Transcript 5. Neuroendocrine syndromes in gynecology

Neuroendocrine
syndromes in
gynecology
prof.: Мagzumova N.M.
Neuroendocrine syndromes in
gynecology
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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 20-55%)
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pathological syndrome that occurs after 2-10 days
before menstruation;
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manifested neuropsychiatric, autonomic
cardiovascular and metabolic-endocrine disorders;
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disappear immediately at the begining of
menstruation or during the first days.
PMS: The prevalence
у 75%
встречаются
предменструальные
симптомы
25%
ПМС
4%
ПМДС
PMS
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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
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Easy - there are 3.4 symptoms for 2-10 days before
menstruation with considerable severity of symptoms
1.2.
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Severe- 5.12 symptoms appear for 3-14 days before
menstruation, and 2-5 of them (or all) pronounced.
PMS stages
Compensated
 Subcompensated
 decompensated
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PMS clinical forms
• Neuropsychiatric
• Edematous
• Cephalgic
• Crisic
Как я ненавижу эти дни!
Mainly in the clinical picture
of PMS - is its cyclicity
PMS symptomes
Physical
Hadeache
Pain in the abdomen
and back, joints
Emotional
Behavioral
Mood swings
ravenous
appetite
Depression
oppression
forgetfulness
Isolation
tearfulness
Voltage breast
heartbeating
irritability
weight gain
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; GnRH agonists, Mirena)
In need of treatment about 15% of women
PMS symptomatic therapy
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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.
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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
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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
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Secondary (genital lesions - endometriosis,
fibroids, PID, adenomyosis, IUDs)
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Treatment - the basic pathology.
Modern OC not only protect against
pregnancy, but also ...
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Regulate and normalize
the menstrual cycle
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Reduce menstrual pain
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Improve skin and hair
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PMS
Postcastration syndrome (PCS)
60-80%
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It is a complex of pathological
neuropsychiatric,
vegetative-vascular,
metabolic-endocrine symptoms
occurring after total or subtotal removal of the
ovaries.
Pathogenesis
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Increased secretion of gonadotropins in the
absence of feedback between the gonadotropins
and sex steroids.
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Violation of all neuroendocrine systems involved
in adaptation.
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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
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Pathogenetic therapy - HRT.
The goal of therapy - pharmacological
hormone replacement lost ovarian function.
Warn sexual dysfunction.
Minimum term HRT therapy - 5-7years
Climacteric
Menopause (from the greek.
Climacter - step ladder)
 physiological period
 age-related changes in a
woman's
 involutional processes of the
reproductive system
 termination of first childbearing,
and then menstruation.
Modern women problems
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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
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Premenopausal
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MENOPAUSE
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Perimenopause
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Postmenopausal
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OLD AGE
Glossary of terms:
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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
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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
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EARLY SYMPTOMS OF CLIMACTERIC SYNDROME
VASOMOTOR
HOT FLUSHES TO THE HEAD
AND UPPER BODY
 CHILL
EXCESSIVE SWEATING
 HEADACHES
 TACHYCARDIA
 HYPO-OR HYPERTENSION
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CLIMACTERIC SYNDROME. CLINICAL FEATURES
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EARLY SYMPTOMS OF CLIMACTERIC SYNDROME
EMOTIONAL-VEGETATIVE
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IRRITABILITY
DROWSINESS
WEAKNESS
ANXIETY
DEPRESSION
FORGETFULNESS
INATTENTION
DECREASED LIBIDO
CLIMACTERIC SYNDROME. CLINICAL FEATURES
By the number of hot flashes determine the severity
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1. Mild form - up to 10 hot flashes a
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
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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
 Reduced Sexual Desire
 Dyspareunia
 Inadequate Lubrication
 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
• dysuria
Decreased
• 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
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"Osteoporosis - a serious and
growing problem“
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75 million people worldwide suffer
from osteoporosis
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The number of fractures related to
osteoporosis is doubling in the next
50 years
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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
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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:
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Expressed menopause
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Postcastration syndrome
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Amenorrhea in young women (gonadal dysgenesis,
hypogonadotropic amenorrhea syndrome, ovarian
failure, resistant ovary syndrome)
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Severe atrophic processes (urogenital disorders)
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High risk of osteoporosis (gr. risk), CVD,
Alzheimer's disease.
Treatment of climacteric
syndrome consists of 3 stages:
1-stage:
 Rational hygienic mode of labor
 Diet (vitamins A, C, E)
 Restricting food dominated hydrocarbons and
fats
 EPE
Therapeutic exercise:
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Morning exercise (15-20 minutes)
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Group lessons three times a week for 30-45 minutes
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Engage with the elements of sports, recreational and
training sessions
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Physical treatments (galvanic "collar" with novocaine or
magnesium sulfate)
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Electrosleep 35 to 60 minutes 15 to 20 sessions
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Spa treatment
Medical therapy without hormones:
2 - stage
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Antianxiety agents: seduksen,
phenazepam, etc.
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Antidepressants: gelarium, Dismenorm;
3- stage:
Hormone replacement therapy
Goal :
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Replace the hormonal ovarian function
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Using minimally-optimal doses of
hormones to improve general condition
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Prevention of metabolic disorders later
HORMONE REPLACEMENT THERAPY
Main advantages of HRT:
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levels of natural estrogen and the lowest dose
(early phase of proliferation).
