Periods of life of a man and a woman. Age-related characteristics of women's health and prevention issues
In special medical literature There are reports of pregnancy in a six-year-old girl with premature sexual development and in a 113-year-old woman, who was apparently distinguished by the special preservation and activity of the endocrine system.
Of course, such cases belong to the category of casuistic, that is, exceptional, falling out of social patterns. But even within the limits of the laws, individual fluctuations are very large, and therefore it is impossible to say with absolute accuracy from what age and ending with what age a woman is able to become pregnant and give birth to a child.
In development female body There are six periods. This is the period childhood(up to 8 years), the period preceding puberty ( prepubertal- 8-11 years old); period of puberty ( pubertal- 12-18 years old); childbearing(reproductive - 19-45 years); transitional ( climacteric 45-55 years): period of withering ( postmenopause- after 55 years).
Their change is determined by the changes that occur in the gonads, in the cerebral cortex, its subcortical structures (hypothalamus), and in the leading endocrine gland - the pituitary gland.
The female sex glands are the ovaries. An egg matures in them, capable of merging with a male reproductive cell - a sperm - to give rise to a new life. But the maturation of the egg occurs only if there is a clear interaction between the functions of the ovary and the mechanisms that regulate its activity. In its most general form, it goes like this: the hypothalamus produces hormones that stimulate the pituitary gland, and pituitary hormones awaken the activity of the ovaries.
In the first years of a girl's life, the regulatory systems and especially the ovaries are almost inactive. This period is rightly called “rest of the reproductive system.” Only within a few days after the birth of a girl, under the influence of placental and maternal hormones, can she develop the phenomenon of the so-called sexual crisis ( bloody issues from the vagina, engorgement of the mammary glands).
Only in the prepubertal period does the formation of the complex system hypothalamus - pituitary gland - ovaries begin. For some time, her activities proceed chaotically, with many disruptions and dissonances. Sex cell As a rule, it does not yet mature, but under the influence of hormones produced by the pituitary gland and ovaries, signs of puberty appear - a female physique is formed, and the mammary glands develop. From 11 to 15 years of age, girls experience a period rapid growth, it seems to “stretch out”, from 15 to 19 years the processes of fatty tissue deposition predominate; The girl doesn’t stretch out so much as she gets fatter and takes shape.
From the moment the first menstruation appears, and this can happen from 11 to 16 years, puberty begins (that is, the period of puberty). Now a clearer relationship is being established between the hypothalamus, pituitary gland and ovaries. Menstruation gradually becomes regular. The time of onset and course of puberty is influenced by external and internal factors. Internal factors include hereditary and constitutional factors, health status and body weight; to the outside - climatic (illumination, geographical position, altitude), nature of nutrition (content of food proteins, vitamins, fats, carbohydrates, microelements).
I wouldn’t want, of course, for the decline of reproductive function to be perceived as a decline of the body in general. No, that's a long way off! A woman even during menopause is still full of strength, energy, and attractiveness. It must be said that sexologists believe that prolonging intimate life at this age helps to prolong the activity of the endocrine system and maintain general tone.
Sevostyanova Oksana Sergeevna
It is generally accepted and natural that one of the main functions of the female body, which by and large determines the role of a woman in any society, is the reproductive function, i.e. reproductive capacity. And this function, as is known, is limited by age. But having crossed a certain age limit, a woman does not cease to be a woman, and she still vitally needs the harmony of mental and physiological principles in the body.
As a rule, our health culture does not extend beyond the reproductive function and, having fulfilled our “obligations” on this point, we conveniently forget about further regular visits to the antenatal clinic. Meanwhile, women's health needs care and attention not only in the phase of active reproductive age, but throughout life.
This material is addressed to all women and girls, regardless of age, but most likely it will be read more carefully by women who have entered that wonderful time when the happy difficulties of bearing a child and childbirth are long behind them and thoughts arise about the natural completion of their mission as a continuator of the family .
In this regard, I would like to talk about the changes and characteristics of the female body in different age periods- what to expect, what to pay attention to, what is considered normal, and what is considered a reason to visit your doctor.
In general, at any age, first place in the structure gynecological diseases occupied by inflammatory diseases (more than 60%), often causing not only impairment of a woman’s ability to work and disruption of her reproductive function, but also affecting other functions of the female body. Nevertheless, great importance in the specifics of diseases women's sphere have certain periods of a woman’s life. This age specificity is mainly determined by the anatomical and physiological characteristics of the female body in individual periods life. Let's figure out together what characteristic features and changes these time periods bring to the female body.
So, in a woman’s life it is customary to distinguish between:
1) period intrauterine development;
2) the period of childhood (from birth to 9-10 years);
3) period of puberty (from 9-10 years to 13-14 years);
4) teenage years(from 14 to 18 years old);
5) period of puberty, or childbearing (reproductive), age from 18 to 40 years;
6) transition period, or premenopause (from 41 to 50 years);
7) the period of aging, or postmenopause (from the moment of permanent cessation of menstrual function).
