Neuroendocrine syndromes in gynecology prof agzumova N M

Neuroendocrine syndromes in gynecology prof. : Мagzumova N. M.

Neuroendocrine syndromes in gynecology n n n n n Premenstrual Syndrome Algomenoreya Postcastration syndrome Menopause Postpartum obesity Neuroendocrine syndrome is not associated with pregnancy Postpartum hypopituitarism (Shien syndrome) Polycystic ovaries AGS Hyperprolactinemia

Premenstrual syndrome (PMS 2055%) n pathological syndrome that occurs after 2 -10 days before menstruation; n manifested neuropsychiatric, autonomic cardiovascular and metabolic-endocrine disorders; n disappear immediately at the begining of menstruation or during the first days.

PMS n n Stress mental strain abortions and pathological labors chronic infectious disease

Who are particularly susceptible to PMS? Women who have standing or sitting work (sedentary) Young mothers after pregnancy or lactation period

PMS symptoms Symptoms of mental and physical nature: Irritability, depressive disorders, anxiety, inner state restlessness, apathy, fear of affect attacks Headaches, mastodynia, swelling, feeling of "overcrowding", bloating, puffiness The consequences of fluid retention

PMS forms n Easy - there are 3. 4 symptoms for 2 -10 days before menstruation with considerable severity of symptoms 1. 2. n Severe- 5. 12 symptoms appear for 3 -14 days before menstruation, and 2 -5 of them (or all) pronounced.

PMS stages Compensated n Subcompensated n decompensated n

PMS clinical forms • Neuropsychiatric • Edematous • Cephalgic • Crisic Как я ненавижу эти дни! Mainly in the clinical picture of PMS - is its cyclicity

PMS symptomes Emotional Behavioral Mood swings ravenous appetite Physical Hadeache Pain in the abdomen and back, joints Voltage breast Depression oppression heartbeating irritability weight gain forgetfulness Isolation tearfulness anxiety

PMS meanegment 1. Prove the recurrence of the problem (menstrual calendar at least 2 -3 months) 2. Are the following symptoms: - swelling - Headaches - Panic attacks - Emotional disorders symptomatic therapy 3. Lifestyle changes (diet, work, exercise, rest) 4. Eliminate cyclic hormonal changes during the menstrual cycle (CCO; Gn. RH agonists, Mirena) In need of treatment about 15% of women

PMS symptomatic therapy n n Swelling, bloating - diuretics (preferably aldosterone blocker spironolactone 100 mg with a 14 -day cycle in Tech. 3 -6 months). Mediana Headaches –medicines with antiprostaglandin (Celebrex, indomethacin, diclofenac). Fatigue, drowsiness, insomnia - behavior regulation: limiting caffeine, alcohol, sedatives and hypnotics, active.

n Drugs with sex hormones: Duphaston 10 -20 mg with a 16 to 25 day cycle, utrojestan 100 mg Norkolut from 5 to 21 mg per day for 5 women closer to menopause with mastopathy and uterine cancer Other treatments: Mastodinon to 25 drops. 2 times a day or 1 tab. 2 times a day for 3 months. Antihistamines (tavegil, diazolin, suprastin). Antianxiety agents: seduksen, phenazepam; Antidepressants: gelarium, Dismenorm;

Algomenoreya (31 -52%) Painful menstruation n Primary (functional) - pain for 1 -2 days before menses, nausea, headache, vomiting, and diarrhea.

Primary algomenoreya Treatment: Prostaglandins inhibitors (indomethacin, brufen, indomethacin, aspirin, Melbeck, Celebrex for 3 days to a month - 3 -5 months Electrophoresis with novocaine OC - 3 -4 months acupuncture tranquilizers

Algomenoreya n Secondary (genital lesions - endometriosis, fibroids, PID, adenomyosis, IUDs) n Treatment - the basic pathology.

Modern OC not only protect against pregnancy, but also. . . n Regulate and normalize the menstrual cycle n Reduce menstrual pain n Improve skin and hair n PMS

n n Postcastration syndrome (PCS) 60 -80% It is a complex of pathological neuropsychiatric, vegetative-vascular, metabolic-endocrine symptoms occurring after total or subtotal removal of the ovaries.

