Climax – the physiological period in the woman's life which is characterized by fading of reproductive function owing to hormonal changes in an organism. Begins after 40 years and about 10 years proceed. It is shown by the gradual termination of periods. Can be followed by a complex of vegetovascular and endocrine frustration: sudden attacks of rush of blood to the top half of a trunk and a face ("heat"), the perspiration, tearfulness, irritability, fluctuations of arterial pressure increased by dryness of skin and mucous membranes, frustration of a dream. Can cause dysfunctional uterine bleedings, serious psychological frustration.
The climax is a natural stage in life of the woman and is characterized by the return changes in reproductive system - the termination of genital and menstrual functions. The word "climax" comes from Greek "klimax" - a ladder, expressing symbolical steps leading from blossoming of specific women's functions to their gradual fading.
Life of the woman consists of several age periods having the anatomo-fiziologochesky features:
- the neonatality period - up to 10 days;
- the childhood period - up to 8 years;
- the puberty period - from 8 to 17-18 years;
- puberty period (reproductive, or genital) - from 18 to 45 years;
- climacteric the period (climax) including:
- to premenopauz - of 45 years to a menopause;
- menopause – the termination of periods (49-50 years);
- postmenopause – from a menopause - up to 65-69 years;
- the old age period - of 70 years.
At average life expectancy of the woman of 75 years, a third of her life is the share of a climax.
At one women the climax has a physiological current and does not cause pathological frustration, at others the pathological current of a climax leads to development of a menopausal (climacteric) syndrome. The menopausal syndrome at a climax at women meets frequency of 26 - 48% and is characterized by a complex of various disorders of functions of endocrine, nervous and cardiovascular systems that quite often breaks normal activity and working ability of the woman. Questions of a pathological current of a climax have important social and medical value in connection with the increased average life expectancy of the woman and her social and active behavior.
Reasons of a menopausal syndrome
In the period of a climax of change occur in all organism: immune protection decreases, the frequency of autoimmune and infectious diseases increases, aging processes progress. But the sexual device of the woman is exposed to the most active changes at a climax. At a climax in ovaries development of follicles stops, cease to ripen and ovulate ova, there is a decrease in vnutrisekretorny activity. Follicles in ovaries are replaced with connecting fabric that conducts to a sklerozirovaniye and reduction of ovaries in sizes.
The hormonal picture at a climax is characterized by increase in level of gonadotropny hormones (follikulostimuliruyushchy and lyuteiniziruyushchy) and decrease in level of estrogen. Within a year after approach of a menopause increase of level of follikulostimuliruyushchy hormone happens at 13-14 times, lyuteiniziruyushchy - by 3 times to the subsequent some decrease.
In the period of a change climax at synthesis of estrogenic hormones consist in the termination of development of an estradiol and prevalence of an estron. Estrogen makes biological impact on a uterus, mammary glands, an urethra, a bladder, a vagina, muscles of a pelvic bottom, a cell of a brain, arteries and heart, bones, skin, mucous membranes of a conjunctiva, a throat, a mouth, etc., and their deficiency in the period of a climax can cause various frustration in these fabrics and bodies.
The menopausal syndrome at a climax serves as manifestation of deficiency of estrogen and is characterized by vegeto-neurotic, urogenital violations, dystrophic changes of skin, high risk of development of atherosclerosis and ischemia of vessels, osteoporosis, psychological violations. To increase in average values of life expectancy of the woman there is a lengthening of a climax and, respectively, increase in the period of estrogenic deficiency that increases probability of development of a menopausal syndrome.
Classification of menopausal frustration
On the manifestations the climacteric syndrome is subdivided into early temporary, srednevremenny and late temporary manifestations of menopausal frustration. At a climax treat early temporary manifestations of menopausal frustration:
- vasomotorial symptoms – feeling of "inflows" of heat, headaches, the increased perspiration, oznoba, fluctuations of arterial pressure, heartbeat;
- psychoemotional symptoms - weakness, concern, irritability, drowsiness, a carelessness, forgetfulness, a depression, decrease in a libido.
