medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/2079-701X-2019-7-126-132medsovet-2940Research ArticleПРЕ- И ПОСТМЕНОПАУЗАPRE- AND POSTMENOPAUSEМенопауза – новый старт в женской судьбеThe menopause – a new chapter giving women a lust for lifeЯкушевскаяО. В.YakushevskayaO. V.

Якушевская Оксана Владимировна – к.м.н., научный сотрудник отделения гинекологической эндокринологии.

Россия, г. Москва, ул. Академика Опарина, д. 4.

Yakushevskaya Oksana Vladimirovna, Cand. of Sci. (Med.), a researcher of Gynaecological Endocrinology Department.

117997, Russia, Moscow, Akademika Oparina St., 4.

ykushox83@mail.ruФедеральное государственное бюджетное учреждение «Национальный медицинский исследовательский центр акушерства, гинекологии и перинатологии им. академика В.И. Кулакова» Министерства здравоохранения Российской Федерации.РоссияFederal State Budgetary Institution «Kulakov National Medical Research Centre for Obstetrics, Gynaecology and Perinatology» of the Ministry of Health of Russian Federation.Russian Federation20190504201907126132Copyright © Якушевская О.В., 20192019Якушевская О.В.Yakushevskaya O.V.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-sovet.pro/jour/article/view/2940

У многих женщин слово менопауза ассоциируется в первую очередь с неизбежной старостью. С одной стороны, эстетическая составляющая деликатного возраста вносит свой вклад в степень неудовлетворенности этим состоянием, с другой – нарастающий пул проблем соматического здоровья не лучшим образом изменяет качество существования. Жизненный путь женщины индивидуален и состоит из череды начинаний и завершений, потерь и приобретений. Личность, развивающаяся гармонично и последовательно, к 50 годам достигает своей творческой кульминации. Это возраст, когда человек способен более глубоко погрузиться в свой внутренний мир, а восприятие того, что происходит во внешнем мире, ослабевает. Ментальная зрелость, накопленный опыт, устоявшиеся социальные связи позволяют уверенно балансировать в повседневной действительности. Однако физиологические изменения, связанные с климаксом и угасанием репродуктивной функции, так или иначе сказываются на личной истории каждой представительницы прекрасного пола. После 50 лет начинается не простой, но одновременно очень значимый период, когда предстоит покорить новые вершины и преодолеть новые расстояния. Только продуманный и успешный старт менопаузы может обеспечить чувство удовлетворенности и безоблачный горизонт в физическом самочувствии.

Many women equate the word menopause primarily with decline of life. On the one hand, the aesthetic component of the delicate age makes negative contributions to the dissatisfaction with this state; on the other hand, the growing pool of somatic health problems does not improve the quality of life in the best way. The woman’s path of life is unique and consists of chapters of beginnings and endings, losses and gains. A person, who develops harmoniously and consistently, reaches their creative climax by the age of 50. This is the age, when a person is able to plunge into their inner world more deeply, and the perception of what is happening in the outer world weakens. Mental maturity, accumulated experience, well established social connections allow a person to feel confidently in everyday reality. However, the physiological changes associated with menopause and the reproductive function failure affect the personal history of each of the fair sex in one way or another. Not a simple, but at the same time a very significant period begins after 50 years, when it is necessary to conquer new peaks and overcome new distances. Only a thoughtful and successful start of menopause can provide a sense of satisfaction and a cloudless horizon in physical well-being.

