Modern approaches to the diagnosis and treatment of menopausal symptoms

Author of the article: Luzan Anna Mikhailovna, obstetrician-gynecologist of the 4th antenatal clinic of the health care institution “1st City Clinical Hospital”

Menopause is the last menstrual period that reflects a decrease in estrogen levels due to loss of ovarian follicular function.

According to the time of occurrence, menopause can be timely, early and premature. Timely menopause occurs in women over the age of 45, early - at the age of 40-45, and premature - before 40 years.

It is also customary to distinguish between natural and induced menopause. Natural menopause occurs due to a decrease in ovarian follicular activity in the absence of other pathological causes

at an average age of 51 years. In turn, induced menopause is defined as amenorrhea (absence of menstruation) after surgical removal of the ovaries or other iatrogenic effects (for example, chemotherapy or radiotherapy for cancer) leading to loss of ovarian function.

In the course of systematizing clinical manifestations and laboratory data during menopause in 2011, the Stages of Reproductive Aging Workshop (STRAW) developed the STRAW +10 criteria for each reproductive stage of a woman’s life. Each of the stages has its own digital designation, where all periods before menopause have a “-” sign, and after menopause - “+”, and the last menstruation (menopause) is represented by the number “0” (Fig. 1).

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Figure 1 - STRAW +10 classification

As follows from the STRAW +10 classification, even before the onset of menopause, a woman may be bothered by an irregular menstrual cycle. According to research, during the late menopausal transition, not only long episodes of amenorrhea (more than 60 days) can occur, but also a shortening of the menstrual cycle (up to 20-25 days) with the presence of heavy menstrual bleeding.

About 80% of women during the menopausal transition and early postmenopause may experience hot flashes and bouts of night sweats, the frequency of which can reach 20 times a day. According to the American Study of Women's Health Across the Nation (SWAN), the average duration of hot flashes in peri- and postmenopausal women is 7 years, which significantly worsens a woman's quality of life and can lead to sleep disturbances and depressive disorders.

In postmenopause, due to prolonged estrogen deficiency, genitourinary menopausal syndrome (GUMS) can develop, which in 2014 replaced the previously widely used term “vulvovaginal atrophy”. GUMS includes a wide range of symptoms associated with the genitourinary tract. The most common manifestations of GUMS are vaginal dryness/itching, dyspareunia (pain during intercourse), urinary incontinence, frequent urination, and recurrent urinary tract infections.

Late menopause symptoms that develop during late postmenopause include osteoporosis, dementia, and cardiovascular disease.

The diagnosis of menopause is based on

the patient’s clinical manifestations and complaints and can be made at the woman’s first visit

to the doctor. Additional laboratory testing (determining the level of follicle-stimulating hormone) is required only in cases presenting diagnostic difficulties. For example, when taking oral contraceptives at age 50, or in women with a history of hysterectomy or endometrial ablation, or in women under 45 who have menopausal symptoms.

Timely diagnosis of menopausal symptoms allows you to promptly select the necessary treatment tactics for the patient and reduce the risks of developing osteoporosis, dementia and cardiovascular diseases.

Treatment of menopausal symptoms should begin with lifestyle modification (regular physical activity, balanced diet, giving up bad habits), which in most cases reduces the intensity of symptoms and improves quality of life.

Because Menopausal symptoms occur due to a decrease in estrogen; the most effective treatment for menopausal symptoms is menopausal hormone therapy (MHT), used when the prescribing criteria are met and there are no contraindications. The criteria for prescribing MHT are age under 60 years (or onset of menopause less than 10 years ago), persistence of menopausal symptoms even after lifestyle modification, absence of contraindications (uterine bleeding of unknown etiology, breast or endometrial cancer, thromboembolism, active liver and gallbladder diseases ).

The most preferred forms of MHT are transdermal forms of estrogens for relief of vasomotor symptoms and vaginal forms of estrogens for GUMS. If

the uterus was not removed before menopause, then it is necessary to prescribe progesterone drugs to protect the endometrium. If there are contraindications to the use of MHT, antidepressants and/or cognitive behavioral therapy for vasomotor and psychological manifestations, lubricants or moisturizers for GUMS can be used.

Thus, timely and effective relief of menopausal symptoms prevents the development of not only menopausal symptoms, but also their complications, as well as the long-term consequences of prolonged hypoestrogenemia.

Patients of any age experiencing menopausal symptoms should contact the antenatal clinic at their place of residence for consultation with a gynecologist. At the appointment, the doctor determines the severity of symptoms, identifies indications and contraindications for therapy, develops treatment and observation tactics, prescribes medications if necessary, and discusses lifestyle modification to alleviate clinical manifestations. It is important to remember that menopausal symptoms are treatable and every woman has the opportunity to improve her quality and life expectancy.