What it is?

Menopause (climax) - the physiological period of human life, characterized by dominance in the reproductive system of involutionary processes against the background of the general age-related changes. The menopausal period may be accompanied by various endocrine, mental and vegetative impairment (climacteric syndrome).

In the menopacteric period, women are distinguished for three periods: premenopause, menopause and postmenopause.
1. Premenopausa It is characterized by increasing disorders of the menstrual cycle in the hymenstrual type: the gaps between menstruation increase, the amount of blood released decreases. Premopause begins usually aged 45-47 years and continues from 2 to 10 years before the cessation of menstruation.
2. Menopause - Full stopping menstruation. The exact date of menopause is set retrospectively, after at least 1 year after the cessation of menstruation.
3. Postmenopausa It comes after the cessation of menstruation and continues on average 6-8 years.

Perhaps early either by contrary, later the onset of Klimaks. The first is due to the primary deficiency of the ovaries, difficult living conditions; In addition, in the early offensive climacteric period Not the last role is played by transferring infectious diseases, nervous shocks, constitutional and hereditary predispositions. Later, the onset of climax in women usually occurs if there is stagnation In a small pelvis, as well as in fibromomiomes of the uterus. The pace of development of the menopausal period is deterministic genetically, however, at the time of the offensive and the flow of different phases of Klimaks can affect such factors as general state Health, Features of nutrition, working conditions and life, climate. In some cases, menstruation stop immediately; In others, this happens gradually. Often in the menopacteric period, uterine bleeding may occur, associated with a violation of the ovarian function and the formation of an eating body in them.

The development of Klimaks is based on complex changes in the system regulating cyclic changes in the female organism, including the central nervous system (hypothalamus, pituitary) and ovaries. Changes begin in the regulatory mechanisms of the hypotalamus hypophisotropic zone and supegotelamic structures. The number of estrogen receptors decreases, the sensitivity of the hypothalamic structures towards the ovarian hormones is reduced. As a result of the disorder of the neurosecretory function of the hypothalamus, the cyclic ovulatory emission is violated by the hypophysome of gonadotropins. In the ovaries, the ripening of follicles and the release of egg cells (ovulation) is stopped. In some cases, however, ovulation continues for some more after the cessation of menstruation. Products of hormones regulating cyclic changes in the reproductive system of women continues after the cessation of menstruation for several years.

In most women, the menopacteric period is not accompanied by any painful phenomena. However, some violations that are usually combined by the term may be observed. climacteric syndrome. The main complaint is the so-called "tides" - a suddenly arising sensation of heat in the upper body, accompanied by redness of the face, neck, chest. Flips usually continue for 2-3 minutes, more often occur in the evenings and at night. During the tides there is plenty of sweating. It may be celebrated headache, increased irritability, insomnia, depressive condition, etc. In some women, blood pressure increases, sometimes there are pain in the field of heart, in the joints.

Men's menopausal period

In men, the menopacteric period is usually between 50 and 60 years. Atrophic changes in the glandocitis of eggs lead to a decrease in testosterone products and a general decrease in the development of androgen in the body. The synthesis of gonadotropic hormones of the pituitary gland has a tendency to increase. The rate of involutionary processes in the genital glands varies significantly; It is conventionally believed that male climax is completed by about 75 years of age.

The menopacteric period of men is clinically less pronounced than women. In the presence of concomitant diseases ( hypertonic disease, IHD, vegetative dystonia) of their symptoms in the menopacteric period are brighter. The heat of the heat to the head are possible, suddenly emerging redness of the face and neck, the feeling of ripples in the head, shortness of breath, heartbeat, pain in the heart, increased sweating, dizziness, non-permanent increase in blood pressure. Characteristic psychoneurological disorders are increased excitability, sleep disorders, muscle weakness, increased fatigue, headache. An unprecedented alarm, absentmaking, depressed state, federation is possible. From the urogenital organs, dysurium and impaired copulatory cycle with a weakening of erection and accelerated ejaculation are noted.

"Climax" translated from Greek means "staircase". At some point, a woman in connection with the reverse development of reproductive bodies has to overcome this step leading to the fatery of the childbearing function. Hormonal changes occurring during the climax is a natural process, it is not necessary to fear it.

Stages of a climacteric period

Climax is a period of life, during which the functioning of the reproductive system ceases.

There are three Klimaks Stages in women:

1. Premenopausa. Begins for several years before the complete end of menstruation. The duration of the stage is from 1 year to 3 years. The ovarian functions gradually begin to fade, ovulation ends, the process of conception becomes problematic. Interregular periods are observed. The interval between them increases, and the duration is gradually decreasing. Stage stretches.
2. Menopause. The period when a woman has no monthly period. At this time, a woman can dial a lot in weight, heart problems occur, diabetes can develop. Menopause most often develops aged 45 to 50 years. The cessation of menstruation under 45 is considered early menopause, and up to 40 years old - premature.
3. Postmenopausa. Time from the end of menopause up to 69-70 years.

It is often believed that climax and menopause are the same. However, Klimax is defined as a loss of a childbearing function, and menopause - a year without menstruation.

There are cases that menopause comes unexpectedly, despite the fact that the woman planned preparation for this stage. To avoid such a situation, you need to know the symptoms of climax approximation in women.

Symptoms

The table presents the main signs of an impending climax.

	Signs
Disruption of menstrual cycles	With the extinction of the hormonal function of the ovaries, the duration of menstruation changes. They proceed irregularly and scarily. There may be an interval from one to three months between menstruation, and sometimes more. After a certain time, monthly stops completely.
Riding	At such moments, the woman throws in the heat that applies to face, neck, chest and hands. In this moment the temperature rises, sweating and lack of air occurs. The skin bluses either covered by stains. Listed symptoms may be accompanied by dizziness, nausea and tachycardia. The duration of the tide is from 30 seconds to 3 minutes.
Mood change	In the premenopausal period, women have disruption of psycho-emotional state. They are expressed in aggressiveness, irritability, plasticity, anxiety, anxiety. Most women have such changes in the mood appear before month.
Change of appearance	Hormonal imbalance in the body leads to lethargy of the skin, hair loss. Nail plates become brittle, dry, begin to get out.
Increased weight	Excess weight is not always a sign of menopause. Grease calorie food also affects the increase in body weight. The development of insulin resistance is possible. With the age of muscles, the muscles are reduced, and fat layers increase.
Night hypergidrosis	Manifests itself in severe sweating during sleep.
Dry vagina	With the slowdown in metabolic processes in the body there is a decrease in elasticity, moisture of tissues. become friable, cracks appear. Low pelvis organs can fall and fall out.
Insomnia	Sleep calm depends on the balance of estrogen and progesterone. The lack of first leads to sweating, the second is to insomnia.
Reducing libido	The first reason for the reduction of sexual desire is the unpleasant sensations arising during intercourse. The second is to reduce the level of hormones responsible for sexual attraction.
Heart problems	Low estrogen levels caused the development of heart disease during climax in women.
Osteoporosis	Most dangerous symptom. Changes are occur bone tissuecharacterized by its vacuum and increased fragility. Risk risk of bone fractures. Woman feels increased fatigue, weakness.
Urinary incontinence	The shortage of female hormones weakens the muscles of the pelvis and leads to sphincter relaxation bladder
Muscular and headaches	With menopause, the tone of blood vessels changes, as a result, headaches arise. Muscular pain appears when calcium exchange is broken.
Memory problems	The reason is the reduced level of estrogen. When normalizing a hormonal background, the problem disappears.
Gynecological diseases	Affect the emergence of early climax (primarily the ovarian tumor).
Allergy	On its appearance affects the connection of endocrine and immune systems. In hormonal changes, allergic rhinitis, asthma, dermatitis can occur.

There are many more signs of the coming female climax, but a woman should not be afraid and worry about this. Timely consultation with the doctor and the correct selection of medicines will help facilitate the state.

Complications of menopause periods

Not in all cases there is a normal leakage of the climax in women. Such complications of this period are possible:

• the difficult course of menopausal syndrome with a violation of the gastrointestinal tract, which causes the depletion of a woman;
• pathological fractures (symptom of osteoporosis);
• breakthrough uterine bleeding due to hormonal failures;
• endometrial hyperplasia;
• development of fibromes of the uterus;
• mastopathy, tumor formations of the mammary glands.

Due to the large number of possible complications, regular prophylactic visits to the gynecologist are needed.

Climacteric syndrome

This is one of the common problems of menopause. Climacteric syndrome is expressed in the emergence of the Endocrine complex neurological violations. The symptoms of this syndrome include:

• headaches, migraine, dizziness;
• tides heat to the head and upper body;
• sharp mood swings;
• insomnia;
• exacerbations of existing chronic diseases;
• violations from the cardiovascular system;
• hypertensive disease, etc.

In the complex, these symptoms significantly worsen the quality of the life of a woman, lead to a decrease in performance.

The severity of the climacteric syndrome depends on the frequency of tides. Easy degree is characterized by the occurrence of tides up to 10 times for 24 hours; The average - up to 20 times, heavy - more than 20 times a day.

Causes of early climax

Early climax is called hormonal restructuring, which began earlier than 45 years. This may be caused by a number of reasons:

• exhaustion of ovaries associated with genetic anomaly (defect X-chromosome);
• inheritance diseases (galactosemia, amenorrhea, blefrophomy);
• effects surgical intervention - removal of Moma with the uterine, ovaredectomy;
• the effect of radiation and chemotherapy appointed in the treatment of malignant neoplasms;
• reducing the intensity of immunity.

Woman should know what doctor to contact early Climeakse. Professional gynecologist-an endocrinologist will consult and prescribe treatment.

How to delay the onset of klimaks?