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combination of estrogen with progestogen
(protects against the development of
endometrial hyperplastic processes in uterus –
if it available).
Basic principles of HRT:
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Estrogen in uterus removed intermittent or continuous
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Progestogens and androgens (endometriosis or
endometrial cancer
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Prevention of osteoporosis, atherosclerosis and urinary
disorders (5-7 years or more)
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Information on the impact of short-term and long-term
estrogen deficiency
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It should also inform women about the positive effect of
HRT
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Consider the contraindications and side effects of HRT.
Мonotherapy of estrogen
Premenopausal estrogen drug for per os
ПРОГИНОВА
ЭСТРАДИОЛ
ВАЛЕРАТ 2 МГ
ТАБ. ПО 21 ШТ.
ЭСТРОФЕМ
17В-ЭСТРАДИОЛ
2 МГ
ТАБ. ПО 28 ШТ.
ПРЕМАРИН
КОНЪЮГИРОВАННЫЕ ЭСТРОГЕНЫ
0,625 МГ
ДРАЖЕ ПО 28 ШТ.
ОВЕСТИН
ЭСТРИОЛ 1 ИЛИ 2
МГ
ТАБ. ПО 30 ШТ.
Combine drug
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Combine two-phase estrogen-gestogen drugs (for woman
with womb)
Фемостон 2/10
17b – эстрадиол 2,0 мг
14 таб
17b – эстрадиол 2,0 +
дидрогестерон (дюфастон) 10
мг 14 таб
Фемостон 1/10
17b – эстрадиол 1,0 мг
14 таб
17b – эстрадиол 1,0 +
дидрогестерон (дюфастон) 10
мг 14 таб
Combine two-phase estrogen-gestogen drugs
(for woman with womb)
Климонорм
эстрадиола валерат 2,0
мг 9 драже
эстрадиола валерат 2,0 мг +
левоноргестрел 0, 15 мг 12
драже
Климен
эстрадиола валерат
2,0 мг 10 таб
эстрадиола валерат 2,0 мг +
ципротерона ацетат 1,0 мг 11
таб
Combine two-phase estrogen-gestogen
drugs (for woman with womb)
Дивина
эстрадиола валерат
2,0 мг 11 таб
эстрадиола валерат 2,0 мг +
медроксипрогестерона ацетат
1,0 мг 10 таб
Циклопрогин
ова
эстрадиола валерат
2,0 мг 11 таб
эстрадиола валерат 2,0 мг +
норгестрел 0,5 мг 10 таб
Combine two-phase estrogen-gestogen drugs
(for woman with womb in postmenopause)
Фемостон 1/5
17b - эстрадиол 1,0 мг
+
дидрогестерон (дюфастон) 5
мг 28 таб
Климодиен
эстрадиола валерат
2,0 мг +
диеногест 2,0 мг 28 таб
Клиогест
17b - эстрадиол 2,0 мг
+
норэтистерон ацетат 1 мг 28
таб
Another estrogen (2009)
Tibolon - Ливиал, ЛЕДИБОН
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Treatment of climacteric syndrome
Prevention of osteoporosis"
ТИБОЛОН
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Химическая структура – тиболона – 19-норстероидный прогестин
1980 г. Работа о защитном влиянии его на костную ткань
С 1980 года зарегистрирован в 91 стране мира для лечения
климактерического синдрома
На фармацевтическом рынке с 1988 г.
С 1990 г. в 45 странах - используется для профилактики
остеопороза
2003 г. Представление на VI Европейском конгрессе по менопаузе
как новый класс в лечении климактерических расстройств
Согласно реестру Center for Drug Statistic Methodology (2009)
Тиболон 2,5 мг отнесен к новой группе «Другие эстрогены»
1400 публикаций
Inspection which is need before
HRT
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Anamnesis
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Gynecological examination and US of genitalia
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Breast examination (mammografy, US)
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Smear cytology (Papanicolau’s method)
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Gemostasiogram (prothrombin index)
Absolute contraindications for HRT
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Breast cancer;
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Bleedings unknown genesis;
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Tromboemboly at last 6 months;
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Liver and renal insufficiency;
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NB! Women with cancer of endometrial, ovary and
cervix HRT is not absolute contraindication
Life phases of women (old Chinese
classification)
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Youth
Family building
Social duties
Opening own mistakes
Last creative period
Favorable period of life
Solidarity
Till 20 years
Till 30 years
Till 40 years
Till 50 years
Till 60 years
Till 70 years
after 70 years
Я быстро
почувствовала
положительное
влияние
Анжелика® на
мой внешний
вид. Я чувствую
себя очень
женственной!
«Самое верное средство завоевать
любовь других – подарить им свою
любовь
Ж.Ж.Руссо
«В молодости мы живем,
чтобы любить; в зрелом
возрасте мы любим, чтобы
жить»
Шарль де Сент-Эвремон
Французкий писатель,
19 век.
Спасибо ЗГТ,
я чувствую
себя легкой,
как ветерок!
Возрастная динамика
доминанты качества жизни женщины
Детство
Юность
(желание скорее стать
взрослой)
Молодость
(обладание способностью к
деторождению)
(желание быть
привлекательной и
любимой)
Зрелость
(социальная
востребованность и
независимость)
Переходный возраст и старость
(здоровье и духовность)