Menopause is a complete break in the menstrual cycle and occurs one year after the last menstrual period and lasts for the rest of woman’s life. The period of gradual extinction of the ovarian function lasts from five to ten years and covers peri-menopause, menopause and post-menopause. Menopause is the end of a woman’s reproductive capacity, caused by hormonal changes. It is a natural phenomenon that occurs in older women due to the depletion of ovarian function. During the period of menopause, there are major changes in the way the body functions of the woman, but also changes that affect the quality of life because, in addition to physical difficulties, there are psychological problems that impair daily functioning.
The main sign that indicates the onset of menopause is irregular menstruation, which may occur more often than usual at first, and then the breaks between the two menstrual periods will increase. Additional symptoms that result from variations in the amount of hormones secreted are: the onset of hot flashes, night sweats, mood swings, insomnia, headaches and rapid heartbeats. Not all ladies will feel all the symptoms, nor will the intensity of the symptoms be the same, so the most sensitive group will be those women who have had intense symptoms in premenstrual syndrome (PMS) and those who have experienced postpartum depression. This group of women is actually most sensitive to changes in hormonal status. Epidemiological data say that as many as 75-85% of women experience symptoms that more or less affect their quality of life and work ability. Although menopausal health and advancement should be a priority for every woman, most of them do not pay enough attention and do not respond adequately to symptoms that should not be neglected, as the consequences can be much more dangerous. Due to the decrease in estrogen production, collagen is lost, so menopausal women experience thinning of the skin and hair, the appearance of joint and muscle pain, but a far more serious consequence is the occurrence of osteoporosis, or reduced bone density, which increases the risk of fracture even with harmless bumps and falls. A decrease in the amount of estrogen in the body will also lead to a decreased secretion of serotonin, a hormone that has a significant effect on mood, which is why panic attacks and depression can occur during menopause.
Menopause can be proven by confirming the patient’s absence of menstruation within the last year or longer. The help of a physician should be sought as soon as irregular menstruation occurs or if the first symptoms of climax occur, in order to initiate adequate therapy on time and to maximize quality of life. Diagnosis is based on the results of hormonal and baseline analyzes, gynecological and internist examination, mammography and breast ultrasound. Menopause most commonly occurs between the ages of 45 and 55. It should not be seen as a disease, but as a process of accustoming the body to new changes.
There are many non-pharmacological measures that can help women during this period. Some of them are: regular exercise, smoking cessation, reduction of caffeine, sugar and alcohol intake, and adequate preparation for a night’s sleep, which involves reducing the lighting in the room, avoiding looking at the TV or mobile phone before going to sleep, etc. Through the numerous tests that have been conducted, experts have come to the conclusion that adequate supplementation would greatly help women to overcome this period and slow down the occurrence of possible complications.
PCOS - Polycystic Ovary Syndrome
Polycystic ovary syndrome (PCOS) is the most common hormonal disease in women in the reproductive period, whose incidence is estimated at as many as 8-18% of the population, meaning that every tenth woman has this problem.
The syndrome is characterized by a number of associated symptoms, the most common of them are: enlarged ovaries with numerous water cysts, menstrual dysfunction, increased malnutrition, occurrence of central type acne and obesity, hair loss and decreased target organ resistance to insulin (insulin resistance).
The exact cause of PCOS is not yet completely clear. In recent years, there has been an association between polycystic ovary syndrome and elevated insulin levels, which, according to some experts, is a central event in the onset and development of PCOS. The diagnosis is certainly made by a gynecologist after an ultrasound examination and medical history. It often happens that women do not recognize or treat this disease for years, which can lead to a number of serious consequences, including an increased incidence of miscarriages, cardiovascular problems, and increased levels of fat in the blood, which introduces the patient to the metabolic syndrome. Therefore is important that women do not ignore any of the symptoms they see in order to diagnose the problem as soon as possible and to start treatment.
Access to PCOS treatment is individual and depends on the patient’s age, cycle disorders, insulin levels, obesity, patient’s desire for pregnancy, etc.
Urinary infections are infections that occur most commonly in women and are the most common infectious diseases immediately after respiratory infections. Urinary infections are divided into acute ones, which occur suddenly with violent symptomatology and chronic – slow flow lasting longer. There is a division into both complicated and uncomplicated, with complicated urinary infections having some pathophysiological or anatomical predisposition to infection. Usually, such an infection is treated with longer or more powerful antibiotics, such as in diabetics, immunocompromised patients suffering from malignancies, patients with stones in the urinary tract or some congenital or acquired urinary tract anomaly, etc. Some urinary infections occur exclusively after sexual intercourse, so we call them “honeymoon” cystitis or “honeymoon” infections, and they require a special form of therapy. Hospital infections are special because they are often caused by highly resistant bacteria, insensitive to the action of numerous antibiotics. The most severe form of urinary infection is urinary sepsis, which is caused by the spread of the infection to other organs, and is a difficult and life-threatening condition and is often treated with special “backup” antibiotics.
