Artificial menopause

Artificial menopause is a condition characterized by decreased ovarian function, which is caused artificially for therapeutic or prophylactic purposes. Often, artificial menopause is the only way to treat a particular pathology. But this condition requires careful correction and monitoring, since changes in other organs and systems are possible. It is necessary to gradually exit artificial menopause, because all changes in the ovaries must be corrected. As for the general hormonal background, strict control is also necessary here.

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Causes artificial menopause

Menopause is a physiological process of changes in the female reproductive system, during which involutionary processes occur in the body. These changes occur primarily with the reproductive system, but since it is continuously connected with the normal functioning of other organs, these changes affect the entire body. The hormonal background of the female body is very diverse and ensures not only the functioning of the female genital organs, but also affects metabolism. Therefore, hormonal changes during menopause lead to changes in the entire body. Under normal conditions, menopause comes gradually and has several stages in its development:

1. premenopause – the period from 45 years to the onset of menopause;
2. menopause – the period of the last menstruation, average age is about fifty years;
3. postmenopause – the period from the last menstruation until the end of a woman’s life.

All these periods are characterized by consistent changes in the body, so that all organs and systems can adapt to such changes. In artificial menopause, an important distinctive feature of such menopause is a sharp change in hormonal levels, which can affect the functioning of other systems.

The main reasons for which artificial menopause can be used as a treatment method are diseases of the female reproductive system. These include uterine fibroids, endometriosis, ovarian cysts, infertility, malignant hormone-dependent diseases of the uterus and appendages.

The main mechanism of action of artificial menopause on the course of these diseases is a sharp disruption of the hormonal background, which is accompanied by a change in the growth and development of diseases. Normally, the level of estrogens during physiological menopause decreases gradually. The most specific changes occur in the ovaries in the form of follicular atresia, destruction of membranes, death of oocytes and preservation of only the stroma, which contributes to a decrease in the amount of secreted estrogen. This, in turn, disrupts the feedback with the hypothalamus, which further increases the changes. Stimulation of the pituitary gland decreases and the release of follicle-stimulating and luteinizing hormones is disrupted, which leads to an anovulatory cycle without the release of an egg. As a consequence of all these processes, there is no sufficient concentration of hormones and their alternation for the onset of the next normal menstruation, and menstruation does not occur. At the same time, the processes in the peripheral cells of the body gradually reduce their activity and "get used" to the deficiency of estrogens.

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Pathogenesis

The pathogenesis of artificial menopause development is almost identical, but has its own peculiarities. At the same time, in the ovaries, against the background of a decrease in the level of estrogens, atresia of follicles, destruction of membranes and death of oocytes do not occur, since these changes are abrupt. Only a delay in the release of the egg from the follicle is observed, that is, ovulation does not occur against the background of normal function of the ovaries and cortical structures regulating the ovariomenstrual cycle. At the same time, there are corresponding changes in the uterus and other organs, since the general hormonal background changes and this affects the peripheral systems. Therefore, the exit from artificial menopause can be normal and the menstrual function can be fully restored.

The main pathogenetic features of artificial menopause in various pathologies are the following:

1. Uterine myoma is a benign disease of the uterus, which is accompanied by high proliferative activity of myometrium cells with the formation of a volumetric structure in the uterine cavity. This disease is hormone-dependent, that is, the stimulus for such active reproduction is female sex hormones. Therefore, to reduce the growth of myomatous structures, it is necessary to reduce the amount of hormones that support their development. Artificial menopause for myoma thus promotes regression of fibroids and allows for further treatment methods, such as surgical treatment of myoma.
2. Endometriosis is a disease, the essence of which lies in the appearance of foci of the endometrium not only in the uterine cavity, but also outside it, which is accompanied by cyclic changes in these areas in the form of menstruation, regardless of localization. Normally, the proliferation of such cells is provided by the level of estrogens and during physiological menopause, a woman fully recovers, since the level of these hormones decreases. Therefore, by artificially reducing the level of estrogens, endometriosis can be completely cured, which is used as the basis for conservative treatment.
3. Ovarian cysts are benign non-proliferating ovarian neoplasms that have a thin wall and fluid inside, or the cyst contents may not be liquid but heterogeneous, for example, areas of endometriosis. At the same time, the cyst tends to grow in accordance with the proliferative activity of cells under the influence of hormonal changes in the ovary. Therefore, artificial menopause can lead to regression of the cyst or to a decrease in its size.
4. Infertility is a common problem for many women, one of the reasons for which may be a hormonal imbalance. This may occur with luteal phase deficiency, which leads to anovulatory cycles, so a woman cannot get pregnant, because the egg does not leave the follicle. Therefore, artificial menopause can help reduce the level of estrogens, and then stimulate the rupture of the follicle. Sometimes artificial menopause is used for reproductive technologies - in vitro fertilization. Then, hypoestrogenism is stimulated, that is, artificial menopause, and then progestin hormones are suddenly given, which promotes the release of several eggs at once, then they are extracted and fertilized, which increases the chances of successful implantation of several eggs at once and their development.
5. Malignant hormone-dependent diseases often require preoperative artificial menopause to reduce the mass of tumor cells, or the operation can contribute to the development of artificial menopause due to the removal of the ovaries. Then this process is irreversible and correction of the hormonal background is necessary.

