Pathology of menopause
Endocrinology / / May 21, 2016
Climacteric neurosis - condition that develops in the age menopause (menopause), is characterized by changes in the higher nervous activity such as neurosis and some expressed autonomic nerve disorders associated with pathological age-related changes in the function of the hypothalamic centers and possibly other parts of the central nervoussystem.
Pathogenesis climacteric neurosis
For a long time there was an idea that climacteric neurosis is the result of loss of ovarian function and hypoestrogenemy.Some authors have linked the development with a high content of gonadotropins in blood that naturally occurs in women after menopause.However, there is evidence that forced to reconsider this idea.Studies have shown that the normal blood levels of estrogen and gonadotropins can be observed at the climacteric neurosis.These observations, along with the presence of a normal menstrual cycle in 15% of women with climacteric neurosis and frequent development of climacteric neurosis until the age of menstr
delay occurs when the cycle and postmenopausal estrogen decrease isolation, may have added value, changing the functional state of the hypothalamus and the reinforcing effects of neurosis.This is supported by the fact that long-term use of low doses of estrogen, causing only a weak proliferative effect, can eliminate the symptoms of climacteric neurosis.
Highlight 17-keto steroids in the urine of women with climacteric neurosis, according to some authors - increased, according to others - dropped.In the study of the fractional composition of the 17-keto steroids also has been shown to increase androgen function of the adrenal cortex, but were marked by a significant fluctuations in the individual fractions and a slight increase in allocation of 11-beta-gidroksietioholanolona.It is possible that these changes are one of the manifestations of neurosis.However, the level of 17-gidroksikortikosteroidov in the blood and excretion of urine from postmenopausal women with climacteric neurosis does not differ from the corresponding figures for women in the same age group with the absence of the phenomena of the climacteric neurosis.
There was also observed a difference of these indices in women with preserved menstrual cycle and postmenopausal.
No convincing data for participation in the pathogenesis of climacteric neurosis and other endocrine glands.
When climacteric neurosis shows an increase in blood cholesterol, cholesterol ratio - phospholipids and beta-lipoprotein, compared with the corresponding figures for persons of the same age but without climacteric neurosis.
can assume that in the genesis of these disorders are common pathological changes in functional hypothalamic centers, one of the features which are characteristic of critical emerging autonomic nervous symptoms.It is necessary in this case to distinguish between high blood pressure that develops in women as a result of physiological and pathological course of menopause.Studies have shown that in women aged 45-49 years with preserved menstrual cycles and postmenopausal there was no significant difference in the level of systolic and diastolic blood pressure and frequency of hypertension.Noted the increasing distribution of essential hypertension in women during menopause, but does not provide data, the extent to which this increase in frequency due to the higher prevalence of hypertension in women with physiological or pathological course of menopause.Experimental data the researchers have received increased blood pressure in animals after castration, can not serve as evidence of climacteric hypertension because the genesis of menopause can not be reduced to the primary loss of ovarian function, and reduction in ovarian function at menopause is a physiological process, strictly coordinated with otherthe aging manifestations.
There is evidence of increasing climacteric neurosis release of norepinephrine, continued at a higher level after the elimination of the main clinical manifestations of climacteric neurosis.These data indicate a change in climacteric neurosis simpatoadrenalovoj system and comply with the predominance in the clinical symptoms associated with an increased excitability of the sympathetic part of the nervous system.Dominance in the clinical picture of climacteric neurosis autonomic nervous disorders and the emergence of a critical characteristic vasomotor and other symptoms of autonomic nervous give reason to explain their genesis violation of the posterior section of the hypothalamus functional state, pertaining to the sympathetic section of the central nervous system.It should be noted that the centers of the posterior hypothalamus are affecting catecholamine excretion.
To what extent concepts of pathogenesis of climacteric neurosis justify the correctness of the existing nomenclature of the disease.Some authors propose to replace the term "climacteric neurosis," "age neurosis" or "menopausal syndrome".However, it seems that the term "climacteric neurosis" has a pathogenetic substantiation.Chronologically, the closest match in the vast majority of women of menopausal symptoms of neurosis, cessation of ovulation and menstruation, undoubtedly has a certain commonality of origin and is determined by age and functional changes in different but related parts of the hypothalamus.From this perspective, the concept of "climacteric" should be extended to this form of neurosis.The therapeutic effect of estrogen affecting the autonomic nervous climacteric neurosis and, at the same time acting on the area of regulating the production of gonadotropins and ovulation, further reinforces this view.The term "menopause" also can not replace the nomenclature of "climacteric neurosis" in view of the fact that there are other pathological manifestations of menopause, such as dysfunctional uterine bleeding.Given all this, the term "menopausal neurosis" must be currently stored.
Distribution climacteric neurosis
climacteric neurosis symptoms most often occur in women between the ages of 45-50 years, and much less in the earlier (38-40 years) or later (50-55 years) age.Climacteric neurosis often appears in women with preserved menstrual cycle, but more often if the cycle irregularities and at different times after the onset of menopause.According to the data stored in climacteric neurosis cycle occurs in 13.1% of cases.In 36.8% of cases, the symptoms of climacteric neurosis observed when stored, but the wrong menstrual cycle, in 15.1% of cases - with the right cycle.The phenomena of the climacteric neurosis in 13.2% of women were in the normal menstrual cycle, 49% - in different menstrual cycle and 37.8% - in different periods after menopause.In some women, the symptoms of the climacteric neuroses appear at a later date after the menopause (3-15 years).
frequency of climacteric neurosis of women in the aging process, according to different authors, ranging from 10-15% and even up to 84%.Such a wide range of frequency detection climacteric neurosis, apparently, due to the different approach to the diagnosis of this condition and the various methods of screening (examination of persons defined professional groups, various social factors and so on. D.).Climacteric neurosis frequency will vary depending on whether the disease accounting mass screening performed at this age group, or on the basis of hospitals and clinics.