Specialists have developed several methods for removal of Clemaks. The period most suitable for the application of delay measures.

1. Hormonal replacement therapy is appointed by a doctor strictly according to indications. To move away the arrival of menopause can preparations estrogen (Ovrestin, Divigel, Klimontorm, Norcut, etc.).
2. The doctor may assign a long-term intake of phytoestrogen - vegetable substances similar to the mechanism of action by natural estrogen. These drugs include Feminal, Estrovale, Femievell, etc.
3. Fitotherapy is the use of bravery and infusions of some medicinal plants (Cabinet, Medicarians, Sage, the horsetail of the field and many others). Effective for delayed Klimaks and monastic tea.
4. In addition, for an effective result, you must follow the following rules:

• do not use fat, sweet food; Fruits, vegetables, dairy products must prevail in the diet;
• to play sports, thereby stimulating the production of biological substances that prolong youth;
• take care of female health and regularly visit the gynecologist;
• avoid stressful situations;
• to refuse from bad habits.

Performing these tips, a woman has the ability to postpone the onset of Klimaks.

Diagnostics

The diagnosis of menopause includes consultations of the gynecologist, endocrinologist, cardiologist, neurologist. Functional state The ovaries are determined by histological analysis and cytological studies of smears. If necessary, the ultrasound of the chest, the abodes of the small pelvis, mammography.

Methods for elimination of symptoms of Klimaks

Modern medicine offers the following methods to eliminate unpleasant manifestations of menopause periods:

• Hormonal preparations (estrogen) are shown in the severe climax.
• Phytoestrogens are a soft option for climacteric disorders therapy.
• Physiostrocesses - Massage, Medical Physical Culture.
• Popular treatment.

What means is being done by the treatment of women's climax, is shown on video.

Climax is an inevitable physiological process in the life of a woman. Therefore, sooner or later, it is forced to survive this period.

The menopausal period (synonymous: Climax, menopause, climacteries) is a physiological period in a person's life characterized by the reverse development (involution) of a sexual system, which occurs against the background of the general age-related changes.

CLIMATIC PERIOD OF WOMEN
The onset of climax in a woman is associated with functional changes in the system - the pituitary gland - the ovaries and is expressed in the gradual fussing of the menstrual function, and then the hormonal activity of the ovaries.

During the climax, there are two phases, or stages, development. The first of these is the periodical change period of the menstrual function - comes in 43-45 years and later, it lasts about one and a half or two years before the complete cessation of the menstrual function (menopause). The most typical in the first phase of Klimaks is the violation of the rhythm of menstruation and the duration of the menstrual cycle. Most women gradually increase the intervals between menstruation and decreases the intensity of bleeding. It is less likely to shorten the intervals and strengthening of bleeding. The time of the onset of menopause ranges from 45-46 to 50 years. The duration of the second phase of the Klimaks is the extinction of the hormonal activity of the ovaries after the cessation of the menstrual function - to establish quite difficult, but sometimes for 3-5 years (or more) after the occurrence of menopause in women of elderly, bleeding of menstrual type can appear and even come. At the end of the second phase of the Klimaks, the hormonal activity of the ovarian stops and occurs the so-called physiological peace of the sexual system.

The premature onset of menopause (up to 40 years) is celebrated in women who had adverse working conditions and life, after frequent genera and abortions, after massive blood loss during childbirth, in chronic infectious diseases. Later, the extinction of the menstrual function (over 50 years old) is observed during the fibromomy of the uterus, with diabetes. Heavy mental injuries, long-term emotional tension in women in transition can contribute to the sudden termination of menstruation.

Among the complications of Klimaks are the highest attention, menopausal uterine bleeding and the so-called climacteric syndrome deserve.

Climacteric bleeding is caused by violations of growth processes, ripening and reverse development of follicles in the ovaries. Hormonal Balance Disorders often cause excessive growth of the endometrium.

The detachment of the functional layer of the mucous membrane is disturbed, as a result of which the patients appear long irregular bleeding of various duration and intensity. Part of patients with bleeding appear after menstruation delay.

To clarify the diagnosis, it is necessary to study in the dynamics of the ovarian function using the Colpocytogram, the use of the test with the crystallization of the cervical mucus, measuring the basal (rectal) temperature (see). The most important is the diagnostic scraping of the uterus mucous membrane, which must be preceded by the beginning of treatment. For histological research Soskoba manages to identify the nature of endometrial changes, and most importantly - to eliminate the presence of a cancer process.

To the menopausal syndrome refer to a kind of symptom complex, manifested by "heat tides" to the head and upper half of the body, rapid, sweating, dizziness, impaired sleep and performance. The diagnosis of climatic syndrome is made on the basis of typical clinical picture, developing at the end of the period of menopacteric changes in menstrual function or at the beginning of menopause.

In the menopacteric period in connection with unstable nervous Women in some cases observed oscillations arterial pressureCould develop typical forms of arthritis, the course and other diseases are exacerbated.

Treatment. In the menopausal period, great attention should be paid to the rational general regime, to establish the correct diet (increase the number of vegetables, limit meat, meat soups), in order to avoid stagnant phenomena in a small pelvis, a woman should move more morning gymnastics, when constipation and obesity is recommended ,.

With menopausal bleeding, the diagnostic scraping is produced before starting treatment. therapeutic action - Part of patients after scraping bleeding are stopped. With recurrent menopacteric bleeding only after special functional research, the doctor conducts. Women at the age of 45-47 prescribe the preparations of a yellow body hormone - in tablets of 0.01 g 3 times a day under the tongue in the second half of the menstrual cycle. Women of older ages, as well as during recurrent polyposera structures of the endometrium, for the purpose of suppressing the menstrual function, use drugs for men (androgens) hormones - methyl testosterone to 0.01 g 3 times a day under the course of 1-2 months. or testosterone propionate (25 mg 2-3 times a week intramuscularly for 3-4 weeks) for the appointment of a doctor.

For the treatment of menopausal syndrome, sedatives (soothing) preparations are recommended - Valerian with bromide, (2-5 mg per night for 1-2 months), Frenolone, etc., as well as small doses hormonal drugs, too, after careful special examination And only by appointing a doctor.

Climax women's

Climax is a female - the age physiological period of the involutional restructuring of the genital glands, as well as all other organs and systems. There are three phases of the menopacteric period, usually coming in women aged 45 to 55 years. In the first phase in the body, a large amount is found in the second content, they are reduced, in the third estrogen, no, but many gonadotropic pituitary hormones. Often in the menopacteric period in women develop menopacteric neurosis representing a special neuroendocrine syndrome associated with the age involution. Pressure disorders can appear with the onset of menopause, as well as long before it.

The syndrome is due to complex changes in central and vegetative nervous systems and systems internal secretion. It is characterized by heat tides to the head and torso, sweating, dizziness, vasomotor lability, increased excitability, insomnia, a sense of unfortunate concern, etc. There is an inferiority of the ovaries of a functional or structural order, the atrophy of the uterus and outdoor genital organs may develop, which does not depend on Contents in the organism of estrogen. The involution of the uterus and external genital organs precedes the age-related rebirth of the ovaries, the hormonal connection between these bodies is disturbed. It is often noted an increase in the thyroid gland, and sometimes an increase in its function. Due to the hyperfunction of the adrenal cortex, a male type may appear. Solving, voices and so on. Increases the number of 17-ketosteroids allocated with urine. Some acromegaloidability of the person and limbs may be observed.

Treatment. Bromide treatment is used (from 0.05 sodium bromide to the reception twice a day; in the absence of the effect of the dose increases to 0.2-0.4 per day) before disappearing or mitigating neurotic phenomena. It is advisable to use Rauolfia preparations, trioxazine, mespotan, Andaxin, Devincana, etc.

Hormonal treatment of menopausal phenomena is carried out, taking into account the phase of the menopausal period, the age of the patient and preserving the menstrual function.

In the first phase of the climax, characterized by sufficient estrogen saturation, in the presence of signs of neurosis, if the menstrual function is preserved, permissible to use small doses of estrogen (in accordance with the phase of the menstrual cycle). Estrogens act on the central nervous system, activating the braking cortical process weakened in the climacteric period. In the first half of the intermenstrument period for 12-14 days, folliculin is prescribed 1000 me to the muscles daily or an octestrol one tablet (10,000 me) 1-2 times a day.

In the presence of uterine functional bleeding, it is possible to use progesterone 5-10 union intramuscularly for 5-6 days and testosterone propionate in 25 mg intramuscularly 2 times a week (only 6-8 injections) or methyltestosterone 0.005 1-2 times a day Under tongue for 10 days.

However, the use of progesterone and androgens requires special caution, because it knows the presence of psychoneurotic shifts in women in front of menstruation, when the body is saturated with a yellow body hormone. In addition, this hormone, as androgens, has a virilizing property. Only with severe climacteric neurosis, when there is no effect on other measures, it is possible to resort to these hormonal drugs, of course, with the complete cessation of their reception in the event of signs of virilization.

In the second phase of Klimaks, when the hormonal level is sharply reduced and resistant menopause has occurred, with pronounced vegetative-nerve disorders, the use of the following drugs is recommended:
Folliculin 1000 me to the muscles (10-12 injections) or 3000 me to the muscles in the day (only 8-10 injections);
Estradiol-dipropionate of 10,000 me in the muscles 1-2 times a week (total 5-6 injections);
Octestrol or sinestrol 1 tablet (10,000 me) inside i-2 times a day for 2-3 weeks.

The course of treatment with estrogen can be repeated 2-3 times with interruptions of 4-6 months. In the second phase, the estrogens are prescribed to replace the missing follicular hormone.

