Menopause is an important stage in a woman’s life. How to survive it and maintain health?
Menopause: causes, symptoms and main methods of therapy
Menopause is a term meaning “end of menstruation.” This is a natural state, a signal of changes in the female body with aging of the reproductive system. Menopause can be natural, due to physiological reasons, and pathological, as a rule, against the background of primary ovarian failure. The norm of menopause in physiological processes is a period from 42 to 60 years, on average, the menopause occurs in 47-51 years. Until the time of menopause, there is the so-called menopausal transition, when certain signs of menopause are noted. Consider the symptoms, how menopause occurs, the causes of early menopause, deviations and norms of menopause and changes in the body, the features of the ovaries and the effect of hormones on the endometrium in the menopause and in the premenopausal period, and options for hormonal, herbal, combined and the latest therapy for hot flashes and poor health of women.
How is menopause determined?
Menopause is determined retrospectively, today there are no technologies that can confidently determine the beginning of the menopausal transition and its timing. Hormonal fluctuations can occur under the influence of various factors, even the main markers of preclimax – follicle-stimulating and luteinizing hormones during menopause do not always accurately indicate the beginning of a new stage. For this reason, the menopause time can be determined only a year after the end of the last menstruation, in which case it is considered that the menopause period is 12 months.
The menopausal transition can be characterized by a change in the duration of the menstrual cycle, skipping and the resumption of monthly bleeding, for this reason you can accurately determine the time of menopause only by analyzing the presence of menstrual flow in recent months.
What happens to hormones in menopause?
The body begins to prepare for the time of menopause several years before the start of the changes. The production of gonadotropins begins to increase, and the release of estrogen and progesterone decreases. When diagnosing a state of health, anovulatory bleeding can be detected.
Often the level of follicle-stimulating hormone (FSH) increases faster than the amount of luteinizing (LH). This is a sign of a lack of inhibitory effects of estrogen and / or inhibin. Stromal cells contained in the ovarian tissues under the influence of an increased amount of luteinizing hormone begin to increase the secretion of androstenedione, and also produce a little more estrogen. The detection of a significant part of circulating estradiol during menopause is possible due to the conversion of androstenedione to estrone, and then to estradiol.
In the postmenopausal period, further changes are noted: the number of androgens, including androstenedione, drops sharply, the rate of progesterone during menopause is only 30% of the normal rates of young women, and this hormone is produced in menopause only by the adrenal glands. The amount of testosterone is reduced by a quarter, the same changes occur with the concentration of dehydroepiandrosterone and dehydroepiandrosterone sulfate.
Stages before menopause: what happens before it occurs?
Menopause is part of a single process of age-related changes in the female body, it also includes the stage of late reproductive age, the menopausal transition (stage of perimenopause), menopause and postmenopause itself, also known as menopause.
Stage of late reproductive age
Late reproductive age precedes the menopausal transition and, on average, begins at the age of 40. At this stage, the amount of inhibin B in the blood serum begins to fall, the level of follicle-stimulating hormone increases slightly, and the production of estradiol is maintained at the same level. But due to a decrease in the secretion of progesterone at the stage of the luteal phase, a decrease in fertile potential begins. How is this manifested?
Although mature follicles are determined by ovulation at the time of ovulation in the ovulation, the follicular phase itself begins to shorten, on average, from 14 to 10 days. That is, from the first day of menstruation to the release of the egg, 10 days elapse (different women have different periods), which can lead to an unplanned pregnancy even against the background of a stable menstrual cycle if the couple is protected by a calendar method or combined, using barrier contraceptives or spermicides only in the “dangerous days.”
This is the stage of transition from fertile age to menopause. On average, the menopausal transition lasts about 4 years, and during this period various physiological changes occur in the body, which can be taken as signs of menopause. They can take place both fairly easily and significantly reduce the quality of life.
The transition to menopause begins due to a decrease in the number of follicles, follicular supply of the ovaries. So begins menopause: the ovaries no longer have an egg supply.
Menopause: ovaries and follicular depletion
As many people know, the number of eggs during a woman’s life is steadily decreasing, since follicle cells are formed and their number is determined even before the girl is born, during fetal development, literally in the first couple of months after conception. The female fetus inside the mother already has sex cells, from which later, if desired and in the absence of obstacles, grandchildren will arise.
Girls are born with a huge supply of eggs, a total of about a million “potential children.” However, by the time of the menarche, the first menstruation during puberty, about 400 thousand of them remain, hopeless, incapable of ripening sifted out. So the millionth reserve of nature is conceived for insurance. But even 400 thousand eggs do not mean that even with the most successful combination of circumstances, a woman could have such a huge number of fertilized cells.
The fact is that after the end of puberty, a whole group of follicles prepares to be released monthly, on average 30-40 pieces, and only one (less often two, extremely rarely three) really matures and leaves the ovary into the fallopian tube to meet the sperm . This is a natural evolutionary selection during which the healthiest germ cell receives a chance of conception from the egg pool.
Such a seemingly huge number of eggs end on average by 51 years. By the beginning of menopause, the follicular supply is exhausted in the ovaries. And when menopause sets in, the ovaries no longer have follicles. And before the period of menopause, at the age of about 47 years, the stage begins when the follicular potential is almost exhausted. Various symptoms of the perimenopausal transition appear: the interval between menstrual bleeding changes, their nature (volume of discharge, duration of menstruation). All this is accompanied by fluctuations in the level of hormones in the body and the clinical picture characteristic of hormonal instability.
Menstrual periods are absent; this stage begins with the last menstruation in a woman’s life. The time of onset of menopause is determined by a retrospective analysis: if there were no periods during the year, menopause has begun.
