From Big Medical Encyclopedia

CLIMACTERIC (grech, klimakter step, age turning point; synonym: klimakteriya, climax) — the physiological period of transition from puberty by the period of the termination of generative function.

The climacteric at women

the Climacteric at women covers a time term from 45 to 60 years and is characterized by the gradual termination of menstrual function, and then and hormonal function of ovaries against the background of the general age changes of an organism. To. the item is inseparably linked with process of aging both cortical nerve centers, and the hypothalamic structures which are carrying out regulation of activity of a hypophysis and ovaries.

In the first phase a klimakteriya — in a phase of climacteric dysfunction of ovaries, or a premenopauza — changes of function of ovaries are characterized by an irregular luteinization of follicles, decrease in secretion of progesterone and estrogen, irregular periods are noted. Time after the last uterine bleeding caused by influence of ovarian hormones is called a menopause. Its approach is preceded by the period of reduced ability of a female body to fertilization. The term «menopause» is used also for designation of the second phase K. the item — postmenopauses when function of a yellow body of an ovary completely stops, against the background of considerable decrease in products of estrogen is noted their residual secretion in tissue of ovaries, menstrual function stops.

Changes in neuroendocrinal system of women in To. items are characterized by decrease in reactivity of summer residents on the gonadotropic incentives from gipotalamo-pituitary system arising owing to decrease in oestrogenic influences of ovaries, funkts. changes of a thyroid gland, dysregulation of the vegetative centers, hyperexcitability of the sympathetic centers and lability of vasculomotor system.

Duration of function of ovaries belongs to genetically programmed fiziol. to processes. By 40 years in ovaries there are 30 000 — 40 000 follicles, next decade their number considerably decreases. Dystrophic changes in ovaries begin with a thickening of a basal membrane of follicles with the subsequent its fibrous transformation.

Speed and degree of a reduction of number of follicles are individual; in the outcome of dystrophy the atresia of follicles with filling of their cavity with connecting fabric is observed. V K. items in ovaries are found follicles at different stages of development, fibrous and atretic bodies, the tendency to melkokistozny regeneration of follicles is noted. In 3 — 4 after a menopause the ripening and atretic follicles meet more and more seldom. Further there comes so-called functional rest of ovaries, their size decreases twice. Sclerous changes in vessels of ovaries of preferential average caliber find after 30 years, long before the first a wedge, manifestations To. the item, then they extend to larger vessels. The gleam of vessels is narrowed, thickened an internal cover, the elastic membrane disappears, there is fatty and hyaline dystrophy of vascular walls. The vascular network of generative organs and especially a uterus is considerably rarefied. Big changes size undergoes it. Only at those women who have climacteric bleedings owing to the increased release of estrogen the uterus in a premenopauza increases. In a postmenopause its weight is lost to 30 g. The number of an anastomosis between branches of vessels of the left and right half of a uterus decreases, and on the centerline the avascular zone is found as if. Distinctions in a structure of a neck and a body of the womb disappear, the antefleksiya is replaced by an easy retroflexion. Puzyrnomatochny and rectouterine spaces are flattened. The endometria gets an atrophic structure: the stroma becomes fibrous, glands are badly developed, spiral arteries become rectilinear. The border between funkts, and a basal layer disappears; in a basal layer the remains of glands remain, it is frequent in a condition of a cystous atrophy. The epithelium of a neck of uterus atrophies. The vagina is unevenly narrowed, especially in an upper third, the structure of vulval contents changes. In external genitals hypodermic fatty tissue disappears, big vulvar lips become flabby, and small decrease and depigmented, the clitoris decreases. Involutional changes are found also in mammary glands: ferruterous fabric disappears, the nipple loses pigmentation; sometimes mammary glands considerably increase in sizes as a result of excess fatty deposits.