In the third phase of the Estrogens Klimaks, applied to oppress the function, pituitary gland and reduce the formation of gonadotropic hormones. Therefore, combine the male and female sex hormones according to the following scheme: Testosterone-propionate in 25 mg is intramuscularly three times a week (only 6-8 injections) or methyltestosterone at 0.005 under a tongue 2-3 times a day for 3-4 weeks; It is also advisable for the use of metylandrostandiol at 25 mg per day - 10-12 days; Folliculin 3000 me in the muscles 2 times a week (only 6-8 injections) or an octestrol or sinestrol 1 tablet (10,000 me) 1-2 times a day for 3-4 weeks.

During estrogenic therapy, it is necessary to control the degree of saturation of the body by estrogens to change the cytological picture of the vaginal smear or other than the described tests.

If, before the end of the course of treatment, the symptoms of menopausal neurosis disappear, the dose of estrogen is reduced.

Contraindications to the use of genital hormones are neoplasms of genital organs and mammary glands (in the past or present), as well as repeated uterine bleeding.

Hormonal treatment must be combined with the use of sedatives, eliminating the possibility of all the injuries of the nervous system of factors, observance of hours and days of rest, reasonable use of vacation, normal sleep, physiotherapeutic procedures, rational psychotherapy.

This section outlines modern ideas On the physiological climax and the causes of the pathological flow of the Pressure period. Data on the features of the flow of somatic and gynecological diseases in the menopausal period (diabetes, hypertensive disease, metabolic disorders, tumor and inflammatory diseases genital organs) and determined the treatment tactics of patients. Considered issues of forecasting, diagnosis and prevention of pathological climax.

The section is designed for gynecologists, therapeutors, psychoneurologists, neuropathologists.

Preface

The problem of aging of a person with deep antiquity attracted the attention of the outstanding thinkers of humanity. In the second half of the 20th century, this problem has gained particular relevance due to the fact that significant changes occurred in the age structure of the population - the life expectancy has increased. Consequently, the duration of the menopausal period has increased. In this regard, all the increasing interest, manifested by this period, is clear, primarily in terms of conservation of health.

Diagnosis and treatment of pathological conditions in the menopausal period have a certain specificity, which obstetric gynecologists do not always take into account. The features of this period are primarily that it is at this time many diseases arise or appear: benign and malignant tumors, psychosis, neurosis, diabetes, obesity, impaired functions of endocrine glands, vegetative-vascular disorders, etc. Clinical symptoms The listed diseases can be similar to the manifestations of the aging of the body and the pathological flow of the climacteric period, in other words, the nature of the manifestations of many diseases and age changes can be almost the same, while treatments should be fundamentally different.

In this regard, the purpose of this work was primarily the presentation of data on physiological and pathological age-related changes in the body of women, in particular in the reproductive system during the aging period. The high frequency of the pathological flow of climacterium and diseases in this period of life obliges doctors to pay special attention to the prevention of climatic pathological flow. In this regard, it was advisable to dwell the most detailed in this aspect of the problem under consideration. Pathological processes developing in the Climacteric period are often due to the carrying out of not always reasonable symptomatic therapy, therefore the book is paying much attention to differential diagnosis and methods of pathogenetically substantiated therapy.

The section is written on the basis of these literature, personal long-term experience of the author and the results of research conducted under the leadership of the author for 25 years in the endocrinological department of the All-Union Center for the Protection of Mother's Health and Child MD USSR.

Climax and menopausal syndrome: What happens in the body of a woman? Prerefficers, tides, symptoms and manifestations, diagnosis of climax (menopause). Cleax associated diseases (uterine mioma, endometrial hyperplasia and others)

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The site provides reference information solely to familiarize yourself. Diagnosis and treatment of diseases must be under the supervision of a specialist. All drugs have contraindications. Consultation of a specialist is obligatory!

Climax - It is the depletion of female sex glands - ovaries, which inevitably experiences every woman. And although the climax is quite a physiological process, and not pathology, every woman feels various symptoms, requires observation from your gynecologist and treatment.

All the rich symptoms of Klimaks is the result of the lack of female sex hormones, which in the life of a woman play a huge role. Probably there is not a single body in the female body, in the activities of which the sex hormones would not participate. Therefore, when CLIMSAKS, changes affect the entire body as a whole, including appearance, psycho-emotional state and sexual life.

What happens in the body of a woman?

Ovaries at Klimakse

The ovaries in the climax undergo irreversible changes. As it has already become clear, at all the stages of Klimaks there is a change in their functions. The activity of ovaries is reduced in premenopause and completely stops in postmenopausal.

In addition to functions, the ovaries change their shape, sizes and structure. At the initial stages, the ovaries slightly decrease in size, they still have a small amount of follicles. After the occurrence of menopause, they seem to be wrinkled, their size decreases several times, the follicles are not determined in them, and the ovarian fabric is gradually replaced by a connecting cloth - that is, a cloth devoid of any function.

Changes in the uterus and endometrials during climax

The uterus also reacts to hormonal imbalance. During the normal menstrual cycle, physiological changes needed to prepare for the fastening of the fetal egg are constantly occurring. Special changes occur in the inner layer of uterus - endometrial, it is updated monthly, rejects during menstruation and compacted after ovulation. And all this under the action of estrogen and progesterone.

Involution in the uterus and in uyatar pipes When climax:

• In Prhenopause The uterus increases slightly in size, but it becomes less dense.
• After menopause The uterus decreases in size several times.
• Myometrium , or muscular layer The uterus is gradually atrophied, in postmenopausa it is replaced by a connective tissue - that is, it loses contractual functions.
• Even at the beginning of Klimaks endometrium uterus , or its inner layer is gradually thinned, it is also replaced by the junction tissue - the inner cavity of the uterus will overgrow.
• Cervix Also shortening, the cerval canal connecting the uterus with the vagina is significantly narrowed or overcomes completely. Also disturbed the operation of the mucous glazed glazed glands, which reduces the number of vaginal muculence, or "lubricant".
• The uterine pipes are gradually atrophized, their permeability disappears, they also bore with a connecting tissue over time.
• Weave ligaments and muscles Supported with appointments in small pelvis. As a result, the risk of loss of vagina and the uterus increases.

How does climax affect the vagina and the external genitals?

Women's hormones are responsible for elasticity, elasticity and moisture moisture, which is necessary for normal sexual life and fertilization. In the extrusion of ovaries and deficiency of estrogen in the vagina, changes also occur, which bring unpleasant discomfort to women.

Changes in the vagina during clicks:

• The gradual loss of elasticity and elasticity of the vagina, the thinning of its walls, as a result - it narrows and is poorly stretched during sexual contact, bringing a woman soreness.
• Reducing the allocation of vaginal secret, or "lubricant". The vagina becomes dry, poorly lubricated during sexual excitement.
• The acidity of the vaginal mucule varies, which reduces local immunity, leads to a violation of microflora (dysbiosis, thrush) and increases the risk of infection with sexually transmitted diseases.
• There is a fragility of vessels that feed the wall of the vagina, which can manifest itself with bloody discharges.

When climax, the appearance of the exterior genital organs changes:

• large sex lips become flabbles due to the loss of adipose tissue;
• small sexual lips are gradually atrophy;
• reduce pubic hair.

Processes in lactic glands

The condition of the mammary glands directly depends on the female genital hormones. They constantly occur, changes associated with the menstrual cycle and lactation. When climax, as in the genital organs, there are also changes in the dairy glands (involution, or reverse development), because the sex hormones have become a little, there is no menstrual cycle, and the breastfeeding is no longer useful.

The physiological involution of the mammary glands during the climax:
1. Fat involution - Replacing the ferrous component of the mammary glands with a fatty tissue that does not carry specific functions.
2. Fibrous involution - replacement of iron fabric with a connective tissue. In this form, the reverse development of the mammary glands can be complicated by the formation of tumors and cysts, which are usually benign, but always have a risk of zero-quality. Such a process is called "Fibrozno-cystic involution."
3. Fibrozno-fat involution - Milk iron consists of fat and connective tissue.

What does dairy iron look like after a climax?

• In premenopause, the dairy glands can be condensed, to swell and increase somewhat in size.
• After menopause, the dairy glands become soft, blamed, change their size, in excess weight, they increase in size due to excess fat, and thin ladies - on the contrary, decrease, can be atrophy completely.
• The nipple is changing, he saves, decreases in size, pale.

Climax leather. What does a woman look like after a climax?

Women's hormones are the beauty of a woman, beautiful skin, hair, taped face and figure, attractiveness. And the saddest thing happens during the climax is the emergence of age-related changes, that is, aging. Of course, the pace of aging every woman is different. Everything is very individual. Some girls are already covered with wrinkles in 30, while other ladies still look very young. But with the onset of Klimaks, everything becomes very noticeable, because changes on the skin can not be avoided.

What changes in appearance may appear in women after klimaks?

1. Wrinkles, leather flabbiness. The products of the formation of their own collagen, elastin and hyaluronic acid deteriorate in the skin, that is, the skin frame becomes loose and flabby. As a result - wrinkles, dry skin, saving contours of the face and body.
2. Tired of the morning swelling. Under the action of lack of hormones and cardiovascular problems, skin microcirculation is disturbed, which worsens the metabolic processes in it. The skin suffers from lack of oxygen and nutrientsIt accumulates harmful connections. Subsequently, the skin fades, pale, has a tired view. Red spots associated with extended vascular (cooper) may appear. Morning swelling on face and limbs are connected with poor blood circulation.
3. Inflammation of the skin. Sex hormones regulate the work of the sebaceous and sweat glands, which provide protection of the skin from negative environmental factors. Therefore, with a shortage of female hormones, the skin becomes sensitive, easily annoyed, various inflammatory dermatological problems appear. Seborrhean dermatitis can appear, as well as the acne and acne, which is accustomed to associate adolescence.
4. Age Pigment spots are confused by many more than wrinkles and diryabe leather. They are covered not only the body, but also face.
Causes of age-related pigment spots after menopause:

• Violation of pigment exchange, in which sex hormones are likely to participate. In this case, the extra pigment melanin is not "utilized", and accumulates in the skin.
• The protective layer of the skin is weakened, so it is more susceptible to the sunshine, which stimulate the production of unnecessary melanin.
• Cressing ages often appear with liver problems, which also participates in the exchange of pigments.
• Many experts believe that pigment spots are manifestations of atherosclerosis, and since during Klimakse, this pathology often progresses, then the stains are becoming more and more.

