as a kind of prevention of ovarian cancer.

However, as new research methods are introduced, it is shown that valuable sex hormones necessary for the female body are formed in the ovaries and postmenopause. They are important for maintaining a certain hormonal balance and have a protective effect on the vascular, genitourinary, skeletal and other systems of the body.

Postmenopausal ovarian hormones are released at low but constantly stable levels. This explains, to a certain extent, the change in the character of a postmenopausal woman. The character becomes more even, stable, and there are fewer mood swings characteristic of young women with cyclical secretion of sex hormones.

So, during menopause, a complex biological restructuring of a woman’s entire body occurs. This is a kind of biological examination of the body, the result of the entire previous life in terms of the influence of various environmental factors and diseases. Consequently, only women who have maintained their health at this period of life can pass this exam with excellent marks. This refers to the broad meaning of the concept of “health” as physical, mental and social well-being. Unfortunately, many women come to this period with a burden of various unfavorable factors: illness, mental, physical trauma.

In approximately 25-50% of women during menopause, the so-called menopausal syndrome occurs, complicating its natural course. Symptoms of menopausal syndrome may appear in premenopause during the period of delayed menstruation, with the onset of menopause, or after 1-2 years or more of postmenopause.

Features of the course of menopause largely depend on the functional state of various parts of the central nervous system. The insufficiency of regulatory mechanisms is accordingly unable to compensate for the deviations that arise as a result of the influence of external and internal environmental factors, which can lead to the development of menopausal syndrome.

The most characteristic are:

• hot flashes to the head and upper torso
• excessive sweating
• blood pressure changes
• headache
• sleep disturbance
• irritability or depression
• pain in the heart area
• general weakness
• decreased ability to work
• chills
• “crises” with increased blood pressure and chills, followed by increased urination

The typical form is characterized by the following symptoms: hot flashes and excessive sweating; other symptoms may also appear with other diseases. Hot flashes appear more often in the second half of the night; more often in autumn and spring, after mental overload.

There is a combined form of menopausal syndrome, which develops in combination with diseases of the cardiovascular system, hypertension, diseases of the central nervous system, gastrointestinal tract, and diabetes. Often during menopause, the course of “old” diseases worsens and latent diseases appear. Therefore, these patients most often turn to a therapist, neurologist, or gynecologist.

If young women experience hot flashes while the menstrual cycle is intact, then this is not menopausal syndrome, but more often it is a symptom of either a disease of the central nervous system or premenstrual syndrome. As a rule, mild forms of menopausal syndrome go away mostly without treatment, and only 10-12% of patients experience a severe course of it and are forced to seek medical help.

Metabolic disorders of varying severity may sometimes occur: vaginal dryness, pain during sexual activity, urination, although symptoms of bladder inflammation are excluded, dry mucous membranes of the mouth and eyes, pain in the joints and bones, increased tendency to fractures.

Climax

A woman’s life is full of events: youth, first love, separation, marriage, the birth of a child, a series of experiences and joys that replace each other. And then comes menopause - a period of hormonal decline, the time of completion of reproductive function.

Many perceive the onset of menopause as final aging, become depressed, and worry about their relationship with their husband. However, with the right approach, the menopause can become a favorable time, not only not bringing significant discomfort and troubles, but also full of new opportunities and prospects.

Basic Concepts

To navigate the changes that occur in the female body during menopause, you should know the basic concepts used by gynecologists to characterize a woman’s condition during this period.

Menopause (menopause, menopause) is a physiological process of involution (extinction) of the female reproductive system.

Menopausal syndrome- pathological condition. It occurs in a woman during menopause and is characterized by a variety of symptoms affecting mainly the nervous and cardiovascular systems, as well as metabolic processes.

Thus, menopause itself is a phenomenon natural, while climacteric syndrome- This pathological course of menopause.

The main sign of a woman’s reproductive function is menstrual bleeding, so the definition of all phases or periods of menopause is based on the characteristics of menstruation.