Early temporary manifestations during a climax take a premenopauza and 1-2 years of a postmenopause. Women with vasomotorial and psychoemotional symptoms in the period of a climax are quite often treated at the therapist concerning a hypertension, coronary heart disease or at the neuropsychiatrist with diagnoses of neurosis or depression.
Srednevremenny manifestations of menopausal frustration at a climax include:
- urogenital symptoms - dryness of a vagina, the painful sexual intercourses, burning, an itch, a dizuriya (increase of an urination and an incontience of urine);
- symptoms from skin and its appendages - wrinkles, fragility of nails, dryness of skin and a hair, a hair loss.
Srednevremenny manifestations during a climax are noted 2-5 years later after a menopause and are characterized by atrophic changes of skin and an urogenital path. As a rule, symptomatic treatment of urogenital and skin symptoms at a climax does not give desirable effect.
At a climax treat late temporary manifestations of menopausal frustration:
- metabolic (exchange) violations – osteoporosis, atherosclerosis, Alzheimer's disease, cardiovascular diseases.
Late temporary manifestations during a climax develop 5-10 years later the field of approach of a menopause. Insufficient level of sex hormones in the period of a climax brings to violation of structure to a bone tissue (osteoporosis) and lipidic exchange (atherosclerosis).
Symptoms of a menopausal syndrome
Development and weight of a current of a menopausal syndrome are influenced by hormonal, environmental, hereditary factors, the general condition of the woman by the climax period.
Vegetososudisty (vasomotorial) symptoms at a pathological current of a climax are noted at 80% of women. They are characterized by sudden "inflows" with sharp expansion of capillaries of head skin, person, neck, thorax, increase in local skin temperature on 2-5 °C, and body temperatures – on 0,5-1 °C. "Inflows" are followed by feeling of heat, reddening, sweating, heartbeat. The condition of "inflows" lasts 3-5 minutes with repeatability from 1 to 20 and more times a day, amplifies at night, causing frustration of a dream. Easy extent of vasomotorial frustration at a climax is characterized by the number of "inflows" from 1 to 10 in days, average – from 10 to 20, heavy – from 20 and more in combination with other manifestations (dizziness, a depression, phobias) leading to decrease in working capacity.
The astenonevrotichesky frustration which are shown irritability, tearfulness, feeling of alarm, fear, intolerance of olfactory and acoustical feelings, a depression occur at 13% of women with a pathological current of a climax. Psychoemotional symptoms at a climax develop before a menopause or right after it, vasomotorial about 5 years after a menopause proceed.
Quite often pathological current of a climax is characterized by urogenital and sexual frustration, and also osteoporosis with development of pathological changes.
The current of a menopausal syndrome at a climax can develop in the form of atypical forms:
- the simpato-adrenalovy crises which are characterized by a sharp headache, increase in arterial pressure, a mocheotdeleniye delay with the subsequent polyuria;
- the miokardiodistrofiya which is characterized by constant heartaches in the absence of changes on the ECG, inefficiency of usual therapy;
- small tortoiseshells, vasomotorial rhinitis, an allergy to medicines and the foodstuff demonstrating change of immunological reactions of an organism, etc.
The current of a climax drops out for important events in the woman's life: a growing and a marriage of children, achievements at work, pension changes, and climacteric frustration accumulate on the raised emotional loadings and social problems. Almost the severe form of frustration occurs at 50% of women with a pathological current of a climax, at 35% of frustration are expressed moderately and only at 15% the menopausal syndrome carries easy manifestations. The easy form of frustration of a climax usually occurs among almost healthy women while women with chronic diseases are subject to atypical forms of manifestation of a climacteric syndrome, tendency to the krizovy character of a current breaking the general health of patients.
Development of a menopausal syndrome at a climax is promoted by genetic factors, endokrinopatiya, chronic diseases, smoking, violations of a menstrual cycle in the period of puberty, an early menopause, a hypodynamia, absence in the anamnesis at the woman of pregnancy and childbirth.
