Menopause
Summary/Definition
Menopause is the “cessation of menstruation” when menstruation is absent for a year after the last menstruation. Menopause is the irreversible cessation of menstruation due to a decrease in ovarian function. Before and after menopause, the levels of the hormones estrogen and progesterone change, causing various symptoms. If a woman over the age of 40 has no menstruation for a year for no particular reason, menopause can be suspected, it is easy to diagnose, especially if it is accompanied by menopausal syndrome. Here, menopause is understood as the remaining period of life after menopause, and during this period, female hormones are practically not released from the ovaries. The period before menopause is called perimenopause, and the period from several years to about a year after the cessation of menstruation is called menopause. The premenopausal period is also called the menopausal transition period, during which ovarian function gradually decreases. This is a normal phenomenon of aging. Menopause can occur at any time between the ages of 30 and 50, or even earlier or later. Depending on the period of onset, it is divided into normal menopause and early menopause. Normal menopause occurs at the age of 48 to 52 years, and early menopause is menopause that occurs due to a decrease in ovarian function before the age of 40.
The causes of menopause include damage to the ovaries due to surgery and chemotherapy.
Symptoms
During menopause, a variety of symptoms are observed in a woman’s body due to changes in the hormonal environment. Symptoms of menopause include changes in the menstrual cycle, hot flashes and sweating, vaginal atrophy, difficulty urinating, sexual problems, sleep disorders, mood swings and physiological changes. First there are changes in the menstrual cycle, the most common symptoms are hot flashes and sweating, occurring in more than 70% of cases. Symptoms of all people are very different, they include urination disorders, urinary incontinence, sleep disorders, as well as emotional changes such as depression, agitation and sudden mood swings.
Diagnostics
Menopause can be easily diagnosed by symptoms such as changes in the menstrual cycle and characteristic redness of the face. In addition, when menopause begins, it is necessary to undergo an examination and pass tests to prevent the development of osteoporosis or cardiovascular diseases that may occur with a decrease in the level of female hormones. First of all, during the consultation, they find out whether any of the patient’s family members have malignant tumors, high blood pressure, cardiovascular diseases or osteoporosis, as well as whether she had breast or uterine diseases, venous thromboembolism, coronary heart disease or stroke in the past. The patient can consult on sexual function, psychopathological conditions, as well as habits that affect health, such as smoking, alcohol consumption, exercise, nutrition and postmenopausal life. During the examination, a systemic examination, gynecological examination, examination of the mammary glands, as well as measurement of blood pressure and weight are carried out, the presence or absence of diseases is checked, as well as cytological examination for cervical cancer. Breast cancer screening is carried out using mammography, breast ultrasound is performed if necessary, and bone density is diagnosed for menopausal women at risk of osteoporosis or with a history of fractures.
Treatment and course of the disease
Menopause is a normal change in life that occurs as part of aging due to a decrease in the secretion of female hormones, and the goal of treatment is to reduce the symptoms of menopause and prevent diseases that may occur due to a lack of female hormones, such as osteoporosis. Treatment can be carried out for symptoms such as changes in the menstrual cycle, redness, atrophy of the genitals, urinary disorders and emotional changes that are symptoms of menopause. Medical treatment includes female hormone therapy and treatment with other drugs such as tibolone, selective estrogen receptor modulators and bisphosphonates. Hormone therapy is effective for relieving symptoms such as hot flashes, vaginal dryness, decreased libido and osteoporosis, but it can increase the risk of breast cancer, stroke and thrombosis. Tibolone has an effect similar to hormone therapy and helps to increase bone density and prevent spinal fractures. Selective estrogen receptor modulators (SERM) can increase bone mineral density and prevent spinal fractures. Although it has been proven that the drug prevents the development of breast cancer, in fact it can cause redness of the face. Bisphosphonates increase bone density and reduce the risk of fractures. Tissue-selective Estrogen Complex (TSEC) effectively reduces menopausal symptoms such as hot flashes, causes fewer side effects such as vaginal bleeding, and does not increase the risk of breast cancer after two years of use. Denosumab is a human monoclonal antibody against the activator of the NF-kB receptor (RANK). The ligand (RANKL) is necessary for differentiation and activation of osteoclasts and is the first targeted agent for the treatment of osteoporosis, intended for the treatment of postmenopausal osteoporosis patients.