Of course, the absence of menstruation during menopause is not the only diagnostic criterion. There should be a spectrum of symptoms, signs of perimenopause and the subsequent stage, if necessary confirmed by laboratory and instrumental studies. If menstruation suddenly begins during menopause, there are two options: either menopause was diagnosed incorrectly (usually by the woman herself only because of cycle irregularities), and the cause of the fluctuation in the interval between menstruation should be determined by the doctor; or such bleeding does not indicate menstruation during menopause (which is impossible physiologically), but about the occurrence of a pathological process, the development of a disease of the reproductive system. In both cases, menopause menstruation requires a mandatory examination, first of all, by a gynecologist, then, in the direction of a specialist, additional consultations with doctors of a different profile are possible.
Transition: causes and symptoms before menopause
At the initial stage, the interval between menstruation increases. If earlier it could be 25-35 days, before the beginning of the menopausal transition it can increase to 45-50, and this is after a shortened cycle of the late reproductive period. Menstruation dates become unstable. A blood test can show fluctuations in the level of follicle-stimulating hormone (FGS): in the first period of the cycle, it is high and can correspond to the norm, and then decreases.
The second stage follows the initial stage of perimenomause: fluctuations in the concentration of hormones in the blood are amplified, the level of inhibin B, antimuller hormone (AMH), and the number of antral follicles (CAF) decrease. Already there are periods of amenorrhea, lack of menstruation, instability and unpredictability of the duration of the menstrual cycle. On an ultrasound, the absence of mature follicles in the ovaries, that is, anovulatory cycles, can be noted. It is worth knowing that not all women observe such a sequence of changes in the menstrual cycle, and, of course, you should not expect such characteristic violations at all if the woman is constantly protected by hormonal contraceptives. Menopause may occur, its causes will be natural, but the manifestations against the background of hormonal contraception are completely different.
Although usually at the stage of perimenopause, the volume and duration of menstrual flow decreases, but in some situations it can happen vice versa. Experts use two parameters to evaluate. Severe bleeding is considered to be more than 80 ml / day, prolonged – longer than 7 days.
Menopause: menopause symptoms
After the end of perimenopause, several years of irregular menstruation with a different nature and duration of discharge, the periods completely stop. To understand whether menopause has occurred, the symptoms and clinical signs – 12 months of no menstruation – are determined retrospectively. Statistically, the average age of the onset of menopause, the symptoms of its onset, is defined as 51.4 years. However, natural menopause may begin earlier, depending on various factors: hereditary, pathological, the presence of bad habits.
Menopause: Symptoms and Clinical Signs
The main symptom at the stage of the menopausal transition and the first postmenopausal years is known to almost all women, even those who have not yet experienced menopause, symptoms and manifestations of the menopausal transition. These are the tides. But there are other signs of menopause, which are also a logical consequence of changes in the hormonal background of the body. These include dryness of the vaginal mucosa, sleep disturbances – from difficulty falling asleep to insomnia or early rises, the development of depressive states. There are some symptoms of menopause that can also develop in individual women, although the cause-effect relationships are not so clear. This is joint pain and memory loss.
Menopause: hot flashes – what is it and why does it appear?
With the word “menopause,” the tides are perhaps the first association with the condition in most women who have reached a certain age period. Such vasomotor symptoms of menopause appear in almost everyone. Interestingly, not only during menopause, hot flashes can affect the condition, but in 4 and 5 cases they develop precisely during the period of perimenopause / menopause. At the early transition stage, up to 40% of women feel their first signs (later – up to 80%), and in time they coincide with premenstrual syndrome or menstruation. In two out of ten women, menopause is not accompanied by hot flashes, or they are so weakly expressed that patients practically do not notice them.
Despite various rumors, only a third of women suffer from hot flashes so much that they go to the doctor and need to prescribe medications.
Menopause: hot flashes at this stage usually disrupt well-being during hot weather, in a stuffy room, and even more often at night, during sleep, which can cause insomnia during menopause.
Not everyone knows that increased night sweats or “night sweats” during menopause are also hot flashes. Vasomotor symptoms appear during sleep amid a decrease in the function of the nervous regulation of vascular tone.
How are the tides felt during menopause? As a rule, they begin unexpectedly, with a sudden sensation of fever, heat in the face, upper chest, which later “spreads”, covers the whole body. The duration of the attack is normal with menopause – no more than 2-3 minutes. During hot flashes, sweating increases sharply, the rhythm of the heartbeat can be accelerated, and at the end there is a feeling of chills, trembling in the body, anxiety, and anxiety. The feeling is not very pleasant, similar to feeling after hard physical work, running, but “attacks” without preliminary signs and is accompanied by a deterioration in well-being.
What causes hot flashes? First of all, an increase in body temperature due to environmental conditions or sleep under a blanket. Due to the increase in body temperature, the peripheral vessels expand reflexively, the pulse quickens, and sweating increases. Sweat secretion and vascular wall expansion are a natural mechanism of protection against overheating, and as a result a decrease in body temperature by 0.2 ° C. Although the episodes themselves last from 10 to 20 minutes, women generally experience a period of a rather brief peak in the vasomotor reaction, which is called the tide, and the subsequent signs of cooling – chills, trembling, agitation or weakness.
During menopause, hot flashes can occur at different frequencies: from 1 time per day to two episodes per hour, at night, as a rule, more often than during the day. Having appeared, on average they last from one to five years, stopping on their own and not requiring treatment.
When will the tides go? It depends on the woman’s health, her lifestyle and, according to some reports, may have hereditary characteristics for the duration of the episodes.
In one in five women, the period of menopausal hot flashes lasts no more than a year.
One of the four tides lasts 4-5 years.
In one out of 10 episodes of tides can last for decades, up to the age of 70, but the frequency of tides is, of course, significantly reduced.