Puberty period is the longest in a woman's life. Reproductive age is characterized by the formation of stable relationships in the hypothalamic-pituitary-ovarian system and cyclical changes in a woman’s body, most pronounced in the sexual sphere. A woman’s body is ready for fertilization, pregnancy and childbirth, lactation. Regular cyclical changes throughout the body are externally manifested by stable menstruation - this is the main indicator of the well-being of the female body. Of course, you should not focus solely on this indicator, and yet the regularity, stability, painlessness of the cycle is what is considered to be the norm. Of course, there are special cases when a given diagnosis is not typical for a certain age group, but, in general, a modern woman must navigate those manifestations and symptoms that can await her and to which it is necessary to pay the closest attention.
For example, most frequent complaints and specific problems of this age period are: inflammatory diseases of the genital organs, menstrual irregularities of various origins, cysts, infertility. Closer to 40 years, the frequency of benign and malignant tumors of the genital organs increases.
In general, you need to understand that it is the reproductive age that is the most risky and critical in terms of impact harmful factors. These include: early start sexual life, big number sexual partners, infection with various infectious agents, early pregnancies, including those ending in abortion.
In addition to the frequent disorders already described, we can also talk about various pathologies of the cervix. The cervix has its own clinical and functional features at different age periods of a woman’s life. IN last years there is an increase in the number of cases of cervical diseases in young women. According to statistics, the peak incidence of human papillomavirus infection also occurs during the reproductive age of women, and it is due to this that the incidence of cervical cancer increases.
Well, another “scourge” of the reproductive period, which is worth mentioning separately, is fibroids. Uterine fibroids are benign tumor, which develops in the myometrium - the muscular lining of the uterus. Myoma increases in size under the influence of female sex hormones - estrogens, and therefore it is generally accepted that this disease is hormone-dependent in nature. In women with uterine fibroids, the period of ovarian functioning is extended. Regular menstruation can last up to 55 years. With the onset of menopause (cessation of menstruation), regression (reverse development) of the tumor is noted. Talking about the prevention and prevention of fibroids can be quite conditional. But risk factors for the development of fibroids need to be identified. These include - hereditary predisposition(the presence of uterine fibroids in direct relatives), menstrual dysfunction, reproductive dysfunction (infertility, miscarriage), metabolic disorders (obesity, diabetes).
We will try to give the most common manifestations and symptoms in women of this age group, the manifestation of which may indicate gynecological diseases: irregular, painful menstruation and cycle disorders; change in the nature of discharge; the appearance of uncomfortable sensations; sexual disorders, disharmony of sexual relations; absence of pregnancy for more than 1 year with regular sexual activity; the appearance of pain, volumetric formations in the pelvic and abdominal areas.
Premenopausal period characterized by the transition from the state of puberty to the cessation of menstrual stability. During this period, women often experience disturbances central mechanisms regulating the function of the genital organs, and as a result, a violation of cyclicity. This age limit somewhat shifts the emphasis - for example, inflammatory processes of the genital organs are less common, but the frequency increases significantly tumor processes and menstrual dysfunction (menopausal bleeding). Also at this age, there is a progressive depletion of the follicular apparatus of the ovaries. Well, probably the main thing that characterizes this period is change hormonal levels, namely, the production of progesterone stops and the secretion of estrogen decreases. All this leads to changes in the internal organs and systems of the body and, in the absence of timely correction, significantly reduces a woman’s quality of life.
40-60% of women during perimenopause may develop symptoms of menopausal syndrome, urogenital and sexual disorders. All this is expressed in the following unpleasant sensations: hot flashes, sweating, increased or decreased blood pressure, headache, sleep disturbance, depression and irritability, frequent urination, both during the day and at night, urine leakage.
Many women are approaching menopause and have existing diseases of the endocrine system, in particular with disorders of the thyroid gland. About 40% of women have nodules and hypothyroidism. Menopause in women with thyroid pathology, unlike women without it, occurs earlier
Next important stage in a woman's life -after 50 years. This period is characterized by a general decline in the female reproductive system, during which the female body continues to lose estrogen. Therefore, at this age various pathological conditions often develop, and therefore during this period it is especially necessary to be observed by a gynecologist to select individual correction age-related changes hormonal status. What can be alarming or frankly “ruin your life”? These include rapid aging and dry skin, frequent headaches and sleep disturbances, decreased memory and irritability, and sudden weight loss or excess. In fact - no matter how sad it is - this is a phase aging, which fits into general process aging of the entire female body.
During the postmenopausal period, prolapse and prolapse of the genital organs occur more often than before, as well as malignant tumors. Gradually, complete extinction of ovarian function occurs (lack of ovulation, cyclical changes in the body), and a decrease in estrogen levels can lead to late metabolic disorders- osteoporosis, atherosclerosis, cardiomyopathy.
What can be done? How can we ourselves reduce the risks described? age-related disorders to a minimum? Of course, this is primarily prevention, which comes from a properly formed culture of health (see material about Culture women's health on our website http://endometriozu.net/informaciya-o-zabolevanii).
