Climacteric syndrome and climacteric depression: causes, symptoms, treatment

The climacteric syndrome, also known as menopause, occurs in women during the period of fertility fading at the age of 45–47 years. It manifests in the gradual decrease in the size of the ovaries and uterus, and menstruation disappears. The climacteric syndrome develops in 40% of women in the premenopausal period, in 40–85% - within a year after menopause, and only in 3% - 2–5 years after its onset.

Short information about climacteric depression

What is a climacteric syndrome?

The syndrome occurs as a result of an age-related decrease in the level of female sex hormones (estrogens) in the body and changes in the hypothalamus. The duration of this pathological condition can be from one and a half to 10 years. On average, the symptoms are observed for about 2-5 years. Their severity depends on the general state of the health of the woman and the individual characteristics of her body.

Menopause, that is, the cessation of menstruation, occurs in all women, without exception, but at the same time, the climacteric syndrome is not necessary for everyone and can be of different severity. It is more likely to occur in women:

- With a decrease in the adaptive system of the body;
- With hereditary diseases;
- With cardiovascular problems.

The occurrence and course of the climacteric syndrome are influenced by the presence of gynecological diseases, such as uterine fibroids and endometriosis. Psychosocial factors are also essential - problems at work, the disorder in personal life. Often, the onset of the syndrome is provoked by a stressful situation. There is also a waveform and seasonality of manifestations of the climacteric syndrome, its peak occurs in spring and autumn.

How does climacteric syndrome manifest?

Symptoms of the climacteric syndrome are very diverse and can cause serious inconvenience to a woman. Specialists divide all manifestations of the syndrome into three groups:

- Neurovegetative;
- Psychoneurotic;
- Somatic.

The most common (up to 98%) neurovegetative symptoms are hot flashes over the face, head, and upper body of a woman. The duration of the hot flashes can be from 30 seconds to 1-2 minutes. Hot flashes are frequently accompanied by increased sweating. The episodes can be triggered by a variety of stimuli such as stress, changes in weather conditions, etc. With hot flashes, the temperature of the skin surface rises by almost 5 C, the heart rate increases to 130 beats per minute or more, peripheral vessels expand. In addition, the appearance of red spots on the chest and neck, resembling a necklace in shape, attacks of severe headache, changes in blood pressure, hypertensive crises, and vasomotor rhinitis are also common vegetative disorders. Often women complain of cramps or numbness of the limbs, dry skin, swelling, drowsiness, or, conversely, increased excitability. Some have asthma attacks and panic attacks.

- Neurovegetative disorders during menopause can also cause increased sensitivity of the nervous system, which leads to the appearance of pain in different parts of the body.

- Psychoneurotic symptoms of the climacteric syndrome are manifested by a decrease in memory and attention, irritability, emotional instability and a feeling of fatigue. Many women experience decreased performance. Almost 13% of patients present with one or another neurotic disorder, accompanied by tearfulness, a feeling of fear or anxiety, bouts of unreasonable irritability, intolerance to some smells or sounds. A very great influence on the behavior of a woman during this period is exerted by her perception of the onset of menopause as a tragedy, the final arrival of old age. In 10% of women with climacteric syndrome, persistent climacteric depression is diagnosed. Such depression is one of the most severe and difficult to treat psychoneurotic symptoms. It is important not to overlook the symptoms and seek medical help or the quality of life can suffer significantly.

- Somatic symptoms can be caused both by general age-related changes in metabolic processes and by an increased response of tissues and organs to a decrease in the level of estrogen in a woman's body. The typical manifestations are inflammation of the vaginal walls, dystrophic changes in the vulva, bleeding, itching, involuntary or painful urination. Loss of tone in the supporting muscles can result in prolapse or even prolapse of the uterus and vagina. At the same time, not only the genitourinary system is estrogen-dependent, but also the skin, nails, hair, and mammary glands. Due to a decrease in the production and content of collagen, skin thickness and elasticity decreases, blood circulation in the capillaries slows down, which leads to the appearance of wrinkles. In 40% of cases, weight increases. A decrease in estrogen levels leads to increased loss of calcium from bones, a decrease in vitamin D synthesis, and calcium absorption, and the process of bone destruction begins to dominate. The consequence of these processes is the occurrence of osteoporosis, nocturnal pain in the extremities, lesions of the spine. Disorders in the functioning of the thyroid gland are possible.

Some women with climacteric syndrome have a decrease in the timbre of the voice and active growth of facial hair, also caused by a decrease in the concentration of female sex hormones.

Severity of climacteric syndrome

Experts distinguish three forms of the climacteric syndrome, depending on the severity of its course:

- Mild: it is diagnosed only in 16% of women suffering from climacteric syndrome. It is distinguished by up to 7-10 hot flashes per day, the general condition and working capacity of the woman practically does not change.
- Medium: this form is typical for 33% of women. The number of hot flashes increases, from 10 to 20 per day. In this case, pronounced symptoms appear: headaches and dizziness, memory impairments, sleep disorders, etc. The general condition worsens, performance decreases.
 

