Menopause is a transitional phase between the extinction of the ability to bear children and the onset of old age. The climacteric period covers about 10-15 years of a woman’s life and consists of three phases. Menopause as the last uterine bleeding, regulated by the ovaries, occurs in 50-51 years. The years preceding menopause (4-5 years) are called premenopause. The period spanning premenopause and one and a half years after menopause is referred to as perimenopause. The remaining period of life to old age – postmenopause.
Involutive changes associated with the onset of menopause occur throughout the woman’s body, including the ovaries. The symptoms, called menopausal syndrome, or the symptoms of “critical age”, pathogenetically coincide with the symptoms of estrogen deficiency syndrome. Along with the objective manifestations of estrogen deficiency, such as menstrual disorders, atrophy of the urogenital tract mucosa, osteoporosis and disorders of cardiovascular activity, a number of subjective complaints appear. These include vegetative attacks, including sudden attacks of sweating and redness of the skin, as well as such more or less uncharacteristic signs such as irritability, forgetfulness, and headaches. Perhaps, every woman during menopause shows any of the above symptoms.
The menopausal syndrome occurs in 37% of premenopausal women and in 40-70% with the onset of menopause. The highest frequency and intensity of typical symptoms of the menopausal syndrome is observed during the first two to three years of the postmenopausal period.
Among the variety of complaints made by women to these or other disorders, psychological and organic symptoms are distinguished. Many women experience depression, mood swings, sleep disturbance, nervousness, memory loss, lack of energy, concentration, which is mainly due to a reaction to estrogen deficiency in the central nervous system. Such changes adversely affect the psyche and significantly reduce the quality of life for women. Organic symptoms of the menopausal syndrome include atrophic changes in the urogenital tract, which are observed in 80% of women 4-5 years after the onset of menopause. In urogenital disorders, itching, bleeding or dyspareunia, vaginal infections, painful and involuntary urination are noted. Loss of tone of the supporting ligaments and pelvic floor muscles can lead to prolapse and prolapse of the vagina and uterus. Estrogen-dependent tissues also include skin, hair, and nails. All of them are prone to atrophy due to a generalized decrease in the collagen content during menopause. Late or chronic postmenopausal diseases include diseases of the cardiovascular system and osteoporosis.
Principles of therapy
The main method of prevention and correction of climacteric disorders is hormone replacement therapy (HRT) with various analogs of sex hormones
Hormone therapy, in this case, does not pursue the goal of restoring the physiological function of the ovaries.
The main provisions on the use of hormone replacement therapy:
- Use only analogs of natural hormones;
- Use of low doses of estrogen, corresponding to the level of endogenous estradiol in the early phase of proliferation in young women;
- The combination of estrogen with progestogens, which eliminates hyperplastic processes in the endometrium;
- With uterus removed, estrogen monotherapy may be prescribed;
- The duration of hormone prophylaxis and hormone therapy is at least 5-7 years for the prevention of osteoporosis and myocardial infarction.
Preparations for hormone replacement therapy are used in various forms: oral and parenteral. Oral dosage forms: tablets, dragees. Parenteral forms: ampoules, sprays, vaginal, skin and intrauterine.
Currently, there are two main modes use of HRT. Estrogen monotherapy (Proginova, Estrofem, Klimara, Divigel) is recommended for women with a womb removed – intermittent or continuous courses. In urogenital disorders, the drug Ovestin (candles, cream) is ideal. Women in perimenopause with an intact uterus are used cyclic two-and three-phase drugs (Klimen, Klimonorm, Femoston, Divina, Trisequens), containing estrogenic and progestin components. With this (cyclic) mode of HRT, about 80% of women have regular menstrual bleeding. For postmenopausal women, it is preferable to prescribe combined medications in a continuous mode in order to avoid cyclic menstruation (Kliogest, Livial).
Before use HRT should conduct an examination:
- The study of gynecological and somatic history;
- Ultrasound examination with an endovaginal probe;
To identify women at risk for the development of late complications, it is desirable to further study the following parameters: blood biochemistry, including lipid profile, blood pressure measurement, hemostasiogram, blood hormones, densitometry.
Hormone replacement therapy is contraindicated in breast and genital cancers; with bleeding of unknown genesis; with thromboembolism in the previous six months, hematoporphyria; hepatic and renal failure.
Indications for t hormone replacement therapy are:
- Climacteric syndrome;
- Postovariectomy syndrome;
- Urogenital disorders;
- Diseases of the heart and blood vessels;
- .Alzheimer’s disease.
Hormone replacement therapy, prescribed in a cyclical mode, provides for the regulation of the rhythm of menstruation in 80-90% of cases and provides a therapeutic effect in relation to typical manifestations of menopausal syndrome in 85-90%. For women at risk of developing cardiovascular diseases, it is preferable to administer drugs that include progestogens – progesterone derivatives (Klimene, Femoston, Divina). If we are talking about patients with the risk of osteoporosis and hyperplastic processes in history, preference is given to drugs that have in their composition norsteroid progestogens (Clemonorm, Trisequens).
For women suffering from climacteric disorders, if there are contraindications or if the patient abandons HRT, general strengthening treatment, physiotherapy exercises, a balanced diet, as well as homeopathic remedies (Menopause-plan) or herbal medicine (Klimadinon) are recommended.
The benefits of HRT in the treatment and prevention of menopausal disorders are obvious. The use of HRT improves the quality of life of women in older age groups, reduces the risk of developing cardiovascular diseases by 30-50% and the risk of fractures from osteoporosis by 50-70%.
However, not all controversial issues on hormone replacement therapy have been studied. This is due not only to a lack of understanding of the changes that occur during the period of menopause but is also the result of poor ideas about the biological effects of hormonal drugs, especially with long-term use. But these questions should be attributed to the fundamental science, clinicians, as well as specialists in the pharmaceutical industry.
The health, quality of life and safety of women taking hormone replacement therapy depend on how soon these issues are resolved.
Hormone replacement therapy, or HRT, is a course of treatment aimed at replacing the missing hormones in the body.
As hormone levels recover, menopause symptoms subside quickly. In addition, HRT prevents the development of long-term effects of menopause, such as osteoporosis and cardiovascular diseases.
Hormonal therapy is better to start as soon as possible – when the first symptoms of menopause occur. For relief of early symptoms, it is enough to take HRT for two years. However, for the prevention of osteoporosis, HRT should be performed for at least 5-10 years after menopause.
As part of drugs for hormone therapy include estrogen and progesterone (female sex hormones).
With the onset of menopause, estrogen is produced in a much smaller amount, which causes the appearance of vegetative, psycho-emotional and urogenital disorders. Therefore, estrogens are the main component of all types of HRT drugs. As part of modern hormone replacement therapy drugs, only natural estrogens are used.
Currently, HRT is supplemented with progesterone drugs, since it was found that it reduces the likelihood of cancer of the mucous membrane of the uterus (endometrium). This combination is assigned to all women using HRT during menopause, with the exception of women who have a uterus removed.
Thus, the choice of means for carrying out HRT is defined to a large extent by its safety and portability. Today, in the arsenal of doctors there is a wide choice of drugs and forms of HRT – tablets, suppositories, creams, patches, subcutaneous implants.
There are drugs that cause menstrual bleeding, and drugs that do not cause them. All this allows the doctor to choose the treatment individually for each woman, according to her features and wishes.