Although hot flashes are considered a normal and natural reaction of the body to changes in hormonal levels, most women experience many inconveniences. The number of tides, their severity, frequency and unpredictability can greatly worsen well-being, not so much a physical as an emotional-mental state. It is unpleasant to be indoors, to travel in transport, many complain about the inability to wear clothes or accessories that cover the neck, hats, scarves, high collars. Frequent tides can affect performance, and the accompanying changes in the emotional plan can worsen relationships in the family and with others.
If hot flashes and other symptoms of menopause reduce the quality of life, you should consult a doctor for a selection of drugs that alleviate the condition and improve well-being. A wide range of hormonal and non-hormonal agents, plant extracts, injectable solutions, estrogen-containing creams and tablets during menopause can reduce or completely eliminate unpleasant manifestations. Important: selection of drugs of any profile and dose selection should be carried out only by a specialist!
Sleep during menopause: causes of violations
Sleep disturbances during menopause are mainly due to hot flashes, they provoke an increase in body temperature during night rest, and they themselves contribute to awakening. If hot flashes cause severe sleep disturbances and insomnia, doctors recommend medical correction to eliminate episodes of vasomotor manifestations in order to restore a healthy sleep.
However, it is important to know that insomnia, problems with falling asleep and early, forced rises with the subsequent inability to fall asleep can occur regardless of the tides, due to changes in the function of the endocrine system, in particular, the adrenal glands and the hypothalamus. Every third woman in perimenopause and almost every second woman during menopause report a deterioration in sleep, not associated with the phenomenon of hot flashes.
Menopause and other symptoms: depression, sexual function, joint pain
Perimenopause and menopause: the symptoms and manifestations at these stages can be varied, and it is not always possible to independently understand that they are caused precisely by age-related changes in fertility.
In our body, everything is interconnected, and changes in the hormonal background due to the extinction of the reproductive function can affect the emotional well-being and mental functions. So, the likelihood of developing depressive and anxious conditions against the background of the menopausal transition increases more than twice due to pronounced fluctuations in the hormonal level. With the onset of menopause, the risk of depression decreases spontaneously without treatment. But if a depressed emotional background, dysphoria, bouts of irritability, low mood or its fluctuations reduce the quality of life, you should not fight physiology on your own and patiently wait for the onset of menopause. A gynecologist-endocrinologist or psychiatrist will select the necessary corrective drugs, and health will improve.
Atrophy of the genitourinary system
The epithelial layer lining the walls of the vagina, uterus and urethra are referred to as estrogen-dependent tissues. With a decrease in estrogen levels, a decrease in the production of mucous secretion begins, which leads to vaginal dryness – this symptom is usually noticed first. Dryness indicates the initial process of atrophy of the epithelial layer of the vagina, urethra, uterus and can be complicated by the development of atrophic vaginitis.
Symptoms of this form of vaginitis are dryness, vaginal itching, dyspareunia. The frequency of complaints of vaginal dryness increases during the transition from reproductive age to postmenopause by 15 times, in the menopause every second woman complains about it.
What else happens to the reproductive organs during menopause?
The cervix is reduced in size.
Atrophic processes in the endometrium and myometrium begin.
If there are fibroids, they also decrease in size.
Symptoms and manifestations of endometriosis in normal menopause are reduced and less disturbed.
Atrophic changes in the epithelium of the urinary tract can lead to the development of atrophic cystitis, accompanied by frequent urination and incontinence of varying degrees.
Sexual dysfunction: why appears and how to treat?
Due to a decrease in estrogen levels, blood flow decreases in the vulva and vagina, which causes narrowing, shortening of the vagina, deterioration of the elasticity of the walls, and atrophy of the cervix. All this affects the occurrence of sexual dysfunction, as sensations during intercourse worsen, attraction decreases, and vaginal dryness and a change in its shape can cause pain during penetration and frictions. Nevertheless, there are a number of studies with reliable results on the positive effect of sexual activity at the menopause stage: continued sexual activity helps prevent such changes even without drug-related hormonal support.
Experts advise using lubricants, not to refuse sexual intercourse, to increase the variety of postures and to use various options to enhance sexual arousal. In addition to pleasure, excitement and contact itself contribute to a rush of blood to the genitals, improve blood supply, which prevents the development of age-related changes and improves women’s well-being.
Joint pain and stiffness often occur before the onset of menopause and at the end of this period. Almost half of women suffer from them. Therapy with combined estrogen-progesterone drugs helps to reduce the severity of symptoms.
Sensation of tension, pain in the mammary glands caused by fluctuations in the level of the hormone estradiol and more often occur in the early stage of perimenopause.
Migraine pains against the background of menstruation can occur during the entire period of puberty. But if they have or had a history, then in perimenopause, the headache can intensify, seizures can become more frequent, and it does not have to coincide with the dates of menstruation, but precede them or develop somewhat later.
Menopausal sex hormone deficiency: long-term health complications
Hormones determine many metabolic processes in our body, and it is not surprising that a change in the concentration of sex hormones during menopause, which are responsible for reproductive function, can also affect other systems, organs and tissues. Estrogen deficiency, which begins in the premenopausal period and continues during menopause and postmenopause, also causes certain changes that can threaten long-term complications in a woman’s health.
Osteoporosis, decreased bone strength
Loss of bone tissue in a healthy woman manifests itself at the stage of perimenopause. The highest rate of decrease in bone strength is observed 12 months before the last menstruation, and the level of bone loss is kept at its maximum for another two years.
A fracture of the radius is one of the most common consequences of injuries and falls in women during menopause. Experts did not agree on a reason. On the one hand, this is due to osteoporosis of bone tissue. On the other hand, there is an opinion about impaired stability as the main complication of the loss of the bulk of estrogen. In any case, the onset of the menopausal transition indicates the need to be more careful and avoid traumatic situations.
