Late menopause

Usually menopause in women occurs in the time period of 45-52 years, and only about 5% of them occur later - after 55 years. This phenomenon is called late climax, and it is rather difficult to say unequivocally whether this is a plus or a minus. This process is individual for every woman, and then, whether it is a good or bad sign, depends on the reasons for which it did not start. Among the main factors of late climax, gynecological pathologies and a hereditary factor are distinguished.

[1], [2], [3],

Causes of the late menopause

The cause of late menopause is often heredity. Women, mothers or grandmothers who experienced a climax at about 60 years, probably expects the same. If the late climax occurs precisely because of heredity, then you should not worry about it.

But in some cases, the later onset of menopause is due to other factors. The causes of this phenomenon can be quite dangerous - because of a serious illness and operations made in the chest, uterus or ovaries.

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

[4], [5], [6]

Pathogenesis

The period of onset of menopause is characterized by slow and gradual extinction of ovarian function, and then generally by their complete "disconnection" (in the first 1-3 years after the onset of postmenopausal menopause, only single follicles appear in the ovaries, which later disappear completely). As a result, the so-called state of hypergonadotropic hypogonadism develops (mainly estrogen deficiency), which is sometimes associated with changes in the limbic system, a violation of the secretion of neurohormones.

[7], [8], [9], [10], [11], [12], [13], [14], [15],

Symptoms of the late menopause

Symptoms of menopause may be completely different, they are completely individual and depend on the organism of each particular woman. Many note such signs as unreasonable anxiety, flush of blood to the skin of the face and neck, headache, frequent insomnia, palpitations. Typically, these symptoms last for several months, but sometimes a longer period may be observed. Such violations are temporary and disappear after the body has adapted to new physiological conditions.

Symptoms of menopause may also depend on the constitution of the body. Thin women may develop osteoporosis, as well as violations in the psychoemotional area. Women with excess weight may have headaches, as well as hypertension. Women who suffer from premenstrual syndrome in their youth, experiencing problems with fertilization, menopause is difficult to tolerate.

When the level of hormones in the blood decreases slowly, the woman almost does not experience any symptoms in the initial period of menopause, but a rapid and sharp decrease is almost always accompanied by unpleasant pathological signs.

What is dangerous for late menopause?

Late menopause is dangerous because it may be one of the signs of the development of malignant neoplasms of the breast or ovaries. That is why, if before the age of 52 years a woman has not started menopause, it is absolutely necessary to be examined from a mammologist, as well as a gynecologist, to make sure that there is no disease.

[16], [17]

First signs

Among the first signs of the approaching late menopause are irregular (rare or more abundant) monthly, and also the so-called "hot flushes". Similar symptoms can occur even a few years before the onset of menopause.

[18], [19]

Complications and consequences

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

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

[20], [21]

Diagnostics of the late menopause

When diagnosing late menopause, doctors first study the history to find out the risk of thrombosis and breast cancer, and also to find out whether the patient had surgery (both conventional and gynecological) and whether she has concomitant endocrinopathies and physical illnesses.

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

Even during the diagnosis with ind. Kupperman scored a score of symptoms of menopause. Assessment of the severity of other symptoms is based on the patient's complaints, after which the scores are summarized for all indicators.

[22], [23], [24], [25], [26], [27]

Analyzes

During the examination, the following laboratory tests are taken in the diagnosis of menopause:

• cytological examination taken from the uterine neck of smears (Papanicolaou method);
• determination of the level of estrogens in the blood (FSH, TTG and LH, as well as testosterone and prolactin);
• biochemical blood test (determination of AST, ALT and AFP, as well as creatinine, cholesterol, glucose, triglycerides and bilirubin);
• determination of lipid levels in the blood (atherogenicity index, LDL cholesterol and HDL cholesterol with VLDLP, as well as lipoprotein (a)).
• coagulogram.

[28], [29], [30], [31], [32]

Instrumental diagnostics

With instrumental diagnosis of menopause, the following procedures are performed:

• Measured pulse and blood pressure;
• 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 Maho);
• If the results of ultrasound showed that on the Maho there is a thickening of the endometrium, and it is more than 5 mm, or the appearance of the HPE / polyp of the endometrium, before starting HRT, you need to perform a pinch biopsy or a separate scraping, and then conduct a histological examination.

Differential diagnosis

Climax is a physiologically conditioned period that occurs in the life of every woman, therefore, differential diagnosis is not required. But if this syndrome is atypical (crisis and severe form or duration of more than 5 years), you need to conduct a survey to exclude the disease of the thyroid or adrenal glands, hyperprolactinaemia, as well as tumors of the pituitary gland, hypothalamus, ovaries, breast or pancreas.

Treatment of the late menopause

Because most diseases in the climacteric period appear due to a deficiency in the body of sex hormones (estrogens and progesterone), it is pathogenetically completely justified to prescribe hormone replacement therapy (HRT). This treatment allows you to fill the hormone deficiency due to extinction of the ovaries. It is very important to get the hormone level that is optimal for the patient, prescribing the minimum dose of the drug. Then treatment for menopause will help improve the general condition and thus will not cause side effects.

There are 3 ways of hormone replacement therapy:

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

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

Medications

Monotherapy with the use of estrogens. It is usually prescribed to women who have a uterus removed. In this case, use Estradiol 2 mg orally 1 time / day for 21-28 days, after which you need to do a one-week break and repeat the course.

