Menopause is not a death sentence

Did you know that a century ago the average human life expectancy was 49 years, and today in civilized countries it reaches 80. The problem of population aging, leading to an increase in the proportion of older people in society, is acute in all highly developed countries of the world. According to UN experts, the aging of the world's population will accelerate in the coming decades.

Key moment of aging

Increasing life expectancy is an indicator of the economic well-being of a country, and longevity should be active. This is socially, ethically and economically beneficial for society, which is why developed countries heavily fund many government programs aimed at reducing disability in old age. Preserving health and quality of life in old age is economically beneficial for any state, since old age diseases are easier to prevent than to invest billions of dollars in their treatment.

In modern society, thanks to the advances of medicine, we reach an age of ill health and live in a state of illness for quite a significant part of our lives. We began to live to see the main disease - deficiency of sex hormones. Yes, a decrease in the production of sex hormones is a key aspect of aging.

It should be noted that once every 4 years the International Congress on Menopause is held in the world, in which not only doctors, but also sociologists, statisticians and economists from all over the world take part, since the problem of population aging is acute in all highly developed countries. At the congress, the latest achievements and innovations in the field of age-related medicine are announced, complex clinical problems are discussed, and patient management tactics in specific situations are agreed upon.

A new “stage” in a woman’s life

So, the menopause period in a woman’s life - what is it?

“Climax” translated from Greek means “step”, a new logical stage, which accounts for a third of a woman’s life. Menopause is characterized by a deficiency of female sex hormones, in particular estrogens, in a woman’s body, which develops as a result of age-related or forced (surgical removal, radiation or chemotherapy) shutdown of ovarian function.

There are many organs and systems in a woman’s body, the functioning of which directly depends on the level of estrogen: genital organs, pituitary gland and hypothalamus, mammary glands, brain, cardiovascular and musculoskeletal systems, bladder, skin and hair, large intestine, liver. Accordingly, under conditions of estrogen deficiency, their work deteriorates.

There are early symptoms of menopause, which often occur even before the end of menstrual function: hot flashes, excessive sweating, chills, headaches, changes in blood pressure, rapid heartbeat, feeling of lack of air, “coma in the throat,” as well as frequent mood swings, anxiety, restlessness , tearfulness, irritability, decreased libido, fear, insomnia, decreased memory, attention, fatigue, weakness.

According to statistics, up to 30% of women pass this stage in life quite easily, without presenting the above-described complaints. It must be remembered that the absence of hot flashes is an indicator of the resistance of the autonomic system to hormonal changes. Unfortunately, the other consequences of menopause are more serious, develop slowly and often unnoticed by the woman.

Medium-term violations include:

• disorders of the vagina and bladder (dryness, itching, burning in the vagina, pain during sexual activity, frequent urge to urinate, loss of urine when coughing, laughing, sneezing, persistent cystitis, inflammatory processes in the vagina);
• disorders of the skin and its appendages (appearance and worsening of wrinkles, dry skin, brittle nails, thinning hair, bleeding and loose gums);
• sexual dysfunction (feeling of loss of sexual attractiveness, femininity, deterioration in the quality of sexual life, lack of sexual satisfaction).

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Late-term disorders (so-called “diseases of old age”) are:

• obesity;
• cardiovascular diseases (atherosclerosis, high blood pressure, heart attacks, strokes);
• osteoarthritis (diseases of joints and bone tissue);
• postmenopausal osteoporosis, manifested by pain in the bones, in the back during prolonged standing, fractures, periodontal disease);
• Alzheimer's disease (senile dementia).

Today, experts distinguish several phases in the menopause.

• The transition to menopause, which begins at the age of 40-45 years and continues until the last independent menstruation. At this time, the duration of menstrual cycles changes and often lengthens; the ability to conceive decreases.
• Perimenopause is a period when the first menopausal symptoms have already appeared, but less than a year has passed since the last menstruation.
• Menopause is the time of the last natural bleeding (menstruation). This can only be determined after 12 months without bleeding (amenorrhea). The average age of menopause is 51.3 years. There may be early menopause - before 45 years, and also premature - before 40 years, this is genetically predetermined.
• Postmenopause is the period after the onset of menopause. There are early postmenopause (5 years without menstruation) and late postmenopause (more than 5 years without menstruation until the end of life).
• Induced menopause is the cessation of menstruation due to surgical removal of both ovaries, as well as “turning off” the work of the ovaries after radiation or chemotherapy.