Never underestimate the importance preventive examinations during the period when it would seem that the childbearing function is completed. Life doesn't just go on. During this period, a woman who is correctly attuned to the perception of her age truly blossoms. And “helping” our body stay in shape is our responsibility to ourselves.
In addition to regular visits to your doctor (need I remind you that mature age should this doctor be a priori?), prevention inflammatory diseases internal genital organs consists of careful adherence to personal hygiene and culture of sexual relations, as well as timely detection and treatment of inflammatory diseases of other organs and systems. By the way, there is a close relationship between diseases of the mammary glands and genital organs, which is confirmed by the high frequency of the combination of these diseases, so you should not forget about timely visits to the mammologist. After all, any organism is a well-coordinated, interconnected mechanism, where there are no separate systems working .
For example, we have already talked about the frequency of disorders in the endocrine system. In this case, we can help ourselves by reflecting necessity early diagnosis and treatment of various thyroid dysfunctions.
In addition, one of the important links in the prevention of acute inflammatory diseases in women is the timely detection of specific infections and sexually transmitted diseases.
Prevention of gynecological diseases has the main goal - the health of a woman in all periods of her life! And it needs to start from childhood. After the start of sexual activity, it is recommended to undergo a routine examination by a gynecologist once a year. Unscheduled examinations are necessary when any complaints arise, or when a sexual partner changes. After all, diseases in gynecology often occur without pronounced symptoms and, in an advanced state, can lead to cancer, infertility, ectopic pregnancy and other unpleasant consequences.
We must not forget that in any period of life regular exercise stress extremely useful, and especially when approaching menopausal changes. It reduces the risk of heart disease and osteoporosis. Physical activity stimulates the brain, causing the release of endorphins, which promote good health. Depression is reduced and physical pain is relieved.
In a woman’s life, the following age periods are distinguished: embryonic period, childhood, puberty, puberty, menopause, menopause, old age.
What are the periods of a woman's life?
Embryonic (antenatal) period A woman’s life lasts from the moment of fertilization until the birth of the child. At the end of the first month of intrauterine development, the genital organs begin to form (uterus, the fallopian tubes, top part vagina). The paired Müllerian ducts come closer and unite during embryogenesis. Each Müllerian duct forms one half of the uterus, one vagina, and one fallopian tube. The external genitalia are formed from genitourinary sinus, ovaries - from the primary gonad.
From the seventh month of intrauterine development, the uterus grows intensively under the influence of placental estrogens. At the time of birth, the length of the uterus is about 3.8 cm, and the length of the body of the uterus is only about 1/3 of the entire length of the organ. After birth, the amount of estrogen decreases sharply, the size of the uterus decreases to the level of a 7-month fetus. Further growth of the uterus begins after 2 years of age.
Childhood period (prepubertal) lasts from birth to 10 years.
The vagina of girls during this period is characterized by smoothness of the arches and has almost vertical direction due to the fact that the uterus with appendages is located outside the pelvis. The walls of the vagina are close to each other, its lumen looks like a slit. Gradually, as the uterus descends into the pelvis, the axis of the vagina changes. The length of the vagina also increases with age.
The mucous membrane of the vagina during childhood is thin, there are few folds, and they are not sufficiently pronounced. muscle layer and vasculature poorly developed.
As blood vessels and elastic fibers develop, the folds of the vagina become more pronounced. They are especially well developed in the lower two thirds of the anterior and rear walls vagina along the midline. The vaginal mucosa is covered with stratified squamous epithelium. In newborns, it consists of 30 or more layers of glycogen-rich epithelial cells.
There is no vaginal microflora in the first hours after birth. The vagina is colonized by microorganisms in the first days after the birth of the child. After 3-4 days, under the influence of Doderlein sticks, the process of self-cleaning of the vagina begins. Later, cocci appear in the vagina.
The uterus in girls is very mobile, in position an-teversio. With age, its position changes.
Blood and lymph circulation in the uterus during this period is reduced, the glandular apparatus is underdeveloped.
The mucous membrane of the uterus in girls has folds running from the fundus of the uterus to the cervical canal. With age, the folds of the uterine mucosa gradually smooth out and completely disappear by puberty.
The uterine pharynx in girls is not fully formed, which facilitates the penetration of infection.
The fallopian tubes in the prepubertal period are long, tortuous, thin, and poorly developed muscle layer, do not have a specific position in the pelvis. With age, they become thicker and their lumen expands.
The ovaries in girls are located above the entrance to the small pelvis, then they gradually descend and take their place in the small pelvis. The ovaries are fusiform in shape and have a smooth surface and contain a large number of primordial follicles. Some of them become atretic with age.
Puberty (puberty) lasts from 10 to 16 years.
One of the signs puberty are menstruation. The first menstruation (menarche) occurs on average at 13–14 years of age. Initially, bleeding is acyclic in nature, the cycle can be anovulatory. Then (after 1–2 years), under the influence of sex hormones, the discharge becomes cyclical. The menstrual cycle averages 28–39 days, and menstruation itself lasts 3–7 days. The volume of blood loss is no more than 30–80 ml.