Phases of menopause

Premenopause- This is the period preceding the cessation of menstrual bleeding. Its onset is judged by the appearance of characteristic signs - usually a loss of regularity of menstruation, an increase in the duration of the cycle (up to several months), etc.

Menopause called the last menstrual bleeding. The date of menopause can only be named retrospectively, that is, somewhat later than its onset. It is generally accepted that if 12 months have passed since the last physiological bleeding, then it was the last and is menopause. The average age of menopause in women is 50 years. If menstruation stops before the age of 45, it is said to be early menopause, up to 40 years – o premature menopause.

Perimenopause– combines the two above periods. Perimenopause begins with the first signs of menopause and ends a year after the onset of the last independent (without the use of hormonal agents) menstruation.

Postmenopause begins with menopause and ends at the age of 65-69 years. Postmenopause is a fairly long period, therefore in gynecology an additional division is used into early (first 5 years) and late postmenopause.

Menopausal syndrome develops in more than half of women and affects the period from the appearance of the first signs of hormonal decline (premenopause) to 5 years after the onset of the last menstruation (early postmenopause).

Normal course of menopause

Normally, the decline of reproductive function is characterized by a change in the nature of menstruation. It can be:

1) shortened menstrual cycles;

2) long delays in menstruation;

3) prolonged menstrual bleeding;

4) irregularity of the appearance of menstruation.

The time of the onset of menopause depends on many factors, the main one of which is heredity. In addition, the age of menopause is influenced by lifestyle, bad habits, nutritional status, and previous diseases.

Reasons for the development of menopausal syndrome

Sex hormones influence not only the functioning of the reproductive system and mammary gland, but also the work and condition of almost any organ - the heart and blood vessels, brain, bones, muscles, connective tissue, bladder, intestines, liver, skin, hair. Hormonal regulation of all processes in the body is a very finely balanced process, so any shift in the production of one of the hormones is fraught with a disruption in the condition of the entire organism as a whole - this is what happens when the functioning of the reproductive system is not smooth enough and the production of female sex hormones decreases.

Symptoms of menopause

1. Early symptoms - occur in premenopause and manifest themselves:

hot flashes;

attacks of chills;

sweating;

headaches;

fluctuations in blood pressure;

palpitations;

neuropsychiatric disorders - irritability, fatigue, tearfulness, anxiety, decreased mood, decreased memory;

decreased sexual desire.

2. Delayed symptoms (in the first 1-3 years after the last menstruation - menopause):

UGR – urogenital disorders, manifested mainly by urinary incontinence;

skin manifestations - dryness, lethargy, brittle nails, hair loss.

3. Late manifestations:

o decreased intelligence

o deterioration of vision and hearing;

o osteoporosis with increased bone fragility;

o joint diseases;

o development of diabetes mellitus, atherosclerosis, hypertension.

Early and premature menopause, as a rule, is a sign of trouble in the body and is often accompanied by pathological symptoms.

Examinations at the onset of menopause

The diagnosis of menopause and menopausal syndrome, as a rule, is made on the basis of a woman’s characteristic complaints, however, due to the fact that the period of extinction of hormonal activity is often accompanied by the development of diseases of various organs, a gynecologist can prescribe a whole range of laboratory, instrumental and hardware tests. Here is their approximate (by no means complete) list.

1. General blood test.

2. General urine analysis.

3. Level of blood hormones (estradiol, follicle-stimulating hormone (FSH), androgens, prolactin, thyroid hormones, etc.).

4. Study of the cellular composition of cervical smears (cytological examination).

5. Biochemical blood test with determination of bilirubin, AST and ALT enzymes, glucose, cholesterol, etc.

6. Study of the blood clotting system.

7. Measurement of blood pressure and pulse.

8. Mammography (x-ray examination of the structure of the mammary gland).

9. Ultrasound of the pelvis.

Treatment of menopausal syndrome

Treatment of menopausal syndrome has two main goals:

1. relieve its painful symptoms;

2. reduce the risk of complications (osteoporosis, arthrosis, atherosclerosis, etc.).