The age spots on the skin can be in the form of conventional dark specks, which merge interfer (chloasm), freckles that are more located on their hands, as well as plaques (kerats, xantellasm), dangerous at risk of misstitution.
5. Increased Hair loss - they are thinned, become more dry, rigid, brilliance, deprived of shine and natural color. Who has not yet seen earlier, gray appears. Relieve cilia and eyebrows.
6. It may be celebrated hair growth in unwanted places , for example, antennae, separate hairs on cheeks, back.
7. Changes in Figure associated excess weight, With skin sagging, redistribution of fat by body. In addition, over time, posture is changing after menopause, and even a human growth is reduced, which is associated with age-related changes in the bones.

What is dangerous climax for bones?

Throughout life there is constantly updating bone tissue, or how this process is called specialists - remodeling. At the same time, the bone tissue is partially absorbed and a new (oste formation) is formed in its place. Remodeling is scheduled at the genetic level and is regulated by many exchange processes and hormones, including sex, it is very difficult process. Without a sufficient number of estrogen in the period of the climax, costh formation is broken, while the bone gradually collapsing. Also as a result of menopause, the absorption of calcium and phosphorus - minerals, which are responsible for the fortress of bones.

Such changes in the bone system lead to slow destruction of bone tissue, or osteoporosis, to an increase in the brittleness of bones and various degenerative processes in them.

Climax, heart and blood pressure

Estrogen in childbearing age protect a woman from the development of cardiovascular diseases. But as soon as their level falls, the risk of atherosclerosis, arterial hypertension with all the consequences increases several times.

How does the deficit of sex hormones affect the vessels?

• When climax, the exchange of fats is violated. Excess fat, namely cholesterol is postponed not only on the sides, but also on the walls of the vessels, that is, atherosclerosis develops. Atherosclerotic plaques gradually increase and narrow the clearance of blood vessels, which leads to a violation of blood circulation, an increase in the risk of heart attack and stroke.
• Climax affects the processes of narrowing and expanding vessels. These processes are necessary for the adaptation of the body in physical or emotional load. Normally, the tone of the vessels is regulated by a vegetative nervous system, and with a lack of estrogen, this regulation is disturbed, which leads to spontaneous vascular spasms or, on the contrary, to a decrease in vascular tone. This is manifested by irritation of blood pressure, the development of arterial hypertension, aggravation of atherosclerosis, the development of arrhythmias and ischemic heart disease.
• Blood coagulation increases. Estrogens dilute blood, and with their lack, blood becomes thick, prone to the formation of blood clots and atherosclerotic plaques. As a result, exacerbation of the flow of atherosclerosis, circulatory disruption and increased risk of heart attacks, strokes and thromboembolism.

Climax and thyroid gland

The hormones of the thyroid gland and ovaries are always interrelated. As for diseases of the thyroid gland is broken reproductive function Women and when climax can occur in the work of the thyroid.

It's all about the hormones of the Central nervous systemwhich regulate the function of these organs, namely the follicularity and luteinizing hormone (FSH and LH) and the thyrotropic hormone (TG). They are very similar in their chemical structure. With the restructuring of the body at the beginning of Klimaks, the level of FSH and LH increases, they react to the lack of sex hormones and are trying to "spur" the ovaries to their work. And when stress, which occurs during a climax, the thyroid gland may begin to perceive FSH and LH instead of TG, which is more often manifested by increasing its functions and allocating a large number of hormones. Such an imbalance of thyroid hormones leads to metabolic disorders and requires urgent specific treatment.

Climax and nervous system

The nervous system when climax suffers most. In addition to the fact that women's hormones participate in various "nervous processes", climax and aging for a woman are always stress both somatic (physical) and psycho-emotional. This is what aggravates the development of nervous disorders.

What happens in the nervous system with the beginning of the climax?

• Sex hormones affect the vegetative nervous system which is responsible for the work of all internal organs, vessels and adaptation of the body to various environmental factors, that is, all internal processes. Under the imbalance of estrogen and progesterone, the operation of the autonomic nervous system is broken, as a result - the rich symptoms of Klimaks: it is risen, and the violation of the tone of the vessels, the work of the heart and other organs.
• The influence of female hormones on the central nervous system. In the brain, the processes of excitation and braking of the nervous system are violated, this is manifested by increased emotionality, depression, emotional explosions, impaired sleep and other mental disorders. In addition, lack of genital hormones affect such structures of the brain as the pituitary gland and hypothalamus, which are responsible for the production of many hormones, including serotonin, norepinephrine and endorphins - hormones of happiness.
• Mental disorders are aggravated by depression , in which the woman herself "rides". She realizes that she agrees, it seems to her that she became ugly, which did not have time, did not have reached. Besides, sexual life suffers which is known is an integral part of inner peace and satisfaction. And survive tides and other unpleasant symptoms of Klimaks are also hard.

Symptoms and manifestations of climax in women

The shortage of genital hormones during menopause affects many systems, organs and processes in the body. All these violations cannot pass without a trace, therefore various symptoms appear with the beginning of Klimaks, which bring discomfort and some women are brought to despair.

Symptoms and manifestations of Klimaks are very individual. We are all unique, every fifth woman does not feel any changes in their health. Menopause is easier to carry people who lead a healthy lifestyle, have interesting hobbies, in demand in the family and are ready to adequately meet their interesting mature age.

Harbinger

Experts believe that Klimaks's harbingers appear already at the age of 30-40 years or even earlier, long before the onset of premenopause, and this is:

• problems with conception and dented child or reduced fertility after 30 years;
• hormone-dependent gynecological diseases, such as endometriosis, ovarian cysts;
• diseases of the mammary glands, mastopathy;
• menstrual cycle, abundant or scant menstruation, menstrual cycles without ovulation.

All these states are associated with the imbalance of female sex hormones and require compulsory treatment of the gynecologist-endocrinologist.

The beginning and first signs of Clemaks, a disruption of the menstrual cycle

Beginning Climax is always characterized by the disorders of the menstrual cycle. Against the background of the failure of menstruals, other symptoms associated with disadvantage of estrogen are also gradually developing. All these manifestations are united in climacteric syndromewhich every woman is manifested very individually. Usually, one of the first symptoms of Klimaks are tides and violation of psycho-emotional state.

The menstrual cycle is completely dependent on hormones, which are produced by the ovaries and the central nervous system (Rilizing hormones, LG and FSH). At the very beginning of Klimaks, the female cycle does not stop, but obvious failures are already noticeable, monthly becomes irregular and absolutely unpredictable. Also, most menstruation take place without ovulation, that is, without ripening the egg.

In what form, and with any regularity there will be monthly, traditionally depends on individual characteristics. But you can define some options for disorders of the menstrual cycle in Prhenopause:

1. Cycle lengthening (more than 30 days) scooty menstruation . This is the most common variation of the menstrual cycle in front of menopause. At the same time, the period between menstruation can be several months, and after 2-3 years it occurs menopause, that is, the complete cessation of menstruation.

2. Sharp cessation of menstruation , you can say in one day. Meets not so often. In this case, the development of two options for the climax flow: a woman almost without any discomfort crosses this step in his life or climax proceeds harder, which is due to the fact that the body does not have time to adapt to the sharp change in the hormonal background.

Why appear tides during CLIMSA?

The mechanism for the development of tides is so complex and multicomponent, which is still not fully understood. But many experts believe that the main mechanism for the development of tides is the "suffering of the" central and vegetative nervous system from a lack of genital hormones.

Modern studies have proven that the main starting link in the development of tides is the hypothalamus - the structure in the brain, the main function of which is to regulate the production of most hormones and control over thermoregulation, that is, over maintenance normal temperature Bodies under the action of various environmental factors. When climax, in addition to the ovaries, the hypothalamus is rebuilt, because it violates the processes of production of rilizing hormones that stimulate the pituitary gland and then the ovaries. As a result - thermoregulation is disturbed in the form of a side effect.

In addition, Climax affects the work of the vegetative nervous system, sweat glands and the cardiovascular system. Obviously, the complex of all these organism reactions to the lack of sex glands appear in the form of seizures of tides.

What are the symptoms of tides when climax?

1. The harbingers of the tides feel not all women, many attacks find surprise. Before the adaptation of the tide, noise can appear in ears and headaches - this is due to the spasm of the brain vessels.
2. Throws in the heat - many describe the sharp beginning of the tide, the head and the upper part of the body as if they are whipped with boiling water, the skin becomes bright red, hot to the touch. This increases the body temperature above 38 o C, but in a short time it is normalized.
3. Increased sweating occurs, sweat drops are instantly, which are quickly flocked by the streams. Many women describe that hair and things become so wet as "at least squeeze."
4. The overall health is disturbed - the heartbeat is accelerated, headache, weakness appears. Against this background, nausea and dizziness may appear. Strong tide attacks can even lead to short-term fainting.
5. The feeling of heat is replaced by chills - due to the fact that the skin becomes wet from sweat and the thermoregulation is broken, the woman freezes, the muscular trembling begins, which can still be saved for some time. After an attack, muscles can hurt due to muscle tremors.
6. Violation of psycho-emotional state - during the tide there is a sharp attack of fear and panic, a woman can start crying, can feel the shortage of air. After that, the woman feels devastated, oppressed, develops pronounced weakness. At frequent tides, depression may develop.