During this period, the endometrium is divided into basal and functional layers. An angle is formed between the cervix and the body of the uterus. The vagina lengthens and changes its position. The fallopian tubes become shorter, thicker, and their lumen increases.
Puberty (reproductive period) lasts from 18 to 45 years. It is characterized by the activity of all functions of the reproductive apparatus aimed at childbirth.
The climacteric period (menopause) begins at 45–50 years of age and lasts 2–3 years. During this period, menstrual function stops. Menopause can occur without disturbances general condition women (physiological menopause) or with vegetative-vascular disorders (pathological menopause). During menopause, reproductive function is lost, but sexual function is preserved.
Menopause period (postmenopausal period) lasts up to 70 years. Characterized by persistent cessation of menstruation. During this period, ovarian function decreases, age-related involution of the genital organs occurs, skin turgor decreases, and metabolism is disrupted.
Senile (senile) period begins at age 70 and lasts until the end of life. The changes that began during menopause continue to develop. Gradual atrophy of the genital organs occurs.
Cyclic changes throughout the body
Cyclic changes in the ovaries and uterus, as well as fluctuations in the level of ovarian hormones, are perceived by nerve endings and transmitted to the central nervous system, affecting its functions and the condition of the entire organism. Before menstruation, many women experience:
1) irritability;
2) drowsiness;
3) increased fatigue;
4) increased tendon reflexes;
5) sweating.
After menstruation, these phenomena disappear.
In the premenstrual period, there is a slight increase in heart rate, an increase in blood pressure, and an increase in temperature by several tenths of a degree. During and after menstruation, these indicators level out.
Noticeable changes during the menstrual cycle occur in the mammary glands. Before menstruation, there is a slight increase in their volume, engorgement, associated with the formation of new foci of glandular tissue under the influence of sex hormones. With the onset of menstruation, the newly formed glandular tissue undergoes reverse development and these phenomena pass.
U healthy women with a normal menstrual cycle, the cyclic changes occurring in the body do not affect general health and do not reduce ability to work.
Ovarian cycle
The ovarian cycle consists of two phases:
1) folliculin;
2) luteal.
The follicular phase begins with the end of menstruation and ends with ovulation, luteal phase begins after ovulation and ends with the onset next menstruation. The ovary also performs endocrine function, which is provided by a functioning follicle and corpus luteum.
The process of folliculogenesis begins in the ovary in the antenatal period and ends in postmenopause. In total, about 400,000–500,000 follicles are formed, of which only 400–500 undergo a full development cycle, the rest undergo atresia. Full cycle development includes the development of the follicle from primordial to preovulatory, ovulation and transformation into the corpus luteum.
Primordial (primary) follicle consists of an immature egg and is covered with a single layer of epithelial cells and a connective tissue membrane. The process of follicle maturation takes place during the first 12–14 days of the menstrual cycle.
During this period, the egg increases in size 5–6 times, becomes covered with a structureless membrane, and divides twice. During the first division, two unequal cells are formed: the smaller cell is discarded, and the larger one undergoes a second, reduction division. During this division, the cell loses half of its chromosomes, thus acquiring a haploid set of chromosomes and becomes suitable for fertilization and maturation.
The follicular epithelium changes from single-layered to multilayered and turns into the granular membrane of the egg. At first, the cells of the granular membrane completely fill the space between the egg and the connective tissue membrane, then voids form between them. They gradually merge into one cavity filled with fluid produced by the follicular membrane and containing estrogens. The cells of the granular membrane are moved by this cavity partly towards the egg, and partly towards the wall of the follicle. Those cells of the granular membrane that are adjacent to the egg form its corona radiata. The cells lying near the walls form the egg-bearing tubercle, in which the egg is located. By the time the follicle matures, the egg leaves the oviductal tubercle and is located in the follicular fluid.
The connective tissue membrane of the follicle sprouts blood vessels and differentiates into two thecae:
1) internal;
2) external.
The theca interna is rich cellular elements and capillaries. The theca externa is formed by dense connective tissue and contains more large vessels.
The maturing follicle increases in size and begins to protrude above the surface of the ovary, and the oviductal tubercle with the egg appears in this protrusion. The produced follicular fluid stretches the follicle, its wall and the adjacent ovarian tissue become thinner, and the mature follicle ruptures - ovulation. The released egg, surrounded by the corona radiata, enters the abdominal cavity and then into the fallopian tube, where fertilization can occur.
Ovulation occurs approximately 12–14 days later in a 28-day cycle.
A gland forms at the site of the ruptured follicle internal secretion – yellow body, producing progesterone. Development corpus luteum lasts the second half of the menstrual cycle - from ovulation to the next menstruation.
The ruptured follicle collapses, its walls form folds, and a blood clot forms in the center due to slight bleeding from the ruptured internal and external theca. The rupture site heals. Cells of the granular membrane multiply, increase in size and accumulate lipoid substance in the protoplasm yellow color– lutein. The cells of the granular membrane turn into luteal cells of the corpus luteum. At the same time, the vascular network grows and new capillaries are formed.