The cause of the development of postmenopausal osteoporosis is increased bone resorption and decreased osteogenesis, both processes occur with the participation of estrogens. The early stage of osteoporosis is characterized by increased excretion of calcium from the body, which can be determined by laboratory analysis of urine composition. This calcium excretion indicates the development of a problem with the trabecular bones. During the first years after the onset of menopause, an average woman loses about 1% of the total metacarpal cortical bone layer. Bones literally become more fragile, the strength of the tissue decreases, and the process of its growth and recovery sharply slows down. During this period, the risk of fractures with a long healing stage increases. To avoid this situation, an additional intake of calcium with a high digestibility coefficient is necessary.
Diseases of the cardiovascular system
An increase in the likelihood of developing diseases of the cardiovascular system is also associated with a decrease in estrogen levels, although not only with it. In some part, the risk of heart and vascular diseases due to changes in the lipid spectrum (types and levels of various fats) of blood serum. So, during menopause there is an increase in the concentration of low density lipoproteins by an average of 6%, and at the same time the protective function of high density lipoproteins decreases.
Skin and hair condition
Estrogen deficiency inevitably leads to a decrease in the accumulation of collagen in the skin layers. The less collagen, the less moisture, lower turgor, elasticity of the skin, and this process is accompanied by accelerated sagging skin, the appearance of wrinkles.
Although it is a deficiency of estrogen that causes changes in the skin layers during menopause due to the effect on the level of collagen, the opposite effect – improving the skin condition with estrogen-containing ointments and creams – does not work. According to studies, the cure for eliminating estrogen deficiency does not affect the elasticity of the skin layers and the moisture content of the skin.
Drugs that are actively used in cosmetology do not seem to have the advertised effect, at least they do not help restore collagen stores through the administration of estrogen with cream.
Hair also loses collagen, dryness and brittleness increase, and hair loss on the head may occur. In the armpit and pubic region, part of the hair falls out under the influence of estrogen deficiency, and on the face (chin, upper lip, cheeks), the hair can be transformed from fluffy to terminal, more dense and thicker, with enhanced growth.
Examinations and menopause rates
The age norm of menopause depends on a number of factors, but there are averaged indicators for women. If we talk about conditional approximate age indicators, then experts distinguish three periods: up to 40 years, 40-45 and older than 45, and when signs of menopause in women of these age groups appear, various methods and indicators of analyzes and studies are used.
For healthy women over 45
In this age period, the diagnosis of the menopausal transition or perimenopause is carried out by assessing the duration of the interval between menstruation, regardless of the presence of other symptoms of menopause. Most experts indicate that there is no need to analyze the level of follicle-stimulating hormone. There is no reliable method for predicting the date of the last menstruation during perimenopause. The diagnosis of menopause is established in the presence of amenorrhea within 1 year, in the absence of other causes of amenorrhea.
For healthy women 40-45 years old
The determination of the onset of perimenopause is also carried out as in the older age period, but with the mandatory exclusion of other amenorrhea provocateurs that are not related to the causes of menopause. For this purpose, blood serum tests for the presence of a marker of pregnancy (human chorionic gonadotropin, hCG), the level of the hormone prolactin, and thyroid function (TSH) are recommended.
For healthy women under 40
Changes in the duration of the menstrual cycle and the presence of menopausal symptoms under the age of 40 do not give a basis for the diagnosis of perimenopause or the menopausal period. As a rule, in the absence of other reasons, women younger than 40 are diagnosed with primary (premature) ovarian failure, which indicates an early pathological depletion of the follicular reserve of the ovaries.
Differential diagnosis in special situations
What else needs to be considered in order to accurately determine whether the menstrual cycle and amenorrhea are caused by upcoming menopause, or are other health features affecting the body that are not related to menopause?
The main diagnostic problems are associated with the presence of pathologies in a woman that cause menstrual irregularities, for example, with sclerocystic ovary syndrome, which are not taken into account in common classifications. In such situations, tests for the level of FGS are recommended.
Menopause, symptoms of the menopausal period, are characteristic not only of age-related changes in the reproductive system. Similar disorders of the menstrual cycle are also accompanied by thyroid disease, thyrotoxicosis and hypothyroidism. The main diagnostic indicator of thyrotoxicosis is a decrease in the concentration of the hormone TSH in the blood. In laboratory tests, hypothyroidism is determined by increased secretion of TSH in serum.
Differential diagnosis should also be carried out with such a pathology as hyperprolactinemia of various anamnesis (an increased concentration of the hormone prolactin is noted in the analyzes).
It should be remembered that breastfeeding in any age period also causes physiological hyperprolactinemia, since this hormone is necessary for the production of breast milk. If the lactation period is long and / or coincides with the age of the possible onset of perimenopause, the absence of menstruation or irregular menstruation can be caused by both increased prolactin levels and the extinction of reproductive function. Or, in some cases, both factors. To identify the cause for women who do not have a regular menstrual cycle for 6 months after breastfeeding, they need to be examined by a gynecologist or endocrinologist.
In the presence of profuse and prolonged monthly bleeding (with volume parameters of more than 80 ml and lasting longer than 7 days), it is necessary to conduct an ultrasound examination of the pelvic area, to exclude the possibility of pathological pregnancy, structural abnormalities, endometrial pathologies in menopause or before it occurs.
With atypical tides, increased night sweats, you must go to the clinic at any age to exclude a neuroendocrine tumor (carcinoid), pheochromocytoma, and other tumor processes.
There are many factors that affect how a woman will feel during menopause. But some risks can be prevented, since the prerequisites for more severe and severe symptoms are known. What will complicate the menopause and worsen health?
Overweight and concomitant diseases. According to statistics, from 65 to 78% of women entering a new stage of age-related changes are overweight or obese. In most cases, overweight is combined with high blood pressure, coronary heart disease, diabetes, arthritis. Chronic gastritis, colitis, pancreatitis, peptic ulcer, thyroid pathology and chronic venous insufficiency are also common. At the 2nd and 3rd stages of obesity, gynecological pathologies are much more common. That is, all the complications that the period of menopause and postmenopause can cause are already there and will only intensify.
