Menopause

Every woman, regardless of the type of activity and place of residence, faces at some point of her life a problem such as menopause. Natural menopause is determined as the permanent cessation of menstruation, established retrospectively after 12 months of amenorrhea (absence of menstruation) without any other obvious pathological or physiological causes. Menopause is a physiological period in a woman's life when the involutional changes in the gonads predominate, leading to the cessation of reproductive and menstrual functions, as well as changes in appearance, well-being and health. This process occurs at age of 51 years and is a reflection of complete or almost complete depletion of ovarian follicles. According to the WHO, the number of menopausal women in the world - 457 million in 1996, in 2010 - 843 million. In 2030, the number of women in this age group will be about 1 billion 200 million.

Menopausal (climacteric) syndrome is a complex of symptoms observed during menopause, it is a pathological state, certain factors play a role in the development of this state:

• genital and extragenital diseases,
• surgery (ovariectomy),
• disorders of reproductive function,
• hereditary factors (Down syndrome),
• medication (breast cancer drugs), radiotherapy,
• modern ecological and reproductive dissonance,
• social and living conditions.

Which signs will help to determine that you have really approached the stage of life called "menopause"? There are 4 groups of symptoms that indicate the appearance of menopausal syndrome:

• vasomotor (hot flashes, chills, sweating, headaches, fluctuations in blood pressure, rapid heartbeat);
• emotional and vegetative (irritability, drowsiness, sleep disturbances, weakness, anxiety, depression, memory loss, ability to concentrate, decreased libido);
• urogenital (vaginal dryness, itching, burning, dyspareunia, urethral syndrome, cystalgia, urinary incontinence, hyperactive bladder);
• dermatological (dry skin, wrinkles, brittle nails, dryness and hair loss).

In case of any of the above symptoms, you should immediately consult an obstetrician-gynecologist, who will conduct a full clinical and laboratory examination. Diagnosis of menopausal syndrome includes:

• anamnesis (somatic and reproductive),
• special gynecological examination with PAP-test,
• ultrasound assessment of uterine structure and endometrial diameter, ovarian structure, exclusion of tumor process,
• examination of the mammary glands - ultrasound, mammography,
• examination of glucose level, lipid complex, calcium, phosphorus levels, kidney tests,
• functional diagnostics (blood pressure, ECG recording, ultrasound of the heart, etc.),
• hormonal test: TSH, T3, T4, antibodies to thyropyroxidase, levels of FSH, LH, estradiol, prolactin, testosterone,
• tumor markers (optional).

Treatment of menopausal syndrome requires a complex approach with the use of symptomatic, hormonal and non-hormonal therapy, as well as the antipsychotic treatment, lifestyle modifications and dietary adjustments. Today, the “gold standard” for the treatment and prevention of menopausal syndrome is menopausal hormone therapy (MHT), which is prescribed by the obstetrician-gynecologist individually, taking into account the state of health and the presence of comorbidities. If it is impossible to use hormonal drugs, preference is given to homeopathic, homeostatic therapy and herbal therapy.

In any case, you should remember that "menopause" and "menopausal syndrome" - not a sentence for a woman's body. It is necessary to consult an obstetrician-gynecologist, who will prescribe the necessary examination and treatment in a timely manner. The elimination of unwanted symptoms will restore a normal rhythm of life and prevent the development of serious complications such as cardiovascular disease and osteoporosis.

Sources:

• Герасимова Т.В. Тези до лекцій по гінекологічній ендокринології, 2018.
• Педаченко Н.Ю., Татарчук Т.Ф. Менопауза: оптимальні методи для покращення якості життя жінки. «Гінекологія, Акушерство, Репродуктологія» № 1 (29), 2018.
• Тобі де Вільєрс, Татарчук Т.Ф. Національний консенсус щодо ведення пацієнток у клімактерії. «Репродуктивна ендокринологія». № 1 (27), 2016. С. 8 – 25.
• Robert F Casper. Clinical manifestations and diagnosis of menopause. UpToDate, 2021.
• https://www.nhs.uk/conditions/menopause/