If the egg is fertilized, the corpus luteum continues to function during the first months of pregnancy as the corpus luteum of pregnancy. If pregnancy does not occur, then from the last day of the menstrual cycle the reverse development of the corpus luteum begins - the corpus luteum of menstruation. Luteal cells die, blood vessels become empty, and the connective tissue, and a scar forms in place of the corpus luteum, which then disappears. From the beginning of reverse development, progesterone production stops. In the ovary, follicle maturation, ovulation and the formation of the corpus luteum again occur.
Under the influence of estrogens and progesterone formed in the follicle and corpus luteum, cyclic changes in tone, excitability and blood supply occur in the uterus.
Especially significant changes occur in the endometrium. Endometrium- the lining of the uterus facing the lumen of the organ. From the point of view of cyclic processes, it consists of two layers:
1)basal;
2) functional.
The basal layer is adjacent to the muscular lining of the uterus - the myometrium and does not undergo cyclic changes. The functional layer faces the uterine cavity and changes during different phases of the menstrual cycle.
The uterine cycle, like the ovarian cycle, lasts on average 28 days and consists of the phases of desquamation, regeneration, proliferation and secretion.
Desquamation phase manifests itself menstrual bleeding and lasts on average 3–4 days. During this period, the functional layer of the uterine mucosa is torn off and released out along with the contents of the uterine glands and blood from ruptured vessels. The phase of endometrial desquamation coincides with the beginning of the death of the corpus luteum in the ovary.
Regeneration phase The endometrium begins during the period of desquamation and ends 5–6 days after the start of menstruation. The restoration of the endometrium occurs due to the cells of the basal layer, its vessels and nerves.
Proliferation phase corresponds to the maturation of the follicle in the ovary and occurs under the influence of the estrogen produced by it. The cycle lasts 14 days. The stroma and endometrial glands grow. The glands elongate and twist like a corkscrew, but do not contain secretions. During this phase, the uterine mucosa thickens 4–5 times.
Secretion phase continues until the end of the cycle. Coincides with the flowering of the corpus luteum, under the influence of which hormone (progesterone) occurs. Glycogen accumulates in the epithelium of the glands, the endometrial stroma swells, and its blood supply improves. Pseudodecidual cells appear in the endometrial stroma. As a result, conditions are created in the endometrium that are favorable for the development of the embryo in the event of pregnancy.
If pregnancy does not occur, the corpus luteum dies, the functional layer of the endometrium is rejected and menstruation occurs.
Cyclic changes in other parts of the reproductive system
In the cervix, vagina and other parts of the reproductive system, cyclic changes are much less pronounced.
Changes in the cervix during the menstrual cycle are associated with the secretion of the glands of the cervical canal.
In the first half of the menstrual cycle they produce clear mucus. During the period of ovulation, its quantity increases, it becomes viscous, less viscous, which contributes to better movement of sperm along cervical canal. After ovulation, these changes disappear.
In the fallopian tubes, in the follicular phase of the cycle, some thickening of the mucous membrane is noted, and in the luteal phase, epithelial cells secrete a secretion containing proteins and glycogen.
Influenced by fluctuations in the level of sex hormones during the menstrual cycle cellular composition changes in smears from the vaginal mucosa. IN stratified epithelium There are four types of cells in the vagina:
1)basal;
2) parabasal;
3) intermediate;
4) superficial.
The predominance of superficial cells in smears indicates a sufficient level of estrogen and is characteristic of the preovulatory period. After ovulation, under the influence of progesterone from the corpus luteum, predominantly intermediate cells are detected in smears.
Based on the biological characteristics of the female body, the following periods of a woman’s life are currently distinguished:
- embryonic,
- childhood period,
- period of puberty,
- period of puberty,
- transitional (menopausal),
- postmenopausal (menopause),
- senile (senile).
Embryonic (prenatal or fetal) the period begins from the moment of conception until the full maturation of the fetus and its birth. An essential feature of the development of the female reproductive gland - the ovary - in ontogenesis is the bisexuality of its rudiment. The gland acquires gender-specific features as the sexual center of the nervous system differentiates. The acquired sexual identity remains persistent and does not disappear either after castration or during menopause. From the end of the eighth week of embryonic development, primary ovarian follicles appear in the ovary, after some time they turn into vesicular ovarian follicles and begin to function. The development of the fetal reproductive system is partly associated with the influence of maternal, predominantly placental, estrogenic hormones. Signs of their influence are revealed in the first weeks after birth.