Urinary infection is usually manifested by frequent urge to urinate, wheezing when urinating, pain in the lower abdomen or in the urethra, especially at the end of urination, and sometimes blood in the urine can be seen, visible to the naked eye or microscopically. In these cases, the most common is inflammation of the bladder (cystitis).
Urinary infections are evidenced by examination of the urine and urinalysis, which requires taking the first morning urine, a medium jet, after washing hands and genitals. It should be remembered that the urine sample should be brought within 30-45 minutes to the laboratory at the latest.
The therapy and length of treatment for urinary infection is prescribed by the urologist after diagnosis. In addition to antibiotic and non-antibiotic therapy prescribed by a urologist, there are non-pharmacological measures that can help reduce symptoms and work to prevent urinary infections. Prevention of urinary infection:
- Increase fluid intake, as this decreases the concentration of bacteria in the urinary tract organs, and with more frequent urination they are mechanically removed,
- Avoiding cold and fizzy drinks,
- In periods of treatment of urinary infections candy intake should be reduced,
- Avoid sexual relations,
- Increase the level of personal hygiene,
- It is not necessary to delay urination, but to urinate as often as possible.
Vaginal infections are among the most common reasons for a visit to a gynecologist. The bacteria can be caused by bacteria, fungi, viruses and protozoa. Symptoms vary depending on the causative agent but are most commonly manifested by irritation, itching, and increased vaginal secretion. The incidence of infections is slightly higher in the summer and the reason is exposure to cold water (sometimes bacteriologically defective), wet bathing suits during rest, and changes in more sexual partners.
The most common cause of vaginal candidiasis is Candida albicans fungi , while in about 10% of cases it can be caused by other fungi types. The most striking symptom is itching in the vulva and vagina. However, symptomatology often does not have to be typical, since candida is a saprophytic microorganism, a normal resident of the vagina in small numbers.
Vaginal fungal infection can cause problems such as:
- Vaginal tingling (increased during urination and intercourse),
- Thick, white secretion (similar to cheese),
- Vaginal irritation,
- Vaginal redness and swelling of the outer intimate region.
The diagnosis is made by a gynecologist after a history and examination of the mucosa. A microscopic examination is taken (thus determining the secretion group). In case of candida, vaginal secretion will be group VI purity. It is less common to have a swab to sow on a medium on which candida albicans colonies or rarely any other candida species will grow after a few days. Although symptoms may indicate that it is candidiasis, it is often only the symptoms that are misdiagnosed, as other causative agents can cause the identical symptoms of vulvovaginitis, and candidiasis itself can develop an atypical clinical picture.
All women with vulvovaginal fungal infection must be treated regardless of severity symptoms. Treatment is performed by a gynecologist who determines the type, method and regimen of therapy individually. Regular gynecological examinations are the best solution for women who have a problem with frequent ones vaginal infections Therapy is performed with vaginal antifungals of which there are several species, usually lasting from 3 to 7 days. Local therapy may also include antimycotic ointments for the skin and mucous membranes of the vulva. If the gynecologist evaluates, he may give oral, single dose systemic antifungal. Prevention:
- Avoid wearing tight underwear, tight pants, socks, or panties,
- Avoid using intimate deodorants or deodorized tampons / pads,
- Don’t sit in wet clothes, especially in a swimsuit,
- Use well-balanced diet,
- Wear natural fiber clothing,
- Avoid sitting in tubs or frequent warm baths,
- Avoid vaginal flushing.
Bacterial vaginosis is caused by an increase in the number of bacteria that are otherwise less present as a normal part of the bacterial flora, while reducing the protective bacteria Lactobacillus, which creates lactic acid necessary to maintain optimal vaginal pH and protect against infections. The cause of the vaginal flora is not well known. However, there are some factors that can increase the risk of bacterial vaginosis. Bacterial vaginosis develops when the natural balance of the vagina is disturbed. Normally, healthy lactobacilli are the dominant bacteria in the vagina, but if bacterial vaginosis develops, other unwanted bacteria begin to outgrow lactobacilli.