Clinic and climacteric symptoms of neurosis
climacteric symptoms of neurosis can be schematically divided into two groups:
1) autonomic nerve;
Most of the symptoms observed in the climacteric neurosis, are also found in other neuroses occurring in violation of the hypothalamus functions.
autonomic nerve disorders in the climacteric neurosis expressed in the presence of hot flushes, sweating, palpitations, pain in the heart, dizziness, noise in my head, and in the ears, shortness of breath, paresthesia, constipation, flatulence and other.The most common and specific symptoms of climacteric neurosis are so-called flushes, which, besides the climacteric neurosis, observed only at neurosis and castration significantly fewer and less severe form - with amenorrhea.Hot flashes occur in the form of short-term feelings of heat, extending from 30 seconds to 1-2 minutes, accompanied by reddening of the face, neck and upper chest, sweating, darkening of the eyes, palpitations and dizziness.Feeling the heat after the tide is often replaced by chills.The strength of the tides and the nature of the accompanying vegetative disorders (sweating, palpitations, and so on. D.) Can be varied.tides frequency even in the same patient can vary from 30-50 to 1-5 per day.In some patients, there is a longer (up to half an hour), feeling of fever, sometimes accompanied by redness of the face and upper body, advancing slowly and gradually stops.Such attacks occur relatively rarely, and mostly occur in individuals who have previously suffered from a neurosis.
Characteristically, climacteric neurosis tides often occur in the state of work and at rest and during sleep.Increased frequency of hot flashes at night disrupts sleep and reduces the ability to work sick.
Sometimes hot flashes are accompanied by a respiratory disorder or begin with reinforced breaths.Then there is a feeling of lack of air, which leads to frequent deep breaths.Such a violation of the rhythm of breathing and shortness of breath in patients with climacteric neurosis occur alone, often at night, regardless of physical activity, which distinguishes it from shortness of breath associated with heart failure.
Respiratory rhythm is often observed in neurasthenia, and in diseases of the hypothalamic region.
At the core of these violations is the weakness and exhaustion of functional central nervous system.
Along with the tide, one of the most common symptoms of menopause neurosis is sweating.Tides are almost always end up sweating.Sweating in some patients and is no tides, especially at night, replaced by a feeling of chill.
climacteric neurosis patients often complain of pain in the heart and the heart.Heart pain, tend to be long and are independent of physical activity, they often occur without apparent cause, but often aggravated by agitation or after the next inflow.Pain often localized in the apex of the heart, are aching or stabbing in nature.In some cases there is irradiation in the left arm or back.
electrocardiogram in patients with climacteric neurosis, suffering from pains in the heart, often do not show pathological changes.Admission of nitroglycerin or validol usually does not remove the pain or brings only partial relief, and pain, as a rule, gradually subside on their own.
upcoming acute lack of blood supply to the heart muscle, observed in angina pectoris, characterized by rapid onset and end of the attack, a characteristic behavior of patients, localization and radiating pain and a distinct effect of the use of nitroglycerin.In climacteric neurosis nitroglycerin without affecting described pain often causes painful sensations in the head, which is why patients use them rarely.The clinical picture of pain in the area of the heart in patients with climacteric neurosis, in most cases fits into cardialgia symptom characteristic of cardiovascular neuroses observed in young adults.
However, given the increase in the frequency of coronary atherosclerosis and myocardial infarction in menopause, with complaints of pain in the heart of the need for careful examination of patients to rule out coronary disease.
A number of patients with heart attacks occur with an increase in heart rate to 100-120 beats per minute, which occur at rest, regardless of physical or mental stress.
to the same functional impairment in patients with climacteric neurosis should include palpitations, occurring without significantly increased heart rate.
peculiar pattern of climacteric neurosis observed in women, in whom the fore severe vestibular disorders, manifesting dizziness, tinnitus, disequilibrium.Vestibular disorders are a rare complication and usually appear simultaneously with other symptoms of climacteric neurosis, in particular with the tides.In more severe cases, vestibular symptoms predominate over the other symptoms of menopause neurosis and reach great intensity, leading to disability.In these patients, dizziness occur when any change of position of the head or in the form of attacks for no apparent reason.Attacks of vertigo may be accompanied by nausea or vomiting.Outside of seizures in patients experiencing unsteadiness of gait, hampering independent movement not only outside, but also in the room."Climacteric genesis" vestibular disorders often remains for a long time not recognized.In a special survey otolaryngologists typically no pathological changes in the hearing is not detected.Often this type of patients unsuccessfully treated by dynamic cerebrovascular accident, and only hormone therapy is effective.Pathophysiological basis of these violations apparently are angioneurotic disturbances in the inner ear - a spasm of blood vessels of the labyrinth.
relatively rare but severe form of climacteric neurosis are diencephalic crises such as seizures, which usually dominate the clinical picture.Attacks often occur at night and are accompanied by pain or a feeling of "fading", "spasms" in the heart, palpitations with an increase in heart rate, usually up to 100 beats per minute or more, cold extremities, blanching or reddening of the face, severe weakness.a large number of light-colored urine with a low specific weight allocated at the end of the attack.In some cases, attacks are accompanied by chills or sweating, severe headache, tinnitus and vertigo.Often patients indicate that the attacks can be unconscious, but this condition is not observed by doctors or others.In some cases, especially in patients suffering from hypertension, during an attack of high blood pressure is observed.Seizures cause a feeling of fear, especially if they happen at night.seizure duration - from several minutes to an hour.