Age periods of a woman's life. Physiological periods in a woman’s life

Our society consists of completely different, dissimilar people. And this is visible not only in appearance - first of all, our behavior, reaction to life situations, especially stressful ones. Each of us - and probably more than once - has encountered people with, as people say, whose behavior does not fit into generally accepted norms and often causes condemnation. Today we will look at mixed disorder personality: the limitations that this disease entails, its symptoms and treatment methods.

If a person’s behavior exhibits a deviation from the norm, bordering on inadequacy, psychologists and psychiatrists consider this a personality disorder. There are several types of such disorders, which we will consider below, but most often they are diagnosed (if this definition can be considered a real diagnosis) mixed. Essentially speaking, it is advisable to use this term in cases where the doctor cannot classify the patient’s behavior into a certain category. Practicing doctors notice that this happens very often, because people are not robots, and it is impossible to identify pure types of behavior. All personality types we know are relative definitions.

Mixed Personality Disorder: Definition

If a person has disturbances in his thoughts, behavior and actions, he has a personality disorder. This group of diagnoses is classified as mental. Such people behave inappropriately and perceive stressful situations differently, in contrast to absolutely mentally healthy people. These factors cause conflicts at work and in the family.

For example, there are people who cope with difficult situations on their own, while others seek help; Some tend to exaggerate their problems, while others, on the contrary, downplay them. In any case, such a reaction is absolutely normal and depends on the character of the person.

People who have mixed and other personality disorders, unfortunately, do not understand that they have mental problems, so they rarely seek help on their own. Meanwhile, they really need this help. The main task of the doctor in this case is to help the patient understand himself and teach him to interact in society without causing harm to himself or others.

Mixed personality disorder in ICD-10 should be looked for under F60-F69.

This condition lasts for years and begins to manifest itself even in childhood. At the age of 17-18, personality formation occurs. But since at this time the character is just being formed, such a diagnosis at puberty is incorrect. But in adulthood, when the personality is fully formed, the symptoms of a personality disorder only worsen. And usually it is a type of mixed disorder.

ICD-10 has another heading - /F07.0/ “Personality disorder of organic etiology”. Characterized by significant changes familiar image premorbid behavior. The expression of emotions, needs and drives is especially affected. Cognitive activity may be reduced in the area of ​​planning and anticipating consequences for oneself and society. The classifier contains several ailments in this category, one of them is personality disorder due to mixed diseases(eg depression). This pathology accompanies a person throughout his life if he does not realize his problem and does not fight it. The course of the disease is wavy - periods of remission are observed, during which the patient feels excellent. Transient mixed personality disorder (that is, short-term) is quite common. However associated factors in the form of stress, alcohol or drug use, and even menstruation can cause a relapse or worsening of the condition.

Worsened personality disorder may lead to severe consequences, including causing physical harm to others.

Causes of personality disorder

Personality disorders, both mixed and specific, usually occur in the context of brain injuries resulting from falls or accidents. However, doctors note that in the formation of this disease Both genetic and biochemical factors, as well as social ones, are involved. Moreover, social ones play a leading role.

First of all, this is incorrect parental upbringing - in this case, the character traits of a psychopath begin to form in childhood. Besides this, none of us understands how detrimental stress really is to the body. And if this stress turns out to be excessively strong, it can subsequently lead to a similar disorder.

Sexual abuse and other psychological trauma, especially in childhood, often lead to a similar result - doctors note that about 90% of women with hysteria in childhood or adolescence were raped. In general, the causes of pathologies that are designated in ICD-10 as personality disorders in connection with mixed diseases should often be sought in the patient’s childhood or adolescence.

How do personality disorders manifest themselves?

People with personality disorders usually have associated psychological problems- they turn to doctors about depression, chronic tension, problems building relationships with family and colleagues. At the same time, patients are sure that the source of their problems is external factors, which do not depend on them and are beyond their control.

So, people diagnosed with mixed personality disorder have the following symptoms:

• problems with building relationships in the family and at work, as noted above;
• emotional disconnection, in which a person feels emotionally empty and avoids communication;
• difficulties in managing one's own negative emotions, which leads to conflicts and often even ends in assault;
• periodic loss of contact with reality.

Patients are dissatisfied with their lives; it seems to them that everyone around them is to blame for their failures. It was previously thought that similar illness not treatable, but Lately the doctors changed their minds.

Mixed personality disorder, the symptoms of which are listed above, manifests itself in different ways. It consists of a range of pathological features that are common to the personality disorders described below. So, let's look at these types in more detail.

Types of Personality Disorders

Paranoid disorder. As a rule, such a diagnosis is made to arrogant people who are confident only in their point of view. Tireless debaters, they are sure that only they are always and everywhere right. Any words and actions of others that do not correspond to their own concepts are perceived negatively by the paranoid. His one-sided judgments become the cause of quarrels and conflicts. During decompensation, symptoms intensify - paranoid people often suspect their spouses of infidelity, as their pathological jealousy and suspicion intensify significantly.

Schizoid disorder. Characterized by excessive isolation. Such people react with equal indifference to both praise and criticism. They are so cold emotionally that they are unable to show either love or hatred towards others. They are distinguished by an expressionless face and a monotonous voice. The world for a schizoid it is hidden by a wall of misunderstanding and embarrassment. At the same time, he has developed abstract thinking, a tendency to think deeply philosophical topics, rich fantasy.

This type of personality disorder is formed in early childhood. By the age of 30, the sharp angles of pathological features level off somewhat. If the patient's profession is related to minimal contact with society, he successfully adapts to such a life.

Dissocial disorder. A type in which patients have a tendency to aggressive and rude behavior, disregard for all generally accepted rules, and a heartless attitude towards family and friends. In childhood and puberty, these children do not find mutual language in a group, they often fight, and behave defiantly. They run away from home. At a more mature age, they are deprived of any warm affections; they are considered “ difficult people”, which is expressed in cruelty to parents, spouses, animals and children. It is this type that is prone to commit crimes.

Expressed in impulsiveness with a hint of cruelty. Such people perceive only their opinion and their outlook on life. Small troubles, especially in everyday life, cause them emotional stress, stress, which leads to conflicts that sometimes turn into assault. These individuals do not know how to assess the situation adequately and react too violently to ordinary life problems. At the same time, they are confident in their own importance, which others do not perceive, treating them with prejudice, just as patients are confident.

Hysterical disorder. Hysterical people are prone to increased theatricality, suggestibility and sudden mood swings. They love to be the center of attention and are confident in their attractiveness and irresistibility. At the same time, they reason rather superficially and never take on tasks that require attention and dedication. Such people love and know how to manipulate others - family, friends, colleagues. TO mature age long-term compensation is possible. Decompensation can develop in stressful situations, during menopause among women. Severe forms manifested by a feeling of suffocation, a coma in the throat, numbness of the limbs and depression.

Attention! A hysterical person may have suicidal tendencies. In some cases, these are simply demonstrative attempts to commit suicide, but it also happens that a hysteric, due to his tendency to violent reactions and hasty decisions, may quite seriously try to kill himself. That is why it is especially important for such patients to contact psychotherapists.

Expressed in constant doubts, excessive caution and increased attention to the details. At the same time, the essence of the type of activity is missed, because the patient is only worried about the details in order, in lists, in the behavior of colleagues. Such people are confident that they are doing the right thing, and constantly make comments to others if they do something “wrong.” The disorder is especially noticeable when a person performs the same actions - rearranging things, constant checks, etc. In compensation, patients are pedantic, precise in their official duties, and even reliable. But during the period of exacerbation they develop a feeling of anxiety, intrusive thoughts, fear of death. With age, pedantry and frugality develop into selfishness and stinginess.