Age-related skin changes

As a cosmetologist, I would like to highlight in more detail the problem of age-related skin changes characteristic of the perimenopausal and menopausal periods.

So, age-related skin changes after 40 years grow and worsen in waves. According to scientists, the process of reverse development of organs and their atrophy, or involution, begins. The epidermis and dermis become thinner, the thickness of the muscle fibers also changes, in which the level of contractile proteins and energy substances gradually decreases, and small sebaceous glands atrophy. The amount of mucopolysaccharides, which, along with collagen and elastin, form the main intercellular substance in the skin and connective tissue, decreases; for this reason, the skin loses more moisture.

During this period, signs of aging in the periorbital zone become more noticeable - due to thinning of the skin, weakening of the tone of the orbicularis oculi muscle, ligamentous apparatus, which is characterized by the appearance of excess tissue and worsening wrinkle lines in this area. There is ptosis of the upper eyelid, exposure of the bony edge of the orbit of the lower eyelid.

There is a loss of volume and gravitational displacement of the soft tissues of the face and neck. Tendency to form nasolacrimal, palpebromal and buccal grooves.

Often, due to the increased content of male sex hormones - androgens - hair growth is observed above the upper lip and on the chin. Vascular disorders may occur - rosacea, in the form of spider veins on the skin of the cheeks, wings of the nose, and chin.

Age-related changes in the skin after 50 years become more profound due to the restructuring of the hormonal system in a woman’s body as menopause occurs.

Blood circulation in the skin is noticeably reduced, which leads to a significant decrease in regeneration processes, the skin becomes dry and dehydrated, and thins even more. Static and dynamic wrinkles worsen against the background of dystrophic changes in the skin. There are “folds”, “bags”, “overhangs” as a result of relaxation of the muscle-ligamentous structures. Decontouring of the oval of the face and neck is also observed, as a result of gravitational ptosis and redistribution of adipose tissue.

The predominance of certain age-related changes in a woman’s face depends on the morphotype of aging: finely wrinkled, muscular or deformed.

Every cosmetologist understands that fighting age-related changes against the background of hormonal aging is quite difficult, and sometimes even unproductive, without prescribing specific therapy aimed at replenishing the deficiency of sex hormones.

What will help a woman change her mind?

The next question that I would like to raise is: how to live this period energetically, beautifully, with dignity?

Firstly, maintaining a healthy lifestyle: physical activity, balanced nutrition, giving up bad habits (heavy smoking can be one of the causes of infertility and early menopause), limiting exposure to the sun and solariums (skin photoaging is a scientifically proven fact), compliance with the work and rest regime, reasonable resistance to stress.

Secondly, the possibilities of modern cosmetology: professional anti-aging care, medium and deep peelings, mesotherapy procedures, contour correction and volume modeling, thread lifting, various hardware techniques. This also includes advances in the field of modern plastic surgery.

Thirdly, alternative symptomatic therapy with non-hormonal agents. In this case, each of the components of the menopausal syndrome is corrected with various types of drugs (for example, when hot flashes appear, herbal remedies that alleviate them are prescribed, etc.).

Such therapy, with an integrated approach and regular long-term use, can be effective to a certain extent, but, unfortunately, it is expensive, since not a single non-hormonal drug can act on all parts of the menopausal syndrome at the same time.

Fourth, hormone replacement therapy (HRT). This is a course of therapy aimed at replacing missing hormones in a woman’s body. HRT is most effective for the treatment and prevention of menopausal syndrome if it is prescribed on time. For example, the patient may notice the disappearance or significant reduction and weakening of hot flashes by the end of the first week of taking the drug. This is explained by the fact that only HRT drugs act on the immediate cause of menopause - a deficiency of female sex hormones, eliminating it.

HRT and breast cancer

Many women associate taking HRT with breast cancer, which claims many lives. There are many misconceptions in this statement.

A lot of research on the effect of taking HRT on the risk of developing breast cancer has been carried out all over the world - both in the USA (they began using HRT before anyone else, in the 60s of the twentieth century) and in Europe. All these studies are serious, extensive, multi-year and expensive, however, they cannot give a clear answer to the question of the effect of HRT on the risk of developing breast cancer. This disease is multifactorial, and it is, in principle, impossible to exclude all other influences during the study (age, number of births and abortions, heredity, poor ecology), leaving only the use of HRT.

