Late menopause

Usually, menopause in women occurs between the ages of 45 and 52, and only about 5% of them experience it later – after 55. This phenomenon is called late menopause, and it is quite difficult to say for sure whether it is a plus or a minus. This process is individual for each woman, and whether it is a good or bad sign depends on the reasons why it did not start. Among the main factors of late menopause are gynecological pathologies and hereditary factors.

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Causes late menopause

The cause of late menopause is often heredity. Women whose mothers or grandmothers experienced menopause at around 60 years of age are likely to experience the same thing. If late menopause is due to heredity, then there is no need to worry about it.

But in some cases, late menopause occurs due to other factors. The reasons for this phenomenon can be quite dangerous - due to serious illness and operations performed in the area of the breast, uterus or ovaries.

Sometimes late menopause can occur as a result of radiation therapy or chemotherapy.

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Pathogenesis

The onset of menopause is characterized by a slow and gradual fading of the ovaries' functioning, and then their complete "switching off" (during the first 1-3 years of postmenopause menopause, only single follicles appear in the ovaries, which later disappear completely). As a result, the so-called hypergonadotropic hypogonadism condition develops (mainly estrogen deficiency), which is sometimes associated with changes in the functioning of the limbic system, and a violation of the secretion of neurohormones.

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Symptoms late menopause

Symptoms of menopause can be completely different, they are completely individual and depend on the body of each specific woman. Many note such signs as unreasonable anxiety, rush of blood to the skin of the face and neck, headache, frequent insomnia, rapid heartbeat. Usually, such symptoms last for several months, but sometimes they can be observed for a longer period. Such disorders are temporary and disappear after the body adapts to new physiological conditions.

Symptoms of menopause may also depend on body constitution. Thin women may develop osteoporosis, as well as disorders in the psycho-emotional sphere. Women with excess weight may experience headaches, as well as hypertension. Women who suffer from premenstrual syndrome in their youth, who have problems with fertilization, have a difficult time during menopause.

When the level of hormones in the blood decreases slowly, a woman experiences almost no symptoms in the initial period of menopause, but a rapid and sharp decrease is almost always accompanied by unpleasant pathological signs.

Why is late menopause dangerous?

Late menopause is dangerous because it can be one of the signs of the development of malignant neoplasms of the breast or ovaries. That is why, if a woman has not started menopause by the age of 52, it is necessary to undergo a mandatory examination by a mammologist and a gynecologist to make sure that there is no disease.

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First signs

Among the first signs of approaching late menopause are irregular (rare or heavier) periods, as well as so-called "hot flashes." Such symptoms may occur several years before menopause.

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Complications and consequences

Among the possible complications and consequences of menopause, the following problems are noted:

• Dysfunctional uterine bleeding;
• The possibility of developing diseases of the cardiovascular system (such as coronary heart disease, arterial hypertension, vascular atherosclerosis);
• Decreased bone density (this is a symptom of osteoporosis), which causes bones to become brittle, increasing the risk of developing various fractures;
• Development of oncological diseases.

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Diagnostics late menopause

When diagnosing late menopause, doctors first study the anamnesis to find out the risk of thrombosis and breast cancer, as well as to find out whether the patient has had any surgeries (both regular and gynecological) and whether she has any concomitant endocrinopathies and somatic diseases.

In addition, a physical examination is carried out, during which anthropometric data and blood pressure are measured, the weight index is determined, the skin and mammary glands are examined, and a gynecological examination is carried out using mirrors.

Even during the diagnostic process, using the Kupperman index, a point assessment of the symptoms of menopause that have manifested is carried out. The severity of other symptoms is assessed based on the patient's complaints, after which the points obtained are summed up for all indicators.

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Tests

During the examination to diagnose menopause, the following laboratory tests are taken:

• cytological examination of smears taken from the cervix (Papanicolaou method);
• determination of the level of estrogens in the blood (FSH, TSH and LH, as well as testosterone and prolactin);
• biochemical blood test (determination of AST, ALT and alkaline phosphatase levels, as well as creatinine, cholesterol, glucose, triglycerides and bilirubin);
• determination of blood lipid levels (atherogenic index, LDL and HDL cholesterol with VLDL, as well as lipoprotein (a)).
• coagulogram.