How is menopause in overweight women? 95% have severe headache, emotional excitability, irritability, sleep disturbances, pain in muscles, joints, urinary tract dysfunctions. In general, menopause is much more severe and is accompanied by tachycardia. Dizziness, frequent and prolonged flushing.
Research results warn: those who want to better tolerate menopause and maintain health should take care of themselves before the menopausal transition, consult a doctor about weight loss and treatment of existing diseases.
Hysterectomy, endometrial ablation and menopause
If there is a history of surgery to remove the uterus (hysterectomy), endometrial ablation in menopause and during the transition period for obvious reasons, it is impossible to navigate the presence or regularity of menstrual bleeding to determine the stage. Therefore, the diagnosis is carried out by collecting an anamnesis with the identification of menopausal symptoms and according to the results of monitoring the level of FSH in laboratory studies. If the FSH level is higher than 25 ME / L, then this indicates a late stage of perimenopause. Indicators from 25 to 70 – the norm of menopause, a range of 70-100 indicates the onset of postmenopause.
Hormonal drugs for menopause
Hormonal medications for menopause can complicate the diagnosis process. The most common situation occurs when birth control pills during menopause mask the main symptoms of changes in the body’s natural hormonal levels.
Modern oral contraceptives, subcutaneous implants and intrauterine devices with a hormonal effect are considered a highly reliable controlled way to prevent unwanted pregnancy.
Taking hormonal contraceptives is safe on average up to 50-51 years, that is, you can take such drugs before menopause. But since, due to the use of contraceptives or the presence of an implant, a hormone-containing helix, the production of follicle-stimulating hormones is suppressed, analysis of their concentration cannot be used to diagnose menopausal changes. In this case, the doctor may recommend taking oral contraceptives for 2-4 weeks or conduct an analysis after removal of the implant / IUD. If, in the absence of the influence of hormonal drugs, the level of FSH is higher than 25 IU / l, then this indicates the onset of a menopausal transition. Since pregnancy can still occur, it is necessary to consult with a gynecologist about protection options.
Menopausal hyperplasia: pathology of the endometrial layer
Menopausal endometrial hyperplasia is an increased risk factor for the development of cancer of the reproductive organs. With hyperplasia in menopause, the mucous membrane of the uterine cavity grows pathologically. The highest probability of the onset of hyperplasia is in menopause and postmenopause, which is caused by constant changes in the concentration of female sex hormones, the main reason for the growth of the endometrial layer and endometrial hyperplasia in menopause.
Additional risk factors in which hyperplasia in menopause is likely include overweight, the presence of type 2 diabetes mellitus, and pathology of the cardiovascular system (hypertension). Prevention methods are the exclusion of these provocateurs or their correction, therapy of concomitant diseases, timely access to doctors.
Diagnosis and treatment of endometrial hyperplasia in menopause
Starting from 40 years and on average up to 60 preventive visits and gynecological examinations of the health of the reproductive system must be planned with a frequency of at least 2 times a year. Fading fertility is not a reason to stop taking care of yourself, on the contrary, the transition period should take place under the supervision of specialists, since changes in the female body, despite their physiology and naturalness, can cause various disorders and lead to malaise, cause diseases. Without proper treatment, illnesses can not only undermine health, but also cause early death. The period of menopause and postmenopause is the time for careful monitoring of changes and their effects on the body.
The first symptom of endometrial hyperplasia in menopause and the menopausal transition is uterine bleeding that is not characteristic of the patient. They may not coincide in time with menstruation, menopause can pass with blood discharge from the vagina against the background of amenorrhea. While maintaining the menstrual cycle in perimenopause, an increase in menstrual flow, blood volume, and duration of bleeding is noted. Drawing, aching pains in the lower abdomen may occur. So endometrial hyperplasia in menopause can manifest itself.
Diagnostics is carried out with mandatory ultrasound to visualize nearby organs in order to exclude the presence of malignant neoplasms. If it is necessary to clarify the diagnosis of “endometrial hyperplasia in menopause”, cells of the endometrial layer of the uterine cavity are taken and their microscopic examination is performed.
Ultrasound of the uterus is a reliable way to assess the state of the organ during menopause, which also allows you to determine the size of the endometrial layer.
The norm of the endometrium in menopause is not more than 5 mm of the layer.
When it grows to 7 mm, regular monitoring of the state of the uterine cavity in dynamics is required, ultrasound tests of the pelvic organs are repeated every 3 months.
With a layer thickness of 8 mm, they speak of pathology. It is necessary to establish precisely the cause of the proliferation, for which they resort to diagnostic curettage with the subsequent analysis of endometrial cells.
With thickness indices of 10 to 15 mm, separate curettage and histological examination of biological material are necessary to exclude malignant neoplasms.
It is important to know that only one indicator – the thickness of the endometrial layer – is not the basis for the diagnosis of “endometriosis” at any age. Diagnosis is based on the results of ultrasound and analysis of biomaterial during diagnostic curettage.
Therapy for endometriosis: current medical trends
Therapy for the growth of the endometrium is carried out by surgical, conservative and combined treatment methods in menopause.
In conservative therapy, the main goal is to correct the concentration and ratio of hormones in the body with control using ultrasound. This treatment option helps to achieve good results and applies not only to therapeutic methods, but also to the spectrum of preventive measures aimed at reducing the risk of cancer processes in the uterine cavity.
Surgical methods of therapy are used with a pronounced stage of endometrial overgrowth in menopause, if drug support does not lead to proper results. Surgical treatment options include:
- mechanical curettage of the endometrial layer in the uterine cavity to remove foci of proliferation of the endometrium, stop bleeding, reduce the thickness of the uterine mucosa. May also be used for diagnostic purposes;
- ablation or cauterization of foci of pathology of the endometrial layer using a laser beam;
- hysterectomy, removal of the uterus is carried out in extreme cases, if neither conservative therapy nor previous surgical treatment options help, the patient has relapses, a high risk of degeneration of the neoplasms into malignant with an atypical form of endometriosis (observed in every 4th woman with pathology).
