Menopause

Menopause - the last menstrual bleeding - is the boundary separating two periods of a woman's life - the premenopausal period, often associated with the occurrence of irregular menstruation, and the postmenopausal period, in which uterine bleeding is not observed under physiological conditions.

Menopause is the permanent cessation of menstruation. It is diagnosed when, after the last menstrual period, there is no monthly bleeding for a consecutive period of 12 months and no pathological cause for this condition is found. The period covering the 2-8 years preceding menopause, in which changes in menstrual rhythm occur and clinical signs announcing menopause appear, and the period of 1 year after the last menstrual period is referred to as the perimenopausal period, or perimenopause.

The symptom of the end of the procreative period of a woman's life is the result of the cessation of generative and inherent hormonal activity of the ovary. In the period preceding the onset of menopause, ovarian ageing and the gradual disappearance of granulosa cells and the associated gradual decrease in oestrogen synthesis are observed. At present, about one third of a woman's life is spent in the period after the cessation of menstruation. It is a natural step for medical science to act to improve the quality of life of women during this time. Consequently, all measures are aimed at restoring postmenopausal women to the hormonal state of the procreative period.

Menopause - symptoms

It is the hormonal state of the woman at menopause that is responsible for a range of clinical symptoms. We can classify menopausal symptoms into several groups, these are:

• psychological,
• somatic,
• vasomotor
• sexual.

Symptoms occur in about 80% of women, and in about 25% vasomotor complaints may persist for up to five years. Early manifestations include vasomotor symptoms and psychiatric changes resulting from neuroendocrine disorders. Emotional labile, increased irritability, impaired memory and concentration, sleep disturbances, migraine headaches, mood changes and depression are also observed.

Atrophic changes in the genitourinary tract also occur during menopause:

• vaginal dryness,
• dyspaurenia,
• frequent urination,
• dysuria,
• stress urinary incontinence
• disorders of the reproductive organ statics.

Estrogen deficiency leads to mucosal atrophy in the genitourinary tract and subsequent inflammatory changes in the vagina and urethra. In addition, there is a reduction in interest in sex life and a decrease in libido. The skin becomes flabby, thin and dry (reduced production of type III collagen), itching is troublesome, hair becomes weaker, falls out more easily, and there is a tendency to rupture skin blood vessels. Sometimes a slight hirsutism appears as a consequence of the relative predominance of androgens in a state of estrogen deficiency. Symptoms of dryness of the mucous membranes and conjunctiva as the so-called 'dry eye syndrome' are quite common. After the menopause, the nipples also undergo atrophic changes, with a decrease in glandular and adipose tissue and an increase in connective tissue.

Oestrogen deficiency

Late changes resulting from estrogen deficiency include postmenopausal osteoporosis (involutionary type I) and cardiovascular disorders. The changes characteristic of osteoporosis occur in areas where there is a lot of trabecular bone: vertebrae, distal aspect of the radius bone, neck of the femur. Loss of bone mass after the menopause is due to excessive bone resorption and can lead to fractures, most often of the wrist, later to compression fractures of the spine , while in the senile period fractures of the neck of the femur are typical, often leading to disability and death.

photo: panthermedia

The disappearance of ovarian function causes an increase in total cholesterol and LDL cholesterol and a decrease in HDL cholesterol, which is an important risk factor for ischaemic heart disease. After menopause, the protective effect of oestrogens ceases and cardiovascular disease is one of the most serious health problems for menopausal women. The aim of hormone replacement therapy (HRT) is to correct estrogen deficiency, thus restoring comfort and improving the quality of life of patients.
In women with a preserved uterus, estrogen-progestogen hormone replacement therapy is used, while in women after hysterectomy, estrogen hormone replacement therapy is used.