Hormone replacement therapy - HRT

The main method of treating menopausal syndrome is the administration of female sex hormones in the form of pharmacological drugs. Properly prescribed HRT can significantly increase a woman’s quality of life, slow down the development of osteoporosis, and dysfunction of the cardiovascular and nervous systems. However, it should be remembered that such treatment can provoke the formation of tumor processes and some other diseases, therefore hormones are prescribed only by a gynecologist, in addition, such treatment should be accompanied by regular examination of the condition of the uterus and mammary glands.

HRT can be used both in premenopause and postmenopause. When prescribing the drug, the doctor:

1. selects the drug and its dose individually;

2. takes into account the presence of contraindications;

3. tries to select the minimum dose of the hormone;

4. chooses a combination of estrogen and progesterone;

5. gradually reduces the dose of the drug in postmenopause.

Contraindications to treatment with hormonal drugs include malignant tumors of the uterus and mammary glands, severe diseases of the liver and cardiovascular system, and many other pathological conditions.

Phytotherapy

If contraindications to hormone replacement therapy are identified, you can try the use of herbal remedies that, to one degree or another, alleviate the manifestations of pathological menopause. For this purpose, so-called phytohormones and phytoestrogens are used - herbal preparations that have hormone-like activity.

Phytoestrogens are found in the following foods:

1 soybeans;

2 grenades;

3 lentils;

4 dates;

5 sunflower seeds;

7 apples;

8 bran;

9 carrots;

10 garlic.

Black cohosh, raponticin, and melbrosia plants also have a healing effect. A fairly popular drug for the treatment of menopausal syndrome, Klimadinon is just such a herbal remedy.

Lifestyle correction

To enhance the effectiveness of hormonal therapy or herbal medicine, it is necessary to adhere to a healthy lifestyle.

1. Give up or at least limit bad habits - smoking, drinking alcohol.

2. Eat right: eat enough protein; limit fats (especially of animal origin), refined carbohydrates (sugar, flour products), spicy seasonings, take complex vitamins with the obligatory inclusion of important minerals and trace elements.

3. Engage in adequate physical activity.

4. Try to maintain a positive attitude, if necessary, seek help from a psychologist or psychotherapist.

5. Monitor your health, regularly visit a gynecologist and other specialists, depending on the presence of diseases and complaints.

Kelly. Fundamentals of modern sexology. Ed. Peter

Translated from English by A. Golubev, K. Isupova, S. Komarov, V. Misnik, S. Pankov, S. Rysev, E. Turutina

Aging is a natural process that affects all living things and involves predictable physiological changes at all levels, from the cellular to the organismal, over time. In humans, this process appears to be largely genetically controlled. Various physiological processes, accompanied by degeneration of certain structures, are triggered by genes, and at the same time, our body is subject to natural wear and tear. There are significant individual differences in all this, but each of us feels how the vital activity of the body gradually slows down and the plasticity of the body decreases. Although the rate of aging may depend on heredity, environmental factors or personal healthy living habits, the process itself is inevitable and irreversible. The impact that aging has on sexuality is rooted in both psychological and biological changes. The aging body can be perceived as having beauty and strength if approached with a positive psychological attitude.

Female menopause

A woman's body is genetically programmed to stop menstruating sometime in middle age, usually between 45 and 55 years of age. This is called the female menopause, and the years immediately before and after menopause are usually referred to as menopause. Modification of the functions of the ovaries usually begins before the age of 30, and from this moment their production of hormones gradually decreases. Certain brain structures are also involved in these changes. Eventually, irregularities in ovulation and menstrual cycles begin to increase. Usually, at first there is an unpredictable alternation of scanty and heavy menstrual flow, but for some women the cycle stops completely suddenly: the next menstruation simply never comes. Although the pituitary gland continues to produce follitropin and lutropin, which help control the female menstrual cycle, the ovaries appear to become increasingly less sensitive to this stimulation. The hormone-producing tissues of the ovaries atrophy until the secretion of estrogen and progesterone reaches a minimum (Wise, Krajnak, & Kashon, 1996).