менопаузаклимаксменопаузальная гормональная терапия (МГТ)дроспиренонАнжелик®Анжелик® Микроменопаузальный переход (МП)вазомоторные симптомы (ВМС)menopauseclimaxmenopause hormone therapy (MGT)drospirenoneAngeliq®Angeliq® Micromenopausal transition (MP)vasomotor symptoms (VMS).ReferencesNorth American Menopause Society (2015). The North American Menopause Society statement on continuing use of systemic hormone therapy after age 65. Menopause.2015;22(7):693. http://www.menopause.org/docs/default-source/2015/2015-nams-hormone-therapy-after-age-65.pdf. Accessed August 24, 2015.North American Menopause Society (2015). The North American Menopause Society statement on continuing use of systemic hormone therapy after age 65. Menopause.2015;22(7):693. http://www.menopause.org/docs/default-source/2015/2015-nams-hormone-therapy-after-age-65.pdf. Accessed August 24, 2015.Siobán D.H., Gass M., Hall E.J., Lobo R. Executive summary of the Stages of Reproductive Aging Workshop + 10: addressing the unfinished agenda of staging reproductive aging. Menopause. 2012 April;19(4):387–395.Siobán D.H., Gass M., Hall E.J., Lobo R. Executive summary of the Stages of Reproductive Aging Workshop + 10: addressing the unfinished agenda of staging reproductive aging. Menopause. 2012 April;19(4):387–395.Zeleke B., Bell R., Billah B., Davis S. Vasomotor and sexual symptoms in older Australian women: a cross-sectional study. Fertil Steril. 2016;105:149–55.Zeleke B., Bell R., Billah B., Davis S. Vasomotor and sexual symptoms in older Australian women: a cross-sectional study. Fertil Steril. 2016;105:149–55.Biglia N., Cagnacci A., Gambacciani M., Lello S. Vasomotor symptoms in menopause: a biomarker of cardiovascular disease risk and other chronic diseases? Climacteric. 2017. http://dx.doi.org/10.1080/13697137.2017.1315089.Biglia N., Cagnacci A., Gambacciani M., Lello S. Vasomotor symptoms in menopause: a biomarker of cardiovascular disease risk and other chronic diseases? Climacteric. 2017. http://dx.doi.org/10.1080/13697137.2017.1315089.Юренева С.В., Дубровина А.В. Эволюция целей МГТ. От лечения приливов к новым горизонтам кардиометаболической протекции. Акушерство и гинекология.2018;6:18. [Yureneva S.V., Dubrovina A.V. The evolution of the MGT objectives. From the treatment of hot flushes to new horizons of cardiometabolic protection. Akusherstvo i Ginekologiya. 2018; 6:18] (In Russ).Юренева С.В., Дубровина А.В. Эволюция целей МГТ. От лечения приливов к новым горизонтам кардиометаболической протекции. Акушерство и гинекология.2018;6:18. [Yureneva S.V., Dubrovina A.V. The evolution of the MGT objectives. From the treatment of hot flushes to new horizons of cardiometabolic protection. Akusherstvo i Ginekologiya. 2018; 6:18] (In Russ).Women’s Heart Foundation. Women and Heart Disease Fact Sheet. 2006. Available from: http://www.womensheart.org/content/heartdisease/heart_disease_facts.asp (last accessed May 2015).Women’s Heart Foundation. Women and Heart Disease Fact Sheet. 2006. Available from: http://www.womensheart.org/content/heartdisease/heart_disease_facts.asp (last accessed May 2015).Lisabeth L., Beiser A., Brown D., Murabito J., KellyHayes M. Age at natural menopause and risk of ischemic stroke: the Framingham heart study. Stroke.2009;40:1044–9.Lisabeth L., Beiser A., Brown D., Murabito J., KellyHayes M. Age at natural menopause and risk of ischemic stroke: the Framingham heart study. Stroke.2009;40:1044–9.Ricci B., Cenko E., Vasiljevic Z., Stankovic G. Acute Coronary Syndrome: The Risk to Young Women. J Am Heart Assoc. 