The clinical picture of menopause is very diverse. Initially, there are usually various vascular disorders, manifested by tides of blood to the head and upper body due to sudden short-term vasodilation. During the tide, the face, neck, and chest suddenly turn red, the temperature of hyperemic areas rises. In many women, hot flushes are accompanied by sweating, dizziness, tinnitus. Tides occur at any time of the day and usually last for a few seconds or minutes. More often they are caused by nervous tension, excitement. Often, the climacteric syndrome is expressed by excessive sweating, short-term chills, fluctuations in blood pressure (often short-term or persistent increase), sometimes palpitations and pain in the heart, as reported by the Internet publication for girls and women from 14 to 35 years Pannochka. net In addition to vascular disorders, various neuropsychiatric disorders are often noted. This is more common in women with unstable psyche, especially in the presence of external factors that cause fear of future old age and infirmity, fear of emerging changes in appearance, leading to a loss of former attractiveness. The climacteric syndrome in these women is often expressed by emotional instability with a propensity to depression, increased reactivity to somatic injuries and mental traumas, a tendency to tearfulness, resentment, quick temper, and sometimes vice versa, insensitivity to sensory stimuli (especially strong sound and light), sensation fears and anxieties (fear of death, fear of loneliness, etc.. Similar nervous and mental disorders are almost always accompanied by hot flushes.
Frequent symptoms of the pathological climax are endocrine disorders, manifested by disorders of the thyroid gland function, cortical substance of the adrenal glands, metabolic processes, etc.. Particular importance is attached to the thyroid gland function in "strained" states of the body, which is the climacteric period, when the organism withstands a great strain in connection with the restructuring both in the nervous and endocrine systems. In this case, the function of the thyroid gland increases with an increase in basal metabolism, and in some patients there is a marked picture of thyrotoxicosis. The content of iodine in the blood with menopause is almost always increased.
The function of the cortical substance of the adrenal glands is in close relationship with the function of the sexual glands, complementing and compensating for their function, therefore the nature and duration of climacteric period disorders in women depends to a certain extent on the compensatory function of the cortical substance of the adrenal glands.
Changes in the function of the adrenal glands are indicated by some clinical symptoms of menopause (adynamia, arterial hypertension, asthenia, pain in the heart, hirsutism, etc.. In some patients, these symptoms appear in isolation, in others - in the aggregate, in the form of a syndrome.
Climacteric syndrome occurs during menstruation, before and at different times after menstruation, as well as in the period of menopause. More often and more pronounced climacteric syndrome in the first phases of menopause.
A serious complication of the climacteric period is dysfunctional uterine bleeding, which in women over 40 years old accounts for 50-60% of all bleeding in this period of life.
Hormonal function of the ovaries with the onset of menopause does not stop immediately. Initially, the development of the follicle or yellow body is disturbed, which causes the appearance of dysfunctional bleeding. The violation of ovulation and the formation of the yellow body is expressed by the follicle's persistence. The yellow body is not formed, the menstrual cycle becomes anovulatory.
Disturbance of maturation of follicles leads to disruption of cyclic changes in the mucous membrane of the uterus. Most often there is hyperplasia of the endometrium in the absence of secretory changes. Glandular-cystic hyperplasia exists for a long time, since the absence of the yellow body and progesterone prevents the onset of the secretory phase. The pathologically altered endometrium is subjected to extensive thrombosis, necrosis and erratic rejection accompanied by menstrual bleeding.
Climacteric hemorrhages begin more often after a delay in menstruation, less often bleeding appears on the day of expected menstruation, or even somewhat earlier, but almost always with subsequent prolonged bleeding of varying degrees, lasting several weeks and even months. In addition to the duration, a characteristic feature of climacteric bleeding is their tendency to recur sometimes during 4-5 years. Bleeding in the climacteric is usually very abundant, sometimes life-threatening. More often, despite the duration of bleeding, patients do not develop significant anemia, except for cases of a combination of menopausal bleeding with uterine fibroids.
Diagnosis of the pathological menopause often does not cause difficulties, since in most cases the characteristic symptoms appear at the age approaching menopause, and coincide in time with the violation of the menstrual cycle or the termination of menstruation.
Diagnosis is impeded by various concomitant diseases that coincide in time with the menopause or occur latent and manifest only in the climacteric period. With climax, somatic diseases become aggravated, and menopausal syndrome against a somatic disease is characterized by a more severe course, often with atypical manifestations.
To clarify the diagnosis, special research methods are needed to judge the functional status of the ovaries. The most commonly used histological examination of scraping of the uterine mucosa and colpositologic examination of vaginal smears in the dynamics. The presence of anovulatory cycles confirms the relationship of functional disorders with climacteric syndrome. The diagnosis of climacteric bleeding confirms the absence of a secretory phase in the endometrium, a single-phase rectal temperature, the presence of IV vaginal smear reaction. The cause of uterine bleeding in menopause and menopause can also be cancer of the neck and body of the uterus, ovarian cancer with metastases to the uterus, fibroids of the uterus, endometriosis, body polyps and cervical uteri, etc.. For differential diagnosis, a diagnostic separate curettage of the mucous membrane of the uterus and the cervical canal with subsequent histological examination of the scraping.
In some cases, the cause of bleeding in the climacteric period may be inflammatory diseases of the genital organs and an incorrect position of the uterus (fixed retroflection), causing stagnation of venous blood in the pelvis. There are data on the occurrence of bleeding in menopause with long-term intake of various hormonal drugs.
Since the pathological course of menopause is associated with the age-related rearrangement of the function of many organs and systems, especially the nervous and endocrine, then the treatment should be aimed at regulating their interrelation.
After examination and diagnosis, the doctor prescribes general restorative therapy, symptomatic, hormonal, physical methods, psychotherapy, etc..
With dysfunctional uterine bleeding in the climacteric period, treatment is carried out in two stages: the first stage - stopping bleeding, the second - the normalization of menstrual function or its complete shutdown. The leading link in the complex of therapeutic measures is hormone therapy, which regulates the influence of both endocrine and nervous system. Along with hormonal therapy prescribe physiotherapy methods of treatment (electrotherapy and ultrasound).
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