Anxiety disorder is expressed in feelings of anxiety, fearfulness, and low self-esteem. Such a person is constantly worried about the impression he makes and is tormented by the consciousness of his own contrived unattractiveness.

The patient is timid, conscientious, tries to lead a secluded life, because he feels safe alone. These people are afraid of offending others. At the same time, they are quite well adapted to life in society, since society treats them with sympathy.

The state of decompensation is expressed in feeling unwell- lack of air, accelerated heartbeat, nausea or even vomiting and diarrhea.

Dependent (unstable) personality disorder. People with this diagnosis are different passive behavior. They shift all responsibility for making decisions and even own life on others, and if there is no one to shift it to, they feel incredibly uncomfortable. Patients are afraid of being abandoned by people who are close to them, are submissive and dependent on other people's opinions and decisions. Decompensation manifests itself in a complete inability to control one’s life with the loss of a “leader,” confusion, and bad mood.

If the doctor sees pathological features inherent in different types disorders, he diagnoses him with “mixed personality disorder.”

The most interesting type for medicine is a combination of schizoid and hysterical. Such people often develop schizophrenia in the future.

What are the consequences of mixed personality disorder?

1. Such mental deviations can lead to a tendency towards alcoholism, drug addiction, suicidal tendencies, inappropriate sexual behavior, and hypochondria.
2. Improper upbringing of children due to mental disorders (excessive emotionality, cruelty, lack of sense of responsibility) leads to mental disorders in children.
3. Mental breakdowns are possible when performing normal daily activities.
4. Personality disorder leads to others psychological disorders- depression, anxiety, psychosis.
5. Impossibility full contact with a doctor or therapist due to mistrust or lack of responsibility for one’s actions.

Mixed personality disorder in children and adolescents

Personality disorder usually appears in childhood. It is expressed in excessive disobedience, antisocial behavior, and rudeness. However, such behavior is not always a diagnosis and may turn out to be a manifestation of a completely natural development of character. Only if this behavior is excessive and constant can we talk about mixed personality disorder.

Not only do they play a major role in the development of pathology genetic factors as much as upbringing and social environment. Eg, hysterical disorder may arise against the background of insufficient attention and participation in the child’s life on the part of parents. As a result, about 40% of children with behavior disorders continue to suffer from it.

Adolescent Mixed Personality Disorder is not considered a diagnosis. The disease can be diagnosed only after puberty has ended - an adult already has a formed character that needs correction, but is not completely corrected. And during puberty, such behavior is often the result of the “perestroika” that all adolescents experience. The main type of treatment is psychotherapy. Young people with severe mixed personality disorder in the decompensation stage cannot work in industries and are not allowed into the army.

Treatment for Personality Disorder

Many people who have been diagnosed with mixed personality disorder are primarily interested in how dangerous the condition is and whether it can be treated. Many people are diagnosed completely by accident; patients claim that they do not notice its manifestations. Meanwhile, the question of whether it can be treated remains open.

Psychiatrists believe that personality disorder can be cured mixed type almost impossible - it will accompany a person throughout his life. However, doctors are confident that its manifestations can be reduced or even achieved stable remission. That is, the patient adapts to society and feels comfortable. At the same time, it is important that he wants to eliminate the manifestations of his illness and fully comes into contact with the doctor. Without this desire, therapy will not be effective.

Medications in the treatment of mixed personality disorder

If organic disorder personalities mixed origin Usually treated with drugs, the disease we are considering is treated with psychotherapy. Most psychiatrists are confident that drug treatment does not help patients because it is not aimed at changing the character that patients mainly need.

However, you should not give up medications so quickly - many of them can alleviate a person’s condition by eliminating certain symptoms, such as depression and anxiety. At the same time, medications must be prescribed with caution, because in patients with personality disorders Drug dependence occurs very quickly.

Leading role in drug treatment neuroleptics play a role - taking into account the symptoms, doctors prescribe drugs such as Haloperidol and its derivatives. It is this drug that is most popular among doctors for personality disorder, as it reduces manifestations of anger.

In addition, other medications are prescribed:

• Flupectinsol successfully copes with suicidal thoughts.
• "Olazapine" helps with affective instability and anger; paranoid symptoms and anxiety; has a beneficial effect on suicidal tendencies.
• - mood stabilizer - successfully copes with depression and anger.
• Lamotrigine and Topiromate reduce impulsivity, anger, and anxiety.
• Amitriptin also treats depression.

In 2010, doctors were researching these drugs, but the effect long acting unknown, as there is a risk of developing side effect. At the same time, the National Institute of Health in the UK released an article in 2009 that said that experts do not recommend prescribing medications if a mixed personality disorder occurs. But with treatment concomitant diseases drug therapy may give a positive result.

Psychotherapy and mixed personality disorder

Psychotherapy plays a leading role in treatment. True, this process is long and requires regularity. In most cases, patients achieved stable remission, which lasted at least two years.

DBT (dialectical - a technique that was developed by Marsha Linehan in the 90s. It is aimed primarily at treating patients who have experienced psychological trauma and cannot recover from it. According to the doctor, pain cannot be prevented, but suffering can be prevented. Specialists help their patients develop a different line of thinking and behavior. This will help you avoid in the future stressful situations and prevent decompensation.

Psychotherapy, including family therapy, is aimed at changing interpersonal relationships between the patient and his family and friends. Treatment usually lasts about a year. It helps eliminate mistrust, manipulativeness, and arrogance of the patient. The doctor looks for the root of the patient’s problems and points them out to him. For patients with narcissism syndrome (narcissism and narcissism), which also refers to personality disorders, a three-year psychoanalysis is recommended.

Personality disorder and driver's license

Are the concepts of “mixed personality disorder” and “driving license” compatible? Indeed, sometimes such a diagnosis can prevent the patient from driving a car, but in this case everything is individual. The psychiatrist must determine which types of disorders predominate in the patient and what their severity is. Only on the basis of these factors will a specialist make the final “vertikt”. If the diagnosis was made years ago in the military, it makes sense to visit the doctor's office again. Mixed personality disorder and a driver's license sometimes don't interfere with each other at all.

Limitations in the patient's life

Patients usually do not have problems finding employment in their specialty, and they interact with society quite successfully, although in this case everything depends on the severity of pathological traits. If a diagnosis of “mixed personality disorder” occurs, restrictions cover almost all areas of a person’s life, since he is often not allowed to join the army or drive a car. However, therapy helps smooth out these rough edges and live like a completely healthy person.

Depending on the etymology of the disease, three types of personality disorders are distinguished.

• Hereditary psychopathy. They can be passed on to children at the genetic level.
• Acquired psychopathy. Such personality disorders can develop against the background of improper upbringing or prolonged exposure to negative examples.
• Organic personality disorders are acquired due to injury and infection of the brain and disorders of the central nervous system both in the womb and during childhood. Such disorders can develop against the background of autoimmune diseases.

Personality disorders can also be caused by overdevelopment childish character. For example, children's fear of adolescence can result in phobias, mania and avoidance behavior.