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Instrumental diagnostics

During instrumental diagnostics of menopause the following procedures are carried out:

• Pulse rate and blood pressure are measured;
• Mammography;
• Osteodensitometry;
• Transvaginal ultrasound (in this case, the criterion that there is no pathology in the endometrium is its thickness within 4-5 mm on the Meho);
• If the ultrasound results show that there is a thickening of the endometrium on the Meho, and it is more than 5 mm, or the appearance of GPE/endometrial polyp was detected, before starting HRT, it is necessary to perform a pipelle biopsy or separate curettage, and then conduct a histological examination.

Differential diagnosis

Menopause is a physiologically determined period that occurs in the life of every woman, so there is no need to conduct differential diagnostics. But if this syndrome is atypical (crisis and severe form or duration more than 5 years), it is necessary to conduct an examination to exclude thyroid or adrenal disease, hyperprolactinemia, as well as tumors of the pituitary gland, hypothalamus, ovaries, mammary gland or pancreas.

Treatment late menopause

Since most diseases during the climacteric period appear due to a deficiency of sex hormones (estrogens and progesterone) in the body, prescribing hormone replacement therapy (HRT) is completely pathogenetically justified. This treatment allows you to compensate for the hormonal deficiency due to the fading of ovarian activity. It is very important to obtain the optimal level of hormones required by the patient, while prescribing the minimum dose of the drug. Then the treatment of menopause will help improve the general condition and will not cause side effects.

There are 3 types of hormone replacement therapy:

• Monotherapy using progestogen or estrogen;
• A combination of estrogens and progestogens (this can be a continuous or cyclic regimen);
• Combination of estrogen and androgen.

If the treatment is longer, it is necessary to measure the effectiveness and safety of such therapy for each individual case.

Medicines

Monotherapy with estrogens. It is usually prescribed to women who have had their uterus removed. In this case, Estradiol is used at 2 mg orally once a day for 21-28 days, after which you need to take a week's break and repeat the course.

It is possible to prescribe a parenteral (cutaneous) method of drug administration. This method is used for chronic diseases of the pancreas, liver, problems with the hemostasis system, malabsorption syndrome, and a high probability of venous thrombosis. Indications for parenteral administration are hyperinsulinemia, hypertriglyceridemia (before and during oral use of estrogens (this especially applies to conjugated drugs)), arterial hypertension. This method is also used if there is a high risk of gallstones, migraines, smoking, and in cases where it is necessary to reduce insulin resistance, improve tolerance to the effects of glucose, and increase adherence to hormone replacement therapy.

Treatment regimen: Estradiol gel is applied to the buttocks and abdomen at 0.5-1.0 mg (Divigel) or 0.75-1.5 mg (Estrogel) daily, once a day. Another option is an Estradiol-releasing patch, applied to the skin at a dosage of 0.05-0.1 mg once a week.

Monotherapy with gestagens is suitable for women who do not require surgical intervention, with diagnosed adenomyosis and uterine myoma in the premenopausal period. Dysfunctional uterine bleeding is also an indication.

Treatment regimen:

• Dydrogesterone is taken orally at 10-20 mg once a day during the period of 5-25 days of the menstrual cycle. The second method is 10-20 mg once a day starting from the 11th day of the cycle for 2 weeks.
• Levonorgestrel, the system of administration is intrauterine (for this purpose a T-shaped rod with an attached container containing 52 mg of Levonorgestrel is used); the device supports the function of releasing Levonorgestrel into the uterine cavity within 20 mcg/day. A single administration is used.
• Medroxyprogesterone in a dosage of 10 mg is used internally once a day during the period of 5-25 days of the menstrual cycle. The second option is 10 mg once a day during the period of 16-25 days of the cycle.
• Micronized progesterone internally at a dosage of 100 mg 3 times a day during the period of 5-25 days of the menstrual cycle. The second option is a dosage of 100 mg 3 times a day during the period of 16-25 days of the cycle. The method of introducing the drug into the vagina at the same dosage during the periods of 5-25 or 16-25 days of the menstrual cycle can also be used.

