Quality of life of a woman during menopause

Качество жизни женщины в период климактерия

The life expectancy of women is now steadily increasing throughout the world. As of the beginning of the 2000s, in developed countries, it was approximately 75 & ndash; 80 years, and in developing countries — 65–70 years old. At the same time, the age of menopause remains relatively stable: it occurs on average at 49 & ndash; 50 years.

Thus, almost a third of a woman's life passes after the end of menstruation, that is, in the period called by the general term — “climax”, which means that the quality of life of a woman during this period is especially relevant today.

The essence of menopause

When analyzing the quality of life, today it is customary to pay attention to five main categories that characterize the menopause:

physical condition (physical ability, physical well-being);
mental status (anxiety and depression levels, mental well-being, control of emotions and behavior, intellectual functions);
social functioning (interpersonal contacts, social connections);
role functioning (role functioning at home and at work);
general objective perception of the state of one's health (assessment of the present state, prospects for the state of health, assessment of pain sensations).

Traditionally, the approach of menopause women meet with anxiety. There is an opinion that this is one of the most difficult periods in a woman's life. From doctors, a woman often has to hear: “Well, what do you want, your menopause is coming.” In the scientific and popular literature, the negative consequences of menopause are constantly emphasized, and hormone replacement therapy is offered as a panacea. What actually happens in a woman's life with the onset of menopause?

The main symptoms of menopause in women

It is known that the common name “menopause” combines several periods:

preclimax — that is, the period starting from the age of 45.
"menopause" indicate a period of steady cessation of menstruation; determination of the time parameters of menopause is possible only retrospectively, after a year of absence of menstruation.
early menopause - the first five years after the end of menstruation, and
subsequent years (up to 70 & ndash; 75 years) — late menopause or postmenopause.
The period of life after 75 years is referred to as old age.

The essence of the menopause is the extinction of the function of the gonads with a corresponding decrease in the levels of sex hormones (estrogens, progestins, androgens) and an increase in the content of gonadotropins (LH, FSH). It is a significant and sustained increase in the level of gonadotropins that is one of the reliable signs indicating the onset of menopause.

Factors affecting the body of a woman during menopause

First Factor — natural aging processes that occur in the human body, regardless of its gender. It is known that with age, due to natural aging processes, the death of cells of the nervous system is observed, mediator and receptor changes occur, motor activity decreases, depressive processes become aggravated, cognitive impairment increases, etc.

Second factor — the burden of somatic and neuropsychiatric diseases that “grows” to this age a person due to genetic predisposition, as well as the impact of environmental factors. Here it would be appropriate to mention hypertension, diabetes, obesity, atherosclerosis, past episodes of depression, anxiety disorders, etc.

Genito-urinary menopausal syndrome

The Third Factor — direct influence of hormonal changes in menopause on peripheral and central structures. So, typical peripheral symptoms of menopausal syndrome are "hot flashes"; fever, the frequency of which varies from 40 to 80%, and urogenital disorders.
Currently, cells that secrete sex hormones, receptors for sex hormones, the mutual influence of sex hormone levels, metabolism, activity of neurotransmitters (norepinephrine, serotonin , dopamine, acetylcholine) and neuropeptides (β-endorphins, substance P, etc.). Therefore, menopause is also a morphofunctional restructuring of the central nervous system, which, of course, is also characterized by certain clinical manifestations.

The Fourth Factor — psychosocial status of women during this period. To a large extent, this indicator is associated with the cultural characteristics of the environment. In this case, we can talk about the professional and financial status of a woman, the "empty nest syndrome", that is, the leaving of adult children from home, the presence or absence of a sexual partner, disharmony in the intimate sphere, peculiarities of self-perception and perception of oneself as a woman, etc. e.

