From Big Medical Encyclopedia

MENOPAUSE (Greek men month + pausis the termination) — the second phase of a climacteric coming after the last menstrualnopodobny bleeding and which is characterized by the termination of cyclic changes in an endometria, menstrual and genital functions, changes of hormonal balance in system a hypothalamus — a hypophysis — ovaries, the progressing involute changes in generative organs. Sometimes use the term «menopause» in literature and for designation of the last uterine bleeding caused by effect of hormones of an ovary. The term «postmenopause» means the period of decrease, and then termination of secretion of hormones in ovaries.

Transition of the first phase climacteric (see) in M., as a rule, is defined retrospectively since it is difficult to establish what of menstrualnopodobny bleedings is the last. Therefore most of clinical physicians considers M. which came at absence at the woman of menstrualnopodobny bleedings within a year from the last periods; usually it happens aged from 48 up to 52 years.

In ovaries synthesis of sex hormones decreases; mature follicles are already absent, dystrophic changes progress, vessels are sclerosed. In an experiment at an incubation of tissue of ovary with marked steroids it is revealed that in the period of M. they are still capable to produce a small amount of estrogen; at the same time secretion of the main hormone — oestradiol 17-beta sharply decreases, decreases also the content of estrone. With reduction of secretion of hormones, especially oestradiol, secretion of follicle-stimulating and luteinizing hormones increases; however ovaries gradually lose ability to react to hyper stimulation gonadotropic hormones (see).

Owing to age hormonal changes hypotrophic processes of generative organs amplify. The sizes of a uterus (first of all at the expense of a muscular layer) and ovaries decrease, cyclic processes in an endometria stop, functional and basal layers of an endometria and its gland atrophy, cortical substance of ovaries becomes thinner, and the white is thickened.

Changes in an epithelium of a neck of uterus and an isthmus are synchronous to changes in a mucous membrane of a body of the womb; glands also gradually cease to cosecrete, the mucous membrane becomes atrofichny. The mucous membrane of a vagina keeps the properties longer because it is more sensitive, than an endometria, to small amounts of estrogen; however gradually it becomes thinner, the skladchatost disappears, proliferation of an epithelium stops, in vulval smears atrophic cells are found.

Changes happen also in nervous, endocrine, cardiovascular and other systems of an organism of the woman. M, as well as the beginning of a climacteric, can accompany the following symptoms inherent to a menopausal syndrome (see): migraines, inflows of heat, the increased perspiration, an itch of generative organs. Dysfunctions of a nervous system are shown by hl. obr. in change of dynamics of cortical processes due to dominance of processes of excitement that is shown in irritability, sensitivity, a memory impairment and working capacity, bystry fatigue, sleep disorders; sometimes there is a depression. Can be observed unsharply expressed funkts, changes of adrenal glands and a thyroid gland, than speak changes of nek-ry types of a metabolism, a hirsutism, a nevus pigmentosus skin, a chill and other changes.

Fatty, water, carbohydrate metabolism changes; it is shown in reduction or increase in fatty deposits, hypostases, disturbance of a diuresis, etc.

M. can be complicated by the bleedings caused by genital and extragenital diseases. The most frequent reason uterine bleedings (see) in M. the hyperplasia of a tekatkana (covers of follicles) in ovaries is, edges arises under the influence of gonadotropic stimulation; at this pathology tekatkan produces sex hormones (oestradiol, androstendion, testosterone). Uterine bleedings in M. arise also at a tecoma, granulocellular tumors of ovaries and an arrhenoblastoma. These tumors happen very small sizes, at a palpation are not defined; diagnose them on the indirect signs indicating a ginerestrogeniya, edges appears in M. Bleedings in M. can arise at tsilioepitelialny pseudomucinous to languor, cancer of an ovary and uterus, uterine tube, polyps of a mucous membrane of a neck of uterus, a senile colpitis. At tumors of ovaries in an endometria the zhelezistokistozny hyperplasia, adenomatous polyps develops. Bleedings in M. can arise also owing to an idiopathic hypertensia, at use of oestrogenic drugs, vasodilators, thermal procedures. The woman who had in M. even one bleeding will enclose to stationary inspection for identification or an exception of malignant new growths and specification of the reason of bleeding.

In the period of M. diseases of cardiovascular system, a hypertension, diabetes, diseases of a liver, kidneys, thyroid and pancreatic glands, allergic states proceed heavier. Women differently transfer the changes happening in M.; at most of women the organism rather easily adapts to these changes. At 50 — 60% of women the arising frustration partially and are even completely normalized at the rational mode of life, and also under the influence of sedative therapy.

When M. proceeds against the background of various somatopathies, women shall be under dispensary observation at the therapist. Special attention needs to be paid to observance of the correct mode. The diet shall include vegetables, cottage cheese, black bread, fruit; meat and meat soups need to be limited. It is necessary to observe a work-rest schedule.

Bibliography: Vikhlyaeva E. M. Menopausal syndrome and its treatment, M., 1966, bibliogr.; N. A hares. Dysfunctional uterine bleedings, Kiev, 1977, bibliogr.; Mandel piece and V. A m. Uterine bleedings in a menopause, L., 1974; Physiology and pathology a klimakteriya of the woman, under the editorship of V. G. Baranov, L., 1965, bibliogr.; Green-b 1 a t t R. Century, Colle M. L. and. M of a h e s h B. Ovarian and adrenal steroid production in the postmenopausal woman, Obstet., and Gynec., v. 47, p. 383, 1976; Judd H. L. Hormonal dynamics associated with the menopause, Clin. Obstet. Gynec., v. 19, p. 775, 1976, bibliogr.; The menopause, ed. by R. J. Beard, Lancaster, 1976.

M. L. Krymskaya.