The cariopicnoic index is the percentage of all exfoliated mature surface cells with pycnotic nuclei to cells containing vesicular nuclei with a diameter of more than 6 m to m. K P And increases the prevalence of estrogen and decreases as a result of the predominant effect of androgens or progesterone. In the case of a prospectively type, a CRPD smear is usually large, but its high level in deep menstruation indicates a pathological proliferation that is not characteristic of this age. Sri intermediate type Vaginal smear KPI is 5i — 15%.
The eosinophilic index is the percentage of all mature, separated surface cells with eosinophilic cytoplasm staining to mature superficial cells with basophilic cytoplasm staining. An increase in EI indicates an increase in estrogen stimulation, and its decline indicates a decrease in the effect of estrogen. With a proliferative type of vaginal smear, EI is usually high, and with an intermediate type of smear, it does not exceed 10%.
Diagnosis and differential diagnosis. The diagnosis of menopause is established on the basis of irregular menstruation with the next menopause at the age of 45-55 years after excluding Other causes of impairment or * the cessation of menstruation (uterus, pituitary, etc.). KSlimacteric neurosis is diagnosed on the basis of “tides?”, Often accompanied by perspiration, palpitations, etc., in an age period close to the onset of menopause, or during menopause. Climacteric neurosis differentiates “from neurosis, cardiovascular diseases, etc.
Forecast. The prognosis of climacteric neurosis largely depends on the duration of its course, its combination with concomitant diseases and timely (early) treatment.
With a typical uncomplicated climacteric neurosis, the duration of which does not usually exceed 2 years, the prognosis
Odd. Work capacity saved.
P p ^ complicated form of climacteric neurosis prognosis
° is largely determined by comorbidities, in the first place, the cardiovascular and nervous systems. With climacteric neurosis of moderate severity, the ability to work is reduced, and in severe form of the disease may be completely or almost completely lost.
Treatment. In the treatment of pathological menopause, 10–5 0% of patients need it. For the prevention and treatment of climacteric neurosis, they carry out bracing measures (correct work and rest regimen, rational nutrition, vitamins of groups B, C, A, E, etc.). Assign a dairy-vegetable diet rich in vitamins, with the exception of products that increase the excitability of the nervous system (spices, coffee, strong tea, alcohol, etc.). Limit foods rich in fat and cholesterol. Therapeutic exercise is widely used.
For the regulation of the functional state of the hypothalamic-hypo-physical system with autonomic-nervous disorders, physical methods of treatment are applied: galvanic collar with no vocaine, anodic galvanization of the head, neck-facial ion-galvanization, etc.
The main method of treatment for a typical, uncomplicated, climacteric neurosis is the treatment with neuroleptic drugs, especially piperazine derivatives of the phenothiazine series — frenolone, triftazine, meterazine, etaderazine, etc., which mainly affect the subcortical structures of the CNS. According to EM Vikhlyaeva and TM Dondukova, treatment with these drugs should be started with a minimum dose (1– 2.5 mg). Subsequently, if necessary, the daily dose of frenolone or triftazine can be increased to 2–5 mg, meterazine – up to 5–15 mg, and epoterazine – up to 2–8 mg. When the therapeutic effect is achieved, the dose of the drug is gradually reduced. The course of treatment 4-12 weeks.
With pronounced hypothalamic disorders and hypertensive syndrome, reserpine gives a good effect, which is prescribed 0.1–0.125 mg 2-3 times a day, and in the absence of an effect – 0.25 mg 2 times a day, aminazine – 25-50 mg per day. They use drugs containing small doses of barbiturates, in combination with substances acting on the autonomic nerve centers (akliman 1 tablet 2–3 times a day, Belloid 1 tablet 3–6 times a day, etc.).
In some cases (complicated forms of climacteric nevus in combination with pronounced atherosclerotic changes of the cardiovascular system, hypertension; dysfunctional uterine bleeding), women and male sex hormones are prescribed. apply independently.
When menstruation is preserved (the initial period of menopausal neurosis), progesterone or its synthetic analogs (oxyprogesterone capronate, etc.) are prescribed. Progesterone is administered intramuscularly in a dose of 1 ml of a 1% solution daily for 6 days, starting 8 days before the expected menses, only 8-10 cycles.
Fishing Oxyprogesterone capronate is injected intramuscularly in 1-2 ml 12 11 days before the expected menstruation. Progesterone and its synthetic analogues can be combined with preparations of male sex hormones (methyl testosterone, etc.). The therapeutic effect of androgens is primarily associated with their ability, on the one hand, to reduce the excitability of the hypothalamic centers, and on the other, to inhibit the gonadotropic function of the pituitary gland. Contraindications for the administration of androgens are pronounced hypertrichosis. Methyl testosterone is administered sublingually by courses, 20 mg per day from the 5th to the 20th day of the cycle (1st course), 20 mg per day (2nd course), 10 mg per day (3rd course) and finally 5 mg per day (4th year).
When menopause is administered intramuscularly oxyprogesterone cap
Ronat 1 ml of 12.5% solution once a week for 4-6 weeks. This drug can be prescribed in combination with methyltestosterone 10-15 mg daily.
Under the control of colpocytogram, estrogen preparations are sometimes prescribed. Such treatment requires caution due to the danger of uterine bleeding. Estrogenic preparations have a proliferative effect on target organs, and therefore they are contraindicated in malignant tumors of the genitals or mammary glands, mastopathy, uterine bleeding, fibromyoma, endometriosis, ovarian cysts. By lowering the excitability of the centers of the hypothalamus, estrogens help eliminate tides. They are effective in vestibular disorders caused by climacteric neurosis, lower serum cholesterol levels, and reduce trophic disorders of the genital organs.
Usually use a combined treatment with estrogen and androgenymi. Possessing a mutual antagonistic effect on the epithelium and vessels of the reproductive system, estrogens and androgens eliminate a number of side effects inherent in each of them separately, and lead to a more pronounced therapeutic effect. Estrogens and androgens are prescribed at a ratio of 1:50. Assign intramuscularly (in one syringe) 0.5 mg of estradiol dipropionate and 25 mg of testosterone propionate 1 time per 5-7 days for 5-7 weeks, followed by switching to maintenance doses – 1 injection of the same doses every 25-30 days for 8-12-16 months. In case of pronounced disorders of the calcium metabolism, ambosex is administered 1-2 tablets per day sublingually.
Ambosex contains 0.004 mg of ethinyl estradiol and 4 mg of methyltestosterone.
In some cases, especially with osteoporosis, anabolic steroids can be used (methylandrostendiol, etc.). Mejandrostendiol is prescribed sublingually at 25–50 mg per day c4 by gradual switching to maintenance doses of 10 mg daily for 3–4 months.
In complicated forms of climacteric neurosis, the use of synthetic progestins (enecundine, biseurin, etc.) gives a good effect. The latter is prescribed in a dose of 1 f4—1 / b of the daily contraceptive dose.
Treatment is carried out for 21 days continuously or with a break for 10 days.
In case of dysfunctional uterine bleeding, diagnostic curettage of the uterine mucosa is performed. Either progesterone or hydroxyprogesterone capronate is administered intramuscularly, or combination therapy with methyltestosterone is prescribed with these drugs for treating menopausal neurosis with preserved menstrual periods.