Climacteric syndrome (menopause)

Climacteric syndrome (menopause) is a symptom complex that develops in some women during the period of fading of the functions of the reproductive system against the background of general age-related involution of the body.

ICD-10 code

• N95.1 Menopause and climacteric state in women.

Epidemiology

Climacteric syndrome occurs on average at the age of 45-55 years and can bother a woman up to 60 years, and sometimes longer. The frequency and prevalence of the disease reach 89.7%, its individual symptoms - from 20 to 92%. In the climacteric period, premenopause, perimenopause and postmenopause are distinguished. Menopause is the last independent menstruation in a woman's life. Perimenopause is the period from the onset of the first climacteric symptoms to one year after the last independent menstruation, i.e. it includes premenopause, menopause and one year after menopause.

Risk factors for cardiovascular disease:

• smoking;
• arterial hypertension;
• hypercholesterolemia;
• obesity;
• sedentary lifestyle.

Risk factors for cancer of the genitals and mammary glands:

• the presence of cancer of the genital organs and breast in close relatives;
• history of precancerous diseases of the genitals and mammary glands;
• frequent sexually transmitted infections and the presence of human papillomavirus;
• early menarche (before 12 years);
• late menopause (over 50 years);
• absence of childbirth;
• a history of frequent abortions, especially before the first birth.

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Classification of menopause

Climacteric disorders are classified as follows.

• Vasomotor: hot flashes, chills, sweating, headache, hypo- or hypertension, increased heart rate.
• Emotional-vegetative: irritability, drowsiness, weakness, anxiety, depression, memory and attention impairment, decreased libido.
• Urogenital: dryness, itching and burning in the vagina, dyspareunia, pollakiuria, cystalgia, urinary incontinence.
• Skin and its appendages: dryness, brittle nails, appearance of wrinkles, dryness and hair loss.
• Metabolic disorders: cardiovascular diseases, postmenopausal osteoporosis, Alzheimer's disease.

There are different forms of climacteric syndrome depending on their severity:

• mild - the number of hot flashes up to 10 per day with a satisfactory general condition and ability to work of the woman;
• average - the number of hot flashes is 10-20 per day, pronounced symptoms of the disease are observed (dizziness, headache, deterioration of sleep, memory, etc., deterioration of the general condition and decreased performance);
• severe - the number of hot flashes is more than 20 per day, a significant decrease in performance is noted.

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Diagnosis of menopause

To assess the severity of climacteric syndrome, the Kupperman index is used as modified by E.V. Uvarova. The identified symptom complexes are analyzed separately. The value of symptom complex (a), assessed from 0 to 10 points, is considered as the absence of clinical manifestations, 10–20 points - as a mild form, 21–30 points - as moderate, over 30 points - as a severe form of the syndrome. The value of symptom complexes (b) and (c), assessed by 1–7 points, is considered as a mild form, 8–14 points - as moderate, over 14 points - as a severe form of climacteric syndrome.

Climacteric syndrome (menopause) - Diagnostics

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Treatment of menopause

Hormone replacement therapy (HRT) is estrogen (ET) or estrogen-gestagen therapy for women in the climacteric period. Clinical symptoms of climacteric syndrome are caused by estrogen deficiency, so the use of estrogen replacement therapy is justified. Progestins are drugs that act like natural progesterone, they are used as hormone replacement therapy to prevent hyperestrogenic conditions (endometrial hyperplasia, genital and breast cancer) against the background of estrogen monotherapy in women with a uterus. Hormone replacement therapy is an effective way to prevent and treat osteoporosis, urogenital atrophy and primary prevention of cardiovascular diseases.

Climacteric syndrome (menopause) - Treatment

Prevention of climacteric syndrome

A healthy lifestyle (no smoking or excessive alcohol consumption) contributes to a later onset of menopause and a reduction in the intensity of climacteric syndrome symptoms. In addition, the use of hormone replacement therapy (HRT) in the perimenopausal period, when the first symptoms of the disease develop, reduces the incidence of moderate and severe menopause.

Forecast

Favorable.

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