2017;6:e007519.Р.10.Ricci B., Cenko E., Vasiljevic Z., Stankovic G. Acute Coronary Syndrome: The Risk to Young Women. J Am Heart Assoc. 2017;6:e007519.Р.10.Huang C., Li C., Kor C., Chang C. Menopausal symptoms and risk of coronary heart disease in middleaged women: A nationwide population-based cohort study. PLOS ONE. https://doi.org/10.1371/journal.pone.0206036 October 18, 2018. Р.9.Huang C., Li C., Kor C., Chang C. Menopausal symptoms and risk of coronary heart disease in middleaged women: A nationwide population-based cohort study. PLOS ONE. https://doi.org/10.1371/journal.pone.0206036 October 18, 2018. Р.9.Muka T., Oliver-Williams C., Kunutsor S. Association of age at onset of menopause and time since onset of menopause with cardiovascular outcomes, intermediate vascular traits, and all-cause mortality: a systematic review and meta-analysis. JAMA Cardiol. 2016;1:767–76.Muka T., Oliver-Williams C., Kunutsor S. Association of age at onset of menopause and time since onset of menopause with cardiovascular outcomes, intermediate vascular traits, and all-cause mortality: a systematic review and meta-analysis. JAMA Cardiol. 2016;1:767–76.Thurston R., Joffe H. Vasomotor symptoms and menopause: findings from the Study of Women’s Health across the Nation. Obstet Gynecol Clin North Am.2011;38:489–501.Thurston R., Joffe H. Vasomotor symptoms and menopause: findings from the Study of Women’s Health across the Nation. Obstet Gynecol Clin North Am.2011;38:489–501.Silveira J., Clapauch R., Souza M., Bouskela E. Hot flashes: emerging cardiovascular risk factors in recent and late postmenopause and their association with higher blood pressure. Menopause.2016;23:846–55.Silveira J., Clapauch R., Souza M., Bouskela E. Hot flashes: emerging cardiovascular risk factors in recent and late postmenopause and their association with higher blood pressure. Menopause.2016;23:846–55.Muka T., Oliver-Williams C., Colpani V. Association of vasomotor and other menopausal symptoms with risk of cardiovascular disease: a systematic review and meta-analysis. PLoS One.2016;11:e0157417.Muka T., Oliver-Williams C., Colpani V. Association of vasomotor and other menopausal symptoms with risk of cardiovascular disease: a systematic review and meta-analysis. PLoS One.2016;11:e0157417.Thurston R., Johnson B., Pepine C. Early-onset menopausal vasomotor symptoms are associated with endothelial dysfunction: the National Heart Lung and Blood Institute-sponsored Women’s Ischemia Syndrome Evaluation (WISE) study. J Am Coll Card. 2015;65(Suppl):Abstr 1512.Thurston R., Johnson B., Pepine C. Early-onset menopausal vasomotor symptoms are associated with endothelial dysfunction: the National Heart Lung and Blood Institute-sponsored Women’s Ischemia Syndrome Evaluation (WISE) study. J Am Coll Card. 2015;65(Suppl):Abstr 1512.Sarrel P., Sarrel P., Portman D., Lefebvre P. Women, work, and menopause. Menopause. 2012;19:250–2.Sarrel P., Sarrel P., Portman D., Lefebvre P. Women, work, and menopause. Menopause. 2012;19:250–2.Crandall C., Aragaki A., Cauley J. Associations of menopausal vasomotor symptoms with fracture incidence. J Clin Endocrinol Metab.2015;100:524–34.Crandall C., Aragaki A., Cauley J. Associations of menopausal vasomotor symptoms with fracture incidence. J Clin Endocrinol Metab.2015;100:524–34.Doshi S., Agarwal A. The role of oxidative stress in menopause. J Midlife Health. 2013;4:140–6.Doshi S., Agarwal A. The role of oxidative stress in menopause. J Midlife Health. 