Diagnostics of a menopausal syndrome
Diagnostics of a pathological current of a climax is based on complaints of the patients appearing at the age of approach or approach of a menopause. Exacerbations of associated diseases sometimes complicates diagnostics of a menopausal syndrome at a climax, making heavier its current and causing development of atypical forms. In the presence of associated diseases, except consultation of the gynecologist, consultation of other experts is shown to the woman: cardiologist, neurologist, endocrinologist.
For the purpose of the correct diagnostics of the complicated current of a climax conduct a research of content in blood of levels of follikulostimuliruyushchy and lyuteiniziruyushchy goromon, estrogen. For specification of a functional condition of ovaries at a climax carry out the histologic analysis of scrape of endometrium of a uterus and cytologic researches of dabs from a vagina in dynamics, creation of the schedule of basal temperature. Identification of anovulyatorny yaichnikovy cycles allows to connect functional violations with a menopausal syndrome.
Treatment of frustration at a climax
The approaches to a problem of treatment of pathology of a climax accepted in modern gynecology are based on reduction of its manifestations and symptoms. Reduction of weight and frequency of "inflows" at a pathological current of a climax is reached by prescription of antidepressants (, fluoxetine, , to tsitalpra, , etc.).
For the purpose of prevention and treatment of development of osteoporosis at a climax non-hormonal medicines-biophosphonates (alendronovy and rizedronovy acids) reducing loss of a bone tissue and risk of development of changes are applied. Biophosphonates effectively replace therapy with estrogen in treatment of osteoporosis at women in the period of a climax.
For reduction of manifestation of urogenital symptoms at a pathological current of a climax local (vaginal) introduction of estrogen in the form of cream or tablets is recommended. Allocation in tissue of a vagina of insignificant doses of estrogen reduces feelings of dryness, discomfort at sexual contacts and frustration of an urination.
The most effective method of treatment of a menopausal syndrome at a climax is the hormonal therapy which is individually appointed by the doctor. Reception of estrogenic medicines well eliminates, in particular, "inflows" and unpleasant feelings in a vagina. Natural estrogen (, 17 - a beta estradiol, etc.) in small doses by faltering courses is applied to hormonal therapy in treatment of pathology of a climax. For prevention of hyper plastic processes in endometrium at a climax the combination of estrogen to gestagena or (more rare) with androgens is shown. Courses of hormonal therapy and a gormonoprofilaktika carry out within 5-7 years for the purpose of prevention of a myocardial infarction, osteoporosis and a stroke.
Hormonal therapy as treatment of pathology of a climax is contraindicated to the patients suffering:
- endometrial cancer, ovaries, mammary gland;
- koagulopatiya (fibrillation violation);
- dysfunction of a liver;
- tromboemboliya, thrombophlebitis;
- uterine bleedings of not clear reason;
- renal failure.
Before purpose of reception of hormonal medicines patients with pathology of a climax need to conduct researches: Ultrasonography of bodies of a small pelvis, ultrasonography of mammary glands and mammography, the cytologic analysis of dabs separated from a uterus neck, a biochemical research of indicators of blood test and the curtailing factors (koagulogramm).
Hormonal therapy mode
The choice of the mode of carrying out hormonal therapy depends on a climax stage. In a premenopauza hormonal therapy not only fills shortage of estrogen, but also has the normalizing effect on a menstrual cycle therefore it is appointed cyclic courses. In a postmenopause when there are atrophic processes in endometrium, for prevention of monthly bleedings, hormonal therapy is carried out in the mode of constant administration of drugs.
If the pathological current of a climax is shown only by urogenital frustration, estrogen () is appointed locally in the form of vaginal tablets, candles, cream. However, in this case there is a risk of development of other menopausal violations of a climax, including, osteoporosis.
The system effect in treatment of a pathological current of a climax is reached by purpose of the combined hormonal therapy (as an example, + an estradiol + a noretisteron acetate). At the combined hormonal therapy reception of hormones is combined with symptomatic medicines (hypotensive, warm, antidepressants, relaksant of a bladder etc.). The combined therapy for treatment of frustration of a climax is appointed after consultation of narrow experts.
The solution of problems of a pathological current of a climax is a key to extension of female health, beauty, youth, working capacity and real improvement of quality of life of the women entering a wonderful "autumn" time of the life.