Artificial menopause

Artificial menopause is a condition characterized by a decrease in the function of the ovaries, which is caused artificially with a curative or prophylactic purpose. Often to cause an artificial menopause is the only way to treat a particular pathology. But this condition requires careful correction and observation, since changes in other organs and systems are possible. It is necessary to gradually get out of the artificial climax, because all changes in the ovaries need to be crooked. As for the general hormonal background, there is also a need for clear control.

[1], [2], [3], [4], [5],

Causes of the artificial menopause

Climax is a physiological process of changes in the reproductive system of a woman, in which involuntary processes take place in the body. These changes occur primarily with the reproductive system, but since it is continuously associated with the normal functioning of other organs, these changes affect the whole organism. The hormonal background of the female body is very diverse and provides not only the functioning of the female genital organs, but also affects the metabolism. Therefore, hormonal changes in menopause lead to changes in the whole body. In normal conditions the climacterium comes gradually and in its development has several stages:

1. premenopause - the period from 45 years to the onset of menopause;
2. Menopause is the period of the last menstruation, the average age is about fifty years;
3. Postmenopause - the period from the last menstruation to 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. With artificial climax, an important distinctive feature of such menopause is a sharp change in the hormonal background, which can affect the functioning of other systems.

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

The main mechanism of the effect of artificial menopause on the course of these diseases is a sharp violation of the hormonal background, which is accompanied by a change in the growth and development of diseases. Normally, the level of estrogen in the physiological climax decreases gradually. In the ovaries, the most specific changes occur in the form of follicular atresia, the destruction of the membranes, the death of oocytes and the preservation of only the stroma, which helps to reduce the amount of secreting estrogen. This, in turn, disrupts the feedback to the hypothalamus, which increases the changes more. The stimulation of the pituitary gland decreases and the release of follicle-stimulating and luteinizing hormones is broken, which leads to anovulatory cycle without isolation of the oocyte. As a consequence of all these processes - there is not enough concentration of hormones and their alternation for the onset of the next normal menstruation, and menstruation does not occur. At the same time, processes in the peripheral cells of the body gradually decrease their activity and "get used" to the deficiency of estrogens.

[6], [7]

Pathogenesis

The pathogenesis of the development of an artificial climax is almost identical, but there are certain features. At the same time, in the ovaries, against the background of a decrease in the level of estrogens, there is no atresia of the follicles, destruction of the membranes and death of the oocytes, since these changes are abrupt. There is only a delay in the release of the oocyte from the follicle, that is, ovulation does not occur against the background of normal ovarian function and cortical structures of the ovario-menstrual cycle. At the same time there are corresponding changes in the uterus and other organs, as the general hormonal background changes and this affects the peripheral systems. Therefore, the exit from the artificial menopause can be normal and the menstrual function can be fully restored.

The main pathogenetic features of the artificial climax for various pathologies are the following:

1. Myoma of the uterus is a benign uterine disease, 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 of 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 supports their development. Artificial menopause with fibroids thus contributes to the regression of fibroids and allows for further treatment, for example surgical treatment of fibroids.
2. Endometriosis is a disease whose essence 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 of these sites in the form of menstruation, regardless of localization. Normally, the proliferation of such cells is ensured by the level of estrogens and in the case of a physiological climax, the woman fully recovers, as the level of these hormones decreases. Therefore, by artificially reducing the level of estrogens, endometriosis can be fully cured, which is used as a basis for conservative treatment.
3. Ovarian cysts are a benign non-proliferating ovarian neoplasm that has a thin wall and fluid inside, or the contents of the cyst can be non-fluid, but non-uniform, for example, those of the same endometriosis. In this case, the cyst is prone to growth in accordance with the proliferative activity of cells under the influence of hormonal changes in the ovary. Therefore, artificial climacteric 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 of which can be a violation of the hormonal background. This can occur if the luteal phase is deficient, which leads to anovulatory cycles, so a woman can not become pregnant, because the egg does not leave the follicle. Therefore, the artificial climax can help reduce the level of estrogens, and then stimulate the rupture of the follicle. Sometimes artificial climax is used for reproductive technologies - in vitro fertilization. Then, they stimulate hypoestrogenesis, that is, an artificial climax, and then dramatically produce progestin hormones, which facilitates the release of several eggs at once, then they are extracted and fertilized, which increases the chances of successful implantation of several eggs and their development.
5. Malignant hormone-dependent diseases often require a preoperative artificial climax to reduce the mass of tumor cells, or the operation can promote the development of an artificial menopause due to removal of the ovaries. Then this process is irreversible and correction of the hormonal background is necessary.