As hormone levels in a woman's body drop, the most noticeable consequence is the gradual cessation of menstruation. This occurs due to the lack of hormonal stimulation of the inner layer of the uterus, the endometrium. Of course, this means that the woman is no longer able to conceive, although most doctors recommend birth control for a full year after her last menstrual period. But this is not the only change in the body. Very gradually, the uterus and breasts decrease somewhat in size. The inner walls of the vagina become thinner, and a decrease in the number of blood vessels in the pelvic area can lead to greater vaginal dryness. Changes in the structure and color of skin and hair may also occur. In addition, there is an increased tendency to gain weight, especially on the thighs. Sometimes noticeable changes in voice occur (Boulet & Oddens, 1996).

Another consequence of decreased estrogen production in some women is bone thinning, called osteoporosis. These manifestations after menopause are more often observed in women of fragile constitution who lead a sedentary lifestyle. Women with osteoporosis are prone to hip and shoulder fractures and often experience chronic back pain due to weakening of the spine. Although these symptoms cannot be completely overcome, they can be treated to strengthen the skeletal system. Vitamin supplementation is usually prescribedD, calcium compounds, estrogen substitutes and/or exercise.

Factors influencing the onset of menopause

Smoking may delay menopause by two years or less

In left-handed people it occurs on average a year earlier

Number of pregnancies. The more you have, the later menopause may occur.

Age of first menstruation. The sooner they start, the later they may stop during menopause.

The mother's age at menopause. While other factors may play a role, heredity makes your mother's age at menopause a good guide

What's happening to your body?

Starting around the age of 35, estrogen production decreases, signaling perimenopause - the beginning of changes in life.

Premenstrual syndrome may worsen gradually or appear immediately

Menstrual cycles may become irregular

You can still get pregnant

Night sweats and hot flashes may occur

Vaginal dryness may develop

Possible sleep disturbances

Possible changes in mood or absent-mindedness

After you haven't had a period for a year, you are postmenopausal. Increased susceptibility to osteoporosis and increased risk of cardiovascular disease

Demographics and menopause

35 million American women have already reached menopause

Menopause usually occurs between 45 and 55 years, with an average age of 51 years. Every year, approximately 1.3 million American women turn 50.

Most women survive about a third of their lives after menopause.

For every 2,000 women after menopause, there are 20 cases of severe bone loss, 6 cases of breast cancer and 3 cases of endometrial cancer.

The case for estrogen

May help prevent osteoporosis (thinning of bones)

May help prevent the development of cardiovascular disease

The case against estrogen

May increase the risk of endometrial cancer

May increase risk of breast cancer

What men should know about menopause

Everything women need to know

Going through menopause can take anywhere from one to three years

Some vaginal dryness may occur, so lubricants may be necessary during sexual intercourse, and in addition, it becomes important to increase the time of foreplay

Insomnia can lead to irritability and fatigue, making your partner less enjoyable. Women may become more whiny

Be understanding and take on part of the household chores

Changes in hormonal balance during menopause can also lead to mood changes and other psychological effects. Some women complain of depression, irritability and other similar symptoms (Huerta et al ., 1995). Some experience an unpredictable dilation of blood vessels in the skin, which causes a hot flash, sometimes called a "hot flash." The exact cause of this phenomenon is unknown ( Doress - Worters & Siegal, 1995). However, we must keep in mind that transitional periods in our lives are understandably often accompanied by some feelings of loss and sadness, and these feelings should not be taken as signs of pathology or psychological problems. It must also be emphasized that many women find many positive aspects of menopause. Aging and the physiological changes it brings with it should not be viewed negatively, because a person still has much to learn with surprise and joy in life ( Barbach, 1993; Rountree, 1993).