Symptoms

Personality disorders can be identified by changes in child behavior. Depending on the type of psychopathy, sick children may behave differently:

• Paranoid personality disorder is characterized by the appearance of an overvalued idea (the idea of ​​illness, jealousy, persecution, etc.). The patient may be overly suspicious and sensitive to rejection. His thinking is characterized by subjectivity and affectivity.
• Schizoid personality disorder is an imbalance in a child's emotions, thoughts and actions. The patient prefers to spend time alone, likes to fantasize, but does not know how to empathize with other people, is emotionally cold, and finds it difficult to establish trusting relationships.
• Dissocial personality disorder may also be called weak-willed psychopathy. The main features of a patient with this diagnosis are a lack of principles, non-compliance with accepted moral standards, and inability to maintain strong ties (family, friendship, business).
• Emotionally unstable mental disorder is characterized by capricious and constantly changing behavior. There may be outbursts of aggression and cruelty, and adolescents periodically threaten suicide or self-injury.
• The hysterical type of personality disorder is characterized by demonstrative behavior. All emotions and actions are exaggerated and aimed at attracting the patient’s attention.
• Psychasthenic disorder is different constant feeling anxiety, worry about every detail, the patient’s desire to do everything in the best way.
• Anxious or sensitive personality disorder is observed in children who are in constant anxiety for any reason, because of which they impose restrictions on their activities and communication.
• Dependent disorder is a child's fear of remaining helpless, the inability to be independent. With this form of psychopathy, children cannot make decisions on their own and always shift responsibility to others.

Diagnosis of personality disorder in a child

To confirm the diagnosis, the doctor observes the child for six months and, if signs persist or worsen, clinical picture can make a diagnosis. To identify the disease, Schulte tables can be used, and the Wechsler method is practiced.

To detect changes in the brain and central nervous system electroencephalogram and magnetic resonance imaging are used.

Complications

The most important complication of any type of psychopathy is difficulties with adaptation and socialization. Depending on the form and stage of the disease, this can lead to a lot of difficulties for the child or his loved ones.

Treatment

What can you do

If one or more signs are detected, you should contact a specialist for a full diagnosis of the child’s psyche. When making a diagnosis, it is necessary to identify the cause and get rid of it.

Many acquired personality disorders can be treated. Of course, this will require treatment and psychotherapy.

In the case of genetic and organic psychopathy, talking about treatment is not entirely correct. You can only maintain a stable condition of the child and prevent exacerbations.

Regardless of the causes and form of the child’s mental illness, it is important to strictly follow the recommendations of a specialist and not be led by children’s whims and their own fears.

What does a doctor do

To make a diagnosis, a specialist must monitor the patient’s behavior for at least 6 months. In case of brain injury or infection, the diagnosis can be made much earlier.

Depending on the form of psychopathy, causes childhood disorder individual, the doctor develops a treatment regimen. Treatment involves addressing the underlying cause of the disorder and restoring the child's behavior. This is achieved by prescribing medications and consulting with a psychologist.

Prevention

First of all, the parents themselves must create an adequate psychological climate in the family in which their child will grow up. During pregnancy or even during the planning period it is worth visiting family psychologist, which will help you prepare for the arrival of a new family member and will tell you how to behave with him and with each other in the presence of the baby. After birth, you can also visit a psychologist to solve any difficulties in parenting.

Mental problems can appear even during prenatal period. For normal development psyche future mom should monitor her condition during pregnancy, any deviations women's health can also have a negative impact on the child’s psyche.

If the family had relatives on the husband’s or wife’s side with mental disorders, then the couple needs to be prepared for the possibility of such a pathology in their baby.

If your child has injured his head or doctors have discovered autoimmune diseases, brain tumors or other pathologies, they must be treated immediately so that they do not become the cause of a child’s personality disorder.

Thesis

Karahalis, Lyudmila Yurievna

Academic degree:

Doctor of Medical Sciences

Place of thesis defense:

HAC specialty code:

Speciality:

obstetrics and gynecology

Number of pages:

INTRODUCTION.

Chapter 1. MODERN VIEWS ON WOMEN’S REPRODUCTIVE HEALTH (LITERATURE REVIEW).

1.1. The reproductive system of women and its role in depopulation processes.

1.2. Assessment methods reproductive health.

1.3. Hormonal relationships with disorders reproductive health.

1.4. Factors influencing disorders in the reproductive system.

1.5. Increased body weight and its role in the regulation of the reproductive system.

1.6. Interaction immunological, biochemical and hormonal factors for reproductive health disorders.

Chapter 2. PROGRAM, MATERIALS AND RESEARCH METHODS.

2.1. Hormonal background of residents of the Krasnodar region.

2.2. Characteristics of the control group and comparison groups.

2.3. Laboratory methods research.

2.4. Study of psychological status.

2.5. Determining the influence of agroecological factors on reproductive health.

2.6. Ultrasonic method.

2.7. Statistical method.

Chapter 3. REPRODUCTIVE SYSTEM OF WOMEN

KRASNODAR REGION AND ITS CHANGES.

3.1. Analysis of the demographic situation in the region and its components.

3.2. Reproductive health of women in the region in different age periods life.

3.3 Impact of agroecological and climate-geographical factors on the reproductive system.

3.4 Psychological factors influencing reproductive health.

Chapter 4. MEDICAL FACTORS AFFECTING

REPRODUCTION.

4.1 Causal relationships in survey groups.

4.2 The influence of reproductive health on the course perimenopausal period.

Chapter 5. STATE OF THE REPRODUCTIVE SYSTEM IN VARIOUS

AGE WITH CHANGES IN HUMORAL

HOMEOSTASIS.

5.1. General clinical characteristics of the survey groups.

5.2. Changes in hormone levels and carbohydrate metabolism indicators.

5.3. Features of the immune status in women of different age groups with menstrual irregularities.255.

5.3.1. Impact of violations menstrual cycle on leukogram indicators of women of different age groups.

5.3.2 Age-related changes cellular immunity in women with menstrual dysfunction.

5.3.3 Comparative analysis indicators of cellular immunity in women with disorders menstrual function relatively relevant! age control.

5.3.5 Comparative analysis of the content of leptin and cytokines in women with menstrual dysfunction relative to the corresponding age control.

CHAPTER 6. TREATMENT PROGRAMS FOR DISORDERS

REPRODUCTIVE HEALTH IN DIFFERENT AGE PERIODS.

6.1 Correction of menstrual dysfunction through complex metabolic therapy and its effect on the course of pregnancy.

6.2 Use of COCs based on a developed system for determining hormonal imbalances.

6.3 Complex therapy in the perimenopausal period.

6.4 Changes in clinical and laboratory parameters during therapy in women with menstrual dysfunction and increased weight.

Introduction of the dissertation (part of the abstract) On the topic "The reproductive system of women at different age periods of life"

The health of the nation is determined by the health of people of fertile age and their ability to reproduce. Having signs of crisis, the difficult demographic situation in modern Russia is an acute problem (Address to the Federal Assembly of the President of the Russian Federation, 2006), requiring development effective programs support for motherhood, childhood, family. Social and political transformations in Russia, which began in the last quarter of the last century, caused the deformation of many cultural and spiritual values, which also affected reproduction: a decrease in indicators reproductive health, transformation of family lifestyle, negative trends in the health of different age groups, manifested differently in different regions of the country (Khamoshina M.B., 2006; Grigorieva E.E., 2007). The implementation of the national project “Health” and the Concept of Reproductive Health of the Russian Federation will significantly change the situation, achieving not only a quantitative increase in children being born, but also optimizing the health of living and future populations.

The study of the characteristics of the functioning of the reproductive system in different age periods of women’s lives, the influence of climatic-geographical, agro-ecological factors on them, as well as the study of changes in the functioning of the reproductive system that occur under their influence is a very urgent task, which involves considering in totality all age segments of a woman’s life - from the antenatal period before menopause.

WHO adopted the Global Strategy for reproductive health, paying attention Special attention professional activity and occupational health (Izmerov N.F., 2005; Starodubov V.I., 2005; Sivochalova O.V., 2005), declaring, in addition to the condition environment and lifestyle, essential adverse influence harmful factors production on the reproductive function of women.