Pathogenesis n Increased secretion of gonadotropins in the absence of feedback between the gonadotropins and sex steroids. n Violation of all neuroendocrine systems involved in adaptation. n PS after ovarectomy develops at every second at the age of 45 -50 years.

Clinical features 1. Neyrovegetative violations 2. Psyhoemotional disorders 3. Endocrine disorders Against the background of estrogen deficiency are observed: In the cardiovascular system: hypertension, ischemic heart disease dishormonal cardiopathy In hormone-dependent organs: atrophic colpitis, urogenital disorders

PCS management n n Pathogenetic therapy - HRT. The goal of therapy - pharmacological hormone replacement lost ovarian function. Warn sexual dysfunction. Minimum term HRT therapy - 5 -7 years

Climacteric Menopause (from the greek. Climacter - step ladder) n physiological period n age-related changes in a woman's n involutional processes of the reproductive system n termination of first childbearing, and then menstruation.

Modern women problems n n n Menopause is perceived by society as a biological, and therefore is emotional call to nature of Homo sapiens The average life expectancy of women in the past 10 years has increased to 75 years The number of elderly people, who are mostly women, is 8 billion, in 2025 is expected to 8840, and in 2050 - 9008 billion On average, for every 100 men over age 60 have 224 women The main causes of death in women over 60 years - loss of mobility after stroke (50%), ischemic heart disease (31%) and the consequences of fractures (20%)

Menopause phases n Premenopausal n MENOPAUSE n Perimenopause n Postmenopausal n OLD AGE

Glossary of terms: n Premenopausal - a period of about 4 years, with the first symptoms of estrogen deficiency (with 45, 5 -47, 5 years) to menopause (50 -51 years) Menopause - the date of the last menstrual period Perimenopause - the period from the first symptoms of menopause up to 2 years after menopause Postmenopause - with menopause until 65 -69 Old age - older than 70 years

Menopause n A. Natural: stop bleeding as a result of reduction of ovarian activity retrospectively last menstrual period - 1 year ago B. Early menopause to 40 years C. Induced menopause after removal of the ovaries or ovarian function after ablation (chemotherapy, radiotherapy)

CLIMACTERIC SYNDROME. CLINICAL FEATURES n EARLY SYMPTOMS OF CLIMACTERIC SYNDROME VASOMOTOR n HOT FLUSHES TO THE HEAD AND UPPER BODY n CHILL EXCESSIVE SWEATING n HEADACHES n TACHYCARDIA n HYPO-OR HYPERTENSION

CLIMACTERIC SYNDROME. CLINICAL FEATURES n EARLY SYMPTOMS OF CLIMACTERIC SYNDROME EMOTIONAL-VEGETATIVE n IRRITABILITY n DROWSINESS n WEAKNESS n ANXIETY n DEPRESSION n FORGETFULNESS n INATTENTION n DECREASED LIBIDO

CLIMACTERIC SYNDROME. CLINICAL FEATURES By the number of hot flashes determine the severity n 1. Mild form - up to 10 hot flashes a n day, condition and performance is not affected. 2. Moderate - 10 -20 tides a day, headache, pain in the heart, the deterioration of the general condition and decreased performance. 3. Severe form - more than 20 hot flashes per day, a significant or total loss of earning capacity.

Mean symptoms: Dry, brittle nails, wrinkles, dryness and hair loss Vaginal dryness, dyspareunia, itching and burning, urethral syndrome, urinary incontinence

CLIMACTERIC SYNDROME n MEAN SYMPTOMS: I Urogenital Disorders - Atrophic vaginitis - Bacterial vaginosis (60% of patients) - Atrophic tsistouretrit (urethral syndrome) - pollakiuria - nocturia - cystalgia - Stressor incontinence - Incomplete emptying of the bladder.