Such symptoms describe women who survived strong attacks tides. However, not everyone suffer climax so. Rays can be short-lived, easier, without disrupting common and psycho-emotional well-being. Often the ladies feel just increased sweating and heat. Some women are experiencing night tides in a dream, while only a wet pillow speaks of the past attack. Many specialists believe that the severity of tides directly depends on the psychological state of the woman, but there are a number of factors that often provoke the development of tides.

Study factors provoking tides:

• Duchot: Poor ventilated room, a large cluster of people, high humidity on a hot day.
• Heat: Long stay under the sun, clothes are not for the season, heating the premises by fireplaces and other heat sources, a bath or sauna.
• Anxiety: stress, emotional experiences, nervous exhaustion, fatigue and lack of sleep.
• Food and drinks: Hot, acute, sweet, too spicy food, hot and hot drinks, coffee, sturdy tea and overeating.
• Smoking, namely, the dependence on nicotine. Often, the tide appears during a large break between the cigarettes and at a strong desire to smoke.
• Embossed clothing , poorly transmitting moisture and air, leads to overheating of the body, and wearing such things can provoke a tide.

In principle, if a woman will avoid exposure to these factors, to control her under force, and if you add good emotions to this everything, the climax will be much easier.

How many tides are tilt when climax?

Tide attacks themselves can last from a few seconds to a few minutes, it is very individual. There are no such attacks per day, and maybe several dozen.

Individually, and how much time they will have to worry at all. Statistics show that almost all women are tested at least 2 years (from 2 to 11 years old). But some "happy" have to experience these heat attacks many years after menopause and even all their lives. The duration and severity of tides are largely dependent on when they started: with early climax and a long period of premenopause, the heat seizures are preserved longer.

What affect tides?

• Psycho-emotional state of a woman, self-confidence.
• Immunity - Disruption of thermoregulation reduces the body's ability to adequately respond to infections and other external factors.
• Fears may appear to leave the house so that people do not see it in such a state.
• Prolonged depressed against the background of heavy tides are not only a manifestation of psychological problems, but also increase the risk of developing other pathologies, such as psoriasis, diabetes, arterial hypertension and many "spiritual" diseases.
• Some women so hard tolerate tides that even have to resort to emergency medical care.

It is necessary to remember that the tides and the climax itself is a normal response of the body that is not any pathology, especially something shameful and shameful. Moreover, many modern women Not only this is not shy, but they are ready to discuss it. It is important to be prepared to be prepared in advance, change your lifestyle, to get everything from life, especially positive emotions, listen to your body. All this will not simply facilitate the symptoms of Klimaks, but also will allow you to easily and dignity to go to a new life stage.

Climacteric syndrome

As already mentioned, the climacteric syndrome has every woman proceeds in different ways. It is a huge complex of symptoms and manifestations from various organs and systems. Many of these symptoms still experiences the majority of women in one degree or more severity. Violation of the menstrual cycle and tides are mandatory components of the Climax. Other manifestations may be absent or unrecognized, often ladies bind poor health with fatigue or other diseases.

Symptomatics depends on the climax phase. Thus, more vivid symptoms are observed in premenopause, and after menopause, the risk of developing many diseases, which often do not associate with the manifestations of Klimaks.

The symptoms of the premopause period - from the first manifestations of Climaks up to 2 years in the absence of menstruation

Symptoms	How do you manifest?
Riding	sudden feeling of heat; profuse; redness of the skin; increasing body temperature; chills; pronounced weakness and impairment of the heart; psycho-emotional disorders.
Increased sweating	may accompany tides and be a separate manifestation of estrogen deficiency; often occurs at night; many women because of this, the symptom has to be changed several times a day and use the most "powerful" antiperspirants.
Increased body temperature	increased temperature can be associated with tide or manifest itself a separate symptom; during tides, the temperature may exceed 38 o C; a long subfebristitet may be observed or temperatures up to 37 o C.
Discomfort in lactic glands	swelling and swelling; drawing chest pain; changes cease to depend on the menstrual cycle phase.
Insomnia and drowsiness	at night heavily fall asleep; during the day I always want to sleep; often women in Klimakse will shoot bad dreams, which are so bright and realistic that they retain the negative for the whole day.
Headache	may be pronounced or nourishing; often develops without visible reasons, at any time of day, including in the morning and at night; often wears migraine character ( acute pain in one half of the head); it is hard to stop conventional analgesics.
Weakness, increased Tired	this symptom accompanies almost all women in the menopacteric period; often weakness and fatigue arises in the first half of the day, both after mental or exercise, and without it; the performance is reduced, memory, concentration and attention deteriorate, decommissioned.
Irritability , plasticity, anxiety and comes in the throat	even the most restrained women can break up on loved ones because of the trifles, often this symptom is accompanied by an attack of hysteria; ladies become touchy and impressionable, it seems to them that no one understands them; constant or sudden anxiety, many have bad "premonitions" of the impending misfortune, all this is accompanied by pathological fears; "Pesssimism" prevails over "optimism", and negative emotions over positive; a woman can stop enjoying life as earlier, but it is interesting that in the period of postmenopause love and joy to life not only return, but also become much stronger than in young years.
Depression, chronic stress	this is the result not only the lack of hormones, but also reluctance to realize the fact of the onset of Klimaks; "Butter in the fire poured" nervous exhaustion due to fatigue, poor sleep, lack of sex, tides and other manifestations of Klimaks.
Sensation of heartbeat	Most often, the increase in cardiac rhythm or tachycardia appears. Usually tachycardia occurs spontaneously and passes independently.
Violation of urination	risk of cystite development increases.
Sex, fertility and premenopause	decrease in sexual entry (libido); there is insignificant dryness in the vagina; sexual intercourse can become painful (dispensing); natural pregnancy is still possible.
Other manifestations	the first signs of skin aging: dry, shallow wrinkles, reduced skin tone, etc.; there appears hair lone and nails; can increase cholesterol in blood; some women begin to gain extra weight.

Symptoms of postmenopause period - 1 year after the last menstruation and until the end of life

Symptoms	How do you manifest?
Tides, sweating and psycho-emotional disorders	tides usually become less likely and proceeding easier, in a few years most women have tides completely; irritability, weakness, fatigue, but with each month and year it becomes easier; insomnia and weakness are preserved for several more years, and some women do not fall out for a long time.
Excess weight	many women gain weight, which is associated with a sedentary lifestyle, slowdown in metabolism, as well as the fact that the body is trying to fill the lack of estrogen by developing its adipose tissue; the type of figure is changing, and the redistribution of fat is being redistributed to the abdomen and upper shoulder belt, the skin saves, the posture changes.
Muscular weakness	the lack of hormones leads to the weakening of muscle tissue, the muscles are accused, and their performance is significantly reduced; "Pump up the muscles" with sports is becoming much harder than in a younger age.
Dry vagina	soreness during sexual intercourse; a sense of discomfort during the wearing of narrow linen and clothes; high risk of developing thrush and other inflammatory processes Vagina.
Allocation from the vagina, itching and burning	allocations from the vagina are normal after menopause if they are transparent, odorless and color, their number is scarce and most importantly, do not deliver any discomfort and itching; the presence of itching, burning and unusual discharge speaks about the presence of inflammatory and other problems, are not a normal state, the appeal to the gynecologist is required; yellowish sequels without smell, itching and discomfort during sexual proximity speak of the dysbiosis of the vagina - the most frequent state of the genital organs after the occurrence of Klimaks; curd discharge with sour smell speak of the candidiasis of the vagina (thrush); discharge with a specific smell talk about the attachment of various pathogenic infections, including sexually transmitted; brown and bloody discharge from the vagina can be associated with the increased fragility of the vessels of the vaginal mucosa, in which case the blood appears to a greater extent after the sexual intercourse, but also blood from the vagina can be a sign of tumors in the uterus and appendages, including malignant.
Violation of urination	urinary urges are much more studied; a very high risk of developing urethritis and cystitis, as a result - the risk of the development of kidney inflammation (pyelonephritis); some women may have incontinence of urine, especially with exercise, and the saying "you can refrank laughter" becomes not so fun.
Sex and fertility	libido continues to decrease, although some women - on the contrary, there is a special interest in sex, such that was not in the youth; pains are intensified during sex due to dryness of the vagina and bad elasticity of its walls; natural pregnancy is no longer possible.
Leather, hair and nails	there is a noticeable aging of the skin, it becomes a dry, flabby, saves, deep age wrinkles appear, and not only on the face; natural blush disappears, the skin of the face dawns, looks tired, problems with eels, acne appear; often appear enemy ages; hair sees, become thin, dull, sad, and also there is an increased loss, with the time of the Spit becomes much thinner; relieve the nails for a beautiful manicure is getting harder, they are brittle, often lose their color.
High risk of developing various diseases	osteoporosis is the deformation of bone tissue; cardiovascular pathologies (arterial hypertension, atherosclerosis, arrhythmia, angina and other); uterus and appendages (mioma, ovarian cysts, polyps, oncological diseases), the loss of the vagina and the uterus; milk glands pathology (mastopathy, cancer); diabetes mellitus, thyroid pathology and adrenal glands; diseases of the nervous system (vegetative-vascular dystonia, strokes, mental disorders and diseases); diseases digestive system (biliary disease, constipation, hemorrhoids); infectilation of the urogenital system and others.