In connection with the peculiarities of the implementation of the reproductive function, the protection of the reproductive health of women in the Russian Federation suffering from adverse consequences influence of environmental and production factors, acquires special meaning(Sharapova O.V., 2003; 2006). The proportion of teenagers who have whole line combined disorders of somatic and reproductive health (Kulakov V.I., Uvarova E.V., 2005; Prilepskaya V.N., 2003; Podzolkova N.M., Glazkova O.L., 2004; Radzinsky V.E., 2004 , 2006).

In the last 10 years, the gynecological morbidity of girls and adolescents has significantly increased and the age of patients has decreased, this is especially noticeable in the increase in the frequency of menstrual irregularities and neuroendocrine syndromes(Serov V.N., 1978, 2004; Uvarova E.V., Kulakov V.I., 2005; Radzinsky V.E., 2006): by 2007, the number of “menstrual disorders” in girls and by 56.4% - in adolescents. The predicted deterioration in the reproductive health of women of fertile age in this regard determines not only the medical, but also the socio-economic relevance of the problem of optimizing the reproductive health of women.

Lack of strategy for guiding a woman away from her intrauterine development to old age leads to an incorrect interpretation of existing age-related problems of reproduction; the cause-and-effect relationships of the formation of somatic, reproductive health and quality of life in the puberty, reproductive and menopausal periods are not determined.

Correction of identified disorders, based on determining the relationships of the body systems responsible for its reproductive function, allowed us to re-imagine the pathogenesis of diseases and disorders of the reproductive system, improve its condition at different age periods, and reduce reproductive losses.

Purpose of the study: to develop and implement a set of staged treatment and health measures to improve and preserve reproductive health in different age periods of a woman’s life in modern environmental and socio-economic conditions of the south of Russia.

Research objectives:

1. to study the indicators of reproduction, reproductive and somatic health of the population of the Krasnodar Territory depending on agro-ecological and climatic-geographical influences, psychological factors in the family and at work, and the quality of medical care.

2. establish the features of hormonal and immune homeostasis in different age periods depending on environmental influences before puberty and in combination with production - in the reproductive and menopausal periods of life.

3. determine age characteristics emergence and development gynecological diseases and disorders, their relationship with extragenital diseases.

4. to substantiate the concept of formation of reproductive health in specific environmental and socio-economic conditions of the Krasnodar Territory, taking into account various agro-ecological loads, somatic and psychological health.

5. develop an algorithm for improving the health of patients with reproductive health disorders based on the research conducted and evaluate its effectiveness.

6. develop and implement a system of organizational, therapeutic and diagnostic measures aimed at improving the state of the reproductive system of girls, teenage girls, women of reproductive and menopausal periods, taking into account antenatal development, childhood and puberty, those born and living in unfavorable conditions of agro-ecological influence and climate-geographical influence of the habitat of the south of the Russian Federation.

Scientific novelty of the research.

A multifactorial mathematical analysis of the influence was carried out climate-geographical and agroecological factors on the formation and functioning of the reproductive system, gynecological morbidity, which helped to clarify the reasons for the low reproduction of the population of the Krasnodar Territory. The understanding of the pathogenesis of disorders in the reproductive system and characteristics has been expanded gynecological diseases at different age periods of a woman’s life.

The concept of formation of reproductive health in different age periods of women’s lives is substantiated, taking into account agro-ecological load, psychological health, immunological and hormonal characteristics of the body.

For the first time, a reliable relationship between the state of the reproductive system and immunological, hormonal characteristics homeostasis depending on the presence extragenital diseases, including metabolic disorders.

Developed and implemented comprehensive program improving the health of patients with disorders of the reproductive system by testing therapeutic and diagnostic measures based on new approaches to the pathogenesis of the formation of reproductive disorders.

Practical significance of the work.

Based on the analysis, a scientifically based system of measures was developed and implemented in the Krasnodar Territory to improve the state of reproductive health and reproductive potential of adolescents and women of the reproductive period to implement their reproductive function in the present and future, improve the state of somatic and gynecological health, quality of life of menopausal women.

Developed, tested and implemented in the territory of the region and the city of Krasnodar " Method for determining hormonal imbalances in women"(invention No. 2225009 dated February 27, 2004) and "Method of hormonal contraception" (invention No. 2222331 dated January 27, 2004), which made it possible to increase the use of COCs in the region by 69.7% and reduce the number of abortions by 63.4% , which is faster than the rate of decline in the number of abortions in the Russian Federation by 34.8%.

An algorithm for clinical and laboratory examination of women at different age periods has been developed and put into practice, including a survey methodology using specially designed questionnaires, determination of hormonal, cytochemical and immunological indicators, which made it possible to develop and implement complex method treatment of reproductive health disorders, which is based on the metabolic therapy complex we offer (decision to grant a patent for an invention 2006 113715/14(014907) dated 04/21/2006).

A center for pediatric and adolescent gynecology, a school for women of late reproductive age and perimenopausal periods in which, along with a gynecologist, the positions of a psychologist, andrologist, geneticist, dermatovenerologist, urologist and infectious disease specialist.

Implementation preventive activities and therapeutic and diagnostic algorithms for improving the health of women at different age periods, outside and during pregnancy, led to a decrease perinatal mortality on

5.3%, indicator stillbirths- by 10.6%, the maternal mortality rate stabilized (13.1/100 thousand births).

Basic provisions submitted for defense.

1. Reproduction of the population of the Krasnodar Territory at the end of the 20th century -beginning of XXI century is characterized by a decrease in fertility and an increase in mortality, negative indicators natural population growth, exceeding those in most territories of the Russian Federation, more early onset depopulation processes than in the country (“Russian cross” - since 1990).

2. In addition to the deterioration of socio-economic living conditions, demographic indicators may be influenced by reproductive health indicators that worsened by the end of the 20th century (1999-2000): growth gynecological morbidity by 12.7% compared to 1990, menstruation disorders by 75.5%, an increase in the number of infertility in marriage by 16.9%, the frequency of absolute male infertility by 15%, kidney diseases and urinary tract by 13.7%, neoplasms by 35.8%, malignant diseases women by 17.6%, including the mammary gland by 31.5%, the cervix and uterine body by 12.7%, and the ovaries by 15.2%. The frequency of diseases of the circulatory system increased by 50.7%, and diseases of the blood and hematopoietic organs- by 63%, including anemia - by 80.5%, diseases of the digestive system - by 45.2%, diseases of the endocrine system - by 64.3%, including diabetes mellitus by 15.3%, which may be a consequence of the ongoing agro-ecological load on the environment, which is 4.5-5.0 times greater than the national average while simultaneously exceeding the level of petroleum products by 1.5-2.5 times in 15 districts and cities of the region .

3. Gynecological morbidity, which has undergone significant changes in all age groups, is characterized by: an increase in childhood gynecological diseases due to an increase in inflammatory diseases evenly in all age groups (0-14 years by 8.7%, 15-17 years by 27.9%, 18-45 years by 48.5%); increasing benign ovarian tumors in old age. 0-9 years only for those born to mothers with a long-term threat of miscarriage who received various, including hormonal, drugs; Premature adrenarche in girls 6–8 years of age is highly correlated with maternal treatment with glucocorticoids during pregnancy. In general, girls and adolescent girls of the region are characterized by an increase in the age of menarche from 13.6±1.2 years to 14.8±1.5 years with a significant increase in the number of menstrual irregularities not only in puberty, but also reproductive periods: 15-17 years -36% (ZPR - 15%, PPR - 21%); 18-35 years old - 40%: amenorrhea - 5.7%, oligomenorrhea - 30-35%, dysmenorrhea - 23%, premenstrual tension syndrome - 17%, failure luteal phase - 14%. A significant increase in diseases of inflammatory origin, uterine fibroids, adenomyosis and their combinations in the late reproductive period (36-45 years) with a decrease in menstrual irregularities may be a consequence of abnormal reproductive behavior.

