Modern therapy for vasomotor symptoms of climacteric syndrome
https://doi.org/10.21518/2079-701X-2022-16-16-116-122
Abstract
As a result of the age-related decline in reproductive function, during the perimenopausal and postmenopausal periods female patients experience an estrogen deficiency state. Due to this state, symptoms of estrogen deficiency, which are combined into the concept of “climacteric syndrome”, begin to manifest. Climacteric syndrome is a complex of vegetative-vascular, mental, and metabolic-endocrine disorders that develop in women not only due to decrease in estrogen synthesis, but also the general ageing of the body. Clinical manifestations of the climacteric syndrome have a certain priority of development. With a decrease of the hormonal function of the ovaries, vasomotor disorders step forward. They represent all forms of autonomic regulation disorders, such as hot flashes, arterial pressure and pulse liability, respiratory disorders, hyperhydrosis, chills, and many others. In this article, the greatest emphasis is placed on the issue of vasomotor disorders, in particular hot flashes, in women of the perimenopausal and postmenopausal periods. Attention is paid to the medical and social component of the issue discussed. Given the fact that today the life expectancy of people, including women, is significantly increasing in the developed countries, a large number of females are faced with the issue of menopausal syndrome. The clinical manifestations of menopause not only have an extremely negative impact on the women’s quality of life, but also lay the groundwork for the development of more severe somatic disorders. The article also considers in detail the frequency of hot flashes, and the pathogenetic mechanisms of their development. The “gold standard” for the treatment of patients suffering from vasomotor disorders is particularly detailed. Today, the menopausal hormone therapy is recognized as the most effective therapeutic approach, which, subject to a personalized approach to patients and the absence of contraindications to its prescription, demonstrates high protective capabilities.
About the Authors
A. Z. KhashukoevaRussian Federation
Asiyat Z. Khashukoeva, Dr. Sci. (Med.), Professor
Department of Obstetrics and Gynaecology
117997
1, Ostrovityanov St.
Moscow
T. Y. Dmitrashko
Russian Federation
Tatyana Y. Dmitrashko, Assistant
Department of Obstetrics and Gynaecology
117997
1, Ostrovityanov St.
129226
6, 1st Leonov St.
Moscow
L. A. Nosova
Russian Federation
Liliya A. Nosova, Рostgraduate Student
Department of Obstetrics and Gynaecology
117997
1, Ostrovityanov St.
Moscow
E. A. Markova
Russian Federation
Eleonora A. Markova, Assistant
Department of Obstetrics and Gynaecology
117997
1, Ostrovityanov St.
Moscow
A. V. Overko
Russian Federation
Aleksey V. Overko, 6th Year Student
Faculty of General Medicine
117997
1, Ostrovityanov St.
Moscow
References
1. Дворянский С. А. Климактерический синдром: современное состояние вопроса (обзор литературы) / С. А. Дворянский, Д. И. Емельянова, Н. В. Яговкина // Вятский медицинский вестник. – 2017. – 1 (53): 7–15. Режим доступа: https://vyatmedvestnik.ru/index.php/vmv/issue/view/4/no1_53_2017. – Dvoryanskiy S. A., Emelyanova D. I., Yagovkina N. V. Climacteric syndrome: current status of the issue (literature review). Medical Newsletter of Vyatka. 2017; 1 (53): 7–15. (In Russ.) Available at: https://vyatmedvestnik.ru/index.php/vmv/issue/view/4/no1_53_2017.
2. Schoenaker D. A. J. M., Jackson C. A., Rowlands J. V., Mishra G. D. Socioeconomic position, lifestyle factors and age at natural menopause: a systematic review and meta-analyses of studies across six continents. Int J Epidemiol. 2014; 43 (5): 1542–1562. https://doi.org/10.1093/ije/dyu094.
3. Costanian C., Zangiabadi S., Bahous S. A., Deonandan R., Tamim H. Reviewing the evidence on vasomotor symptoms: the role of traditional and non-traditional factors. Climacteric. 2020; 23 (3): 213–223. https://doi.org/10.1080/13697137.2019.1711051.
4. Кострома Я. В. Оценка выраженности климактерического синдрома и особенности психосоматического статуса / Я. В. Кострома [и др.] // Журнал акушерства и женских болезней. – 2019. – 68 (1): 13–20. Режим доступа: https://journals.eco-vector.com/jowd/article/view/10725. – Kostroma Y. V., Belyaeva E. N., Khazova E. L., Kuznetsova L. V., Zazerskaya I. E. Assessment of the severity of menopausal syndrome and psychosomatic peculiarities. Journal of Obstetrics and Women’s Diseases. 2019; 68 (1): 13–20. (In Russ.) Available at: https://journals.eco-vector.com/jowd/article/view/10725.
5. Freeman E. W., Sammel M. D., Sanders R. J. Risk of long-term hot flashes after natural menopause: evidence from the Penn Ovarian Aging Study cohort. Menopause. 2014; 21 (9): 924–932. https://doi.org/10.1097/GME.0000000000000196.
