Pathology of menopause
Endocrinology / / August 12, 2017
Diagnosis and differential diagnosis of climacteric neurosis
climacteric neurosis diagnosis is based on clinical symptom of the disease.Almost all of the symptoms observed in the climacteric neurosis, there are also other disorders of the nervous system, proceeding with the dysfunction of the autonomic nerve centers of higher diencephalic area (eg, cardiopsychoneurosis).A feature of the climacteric neurosis should be considered as the presence of peculiar crises - tides.In the presence of other disorders without the characteristic tides diagnosis climacteric neurosis based on their occurrence in the age period close to the time of menopause or menstrual disorders.In addition, it is necessary to rule out other possible diseases that can cause symptoms similar to climacteric neurosis (neurosis, hypertension, cardiovascular disease and so on. D.).
Treatment climacteric neurosis
For most women, the disease is mild and lasts for several months, not reflecting any general state or the disability.Th
long your symptoms of climacteric neurosis is different.The duration of the disease in 25% of patients do not exceed one year.For most women after 1-2 years autonomic nervous symptoms gradually fade.However, some patients with severe climacteric neurosis persist decades after menopause.
A significant proportion of patients with a mild form of climacteric neurosis settlement work, leisure and everyday life, physical training, water treatment and staying in the open air are quite effective.
important part of treatment is psychotherapy.Psychotherapy should be aimed at clarifying the fact that most of the unpleasant symptoms of menopause neurosis associated with purely functional changes and does not indicate the presence of any life-threatening diseases and operability.Most women care issue related to the cessation of menstruation and menopause, which is properly regarded as an indicator of rapid aging and cessation of sexual activity.It is necessary to clarify that the cessation of menstrual function does not mean the end of sex life and that most severe symptoms of menopause will be eliminated.However, it is impossible to exaggerate the role of psychotherapy and the role of the psychogenic factor in the origin of climacteric neurosis, as some foreign authors.Therefore, along with obschegigienicheskih activities even when not heavy, but persistent forms of climacteric neurosis, not fixed by resolution of the regime of work, life, physical education and psychotherapy, should seek to address them through the use of effective medicines, non-hormonal and hormonal (hormones and their synthetic analogues).
For the treatment of climacteric neurosis often appointed bromine products.Treatment is advisable to start with small doses (0.5% sodium bromide solution, 2-3 tablespoons a day) and in the absence of a sufficient effect to produce a gradual increase in the dose of the drug.When bromine within individual selection of doses.Some authors recommend intravenous administration of sodium bromide.In mild cases of the disease, especially if there is pre-existing neurosis, which can burden the climacteric neurosis, bromine application can have a certain therapeutic effect.
Patients with a mild form of climacteric neurosis beneficial therapeutic effect can be obtained by the use of low doses of reserpine.Studies have shown that small doses of reserpine having peripheral effect by reducing the content of epinephrine and serotonin without affecting their content in brain tissue.However, we can not exclude the central effect of low doses of reserpine.As shown by experimental studies, large doses of reserpine lowers norepinephrine and serotonin in the central nervous system, especially the hypothalamus, have a sedative effect reduced gonadotropic pituitary activity violate sexual cycle, cause trophic changes in the ovaries, disinhibited production of prolactin, cause changes in the mammary glandsand a number of other biological effects.With the fall of serotonin content in the central nervous system related sedative effect of reserpine, which is explained by the fact that most of the symptoms of climacteric neurosis associated with an increased excitability of the sympathetic part of the central nervous system.
reserpine can be used both independently and in combination with other agents.Special indications for the use of reserpine are labile pulse with a tendency to tachycardia, increased blood pressure and diencephalic crises.In some patients, reserpine improves sleep.
reserpine Treatment should start with small doses (0.1 mg 2 times a day).Gradually increase the dose to the minimum effective dose (0.1-0.25 mg 3 times a day).After reaching the clinical effects of the treatment can be continued for a long time, with a gradual reduction of doses.
With regard to the most specific symptoms of climacteric neurosis-tide - reserpine effect usually occurs only at a low intensity.In the treatment of hot flushes reserpine usually they not disappear completely, but their strength is considerably reduced and the frequency.
reserpine has a favorable effect on the symptoms of climacteric neurosis associated with an increase in the excitability of the sympathetic division of the nervous system (pulse lability, tendency to tachycardia, persistent increase in blood pressure, diencephalic crises).
Treatment reserpine is contraindicated in the presence of a peptic ulcer, gastric hyperacidity, asthma and angina.From reserpine side effects should be pointed out the possibility of pain in the heart, bradycardia and gastrointestinal disorders (diarrhea).
From phenothiazine drugs for the treatment of a number of climacteric neurosis used chlorpromazine (chlorpromazine).The mechanism of action of chlorpromazine is to reduce the excitability of the reticular formation and the suppression of its reactivity to epinephrine.Small doses of chlorpromazine inhibit the reticular formation, bolshie- excite.Aminazin adrenergic blocking mechanisms within the reticular affects subcortical structures of the midbrain, hypothalamus.Chlorpromazine, reserpine and the like, in large doses reduces serotonin in the central nervous system, and in contrast to reserpine it does not change or increases its content of norepinephrine.In the application of very high doses of chlorpromazine norepinephrine drop occurred in all areas of the brain other than the hypothalamus.Unlike chlorpromazine reserpine in rats causes a drop in serotonin in the brain tissue even at low ambient temperature conditions.
