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Zebo Raximberdievna Djabbarova
Samarkand State Medical Institute
yokubjon1994@mail.ru
RATIONALE OF TACTICS OF COMPREHENSIVE TREATMENT OF CLIMACTERIC
SYNDROME
For citation:
Zebo Raximberdievna DJABBAROVA RATIONALE OF TACTICS OF
COMPREHENSIVE TREATMENT OF CLIMACTERIC SYNDROME
.
Journal of Biomedicine
and Practice. 2021, vol. 6, issue 1, pp.175-182
http://dx.doi.org/10.26739/2181-9300-2021-1-25
ANNOTATION
In this article, we see substantiation of the need for an integrated approach to the treatment of
climacteric syndrome, taking into account the peculiarities of the lipid profile in women. The duration
of this pathological condition can be from one and a half to 10 years. On average, the symptoms are
observed for about 2-5 years. Their severity depends on the general state of health of the woman and
the individual characteristics of her div. Menopause, that is, the cessation of menstruation, occurs
in all women, without exception, but at the same time, climacteric syndrome does not manifest itself
in everyone.
Key words:
climacteric syndrome. women. symptoms. atherogenic dyslipidemias increases
Зебо Раксимбердиевна Джаббарова
Самаркандский Государственный Медицинский Институт
yokubjon1994@mail.ru
ОБОСНОВАНИЕ ТАКТИКИ КОМПЛЕКСНОГО ЛЕЧЕНИЯ
КЛИМАКТЕРИЧЕСКОГО СИНДРОМА
АННОТАЦИЯ
В данной статье мы видим обоснование необходимости комплексного подхода к лечению
климактерического синдрома с учетом особенностей липидного профиля у женщин.
Продолжительность этого патологического состояния может составлять от полутора до 10 лет.
В среднем симптомы наблюдаются около 2-5 лет. Их выраженность зависит от общего
состояния здоровья женщины и индивидуальных особенностей ее организма. Менопауза, то
есть прекращение менструации, наступает у всех женщин без исключения, но при этом
климактерический синдром проявляется не у всех.
Ключевые слова:
климактерический синдром. женщины. симптомы. увеличивается
атерогенная дислипидемия
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Zebo Raximberdievna Djabbarova
Normal fiziologiya kafedrasi assistenti
Samarqand davlat tibbiyot instituti
yokubjon1994@mail.ru
KLIMAKTERIK SINDROMNI KOMPLEKS DAVOLASHNI RATSIONALIZATSIYA
QILISH
ANNOTATSIYA
Ushbu maqolada biz klimakterik sindromni davolashda ayollarda lipid profilining o'ziga xos
xususiyatlarini hisobga olgan holda kompleks yondashuv zarurligini asoslaymiz. Ushbu patologik
holatning davomiyligi bir yarim yildan 10 yilgacha bo'lishi mumkin. O'rtacha alomatlar taxminan 2-
5 yil davomida kuzatiladi. Bunday alomatlar ayolning umumiy sog'lig'iga va uning tanasining
individual xususiyatlariga bog'liq. Menopoz, ya'ni hayz ko'rishning to'xtashi, istisnosiz, barcha
ayollarda uchraydi, biroq ayni paytda klimakterik sindrom hammada ham o'zini namoyon qila
olmaydi.
Kalit so'zlar:
klimakterik sindrom. ayollar. alomatlar. aterogen dislipidemiya kuchayadi
Materials and Methods:
94 women aged 40 to 64 years old, with complaints typical of
climacteric syndrome, were included in a prospective study on conditions of voluntary informed
consent. All women examined were diagnosed with moderate climacteric syndrome. The severity of
the climacteric syndrome was assessed by calculating the values of the modified menopausal index
(MMI), which corresponded to 8-14 points. The patients included in the study were divided into 3
groups. The first group consisted of 22 women under 45, the second - 34 people aged 46 to 50, the
third - 38 women aged 51 to 64. The syndrome occurs as a result of an age-related decrease in the
level of female sex hormones (estrogens) in the div and changes in the hypothalamus. It is more
likely to occur in women:
with a decrease in the adaptive system of the div;
with hereditary diseases;
with cardiovascular problems.