2013;4:140–6.Avis N.E., Crawford S.L., Green R. Vasomotor Symptoms Across the Menopause Transition: Differences Among Women. Obstet Gynecol Clin North Am. 2018 Dec;45(4):629-640. doi: 10.1016/j.ogc.2018.07.005. Epub 2018 Oct 25.Avis N.E., Crawford S.L., Green R. Vasomotor Symptoms Across the Menopause Transition: Differences Among Women. Obstet Gynecol Clin North Am. 2018 Dec;45(4):629-640. doi: 10.1016/j.ogc.2018.07.005. Epub 2018 Oct 25.Greendale G.A., Wight R.G., Huang M-H. Menopauseassociated symptoms and cognitive performance: results from the Study of women’s health across the nation. Am J Epid. 2010;171:1214.Greendale G.A., Wight R.G., Huang M-H. Menopauseassociated symptoms and cognitive performance: results from the Study of women’s health across the nation. Am J Epid. 2010;171:1214.Pandeya N., Dobson A., Cade J., Greenwood D. Relationships between intensity, duration, cumulative dose, and timing of smoking with age at menopause: A pooled analysis of individual data from 17 observational studies. PLOS Medicine. https://doi.org/10.1371/journal.pmed.1002704 November 27, 2018.Pandeya N., Dobson A., Cade J., Greenwood D. Relationships between intensity, duration, cumulative dose, and timing of smoking with age at menopause: A pooled analysis of individual data from 17 observational studies. PLOS Medicine. https://doi.org/10.1371/journal.pmed.1002704 November 27, 2018.Thurston R.C., Sowers M.R., Sutton-Tyrrell K. Abdominal adiposity and hot flashes among midlife women. Menopause.2008;15:429e34.Thurston R.C., Sowers M.R., Sutton-Tyrrell K. Abdominal adiposity and hot flashes among midlife women. Menopause.2008;15:429e34.Gass M., Larson J., Cochrane B., Manson J. Sexual activity and vaginal symptoms in the postintervention phase of the Women’s Health Initiative Hormone Therapy Trials. Menopause. 2018 Mar;25(3):252-264. doi: 10.1097/GME.0000000000000994.Gass M., Larson J., Cochrane B., Manson J. Sexual activity and vaginal symptoms in the postintervention phase of the Women’s Health Initiative Hormone Therapy Trials. Menopause. 2018 Mar;25(3):252-264. doi: 10.1097/GME.0000000000000994.Delamater L., Santoro N. Management of the Perimenopause. Clin Obstet Gynecol. 2018 Sep;61(3):419-432. doi: 10.1097/GRF.0000000000000389.Delamater L., Santoro N. Management of the Perimenopause. Clin Obstet Gynecol. 2018 Sep;61(3):419-432. doi: 10.1097/GRF.0000000000000389.Polotsky H.N., Polotsky A.J. Metabolic implications of menopause. Send to Semin Reprod Med. 2010 Sep;28(5):426-34. doi: 10.1055/s-0030-1262902. Epub 2010 Sep 23.Polotsky H.N., Polotsky A.J. Metabolic implications of menopause. Send to Semin Reprod Med. 2010 Sep;28(5):426-34. doi: 10.1055/s-0030-1262902. Epub 2010 Sep 23.Huang G., Coviello A., LaValley M.P., Ensrud KE. Surgical Menopause and Frailty Risk in CommunityDwelling Older Women: Study of Osteoporotic Fractures. J Am Geriatr Soc. 2018 Nov;66(11):2172-2177.Huang G., Coviello A., LaValley M.P., Ensrud KE. Surgical Menopause and Frailty Risk in CommunityDwelling Older Women: Study of Osteoporotic Fractures. J Am Geriatr Soc. 2018 Nov;66(11):2172-2177.Lovejoy J.C., Champagne C.M., de Jonge L. Increased visceral fat and decreased energy expenditure during the menopausal transition. Int J Obes (Lond).2008;32:949e58.Lovejoy J.C., Champagne C.M., de Jonge L. Increased visceral fat and decreased energy expenditure during the menopausal transition. Int J Obes (Lond).2008;32:949e58.Karvonen-Gutierrez C., Kim C. Association of MidLife Changes in Body Size, Body Composition and Obesity Status with the Menopausal Transition. Healthcare (Basel).2016 Jul 13;4(3):pii: E42. doi: 10.3390/healthcare4030042.Karvonen-Gutierrez C., Kim C. Association of MidLife Changes in Body Size, Body Composition and Obesity Status with the Menopausal Transition. Healthcare (Basel).2016 Jul 13;4(3):pii: E42. doi: 10.3390/healthcare4030042.Lobo R.A., Davis S.R., De Villiers T.J. Prevention of diseases after menopause. Climacteric. 