Folk remedies

Most folk remedies can be combined with the main therapy (using medications), but you must first consult a doctor.

The symptoms of late menopause can be alleviated by using medicinal baths. It is necessary to use herbal mixtures that contain rosemary and sage. The mixture is poured into the bath, filled with hot water (proportions: 1 package of herbs / 5 liters of water) and wait until the water cools to 34˚. You should take such a bath for no more than 1 hour.

Freshly squeezed beet juice, drunk together with carrot juice in a 1:1 ratio, is very suitable for alleviating the symptoms of menopause.

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Herbal treatment

For mild symptoms, and also if a woman does not want to be treated with HRT during menopause or has contraindications to these drugs, herbal preparations (phytohormones) and herbal treatment may be prescribed.

Phytohormones are medicinal components of plant origin. They are able to have a therapeutic effect on the body due to their isoflavone structure. These substances are contained in the following plants: melbrosia and cimicifuga, as well as rhaponticin. One of the drugs based on an extract called Cimicifuga racemosa is klimadinon. This herbal preparation should be taken in a dosage of 30 drops (or 1 tablet) twice a day.

If late menopause has caused depression and neuroses, you can use the following remedy - a tincture made from 400 ml of boiled water and 2 tablespoons of oregano. It should be taken before meals 3 times a day.

If you have uterine bleeding that is not related to cancer, you can use this tincture: take 40g of shepherd's purse herb and pour 1 liter of boiling water, then leave the mixture to infuse for about 1 hour. You need to take 0.5 cups 3 times a day.

An infusion of dry Veronica sylvatica herb (2 tbsp. pour 600 ml of boiling water) helps with headaches. Drink 0.5 cups before meals, and also drink a few sips during the day.

Hot flashes can be reduced by using sage. Pour 2 cups of boiling water over 1 tbsp of the herb leaves, let the mixture sit for 30 minutes, then drink throughout the day.

To prepare a soothing tincture, you can take 1 tbsp. of chamomile flowers and crushed valerian root. The herbs are poured with 2 cups of boiling water and infused for several hours. The tincture should be drunk twice a day, 1/3 cup at a time.

Homeopathy

Homeopathic medications are also prescribed to treat menopause symptoms.

The drug Remens eliminates estrogen deficiency in the body, and also has a general strengthening effect and alleviates the condition during hot flashes. It must be taken for at least six months.

Klimaktoplan is able to improve the general well-being, as well as the psycho-emotional state of a woman.

Klimaxan strengthens the body and helps to more easily tolerate the symptoms of hot flashes.

Klimakt-Hel prevents the development of osteoporosis, reduces the severity of menopause symptoms and has a strengthening effect on the body.

Inoklim helps to stabilize the psycho-emotional state and sleep, and generally facilitates the course of menopause.

Surgical treatment during menopause is usually not performed. It can be prescribed only in rare cases, if late menopause is accompanied by the development of oncological diseases of the mammary gland, uterus or ovaries.

Prevention

As a preventative measure to ease the course of menopause, you should use the following recommendations:

• Start treatment with HRT promptly;
• Give up bad habits: alcohol and smoking;
• Lead an active lifestyle: moderate physical activity, proper and balanced nutrition (do not consume salt, as well as smoked, fatty, canned foods);
• Take herbal remedies;
• At least once a year, undergo examination by a gynecologist and mammologist.

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Forecast

Late menopause with a positive effect from hormone replacement therapy can have a favorable prognosis. As a result of treatment, the following improvements are observed:

• Typical symptoms of menopause are reduced in 90–95% of patients;
• The severity of depression symptoms decreases;
• The severity of signs of urinary system disorders decreases in 85% of patients;
• There is an improvement in the condition of the skin, hair, and muscle tone;
• The risk of hip fracture is reduced by 30%;
• The incidence of colon cancer is reduced by 37%.

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