During menopause, women receiving additional doses of progesterone and estrogen experience a reversal of the physiological changes that usually accompany it (Barbach , 1993). However, the use of hormone replacement therapy is sometimes controversial. First popularized by Robert Wilson ( Wilson , 1964) as a way to remain “feminine” and full of youth throughout life, the use of estrogen alone in therapy was eventually criticized as too risky a procedure. A number of studies in the 1970s began to show a statistical link between estrogen treatment and certain diseases, including uterine and breast cancer. Report published in "New England Journal of Medicine" in June 1995, confirmed the link between estrogen replacement therapy and breast cancer, especially in women who have used estrogen for five years or more ( Colditz et al., 1995).

When progesterone was prescribed along with estrogen to counteract the potential risks, there was initial concern that the hormone might undo the gains achieved with estrogen. However, research in middle-aged women suggests that the benefits method outweigh the possible risks. One of these studies examined the medical records and survey results of 8,881 women and found that women who received hormone replacement therapy lived longer than those who did not, and that they were less likely to have heart disease, strokes, and fractures. Combining estrogen and progesterone over a long period appears to have the most beneficial effects (Henderson, Paganini-Hill, & Ross , 1991). Other studies have shown that replenishing hormones after menopause helps maintain memory and mental acuity, reduces the risk of Alzheimer's disease, and significantly reduces the incidence of heart disease. The risk of dying from cardiovascular disease is definitely reduced with hormone replacement therapy ( Friedman et al ., 1996). The combination of synthetic testosterone with other hormones can more effectively prevent osteoporosis without reducing the positive effect on cardiac function ( Davis et al., 1995; Honor, Williams, & Adams, 1996).

Proven Benefits of Estrogen

Relieves hot flashes, night sweats and other menopausal symptoms

Reduces bone loss (osteoporosis)

Reduces vaginal dryness and atrophic processes in it

Very likely benefits

Reduces the risk of heart disease (improves cholesterol levels and makes blood vessels more flexible)

Reduces the risk of colon cancer

Reduces mood swings, confusion and memory loss

Helps maintain skin thickness, moisture and a more youthful appearance

Proven Risk

Increases the incidence of endometrial cancer (the inner layer of the uterus)

If taken with progesterone, menstrual bleeding may resume

Manifestations similar to premenstrual syndrome (fluid retention, breast sagging, irritability)

May lead to the growth of benign fibroid tumors in the uterus

Very likely risk

Greater risk of breast cancer

Abnormal blood clots

Weight gain

Greater risk of gallstones

Headache

Conflicting evidence about the possible benefits and risks of hormone replacement therapy has created some confusion among doctors and their patients. National Institute of Health ( National Institutes of Health)has undertaken a long-term study of over 57,000 women, but final results will not be available until the end of the century. There is already compelling evidence that such therapy significantly reduces the risk of cardiovascular disease in women aged 45 to 65 years - just when their cardiovascular system becomes more susceptible to various ailments. Careful research has shown that hormonal therapy does not lead to an increase in blood pressure or a tendency to form clots in the bloodstream. Gradually, medical opinion is shifting in favor of hormone replacement therapy as a way to prevent many of the dangers associated with aging ( Healey, 1995).

Problems of female sexuality. Women are typically raised to believe that menstruating means being a woman—that is, being fertile, feminine, and sexually active. The first menstruation is often heralded as the beginning of a woman's life. Consequently, for many women, menopause represents the loss of an important part of their feminine nature. They fall victim to one of the myths associated with this topic: that this is the beginning of the end of life, that sexual attractiveness and arousal decline after menopause, and that the purpose and meaning of being a woman (i.e., the ability to reproduce) is lost (Barbach, 1993).