Childhood period begins at birth and lasts until 10-11 years. In this period of life functional difference between feminine and male body No. The period of childhood is characterized relative peace female reproductive system. A well-known exception is represented only by the first weeks of the newborn period, during which the influence of maternal estrogens on the genitals and mammary glands of the girl continues. In this regard, signs of a sexual crisis may appear - bloody discharge from the vagina, keratinization of the multilayered squamous epithelium vaginal mucosa, enlarged uterus, engorgement of the mammary glands with the release of colostrum. During the first week of life, estrogen saturation decreases and signs of sexual crisis reverse. Hormonal function The child's ovary is extremely small. However, a small amount of estrogens (as well as androgens) is already detected in the girl’s body. The amount of androgens secreted by a girl is almost the same as that of boys. During this period, both estrogens and androgens in girls are formed in the ovaries and adrenal glands. From the age of 10, the release of estrogen increases significantly, and 1-1.5 years before the onset of menstruation, their release becomes cyclical. By this time, increased release of gonadotropic hormones begins. The release of androgens after ten years of age increases slightly and without much cyclicity. Girls grow more rapidly in childhood compared to boys. In this case, the ovaries enlarge, but their specific functions do not appear. The uterus is relatively small; the cervix is longer and thicker than the body of the uterus. The fallopian tubes are relatively long, thin, and tortuous. The vagina and its vaults are short, narrow, the folding of the mucous membrane is well expressed, but the folds are mobile, easily smoothed out, and do not have elasticity, as in adults. The vagina in the small pelvis is located almost vertically and only with age it becomes at an acute angle to the horizontal plane of exit from the small pelvis. The epithelium of the vaginal mucosa does not contain enough glycogen, the reaction of the contents is slightly alkaline, which often contributes to the development of vaginitis. The external genitalia and mammary glands are formed, but not developed, and there is no pubic hair.
Puberty — puberty(from 10-11 to 16 years), associated with the growth and development of primary ovarian (primordial) follicles. During this period, the secretory function of the ovaries begins with the formation of estrogenic hormones. Under the influence of estrogenic hormones, secondary sexual characteristics develop, the uterus, ovaries, vagina, external genitalia, and mammary glands grow and develop; hair appears on the pubis and in the axillary fossae. An increase in the size of the pelvis and its formation according to the female type is accompanied by the development of the subcutaneous fat layer. The menstrual cycle is accompanied by monthly changes in the ovary (growth and development of follicles producing estrogen hormones, rupture of the vesicular ovarian follicle (Graafian vesicle) - ovulation and development of the corpus luteum secreting progesterone) and the uterine mucosa (phase of regeneration and proliferation of the endometrial epithelium, phase of secretion and phase of desquamation of the functional layer of the endometrium). The menstrual cycle is regulated by releasing hormones of the subcutaneous region and gonadotropic hormones (FSH, LH and LTG) of the pituitary gland, the function of which is closely related to all the endocrine glands of the woman’s body. During puberty, menstruation appears, i.e., the menstrual cycle is established. The time of onset and end of puberty is subject to individual fluctuations, and also depends on climatic and living conditions. In the central republics of our country, most girls begin menstruation at the age of twelve or thirteen. In the southern regions puberty begins and ends earlier than in the northern ones, but not earlier than ten years of age. Menstruation after 16-17 years is called delayed (menstruatio tarda). Delayed puberty is caused by chronic debilitating diseases, intoxication, overwork, poor nutrition, etc. Delayed sexual development is often a manifestation of general or sexual infantilism. Much less often, menstruation occurs before the age of 10 (6-8 years). This phenomenon is called premature menstruation (menstruatio praecox). Precocious puberty is observed more often with dysfunction of the hypothalamic-pituitary system, adrenal glands and ovaries (tumors), as well as with other pathological processes (hereditary diseases, metabolic disorders, etc.). During the 3rd period of puberty, final sexual differentiation occurs and a normal two-phase menstrual cycle is established. In girls with an asthenic constitution, menstruation begins earlier, with a picnic constitution - a little later. Most often, the first menstruation occurs during the winter months. Simultaneously with the formation of ovarian function during puberty, thyroid-stimulating and adrenocorticotropic influences on the development of the female reproductive system intensify. In this case, there is a friendly influence of the hormones of the thyroid gland and the cortex of the adrenal glands, which have common mechanisms of central regulation with the ovaries. By the end of this period, all organs and systems of the female body reach functional maturity and the woman’s body is capable of reproductive function.
Puberty period begins at 18 and lasts until 45-47 years. At puberty they reach maximum activity all specific functions of the female body aimed at childbirth. Puberty period - childbearing, active life period. The most significant characteristic of the state of the reproductive system is the presence of a two-phase menstrual cycle and correct rhythm menstruation
Transitional (menopausal) period occurs at the age of 45-47 years and lasts 2-3 years. During this period, the maturation of follicles and the intrasecretory function of the ovaries gradually fades away: the woman enters a new period of life - the period physiological cessation menstrual function. At that time average duration the menstrual cycle increases and the frequency of defective biphasic and anovulatory cycles increases. There are two stages in the menopause: the stage of climacteric changes and the stage of menopause. The stage of menopausal changes lasts from 2 to 3 years. Changes in menstrual function at this stage occur according to the hypoestrogenic type, with rare and more scanty bleeding. The main features of ovarian function are a gradual transition to a single-phase cycle and disruption of the menstrual rhythm. Subsequently, menstrual function ceases and the second stage of the menopause begins - menopause. The time of onset of menopause is individual and varies within a fairly wide range (46-50 years). The basis for identifying the second stage was numerous observations indicating the continuing hormone-producing function of the ovaries for several years after menopause.