6. Юренева С. В. Вазомоторные симптомы в менопаузе: центральные триггеры, эффекторы и новые возможности патогенетической терапии / С. В. Юренева, В. Г. Аверкова // Российский вестник акушера-гинеколога. – 2018. – 18 (5): 43–48. https://doi.org/10.17116/rosakush20181805143. – Yureneva S. V., Averkova V. G. Menopausal vasomotor symptoms: central triggers, effectors, and new possibilities of pathogenetic therapy. Russian Bulletin of Obstetrician Gynecologist. 2018; 18 (5): 43–48. (In Russ.) https://doi.org/10.17116/rosakush20181805143.
7. Потупчик Т. Возможности применения препарата ФемоКлим в климактерическом периоде / Т. Потупчик // Врач. – 2019. – 30 (8): 80–85. https://doi.org/10.29296/25877305-2019-08-17. – Potupchik T. Possibilities of using Femo-Klim in the menopausal period. Vrach. 2019; 30 (8): 80–85. (In Russ.) https://doi.org/10.29296/25877305-2019-08-17.
8. Юренева С. В. Роль гипоталамических (триггеров) нейропептидов в генезе приливов жара. Перспективы новых терапевтических подходов к лечению вазомоторных климактерических симптомов / С. В. Юренева, З. Х. Эбзиева // Акушерство и гинекология. – 2017. – (8): 115–120. https://doi.org/10.18565/aig.2017.8.115-20. – Yureneva S. V., Ebzieva Z. K. Role of hypothalamic (trigger) neuropeptides in the genesis of hot flushes. prospects for new therapeutic approaches to treating vasomotor menopausal symptoms. Akusherstvo i Ginekologiya (Russian Federation). 2017; (8): 115–120. (In Russ.) https://doi.org/10.18565/aig.2017.8.115-20.
9. Таболина А. А. Особенности психопатологических нарушений у женщин в перименопаузе / А. А. Таболина //. Медицинские новости. – 2017. – (8): 60–65. Режим доступа: https://www.mednovosti.by/Journal.aspx?id=369. – Tabolina A. Peculiarities of psychopathological violations in women in perimenopause. Meditsinskie Novosti. 2017; (8): 60–65. (In Russ.) Available at: https://www.mednovosti.by/Journal.aspx?id=369.
10. Avis N. E., Crawford S. L., Greendale G., Bromberger J. T., Everson-Rose S. A., Gold E. B. et al. Duration of Menopausal Vasomotor Symptoms Over the Menopause Transition. JAMA Intern Med. 2015; 175 (4): 531–539. https://doi.org/10.1001/jamainternmed.2014.8063.
11. Касян В. Н. Вазомоторные симптомы климактерия: только ли приливы жара? Альтернативные (негормональные) методы коррекции с доказанной эффективностью (обзор литературы) / В. Н. Касян, Л. В. Адамян // Медицинский совет. – 2020. – (21): 192–198. https://doi.org/10.21518/2079-701X-2020-21-192-198. – Kasyan V. N., Adamyan L. V. Vasomotor menopausal symptoms: is it just hot flashes? Alternative non-hormonal methods of treatment with proven effectiveness (literature review). Meditsinskiy Sovet. 2020; (21): 192–198. (In Russ.) https://doi.org/10.21518/2079-701X-2020-21-192-198.
12. Касян В. Н. Патофизиология приливов жара. Фокус на нейрогормональную регуляцию (обзор литературы) / В. Н. Касян, Л. В. Адамян // Проблемы репродукции. – 2017. – 23 (1): 115–121. https://doi.org/10.17116/repro2017231115-121. – Kasyan V. N., Adamyan L. V. Pathophysiology of hot flashes with focus on neurohormonal regulation (a review). Russian Journal of Human Reproduction. 2017; 23 (1): 115–121. (In Russ.) https://doi.org/10.17116/repro2017231115-121.
13. Tataryn I. V., Meldrum D. R., Lu K. H., Frumar A. M., Judd H. L. LH, FSH and skin temperature during the menopausal hot flash. J Clin Endocrinol Metab. 1979; 49: 152–154. https://doi.org/10.1210/jcem-49-1-152.
14. Glanowska K. M., Burger L. L., Moenter S. M. Development of gonadotropin-releasing hormone secretion and piyuitary response. J Neurosci. 2014; 34 (45): 15060–15069. https://doi.org/10.1523/JNEUROSCI.2200-14.2014.
15. Mittelman-Smith M., Williams H., Krajewski-Hall S. J., McMullen N. T., Rance N. E. Role for kisspeptin/neurokinin B/dynorphin (KNDy) neurons in cutaneous vasodilatation and the estrogen modulation of body temperature. PNAS. 2012; 109 (48): 19846–19851. https://doi.org/10.1073/pnas.1211517109.