The main drugs for artificial menopause are agonists for gonadotropin-releasing factors. These drugs contribute to the regulation of the hormonal background by the release of statins that inhibit the synthesis of estrogens and progesterone, which reduces their amount in the blood and the regulatory ability. Representatives of this group of drugs are:

• Diferelin or Tryptorelin - the drug is used from 3 days of the menstrual cycle for six months to 3.75 milligrams.
• Goserelin - applied for six months to 3.6 milligrams subcutaneously.
• Buserelin - 200 micrograms in the nose twice a day for six months.
• Zoladex - from the 1st to the 5th day of the cycle injectively.

[8], [9], [10], [11], [12],

Symptoms of the artificial menopause

All changes in the body of a woman with an artificial climax are associated with a violation of the amount of hormones and their insufficient function, which occurs quite dramatically. Normally, estrogens and progesterone regulate the work of the nervous system, bone tissue, cardiovascular system and the processes of mineral metabolism. During an artificial climax, the level of estrogen decreases, their regulatory effect on the tone of the vessels of the brain and peripheral tissues decreases, which in turn contributes to the disruption of the adrenal glands. A high level of catecholamines contributes to a change in pressure, causes palpitation and vegetative reactions in the form of sensations of sweat tingling, sensation of the heat of the face. In the body, extra-ovarian sources of the synthesis of estrogens start to be activated - they are adipose tissue, as well as the adrenal cortex, which causes an increased synthesis of androgens, leptin, and mineralocorticoids. They have other undesirable effects in the form of development 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 an artificial menopause

The first symptoms of artificial menopause also often can be nonspecific, and can manifest themselves in vegetative and emotional changes. At the same time, the processes of emotional instability are clearly expressed, which is due to a disturbance in the regulation of the processes of excitation and inhibition in the central nervous system. This is manifested by increased lability of the psyche, irritability, depression, sleep disturbance in the form of drowsiness or insomnia. Significantly reduced performance and endurance, increased fatigue, decreased libido. Sex with artificial menopause also suffers, because in addition to reducing libido, emotional changes occur in the form of a sensation of aging. Also, there is dry skin of the genitals, itching, unpleasant sensation during sexual intercourse. All this can further exacerbate intimate relationships with her husband, so it is necessary to monitor the activity of the treatment and the degree of expression of such changes.

Sometimes the symptoms of artificial menopause may manifest as pathology from other organs and systems, which is caused by a sharp decrease in the hormonal background. Therefore, often such changes come to the fore. The cardiovascular system suffers from hyperkatecholamineemia, which is characterized by arrhythmias in the form of heart failure, paroxysmal tachycardia. Violation of the regulation of vascular tone, which contributes to periods of spasm of peripheral vessels, increased peripheral resistance and increased blood pressure. Also, hypertension is promoted by sodium and water retention and increased circulating blood volume.

Breaking the hormonal balance in menopause causes a metabolic disorder in the form of hypercholesterolemia, dyslipidemia. This is an unfavorable sign and therefore often in this period develops ischemic heart disease and angina.

Another serious disorder occurs with the bone tissue. A decrease in the level of estrogens helps to remove calcium from bones, impair its absorption in the intestine 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 by the principle of introducing a woman into an artificial climax lasts for 3-6 months, it is necessary to control all the processes of the body.

Monthly after the artificial menopause should be fully restored, in case of a correct and timely exit from menopause. But in the first three months there may be minor changes in the form of heavy menstruation or scant excretions. But in any case, this should also be carefully monitored.

The way out of the artificial menopause should be gradual, the preparations should be gradually taken with a decrease in the dose before the appearance of menstruation, and then gradually canceled. It is necessary to carry out screening of the hormonal background after treatment and to determine the amount of basic hormones, since it is possible that correction will be required.

[13], [14], [15]

Complications and consequences

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

[16]

Forecast

The prognosis for recovery in the case of using artificial menopause as a method of treatment is positive, as this can be a very effective method with its correct use.

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

[17], [18], [19], [20]