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The climacteric period (syn .: climax) in women is due to functional changes in the hypothalamus-pituitary-ovary system and is expressed in the gradual cessation of menstruation, followed by the almost complete extinction of the hormonal activity of the ovaries against the background of general age-related changes.

The first phase (premenopause) is characterized by a violation of the rhythm of menstruation and the duration of the menstrual cycle. Most women gradually increase the intervals between periods and decrease the intensity of bleeding. Less frequent shortening of intervals and increased bleeding. Premenopause usually occurs at the age of 45 years and later, lasts about 5 years before the complete cessation of menstruation (menopause). The duration of the second phase of the climacteric period (postmenopausal), characterized by the extinction of the hormonal activity of the ovaries after the cessation of menstruation, is rather difficult to establish, but sometimes within 3 to 5 years (and more) after the onset of menopause, menstrual discharge may appear. At the end of the postmenopausal hormone activity of the ovaries almost stops and comes the so-called physiological rest of the reproductive system.

Premature onset of menopause (up to 40 - 43 years) is observed in women with adverse working and living conditions, after frequent childbirth and abortion, massive blood loss during childbirth, in chronic infectious diseases. Later extinction of menstrual function (after 53 - 55 years) is observed in uterine myoma, hypertension. In women of transitional age, severe mental trauma and prolonged emotional stress can contribute to the sudden cessation of menstruation.

In the climacteric period, dysfunctional uterine bleeding is often observed - prolonged irregular bleeding of various duration and intensity. A number of patients with bleeding occur after a delayed menstruation. In clarifying the cause of uterine bleeding is important separate diagnostic curettage of the mucous membrane of the cervical canal and the body of the uterus. Histological examination of the scraping can identify the nature of changes in the endometrium, and most importantly - to exclude the presence of a tumor process.

In case of uterine bleeding dysfunctional, diagnostic scraping of the endometrium produced before the start of treatment simultaneously has a therapeutic effect. When recurrent uterine bleeding, as well as endometrial hyperplastic processes in women aged 45 years and older, according to a doctor's prescription, hormonal therapy (gestagens, androgens) is performed in a cyclic or continuous mode.

In menopause, there are specific disorders. These include: 1) vasomotor disturbances - hot flashes, sweating, fluctuations in blood pressure, palpitations; 2) emotional-mental - irritability, tearfulness, sleep disturbances, a tendency to depression ; 3) urogenital - typical for postmenopausal dryness of the vulva and vaginal mucosa (senile colpitis), frequent urination.

All these disorders occur against the background of a deficiency of female sex hormones and manifest themselves with different intensity. Vasomotor and emotional-mental disorders are called climacteric syndrome.

Its severity is determined by the frequency of hot flashes. Light form - up to 10 tides per day; moderate severity - up to 20 tides, accompanied by dizziness, rapid heartbeat; severe form - more than 20 hot flashes with sharp fluctuations in blood pressure, heart attack, weakness, disability.

Treatment . In milder forms of menopausal syndrome, sedatives, antihypertensive drugs, beta-blockers are used. We recommend light physical exercises (morning gymnastics), rational nutrition with a restriction in the diet of carbohydrates and fats, light water procedures (showers, douche), and quitting smoking. Estrogens and gestagens, specially developed for the treatment of menopausal disorders, are also used. Contraindications for hormone therapy are: uterine bleeding of unknown etiology; tumors of the uterus, ovaries, mammary glands, thrombophlebitis in history, liver and kidney diseases; arterial hypertension (blood pressure above 150/90 mmHg), severe diabetes. For the treatment of age-related colpitis, topical ointments containing estrogen - estriol are used. With frequent urination effective tablet drug estriol.