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

Scheme of therapy : Estradiol gel is applied to the buttocks and abdomen in 0.5-1.0 mg (preparation Divigel) or 0.75-1.5 mg (preparation ESTROGEL) daily 1 time / day. Another option is the estradiol releasing plaster applied to the skin in a dosage of 0.05-0.1 mg 1 time / week.

Monotherapy with gestagens is suitable for women who do not need surgery, with diagnosed adenomyosis and uterine myoma in the period of premenopause. Dysfunctional uterine bleeding is also an indication.

Scheme of therapy :

• Dydrogesterone is taken orally 10-20 mg once a day during the 5-25 days of the menstrual cycle. The second method is 10-20 mg 1 time / day starting from the 11th day of the cycle for 2 weeks.
• Levonorgestrel, the administration system is intrauterine (using a T-shaped rod with an attached container that contains 52 mg of Levonorgestrel); the device supports the function of releasing Levonorgestrel into the uterine cavity within 20 μg / day. A one-time injection is used.
• Medroxyprogesterone in a dosage of 10 mg is applied internally 1 time / day in the period of 5-25 days of the menstruation cycle. The second option is 10 mg 1 time / day in the period of 16-25 days of the cycle.
• Micronized progesterone internally at a dosage of 100 mg 3 times / day in the period of 5-25 days of the menstrual cycle. The second option is the dosage of 100mg 3 times / day in the period of 16-25 days of the cycle. Also, a method of administering the drug to the vagina at the same dosage can be used during the periods 5-25 or 16-25 days of the menstrual cycle.

Alternative treatment

Most methods of alternative treatment can be combined with the main therapy (using drugs), but you must first consult with your doctor.

Symptoms of late menopause can be alleviated by using therapeutic baths. Use must be herbal preparations, in which there is rosemary and sage. The mixture is poured into the bathroom, poured hot water (proportions: 1 pack of herbs / 5 liters of water) and wait until the water has cooled to a value of 34˚. Take a bath should not more than 1 hour.

To alleviate the manifestations of menopause, freshly squeezed beet juice is very suitable, which is drunk with carrots in the proportions 1k1.

[33], [34],

Herbal Treatment

For mild symptoms, and also if a woman does not want to be treated with HRT in her menopause, or if she has contraindications to these medicines, herbal preparations (phytohormones) and herbs can be prescribed.

Phytohormones are medicinal components that are of vegetable origin. They are able to exert a curative effect on the body due to its isoflavin structure. Contains these substances in the following plants: melbrosia and tsimitsifuga, as well as raponticin. One of the drugs, which is based on an extract called Cimicifuga racemosa, is climadinone. This phytopreparation should be taken at a dosage of 30 drops (or 1 table) twice a day.

If the late climax is the cause of depression and neuroses, you can apply the following remedy - tincture made from 400ml boiled water and 2 tablespoons. Oregano. It must be taken before meals 3 times / day.

If you have a uterine bleeding that is not associated with cancer, you can apply this tincture: take 40g of herb herd bag and pour 1 liter of boiling water, and then for about 1 hour to insist the mixture. You need to take 0.5 cup 3 times a day.

With headaches helps infusion of dry herbs of oak groves (2 tablespoons pour 600ml boiling water). Eat 0.5 cup before meals, and drink a few sips during the day.

Hot flashes can be reduced by using sage. 1 tbsp. Leaf grass pour 2 stack. Boiling water, allow the mixture to stand for 30 minutes, after which to drink during the day.

To prepare a soothing tincture, you can take 1 tbsp. Chamomile flowers and chopped valerian root. Herbs are poured 2 stacks. Boiling water and insisted for several hours. Tincture should be drunk twice a day for 1/3 cup.

Homeopathy

To treat the symptoms of menopause prescribed preparations homeopathy.

The drug Remens eliminates the deficiency of estrogens in the body, and also has a general strengthening effect and eases the condition with hot flashes. It should be taken for at least six months.

Climaktoplan can improve overall health, as well as the psycho-emotional state of a woman.

Climaxan strengthens the body and promotes an easier tolerance of hot flushes.

Climact-Hel prevents the occurrence of osteoporosis, reduces the strength of manifestations of symptoms of menopause and has a strengthening effect on the body.

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

Operative treatment for menopause is usually not carried out. It can be prescribed only in rare cases, if the late climax is accompanied by the development of cancer of the breast, uterus or ovaries.

Prevention

As a prophylaxis to facilitate the course of menopause, the following recommendations should be used:

• Timely start treatment with HRT;
• Refuse bad habits: alcohol and smoking;
• To lead an active way of life: moderate physical activity, correct and balanced nutrition (not to consume salt, as well as smoked, fatty, canned food);
• Take phytopreparations;
• At least 1 time / year to undergo examination at the gynecologist and mammologist.

[35], [36]

Forecast

Late menopause with a positive effect of hormone replacement therapy may have a favorable prognosis. As a result of treatment, there are such improvements:

• Typical symptoms of menopause are reduced in 90-95% of patients;
• The severity of manifestations of depression is reduced;
• Severity of signs of violations of the urinary system is reduced in 85% of patients;
• There is an improvement in the condition of the skin, hair, and also muscle tone;
• The risk of fracture of the femoral neck is reduced by 30%;
• The incidence of malignant neoplasms of the colon decreases by 37%.

[37], [38], [39], [40], [41]