16. Кузнецова И. В. Менопаузальные симптомы и расстройства сна у женщин: возможности альтернативной терапии / И. В. Кузнецова // Акушерство и гинекология: новости, мнения, обучение. – 2019. – 7 (1): 85–91. https://doi.org/10.24411/2303-9698-2019-11012. – Kuznetsova I. V. Menopausal symptoms and sleep disorders in women: possibilities of alternative therapy. Akusherstvo i Ginekologiya: Novosti, Mneniya, Obuchenie. 2019; 7 (1): 85–91. (In Russ.) https://doi.org/10.24411/2303-9698-2019-11012.
17. Nelson R. HRT Update Regarding Breast Cancer Risk Advised in EU. Medscape Medical News. 2020. Available at: https://www.medscape.com/viewarticle/930707.
18. Collaborative Group on Hormonal Factors in Breast Cancer. Type and timing of menopausal hormone therapy and breast cancer risk: individual participant meta-analysis of the worldwide epidemiological evidence. Lancet. 2019; 394 (10204): 1159–1168. https://doi.org/10.1016/S0140-6736(19)31709-X.
19. Адамян Л. В. Менопауза и климактерическое состояние у женщины: клинические рекомендации / Л. В. Адамян [и др.] – М.; 2021. – 86 с. Режим доступа: https://geropharm.ru/uploads/file/menopauza-i-klimaktericheskoe-sostoyanie-u-ghenschiny-kr-2021.pdf. – Adamyan L. V., Andreeva E. N., Artymuk N. V., Ashrafyan L. A., Balan V. E., Ermakova E. I. et al. Menopause and menopause in women: clinical guide lines. Мoscow; 2021. 86 p. Available at: https://geropharm.ru/uploads/file/menopauza-i-klimaktericheskoe-sostoyanie-u-ghenschiny-kr-2021.pdf.
20. Сухих Г. Т. Менопаузальная гормонотерапия и сохранение здоровья женщин в зрелом возрасте. Клинические рекомендации (протокол лечения) / Г. Т. Сухих [и др.] – М., 2015. – 54 c. Режим доступа: https://moniiag.ru/wp-content/uploads/2019/07/Menopauzalnaya-gormonalnaya-terapiya-i-sohranenie-zdorovya-zhenshhin-zrelogo-vozrasta.pdf. – Sukhikh G. T., Smetnik V. P., Andreyeva E. N., Balan V. E., Gavisova A. A., Grigoryan O. R. et al. Menopausal hormone therapy and maintaining the health of women in adulthood. Clinical guidelines (treatment protocol). Moscow; 2015. 54 p. (In Russ.) Available at: https://moniiag.ru/wp-content/uploads/2019/07/Menopauzalnaya-gormonalnaya-terapiya-i-sohranenie-zdorovya-zhenshhin-zrelogo-vozrasta.pdf.
21. Colpani V., Baena C. P., Jaspers L., van Dijk G. M., Farajzadegan Z., Dhana K. et al. Lifestyle factors, cardiovascular disease and all-cause mortality in middle-aged and elderly women: a systematic review and meta-analysis. Eur J Epidemiol. 2018; 33 (9): 831–845. https://doi.org/10.1007/s10654-018-0374-z.
22. Kapoor E., Collazo- Clavell M. L., Faubion S. S. Weight Gain in Women at Midlife: A Concise Review of the Pathophysiology and Strategies for Management. Mayo Clin Proc. 2017; 92 (10): 1552–1558. https://doi.org/10.1016/j.mayocp.2017.08.004.
23. Lambrinoudaki I., Ceasu I., Depypere H., Erel T., Rees M., Schenck-Gustafsson K. et al. EMAS position statement: Diet and health in midlife and beyond. Maturitas. 2013; 74 (1): 99–104. https://doi.org/10.1016/j.maturitas.2012.10.019.
24. Armeni E., Lambrinoudaki I., Ceausu I., Depypere H., Mueck A., Pérez-López F. R. et al. Maintaining postreproductive health: A care pathway from the European Menopause and Andropause Society (EMAS). Maturitas. 2016; 89: 63–72. https://doi.org/10.1016/j.maturitas.2016.04.013.
25. Chang J. T., Anic G. M., Rostron B. L., Tanwar M., Chang C. M. Cigarette Smoking Reduction and Health Risks: A Systematic Review and Meta-analysis. Nicotine Tob Res Off J Soc Res Nicotine Tob. 2021; 23 (4): 635–642. https://doi.org/10.1093/ntr/ntaa156.
Review
For citations:
Khashukoeva AZ, Dmitrashko TY, Nosova LA, Markova EA, Overko AV. Modern therapy for vasomotor symptoms of climacteric syndrome. Meditsinskiy sovet = Medical Council. 2022;(16):116-122. (In Russ.) https://doi.org/10.21518/2079-701X-2022-16-16-116-122