[Current aspects of the treatment of urogenital atrophy (based on the consensus of britain society of menopause)].

The symptoms of genitourinary syndrome of menopause are considered as typical for late menopausal period. However, these symptoms are increasingly diagnosed in perimenopausal and early menopausal period. Women seldom seek medical care, since autonomic menopausal symptoms are usually more bothersome. In many cases, doctors are not sure in necessity of any hormonal replacement. Moreover, a confusion still exists between systemic hormone replacement therapy (HRT) and local estrogen preparations. Besides moisturizers and local intravaginal estrogens, novel treatment modalities have emerged that extend therapeutic armamentarium.

[Prevention and treatment of mental disorders in women during the climacteric period]. / Profilaktika i lechenie psikhicheskikh narushenii u zhenshchin v klimaktericheskom periode.

The authors review problems of the treatment and prevention of mental disorders in climacteric women depending on the etiopathogenetic mechanisms of their origin. Group I included women with mental disorders accompanying vasomotor manifestations of the climacteric syndrome. To prevent and treat these disorders, of great importance is their diagnosis at the initial stage in the premenopausal period, particularly within the framework of the premenstrual syndrome. It is pathogenetically justified that this group patients be administered replacement hormonal therapy. Still, if mental disorders are aggravated, the hormonal drugs or their combinations with psychotropic agents should be withdrawn. Group II included women with psychogenous and endogenous mental diseases that occurred for the first time in the climacteric period. In this group patients, hormonal therapy should be withdrawn to prevent exacerbation of the health status and adequate treatment be instituted.

[Epidemiology of the climacteric period in a large city]. / Epidemiologiia klimaktericheskogo perioda v usloviiakh bol'shogo goroda.

Epidemiological screening of 1,939 females working in Moscow showed the incidence of the climacteric syndrome to be as high as 42.4%. The mean age at the onset of the pre-menopause was 48 +/- 0.4, its duration 12 to 17 months, mean age at menopause onset 49 +/- 0.5. A close correlation between the development of the climacteric syndrome and arterial hypertension was detected.

[Pathogenetic mechanisms of the development of "hot flushes" in patients with climacteric disorders of the sympathetic-adrenal type]. / Patogeneticheskie mekhanizmy vozniknoveniia "prilivov" u bo'lnykh s klimaktericheskimi rasstroistvami simpatiko-adrenalovogo kharaktera.

Examinations of 19 patients aged 49 to 55, suffering from climacteric disorders of sympathoadrenal nature, have revealed during 42 hot flushes an activation of the sympathoadrenal section of the autonomic nervous system (increased arterial pressure, heart and respiration rates, and skin galvanic reflex), as well as activation of peripheral vasodilatation, elevated skin temperature, and increased concentrations of LH, ACTH, thyrotropic hormone (TTH), cortisol, aldosterone, and testosterone. These data suggest that the trigger mechanism of a hot flush in the patients with the climacteric syndrome represents modified (due to changes in the external or internal conditions) activity of the LH releasing factor-secreting neuron structures and of the central temperature-sensitive neurons. Activation of the sympathoadrenal section of the autonomic nervous system and of the hypothalamo-hypophyseo-adrenocortical system is explained by their important role in the adaptive reactions of the body. Increase of the TTH level results from increased activity of the thyrotropin releasing factor, contributing to the central mechanisms of thermoregulation.

[Pathogenetic mechanisms of the development of the cephalgic form of premenstrual syndrome in patients of older age groups]. / Patogeneticheskie mekhanizmy vozniknoveniia tsefalgicheskoi formy premenstrua'lnogo sindroma u bo'lnykh starshikh vozrastnykh grupp.

Measurements of the blood plasma gonadotropic hormones, sex steroids, and biogenic amines, and investigation of the patterns of vegetative reactions to functional tests during both menstrual cycle phases, carried out in 26 patients with the cephalgic form of the premenstrual syndrome, aged 39-49, and in 13 age-matched women without this syndrome, have shown the contribution of changes in progesterone, serotonin, and histamine levels to the pathogenesis of this condition. These studies have also demonstrated a reduction of the adaptive potentials of the body, i. e. no regular rise of the tone and functional activity of the autonomic nervous system sympathoadrenal section in the lutein phase of the cycle, as well as the development of inadequate reactions in some patients aged 44-49, in whom the disease runs the most severe and long course.

[Anatomic and functional characteristics of resistant ovaries]. / Anatomo-funktsional'naia kharakteristika rezistentnykh iaichnikov.

Resistant ovary syndrome has been confirmed in 42 women using clinical, roentgenologic (craniography, hysterosalpingography, pneumogynecography, electroencephalography), genetic, sonographic, endoscopic and histologic studies. Fibrocystic breast disease was identified in 64% and normal ovarian size in 74% of the patients with resistant ovary syndrome. Progesterone test was positive in 84% of the patients. Resistant ovary syndrome was associated with higher serum estradiol levels as compared with ovarian dystrophy and pure gonadal dysgenesis. Diagnosis confirmation requires ovarian biopsy with a histological examination of ovarian specimen, but its outcome is not always significant.

[The psychiatric aspect of the climacteric syndrome: its clinical picture and treatment]. / Psikhiatricheskii aspekt klimaktericheskogo sindroma: klinika i lechenie.

A total of 130 patients with the climacteric syndrome associated with mental disorders were examined by psychiatrists. Two groups of patients were distinguished. In Group 1 specific climacteric disorders ('flushes', excessive sweating, etc.) were the major components, whereas mental disorders (asthenic, phobic, hysterical, depressive) were just concomitant. In Group 2 the climacteric syndrome resulted in development of various mental diseases, mostly neuroses, depressions of various origins, superworship ideas. Recommendations on psychotropic therapy of these disorders were developed and contraindications against the use of hormonal therapy formulated.

[The pathogenetic mechanisms of hyperthermia in patients with the premenstrual syndrome]. / Nekotorye patogeneticheskie mekhanizmy gipertermii u bol'nykh s predmenstrual'nym sindromom.

Functional status of the central and autonomic nervous system was analyzed in 28 patients with the premenstrual syndrome one of whose manifestations was disordered thermoregulation. The examinations were carried out during both cycle phases. Analysis of the EEG data and clinical findings has shown different patterns of autonomic thermoregulation disturbances in three groups of patients and permitted the authors to suggest that changed activity of certain neurotransmitter systems connected with hormonal secretion over the course of the cycle was responsible for these disturbances.