4. Differences in the frequency of gynecological morbidity are due to living in areas with varying intensity use of agrochemical fertilizers. Gynecological morbidity with a significant predominance of inflammatory and endocrine-determined diseases is higher in areas where the pesticide load is greater (2.0-2.5 MPC).

5. Psychological aspects reproductive health, differentiated at different age periods of a woman’s life, highly correlate with the presence of gynecological diseases and disorders: in prepuberty and puberty, low self-esteem and feelings of guilt prevailed due to delayed sexual development, late formation of secondary sexual characteristics, cosmetic defects, earlier pubarche, then in the reproductive period there is more often a feeling of guilt due to infertility in marriage, miscarriage, including habitual pregnancy, it is not self-accusation that prevails, but the search for causes from the outside. After the birth of a child, these phenomena disappear, replaced by a feeling of superiority over their remaining infertile peers. Sharp deterioration psychological status in the menopausal period is associated with both an increase in extragenital diseases and menopausal disorders. Women who had psychological problems during puberty and reproductive periods are almost 100% susceptible to depression during menopause. .

6. Hormonal homeostasis is characterized by prolactin secretion that differs from the norm in all age groups: prepubertal and puberty prolactin exceeds the national average by 5.7±0.3%; at the same time, in obese girls and young women it is significantly higher than in normal weight body, and in reproductive age its content is higher than the norm by 9.3±0.1%, in case of obesity - by 13.2±0.1%. During the menopausal period, prolactin levels decrease at a faster rate than in the Russian Federation; at 49.2±0.3 years its level is 42% lower, and at 55.1±0.7 years - 61%.

7. Indicators of immune homeostasis highly correlate with menstrual irregularities and body weight. With an increase in body weight in all age groups, a significant increase in leptin was found, most pronounced up to 18 years of age (3.7 times). When the menstrual cycle is disrupted, leptin decreases: its level significantly decreases in reproductive age by 1.7 times, in menopausal age by 2.4 times, which correlates with the quantitative depression of the cellular immune system increasing with age. At increased weight at reproductive age significantly (p<0,05) повышается число МС-клеток, а в возрасте старше 46 лет происходит отмена количественных дефектов клеточного иммунитета. При нарушениях менструального цикла с возрастом снижается содержание интерлейкина -4 и увеличивается концентрация интерлейкина-1(3, а при повышении массы тела - увеличение концентрации интерлейкина-4 и тенденция к снижению интерлейкина-1Р

8. Gynecological Diseases and disorders occur the earlier, the smaller the birth weight of girls. Low birth weight of daughters of mothers treated for a long time during pregnancy is observed in 72% of cases, in 78.8% combined with chronic and/or acute hypoxia. Violations immune status, frequent and long-term illnesses in childhood are associated with inflammatory diseases of the genitals (12%), disorders of the formation of the menstrual cycle (17%), oligo- and dysmenorrhea (27%), premenstrual syndrome (19%), uterine bleeding during puberty (3%). Debut at reproductive age inflammatory diseases occurred at 20-24 years of age (70%), mainly as a consequence of induced abortion, IPPGT, associated with frequent changes of sexual partners. In the late reproductive and menopausal periods, abnormal uterine bleeding (40-44 years), endometrial hyperplasia (47 years), uterine fibroids (40 years), endometriosis (38-42 years) and their combination (41-44 years) predominate. The combination of genital and extragenital diseases in all age groups was 1:22.5: on average, there were 2.9 diseases per woman in the reproductive period, 3.1 in the late reproductive period, and 3.9 diseases in the menopausal period.

9. The concept of the formation of RD in specific climatic-geographical, environmental and socio-economic conditions of Kuban provides for the interdependence of ante- and intranatal factors, low birth weight as an integral indicator of intrauterine distress, high infectious index, burdened heredity, high allergenicity, extragenital and gynecological morbidity in all age periods of life women and the possibility of correcting predicted and identified disorders using the developed algorithm of therapeutic and diagnostic measures.

10. The algorithm for improving the reproductive system is based on optimizing the required medical examination girls and women of fertile age with the necessary volume of laboratory diagnostic methods in high-risk groups for reproductive health disorders and traditional treatment of identified and prevention of predicted diseases. This makes it possible to reduce gynecological morbidity under the age of 18 by 29%, at the age of early reproduction - by 49.9%, in the late reproductive period by 35% and in the menopausal period - by 27.6%.

11. The developed and implemented system of organizational, therapeutic and diagnostic measures makes it possible to generally improve reproductive health in various age groups: in 2004-2006, maternal mortality was consistently 2 times lower than the national average, perinatal mortality was reduced by 1.3 times, the stillbirth rate was reduced by 10 .6%, infant mortality from congenital anomalies decreased by 1.1 times, the number of infertile marriages decreased by 19.6%, the birth rate increased by 3.7%, the number of abortions decreased by 9.9%, the number of women using effective methods increased contraception by 69.7%.

Approbation of research results and publication.

The main provisions of the dissertation were presented at the Russian Scientific Forum " Maternal and child health"(Moscow, 2005), Republican scientific forums "Mother and Child" (2005, 2006), Kuban congresses of obstetricians and gynecologists (2002, 2003, 2004), international conference "Immunology of reproduction: theoretical and clinical aspects" (2007), International conference "Therapeutic aspects of modern hormonal contraception"(2002), congresses of obstetricians and gynecologists of the North Caucasus (1994, 1998) and European Congresses on Contraception (Prague, 1998; Ljubljana, 2000; Istanbul, 2006),

The results of the study are presented in 41 published works, including 11 works in journals recommended by the Higher Attestation Commission of the Russian Federation; methodological manual for doctors " Algorithm for prescribing hormonal contraceptives"(regional department health), monographs " Reproductive health of women in the Krasnodar region: ways to improve it"(2007).

Implementation of research results.

The results were implemented in the work of: the Department of Health of the Krasnodar Territory (department of assistance to mothers and children), Regional Clinical Hospital No. 1; Regional Perinatal Center, Regional Family Planning Center, City Multidisciplinary Hospital No. 2 of Krasnodar, as well as antenatal clinics, obstetric and gynecological hospitals in Krasnodar and the Krasnodar Territory. The developed complex is used in the work of endocrinologists and neurologists dealing with reproductive health problems. The data obtained are used in the educational process at the Department of Physics and Pedagogical Training and Teaching Staff of KSMU for training obstetricians-gynecologists, general practitioners, clinical interns and residents, as well as at the Department of Obstetrics, Gynecology and Perinatology of KSMU.

A short-term training program on topical issues has been developed, tested and introduced into the educational process of the departments of obstetrics and gynecology of KSMU. reproductology, including issues of a systematic approach, management of patients with disorders at different age periods, as well as infertility and miscarriage.

Structure and scope of the dissertation.

The dissertation consists of an introduction, an analytical review of the literature, a description of the program, materials and research methods, four chapters of materials from own research, justification and evaluation of the effectiveness of the activities carried out, a discussion of the results,

Conclusion of the dissertation on the topic "Obstetrics and Gynecology", Karahalis, Lyudmila Yurievna

1. Reproduction of the population of the Krasnodar Territory at the end of the 20th and beginning of the 21st centuries has unidirectional trends with the country as a whole, significantly differing in the earlier onset of depopulation processes (the “Russian cross” was implemented in 1990) and significantly higher rates of natural population decline, which is determined climatogeographical characteristics of the region, excessive agrochemical load in most of the region, consumption of food products and water containing toxicants.

2. The deterioration of RH is due to the constantly increasing gynecological incidence in all age periods of life: the total indicators are 12.4% under 18 years of age, 45.8% are at the age of 18-45 years, over 45 years - 41.8%.

