Climacterium, also called climax is a natural stage in a woman’s life and is characterized by reverse changes in the reproductive system – cessation of childbearing and menstrual function.

The word “climax” originates from the Greek “klimax” – a staircase, symbolically expressing the steps leading from the flowering of specific female functions to their gradual attenuation.

A woman’s life consists of several age periods, possessing characteristic anatomical and physiological features:

• Neonatal period – up to the 10th day after birth;

• Childhood – up to 8 years of age;

• Period of puberty or puberty – from 8 to 17-18 years of age;

• Period of sexual maturity /reproductive or childbearing/ – from 18 to 45 years of age;

Climacteric period or climax, including:

– Premenopause – from age 45 to menopause;
– Menopause – cessation of menstrual cycles, age 49-50;
Postmenopausea – from menopause up to 65-69 years;

Old age – from the age of 70;

And since the average life expectancy of women in Bulgaria is 76.2 years, therefore the menopause represents more than 1/3 of it.

In some women, menopause has only a physiological course and does not cause pathological disorders.

But in others, the disease course of menopause leads to the development of menopausal/climacteric/ syndrome.

It occurs with a frequency of 26-48% and is characterized by a complex of various disorders in the functions of the endocrine, nervous and cardiovascular systems, which often worsen the quality of life and reduce a woman’s ability to work .

Issues of pathological menopause have important social and medical importance in connection with the increase in the average life expectancy of women and their socially active behavior.

Treatment of menopause

The approaches adopted in modern gynecology to the treatment of disease states due to menopause focus on reducing their manifestations and symptoms.

Antidepressants are prescribed to reduce the intensity and frequency of hot flashes during pathological menopause.

In order to prevent the development of osteoporosis during the menopause, non-hormonal preparations – biophosphonates – alendronate and risedronate are used, reducing bone loss and increasing the risk of fractures.

Biophosphonates effectively replace estrogen therapy in the treatment of osteoporosis in postmenopausal women.

In order to reduce the manifestation of urogenital symptoms during the pathological course of menopause, local /vaginal application of estrogen in the form of cream or tablets is recommended.

Separation of small doses of estrogen in the vaginal tissues reduces the sensation of dryness, discomfort during intercourse and urination.

The most effective treatment of menopausal syndrome is hormone therapy individually prescribed by the woman’s doctor.

Taking estrogen preparations helps to reduce the frequency and intensity of characteristic hot flashes and unpleasant sensations in the vagina.

As hormonal therapy for the treatment of pathologies due to menopause, natural estrogens are applied – estradiol valerate and 17-beta estradiol in small doses periodically.

To prevent hyperplastic processes in the endometrium during menopause, combined estrogens with progestins or rarely androgens are used.

Courses of hormone therapy and prophylaxis are carried out for 5-7 years to prevent myocardial infarction, osteoporosis and stroke.

Hormonal therapy as a way to treat menopause pathologies is contraindicated for patients with:

• Cancer of the endometrium, ovaries and breast;
• Coagulopathies – disorders in the blood clotting process;
• Impaired liver function;
• Thromboembolism, thrombophlebitis;
• Uterine bleeding of unknown origin;
• Kidney failure;

Before the appointment of hormone therapy, a detailed examination of the pathologies of menopause is necessary.

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