First phase K. the item comes aged apprx. 45 years. To a precocity To. items refer approach it up to 40 — 42 years, to late — after 55 years. In the presence of an idiopathic hypertensia duration of a premenopauza increases up to 3 — 3,5 years. Typical feature of changes of menstrual function in this period are disturbances of a rhythm and duration of a menstrual cycle and gradation from two-phase (ovulatory) to a single-phase (anovulatory) cycle. After 43 years average duration increases menstrual cycle (see), a considerable part of women has a single-phase cycle at the broken rhythm of periods. Time of approach of the second phase K. the item fluctuates in quite wide limits even at absolutely healthy women (as a rule, in 45 — 46 years).

At most of women both phases K are expressed. the item, and the period of climacteric changes of menstrual function precedes approach of a menopause: gradually intervals between periods increase and intensity of menstrualnopodobny allocations decreases. Less often changes of menstrual function are characterized by emergence of irregular, plentiful and long menstrualnopodobny bleedings. At a third of women of periods stop suddenly. Earlier termination of menstrual function is promoted by frequent repeated childbirth, abortions, a long lactation though approximately at a half of women it is caused by primary hypothalamic disturbances. The menopause comes later at patients with a hysteromyoma, idiopathic hypertensia, etc.

In a premenopauza the level of hormonal secretion in residual follicles of an ovary decreases, at the initial stages of age reorganization concentration in a blood plasma of oestradiol at not changed products decreases a yellow body of progesterone, later there is a decrease in secretion of each of these hormones. The reserve of the ovarian follicles capable to maturing is gradually exhausted, and by the time of a menopause the level of allocation with urine of total estrogen decreases to 20 mkg/days. Within the first year of a postmenopause still cycle variations of level of oestrogenic influences are noted, by the end its level of release of estrogen with daily urine decreases almost twice — to 10 mkg. This amount of estrogen turns out insufficiently for fiziol, stimulations of an endometria though sensitivity of the last to stronger endo-and to exogenous hormonal incentives remains during quite long period. After decrease and the subsequent termination of production of estrogen in the follicular device of ovaries ekstrafollikulyarny products of steroid hormones remain in a female body for a long time and steroid hormones or their predecessors in small amounts. With the expressed individual fluctuations they continue to be formed preferential in the field of gate of ovaries where the hyperplasia of cellular elements of a stroma with signs of euzymatic activity quite often is found. 6 — 10 years later after approach of a menopause a small part of estrogen is formed in an ovary, other quantity is a product of aromatization of androgenic predecessors out of ovarian fabric — in hypodermic cellulose and a gastroenterohepatic complex. Products of sexual steroids cortical substance of adrenal glands in awkward age remain not changed within 10 — 20 years after a menopause.

The progressing decrease in formation of ovarian hormones, especially estrogen, in awkward age is followed by disturbance of influence of the last on gipotalamogipofizarny system. It is shown by the termination of influence of ovarian steroids on the Hypothalamic centers, strengthening of cyclic products of hypothalamic rileasing-hormones and gonadotropic hormones in a front share of a hypophysis. The maintenance of gonadotrophins increases in a front share of a hypophysis by 10 times; it is combined with increase in weight of this share and contents in it basphilic elements. Content of the luteinizing hormone (LH) in a blood plasma, according to radio immune definitions, increases from 30 ng/ml up to 500 ng/ml, follicle-stimulating hormone (FSG) — from 20 up to 760 ng/ml, and the ratio of LG/FSG equal in reproductive age 1,0 decreases to 0,4 — 0,7. The ratio of LG/FSG in plasma less than 0,7 is a sign of approach To. item. The maximum of maintenance of L G and FSG in blood is noted on the 3rd year of a postmenopause and remains within 10 years. With approach of a menopause decrease in oestrogenic activity is noted at 50% of women, signs of moderate oestrogenic influences are found in 33 — 40% of women, 10 — 17% have signs of the strengthened oestrogenic influences.

Disturbances To. the item — climacteric dysfunctional uterine bleedings (see) and menopausal syndrome (see).

