Chronology of disorder development
Estrogen deficiency causes a sequential chain of disorders, which are usually divided into three groups depending on the time of onset:
- Early symptoms: include neurovegetative (hot flashes, sweating, blood pressure surges, sympathoadrenal crises) and psycho-emotional manifestations (irritability, depression, sleep disturbances, asthenia).
- Medium-term disorders: manifest predominantly in the 2nd–5th year of postmenopause. These include urogenital disorders and atrophic changes in the mucous membranes and skin.
- Late complications: develop years later and include systemic diseases such as postmenopausal osteoporosis and cardiovascular pathology.
The clinical course of the syndrome varies in severity: mild form occurs in 40% of patients, moderate in 35%, and severe in 25%.
Urogenital manifestations
The decrease in sex hormone levels triggers dystrophic processes in estrogen-sensitive tissues: the vagina, urethra, bladder, and pelvic floor muscles. The clinical picture develops comprehensively:
- Atrophic vaginitis develops, accompanied by pain during sexual intercourse (dyspareunia).
- Cystourethritis, frequent urination (pollakiuria), and urinary incontinence occur.
- Pelvic organ prolapse progresses. This is due to the fact that hypoestrogenenia disrupts the biosynthesis and deposition of collagen in fibroblasts.
Impact on the cardiovascular system and bone tissue
Cardiovascular risks: Up to the age of 40, myocardial infarction in women is 10–20 times less common than in men, but after the cessation of ovarian function, this ratio changes and by age 70 reaches 1:1. Against the background of hypoestrogenism, total cholesterol, triglycerides, and low-density lipoprotein (LDL) levels increase, and the anticoagulant potential of blood decreases. Prolonged hormone deficiency is also thought to be involved in the pathogenesis of Alzheimer's disease.
Postmenopausal osteoporosis: Occurs in 40% of patients. Osteoblasts reduce bone matrix synthesis, and osteoclasts enhance resorption.
- In the first 5 years, trabecular bone tissue is primarily affected (spinal and radial bone fractures occur).
- Later, lesions of tubular bones join (hip fracture).
- Important: radiography is not suitable for early diagnosis, as it shows changes only when more than 30% of bone mass is lost. The basis of diagnosis is clinical manifestations and densitometry.
Principles of treatment
The only pathogenetically substantiated method of correction is recognized as hormone replacement therapy (HRT). Natural estrogens are used (e.g., estradiol valerate, 17-β-estradiol, estriol) in combination with progestogens or androgens. Drugs can be administered orally or parenterally (transdermally, vaginally, as injections).
- Short-term courses (1–3 years): are prescribed to relieve climacteric syndrome and urogenital disorders.
- Long-term courses (more than 3 years): are used for the prevention and treatment of osteoporosis, if necessary, in combination with bisphosphonates.
To remember the chronology of climacteric disorders, use the rule 'Emotions — Mucosae — Bones': first the nervous system suffers (early), then the mucous membranes dry out (medium-term), and finally the bone tissue is destroyed (late).
Class and exam questions
How often does climacteric syndrome occur?
During the premenopausal period, the syndrome is observed in 20–30% of women, and in postmenopause its frequency increases to 35–50%.
Which women are at maximum risk for developing osteoporosis?
Caucasian women with a thin physique, early menopause (under 45 years), smokers, alcohol abusers, and those with a sedentary lifestyle are at the highest risk.
Can osteoporosis be detected at an early stage using a regular X-ray?
No, X-ray examination is uninformative in the early stages, as it registers pathology only with a loss of 30% of bone mass or more. Densitometry must be performed.
What else to study on this topic
- Ultrasonographic appearance of ovaries in postmenopause (atrophic and hyperplastic types)
- Full list of risk factors for the development of postmenopausal osteoporosis
- Changes in the lipid profile and hemostasis system against the background of hypoestrogenism
- Kupperman index: criteria and method for calculating the severity of the syndrome
- Differential diagnosis of dysfunctional uterine bleeding in the premenopausal period
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