Diseases with climax

One of the manifestations of Klimaks after the onset of menopause is the risk of developing various diseases. This does not mean that all women in the period of Klimaks must begin to hurt with all diseases. It all depends on much from the level of hormones, as from the lifestyle, genetic predisposition, and many environmental factors. In addition, many of these diseases can develop without Klimaks in a younger age. And men, not as dependent on estrogen, also suffer from these ailments. But many scientific research has proven that it is the deficit of sex hormones that is a launch mechanism for the development of many of the "age" pathologies. Consider some of them.

Cleax associated diseases:

Disease	Factors and reasons that increase the risk of disease	Basic symptoms	What is dangerous?	How to reduce and prevent disease manifestations?
Osteoporosis - Reducing the density of bones, the lack of calcium, phosphorus and other minerals in them leads to gradual destruction of bone tissue.	heredity; smoking; alcohol; sedentary lifestyle; excess weight; rare stay under sunshine; unbalanced nutrition; diseases of the digestive and endocrine system.	pain in the bones, especially "on the weather"; disruption of movements in some joints; weakness, reduction of physical strength, nervousness; the deformation of the spine is manifested by disruption of movements and posture, pain and reduction of growth; deformation of the fingers and legs and other bones; litness of nails, teeth disease and hair loss.	Pathological fractures of bones that may occur even at the slightest injuries and just unsuccessful movements. Fractures are seriously stranged and can permanently shorten a woman to bed. Brain circulation impairment as a result of the osteochondrosis of cervical and / or breast departments spine.	Proper lifestyle; food rich in calcium and phosphorus; moderate sunbathing; moderate physical exertion, right mode work and recreation; overweight; avoid falls, injuries, awkward movements; hormonal replacement therapy by sex hormones reduces the manifestation of osteoporosis; reception of calcium preparations: calcium D3, Ergocalciferol and many others.
Mioma uterus is a benign tumor of uterus, associated with violation of the balance of sex hormones. Momom can be of different sizes, single or multiple. It often occurs on the background of Klimaks, and after the onset of menopause, small myomatous nodes are able to solve themselves.	Abortions and operations in the uterus; lack of labor; endometriosis; irregular sexual life; chronic stress; early menarche (first menstruation); excess weight; animal food abuse; alcohol abuse; heredity; late pregnancy can aggravate the growth of Moma.	Long, frequent and abundant menstruation; blood discharge not related to the monthly cycle; an increase in abdomen in volume; frequent urges for urination; constipation; soreness during sexual intercourse.	Uterine bleeding, including massive. Pelvioperitonitis associated with the flip of the legs of the Miomatics node requires operational intervention. Cancer - Largeness of the tumor.	Replacement hormonal therapy; healthy image life; regular sex; prevention of venereal diseases; overweight; regular observation at the gynecologist.
Cysts ovarian - Benign extensive education. Climax often occurs dermoid, endometrioid and other types of non-functional cysts, as well as polycystic ovarian polycystosis.	Endocrine diseases of the thyroid gland, adrenal glands, brain; abortion and operations; inflammatory diseases of the organs of a small pelvis; sexually transmitted infections; genetic predisposition; reception of contraceptives and hormone replacement therapy by sex hormones.	Abdominal pain, lower abdomen or lower back, amplifying during exercise and sexual intercourse; impairment of urination and constipation; asymmetric increase in abdomen; separating bleeding; painful menstruation in premenopause.	Cancer - non-functional cysts have a big risk of illustrative. The breakdown of the cyst, the ovarian break and twist the legs of the cysts - states requiring urgent surgical treatment.	Annual examination of the gynecologist and timely treatment of gynecological problems; if necessary, surgical treatment; prevention of venereal infections; healthy lifestyle and no carcinogens.
Uterine bleeding - Blood discharge from vagina of various nature, related either non-monthly related.	In the premenopause of bleeding are often associated with hormonal perestroins of the climax and a disruption of the menstrual cycle; endometriosis; myoma uterus; polyposis; pathology of cervix; polycystosis and other ovarian cysts; spontaneous abortions.	Oremptic bleeding options in the period of premanopause: long and abundant menstruation (more than 6 gaskets per day and more than 7 days); periodic oscillations of discharge bleeders, not related to monthly; the presence of large blood clots, lumps during menstruation or between them; frequent monthly (more often than every 3 weeks); blood seals appearing after sexual intercourse; prolonged bleeding of various intensity (more than 1-3 months). After the occurrence of menopause, any bleeding should be alert.	Cancer. The uterine bleeding can be a sign of severe diseases, including cancer. Anemia - with long and abundant bleeding lead to loss of blood. Hemorrhagic shock - can develop with massive royal bleeding, requires urgent resuscitation, surgical intervention and transfusion of blood products.	Timely appeal to the doctor to clarify the causes of bleeding and their correction; food rich in protein and iron; control over the number of lost blood.
Mastopathy - benign tumor of the mammary glands.	The involution of the mammary glands associated with hormonal restructuring; early occurrence of monthly and early puberty; various diseases of the uterus and appendages, especially inflammatory; lack of lactation or short period of breastfeeding; lack of pregnancies under the age of 30; abortions and miscarriages; stress; excess weight; reception of contraceptive and other hormonal drugs in large doses; endocrine pathologies. heart attack; heart failure.	Proper lifestyle and nutrition; Regular physical activity; overweight; control of diabetes; regular reception of drugs containing aspirin; arterial pressure control; timely appeal to the doctor and compliance with his recommendations.

Climate-related diseases can be prevented not only by substitution hormone therapy, often recommended during severe climax, but also in the right way of life and regular surveys at their gynecologist.

Climax is one of the reasons for panic attacks in women (the opinion of the psychotherapist) - video

Diseases when climax: obesity, diabetes, uterus omission, thrombosis, Alzheimer's disease - video

Diagnosis of Klimaksa

Climax is not a disease and, it would seem why it is necessary to diagnose, because everything is understandable - tides, disruption of the menstrual cycle, the onset of menopause and addictive organism to live on small doses of sex hormones. But there are situations when you just need to know whether Climax began, and on what stage he.

Why do I need to diagnose klimaks?

• differential diagnosis of Klimaks and other diseases;
• identification of complications and diseases associated with climax;
• examination before appointing substitution hormone therapy and contraceptives.

What is included in the climax survey plan?

1. Analysis of the history of life and complaint (the time of the onset of menarche, the presence of pregnancies, abortion, the regularity of the menstrual cycle and so on).
2. Inspection of the gynecologist, taking of smears, bakposev from the vagina, cytological study of swabs from the cervix. Inspection of the mammary glands.
3. Blood test for sex hormones.
4. Ultrasound uterus and appendages.
5. Ultrasound of the mammary glands or mammography.
6. Ostosomometry - measuring the density of bone tissue.
7. Electrocardiography (ECG)
8. Biochemical analysis blood: glucose, triglycerides, cholesterol, lipoproteins, blood coagulation factors, calcium, phosphorus, etc.
9. Analysis on HIV and syphilis.

Sex hormones (estrogens, progesterone, FSH and LH) in blood test when climax:

The period of life of a woman	Gomon level indicators in blood, norm *
	Estradiol, pg / ml	Progesteronenmol / l	FSH. (Folliculizing hormone), honey / ml	LG (luteinizing hormone), honey / ml	Index LG / FSH
Reproductive period to menopause: 1. Phase ripening follicles (1-14th day of the menstrual cycle).	less than 160.	up to 2.2.	to 10	less than 15.	1,2-2,2
2. Ovulation (14-16th day).	more than 120.	to 10	6 – 17	22 – 57
3. Lutein phase (16-28th day).	30 – 240	more than 10.	up to 9.	less than 16.
Premenopausa	Women's sex hormones gradually decrease **, menstrual cycles are observed without ovulation.		more than 10.	more than 16.	about 1.
Postmenopausa	5 – 30	less than 0.6	20 - 100 and above	16 - 53 and above	less than 1.

* All norms are approximate. For each laboratory, there are their reference (normal) values \u200b\u200bthat are usually indicated in the score with the answer. This is due to various techniques and test systems that are used in the process of laboratory research. Therefore, it is necessary to consider those reference values \u200b\u200bthat the laboratory gives.

** Interestingly, at the beginning of the premenopause, the deficit of progesterone is especially expressed, and not estrogen. And by the time menopause, progesterone is formed in very low doses, and estrogen - just half less than in childbearing age.

Hormonal background Each woman is very susceptible to environmental factors, emotional state and various diseases, so the same woman has a hormone levels.

When to take blood test to sex hormones?

Analysis on sex hormones during premanopause, that is, with preserved menstruation, it is necessary to take in certain periods of the menstrual cycle, accurately indicating the day from its start. Usually FSH and LGs are recommended to take on the 3-5th day from the beginning of the monthly, and estradiol and progesterone on the 21st day. After the occurrence of menopause, the analysis can be passed on any day.

Preparation for the surcharge of blood analysis on sex hormones:

• an analysis is surrendered strictly in the morning on an empty stomach, in the evening light dinner;
• before analysis, it is worth abandoning the admission of alcohol, coffee and drugs, not smoking;
• when receiving contraceptives, the results are adjusted taking into account their doses;
• the day before the blood is given, it is recommended to refuse sex and heavy physical exertion;
• before surrendering blood, it is necessary to fully relax, sit calmly at least 10 minutes.

With the help of blood test to sex hormones, the doctor can identify the beginning of the climax or the occurrence of menopause whether pregnancy is possible and to wear it. Also, depending on the level of hormones and the severity of symptoms, you can determine the severity of the climax. Heavy Klimaks speak high FSH rates, as well as the LG / FSH coefficient: what it is lower, the woman's body is harder to transfers the lack of sex hormones and the more brightly express symptoms and diseases associated with the climax.