In general, research confirms that menopause does not always have any significant impact on a woman's sexual activity, although some studies indicate that women may experience a decrease in sexual desire at this age. When a woman experiences the physiological and psychological changes associated with menopause, it can cause temporary shifts in her sexual desire. It may increase or decrease, but usually there is no significant, long-term change. Some women experience menopause as a release from concerns about pregnancy, allowing them to feel less sexually stressed during intercourse (Barbach , 1993). As women approach menopause, they sometimes assume that they can no longer become pregnant. However, approximately 25% of women aged 40 to 44 are still at risk of unintended pregnancy, and only one in five women in this group use some form of contraception. This may explain why women over 40 have about 18,000 abortions a year in the United States, an age group with the second-highest abortion-to-birth ratio behind teenage girls ( Fortney, 1989).

In many ways, how a woman’s life will change depends on her attitude towards menopause and towards herself. Her cultural background, her sexual value system, her social environment, her general health, and the fantasies and expectations associated with menopause may all play a role. However, even if a woman expects menopause to deteriorate her sex life, this does not necessarily happen (Barbach, 1993; Frock & Money, 1992). It is therefore critical that women receive accurate information and emotional support throughout the transition. There are counselors, women's centers and trained social workers who can provide the help you need. A woman needs to be able to discuss her fears, doubts and concerns in order to achieve an understanding that menopause is a natural stage of human development ( Barbach, 1993; Sheehy, 1993). It is also important for a woman's partner to receive information and advice about what is happening to her.

Male menopause

Men do not appear to experience well-defined cyclical changes in their hormonal balance, procreation, and sexual activity that vary with age. They typically continue to produce sperm throughout their lives, even at very old ages, although the risk of genetic abnormalities in sperm also increases with age. Testosterone secretion has been studied in aging men, but the results are controversial. The concentration of the hormone in the body decreases very gradually in the fourth decade of life, and by age 75, testosterone levels have fallen to approximately 90% of their levels at age 30. More importantly, biochemical changes in the body mean that as we age, more testosterone becomes chemically bound to blood proteins. This is reflected in a decrease in free testosterone, and it is free, unbound testosterone that is believed to have the most powerful effect on the body.

Optimal sexual function in men may depend on the presence of minimal amounts of free testosterone in the body. For those men whose levels are low, supplemental testosterone may increase sexual interest and potency. Testosterone replacement therapy carries with it a slight increase in the risk of prostate dysfunction and cardiovascular disease and should therefore be recommended with caution (Cowley, 1996).

Since men usually do not experience any noticeable decline in hormone levels or reproductive abilities, they do not experience anything like menopause. Nevertheless, popular magazines continue to publish articles about “male menopause.” Men do experience periods of stress frequently, although it is less predictable and its symptoms more varied. It is often called a midlife crisis, or transition, or male climacteric (male menopause), and is characterized by increased anxiety, depression, insomnia, hypochondria, loss of appetite and/or chronic fatigue.

This period in a man’s life is usually marked by big changes and the implementation (or non-implementation) of plans. Most experts believe that it is these psychological stresses that underlie male menopause. Moreover, in a society focused on the cult of youth, it is especially difficult for men to come to terms with their aging. Men with wives and children also share problems associated with their spouse's menopause and the children's beginning to live independently. In more traditional families, where the man is primarily the breadwinner, he may begin to feel tired from the many years of responsibility for the family. Midlife may be the time when you reach a stable position in your career, and your options for further change are much more limited. Physical changes and stress-induced tension can create swings in sexual interest and behavior, leading to even greater anxiety and frustration. Psychological stress in middle age is only exacerbated by strained relationships in marriage or with older children (Julian, McKenry, & Arnold, 1990). The male menopause primarily appears to be a vicious circle of midlife stresses that reinforce each other.

Experiencing male menopause. Because menopause is more pronounced, women receive more support and understanding of their physiological and psychological difficulties and symptoms during this period. Meanwhile, men may no less need the same help and support during a midlife crisis. Professionals can help a man express his concerns and deal with conflicting emotions, but men may be reluctant to seek this kind of help. To help them realize that the ability to find the support they need during life's crises is a strength, not a weakness, men may need guidance. It is important to warn them about the dangers of making major changes in their lives during such a crisis. The best solution may be to try to consolidate personal relationships and already achieved position in society, trying to resolve any conflicts and tensions in these important areas of life. Then, as things begin to become more rational, you can consider making major changes to your lifestyle and life goals.