Like reserpine, chlorpromazine belongs to the group of tranquilizers - drugs with sedating effects.
Aminazin shows the predominance in the clinical picture of climacteric neurosis neuropsychiatric symptoms - increased irritability, tearfulness, anxiety, insomnia.
Aminazin assigned to 25 mg orally at night, with a gradual increase of the dose to 50-150 mg per day (administered in divided doses).It is necessary to monitor the composition of the white blood as chlorpromazine may even cause neutropenia and agranulocytosis, and liver function.Of the side effects of chlorpromazine should be noted a feeling of drowsiness, weakness, heaviness in the head, dry mouth and mucous membranes of the nose.Due to the properties of chlorpromazine cause increased heart rate it is expedient to combine with the appointment of reserpine.
effect of chlorpromazine on the tides is more pronounced than that of reserpine, but in view of the adverse effect to assign it with caution in the presence of marked autonomic manifestations.
For the treatment of patients with climacteric neurosis with the predominance of their feelings of fear, insomnia, excitation at elevated andaksin recommended.Andaksin administered in a dose of 0.5 mg per night with a gradual increase to three administrations per day.Andaksin no effect on hot flashes and other menopausal symptoms of autonomic neurosis, and because its application can only be added to other therapeutic agents.
Also, as an additional therapeutic agent can be recommended to use small doses of barbiturates.Small doses of barbiturates are widely used in a number of branded products in combination with substances acting on the autonomic nervous centers (Belloidum, Akliman and others).
For the treatment of climacteric neurosis also apply ergot alkaloids, which have a calming effect and sympatholytic.As an independent form of treatment ergot alkaloid drugs are not used, but they are part of a series of proprietary funds ( "Belloidum", "Akliman") in combination with belladonna alkaloids and barbiturates.They are used for menopausal neurosis with a clear predominance of the excitability of the sympathetic part of the nervous system: 1 tablet 3 times a day for at least a month.
Some authors in the treatment of climacteric neurosis received the favorable effect of the use of novocaine.Procaine administered in an amount of 3-5 ml a day (preferably freshly prepared solution of 2% to 5% glucose solution).Gradually increasing the dose to 10 mg, up to 1 mL per injection.The course of treatment is 12 injections can be repeated 2-3 times at 10-day intervals.In the treatment of novocaine, according to Romanian authors and others, noted improvement in general condition and well-being, sleep, reducing headaches and improving memory.In some patients, the treatment reduces the amount of novocaine tides.
For the treatment of climacteric neurosis, in some cases the active vitamin therapy can be offered.For this purpose, appointed ascorbic acid orally at a dose of 0.6 grams per day or intravenously, vitamin B complex Vitamin B1 - 5% - 1 ml intramuscularly daily for a month, vitamin B6 - 2.5% - 1 ml every other day in the complexvitamin B6 and B12 200 ug every day or two.Nicotinic acid is used in doses of 0.025-0.05 per day orally or intravenously (1 and 5% solutions).
There are some indications of the successful application of climacteric neurosis of vitamin A, 30 mg 3-4 times a day.
There is also a beneficial effect of vitamin E, which is recommended to appoint 80-100 mg per day.However, some authors have observed good effects from the use of much higher doses of vitamin E (200-500 mg per day for at least a month).
For the treatment of climacteric neurosis as aids may be used physical therapies - hydrotherapy, treatment currents d'Arsenvalya, franklinization, ultraviolet irradiation and radiotherapy.
physiotherapy treatment often has a beneficial effect on sleep, reduces irritability, headaches, sweating.The beneficial effect of physical therapy, marked by some authors, apparently, be attributed to the tonic influence.Exercise therapy can be administered to all patients climacteric neurosis if they have no specific contraindications.
All of these methods of medical and physical treatment of climacteric neurosis are efficient treatment of sex hormones.
- Menopause (Menopause) and diseases of menopause in women
- Pathology of menopause (menopause).Climacteric neurosis
- menstrual cycle Hormonal
- menstrual irregularities
- granulosa tumor.Follikuloma
- Violation monthly rate.Amenorrhea
- Violation of the menstrual cycle with monthly rhythm disorder.Polimenoreya
- principles of hormone therapy violations
- menstrual Principles of hormonal treatment of dysfunctional uterine bleeding
- Prevention of recurrence of dysfunctional uterine bleeding
- Tumor cells Leydigovyh hilyusa ovaries.
Hormonal treatment of menopausal neurosis
most effective treatment for menopausal neurosis is a hormone therapy.estrogens (and their synthetic analogues) are used for the treatment of climacteric neurosis, androgens (and close to androgens in the structure of matter - metilandrostendiol), as well as their combination with each other.Application of preparations of estrogen and androgen groups, and combinations thereof are strictly defined indications and contraindications, without which hormone therapy may not be effective or may cause unwanted complications.Sustained elimination of symptoms of the climacteric neurosis observed only in long-term continuous treatment.
main methods of hormonal treatment of menopausal neurosis
The use of estrogen for the treatment of climacteric neurosis
The use of androgens in the treatment of climacteric neurosis
combined use of estrogen and androgen