Combination therapy combines hormonal correction and surgical methods of treatment. Hormonal drugs for menopause in this case are prescribed both before surgery to reduce the size of foci of proliferation of the mucosa, and after to consolidate the result.
Modern gynecologists and oncologists, unlike the previous generation, do not always recommend the procedure for curettage of the overgrown endometrial layer, considering it traumatic and contributing to relapse pathology. However, monitoring of hyperplasia, therapy and monitoring of neoplasms against the background of menopausal hyperplasia should be carried out regularly.
Hormonal correction for menopause: treatment and correction
Although a generally healthy body does not need support, correction, or menopausal hormone therapy, the symptoms accompanying a period of extinction of reproductive function can sometimes be so painful and unpleasant that a treatment regimen has been developed to alleviate the condition, menopause in which is less obvious. The purpose of such therapy is to improve well-being and reduce primarily the severity of vasomotor symptoms, the so-called hot flashes. However, other manifestations accompanying menopause also respond positively to estrogen therapy. Emotional lability decreases (bouts of irritability, increased vulnerability, emotional hyperreactions, frequent mood swings), well-being in depressive conditions improves, sleep improves if its disturbances were caused by hot flashes, positive dynamics in the manifestations of menopausal urogenital syndrome (dryness and irritation of the vaginal mucosa, frequent urination, an increased risk of bacterial infections and disturbances in the vaginal microflora, etc.).
Modern gynecologists-endocrinologists criticize the universal appointment of menopausal hormone therapy methods. These treatment regimens for menopause require a preliminary examination of the patient to exclude possible contraindications and control health during hormonal correction. However, in general, the scientific world believes that, under the conditions of appointment, admission and regular examinations, the treatment of menopause and the influence of its symptoms with hormonal drugs in menopause is safe for healthy women 40 years and older, if the duration of therapy is no more than 5 years .
Who is indicated for hormone replacement treatment for menopause? This is the treatment of choice for moderate or severe vasomotor symptoms in two categories of patients.
Healthy women during the menopausal transition, menopause, postmenopause, which generally last more than 10 years.
Women under 60 years old.
A similar therapy is carried out with artificial menopause caused by a hysterectomy with removal of the ovaries or other reasons accompanied by early menopause.
Contraindications to hormone therapy
Menopausal hormone therapy has a list of absolute and relative contraindications, and they must be taken into account. The absolute contraindications to hormone therapy during menopause include the presence of:
- estrogen-dependent tumor formations;
- acute, chronic liver diseases, especially in the active phase or a tendency to exacerbations against the background of remissions;
- venous thromboembolism;
- a history of a malignant breast tumor;
- stroke, cerebrovascular pathologies;
- coronary heart disease;
- high risk of developing these diseases.
Among the relative contraindications are:
- arterial hypertension;
- fibrocystic mastopathy;
- allergies or individual sensitivity to the components of the drugs.
Is hormone therapy in menopause safe: formulas, treatment principles
“Turning off” the function in premenopausal and menopausal ovaries causes a spectrum of changes and provokes diseases that can be avoided by pharmacologically replacing the hormonal function of the ovaries in patients with deficiency of sex hormones. An important factor in the effectiveness and safety of treating menopausal symptoms and the consequences of hormonal deficiency is to achieve the minimum optimal level of hormones that would provide a therapeutic and prophylactic effect, while at the same time it would be accompanied by a minimum of side effects of estrogen intake, especially in endometrial tissues and mammary glands.
When deciding on the choice of the type of hormone replacement therapy, the doctor must fully inform the patient about the features of the systemic effect of sex hormones, their deficiencies, the specifics and effectiveness of the treatment, and obtain informed consent for this type of therapy.
In modern gynecology, there is a tendency to justify the early appointment of hormone replacement therapy at the stage of premenopause, in the menopausal transition. An early therapeutic effect is resorted to if an early or premature pause is detected (ovarian deficiency syndrome in 38-45 years), with prolonged episodes of secondary amenorrhea in the reproductive period; with primary amenorrhea (with the exception of Rokytansky-Kustner syndrome), against the background of artificial menopause, with the early manifestation of vasomotor symptoms of menopausal syndrome, urogenital disorders, increased risk of osteoporosis, diseases of the cardiovascular system, Alzheimer’s disease.
The basic principles of hormone replacement therapy in menopause
Low-dose estrogen therapy is selected in accordance with the estrogen level of the early phase of the proliferation of the menstrual cycle according to the indicators of young healthy women, i.e., the selection of the dose follows the balance of the minimum dose and optimal exposure.
“Natural” estrogens, which completely repeat the formula of endogenous hormones, and their analogues are preferred in therapy, since they act “softer” than synthetic analogues, treatment is accompanied by a minimum of side effects, and metabolism occurs according to the scheme of endogenous estrogens.
In order to prevent endometrial hyperplasia in menopause, it is recommended to combine the intake of estrogen and progestogen (progesterone and analogues).
When removing the uterus, estrogen monotherapy is used, depending on the patient’s condition and response to therapy, courses may be intermittent or prolonged.
In order to prevent the late consequences of menopausal changes (osteoporosis, coronary heart disease, atherosclerosis, Alzheimer’s disease, etc.), as well as for the treatment of genitourinary disorders, the course of hormone replacement therapy should be 5 years or longer.
Menopause: formula and main types of hormone therapy
In modern hormone replacement therapy for menopausal symptoms, the main types are distinguished:
- estrogen monotherapy;
- combinatorial therapy: estrogens and progestogens in different variations (Klimonorm, etc.);
- combinatorial therapy based on a combination of estrogen and androgen;
- progestogen or androgen monotherapy (in rare cases).
