Climax. Author of the article: obstetrician-gynecologist Starostina Antonina Viktorovna.

Forty-five years is considered a transitional stage in a woman’s life: the time comes when the body begins to prepare for menopause, which is reflected in the hormonal background and entails various symptoms. Menopause is not only the cessation of menstruation, the appearance of hot flashes and the inability to get pregnant. A woman’s hormonal system begins to work in a different mode, and this happens a year or two before the cessation of menstruation. The onset of premenopause is indicated by a routine hormone test, which a woman can take at any center. The “Formula Health” gynecological clinic carries out hormone tests and gives accurate results.

Hormone analysis

We will not go into detail about the structure of a woman’s hormonal system. You should know only one thing - with the onset of menopause, the production of estrogen in the female body decreases. And to compensate for this decrease, the pituitary gland begins to produce increased levels of follicle-stimulating hormone - FSH. Natural estrogen is reduced, the amount of FSH is increased, which contributes to increased production of another LH hormone - luteinizing hormone. There comes a time when a woman can no longer conceive.

So, in order to understand whether an existing menstrual cycle disorder is a harbinger of menopause or is it a consequence of some disease, a woman takes a blood test for the following types of hormones:

• FSH content - a low FSH rate (10 units) is typical for women of reproductive age. If FSH reaches 20 units, the woman has entered premenopause. The normal FSH level in the blood when approaching menopause is 30-40 units. A year after the cessation of menstruation, this number increases to 125 units.
• Estradiol content. This is the main hormone among estrogens, responsible for the strength of bones, the amount of fat, and the elasticity of the skin. Lack of estradiol leads to the risk of fractures and atherosclerosis. During menopause, the norm of estradiol is from 8 to 82 units. When the limit is low, a woman has no libido, severe dry skin, including dryness of the vaginal mucosa, and a noticeable weight gain. At the upper limit, there is a risk of benign tumors, kidney problems, and the woman feels increased fatigue. This analysis is necessary for the doctor to decide on the advisability of prescribing hormone replacement therapy.
• Contents of LG. This hormone is responsible for the maturation of the egg and the onset of ovulation. During menopause, the LH value is increased: with a norm of 5-20 units, the content in menopause increases to 29-50 units. This value is necessary to calculate the proportional content of FSH to LH. Typically this value during menopause is between 0.35 and 0.75. A lower value means the symptoms of menopause are more pronounced.
• Progesterone content. The normal level of progesterone during menopause is from 0.50 to 0.64 units. Before the onset of menopause, this value is lower, which provokes mood swings.

Menopause: first symptoms and age

Menopause is manifested by the following symptoms:

• Irregular periods
• Unstable hormonal levels
• Hot flashes, sweating
• Frequent mood swings, depression, anxiety
• Decreased sex drive
• Deterioration of skin condition, hyperemia
• Sleep disorder
• Absent-mindedness
• Dry mucous membranes
• Enuresis
• Weight gain

There are three stages of menopause: premenopause, menopause and postmenopause.

Premenopause

Onset: 40–45 years, lasts up to ten years. Signs of premenopause:

• Destabilization of menstruation
• Frequent urination
• Increased thermal sensitivity
• Weight gain
• Skin problems

If you start to notice the above, it's time to see a doctor. Do not ignore the first signs so as not to develop problems with the heart, blood vessels and nerves in the future.

Menopause

Occurs between the ages of 49 and 55 years. At this stage it is impossible to conceive a child. Menopause is characterized by:

• Dysmenorrhea
• Aging skin
• Tides
• No lubrication in the vagina
• Brittle bones

Hot flashes are the most noticeable sign of menopause. The duration is approximately two minutes. Manifestations:

• Slight disorientation
• Feeling of heat in the upper body
• Hyperemia of the face and chest
• Sweat, palpitations
• Anxiety

Hot flashes do not pose a health risk. When this state occurs, it is advisable to find complete peace and take a deep breath. You can exclude the reasons that aggravate its manifestation: control emotions, give up spicy food, coffee and alcohol, do not wear excessively warm clothes, minimize stay in a stuffy room.

Important!

If hot flashes cause persistent discomfort, see a doctor.

Postmenopause

The third stage of menopause, postmenopause, begins around age 55 and lasts for about six years. The ovaries completely stop functioning. Postmenopausal symptoms:

• Pubic descent
• Lack of lubrication in the vagina
• Hair loss on the head
• Decreased vision
• Weight gain

Let's talk separately about perimenopause.

It begins with perimenopause and ends one year after the last menstruation.

As research by scientists from the Kharkov National Medical University has shown, one of the leading complaints with which 20-30% of women in the perimenopausal period turn to a gynecologist is uterine bleeding. They occupy a leading place among the reasons for women's hospitalization in hospitals. Excessive blood loss creates a risk of iron deficiency anemia, increases the risk of developing cancer, causes disruption of sexual life, and reduces quality of life. A common cause of uterine bleeding in the perimenopausal period is endometrial polyps. In women of older age groups, bleeding can occur not only with benign changes in the uterine mucosa, but also against the background of endometrial cancer. Peak incidence occurs between 55 and 65 years of age.