2014;17:540e56.Lobo R.A., Davis S.R., De Villiers T.J. Prevention of diseases after menopause. Climacteric. 2014;17:540e56.The 2017 hormone therapy position statement of The North American Menopause Society. The Journal of The North American Menopause Society2017;24(7):728-753.The 2017 hormone therapy position statement of The North American Menopause Society. The Journal of The North American Menopause Society2017;24(7):728-753.Baber R.J., Panay N., Fenton A. и рабочая группа IMS. Рекомендации IMS 2016 г. по здоровью женщин зрелого возраста и менопаузальной гормональной терапии (перевод). Climacteric. 2016. http://dx.doi.org/10.3109/13697137.2015.1129166. [Baber R.J., Panay N., Fenton A., the IMS Writing Group. 2016 IMS Recommendations on women’s midlife health and menopause hormone therapy. (Translation). Climacteric. 2016. http://dx.doi.org/10.3109/13697137.2015.1129166.] (In Russ).Baber R.J., Panay N., Fenton A. и рабочая группа IMS. Рекомендации IMS 2016 г. по здоровью женщин зрелого возраста и менопаузальной гормональной терапии (перевод). Climacteric. 2016. http://dx.doi.org/10.3109/13697137.2015.1129166. [Baber R.J., Panay N., Fenton A., the IMS Writing Group. 2016 IMS Recommendations on women’s midlife health and menopause hormone therapy. (Translation). Climacteric. 2016. http://dx.doi.org/10.3109/13697137.2015.1129166.] (In Russ).Neves-e-Castro M., Birkhäuser M., Samsioe G. EMAS position statement: The ten point guide to the integral management of menopausal health. Maturitas. 2015;81(1):88–92.Neves-e-Castro M., Birkhäuser M., Samsioe G. EMAS position statement: The ten point guide to the integral management of menopausal health. Maturitas. 2015;81(1):88–92.Allen R.H., Cwiak C.A. Nams Practice Pearl: Contraception for midlife women. Menopause: J. NAMS.2016;23(1):111–113.Allen R.H., Cwiak C.A. Nams Practice Pearl: Contraception for midlife women. Menopause: J. NAMS.2016;23(1):111–113.Klipping C., Duijkers I., Parke S., Mellinger U., Serrani M., Junge W. Hemostatic Effects of a Novel EstradiolBased Oral Contraceptive. Drugs. 2011;11:2:159-170.Klipping C., Duijkers I., Parke S., Mellinger U., Serrani M., Junge W. Hemostatic Effects of a Novel EstradiolBased Oral Contraceptive. Drugs. 2011;11:2:159-170.The ESHRE Guideline group on POI, Webber L., Davies M. ESHRE Guideline: management of women with premature ovarian insufficiency. Hum. Reprod. 2016;31(5):926–937.The ESHRE Guideline group on POI, Webber L., Davies M. ESHRE Guideline: management of women with premature ovarian insufficiency. Hum. Reprod. 2016;31(5):926–937.National institute for health and clinical excellence. Menopause: Diagnosis and management (NG23). 2015. 29 p.National institute for health and clinical excellence. Menopause: Diagnosis and management (NG23). 2015. 