Menopause on average lasts from 2 to 5 years after the cessation of menstrual function. Thus, the menopause is a period characterized by reverse development female reproductive system - involution with phasing out menstrual and then hormone-forming function of the ovaries.
Menopause can occur physiologically and pathologically. The physiological menopause passes without any painful disturbances, menstruation becomes scanty and rare and, finally, stops altogether. Pathological menopause is often very difficult and is expressed by a disorder of menstrual function in the form of acyclic uterine bleeding and angioneurosis, which is the result of dysfunction of the endocrine, nervous and vascular systems. Menopausal angioneurosis is manifested by increased excitability, dizziness, rush of blood to the vessels of the head, sudden sensation of heat, fluctuations in blood pressure, etc. Disorders of the transition period in mild form, as a rule, are observed during physiological menopause. This is due to the weakening of nervous (mainly inhibitory) processes and age-related restructuring of the gonadotropic function of the subtubercular region and pituitary gland, leading to disruption of cyclic processes in the ovaries, as well as to the cessation of menstrual function. In the normal state of the female body after the cessation of menstruation sexual desire on long time is preserved due to the fact that the body contains sufficient quantity estrogen and other hormones. Working capacity is not reduced. Aging occurs much later than menopause. When pathological condition female reproductive system or any common diseases In the body, the onset and duration of menopause are different. With fibromyoma and adenomyosis of the uterus, menopause occurs at a later age (after 55 years). This condition is called late menopause (climax tarda). Cases of early menopause (climax praecox) at the age of 40 years and earlier are less common. Early menopause is usually associated with severe infectious diseases, infantilism, mental trauma, malnutrition, tumors of the central nervous system. The postmenopausal period (menopause) lasts from 47-50 to 57-59 years. General and local changes in organism. General changes are expressed in the visible aging of the body: a tendency towards obesity, the appearance of wrinkles on the face, a decrease in libido; local - in the gradual atrophy of the uterus and mammary glands, cessation of menstruation. Ovarian function fades gradually. Atrophy of the genital organs is observed much later than the cessation of menstruation.
Senile (senile) period— the last period of a woman’s life lasts from 59-60 years until the end of her life. This period is characterized by general senile changes throughout the body and decreased ability to work. The genital organs atrophy: the uterus and fallopian tubes become sharply smaller, the ovaries shrink and thicken, the vagina narrows, its mucous membrane becomes thin, easily vulnerable, and its folding disappears. Senile colpitis often develops. Atrophy also extends to the external genitalia: the subcutaneous fat layer becomes flabby, pubic hair thins, becomes short and thin. Thus, the senile period is characterized by physiological rest of the reproductive system and age-related hypotrophy of the genital organs. Signs of estrogenic influences often found in older women are, obviously, the fact of excretion steroid hormones adrenal cortex or development of an ovarian tumor.
The characteristics of the female reproductive system are given, the features of its functioning depending on the time of ontogenesis. Are being considered possible deviations and complications in the reproductive system, their pathogenesis in different periods life. The dynamics of the female population in general and in individual areas is presented. age groups, its impact on the demographic situation in the republic.
The human body is a complex physiological systems, the normal operation of which ensures his existence as an individual. Currently, there are 12 systems in the human body: central nervous, reproductive, endocrine, musculoskeletal, lymphatic, immune and peripheral nervous, respiratory, circulatory, hematopoietic, digestive, excretory and skin. All systems consist of various organs, functionally related friend with each other, and represent a single whole, existing in constantly changing environmental conditions, performing all vital functions, the quality of which determines the level of health of the human body. The normal operation of these systems ensures the existence of the individual and his life activity. In addition, nature has endowed the human body with a unique mechanism of self-regulation and self-healing; it is also called the natural self-organizing system of the human body. The principle of self-regulation is that the body, using its own mechanisms, changes the intensity of the functioning of organs and systems according to its needs in various living conditions. Thanks to this, a person is able to endure significant loads and restore his health.
When any of the body systems is disrupted, disorders occur that are often incompatible with life. But there is a system that is not involved in life support processes, but its importance is extremely great - it ensures the continuation of the human race. This is the reproductive system. Like all body systems, the reproductive system is established and begins to develop during fetal development. This system is unique: if all others are vital important systems formed and function from the moment of birth to death, then the reproductive system works only during a certain period of time - during the heyday of all vitality. Genetically, this period is programmed for the age of 15-49 years.
The optimal age for the implementation of the basic functions of the reproductive system is considered 20-40 years, when a woman’s body is fully prepared for conceiving, bearing, giving birth and feeding a child.