UZI-Survey at CLIMSAKS

With the arrival of menopause often come and problems with women's health. This is, first of all, various tumor formations, both benign and malignant. It is for their identification and observation that an ultrasound diagnosis of small pelvis organs is necessary, and annually. In addition, the ultrasound helps to diagnose the starting climax and determines the possibility of late pregnancy.

Uzi-signs of the Coming Climax:

• With the help of ultrasound you can reveal the presence or absence of follicles In the ovary and their number. The closer to menopause - the less follicles, and the less chances to get pregnant. After menopause in the ovaries, follicles are not defined.
• Ovaries gradually decrease in size They lose their echoism. After menopause, they can not be completely defined.
• The uterus decreases in size , it becomes more dense, moma of small sizes may be observed, which after menopause most often are resolved independently. Also changing the location of the uterus in a small basin, it is somewhat shifted.
• Life after Klimaks - what is she? Sex and sexual relationship. Is it possible to get pregnant at klimaks? Recommendations for proper nutrition for women before and after menopause. Does climax have men?

Citation:Serov V.N. Pressure period: Normal condition or pathology. RMW. 2002; 18: 791.

Scientific Center of Obstetrics, Gynecology and Perinatology Ramna, Moscow

TO The limacteric period precedes aging, and depending on the cessation of menstruation is divided into premenopause, menopause and postmenopause. As a normal state, the menopacteric period is characterized by pronounced signs of aging. Climacteric syndrome, cardiovascular pathology, hypotrophic manifestations in gOOD SYSTEM, osteopyings and osteoporosis are the incomplete listing of the pathology of the climacteric period caused by aging and turning off the ovarian function. Almost a third of the life of the woman passes under the sign of the climacter. AT last years It is convincingly shown to significantly improve the quality of life during the climattery period using return Hormone Therapy (HGT)allowing you to cure with climacteric syndrome, by 40-50% reduce cardiovascular pathology, osteoporosis, urinary incontinence.

Premenopausapreceded by menopausis by somatic and psychological changes due to the extinction of the ovarian function. Their early detection makes it possible to prevent the development of severe climacteric syndrome. Premenopause usually begins after 45 years. First, its manifestations are insignificant. Both the woman herself and her doctor usually either do not give them values, or they associate them with mental overstrain. Hypoestroyment should be excluded from all women after 45 years, applying for fatigue, weakness, irritability. The most characteristic manifestation of premenopause - disorders of the menstrual cycle. For 4 years preceding menopause, this symptom is celebrated in 90% of women.

Menopause- Part of the natural process of aging, actually, is the cessation of menstruation as a result of the fading of the ovarian function. The age of menopause is determined retrospectively, after 1 year after the last menstruation. The average age of the onset of menopause is 51 years. It is determined by hereditary factors and does not depend on nutritional and nationality features. Menopause comes earlier in smoking and unborn women.

Postmenopausait follows the menopause and on average a third of the life of a woman continues. For ovaries - this is the period of relative rest. The consequences of hypooestrogenation are very serious, they are similar to importance to health with the effects of hypothyroidism and adrenal insufficiency. Despite this, doctors do not pay due attention to the WGT in postmenopausal, although it is one of the most important components of prevention and treatment. diverse pathology in older women. Apparently, this is due to the fact that the consequences of hypoestrogenation develop slowly (osteoporosis) and are often attributed to aging (cardiovascular diseases).

Hormonal and metabolic changestake place in premenopause gradually. After an almost 40-year period, during which the ovaries were cyclically secreted by sex hormones, gradually decreases and the monotonous secretion of estrogen becomes. In Premopause, the metabolism of sex hormones is changing. In postmenopausal ovarian does not completely lose their endocrine function, they continue to secrete some hormones.

Progesterone is produced only by the cells of a yellow body formed after ovulation. In premopause, the whole majority menstrual cycles It becomes annevory. In some women, ovulation occurs, but the lack of yellow body develops, which leads to a decrease in the secretion of progesterone.

The secretion of estrogen ovarian in postmenopausus is practically stopped. Despite this, all women in serum are determined by estradiol and estro. They are formed in peripheral tissues from androgens secreted by adrenal glands. Most of the estrogen is formed from Androstendion, secreted mainly by adrenal glands and to a lesser extent by the ovaries. This occurs mainly in muscle and adipose tissues. In this regard, when obesity, the levels of estrogen in serum increases, which in the absence of progesterone increases the risk of body cancer. In thin women, the levels of estrogen in serum are lower, so they have increased the risk of osteoporosis. Interestingly, menopacteric syndrome is possible even with high levels of estrogen in women with obesity.

In postmenopausal, the secretion of progesterone stops. In the root portion, progesterone protects endometrium and dairy glands from estrogenic stimulation. It reduces the content of estrogen receptors in cells. In premopause and postmenopausage, some women persist enough high levels Estrogen to stimulate the proliferation of endometrial cells. This, as well as the lack of the secretion of progesterone leads to an increase in the risk of endometrial hyperplasia, the body cancer of the uterus and the mammary glands.

Psychological consequencesassociated with aging is usually much more pronounced than related to the loss of a childbody function. In modern society, youth appreciates above maturity, so menopause, as a tangible proof of age, part of women is anxiety and depression. Psychological consequences are largely dependent on what a woman pays attention to its appearance. Fast aging of the skin, especially in postmenopausal, worries many women. The results of numerous studies confirm that age-related changes in women are caused by hypo-ethystroy.

In the menopacteric period, many women note anxiety and irritability. These symptoms even became an integral part of the climacteric syndrome. It is believed that they are associated with hypo estroy. Despite this, none of the studies of anxiety with menopause and its disappearance during replacement hormone therapy are not confirmed. Probably anxiety and irritability are due to various social factors. The doctor must remember the symptoms often occurring in the elderly women and provide relevant psychological support.

Riding - Perhaps the most well-known manifestation of hypooestrogenation. Patients describe them, as a periodic short-term feeling of heat, accompanied by sweating, heartbeat, anxiety, sometimes followed by chills. Riding lasts, as a rule, 1-3 minutes and repeated 5-10 times a day. In severe cases, patients note up to 30 tides per day. With natural menopause, tides arise about half of women, with artificial - much more often. In most cases, tides are slightly disturbing well-being.

However, approximately 25% of women, especially those who have underwent bilateral ovarisectomy, mark heavy and frequent tides, leading to increased fatigue, irritability, anxiety, depressed mood and reduce memory. In part, these manifestations may be due to sleep disorders at frequent night tides. In early premopause, these violations may arise as a result vegetative violations And not related to tides.

Flips explain to a significant increase in the frequency and amplitude of the secretion of gonadillaberin. It is possible that strengthening the secretion of gonadoliberin does not cause tides, but only one of the symptoms of disorders of the CNS function leading to thermoregulation disorders.

HGT quickly eliminates tides from most women. Some of them, especially those who had moved bilateral ovariectomy, are required high doses of estrogen. In light cases in the absence of other testimony to the UGT (for example, osteoporosis), treatment is not prescribed. Without treatment, tides are held in 3-5 years.

The epithelium of the vagina, the urethra and the base of the bladder is estrogen-dependent. 4-5 years after menopause, approximately 30% of female, not receiving replacement hormone therapy, its atrophy develops. Atrophic vaginitis It is manifested by dryness in the vagina, dyspaure and recurrent bacterial and fungal vaginites. All these symptoms are completely disappearing on the background of substitution hormone therapy.

Atrophic urethritis and cystitis manifest themselves to rapid and painful urination, imperative urinary urges, urinary incontinence at stress, as well as recurrent urinary tract infections. Conducted hypo estroyia atrophy epithelium and shortening of the urethra contribute to urinary incontinence. The UGT is effective in 50% of postmenopausal patients suffering from urine incontinence at tension.

Women in the menopacteric period often celebrate disorders of the concentration of attention and short-term memory. Previously, these symptoms were explained by aging or sleep disorders caused by tides. Currently it is shown that they may be due to hypo estroy. Replacement hormone therapy improves the functions of the central nervous system and the psychological state of postmenopausal women.

One of the most interesting directions of future research is the definition of the role of GT in the prevention and treatment of Alzheimer's disease. It has evidence that estrogens reduce the risk of this disease, although the role of hypoestrogenation in Alzheimer's pathogenesis has not yet been proven.

Cardiovascular diseases Have many predisposing factors, the most important of which remains age. In age, the risk of cardiovascular diseases increases both in men and women. The risk of death from IHD in women of childbearing age is 3 times less than in men. In postmenopausal, he rises sharply. Previously, the increase in the frequency of cardiovascular diseases in postmenopausus was explained only by age. Currently, it is shown that in their development big role Playing hypoestroy. This is one of the most easily eliminated risk factors atherosclerosis. In postmenopausal, women receiving estrogens, the risk of myocardial infarction and stroke decreases more than 2 times. The doctor who is watching a woman in postmenopausus should tell her about cardiovascular diseases and their prevention capabilities. This is especially important if it is abandoned by SGT for any reason.

In addition to hypoestrogenation, it should strive to eliminate and other risk factors atherosclerosis. Perhaps the most significant of them are arterial hypertension and smoking. Thus, arterial hypertension increases the risk of myocardial infarction and stroke 10 times, and smoking at least 3 times. Among other risk factors should be noted sugar diabetes, hyperlipidemia and a sedentary lifestyle.

It has long been known that menopause, natural or artificial, leads to osteoporosis. Osteoporosis- This is a decrease in density and restructuring of bone tissue. For convenience, some authors propose to call osteoporosis such a decrease in the bone density at which fractures arise, or very high risk. Unfortunately, the degree of loss of compact and spongy bone substance in most cases remains unknown until the occurrence of the fracture. The number of older women with ray bone fractures, femoral neck and compression vertebral fractures on the background of osteoporosis are large. With an increase in the average life expectancy, it seems to be only increasing.