The occurrence and course of climacteric syndrome is influenced by the presence of
gynecological diseases, such as uterine fibroids and endometriosis. Psychosocial factors are also
essential - problems at work, disorder in personal life. Often, the onset of the syndrome is provoked
by a stressful situation. There is also a waveform and seasonality of manifestations of climacteric
syndrome, its peak occurs in spring and autumn. All patients included in the study had a normal div
mass index. The criteria for exclusion from the study were the following parameters: The climacteric
period is translated from Greek as "rung of the ladder". It is a physiological process that is observed
in the div of every woman upon reaching a certain age. It is accompanied by a decrease and
extinction of reproductive function. It occurs during menopause and is accompanied by a number of
disorders: from neurovegetative to psychoemotional. The reason for their development is fluctuations
in sex hormones. They appear against the background of age-related changes in the female div.
Their development can be triggered by the following factors:
stress;
past illnesses;
Lifestyle.
This syndrome is observed in almost half of women during premenopause, and during
menopause the number rises to 70%. With the early onset of menopause (up to 40 years) and removal
of the appendages, it becomes severe.There are three stages of the syndrome:
heavy;
medium;
easy.
The main factor in the differentiation of stages is the presence of changes in well-being and the
number of available hot flashes.
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Symptoms of climacteric syndrome are very diverse and can cause serious inconvenience to a
woman. Experts divide all manifestations of the syndrome into three groups:
neurovegetative;
psychoneurotic;
somatic.
The most common (up to 98%) neurovegetative symptoms are hot flashes of the face, head, and
upper div of a woman. The duration of the "hot flashes" can be from 30 seconds to 1-2 minutes.
The syndrome is also characterized by increased sweating accompanying hot flashes. It occurs in
almost 80% of cases.
Hot flashes can be triggered by a wide variety of stimuli such as stress, changes in weather
conditions, etc. With "hot flashes", the temperature of the skin surface rises by almost 5 ° C, the heart
rate increases to 130 beats per minute or more, peripheral vessels expand. In addition, the appearance
of red spots on the chest and neck, resembling a necklace in shape, attacks of severe headache,
changes in blood pressure, hypertensive crises, and vasomotor rhinitis are also common vegetative
disorders. Often women complain of cramps or numbness of the limbs, dry skin, swelling, drowsiness,
or, conversely, increased excitability. Some have asthma attacks and panic attacks.
Neurovegetative disorders during menopause can also cause increased sensitivity of the nervous
system, which leads to the appearance of pain in different parts of the div.Psychoneurotic symptoms
of climacteric syndrome are manifested by a decrease in memory and attention, irritability, emotional
instability and a feeling of fatigue. Many women experience decreased performance. Almost 13% of
patients present with one or another neurotic disorder, accompanied by tearfulness, a feeling of fear
or anxiety, bouts of unreasonable irritability, intolerance to some smells or sounds [2]. A very great
influence on the behavior of a woman during this period is exerted by her perception of the onset of
menopause as a tragedy, the final arrival of old age. In 10% of women with climacteric syndrome,
persistent depression caused by these experiences is diagnosed [3]. Such depression is one of the most
severe and difficult to treat psychoneurotic symptoms.
Somatic symptoms can be caused both by general age-related changes in metabolic processes,
and by an increased response of tissues and organs to a decrease in the level of estrogen in a woman's
div. There are inflammation of the vaginal walls, dystrophic changes in the vulva, bleeding, itching,
involuntary or painful urination. Loss of tone in the supporting muscles can result in prolapse or even
prolapse of the uterus and vagina.
At the same time, not only the genitourinary system is estrogen-dependent, but also the skin,
nails, hair, and mammary glands. Due to a decrease in the production and content of collagen, they
all undergo atrophy. Skin thickness decreases, its elasticity decreases, blood circulation in the
capillaries slows down, which leads to the appearance of wrinkles
Bleeding from the genital tract of unclear etiology; oncological diseases of any localization;
endometrial pathology; as well as extragenital pathology of moderate or severe severity.
Determination of the lipid spectrum of blood (cholesterol (ChC), high density lipoprotein cholesterol
(HDL), triglycerides (TG)) was performed using standard biochemical kits for the enzymatic
colorimetric method on the COBAS analyzer "COBAS S "(Austria). Based on the determination of
three main indicators, total cholesterol (TC), the content of low-density lipoprotein cholesterol (LDL-
C) and very low-density lipoprotein cholesterol (LDL-C), as well as the atherogenic index (AI) were
calculated.Symptoms are divided into 3 types: early, medium-term (after one to three years of the
postmenopausal period) and late - after five years of postmenopause.
Early manifestations of increased irritability and sweating;
aggressiveness;
decrease / increase in appetite;
hot flashes;
the presence of headaches and dizziness;
palpitations;
lability of blood pressure;
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pretentiousness.