The normal functioning of this mechanism depends on the coordinated interaction of the hypothalamus, pituitary gland, ovaries and endometrium, which ensures the regularity of menstruation every 21-35 days, which makes it possible to judge regular ovulation and, in general, the functional viability of the reproductive system. Any disease of the tissues and organs of the reproductive system or organs of the endocrine system can cause disturbances or absence of ovulation, which is manifested by irregular uterine bleeding.
Functionally, all organs and systems of a woman’s body are closely interconnected: activation of the activity of one body system necessarily entails activation of the activity of others. For example, during pregnancy, all organs and systems of the mother’s body work with increased load, the quantity and quality of which increases with the duration of pregnancy, which ensures its normal course, fetal development and prepares the woman’s body for childbirth and lactation. Exceeding the functional capabilities of the mother's body leads to pathological course pregnancy or its termination. On the other hand, modern traditional medicine cannot completely cure many diseases, since it is not possible to immediately influence all systems of the body. For example, not well known optimal conditions to maintain pregnancy, therefore, if there is a threat of its premature termination, they are used standard methods treatments provided for by the protocol, without correction of other body systems, the function of which, as a rule, is involved to a greater or lesser extent. As a result, treatment may not be effective. Therefore, for an accurate diagnosis and development of the correct treatment tactics, it is necessary to have a clear understanding of the functional state of both the reproductive system and other organs and systems.
The female reproductive system is represented by an anatomical and functional system that ensures the reproduction of the body. Anatomically, it is a set of female internal and external genital organs located in the pelvic area, between the rectum and bladder in the lower abdomen. The internal female genital organs are: ovaries, fallopian tubes, uterus and vagina, external - the pubis, labia majora and minora, vestibule of the vagina, clitoris, large glands of the vestibule of the vagina, hymen. The female reproductive system is characterized by four specific functions: menstrual, sexual, reproductive and secretory, the normal implementation of which ensures the continuation of the human race.
Functional status The reproductive system of a woman is largely determined by age-related anatomical and physiological characteristics, depending on which the following periods of a woman’s life are distinguished: antenatal, childhood, puberty, puberty, menopause (premenopause, menopause, perimenopause and postmenopause). The boundaries between periods are very arbitrary and vary depending on individual developmental conditions, hereditary, biological and social factors. Modern interpretation of existing age-related problems of reproduction, establishment of cause-and-effect relationships in the formation of somatic, reproductive health and quality of life during puberty, reproductive and menopausal periods makes it possible to develop a strategy for managing a woman from her intrauterine development to old age. Correction of identified disorders, based on determining the relationships of the body systems responsible for its reproductive system, allows us to re-imagine the pathogenesis of many diseases and disorders of the reproductive system, improve its condition at different age periods, and reduce reproductive losses.
I have just returned from a large international forum of doctors and scientists that took place in St. Petersburg. It discussed issues of improving the diagnosis and treatment of chronic myeloid leukemia. We have now achieved that the life expectancy of such patients has increased fourfold; people cured of this are already living, enjoying life and working in Russia serious illness... Along with domestic clinicians, hematologists from Houston (USA), Turin (Italy), and Mannheim (Germany) spoke at the forum.
I remember my conversations with sick teachers medical institute, professors. What can I say, it’s difficult to work with them! It is difficult to talk and act with them, as with all other patients... What else is characteristic of a sick doctor psychologically? Often such a patient completely forgets not only the effect of the drugs, but also the time of taking them, although he himself has prescribed them several times in his life.
During the inspection, we also first of all pay attention to Special attention skin. Normal skin and its changes during various diseases presented in sufficient detail in textbooks and monographs. Here I would just like to provide some information that will be of interest to doctors of various specialties and will allow them to understand why the skin undergoes changes. It is known that the skin is a full-fledged organ that complements and duplicates the functions of various internal organs. It actively participates in the process of respiration, excretion, and metabolism.
I never finish a questioning or conversation with a patient without finding out at least approximately the state of relationships in the family. Polypharmacy is a scourge modern medicine, internal medicine clinic. On rounds, we often see how patients are prescribed 13-16 drugs, often with mutually exclusive pharmacological properties.
Having studied hundreds of diagnostic errors, our team members are convinced that during diagnostic process practical doctors violate even the most elementary rules of logic. For example, they incorrectly use the methods of analogy, induction, and deduction.
And now, both in clinics and in hospitals, I myself have heard such “respectful and sweet” addresses from medical workers (and even students who take an example from their elders!!!), such as “darling”, “grandmother”, “darling” ", "darling", "darling", "grandmother", "grandfather", "grandfather", "woman", "man", "old man", "daddy", "mother", "father", "mother", “young lady”, “man”, “aunt”, “uncle”, etc. Many of these words are offensive to patients, full of contempt, and, as a rule, hurt the pride of patients and their relatives.
He rarely listened to the end of a report about a patient, often immediately asking questions clarifying the nature of the course of the disease and the characteristics of life. It’s amazing that he could say out loud: “Something is not clear to me here. There’s something missing in the medical history.” And he began to collect and figure out these “missing links” himself.