If a woman has special indications or menopause is severe, the hormone therapy formula is selected individually.
Types of estrogen in therapy
Current clinical practice of hormone replacement therapy uses three types of estrogen preparations:
- synthetic estradiol-17b, with a formula identical to natural human estradiol;
- estradiol valerate, a compound that, after biotransformer processes in the liver, goes into estradiol;
- natural or conjugated estrogens, also called conjugated equin estrogens (CEEs), excreted from the urine of pregnant horses.
Over the past quarter century, in European countries, the first two drug options have been preferred, for which the optimal dosages in the treatment of typical cases of menopausal syndrome and the doses for the prevention of late metabolic complications have been studied and identified. However, each case is unique, and any menopause requires attention, the formula of the drugs and their route of administration are selected only by the doctor!
Menopause hormone replacement therapy: pills, implants or injections?
Menopause hormones for replacement therapy can be administered in two main ways – enteral and parenteral. If menopause is difficult to tolerate, hormone support pills are considered more traditional and convenient for many through treatment. Consider the advantages and disadvantages of this method of treatment, the oral route of hormones during menopause.
Menopause: hormone pills as a therapy
The positive aspects of the treatment of menopausal symptoms with hormonal tablets include the simplicity and convenience of the traditional method of use, the positive effect on individual indicators of the blood lipid spectrum, metabolic processes in the endothelial vascular layer.
Of the negative characteristics in the treatment of menopause with estrogen tablets as the active substance, the probability of incomplete absorption of oral estrogens in the digestive tract is distinguished, especially against the background of its diseases and pathologies; increased activity of the metabolic processes of oral forms of estrogen in the liver, which can cause excessive stimulation of the synthesis of various bioactive substances, in particular, blood coagulation factors; the existing likelihood of no effect from oral hormone replacement therapy, which is possibly due to a change in sensitivity to minor changes in estradiol concentration or its protein binding processes.
Since such negative factors can affect pharmacokinetic processes, it is worth considering the likely need for switching to other forms of drugs during menopause, the formulas of their compositions and form options. The prevalence of tablet forms is great, if menopause is difficult, tablets in many cases become the first choice option due to the traditional form, low cost compared to other options. Many doctors prefer to prescribe tablet forms because of the availability and long enough experience of their use in personal and world practice.
Parenteral forms: from gels to implants
Preparations of the parenteral route of administration, bypassing the gastrointestinal tract, allow the delivery of active substances into the body without pronounced losses. The lipophilicity of estrogens helps to invent forms of drugs that can penetrate the skin layers, absorbed into the bloodstream and have a systemic effect. What are the indications for parenteral forms?
- Low or absent sensitivity to tablet therapy options.
- Diseases of the liver, pancreas, malabsorption in the stomach, intestines.
- Violations of coagulation, thromboembolism in the anamnesis of patients, the risks of thrombosis.
- High blood pressure.
- A history of hypertriglyceridemia or diagnosed with oral forms of estrogen.
- The likelihood of cholelithiasis.
- Insulin resistance, reduced glucose tolerance.
Since transdermal, transdermal forms of drugs are absorbed into the bloodstream, bypassing the liver, they are not subjected to metabolic processes. In addition to changing the estrogen formula, it also helps to maintain a stable estradiol concentration and to avoid the early peaks characteristic of oral therapy.
The most convenient transdermal forms of hormone therapy for menopause are patches and gel. The patch is glued to the hips, the gel is applied to the skin, alternating between the hips, abdomen and / or buttocks. The hips are the optimal area for transdermal forms, since it has an increased permeability of estradiol in the gel in comparison with, for example, the forearm.
Vaginal and other forms of drugs
Vaginal forms are indicated for patients with genitourinary disorders, they are available in the form of suppositories and ointments and have a pronounced local colpotropic effect, while the systemic effect on the endometrium in menopause is negligible.
Alternative options for hormone replacement therapy for menopause are subcutaneous implants. They are administered for a long time and stably supply the necessary amount of hormones. However, before switching to implant forms, the selection of doses and other treatment options for other forms is recommended.
Modern studies indicate that the optimal way to start hormone replacement therapy in menopause is with a transdermal form of estradiol 17-b, especially with hypertriglyceridemia or risk factors for thromboembolism.
It is worth noting that over the past decade, the number of contraindications to hormone replacement therapy has significantly decreased, and most of the former absolute contraindications are transferred to the relative category. To a large extent, this is the merit of specialists who have created new, parenteral forms of drugs.
What examination should be done before starting hormone therapy?
Despite the merits of pharmaceutical companies, contraindications and limitations to hormone replacement therapy still exist. To determine the possibility of using hormonal drugs, the optimal form and dose, it is necessary to undergo a specialist examination, which includes the following steps:
- medical history taking into account the presence of restrictions;
- gynecological examination, cytological examination of vaginal cells, uterine endometrium;
- ultrasound examination of the pelvic organs;
- mammography and palpation of the mammary glands;
- blood test for lipid composition;
- dynamic blood pressure assessment.
If necessary, a blood test for TSH, T3, T4, an electrocardiogram, a hemostasiogram, an assessment of bone density (osteodensitometry), etc. can be prescribed.
After the start of the course of therapy, several series of control are carried out, the first – after 3 months, then every six months. Every year it is necessary to undergo mammography, ultrasound of the genitals, oncocytological examination.
Hormone replacement therapy can cause side effects of varying severity, which can be manifested by a feeling of nausea, engorgement of the mammary glands, changes in body weight, swelling, headache, increased secretion of vaginal mucus, cholestasis, libido fluctuations, hyperpigmentation.
In some cases, it is possible to change the dosage of drugs, but in most situations, side effects disappear on their own after the initial period of therapy.