3. The “peak” of gynecological morbidity at the age of 0-18 years is at the age of 15.4±1.2 years, 18-45 years - 35.2±1.1 years, over 45 years - 49.7±0.8 years.

4. The somatic health of the female population is characterized by a significant excess of statistical indicators for the Russian Federation: diseases of the cardiovascular system - by 4.7%, respiratory diseases - by 11.3%, diseases of the gastrointestinal tract - by 17.6%, endocrine pathology - by 5.9%, breast diseases by 3.7%.

5. Infertile marriage, the frequency of which increases from 13.7% in 2000 to 17.9% in 2006, is an integral indicator reproductive disadvantage in the region, due not only to socio-economic, agro-ecological, climatogeographical impact on the environment, but also psychological changes in the individual, family, society, most pronounced in girls with gynecological diseases and disorders and in women in infertile marriages.

6. Gynecological the morbidity of girls and adolescents highly directly correlates with frequent and long-term treatment of the threat of miscarriage in their mothers, mainly with corpus luteum hormone preparations (low-weight - 3.9%, macrosomia - 12.9%, adrenarche 24.2%). The influence of chronic hypoxia during pregnancy and/or acute hypoxia during childbirth on the development of MS, in particular mental retardation, should be considered proven. These same groups are characterized by a decrease in immune status, an increase in infectious (ARVI, chickenpox, scarlet fever) and somatic morbidity of allergic and endocrine origin.

7. Endocrine-determined diseases, having a tendency to increase, have reached values ​​in women of reproductive age comparable to inflammatory diseases: 29.4% and 32.1%. Dominant in the structure of gynecological morbidity are fibroids, adenomyosis, their combination, MC disorders, abnormal uterine bleeding with corresponding age-related peaks. The predominance of inflammatory diseases in the age group of 20-24 years is associated with abortion of the first pregnancy, frequent change of sexual partners and a high prevalence of SIS.

8. Features menopausal period of Kuban residents should be considered its earlier onset (47.6±1.5 years), manifested by psychological (37.8±2.6 years), vegetative-vascular (38.5±3.4 years) and urogenital(41.7±2.4 years) disorders. Significantly more frequent somatic morbidity (2-2.5 per 1 woman); on average, per 1 woman there are 3.1 diseases in the reproductive period and 3.9 in the menopausal periods.

9. Features of hormonal homeostasis of all women with endocrine-related diseases of the genital organs are changes in prolactin excretion: increased up to 45 years of age (pubertal and reproductive) and decreased in the menopausal period. At all age periods, the level of prolactin excretion correlates with the excretion of cortisol, testosterone, and 17-OP. There are significant differences in the interaction of these hormones in women with and without obesity (p<0,05).

10. Hormonal effects are metabolically realized through leptin and cytokines, especially altered during obesity in the reproductive and perimenopausal periods: leptin increases by 3.7 times, interleukins by 1.7-2.1 times.

11. Disrupted relationships between endocrine-metabolic regulation of homeostasis are transformed into pronounced immune failure(the level of interleukins decreases by 7.9%, lymphocytes - by 5.1%, leukocytes - by 1.2%, the content changes immunocompetent lymphocytes in almost all cases gynecological diseases, which may explain the high incidence of chickenpox in women with MC disorders in the reproductive period of life.

12. The concept of formation of RP in specific environmental, climate-geographical conditions of Kuban is based on the idea of ​​interdependence of the cause-and-effect determinants identified by this study heredity, drug load on the body of the mother of a future girl, leading to an increase in gynecological morbidity in childhood and adolescence, associated with it somatic and infectious diseases of immune-weakened children and adolescents, almost two times the total incidence in reproductive age and one and a half times in menopausal age. In combination with an agrochemical load, increased insolation, the harmful effects of industrial production, a decrease in material wealth in families and psychological changes in attitudes towards reproduction in society, the problem of reproductive health of women in the Krasnodar Territory can be considered interdisciplinary multifactorial a problem that requires urgent action by government authorities, changes in the organizational framework of medical care for women of all age groups, and public interaction between educational, humanitarian and religious organizations.

13. A system of organizational and therapeutic and diagnostic measures developed on the basis of this concept, based on the primary use of methods for optimizing medical care to improve the state of the reproductive system of girls, adolescent girls, women of fertile and menopausal age using modern technologies for the diagnosis and treatment of reproductive disorders, the creation new structural and functional institutions (adolescent health center) with simultaneous treatment of gynecological, andrological, somatic, urological diseases and psychological rehabilitation, identification of risk groups and expanded laboratory studies of homeostasis in groups at risk of reproductive disorders, including rational contraceptive The policy made it possible to reduce the maternal mortality rate, improve perinatal indicators, reduce the incidence of diseases under 18 years of age by 6.8%, 18-45 years of age - by 10.2%), 46 years of age and older - by 4.9%. I I

1. Clinical examination girls in a children's clinic should be carried out with the participation of a pediatric gynecologist, especially in groups at risk of disrupting the development of the reproductive system: children from mothers treated for a long time during pregnancy, with an increased drug load.

2. Prognostic and an early diagnostic criterion for the state of the reproductive system is a combined determination of the excretion of prolactin, 17-OP, testosterone. Their abnormal values ​​should include an in-depth study of the excretion of leptin, interleukins and determination of the immune status. First of all, girls who already have metabolic changes in areas with an unfavorable agro-ecological situation and the harmful influence of other production factors are subject to in-depth examination. Continuous staged medical examination of girls, teenage girls, and women of fertile age is advisable for timely prediction, detection and treatment of RD disorders and gynecological morbidity.

3. Further reduction in the number of abortions, especially during the first pregnancy, is possible only with the joint participation of education workers (secondary schools, vocational schools), health care (territorial antenatal clinics, youth centers), public and religious organizations in the education of adolescents.

4. Staged medical examination of women of fertile age can be effective only with a full comprehensive examination of girls at the age of 18 during its transition from the stage of a children's clinic (pediatric gynecologist) to an adult network - a territorial clinic and antenatal clinic. Further medical examination, the scope of examination and treatment should be determined by the state of somatic and reproductive health, the presence of harmful environmental factors and the psychological status of patients.

5. Treatment of gynecological diseases, carried out in a timely manner using traditional methods, allows for the cure of uterine fibroids - absolute with surgical treatment and up to 60% with conservative treatment methods, inflammatory diseases of the genitals in 31.4%, cervical dysfunction in groups under 18 years of age in 49.9% , in the reproductive period - in 39.8%>, in perimenopausal- in 27.6%.

6. Infertile marriage, timely diagnosed with proper examination and use of assisted reproductive technologies, it allows to achieve the birth of the desired child in almost 85% of cases, including with tubal pregnancy - 32.7%, ovarian - 16.8%, male infertility - 21.7%, with insemination - in 9.6% and IVF - 19.2%.

7. The increase in the number and severity of diseases of the reproductive system of menopausal age provides for the timely improvement of women in late reproductive age, in relation to the conditions of Kuban in 39-43 years - “ peak gynecological morbidity": tumors of the uterus and ovaries - 39.7 years, endometriosis - 40.3 years, cervical erosion - 42.3 years.

8. HRT for menopausal disorders, based on the conscious choice of the method by the patient herself, lasting 3-5 years, including in somatically burdened women with individual selection of the drug, taking into account the route of administration, can level out the psychological problems of menopause in 70%, urogenital - in 87% , vegetative-vascular - in 80%, metabolic-endocrine - in 17%, there is no significant increase in DMG and diseases of the circulatory system and gastrointestinal tract. The increase in prolactin that occurred before menopause is leveled out by the appointment dopaminergic herbal medicines.