POSTMENOPAUSAL SEXUAL DISORDERS ü Reduced Sexual Desire ü Dyspareunia ü Inadequate Lubrication ü Reduction In The Frequency And Intensity Of Orgasms

Vulva dystrophy

Multiple foci of hemorrhage atrophy

Atrophic Epithelium

Skin of genitalis: • dystrophy (kraurosis) Epithelium of vagina: Urethra, urinary bladder: • thinning • dryness • infections Decreased • dysuria • infections estrogen Cervix: • Thinning of epithelium Muscles and ligaments of pelvis: • Trauma • prolapsus • Changes in cervical topography • fall • retension

CLIMACTERIC SYNDROME LATE METABOLIC DISORDERS: - Cardiovascular disease (coronary heart disease, atherosclerosis) - Postmenopausal osteoporosis - Alzheimer's disease

Postmenopausal Osteoporosis "Silent Disease", which are the only manifestation is the fractures. Each year in the U. S. due to osteoporosis is 1. 3 million fractures. 40 60 80 лет

Woman´s bones age-specific of dynamics state 33 года 55 лет 72 года

Osteoporosis n "Osteoporosis - a serious and growing problem“ n 75 million people worldwide suffer from osteoporosis n The number of fractures related to osteoporosis is doubling in the next 50 years n Bones at 33 y "HRT is gold standard of prevention of osteoporosis" World Congress on Osteoporosis, Amsterdam, 1996 Bones at 55 y Bones at 72 y

POSTMENOPAUSAL OSTEOPOROSIS Risk factors n n n n n Women are underweight; A history of trauma of bones; late menarche (after 15 years); Early menopause (before age 50); Oligo-and amenorrhea in reproductive age; Anovulation and infertility; Prolonged lactation; Smoking, alcohol and coffee consumption in large quantities; Sedentary lifestyle.

Indications for HST: ü Expressed menopause ü Postcastration syndrome ü Amenorrhea in young women (gonadal dysgenesis, hypogonadotropic amenorrhea syndrome, ovarian failure, resistant ovary syndrome) ü Severe atrophic processes (urogenital disorders) ü High risk of osteoporosis (gr. risk), CVD, Alzheimer's disease.

Treatment of climacteric syndrome consists of 3 stages: 1 -stage: n Rational hygienic mode of labor n Diet (vitamins A, C, E) n Restricting food dominated hydrocarbons and fats n EPE

Therapeutic exercise: n Morning exercise (15 -20 minutes) n Group lessons three times a week for 30 -45 minutes n Engage with the elements of sports, recreational and training sessions n Physical treatments (galvanic "collar" with novocaine or magnesium sulfate) n Electrosleep 35 to 60 minutes 15 to 20 sessions n Spa treatment

Medical therapy without hormones: 2 - stage n Antianxiety agents: seduksen, phenazepam, etc. n Antidepressants: gelarium, Dismenorm;

3 - stage: Hormone replacement therapy Goal : n Replace the hormonal ovarian function n Using minimally-optimal doses of hormones to improve general condition n Prevention of metabolic disorders later

HORMONE REPLACEMENT THERAPY Main advantages of HRT: Ø levels of natural estrogen and the lowest dose (early phase of proliferation). Ø combination of estrogen with progestogen (protects against the development of endometrial hyperplastic processes in uterus – if it available).

Basic principles of HRT: n Estrogen in uterus removed intermittent or continuous n Progestogens androgens (endometriosis or endometrial cancer n Prevention of osteoporosis, atherosclerosis and urinary disorders (5 -7 years or more) n Information on the impact of short-term and long-term estrogen deficiency n It should also inform women about the positive effect of HRT n Consider the contraindications and side effects of HRT.

Another estrogen (2009) Tibolon - Ливиал, ЛЕДИБОН n n Treatment of climacteric syndrome Prevention of osteoporosis"

Inspection which is need before HRT § Anamnesis § Gynecological examination and US of genitalia § Breast examination (mammografy, US) § Smear cytology (Papanicolau’s method) § Gemostasiogram (prothrombin index)

Absolute contraindications for HRT n Breast cancer; n Bleedings unknown genesis; n Tromboemboly at last 6 months; n Liver and renal insufficiency; n NB! Women with cancer of endometrial, ovary and cervix HRT is not absolute contraindication

Life phases of women (old Chinese classification) n n n n Youth Till 20 years Family building Till 30 years Social duties Till 40 years Opening own mistakes Till 50 years Last creative period Till 60 years Favorable period of life Till 70 years Solidarity after 70 years