Early termination of menstrual function: modern views on pathogenesis and consequences

Abstract

One of the problems of modern endocrine gynecology is the increase in the number of women living in the peri-menopausal and post-menopausal period, therefore the study of the climacteric syndrome pathogenesis is of considerable interest to scientists. Separate issues are the problem of early termination of menstrual function, which can be based on both spontaneous and surgically induced ovarian stops. The article presents modern and evidentiary data concerning the pathogenetic factors of early ovarian exhaustion, such as genetic, infectious, social factors, bad habits. Particular attention is paid to the possible iatrogenic factors of premature cessation of menstrual function, such as the use of oral combined contraceptives and chemotherapy for oncological diseases. Actually, the views of oral contraceptives have done fundamental changes over the last decade, from the protective effect of gonadotropic hormone synthesis inhibition on the maintenance of the ovarian reserve to the current perception it as a damaging factor.Theories of the development of changes in extragenital organs and systems with timely and premature menopause are identified, namely, the time theory and the theory of the critical window. The actual data concerning the characteristics of the menopausal period in patients with early termination of menstrual function, in particular, the more rapid development of atherosclerosis, lipid regulation disorders, osteoporosis and its complications, are given. The mechanisms of increased cardiovascular morbidity and mortality risk of in the case of early cessation of menstrual function are discussed – a sharp imbalance of lipid metabolism with an level up of the atherogenic lipoproteins fractions, estrogen-dependent suppression of fibrinolysis, endothelial disfunction.The greater tendency of women with early menopause to develop depression is emphasized. The actual tension of waiting for or excluding the diagnosis of early menopause, which completes the period of young self-perception of a woman, exacerbates hormonal disorders. Most of all the duration of cyclic estrogen exposure determines the risk of depression developing, but there is also a dependence on ethnicity, the severity of vasomotor symptoms, smoking, and excess body weight. From these perspectives, early cessation of menstrual function is an independent risk factor for postmenopausal depression.