Today, a physician in any specialty dealing with menopausal women is required to take into account those disorders that are specific or most common in his patients at that time. Among them, the following disorders should be highlighted:

Psycho-emotional disorders in menopause

The connection between the female psyche and changes in the female reproductive system has been known since the time of Hippocrates. It is no coincidence that such diagnoses as "climacteric depression", or "involutional melancholia", "involutional hysteria", "climacteric neurosis" are still widespread. However, if we talk about severe or endogenous depression, then no convincing evidence has yet been obtained that during menopause they occur more often than during other periods of a woman's life.

At the same time, climacteric depression, which develops in the structure of the climacteric syndrome, usually accompanies somatovegetative disorders. It can manifest itself in a variety of emotional and affective syndromes: a decrease in mood, loss of interest in one's own personality and in the environment, increased fatigue, a decrease in activity, unmotivated anxiety, suspiciousness, restlessness, a constant feeling of internal tension, fear of impending old age and disturbing fears for one's health. .

Often women note increased vulnerability, touchiness, excessive sensitivity, mood lability, tearfulness. For some, during this period, irritability, aggressiveness, and a sense of hostility towards others increase.

Vegetative disorders in menopause

These disorders are usually combined with emotional disorders and are referred to as psychovegetative syndromes. Their structure is represented by both permanent and paroxysmal disorders, they usually include several systems, that is, we can talk about their polysystemic nature. The most typical complaints are palpitations, arrhythmia, discomfort in the left half of the chest, fluctuations in blood pressure, lack of air, dyspeptic disorders, chills, trembling, sweating. Sometimes these polysystemic vegetative disorders manifest themselves in the form of seizures and, combined with emotional syndromes (fear, anxiety, aggression), take on the character of panic attacks.

Psychovegetative disorders are often combined with pain syndromes of various localization, with chronic forms predominating: headaches, tension and back pain.

Dyssomnic disorders in menopause

This is one of the most characteristic manifestations of the menopause. So, in our special study, a statistically significant deterioration in the quality of sleep, compared with premenopause, was found in more than 60% of women, and the structure of these disorders consisted in an increase in the time to fall asleep, more frequent nocturnal awakenings and a lower subjective assessment of the quality of sleep.

When determining the tactics of treating sleep disorders, the attending physician must first of all clarify their etiology, since dyssomnias in menopause can be associated with both central cerebral disorders and peripheral ones. The central factors include organic brain disorders (vascular, toxic-metabolic), emotional disorders (depression, anxiety, fears). In menopause, women are much more likely than in the reproductive period to experience respiratory disorders (somnoea syndrome) and movement disorders during sleep.

Clinical criteria for “sleep apnea” — these are snoring, pauses in breathing during sleep, morning high blood pressure and morning headaches, as well as daytime sleepiness. Movement disorders during sleep are usually manifested by restless legs syndrome; (Ekbom's syndrome), and discomfort in the legs usually occurs during periods of rest, more often before bedtime or during sleep, and is accompanied by an irresistible need to move the legs; only at the moment of movement do these sensations disappear.

Night "hot flashes" are primarily considered as peripheral factors; and nocturic disorders. In addition, dyssomnic disorders can be associated with pain syndromes, nocturnal paresthesias in the hands (Wartenberg syndrome) and other disorders that occur or worsen at night.

Sexual disorders in menopause

According to the literature, from 54 to 75% of women report a decrease in sexual activity during menopause. Moreover, the predominantly psychological component is deteriorating — the interest in sex, the value assessment of sex decreases with the relative preservation of the implementing mechanisms: sexual activity, the ability to obtain an orgasm, the degree of satisfaction.

Reduced sexual function is due to hormonal changes that occur in perimenopausal women, namely a decrease in the production of sex hormones by the ovaries: estrogens, progesterone and androgens. Deficiency of biologically active (free) testosterone leads to a decrease in sexual desire. With a decrease in estrogen levels, the vaginal mucosa becomes pale, thinned and more prone to microtrauma, the production of vaginal lubrication decreases and slows down, and constant pain occurs during intercourse (dyspareunia). In addition, the sexuality of a woman in menopause is determined by the presence of a sexually interested partner, subject to a good relationship with him, the presence of a favorable family microclimate.