The main drugs for artificial menopause are gonadotropin-releasing factor agonists. These drugs help regulate hormonal levels by releasing statins, which inhibit the synthesis of estrogens and progesterone, which reduces their amount in the blood and regulatory capacity. Representatives of this group of drugs are the following:

• Diphereline or Triptorelin - the drug is used from the 3rd day of the menstrual cycle for six months at 3.75 milligrams.
• Goserelin - is used for six months at 3.6 milligrams subcutaneously.
• Buserelin – 200 micrograms in the nose twice a day for a six-month course.
• Zoladex – from the 1st to the 5th day of the cycle by injection.

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Symptoms artificial menopause

All changes in a woman's body during artificial menopause are associated with a violation of the amount of hormones and their insufficient function, which occurs quite abruptly. Normally, estrogens and progesterone regulate the nervous system, bone tissue, cardiovascular system and mineral metabolism processes. During artificial menopause, the level of estrogens drops, their regulatory effect on the tone of the brain vessels and peripheral tissues decreases, which in turn contributes to the disruption of the adrenal glands. High levels of catecholamines contribute to changes in pressure, cause heart palpitations and vegetative reactions in the form of a feeling of sweating, a feeling of facial heat. Extraovarian sources of estrogen synthesis begin to activate in the body - this is adipose tissue, as well as the adrenal cortex, which causes increased synthesis of androgens, leptin, mineralocorticoids. They have other undesirable effects in the form of obesity, masculinization, decreased libido, as well as water and sodium retention, which affects the development of hypertension. These symptoms can develop suddenly and may be the first signs of artificial menopause.

The first symptoms of artificial menopause can also often be non-specific, and can manifest themselves in vegetative and emotional changes. At the same time, the processes of emotional instability are clearly expressed, which occurs due to a violation of the regulation of excitation and inhibition processes in the central nervous system. This is manifested by increased mental lability, irritability, depression, sleep disturbance in the form of drowsiness or insomnia. Work capacity and endurance are significantly reduced, fatigue is increased, and libido decreases. Sex during artificial menopause also suffers, since in addition to a decrease in libido, emotional changes occur in the form of a feeling of aging of the body. Dry skin of the genitals, itching, and unpleasant sensations during sexual intercourse also occur. All this can further aggravate intimate relationships with the husband, so it is necessary to monitor the activity of treatment and the degree of expression of such changes.

Sometimes the symptoms of artificial menopause can manifest themselves in the form of pathology from other organs and systems, which is caused by a sharp decrease in hormonal levels. Therefore, such changes often come to the fore. The cardiovascular system suffers due to hypercatecholaminemia, which is characterized by arrhythmias in the form of interruptions in the work of the heart, paroxysmal tachycardia. The processes of regulation of vascular tone are disrupted, which contributes to periods of spasm of peripheral vessels, increased peripheral resistance and increased arterial pressure. Also, arterial hypertension is facilitated by sodium and water retention and an increase in the volume of circulating blood.

Hormonal imbalance during menopause causes metabolic disorders in the form of hypercholesterolemia and dyslipidemia. This is an unfavorable sign and therefore ischemic heart disease and angina often develop during this period.

Another serious disorder occurs with bone tissue. A decrease in estrogen levels contributes to the removal of calcium from bones, disruption of its absorption in the intestines and the development of osteoporosis. This causes clinical manifestations in the form of pain in the legs, fatigue, muscle twitching.

All these conditions need to be corrected, and since the treatment of pathologies based on the principle of introducing a woman into artificial menopause lasts for 3-6 months, it is necessary to monitor all processes in the body.

Menstruation after artificial menopause should be fully restored, in case of correct and timely exit from menopause. But in the first three months there may be minor changes in the form of heavy menstruation or scanty discharge. But in any case, this also needs to be carefully monitored.

The exit from artificial menopause should be gradual, the drugs should be taken gradually with a decrease in dose until menstruation occurs, and then gradually discontinued. It is necessary to conduct a screening of the hormonal background after treatment and determine the amount of the main hormones, since it is possible that correction will be required.

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Complications and consequences

The consequences of artificial menopause may be ovarian atresia or involution of the functional endometrial sphere, which occurs with prolonged incorrect treatment. Then it becomes very difficult to restore the normal cycle. Therefore, it is necessary to prevent such conditions by proper management of patients with timely exit from artificial menopause.

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Forecast

The prognosis for recovery in the case of using artificial menopause as a treatment method is positive, since it can be a very effective method if used correctly.

Artificial menopause is one of the effective methods of treating some diseases that are hormone-dependent. It is very important to follow the basic recommendations regarding taking medications and correcting the general condition, since hormonal treatment is a very complex method and requires constant monitoring.

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