Medium-term manifestations
cystalgia;
decreased libido;
feeling anxious and weak;
depressive state;
dryness of the skin and mucous membranes of the vagina;
loss of concentration;
incomplete control of urination.
Late manifestations
the presence of osteoporosis and atherosclerosis;
diseases of the joints, muscles;
type II diabetes mellitus, IR;
dyslipidemia;
decreased cognitive function;
arterial hypertension;
hearing and / or visual impairment.
Table 1. Comparative characteristics of lipid profile parameters in patients of the considered
groups
Index
I group
(n=22)
II group (n=34) III
group
(n=38)
p I‐II
p II‐III
p I‐III
ChC, ммоl/l
4,8±0,62
5,7±1,03
6,1±0,81
0,003
0,111
0,001
Triglycerides mmol
/ l
1,02±0,44
1,49±0,80
1,63±0,45
0,011
0,001
0,001
ChC HDL, mmol / l
1,52±0,36
1,20 ±0,27
1,18±0,28
0,117
0,117
0,117
ChC LDL, mmol / l
2,81±1,13
3,81±0,81
4,17±0,55
0,001
0,064
0,001
ChC LVDL, mmol /
l
0,47±0,21
0,68±0,36
0,75±0,42
0,002
0,011
0,012
AI
2,16
(3,20‐
4,27)
3,75
(3,31‐
5,13)
4,17
(3,65‐
5,31)
0,009
0,001
0,011
ChC LDL- / ChC
HDL
1,85
3,18
3,53
0,008
0,002
0,001
In order to select the methods of statistical analysis, the conformity of the studied quantitative
indicators to the law of normal distribution was checked on the basis of the Shapiro – Wilk test [6].
The significance of the differences in the frequencies in the groups was assessed using Fisher's exact
test (the differences were considered significant at p <0.05). The reliability of the statistical
assessments were accepted at least 95%.
Treatment of climacteric syndrome can be medication, hormonal or non-medication. The choice
of technique depends on the patient's age, the presence of pathologies, the duration of the condition
and the degree of its severity. It is not uncommon for doctors to combine several treatments. Timely
seeking help from a specialist will allow you to improve your health and well-being, to suspend and
prevent the negative impact of age-related changes on the div
Results and discussion:
When evaluating the results of the study, we found that patients with
initially the same degree of CS and BMI have significant differences in the lipid profile depending
on age, which is confirmed by us and in other works [7,8]. The study found that the change in the
lipid spectrum towards atherogenic dyslipidemias was significantly higher in women in the age group
older than 51 years, compared with patients younger than 45 years old (p <0.05) and older than 46-
50 years old (p <0, 05). Statistical analysis of changes in cholesterol content, its subtractions and
calculated indices (AI, LDL-C / HDL-C) in women with climacteric syndrome, depending on their
biological age, is presented in Table 1. With increasing age, an increase in the TG index is observed.
The age of the patients varied from 75 to 98 years, averaging 86.8 (± 5.0) years.
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An increased level of total cholesterol was found only in 13.3% of patients;
hypertriglyceridemia was detected in 10.4% of patients, and an increase in the content of LDL-C in
26.3% of patients, however, in most cases, the severity of dyslipidemia was insignificant. With
increasing age of patients, the content of total cholesterol and LDL-C in blood serum significantly
decreased. Correlation analysis revealed a significant negative correlation between the total
cholesterol level and the age of patients (r = -0.13; p = 0.001).
The average total cholesterol level in the group of patients under 80 years old was 5.43 mmol /
L; in persons aged 80 to 90 years - 5.0 mmol / l; in patients aged 90 years and older - 4.7 mmol / L (p
= 0.001 for the differences between the first and third groups). Similar results were obtained for LDL-
C (r = -0.14; p = 0.04). The average level of LDL-C in patients under 80 years of age was 3.69 mmol
/ L, and in the group of patients over 90 years old, 2.7 mmol / L (p = 0.004). In women, the
concentration of all studied lipids (total cholesterol, LDL-C, HDL-C and triglycerides) was
significantly higher than in men. Thus, the average level of total cholesterol in women reached 5.1
mmol / l, in men 4.5 mmol / l (p <0.0001). The content of LDL-C on average in women was 3.1 mmol
/ l, while in men 2.5 mmol / l (p = 0.0002). It should be noted that the level of HDL-C in women was
also higher - 1.26 mmol / L compared to the same indicator in men 1.17 mmol / L (p = 0.01).
