Stepanenko T. Optimization of therapy methods in women with pathological climacteric

The thesis is devoted to the study of risk factors and prognosis of early menopause, the substantiation of the use of exogenous estrogen necessity for the consequences of early termination of menstrual function correction and the best method of their appointment. The study of the hereditary history of patients with early menopause showed that the absolute majority of menopausal patients under 40 years of age showed the same early exhaustion of ovarian function in the mother and (or sisters). The relative risk of early menopause in a woman, if her mother's menstrual function is over 40 years old, is 3.37, if one of the sisters is 2.459. Based on the concept of a genetically determined age at the onset of menopause, this factor was analyzed by relatives on the parent line, and a similar pattern found the genesis of complications. there was no yen, the proportion of women with such a hereditary history in the main group was even lower than in the comparison group. Late menarche is likely to increase the likelihood of early exhaustion of the menstrual function. Significant increases in the relative risk of early termination of menstrual function (2,506) among the factors of special history were calculated for laparoscopic ovarian interventions. In a study of the hormonal status of patients with early menopause, a number of features were also revealed. In particular, despite the fact that there were no differences in the mean concentrations of estradiol in women with early and timely menopause, the women in the main group were critically low in hormone content of less than 15 pg / ml. In addition, these women are also characterized by the simultaneous reduction of estrone concentration, while in patients with timely menopause, the domination of estrone over estradiol persists for a long time. It has been shown that within 12-18 months of the last menstruation in the body of women with early termination of reproductive function, changes in the fibrinolytic linkage of hemostasis – a decrease in the content of tissue plasminogen activator and increased plasma plasminogen activator inhibitor are observed. In the instrumental study of regulatory vascular abilities, it has been established that in women with early menopause, an endothelium-dependent process of dilatation of the brachial artery after decompression, which is a non-invasive criterion of endothelial dysfunction, has been impaired for 12-18 months after the last menstruation. Based on the data obtained, the expediency of exogenous estrogen therapy in patients with early menopause was substantiated. Among the proposed treatment regimens against the background of equal efficacy in relation to the main clinical manifestations of climacteric syndrome, a better dynamics of indicators of fibrinolysis, endothelial regulation and psychological adaptation is shown against the background of the use of exogenous estrogens in the mode of continuous oral administration.