PATHOLOGICAL CLIMAX BY WOMEN

A climacteric syndrome is observed in 65-70% women. A premature (early) climax develops earlier than 45 years. A late climax appears after 55 years old.

Select a few variants of climacteric syndrome after the features of clinical displays:

1) typical form;

2) аtypical form;

3) a combined form.

Medical tactic for the different forms of climacteric syndrome differs substantially.

1. Typical form of climacteric syndrome

Most frequent form of climacteric syndrome. More frequent observed for women which carry the protracted mental or physical overloads. Menopause comes in good time, but in postmenopause(in 2-6 months) there are typical climacteric symptoms, the expressed of which grows during 3-6 months, and then slowly diminishes for period 15-20 months.

A major diagnostic criterion is violation of menstrual function. At first the delays of monthly appear on 2-3 months (opsomenorrhea), quite often with the next uterine bleeding. Afterwards there is the proof stopping of menstruations (amenorrhea).

There are unsteady emotionally-psychical violations – nervousness, promoted fatigueability, tearfulness, feeling of fear. Characteristic general amotivational weakness, violation of rhythm of sleep.

Head pain also is a widespread enough complaint. Most characteristic moderately expressed, but practically permanent head pain, feeling of weight in a head. At a mental and physical overstrain, insomnia, overeating before sleep, intoxications brief pains appear in parietal and temporal areas.

Dizziness develops as a result of vegetative-vascular violations, atherosclerosis of vessels of cerebrum.

"Waves" of heat to the head and neck, pathological sweating is leading symptoms of climacteric syndrome. Type "waves" begin from the brief feeling of alarm, "pressure" in breasts and palpitation during a 30-60 sec. Then a face and neck blushes quickly, through 2-3 minutes hyperemia disappears, a face and neck is covered sweat. Frequency and expressed of "waves" is the basic (but not unique) criterion of weight of climacteric syndrome. At the easy form of climacteric syndrome the number of episodes of "waves" is small (to 10 on days), at middle- 10-20 on days, at heavy – more than 20 on days.

Pains are possible in bones and joints of different character and localization. The most characteristic pains are in a spine, large and shallow bones and joints. Оsteoporosis results in squeezing of vertebrae, diminishing of growth.

Obesity is a frequent sign of menopause, result of age-old change of hormonal background and exchange of matters

The symptoms of hypercorticism quite often are observed in an initial period of climax. Glucocorticoid and androgenic function of adrenal cortex rises, possibly, as an adaptation reaction on hypofunction of gonads. In menopause for patients with hypofunction of ovaries, which developed before time, the signs of hyperandrogenia- hirsutism can develop, pigment spot on the skin of face, hands, becoming rough of voice.

Violations of the functional state of щитоподібної gland are possible. There is insignificant гіпофункція of щитоподібної gland in 50% women, in 7% is гіперфункція.

Additional criteria of средньотяжкої form of climacteric syndrome: dizziness, head pain, worsening of memory and common state.

Additional criteria of heavy motion of climacteric syndrome: vegetative-vascular, endocrine, metabolic and trophic violations, disfunction of the репродуктивної system.

2. Аtypical form of climacteric syndrome

An аtypical form develops for women, which carried psychical or physical traumas, heavy diseases (infectious, somatic, gynaecological), operative interferences before, workings in the conditions of action harmful factors, protracted mental and physical overloads.

Characteristic violation of menstrual function (оpsо- or hypomenorrhea, and then proof amenorrhea). In 1-3 months typical climacteric symptoms (violation of rhythm of sleep, crabbiness, tearfulness, worsening of memory, decline of capacity promoted) which are combined with untypical appear after appearance of violation of menstrual cycle: by a general weakness, pains in the area of heart, palpitation, head pain, worsening of ear, sight, constipations or diarrhoea.

There is dryness of skin, fragility of nails, fall and fragility of hairs, appearance of pigmental spots on the skin of face, hands.

Almost all women have multiplying mass of body with the even or regional deposit of fat on a breast, stomach.

The symptoms of delay of liquid, edemata, pains, are possible in bones, joints, sometimes sickly urination.

The state progressively gets worse with the decline of capacity or its complete loss.

For patients with the atypical form of climacteric syndrome can develop the attacks of bronchial asthma, hypercholesterinaemia, hyper- and hypoglycaemia. Hormonal cardiopathy, osteoporosis, osteochondrosis is formed quite often.

Typical development of crises.