An inverse relationship was observed between lower lipid values (primarily total cholesterol)
and clinically significant chronic heart failure (p <0.0001), as well as atrial fibrillation (p <0.0001).
There was a marked positive correlation between the level of total cholesterol and triglycerides, on
the one hand, and blood pressure indicators, on the other (p = 0.001). In addition, a highly significant
relationship was found between an increase in the concentration of triglycerides and glucose in serum
(p <0.0001), as well as triglycerides and uric acid (p = 0.001). With an increase in the level of
creatinine in the blood serum, an increase in the content of triglycerides (p = 0.001) and a decrease in
HDL-C (p = 0.0003) were noted. Only 11.4% of patients took statins.
The dynamics of the parameter increase was significant in all age groups (Table 1, p <0.05).
Correlation analysis revealed an increase in atherogenic cholesterol fractions with increasing age of
the patients; a direct positive relationship was traced between age and LDL-C level. In their works,
the authors G. Assmann, H. Schulte [9], also indicate an increase with age in the levels of low density
lipoproteins. Authors it is noted that the increase in the above parameter is gender-specific and is
more typical for women. According to the data obtained (Table 1), in the course of the statistical
analysis, there were no significantly significant differences between the patients of the first and third
groups for the GCs (p = 0.1) and LDL-C (p = 0.06) indicators.
However, there was an increase in the level of total cholesterol and LDL-C in women of the
third group compared to patients in the first and second groups (p <0.05). An interesting fact is that
in women with climacteric syndrome, as their biological age increased, along with a statistically
significant increase in CHC, TG, LDL-C, LDL-C, the expected decrease in HDL-C level was not
obtained. Thus, the decrease in HDL-C values in women in cases of a hypoestrogenic state, with an
increase in age from 40 to 64 years (table), was statistically insignificant (p = 0.1). Although, a
number of scientific works confirm that menopause is associated with a decrease in the values of
HsHDL. It is believed that isolated low values of HsHDL themselves may be the main risk factors
for the development of coronary heart disease (CHD) in postmenopausal women [10].
At the same time, the changes in lipid profile parameters that we identified in women with
hypoestrogenism did not differ from the general population trends. As a result of the study, the
obtained increase in the values of atherogenic LDL-C with increasing age of women, with stable
values of the protective HDL-C, explain the gradual increase in IA values, the ratio of LDL-C / HDL-
C among women in the study groups with an increase in their biological age. According to the results
of this study, in all groups of women, there is a clear relationship between the incidence of lipid
metabolism disorders with increasing age. It can be assumed that this fact is phenotypically and / or
genetically determined. However, this requires more detailed research in the future.
In 40% of cases [4], weight increases. A decrease in estrogen levels leads to increased leaching
of calcium from bones, a decrease in vitamin D synthesis and calcium absorption, and the process of
bone destruction begins to dominate. The consequence of these processes is the occurrence of
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osteoporosis, nocturnal pain in the extremities, lesions of the spine. Disorders in the functioning of
the thyroid gland are possible.
Severity
Experts distinguish three forms of climacteric syndrome, depending on the severity of its
course.Lightweight form. It is diagnosed only in 16% of women suffering from climacteric syndrome
[5]. With this course, up to 7-10 hot flashes per day are noted, the general condition and working
capacity of the woman practically does not change.
Medium form. This form is typical for 33% of women [6]. The number of hot flashes increases,
from 10 to 20 per day. In this case, pronounced symptoms appear: headaches and dizziness, memory
impairments, sleep, etc. The general condition worsens, performance decreases.
A severe course is typical for 51% of women [7]. In this case, a complete or almost complete
loss of performance is possible, a sharp deterioration in the general condition. Especially difficult and
long climacteric syndrome occurs if it appeared during the early development of menopause, at the
age of 38–43 years. The disorders that arise in this case can lead to serious disorders of psychosocial
adaptation in all spheres of life, including family and intellectual.
In addition, there is a classification of the syndrome depending on the characteristics of the
clinical manifestations. In this case, three forms are also distinguished.
Typical (uncomplicated). It is characterized only by hyperhidrosis (excessive sweating) and hot
flashes. It is observed in practically healthy women experiencing prolonged physical or mental stress.
The typical form is characterized by the timely onset of menopause and the appearance of the classic
symptoms of menopause, disappearing on average after one and a half to two years.
The general condition of a woman does not change. There is a moderately excessive deposition
of subcutaneous fat, a decrease in skin elasticity and other signs of changes in the div, fully
consistent with age. The state of the reproductive system in this form is also age appropriate.