How to take a hormone test correctly?

Blood tests are taken on certain days of the cycle - the day of the test will be calculated by the doctor. So tests for FSH and LH are taken at the beginning of the cycle - on days 4-5. Analysis for estradiol - 19-22 days. Progesterone test at the same time. There are a number of restrictions before donating blood for hormones; they must be observed, otherwise the result will be distorted. Avoid alcohol and physical activity a week before the test. Do not have sex the day before the test day. Take the test strictly on an empty stomach - in the morning, the break from the last meal should be at least 8 hours. You can drink water. Do not take medications.

Changes in the mammary glands during menopause

The hormonal changes that occur in a woman’s body during menopause, of course, also affect the condition of the mammary glands. Many women experience painful tension (“engorgement”), especially in the area around the nipples. Sometimes in the thickness of the glands, palpable small painful nodules either disappear or reappear.

This is not necessarily breast cancer, and yet with such manifestations it is necessary to see a doctor. Only a thorough examination, including mammography and other examination methods, will help determine whether these formations are tumorous.

Why do you need to know these values?

To prepare for menopause. In addition to prescribing replacement therapy, a woman should introduce calcium-containing foods into her diet: cottage cheese, fermented milk products, cheese to prevent osteoporosis. You need to undergo a gynecological examination: take a smear for oncocytology, do an ultrasound of the pelvic organs and mammography. You should donate blood for sugar and cholesterol levels. Adjust your diet, move more, follow a sleep and rest schedule. Your doctor may prescribe vitamins or supplements to relieve menopausal symptoms.

Obstetrician-gynecologist of the highest category. Chernovskaya Rosa Uranovna

Discharge during menopause

During premenopause, menstruation gradually loses its former regularity: it may occur later or earlier than expected. Their intensity changes - and it can either decrease or increase. Occasional intermenstrual discharge is possible - light, “spotting”, brownish in color.

So-called menopausal bleeding, associated with impaired production of sex hormones, develops in women aged 40-50 years, before menopause. Typically, such bleeding begins after a missed period, but it may coincide with the expected period or even begin a little earlier. It differs from regular menstruation in its long duration - up to several weeks.

The intensity of such bleeding may vary and may be repeated. Sometimes they are quite abundant, even threatening health and life.

Menopausal bleeding requires treatment in a hospital, usually responds to hormone therapy, but surgery may also be required. As a rule, diagnostic curettage is required to clarify the diagnosis in such cases. This is necessary in order not to miss possible hyperplasia (overgrowth) of the endometrium, its polyps and other conditions that are also manifested by uterine bleeding. Treatment tactics will depend on the correct diagnosis.

Uterine bleeding that occurs in postmenopause is much more dangerous, as it often indicates a serious illness. For example, spotting in a woman not receiving hormone replacement therapy that occurs several years after menopause can be caused by uterine cancer or ovarian tumors. In this case, it is necessary to undergo a thorough medical examination as quickly as possible with mandatory separate diagnostic curettage of the mucous membrane of the cervix and body of the uterus. Early diagnosis allows for timely successful treatment.

Water retention versus gas retention

Water retention and gas retention are the two main causes of bloating and bloating. It can be difficult to determine which of these two causes bloating.

Retention of gas , which is usually found in the stomach and is the result of trapped air. Bloating can often be prevented by eating more slowly, avoiding carbonated drinks, and eating less food.

Water retention can occur in more cases than gas retention. A woman may notice swelling in her arms and legs, across her middle or throughout her body. Water retention can cause painful bloating in affected parts of the body.

There are simple steps a woman can take to reduce the swelling and bloating associated with excess fluid retention.

Non-drug methods

• Exercise therapy, yoga, massage.
  Any physical activity of moderate intensity, as well as relaxation and stretching exercises, have a beneficial effect. Preference should be given to activities such as recreational walking, swimming, and breathing practices.
• Medical nutrition.
  A low-calorie diet with a predominance of greens, vegetables, fruits, grains, legumes, vegetable oils and a limitation of simple carbohydrates and animal fats is recommended. A nutritionist will advise which nutritional system is suitable in a particular situation.
• Physiotherapy.
  To relieve symptoms, galvanization, electroanalgesia, electrosleep, light therapy, various baths and many other techniques are used. However, some physiotherapeutic procedures during menopause may be contraindicated due to the presence of concomitant diseases, including the genital area, so a detailed preliminary examination is very important.
• Spa treatment.
  Hydrotherapy, balneotherapy, and thalassotherapy are performed as prescribed by the doctor.
• Psychotherapy.
  Working with a specialist helps a woman accept a new stage in her life, learn to relax, get rid of excessive anxiety, and prevent the development of depression and psychosomatic pathology.

Prevention and relief

Regular exercise and staying hydrated will help reduce water retention.

