Climacteric syndrome (menopause) - Diagnosis

Climacteric syndrome (menopause) has the following symptoms:

• menstrual cycle disorders (delayed menstruation, scanty menstruation or absence of menstruation, as well as menometrorrhagia);
• the presence of hot flashes (especially in the evening and at night);
• mood changes (irritability, tearfulness, anxiety, restlessness, etc.);
• urination disorders (frequent urination, painful urination, urinary incontinence);
• changes in the sexual sphere (decreased libido, pain during intercourse).

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.

During the examination, the general condition of the patient is assessed (general appearance, facial expression, color and turgor of the skin), the development and distribution of subcutaneous fat, height and body weight are measured (in climacteric syndrome, abdominal obesity is often detected).

The patient's decreased height and curvature of the spine (kyphosis) indicate osteoporosis.

When examining the mammary glands, it is necessary to pay attention to their shape, consistency, local compaction or retraction.

During a gynecological examination, it is important to exclude pathological changes in the genitals and pay attention to the presence of atrophic processes in the vulva and vagina, and the presence of cystorectocele.

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Indications for consultation with other specialists

• Endocrinologist: in the presence of symptoms similar to climacteric syndrome in women under 40 years of age (another pathology of the endocrine system is possible).
• Neurologist or psychoneurologist: if symptoms of menopause (vegetative-vascular, psychoemotional or neurovegetative disorders) persist during therapy.

Special methods of studying climacteric syndrome

• The content of follicle-stimulating hormone in the blood serum is elevated (more than 30 IU/L), in perimenopause it can be 12–30 IU/L.
• Mammography: for the diagnosis of breast diseases.
• Ultrasound of the genitals using a vaginal probe.
• Cytological examination of a smear from the surface of the cervix and cervical canal.
• Endometrial biopsy in patients with acyclic bleeding.
• To diagnose atrophic processes of the vulva and vagina, it is necessary to use a pH test and a comprehensive microbiological examination of vaginal discharge (microscopic examination of a smear and bacteriological culture).

Screening

It is necessary to examine women with risk factors for cardiovascular diseases and, especially, oncological diseases of the mammary gland and genital organs.

Differential diagnostics of climacteric syndrome

Differential diagnostics are carried out with the following diseases:

• premature shutdown of ovarian function (age under 40 years);
• thyroid diseases (weight gain or loss, cold intolerance, fatigue, anxiety, constipation);
• autoimmune diseases;
• hyperprolactinemia;
• congenital adrenal hyperplasia (elevated levels of 17-hydroxyprogesterone);
• polycystic ovary syndrome (menstrual cycle disorders from the age of menarche);
• alcoholism;
• pheochromocytoma;
• infectious disease (eg malaria);
• psychopathy accompanied by panic attacks.

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