The complicated form occurs against the background of diseases of the digestive system,
cardiovascular system, diabetes mellitus, thyroid dysfunction in women after 45 years. With a
complicated form, the frequency of hot flashes increases, and the severity of their course increases.
Pain or a feeling of fading in the region of the heart, increased heart rate, memory and sleep
disturbances may occur. According to studies, women with hypertension have a complicated form of
climacteric syndrome twice as often as healthy women [8].
The atypical form does not occur very often, mainly in women who have suffered in the past
physical or mental trauma, serious illness, surgery, or those who have worked for a long time under
the influence of harmful factors. The atypical form is characterized by a violation of the menstrual
cycle, and then a persistent absence of menstruation.
Treatment of climacteric syndrome
First of all, you need to understand that menopause is a physiological process. Complications
of menopause or the pathological course of menopause require consultation with specialists, and
therefore, in such cases, suffering women should be examined by doctors of several specialties,
including a neurologist and a psychotherapist. Nevertheless, the gynecologist plays the leading role
in reducing the negative effect of the syndrome on the patient's quality of life. It is he who makes the
diagnosis and chooses the method of treatment. Today there are three main areas of therapy, each of
which has its pros and cons.
Non-drug therapy
It is advisable to start this stage as early as the preparation of a woman for menopause. This
approach facilitates the course of climacteric syndrome or even avoids it. Complexes of special
physiotherapy exercises have a good effect. It has been proven that daily exercise has a positive effect
on various mechanisms of the nervous system, which is very important for reducing psychoneurotic
symptoms. Physiotherapy exercises can be recommended in the form of morning exercises or group
exercises. Physiotherapy is an important direction in the treatment of climacteric syndrome and, first
of all, in the impact on the central links of regulation [3]. Spa therapeutic factors have a powerful
biological effect on almost all human systems and organs. Therefore, it was traditionally believed that
the use of physical factors is absolutely contraindicated in cancer diseases, since many of them -
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therapeutic mud, ozokerite, hot baths and showers, mineral baths, heliotherapy, as well as general
physiotherapy procedures - can stimulate the growth of malignant tumors and contribute to the
progression or recurrence of cancer.
However, such sanatorium-resort factors as climatotherapy, drinking treatment with mineral
waters, indifferent isothermal baths, classes in reservoirs and swimming pools, help to improve the
general condition of patients, restore impaired functional indicators, increase efficiency and,
accordingly, improve the quality of life of this group of patients [2 ]. Sanatorium treatment has a great
influence on the psycho-emotional state of cancer patients: patients, getting into the atmosphere of a
sanatorium-resort institution, cease to record their somatic sensations, and, being involved in the
rhythm of the resort routine, they get out of a severe stressful situation related both to themselves
cancer, and with the consequences of its radical treatment [4]. The type of exercise and its amount is
determined by the doctor. Regular physical activity, especially walking, increases oxygen
metabolism, lowers insulin levels, and normalizes carbohydrate metabolism.
Weight control is also included in the complex of non-drug therapy. Proper nutrition is very
important. A woman's diet should be dominated by vegetables and fruits, vegetable fats. Limit your
carbohydrate intake. During this period, it is recommended to include in the daily diet food rich in
phytoestrogens, for example, soy, flaxseed oil, parsley leaves, etc. Vitamin deficiency is replenished
with the help of vitamin complexes, which must include vitamins A, C, E.
Drug therapy
It is mainly used to treat moderate to severe climacteric syndrome to normalize the nervous
system. For this purpose, sedatives may be recommended to the patient. With prolonged climacteric
syndrome, accompanied by also chronic diseases, tranquilizers, antidepressants and neuroleptics are
prescribed. The course of treatment must include vitamins.
Conclusion
In patients with climacteric syndrome, as the woman's age increases, the severity of atherogenic
dyslipidemias increases, but their phenotypic characteristics do not change. It can be assumed that
lipid metabolism disorder is a condition caused by a genetic component. Thus, the relationship
between age and lipid profile, revealed by us in women with climacteric syndrome, necessitates an
integrated approach to the treatment of manifestations of climacteric syndrome, namely: on the one
hand -carrying out menopausal hormone therapy, focusing on the criterion of its "metabolic
neutrality" when choosing a drug, and on the other hand, the appointment of lipid-lowering drugs
(differentiated in depending on the revealed violations - nicotinates, statins, fibrates, etc.), bringing
the therapy of menopausal disorders in perimenopausal women to a new, "not stereotyped", but
personalized level individually selected for each woman.
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