The condition of oestrogenic deficit developing, as a rule, at late stages of the period of a postmenopause promotes development of atrophic changes of a vulva, vagina and urinary tract, atherosclerosis, system osteoporosis, a dystrophic arthropathy. At preservation in this period of oestrogenic influences there is a bent to hypertensia, diabetes, development hyperplastic processes in an endometria and mammary glands.

V K. the item at many women is observed obesity, development hron, locks, the general weakening of an organism. The prevention of the specified phenomena is promoted by walks, gymnastics, massage, restriction of amount of food, especially meat dishes. The alcohol, spices which are sharply exciting a nervous system shall be excluded. It is better to regulate action of intestines purpose of the corresponding diet.

V K. the item almost healthy women shall have medical examination at the gynecologist at least 2 times a year. The close attention and careful inspection is demanded by emergence in this period of unusual symptoms.

The climacteric at men

the Climacteric at men is defined by the age involutional processes happening in gonads and most often comes aged from 50 up to 60 years. Atrophic changes of glandulotsit of a small egg (cells of Leydiga) at men of this age lead to reduction of synthesis of testosterone and decrease in level of an androgenic saturation of an organism. At the same time products of gonadotropic hormones of a hypophysis tend to increase. Decrease in incretory function of testicles plays a role of a so-called starting factor in disturbance of mechanisms of regulation of system a hypothalamus — a hypophysis — gonads. The complex neuroendocrinal changes including dysfunction of c result. N of page and defining a picture of a men's climax. At the vast majority of men age fading of function of gonads is not followed any klinich, manifestations though characteristic symptoms of a climax and in similar cases a current sometimes take place To. the item is regarded as pathological.

Wedge, manifestations patol. To. items at men are characterized cardiovascular, psikhonevrol, and urinogenital disturbances. Cardiovascular disturbances are shown by feeling of inflows to the head, sudden face reddening and necks, heartbeat, pain in heart, the asthma raised by perspiration, dizziness, etc. Sometimes there is non-constant arterial hypertension.

Psikhonevrol, disturbances in To. p, can be weak or are sharply expressed. Patients complain of easy excitability, bystry fatigue, a sleep disorder, muscular weakness, a headache. The depression, causeless alarm and fear, loss of former interests, the increased suspiciousness, tearfulness is observed.

Among symptoms of dysfunction urinogenital bodies it is noted various degree dysuria (see). Disturbances of a sexual potentiality are observed at the vast majority of men (see. Impotence ). At the same time all compound moments of a copulative cycle suffer, but preferential weakening of an erection and a premature ejaculation is noted.

Treatment at patol. To, the item at men includes the normalization of a work-rest schedule dosed physical. loading, creation of the most favorable psikhol, climate. An obligatory component of treatment is psychotherapy (see). Drug treatment includes the means normalizing a futsktion of c. N of page (sedative drugs, psychogogic antidepressants, tranquilizers, etc.), vitamins, biogenic stimulators, drugs, phosphorated, antispasmodics. In some cases purpose of drugs of sex and gonadotropic hormones for the purpose of correction of disturbances of endocrine relationship, and also use of anabolic hormones is shown.

See also Menopause .

Bibliography: Arsenyev M. G. Kolpotsitologicheskiye of a research in diagnosis and therapy of endocrine gynecologic diseases, page 206, L., 1973, bibliogr.; Vikhlyaeva E. M. Menopausal syndrome and its treatment, M., 1066, bibliogr.; 3 m and N about Sunday to and y Yu. t. Age neurophysiological features and climacteric frustration at women, M., 1975, bibliogr.; Malinovsky M. S. and With in e of t - M about l d and in with to and I am V. D. Klimaktery and a menopause, M., 1963, bibliogr.; Mandelstam V. A. Uterine bleedings in a menopause, L., 1974, bibliogr.; Teter E. Hormonal disturbances at men and women, the lane with polsk., Warsaw, 1968.

E. M. Vikhlyaeva; D. V. Kan (Urals.)