29 p.Scarabin P.Y. Hormone therapy and venous thromboembolism among postmenopausal women. Front Horm Res. 2014;43:21–32.Scarabin P.Y. Hormone therapy and venous thromboembolism among postmenopausal women. Front Horm Res. 2014;43:21–32.Follow us: rusmedjournal on Facebook Rizzo M.R., Leo S., Franciscis P., Colacurci N. Short-term effects of low-dose estrogen/drospirenone vs low-dose estrogen/dydrogesterone on glycemic fluctuations in postmenopausal women with metabolic syndrome. AGE.2014;36:265–274.Follow us: rusmedjournal on Facebook Rizzo M.R., Leo S., Franciscis P., Colacurci N. Short-term effects of low-dose estrogen/drospirenone vs low-dose estrogen/dydrogesterone on glycemic fluctuations in postmenopausal women with metabolic syndrome. AGE.2014;36:265–274.Caprio M., Antelmi A., Chetrite G. Antiadipogenic effects of the mineralocorticoid receptor antagonist drospirenone: potential implications for the treatment of metabolic syndrome. Endocrinology.2011;152(1):113–25.Caprio M., Antelmi A., Chetrite G. Antiadipogenic effects of the mineralocorticoid receptor antagonist drospirenone: potential implications for the treatment of metabolic syndrome. Endocrinology.2011;152(1):113–25.Zhang Y., Somers K.R., Becari C., Polonis K., Pfeifer M.A. Comparative Expression of Renin-Angiotensin Pathway Proteins in Visceral Versus Subcutaneous Fat. Front Physiol. 2018 Oct 10;9:1370. doi: 10.3389/fphys.2018.01370. eCollection 2018.Zhang Y., Somers K.R., Becari C., Polonis K., Pfeifer M.A. Comparative Expression of Renin-Angiotensin Pathway Proteins in Visceral Versus Subcutaneous Fat. Front Physiol. 2018 Oct 10;9:1370. doi: 10.3389/fphys.2018.01370. eCollection 2018.Lambrinoudaki I., Georgiopoulos G.A., Athanasouli F. Free androgen index as a determinant of arterial stiffness in menopause: a mediation analysis. Menopause.2017;24(6):635–44.Lambrinoudaki I., Georgiopoulos G.A., Athanasouli F. Free androgen index as a determinant of arterial stiffness in menopause: a mediation analysis. Menopause.2017;24(6):635–44.Franciscis P.D., Mainini G., Labriola D. Low-dose estrogen and drospirenone combination: effects on metabolism and endothelial function in postmenopausal women with metabolic syndrome. Clin Exp Obstet Gynecol. 2013;40(2):233–5.Franciscis P.D., Mainini G., Labriola D. Low-dose estrogen and drospirenone combination: effects on metabolism and endothelial function in postmenopausal women with metabolic syndrome. Clin Exp Obstet Gynecol. 2013;40(2):233–5.Dinger J., Bardenheuer К., Heinemann К. Drospirenone plus estradiol and the risk of serious cardiovascular events in postmenopausal women. Climacteric. 2016. doi: 10.1080/13697137.2016.1183624.Dinger J., Bardenheuer К., Heinemann К. Drospirenone plus estradiol and the risk of serious cardiovascular events in postmenopausal women. Climacteric. 2016. doi: 10.1080/13697137.2016.1183624.Балан В.Е., Ильина Л.М., Тихомирова Е.В., Царь-кова А.В. Кардиометаболические расстройства и менопаузальная гормонотерапия. Гинекология. 2017;05:10-14. [Balan V.E., Ilyina L.M., Tikhomirova E.V., Tsarkova A.V. Cardiometabolic disorders and menopause hormone therapy. Ginekologiya. 2017;05:10-14.] (In Russ).Балан В.Е., Ильина Л.М., Тихомирова Е.В., Царь-кова А.В. Кардиометаболические расстройства и менопаузальная гормонотерапия. Гинекология. 2017;05:10-14. [Balan V.E., Ilyina L.M., Tikhomirova E.V., Tsarkova A.V. Cardiometabolic disorders and menopause hormone therapy. Ginekologiya. 2017;05:10-14.] (In Russ).ACOG Practice Bulletin No. 141: Management of Menopausal Symptoms. Obstetrics & Gynecology.2014;123:202–16.ACOG Practice Bulletin No. 141: Management of Menopausal Symptoms. Obstetrics & Gynecology.2014;123:202–16.

The authors declare that there are no conflicts of interest present.