Symptoms of bacterial vaginosis may include:
- Abundant rare white secretion,
- Vaginal tingling (intensified during urination),
- Vaginal itching,
- Intense unpleasant odor,
The diagnosis is made by clinical and microbiological examination of vaginal secretions. The clinical picture shows signs of inflammation such as redness or swelling of the mucosa and copious clear secretions. Microscopic examination of the vaginal swab preparation reveals the mass of gram labile bacilli and characteristic clue cells (epithelial cells covered with bacterial mass), lactobacilli deficiency, and leukocytes are absent. The pH value is elevated (ph> 4.5) and the amine test is positive (smear vaginal secretion on the glass slide, 1-2 drops of 10% KOH are added, which develops a characteristic unpleasant odor).
Bacterial infections are treated with antibiotic therapy, as recommended by a gynecologist. Antibiotics may be effective, but they have their drawbacks and carry the risk of developing resistance, which is why it is important that gynecologists recommend antibiotic therapy.
The most common disorder that results from impaired bladder position or function is urinary incontinence, which involves involuntary loss of urine. Normal bladder:
- is emptied 4-8 times during the day, at 3- 4 hours,
- can store 400 to 600 ml of urine, although the need to urinate occurs when there is about 300 ml of urine,
- it can wake you up to empty it 1-2 times during the night if you are over 65,
- it indicates that it is full but gives you plenty of time to reach the toilet completely empty,
- does not allow the urine to leak involuntarily.
The disorder that causes involuntary loss of urine at the level of the bladder or sphincter muscle is called incontinence. The most common two types of incontinence are: Stress incontinence and Urgent incontinence. Stress incontinence occurs with increased pressure that occurs when sneezing, coughing, straining, lifting weights and exercising. Then there is the involuntary loss of urine in the amount of a few drops to tens of milers of urine. In stress incontinence, there is no prior need to urinate before losing urine. Incontinence stress in women occurs as a result of impaired anatomical relationships as a result of the weakening of the pelvic floor muscles (for example, after birth) or as a result of sphincter weakness. In men, stress incontinence may be a consequence of surgical treatment of the prostate due to benign enlargement or cancer. In cases of urgent incontinence, patients feel an urgent need for urination, which they can not control.
The gynecological examination determines whether there is a “lowering” of the genital organs, ie whether there is an anatomic defect as a cause of incontinence. It is necessary to keep a log of urination on the basis of its daily activity, as well as to record data on the amount of fluid entered and urinated during the day. The exact time and record of any episode of involuntary release of urine or activity during which there was an involuntary swelling of urine should be recorded. Laboratory analyzes involving urine sedimentation and urinalysis should be performed in order to conduct adequate treatment. If there is an infection, treating the infection can reduce or completely eliminate the symptoms of frequent urination and lower abdominal pain. Urodynamic processing is a way of diagnosing incontinence, that is, impaired bladder function for filling and emptying. A catheter is inserted through the urethra through which the bladder is filled. When filling the bladder, it can be seen whether it is an urgent or overactive bladder. As part of urodynamics, a cough test with a filled bladder is performed to establish a diagnosis of stress incontinence.
Urgent incontinence is treated with medicines that aim to relax the bladder muscles, thereby increasing the capacity of the bladder. Depending on the severity of stress, incontinence is treated in a number of ways. The simplest way is Kegel exercises, which are effective, especially in the initial stages, but must be performed regularly. Kegel exercises are exercises for vaginal muscles that help women and men strengthen their pelvic floor. They are especially recommended after birth and due to health problems such as urinary incontinence. In menopause, these exercises are also the perfect solution because they prevent the uterus and bladder from lowering. It is important to identify the muscles to be exercised before starting the exercises. This is most easily achieved by interrupting the flow of urine during urination, thus recognizing the right muscles. Further, exercises are never done in the urination phase. Since you have correctly identified the muscles to be exercised and as you empty the bladder, you will work in a standing or lying position. The muscles are first tightened for three seconds, then relaxed for the same duration. This exercise should be repeated 10 times. In the following exercises, the contraction and relaxation length should gradually increase to 10 seconds alternately. This set of exercises should be repeated three times a day. In case of urgent incontinence, there is also a possibility of self-help which consists in the following: at the moment when the urgent need for urination is obtained, one should stop, tighten the pelvic floor muscles, relax other parts of the body, concentrate on stopping the need for urination. Then it is necessary to wait for this unbearable urge to gradually subside and then slowly leave to the toilet. Electro stimulation is a method used in the treatment of stress incontinence, mixed incontinence and urgent incontinence. Depending on incontinence, different currents are used, sessions last up to 30 minutes and can be performed at home after the patient is pre-trained. The current is administered via a vaginal probe in women or anal in men.