- Severe: A severe course is typical for 51% of women. In this case, a complete or almost complete loss of performance is possible due to the sharp deterioration in the general condition. The climacteric syndrome is especially difficult and long-lasting if it appears during the early development of menopause, at the age of 38–43 years. The disorders that arise in this case can lead to serious disorders of psychosocial adaptation in all spheres of life, including family and intellectual.

In addition, there is a classification of the syndrome depending on the characteristics of the clinical manifestations. In this case, three forms are also distinguished.

- The typical (uncomplicated). It is characterized only by excessive sweating and hot flashes. It is observed in practically healthy women experiencing prolonged physical or mental stress. The typical form is characterized by the timely onset of menopause and the appearance of the classic symptoms of menopause, disappearing on average after one and a half to two years. The general condition of a woman does not change. There is moderately excessive deposition of subcutaneous fat, a decrease in skin elasticity and other signs of changes in the body that are fully consistent with age. The state of the reproductive system in this form is also age-appropriate.
- The complicated form occurs against the background of diseases of the digestive system, cardiovascular system, diabetes mellitus, thyroid dysfunction in women after 45 years. With a complicated form, the frequency and severity of hot flashes increases. Pain or discomfort in the region of the heart, increased heart rate, memory and sleep disturbances may occur. According to studies, in women with hypertension, a complicated form of climacteric syndrome occurs twice as often as in healthy women.

- The atypical form does not occur very often, mainly in women who have suffered in the past physical or mental trauma, serious illness, surgery, or those who have worked for a long time under the influence of harmful factors. The atypical form is characterized by a violation of the menstrual cycle, and then a persistent absence of menstruation. After a while, typical climacteric syndromes appear: sleep disturbance, tearfulness, impairment of memory and performance. In addition, dry skin, hair loss and brittleness are observed, pigment spots appear on the skin of the hands, head and chest. Itching of the skin of the extremities or genital area may begin. Almost all patients have weight gain, edema, joint pain, frequent urination, sometimes painful. The condition worsens quickly enough, causing a complete loss of performance. Women with an atypical form may develop asthma attacks, osteoporosis, hypoglycemia, osteochondrosis, and panic attacks.

Treatment of climacteric syndrome

First of all, you need to understand that menopause is a physiological process. Complications of menopause or the pathological course of menopause require consultation with specialists, and therefore, in such cases, suffering women should be examined by doctors of several specialties at once, including a neurologist and a psychotherapist (especially in case of climacteric depression).

Nevertheless, the gynecologist plays the leading role in reducing the negative effect of the syndrome on the patient's quality of life.

Namely gynecologist makes the diagnosis and chooses the method of treatment. Today, there are three main areas of therapy, each of which has its own pros and cons.

Non-drug therapy

It is advisable to begin this stage as the preparation for menopause. This approach facilitates the course of climacteric syndrome or even avoids it. Complexes of special physiotherapy exercises have a good effect. It has been proven that daily exercise has a positive effect on various mechanisms of the nervous system, which is very important for reducing psychoneurotic symptoms. Physical therapy can be recommended in the form of morning exercises or group exercises. The type of exercise and its amount is determined by the doctor. Regular physical activity, especially walking, increases oxygen metabolism, lowers insulin levels, and normalizes carbohydrate metabolism.

Weight control is also included in the complex of non-drug therapy. Proper nutrition is very important. A woman's diet should be dominated by vegetables and fruits, vegetable fats. Limit your carbohydrate intake. During this period, it is recommended to include in the daily diet food rich in phytoestrogens, for example, soy, flaxseed oil, parsley leaves, etc. Vitamin deficiency is replenished with the help of vitamin complexes, which must include vitamins A, C, E.

Drug therapy

It is mainly used to treat moderate to severe climacteric syndrome to normalize the nervous system. For this purpose, the patient may be recommended sedatives. With prolonged climacteric syndrome and climacteric depression, accompanied by chronic diseases, tranquilizers, antidepressants (for instance, Imipramine) and neuroleptics are prescribed. The course of treatment must include vitamins.

Hormone therapy

It is recommended only in the absence of the effect of non-hormonal therapy. The goal is to compensate for the age-related hormonal changes occurring in the woman's body. The method of exposure is usually chosen based on the symptoms that appeared at the start of treatment, the absence or presence of menstruation. This allows to plan the duration of therapy and determine its goal - the treatment of only climacteric syndrome or all disorders that have developed against its background. Depending on the clinical manifestations of the syndrome, estrogens, gestagens and their various combinations can be used in each case. A prerequisite for effective hormone therapy is the individual selection of drugs and their doses, taking into account the degree of hormonal deficiency in the patient. Any hormones should be prescribed only by the gynecologist and taken under strict supervision.

It is usually recommended to start therapy no later than the first 6-12 months after the first appearance of hot flashes and other symptoms. At the initial stage, the symptoms are much easier to correct, and also more likely to prevent the development of a severe form of the syndrome.

Today, women have a lot of opportunities to reduce the number and strength of unpleasant manifestations of menopause. It only remains to choose a method and do not hesitate both non-drug and drug treatments appointed by qualified medical professionals.

Post is made based on the information provided by: Elizabeth Agrer, clinical pshychiatrist, Copenhagen, Denmark