Phase of menopause

Disturbances in the autonomic nervous system during the physiological course of menopause appear in the form of relatively rare headaches, palpitations, uneven pain in the heart, increased sweating, dry mouth, disorders of the gastrointestinal tract in the form of constipation or diarrhea. These manifestations may not always be, but arise only when mental and physical fatigue, overeating, systematic lack of sleep, prolonged exposure to sun or cold, a sharp change in climate, fluctuations in humidity, ambient temperature, atmospheric pressure.

The vegetative nervous system is more labile, more mobile than the central nervous system, so even with weak stimuli and minor stresses, the woman immediately develops heartbeats, digestive disorders, worsening of urination (by the type of frequency), fluctuations in arterial pressure - then increase or decrease.

All these symptoms in practically healthy women are unstable and when the factors that cause them are either weakened or disappear altogether.

If these symptoms become persistent or become more pronounced, the woman should think about the fact that the normal course of the menopause may have become pathological and seek medical help.

In addition, it must be remembered that during the period of aging, such diseases of the nervous system as senile psychoses, schizophrenia, depressive states, etc. can arise.

All these changes are caused by a decrease in the level of female sex hormones, which counterbalance the nervous system of women at a young age, protect it from stress.

Violations in the cardiovascular system in menopause can be one of the main factors affecting the health and life expectancy of women, it is very difficult to distinguish between age changes in the cardiovascular system and its damage in atherosclerosis. On the other hand, the age-related changes in the metabolism in the wall of the vessels - this is atherosclerosis.

The property of female hormones to positively influence the function of the cardiovascular system decreases in the climacteric period, when their level decreases. The woman notes the appearance of various kinds of pains and unpleasant sensations in the region of the heart, palpitations, feelings of heaviness.

Scientists have proved that the blood pressure in a person from 20 years to old age gradually increases (and in women more than men). At 60 years, the pressure stabilizes, and in women even slightly decreases. Also, due to the development of atherosclerosis with age, the vessels become more elastic and rigid, which increases their resistance, and hence blood pressure.

The pressure in the veins practically does not change, but their structure is also broken, so-called "veins dilatation" develops, thrombophlebitis, which can even cause trophic ulcers of the shin.

Atherosclerotic changes affect the area of ​​the bundle of His in the heart - the place that is the driver of the rhythm, so the pulse rate can either change with age, or may increase or decrease, or arrhythmia in general without a clear rhythm. Therefore, the heart finds itself in such conditions when, with increased physical exertion, mental stress, overeating, changing weather conditions, i.e. under conditions that are easily tolerated in youth, already in the climacteric period the heart can dramatically disturb its state, Before the development of heart failure and myocardial infarction.

In pre-menopause, there is a change in the coagulation properties of the blood, a moderate increase in its coagulation. With age, the activity of platelets increases - blood cells involved in blood clotting, intravascular fibrinogenesis increases and, in addition, the ability to resolve blood clots decreases. But this is counteracted - in postmenopause, as a result of a significant decrease in estrogen, thrombus formation is inhibited and fibrinolysis is activated (resorption of already existing clots). That is, the age-related decrease in estrogen is a genetically programmed factor that reduces the risk of thromboembolism, which means, heart attacks and strokes. This factor in men do not.

Changes in other endocrine glands are almost identical to changes in the ovaries: at the beginning of the climacteric period, there is a slight hypertrophy (increase) and an increase in the number of hormones released, and in postmenopause, hypotrophy occurs, that is, a decrease in the gland, a decrease in its function.

The thyroid gland also increases somewhat in size at the beginning of the climacteric period, and by 70-75 years of the woman's life her weight decreases by one third.

In the normal course of menopause, in almost healthy women, slight thyrotoxicosis (increased thyroid activity) is observed at the beginning of the menopause (premenopause). And in postmenopause, hypotrophy (reduction in the size of the gland) occurs with hypothyroidism (a decrease in the thyroid function), and with age these changes progress, the gland decreases more and more in size, and there comes a severe failure of its function, that is, pronounced hypothyroidism. Hypothyroidism generally refers to slowly developing diseases, and its manifestations are very similar to the aging of the body: dry skin, brittle nails and hair, memory impairment and decreased performance, chilliness and even chills, weakness, drowsiness. Therefore, in order to accurately diagnose, it is necessary to investigate both the function of the thyroid gland and the function of the hypophysis-the hypothalamus: if the content of the thyroid gland and TSH (thyrotropic hormone) of the pituitary gland is simultaneously reduced, this is an indication of the aging of the organism. If only a decrease in the hormone of the thyroid gland is observed, then this is a pathology of the thyroid gland, hypothyroidism.

At the beginning of the climacteric, the adrenal glands take on the dying function of the ovaries. They also secrete both female sex hormones and masculine. But more still there is a preponderance in the direction of male sex hormones. Therefore, at the beginning of the climacteric period, women have the so-called virile symptoms (those that make a woman look like a man: a lower voice, hirsutism (growth of hair on the chin, "whiskers", single hair on the mammary glands, increased hairiness of the hands and feet) Porosity of the facial skin, acne). But, as in all other cases, the adrenal glands are depleted, and the woman shows signs of insufficiency of their activity: muscle weakness, pallor and flabbiness of the skin, low blood pressure appears and progresses.