Staged clinical examination of girls, teenage girls, women of fertile and menopausal age, taking into account socio-economic, environmental, psychological factors of life, carried out by the joint activities of doctors of various specialties, allows to reduce the incidence: up to 18 years in general by 49.9%, 18- 35 years old - by 39.9%, 36-45 years old - by 31.6%, 46 years old and older by 27.7%.

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In a woman’s life, we can distinguish periods that are characterized by certain age-related anatomical and physiological characteristics: 1) childhood; 2) puberty; 3) period of puberty; 4) menopause; 5) menopause and 6) postmenopausal period. Childhood is a period of life up to 8 years, in which the specific functions of the ovaries do not appear, although estrogens are synthesized. The uterus is small. The cervix is ​​longer and thicker than the size of the uterus; fallopian tubes are tortuous, thin, with a narrow lumen; the vagina is narrow, short, the vaginal mucosa is thin up to 7 years, the epithelium is represented by basal and parabasal cells. The external genitalia are formed, but there is no hair. During the first year of life, the size of the uterus decreases (by the end of the 1st year, the weight of the uterus is 2.3 g, its length is 2.5 cm). Subsequently, the weight of the uterus increases, and by 6 years it weighs 4.0 g. The ratio of the length of the cervix to the body of the uterus at the end of the 1st year is 2:1, by 5 years - 1.5:1, at 8 years - 1, 4:1. Gonadotropin-releasing hormone (GT-RH) is produced in the hypothalamus in very small quantities. The pituitary gland produces and releases FSH and LH. The gradual formation of feedback begins. However, the hypothalamic-pituitary-ovarian system is characterized by immaturity. The immaturity of the hypothalamic nuclei is manifested by the high sensitivity of the anterior pituitary gland and the neurosecretory nuclei of the mediobasal hypothalamus to estradiol. It is 5-10 times higher than in women of reproductive age, and therefore small doses of estradiol inhibit the release of gonadotropins by the adenohypophysis. By the age of 8 years of life (the end of childhood), the girl has formed all 5 levels of the hypothalamic-pituitary-ovarian (HPT) system, the activity of which is regulated only by a negative feedback mechanism. Estradiol is released in very small quantities, follicle maturation occurs rarely and unsystematically. The release of GT-RG is episodic, synaptic connections between adrenergic and dopaminergic neurons are not developed, and the secretion of neurotransmitters is insignificant. The release of LH and FSH by the adenohypophysis is in the nature of individual acyclic emissions.

The period of puberty (puberty) lasts from 8 to 17-18 years. During this period, the reproductive system matures and the physical development of the female body ends. Uterine enlargement begins at age 8. By the age of 12-13 years, an angle appears between the body and the cervix, open anteriorly (anteflexio), and the uterus takes a physiological position in the pelvis, deviating anteriorly from the wire axis of the pelvis (anteversio). The ratio of body length to cervix becomes 3:1.

In the first phase of puberty (10-13 years), enlargement of the mammary glands (thelarche) begins, which is completed by 14-17 years. By this time, hair growth (pubis, armpits), which began at 11-12 years, ends. In the vaginal epithelium, the number of layers increases, cells of the superficial layer appear with pyknosis of the nuclei. The vaginal microflora changes, lactobacilli appear. The process of maturation of hypothalamic structures is underway, a close synaptic connection is formed between cells secreting liberins (GT-RH, somatoliberin, corticoliberin, thyroliberin) and neurotransmitters. A circadian (daily) rhythm of GT-RG secretion is established, the synthesis of gonadotropins is enhanced, their release becomes rhythmic. An increase in the secretion of LH and FSH stimulates the synthesis of estrogens in the ovaries, the number of receptors sensitive to sex steroid hormones in all organs of the reproductive system increases. Reaching a high level of estradiol in the blood stimulates the release of gonadotropins. The latter completes the maturation of the follicle and the ovulation process. This period ends with the onset of the first menstruation - menarche.

In phase II of puberty (14-17 years), the maturation of the hypothalamic structures that regulate the function of the reproductive system is completed. A circhoral (hourly) rhythm of GT-RG secretion is established, the secretion of LH and FSH by the adenohypophysis increases, and the synthesis of estradiol in the ovaries increases. A positive feedback mechanism is formed. The menstrual cycle becomes ovulatory. The timing and course of puberty is influenced by internal and external factors. Internal factors include hereditary and constitutional factors, health status, body weight; to external - climatic conditions (illumination, geographical location, altitude), nutrition (content of proteins, vitamins, fats, carbohydrates, microelements in food).

The period of puberty (reproductive period) takes a period of time from 16-17 to 45 years. The function of the reproductive system is aimed at regulating the ovulatory menstrual cycle. By the age of 45, the reproductive system fades away, and by the age of 55, the hormonal activity of the reproductive system fades away. Thus, the duration of the functional activity of the reproductive system is genetically encoded for the age that is optimal for conceiving, bearing and feeding a child.

Menopausal period (premenopausal) - from 45 years to the onset of menopause. According to the hypothesis put forward in 1958 by V. M. Dilman and developed in his subsequent works (1968-1983), during this period, aging of the hypothalamus is observed, which is manifested by an increase in the threshold of its sensitivity to estrogens, a gradual cessation of pulsating rhythmic synthesis and release of GT- RG. The negative feedback mechanism is disrupted, the release of gonadotropins increases (increased FSH levels from 40 years of age, LH from 25 years of age). Disturbances in the function of the hypothalamus aggravate disturbances in the gonadotropic function of the pituitary gland, folliculogenesis and steroidogenesis in the ovaries. The formation of catecholamines in brain tissue increases. Probably, age-related changes occur in the receptor apparatus - a decrease in estradiol receptors in the hypothalamus, pituitary gland and target tissues. Disturbances in the transmission of nerve impulses are associated with age-related degenerative changes in the endings of dopamine and serotonergic neurons of the hypothalamus and suprahypothalamic structures. The process of oocyte death and atresia of primordial follicles accelerates, the number of layers of granulosa cells and theca cells decreases. A decrease in the formation of estradiol in the ovaries disrupts the ovulatory release of LH and FSH, ovulation does not occur, and the corpus luteum does not form. The hormonal function of the ovaries gradually decreases and menopause occurs.

Menopause is the last menstrual period, which occurs on average at age 50.8 years.

The postmenopausal period begins after menopause and lasts until the woman's death. In the postmenopausal period, the level of LH increases by 3 times, and FSH by 14 times compared to secretion during the reproductive period. In deep postmenopause, the formation of dopamine, serotonin, and norepinephrine decreases. The main route of estrogen synthesis becomes extraovarian (from androgens), and estrone becomes the main estrogen: 98% of it is formed from androstenedione, secreted in the ovarian stroma. Subsequently, only 30% of estrogens are formed in the ovaries, and 70% in the adrenal glands. 5 years after menopause, single follicles are found in the ovaries; the weight of the ovaries and uterus decreases. By the age of 60, the weight of the ovaries decreases to 5.0 g, and the volume to 3 cm3 (at reproductive age, the volume of the ovaries is on average 8.2 cm3).

Literature

Obstetrics: Textbook for medical schools. 4th ed., add./E. K. Aylamazyan

Modern physiology, based on biological characteristics, distinguishes the following periods of a woman’s life:

1. Childhood period. This period lasts from birth until the onset of puberty, i.e. until approximately 10 years.

2. Puberty period - from 10 to 16 years. This period is characterized by the onset of the first menstruation (menarche).

3. The period of puberty begins with the appearance of menstruation and continues until they begin to cease (up to approximately 45-47 years). Thus, the duration of this period is 30-35 years.

4. Menopause is a relatively short period between the end of puberty and menopause. It lasts from six months to 2-3 years.