Definitions

MENOPAUSE - a period experienced by men and women during the aging process, accompanied by greater susceptibility to emotional stress and sometimes somatic symptoms.

OSTEOPOROSIS - a disease caused by a decrease in calcium content in the bones in women after menopause, leading to increased bone fragility and poor posture.

"TIDES" - paroxysmal sensations of heat on the skin, caused by dilation of blood vessels, are often associated with menopause.

HORMONE REPLACEMENT THERAPY - treatment of changes that occur during menopause using dosed administration of the hormones estrogen and progesterone.

TESTOSTERONE REPLACEMENT THERAPY - Treatment with testosterone injections aimed at increasing sexual interest or potency in aging men is not considered safe enough for widespread use.

Menopause is the physiological period of transition from puberty to the period of cessation of generative function.

The climacteric period in women covers a period of time from 45 to 60 years and is characterized by a gradual cessation of menstrual function, and then the hormonal function of the ovaries against the background of general age-related changes in the body. The menopausal period is inextricably linked with the aging process of both cortical nerve centers and hypothalamic structures that regulate the activity of the pituitary gland and ovaries.

In the first phase of menopause - in the phase of menopausal ovarian dysfunction, or premenopause - changes in ovarian function are characterized by irregular luteinization of follicles, decreased secretion of progesterone and estrogens, and irregular menstruation. The time after the last uterine bleeding, caused by the influence of ovarian hormones, is called menopause. Its onset is preceded by a period of reduced ability of the female body to fertilize. The term “menopause” is also used to designate the second phase - postmenopause, when the function of the corpus luteum of the ovary completely ceases, against the background of a significant decrease in estrogen production, residual secretion is noted in the ovarian tissue, and menstrual function ceases.

The duration of ovarian function refers to genetically programmed physiol. processes. By the age of 40, 30,000–40,000 follicles remain in the ovaries; in the next decade, their number decreases significantly. Dystrophic changes in the ovaries begin with thickening of the basal membrane of the follicles, followed by its fibrotic transformation.

In most women, both phases are expressed, and the period of menopausal changes in menstrual function precedes the onset of menopause: the intervals between menstruation gradually increase and the intensity of menstrual-like discharge decreases. Less commonly, changes in menstrual function are characterized by the appearance of irregular, heavy and prolonged menstrual-like bleeding. In a third of women, menstruation stops suddenly. Frequent re-births, abortions, and prolonged lactation contribute to an earlier cessation of menstrual function, although in about half of women it is caused by primary hypothalamic disorders. Menopause occurs later in patients with uterine fibroids, hypertension, etc.

The state of estrogen deficiency, which usually develops in the later stages of the postmenopausal period, contributes to the development of atrophic changes in the vulva, vagina and urinary tract, atherosclerosis, systemic osteoporosis, and dystrophic arthropathy. If estrogenic influences persist during this period, there is a tendency to hypertension, diabetes, and the development of hyperplastic processes in the endometrium and mammary glands.

During menopause, many women experience obesity, the development of chronic constipation, and a general weakening of the body. Walking, gymnastics, massage, and limiting the amount of food, especially meat dishes, help prevent these phenomena. Alcohol and spices that sharply excite the nervous system should be excluded. It is better to regulate the action of the intestines by prescribing an appropriate diet.