In the intestine there is a violation of the motor function, which manifests itself as constipation, less often diarrhea or alternating constipation with diarrhea.

Disturbances in the liver also manifest stasis - dyskinesia of the biliary tract to the formation of stones in the gallbladder and ducts. Changes in the liver - one of the reasons that contribute to the development of metabolic disorders and obesity.

In the kidneys there is a slight decrease in the daily amount of urine released. But at the same time there is an increased frequency of urination.

With the age of significant changes occur in the bone system. Reduces the density and thickness of bones, which can even reduce the growth of women.

In the connective tissue, which is particularly rich in the skin, the following changes are observed: its elasticity is reduced by decreasing the water content in the fibers, by increasing the strength of the collagen fibers themselves and by reducing the percentage of the intermediate substance. As a result, wrinkles appear, the skin is hanging, etc.

During the climacteric period, physicians distinguish three phases:

• 1) premenopause - the period of menstrual dysfunction until the last "menstruation" (menopause); Occurs in 45-49 years and lasts from 2 to 6 years; Syndrome of ovulation failure;
• 2) menopause - the last "menstruation", i.e. the last uterine bleeding; Syndrome of persistent age-related cessation of cyclic ovarian function; Is calculated after the year of existence of a persistent cessation of bleeding; Comes about 50-55 years;
• 3) postmenopause - a syndrome of progressive atrophy of hormone-dependent organs (uterus, ovaries, mammary glands) and age-related evolution of the organism; This period from the cessation of bleeding (menopause) to a persistent change in the hormonal function of the ovaries; Lasts 5-10 years; From 49.5 to 60 years.

Changes in each phase of menopause

The first phase of the menopause, premenopause, is the very first and most vulnerable, it is at this time that the normal course can pass into the pathological path from various provoking factors. As already mentioned, in the normal course of menopause in this phase there is a gradual decrease in blood loss with "monthly" and an increase in the intervals between them to 40-90 days or more until the final stop (menopause). Sometimes women are meager, with a gradual decrease in the amount of blood until the complete cessation of spotting, but they come on time, and this "cycle" persists until menopause. Sometimes bloody discharge stops immediately. In any case, if a woman lives a regular sex life, pregnancy can not be ruled out, and with prolonged absences of menstruation it is necessary to appear to the gynecologist and / or to make an ultrasound of the uterus. After menopause, women still have some "hidden cycles" for some time (6-12 months or more), that is, although the menstruation is over, but the sensations that preceded and corresponded to the days of menstruation have remained.

The age-related rearrangement of the hypothalamus centers occurs in women long before the onset of disturbances in menstrual function. Already from 35-40 years, changes in carbohydrate, fat, protein metabolism, increase in body weight, changes in blood pressure and functions of the cardiovascular system, disorders of the gastrointestinal tract, etc., begin, which indicates that disorders occur in the hypothalamus.

The main violation in premenopause in the function of female genital organs is the absence of ovulation and the hormone of the yellow body - progesterone.

In the first cycles, ovulation can still come (after a delay), but little progesterone, the yellow body works very badly, and then ovulation stops at all and the yellow body is absent.

The second phase is menopause, the age of its onset ranges from 49 to 52 years. There is an earlier onset of menopause (38-48 years). The later onset of menopause (over 55 years) is not considered a pathology, as the worldwide trend is to increase the age of menopause and the duration of the hormonal activity of a woman. But women whose menopause does not come in 52-53 years, and even more so at 55 years, constitute a group of increased risk of developing genital tract tumors and are to be monitored by district gynecologists with appropriate examinations. First of all, it is necessary to exclude the tumor of the ovaries, then - the tumor of the uterus, precancerous and cancerous changes in the mucous uterus. In women with late onset of the first menstruation, there is often ovarian hypofunction (a decreased hormonal background), underdeveloped genitals - they and menopause comes earlier, as the weak ovaries are depleted earlier.

In the third phase of menopause - postmenopause - there are more pronounced age-related changes in the reproductive system, in the appearance of the woman and in her entire body. The pubic hair thinens, the skin of the labia major becomes flabby, the vaginal walls become smooth, pale pink, and then whitish, the uterus decreases considerably in size, the amount of mucus decreases dramatically and eventually disappears altogether, the cervix and vagina become " Dry "is a sign of a sharp decline and even the absence of estrogens.

The uterine mucosa first in the premenopause (and at the very beginning of the postmenopause) is somewhat hypertrophied, overgrown, is in the stage of proliferation (i.e., proliferation). Gradually, hypotrophic processes occur, the endometrium becomes thinner and then disappears altogether.

The mammary glands are also hormonally dependent organs, like in the uterus, the same processes are observed: in the first phase of the cycle (estrogen) - proliferation - glandular proliferation, in the second (progesterone) - maturation and secretion of glands (colostrum may even appear) . Since the second phase (progesterone) in the menopause is first strongly inhibited, and then absent at all, then in the mammary glands (as in the uterine mucosa) the maturation of the mammary glands stops, and their proliferation (proliferation, increase in quantity) first increases, which threatens the development Mastopathy, benign (cysts) and malignant tumors in the mammary gland in the first phase of menopause. But in postmenopause, the atrophic process begins, and the mammary glands gradually decrease in size, become flabby, the nipples turn pale and flatten.

Fat women have fatty degeneration of the mammary glands, and their size even increases.