Sympato-adrenal crisis. The exchange of matters is reduced. Аsthenic constitution. Crises more frequent develop in the day-time or in the evening. Crisis begins from feeling of alarm, fear of death, chill. Promoted arterial hypertension, tachycardia. A skin is initial cold, pale, extremities are cold. With development of crisis a skin turns pale or blushes. Temperature of 37-39С°. Characteristic spasms of vessels of different localization, which squeeze pains in the area of heart. Head pains each evening, sleep is uneasy. Crabbiness is promoted. A capacity is higher in the evening. Pupils are extended. Dryness of mucous membrane of mouth, appetite reduced. Constipations. Liquid urination. The level of adrenalin in blood is promoted, hypopotassiumaemia. Duration of crisis 20-40 minutes, ends with intensive urination, sharp general weakness. Intervals between crises can have different duration.

Vagoinsular of crises. The exchange of matters is promoted. Constitution of picnic. Crises more frequent at night, in the morning. Skin is heat, rose. Extremities heat, hot. Temperature of 35,5-36С°, sweat is warm, liquid. Reduced arterial blood pressure, bradycardia. Characteristic prickly pains in the area of heart, head pains in the morning. Sharp weakness, episodes of fainting fit. Depression. Sleep is deep. Pupils are narrowed. Capacity higher in the day-time. Salivation. An appetite is promoted. Diarrhoea, nausea. Urination is frequent. The level of adrenalin in blood is reduced, hyperpotassiumaemia.

3. Combined form of climacteric syndrome.

The combined form develops for patients with chronic diseases of cardiac, hepato-billiary systems, by diabetes and other endocrine diseases, allergy.

Dysfunctional climacteric uterine bleeding – one of basic variants of pathological motion of menopause. Observed in 30% women which are in the period ofpre-menopause. The origin of dysfunctional of the uterine bleeding is caused the age-old increase of hypothalamic activity with the increase of gonadotrophic function of hypophysis. In a pre-climacteric period a sensitiveness is to hormonal stimulation in peripheral organs normal or promoted, and as a result the promoted hormonal stimulation there is persistence of follicles in ovaries, in an uterus and pectoral glands are hyperplastic processes.

Dyshormonal climacteric cardiopathy.

Climacteric cardiopathy (myocardial dystrophy) is the atypical form of climacteric syndrome which runs across with pains in the area of heart for as cardialgia and by the defeat of myocardium of non-coronarogenic character.

Typical cardialgia is pains in the area of heart of non-coronal character. Pains are localized in the area of apex or in a precardial area. An irradiation of pain can be absent, to be limited (in the left shoulder-blade) or widespread (the half of thorax engulfs all left). Variable intensity of the removed pain – from the easy aching to very great, unbearable pain. The typical bright emotional colouring of pain syndrome is feeling of the "killed nail", "stuck knife".

The signs of electrocardiographies are expressed moderately, unsteady, the expressed of rejections on ECG does not answer weight of pain syndrome.

Hormonal therapy results in reverse development of symptoms of disease - removal of cardialgia, normalization to the positive dynamics of ECG, normalization of indexes of lipid exchange, decline of secretion of lutropine and follitropine.

Diagnostics of climacteric syndrome by woman.
For diagnostics drawn on hormonal researches.

In development of climax for women select three stages.

I phase - the recurrence of excretion of estrogen is violated, there is relative hyperestrogenia, metabolism of estrogen is violated. The sensitiveness of tissues rises to estrogen, an allergy can develop to own estrogen. Excretion is promoted with urine of 17-КС and 17-ОКС.

II - excretion of estrogen with urine is reduced. Cytological reaction of vaginal stroke of 2-3 degrees. The phenomenon of crystallization of cervical mucus is poorly expressed. Mucus shells of body of uterus at histological research in the stage of atrophy.

III is the ahormonal stage. The secretion of gonadotropins is promoted. Correlation of lutropine / follitropine diminishes to 0,4-0,7 (in reproductive age even 1,0).

Treatment of climacteric syndrome.
Treatment must be complex, such, which sets rational mode of labour and rest, rational feed: hypocalorial ration with limitation of carbohydrates, enriched cellulose. Expedient psychotherapy, physiotherapy and medical physical education.

For the correction of vegetative-vascular violations apply tranquilizers, neuroplegics, antidepressants. The extracts of root of valerian normalize the function of hypothalamus. Effectively preparations which contain alkaloids remove vegetative dysfunction –belloidum, bellataminalum, bellasponum.