The climacteric period in men is determined by age-related involutional processes occurring in the gonads, and most often occurs between the ages of 50 and 60 years. Atrophic changes in testicular glandulocytes (Leydig cells) in men of this age lead to a decrease in testosterone synthesis and a decrease in the level of androgen saturation in the body. At the same time, the production of gonadotropic hormones of the pituitary gland tends to increase. A decrease in the endocrine function of the testicles plays the role of a so-called trigger factor in disrupting the regulatory mechanisms of the hypothalamus-pituitary-gonadal system. As a result, complex neuroendocrine changes occur, including dysfunction of the central nervous system and determining the picture of male menopause. In the vast majority of men, age-related decline in the function of the gonads is not accompanied by any clinical manifestations, although sometimes characteristic symptoms of menopause occur and in such cases the course of the menopause is regarded as pathological. Clinical manifestations of the pathological menopause in men are characterized by cardiovascular, psychoneurological and genitourinary disorders. Cardiovascular disorders are manifested by a feeling of hot flashes in the head, sudden redness of the face and neck, palpitations, pain in the heart, shortness of breath, increased sweating, dizziness, etc. Sometimes unstable arterial hypertension occurs.

Psychoneurological disorders during menopause can be mild or pronounced. Patients complain of mild excitability, sleep disturbances, muscle weakness, and headache. There is depression, causeless anxiety and fear, loss of former interests, increased suspiciousness, and tearfulness.

Among the symptoms of dysfunction of the genitourinary organs, varying degrees of dysuria are noted. Sexual potency disorders are observed in the vast majority of men.

Treatment for pathological menopause in men includes normalization of the work and rest regime, dosed physical activity, and the creation of the most favorable psychological climate. Psychotherapy is a mandatory component of treatment. Drug treatment includes drugs that normalize the function of the central nervous system (sedatives, psychostimulant antidepressants, tranquilizers, etc.), vitamins, biogenic stimulants, drugs containing phosphorus, antispasmodics. In some cases, the prescription of drugs of sex and gonadotropic hormones is indicated for the purpose of correcting endocrine relationships, as well as the use of anabolic hormones.

Climacteric syndrome (CS) is a unique symptom complex that occurs against the background of age-related changes in the body, characterized by neuropsychic, vasomotor and metabolic-endocrine disorders that complicate the natural course of menopause.

The reasons for the development of CS are that the universal hormonal characteristic of postmenopause is an increase in the level of gonadotropins and estrogen deficiency. These changes occur during premenopause. During the reproductive period of a woman’s life, estrogens constantly influence various organs and tissues, interacting with specific estrogen receptors, which are localized, in addition to the uterus and mammary glands, in the urethra, bladder, cells of the vagina and pelvic floor muscles, in the cells of the brain, heart and arteries. , bones, skin, in the mucous membranes of the mouth, larynx, conjunctiva.

In this regard, against the background of estrogen deficiency during menopause, pathological conditions of the above-mentioned organs and tissues may occur.

All the main clinical symptoms of menopausal disorders are divided into 3 groups:

TREATMENT of menopause complex and includes non-drug, drug and hormonal therapy.

Non-drug treatment involves morning exercises (15-20 minutes), therapeutic exercises in “health” groups 2-3 times a week for 40-45 minutes, general massage, walks before bed. The diet should be dominated by fruits and vegetables, vegetable fats, and limiting carbohydrates. Hydrotherapy at home is indicated: dousing, washing, showering, baths (pine, sage, hot foot baths). Balneotherapy involves the use of mineral and radon waters, natural or imitating the corresponding natural factors in artificially prepared analogues. Sanatorium-resort treatment is preferably carried out in the usual climatic zone or on the southern coast of Crimea (during the cool season).

In the typical form of CS (mild and moderate), pearl, oxygen, foam and nitrogen baths are quite effective, and in patients with uterine fibroids, endometriosis, mastopathy, thyrotoxicosis - radon or iodine-bromine baths.

Over the past decade, long-term hormone replacement therapy has been used to successfully treat menopausal syndrome. The choice of hormone therapy method is the prerogative of the obstetrician-gynecologist.

Patients with menopausal syndrome should be monitored dynamically. A gynecologist should examine the patient once every 3 months, a therapist – 2 times a year.