Preventing bloating during menopause may be the best treatment. Luckily, you can avoid bloating with a number of simple lifestyle changes, including:

• Drink more water. While water retention causes bloating, hydration keeps the gastrointestinal tract in good condition.
• Exercise regularly. Sweating during exercise helps reduce water retention and move food through the digestive system.
• Avoid trigger foods. Foods that cause gas retention include some beans, broccoli, and fatty, fried foods.
• Avoid carbonated drinks. Carbonated drinks can cause excess gas in the stomach.
• Don't use chewing gum. Chewing gum can cause a person to swallow air.
• Quit smoking. Smoking can cause a person to swallow air, which causes bloating.
• Reduce salt intake. Too much salt can cause water retention and swelling. To reduce salt content, a person should avoid processed foods.
• Take probiotics. Yogurt, sauerkraut, kefir and other probiotic foods can aid digestion.
• Eat less. Large meals can be difficult to digest, especially as metabolism slows during menopause.

If a woman finds that she suffers from frequent bloating during menopause, there are several medical treatments to relieve the discomfort. Ways to relieve bloating during menopause include:

• use of over-the-counter gas medications
• take prescription pills and diuretics
• taking hormone replacement therapy
• birth control pills

When to see a doctor

This is typical for a woman who experiences bloating during hormonal fluctuations associated with her menstrual cycle and menopause. In most cases, bloating that clears up on its own is not a cause for concern.

However, in cases where the bloating is prolonged and painful, a woman should talk to her doctor. Painful bloating that lasts for several weeks may indicate other medical conditions that should be diagnosed by a medical professional.

Bloating or weight gain?

If bloating is painful or persistent, you should consult your doctor.

Bloating, especially from water retention, can lead to weight gain. Sometimes it can be difficult for a woman going through menopause to differentiate between weight gain and bloating.

Menopausal bloating, unlike weight gain, is also often accompanied by a distended, swollen belly and discomfort. Bloating is characterized by:

• rapid onset of weight or size during or after eating
• changes in stomach size and shape throughout the day
• short periods of bloating, either after eating or during hormone fluctuations
• discomfort or pain

On the contrary, weight gain will continue and remain. Weight gain often occurs during menopause as a result of a slower metabolism and can occur with or without bloating. Weight gain alone does not cause stomach distension during the day.

Urinary incontinence during menopause

Urinary incontinence is a fairly common manifestation of menopausal syndrome. The fact is that the work of the bladder, urethra and the tone of the pelvic floor muscles depend on the level of estrogen in the body. And their deficiency can lead to weakening of the muscles responsible for urinary control. The following violations may occur:

• stress urinary incontinence - involuntary leakage of a small amount of urine during sudden movements, jumping, lifting heavy objects, coughing, sneezing, laughing;
• Urgent (induced) urinary incontinence, in which the muscles of the bladder contract untimely, which causes the involuntary release of a large amount of urine (an irresistible urge is felt, the woman simply does not have time to run to the toilet);
• pain, burning when urinating;
• frequent urination, the need to urinate even several times a night.

We must also not forget that the cause of urinary dysfunction in women in adulthood can be not only menopause itself, but also urinary tract infections. Age-related weakening of the sphincters contributes to their occurrence. The condition of the urinary tract can also be affected by concomitant diseases, such as diabetes mellitus, cerebrovascular accidents and many other factors.

Urinary problems should not be accepted as an inevitable part of aging. You should not hesitate to discuss this problem with a gynecologist and urologist, and also undergo a detailed examination of the pelvic region and urinary system. Specialists will help you find out the true causes of problems and suggest ways to solve them.

Typically, for urinary incontinence, the following are recommended:

• strengthening the pelvic muscles using Kegel exercises, which are based on prolonged contraction and subsequent relaxation of the pelvic floor muscles;
• “training” of the urinary tract using special simulators;
• limiting caffeine consumption;
• fight against excess weight;
• biofeedback method, electrical stimulation of the pelvic muscles;
• drug therapy, local use of hormones;
• surgical intervention.

The main problems for women during menopause

One of the most striking problems of this period is the violation of intimate life. A woman’s desire naturally decreases, discomfort appears during sex, and the amount of natural lubrication decreases. But this is not a reason to give up intimate life altogether!

It is important to discuss the problem with your doctor and select special products - lubricants (for example, with a warming effect) that will relieve discomfort. It is also necessary to replenish the balance of hormones, which we will discuss later in the article.

In some cases, uterine bleeding that is not menstrual is possible. In this case, it is necessary to consult a gynecologist as soon as possible to avoid the development of pathologies.

Also, during menopause in women, calcium is actively washed out of the bones, which causes the development of osteoporosis - fragility of bone tissue. Modern diagnostics make it possible to detect the development of osteoporosis in a timely manner. And prevention will be stable moderate physical activity, a nutritious and varied diet.

What is menopause

Menopause or menopause is a period of gradual decline in the reproductive function of the female body. The average age of its onset is 45–50 years.

• 45–47 years is the normal age for the onset of menopause
• Under 40 years old - early menopause
• After 55 - late menopause

This process begins with a change in the menstrual cycle - periods become irregular, discharge becomes more scanty every month. The functional activity of the ovaries decreases: they produce less and less hormones that affect the woman’s body, and conceiving a child becomes almost impossible.

The menopausal period is accompanied by not the most pleasant symptoms, but, fortunately, today, with the help of specially selected therapy, it is possible to reduce their manifestations or even get rid of them completely.