In more heavy cases use tranquilizers –elenium, sibazonum, andaxinum, trioxazinum. Treatments begin with small doses (1/2 pills 2-3 times per a day), gradually multiplying a dose to optimum. Course of therapy – 1-2 months.

Heavy symptoms of climacteric neurosis are a testimony for setting of neuroplegics–aminazinum, propazinum, etaperazinum. Apply small doses (1/2 pills 2-3 times per a day) during 2-4 weeks to development of proof effect, then a dose is gradually reduced. At presence of depression use antidepressants, for example, amitriptilinum or azaphenum.

If violations of menstrual function appear in age 40-45, it is expedient to conduct a hormonal correction gestagen preparations with the purpose of proceeding in the reproductive system. Proceeding in hormonal homeostasis allows to normalize and functioning of privy parts, and all organism on the whole. Proceeding in a menstrual cycle in pre-menopause, with appearance of proof violations of menstrual cycle, favourably influences on the state of women: a feel gets better, "waves" are halted, sleep gets better.

Treatments begin from the periodic setting of gestagens during lengthening terms between menstruations. Gestagen preparations assign for the 18-20th day of the induced menstrual cycle at the positive phenomenon of "pupil" (-++) and (+++) during 6-8 days. The courses of treatment by gestagen preparations conduct until menstrual reactions are not halted (6-18 months). Testimonies for the repeated setting of gestagen is a delay of menstruation, the positive "phenomenon of pupil", high kariopicnotic index, is prolonged.

Norkolut (noretisteronum) accept for 1/2-1 pills (5 mg in a pill) daily in 20 minutes after a meal.

Turinal appoint for 2 pills on a day.

Pregnine accept on a 1 pill 3 times per a day sub lingua, or 1 injection of прогестерону for 1 мл of a 1% solution intramuscular daily.

Oxyprogesterone capronatis is the synthetic prolonged analogue of progesterone, enter intramuscular for 1 ml of a 12,5% solution on the 16-18th day of the created cycle.

In the hyperestrogenic phase of climax treatment is recommended by the combined estrogen-gestagen preparations. Application of the combined preparations imitates a normal ovarial cycle: primary estrogenic stimulation of endometrium is with a subsequent progestin-estrogen action. Rigevidonum, non-ovlonum appoint for 1/4-1/6 pills from the 5th day of spontaneous or induced menstruations during a 21th day and by a next interruption on 7 days. A continuous reception is practiced in small doses.

Divina removes the displays of climacteric syndrome and normalizes a lipid exchange. During the first it is 11 days accepted a cycle on a 1 white pill on a day (2mg estradiole), then 10 days on a 1 blue pill (2 mg estradiole and 10 mgmedroxyprogesterone), interruption 7 days.

The second and third phases of climax for women run across on a background of estrogenic insufficiency, in these phases it is recommended to apply estrogen. To the most active estrogenic preparations take estradiole and ethynilestradiole, less active estrone and estriole.

With средньотяжким motion of climacteric syndrome folliculinum is appointed patients for 5000 IU daily or for 10 000 IU in a day intramuscular during 15 days. Then conduct supporting therapy of synestrole for 1 mg (10 000 IU) 2 times per a day (10 days) and for 0,5 mg 1 time per a day (5 days).

The patent combined preparation which contains estrogen is climacterinum. On the course of treatment - 100 drops, accept for a 1 drop 3 times per a day in 1 hour after a meal. It is possible to move 3-4 courses with interruptions on 2-3 months.

Contra-indication is to application of estrogen: disease of liver and kidneys, tumor, mastopathia, vaginal bleeding of unknown etiology, endometriosis.

By a patient in the age 50 and more years, proceeding in a menstrual cycle does not follow. The symptoms of climacteric syndrome are removed the combined setting of estrogen and аndrogens. In one syringe enter intramuscular 0,5 ml of a 0,1% solution of estradiole dipropionatis(0,5 mg) and 2,5 ml of a 1% solution of testosterone propionatis (25 mg). Injections execute 1 time per 5-7 days during 5-7 weeks to the removal of symptoms of climacteric syndrome, then 1 time per a month during 6-12 months.

Аmboseks, combined preparation of estrogen and androgen, enter intramuscular for 1 ml 1 time per a month during 6-12 months.

Contra-indication is to the use of androgen: gout, rheumatoid arthritis, hypertensive illness.