But, summing up the data from these studies, we can clearly say that estrogens (the main therapeutic component of HRT drugs) are not oncogenes.

All studies have also shown that even if a patient receiving HRT developed breast cancer (not directly related to taking HRT), it was less malignant, had a lower stage of spread, was less prone to metastasis, and responded better to treatment.

You need to know that the main cause of death among women 50-94 years old is cardiovascular diseases (including myocardial infarction). Every year they kill 34% of older and elderly women - this is more than from all types of cancer combined!

According to statistics, in postmenopausal women the relative risk of getting cancer is 1:20,000, that of dying in a plane crash is 1:10,000, and the risk of getting a disabling fracture due to osteoporosis 10-15 years after menopause is equal 1:60!

And finally, what you need to know about HRT

1. First: HRT can only be prescribed by a gynecologist.
2. Second: in the modern pharmaceutical market, the choice of HRT drugs is quite wide, which gives the doctor the opportunity to individually select therapy for each patient, taking into account risk factors, features of the course of menopause and its phase. For example, there are medications for women who are still menstruating, for postmenopausal women, and for patients who have undergone surgery to remove the ovaries.
3. Third: the drugs also differ in composition. Some contain only estrogen, others contain both estrogen and gestagen in different modes: cyclic (some of the tablets in the package contain only estrogen, others - estrogen and gestagen) and continuous (each tablet contains an equal amount of estrogen and gestagen).

HRT drugs may differ in release form: tablets, skin gels, patches, intranasal sprays, etc.

It is necessary to pay attention to the fact that the dose of natural estrogens in modern HRT preparations is extremely small and, at the same time, highly effective. For comparison, it is 20-10 times lower than the dose of synthetic estrogens that are part of the newest hormonal contraceptives, which themselves are micro-dose drugs with a high level of safety and can be used for a long time in healthy women without any particular concerns.

Fourth: HRT is not carried out in short-term courses. The minimum duration of treatment should be 1-2 years. The goal of therapy at this stage is to help a woman more easily survive hormonal changes in her body and help her adapt to a new state for her. You can stop taking HRT or decide to change the treatment method at any time, after consulting with your doctor.

It should be noted that restrictions on the duration of taking HRT have now been lifted (this applies to patients who receive HRT without neglecting observation by a gynecologist).

Indications and contraindications for the use of HRT

Like other pharmaceutical drugs, HRT has indications and contraindications for its use.

HRT is indicated for the treatment of early and mid-term symptoms of menopause, as well as for the prevention of late complications of menopause, mental changes (Alzheimer's disease).

There are not many absolute contraindications to HRT. This:

• pregnancy and lactation;
• bleeding from the genital tract, the cause of which is not specified;
• myocardial infarction, stroke currently or in history;
• severe hypertension (until stable normalization of blood pressure levels);
• marked increase in blood triglyceride levels;
• deep vein thrombosis currently and in history;
• severe chronic diseases of the liver and kidneys with impaired function;
• established or suspected diagnosis of breast cancer or hormone-dependent malignant tumor.
• allergy to HRT components (extremely rare).

Due to the low dose and high selectivity of the action of modern HRT drugs, their side effects are insignificant. Among these side effects, the most common is engorgement of the mammary glands - as an adaptive reaction of the body in response to the introduction of additional amounts of female sex hormones. Other phenomena (headache, nausea, fluid retention in the body, etc.) are rare. If they appear, it is advisable not to discontinue the drug yourself, but to consult with your doctor.

Many women are interested in the issue of menstrual flow during HRT. Among the HRT drugs, there are those that cause menstruation (cyclic HRT regimen) and those that cause no menstrual flow (continuous HRT regimen). As a rule, when choosing an HRT regimen, the gynecologist is guided by whether the patient is premenopausal (irregular menstruation, but less than a year has passed since the last one) or postmenopausal (no menstruation for more than a year), as well as the patient’s age.

So…

Summarizing the above, it should be noted that HRT today remains the most effective therapy for the treatment and prevention of menopausal disorders.

In the practice of a dermatocosmetologist, it is important to understand the recommendations for HRT in order to achieve maximum results from cosmetic procedures in patients of a certain age group.

Modern HRT drugs will allow your patients to feel younger, remain cheerful, active, energetic, protected and self-confident. But still, only a gynecologist should prescribe HRT, adjust and cancel therapy.

First published: Cosmetologist No. 5, 2017