Despite the fact that the speed of resorption of bone tissue increases already in premopause, the greatest frequency of fractures caused by osteoporosis is noted in several decades after menopause. The risk of femoral bone fracture in women over 80 years is 30%. Approximately 20% of them die for 3 months after a fracture from the complications of long-term immobilization. Treat osteoporosis already at the stage of fractures is extremely difficult.

There are many risk factors osteoporosis. The most important of them is age. Another risk factor of osteoporosis is undoubtedly hypoestroaction. As already noted, in the absence of the UGT, the loss of bone tissue in postmenopausus reaches 3-5% per year. The most active bone tissue is resistive during the first 5 years postmenopause. It is believed that during this period, 20% of the compact and spongy substance of the neck of the femoral bone lost during life is lost.

Low calcium content in food leads to osteoporosis. The use of products rich in calcium (primarily dairy products) reduces the loss of bone tissue in premopause. In postmenopausis, women receiving GHT to maintain the bone density are enough to take calcium preparations at a dose of 500 mg / day inside. Calcium intake in these doses does not increase the risk urolithiasisAlthough it may be accompanied by gastrointestinal disorders: meteorism and constipation. Physical exercises And the refusal to smoking also warns the loss of bone tissue and reduce the risk of osteoporosis.

In order to prevent complications of the Climacteric Period, the most effective replacement hormone therapy. Climacteric syndrome, which is most often observed in the perimenopausal period, is characterized by vegetual-vascular, neurological and exchange of manifestations. The heat of the heat, the instability of the mood, the tendency to depression is often aggravated by hypertension, progresses type-diabetes mellitus, arise aggravating ulcerative disease, lung pathology. Gradually progress the hypotrophic processes of the mucous membrane, urethra, bladder. Conditions are created for frequent urinary and vaginal infections, sex life is disturbed. Atherosclerosis progresses, the risk of myocardial infarction and stroke increases. In the late menopause due to progressive osteoporosis, bone fractures arise, especially the spine, hip necks.

UGT is effective in mailing syndrome in 80-90% of cases , It doubled the risk of myocardial infarction and stroke and increases the life expectancy, even in those patients who, in angiography, determines the narrowing of the enlightenment of the coronary arteries. Estrogens warn the formation of atherosclerotic plaques. Estrogens included in combined drugs For UGT, reduce loss of bone tissue and partially restore it, warning osteoporosis and fractures.

UGT has a negative effect. Estrogens increase the risk of hyperplasia and body cancer, but the simultaneous purpose of Progestogen prevents these diseases. According to the literature, it is impossible to make a clear idea of \u200b\u200bthe risk of breast cancer; Many authors in randomized studies have shown the lack of increased risk, but in other studies it increased. In recent years, the favorable effect of the UGT in relation to Alzheimer's disease has been shown.

Despite the obvious advantages of the SGT, it has not been widespread. It is believed that only about 30% of women in postmenopausus take estrogens. This is explained large number Women with relative contraindications and restrictions for the UGT. In a mature age, many women have the place of uterus, endometriosis, hyperplastic processes of reproductive organs, fibrozno-cystic mastopathy et al. All this forces it to look for alternative methods for the treatment of menopausal disorders (physical activity, restriction or refusal of smoking, reducing the consumption of coffee, sugar, salt, balanced diet).

Perennial medical observations have demonstrated high efficiency of a balanced diet and the use of multivitamin, mineral complexes, as well as medicinal plants.

Climactory - complex drug Natural origin. The vegetable components that are part of the drug have an impact on thermoregulation, normalizing braking processes in the CNS; reduce the frequency of seizures of sweating, heat tides, headaches (including migraine); Remove the feeling of constraint, inner concern, help with insomnia. The drug is used inside until complete resorption in the oral cavity is half an hour before or an hour after eating 1-2 tablets 3 times a day. Contraindications for the use of the drug not marked side Effects not found.

Climadinon is also a preparation of plant origin. Tablets at 0.02 g of 60 pieces per pack. Drops for intake - 50 ml in a bottle.

The new direction in the treatment of climacteries are selective estrogen receptor modulators. Raloxyphen stimulates estrogen receptors, while at the same time having anti-estrogen properties. The drug was synthesized for the treatment of breast cancer, it enters the tamoxifen group. Raloxyphen warns the development of osteoporosis, reduces the risk of stroke and myocardial infarction, does not increase the risk of breast cancer.

For UGT, conjugated estrogens are used, estradiol Valerat, Estriol succinate. In the US, conjugated estrogens are used, in European countries - estradiol Valerat. Listed estrogens do not have a pronounced effect on the liver, coagulation factors, carbohydrate exchange, etc. The cyclic addition of progestogen adding to estrogens is obligatory for 10-14 days, which avoids endometrial hyperplasia.

Natural estrogens depending on the route of administration are divided into 2 groups: for oral or parenteral use. In parenteral administration, the primary metabolism of estrogen in the liver is excluded, as a result, smaller doses of the drug are required to achieve therapeutic effect Compared to preparations for oral application. During the parenteral use of natural estrogen, various methods of administration are used: intramuscular, civory, percutaneous and subcutaneous. The use of ointments, candles, nesting tablets makes it possible to reach a local effect in urogenital disorders.

Widespread in the world got preparations containing estrogen and progestin. These include drugs of monophasic, two-phase and three-phase types.

KLUGEST - monophasic preparation, 1 tablet of which contains 1 mg of estradiol and 2 mg of the norethysterone acetate.

To two-phase preparationssupplied to the Russian pharmaceutical market, currently belong:

Divine. Calendar package with 21 tablets: 11 white tablets contain 2 mg estradiol Valerat and 10 blue tablets consisting of 2 mg estradiol of Valerat and 10 mg methoxyprogesterone acetate.

Kliten. Calendar packaging with 21 dragees, of which 11 white dragee contains 2 mg estradiole of Valerat, and 10 pink dragee - 2 mg estradiol Valerat and 1 mg Ciproteron acetate.

Cycle Proginova. Calendar packaging with 21 dragees, of which 11 white dragee contains 2 mg estradiole Valerat, and 10 of the reflux of light brown color contain 2 mg estradiol of Valerat and 0.5 mg of Northela.

Cymontorm. Calendar Packing with 21 Dragees: 9 Dragee yellow colorcontaining 2 mg of estradiol Valerat and 12 dragee of turquoise color, which consists of 2 mg estradiol Valerat and 0.15 mg of Levonorggestrel.

Three-phase drugsfor the UGT are represented by Trizekven and Trisekvent-Forte. Active substances: estradiol and norethysterone acetate.

To monocomponent drugs For oral administration include: Proginov-21 (calendar packaging with 21 dragey 2 mg estradiol Valerat and Estrolement (2 mg of estradiol tablets, 28 pieces).

All of the above-mentioned drugs imply bleeding, resembling menstruation. This fact confuses many women in menopause. In recent years, the country presents the drugs of continuous action Fometon and Livial, when using bleeding, either do not occur at all, or after 3-4 months of reception cease.

Thus, climate maid normal phenomenon, lays the basis of many pathological conditions. The most noticeable change in menopauca is the extinction of the ovarian function. Reducing the level of estrogen contributes to aging. That is why the effect of replacement hormone therapy is so actively studied female organism. It would be naive to believe that all the troubles of aging can be eliminated by hormonal means. But it should be considered unreasonable refusal of great opportunities for hormone therapy to preserve women's health in marsh.

Literature:

1. Serov V.N., Kozhin A.A., Plipskaya V.N. - Clinical and physiological bases.

2. Knotnik V.P., Kulakov V.I. - Climate Customer Guide.

3. Bush T.Z. The Epidemiology of Cardiovascular Disease in Postmenopausal Women. Ann. N.Y. ACAD. SCI. 592; 263-71, 1990.

4. CANLEY G.A. ET AAL. - Prevalence and Determinants of Estrogen Replacement Therapy in Eldery Women. Am. J. Obster. Gynecol. 165; 1438-44, 1990.

5. Colditz G.A. et al. - The Use of Esstogens and Progestins and The Risk of Breast Cancer in Postmenopausaal Women. N. ENG. J. Med. 332; 1589-93, 1995.

6. Henderson B.E. et al. - Decreased Mortality In Users of Estrogen Replacement Therapy. - Arch. Int. Med. 151; 75-8, 1991.

7. EMANS S.G. et al. - Estrogen Deficiency in Adolescents and Young Adults: Impact on Bone Mineral Content and Effeects of Estrogen Replacement Therapy - Obster. and gynecol. 76; 585-92, 1990.

8. EMSTER V.Z. et al. - Benefits of Menopausal Estrogen and Progestin Hormone Use. - Prev. Med. 17; 301-23, 1988.

9. Genant H.K. et al. - Estrogens in the prevention of Osteoporosis in Postmenopausal Women. - am. J. Obster. and gynecol. 161; 1842-6, 1989.

10. Persson Y. et al. - Risk of Endometrial Cancer After Treatment with Estrogens Alone or in Conjunction with Progestogens: Results of a Prospective Study. - Br. Medd. J. 298; 147-511, 1989.

11. Stampfer M.G. et al. - Postmenopausal Estrogen Therapy and Caardiovascular Disease: Ten Years Follow-Up from the Nurses' Health Study - N. ENG. J. Med. 325; 756-62, 1991.

12. Wagner G.d. et al. - Estrogen and Progesterone Replacement Therapy Reduces Low Density Lipoprotein Accumulation In The Coronary ARTERIES OF Surgically Postmenopausal Cynomolgus Monkeys. J. Clin. Invest. 88; 1995-2002, 1991.