Menopause: Enhanced Vitamin Support
If menopause occurs, enhanced vitamin therapy can be good support for health and well-being, and in many cases can help to avoid hormone therapy and cope with hot flashes and other symptoms without side effects. What vitamins are recommended for menopause, enhanced formulas and special formulations for this stage?
During menopause, the likelihood of osteoporosis, changes in bone strength increases. For prevention, popular sources recommend taking calcium supplements in combination with vitamin D, but they often forget about the importance of vitamin A, which is also responsible for bone strength. It also improves the condition of the skin and teeth, affects the vigilance of vision and helps strengthen immunity.
Riboflavin is the second name for vitamin B2, indispensable for the immune system, growth processes and metabolic functions. And its deficiency, even insignificant, causes an increase in the susceptibility of the body to infections, and also affects the increased risk of developing depressive states, which are much more likely to occur during menopause due to changes in hormonal levels.
B6 or pyridoxine is also included in group B. It is especially important for the immune system, and is also associated with fluctuations in the emotional background. It is recommended to include it in therapy when taking magnesium preparations as an enhancer of magnesium exposure and a mood regulator.
B7 is not as famous as B6 or B9. The second name for vitamin B7 is biotin. It helps to improve the condition of hair, nails and skin, helping to avoid excessive dryness or excessive secretion of sebum. And this vitamin helps maintain a normal concentration of cholesterol and regulate the lipid profile.
Most women know this vitamin under the second name – folic acid. It is indispensable in the planning of conception and in the early stages of pregnancy, but in menopause, the folic acid formula is also important, since it helps maintain hormonal balance and reduce the likelihood of heart and vascular diseases.
And another vitamin from group B promotes metabolism. It is well known that menopause can contribute (and most often this happens) to fluctuations in body weight, since metabolic processes, energy consumption of tissues, and also the pathways of accumulation of fatty tissues change. An additional important function of B12 is the prevention of cognitive impairment (memory, concentration of attention) and depressive states.
It is impossible to forget about “ascorbic acid”, ascorbic acid, which is rich in citrus fruits, at any age. But especially in menopause: it affects the process of production of red blood cells, activates tissue growth and is involved in oxygen metabolism. Thanks to this, vitamin C helps to return to their usual state much faster.
Thus, with the onset of menopause, the formulas of habitual vitamin complexes need to be reviewed taking into account the presence of the most important components. With menopause, enhanced formulations of drugs help to quickly get rid of unpleasant symptoms and restore normal health.
The drug “Ladys menopause”
“Ladys Menopause” (correct name: “Menopause Lady’s Formula”) refers to a group of dietary supplements. “Ladys menopause” consists of a group of several vitamins, minerals that are important for well-being during age-related hormonal changes, and an extract of the active components of Chinese angelica, which helps maintain the production of endogenous hormones by the female body. Reception “Ladis menopause” can be combined with other forms of therapy, however, in some cases, it is necessary to consult a specialist about the effect of the plant provocateur of estrogen production.
Phytoestrogens in support of women’s health
In addition to supporting the condition with the help of vitamin-mineral complexes, phytoestrogens can help to avoid hormone replacement therapy. These are drugs based on substances of plant origin, which have an estrogen-like effect on the body. Although their effects and basic characteristics are still under the scrutiny of scientists, there is extensive evidence on properties such as the prevention of heart and vascular diseases, the risk of malignant neoplasms, and also help with menopausal symptoms. What are the indications for taking phytoestrogens?
This group of drugs can be used for arterial hypertension, type 2 diabetes mellitus, an increased likelihood of developing or the presence of vascular pathologies, to correct the consequences of eating disorders (for example, excess caffeine in the diet or underweight). When menopause occurs, increased support by phytoestrogens can reduce the severity of manifestations, especially in the case of premature onset of menopause.
Herbal preparations recommended for menopausal women contain flavones, cumestanes, lignans, isoflavones. The last component is closest in action to endogenous estrogen. A feature of phytoestrogens is a milder effect than natural or synthesized hormonal preparations. Based on their action, recommendations were developed on special components of the diet for women.
It is reliably known that women whose diet includes soy products or natural soybeans can tolerate menopause much more easily. This is due to phytoestrogens in the composition of soybeans, it is especially rich in hormone-like substances. So, the popular drug with menopause Inoclim contains an extract of soya. Given its cost (about 800 rubles per package), it is possible to replace the intake of dietary supplements with new food products.
The advantage of soy is that it is not difficult to add to the daily diet, unlike other widely known and inedible plants-sources of phytoestrogens, such as red clover, tsimifuga, etc.
Latest Therapies for Menopause
Most treatment options for menopausal syndrome and its consequences are well known: vitamin-mineral complexes enriched in fatty acids and various important components, phytoestrogens, hormonal drugs and symptomatic treatment. However, science does not stand still, and in recent years there are drugs with a new principle of action. Rather, the principle already known is the components of the extract from the pineal gland, which underlie such drugs as Cerebrolysin and Cortexin.
New medicines are designed to regulate the balance of hormones during menopause, acting at the level of the hypothalamus and the pituitary gland and stimulating the body itself to produce more essential substances and avoid deficiencies. In addition to alleviating the symptoms of menopause, the drug, according to the promise of the creators, will provide an anti-aging effect and restore hormonal youth. The drug Pinamine, which has been used for three years, is registered on the Russian market. Feedback on the impact is inspiring, although many experts prefer to expect the accumulation of a statistical base on a massive scale. Consumers are stopped by the cost of a new product – about 18,000 rubles per course of 10 injections, they need 3-4 courses a year.
Despite the availability, a new direction in the development of drugs that help to survive the difficult age stage – menopause – and prolong youth is inspiring. Perhaps very soon we will be able to forget about unpleasant tides, bouts of irritation, night sweats and other discomfort and continue to enjoy life.