5. Menopause period - from the complete cessation of menstruation, i.e. from 45-47 years to approximately 55 years.

6. Senile period (senium) from 55 years to death.

Let us dwell in more detail on the period of puberty.

A girl and a boy, in addition to differences in the structure of the gonads, also differ in height and weight. It is known that a newborn boy weighs on average more than a newborn girl (approximately 250 g). The height of newborn boys, on average, exceeds the height of newborn girls by 1 cm. But at the age of 10 to 15 years, a noticeable increase in the girl’s height occurs, and she catches up with the boy’s height. By the end of the 15th year, the boy again surpasses the girl in height.

A man has a shorter body than a woman, which is caused by the latter developing a longer abdomen in the interests of the growth of the future fetus. The shoulder width of a man is greater than that of a woman, the width of the hips is greater in women. A woman has an absolutely smaller, but relatively larger head than a man. The bony protrusions of the face are less pronounced, the lower jaw is much smaller than in a man. The entire skeletal system of a woman is less developed than that of a man; the same can be said for muscles. All these signs of differences in the structure of the body of a man and a woman (boy and girl) are called secondary sexual characteristics. As you approach puberty, secondary sexual characteristics become more noticeable. This is especially true for the development of the subcutaneous fat layer. The latter is much more developed in women than in men. Fat content in men is 18.2% of total body weight, and in women it is 28.2%. The developed subcutaneous fat layer makes the female body soft and rounded already at the onset of puberty. The skin of women (girls) is somewhat lighter than that of men. Hair in the pubic area in men and women has a different shape: in women, pubic hair has the shape of a triangle, the apex of which is directed downward; in a man it has the shape of a diamond, sometimes reaching the navel. Characteristic; A characteristic feature of a man is facial hair in the form of a mustache and beard; But in women, hair on the head is more developed. Her hair falls out later and in less quantity than a man's.

The most noticeable of a woman's secondary sexual characteristics is the development of the mammary glands. Located under the fourth rib in a child, the mammary glands at the beginning of a woman’s puberty grow and occupy the space between the third and sixth ribs. A distinctive secondary sexual characteristic is also the voice: in women it is higher than in men, in low tones by an average of one octave, in high tones - by two.

A woman’s larynx is approximately 1/4 smaller than a man’s, and its shape remains at the childhood stage of development; Depending on this, the protrusion of the larynx, the “Adam’s apple,” is almost absent in women.

But the most striking sign of a girl’s onset of puberty is the appearance of her first menstruation. In our climate zone, they appear in girls aged 12-14 years. If menstruation occurs before the 10th year of life (4-6 years), then this phenomenon is called premature menstruation. Usually, along with premature menstruation, early development of secondary sexual characteristics is observed. If menstruation occurs after 20 years or even later, then it is called delayed menstruation. Late menstruation is most often observed in infantile women.

Climax. According to V.V. Slonitsky’s definition, the climacteric period should be understood as a relatively short period of a woman’s life, during which she, according to the general laws of the whole organism, enters a new period of life - a period of physiological sterility and gradual extinction of menstrual function.

The widespread and deep-rooted opinion that a woman’s menopause is a direct transition from childbearing age to old age is incorrect, scientifically unfounded and practically harmful.

Under normal conditions and the normal state of the body, the physiological cessation of reproductive function and menstruation not only does not lead to old age and withering of all sexual functions, but, on the contrary, as a protective process, contributes to the preservation of health and libido for a long time: women; genital atrophy usually does not occur; the body contains a sufficient amount of estrogens and other hormones for a long time.

The aging of an organism occurs throughout life, and from its very beginning, involution processes develop in parallel with the processes of evolution. Therefore, it is incorrect to consider the menopausal period as a woman’s critical age, which is supposedly characterized by old age and a number of diseases. Menopause is followed not by old age, but by menopause, which has its own characteristics.

The climacteric period is divided into physiological and pathological. Menopause, as a physiological process, should pass unnoticed, with a gradual cessation of menstruation, without any painful disorders requiring treatment.

Pathological menopause is often very difficult and requires special treatment. The most common and severe disorders of the normal course of menopause are angioneurosis (“hot flashes”) and menstrual dysfunction, which clinically manifest themselves in the form of acyclic bleeding.

The duration of menopause varies greatly. In some diseases, such as uterine fibroids, a late onset of menopause is observed - at the age of 55 years and older (climax tarda). On the other hand, there are cases of early onset of menopause - at the age of 30-35 years, which happens with infantilism and bilateral ovarian tumors.

According to Tsondek, menopause can be divided into three stages (corresponding, to a certain extent, to anatomical changes in the uterus): hyperfolliculin (polyhormonal); oligofolliculin (hypofolliculin) and polyprolan (afolliculin according to Mandelstam).

The first stage, hyperfolliculin, is characterized by increased production of folliculin in the urine (up to 500 and even up to 1000 IU per 1 l). Under the influence of enormous amounts of folliculin in the blood, the uterus enlarges and softens. This stage may last for weeks or even months and may manifest clinically as polyhormonal amenorrhea or bleeding.

The second stage, oligofolliculin (hypofolliculin), is accompanied by a sharp decrease in the amount of folliculin, the production of which may stop altogether. Clinically, this stage is characterized by a number of well-known vasomotor and neuropsychiatric disorders (due to irritation of the vasomotor center).

The third stage, polyprolan, is characterized by an increase in the function of the anterior lobe of the pituitary gland with the release of large quantities of prolan A (pituitary gonadotropin), up to 110 IU in 1 liter of urine, which proves the cessation of ovarian function. The difference between menopause and castration in the sense of flooding the body with gonadotropic hormone is found in the fact that in the first case this happens gradually, and in the second - quickly. At this stage, uterine atrophy occurs. Some modern authors divide menopause into stages: hyperfolliculin, oligofolliculin and ahormonal.

The term menopause refers to the period of complete cessation of menstruation and the gradual transition from menopause to old age. Menopause, as stated above, lasts about 10 years - from 45-47 to 55. Mazer and Israel estimate it at 15 years: from 45 to 60 years, which is not entirely correct. Menopause is characterized by the appearance of noticeable general and local changes in the body. Common changes include visible aging: the appearance of wrinkles on the face, a tendency toward obesity, and decreased libido. Unpleasant subjective symptoms are observed - “hot flashes” to the head, a feeling of suffocation, symptoms of psychoneurosis, hypertension, dysfunction of the endocrine glands. In connection with the latter, Graves' disease, acromegaly, and depigmentation sometimes develop during menopause; stones appear in the liver and kidneys. Particularly noteworthy is the tendency in this period to the development of malignant neoplasms.

Noticeable changes are observed in the thyroid gland; it, as after castration, increases in volume, lipoids and colloids accumulate in it. In the pituitary gland, the anterior lobe decreases, the number of eosinophilic cells increases, and so-called castration cells appear. In the adrenal glands, hypersecretion occurs in the cells of the cortical layer, the protoplasm of which becomes transparent and granular and contains lipoids.

The main changes in the genital system include atrophy of the uterus and mammary glands and the complete cessation of menstruation. Ovarian function fades gradually. In this case, atrophy of the external genitalia, vagina and uterus is observed much later than the cessation of menstruation. This explains the casuistic cases of ovulation, pregnancy and childbirth at the age of 55-60 years. Thus, G.D. Sofronenko observed the birth of a 62-year-old woman.

With the cessation of ovarian function during menopause, the vaginal mucosa becomes thin, easily vulnerable, and susceptible to infection. The entrance to the vagina is not stretchable, sexual intercourse is difficult. The external opening of the urethra, participating in reverse involution, narrows significantly. During menopause they often develop