The dynamics of quality of life indicators in women against the background of personalized therapy of menopausal syndrome combined with perimenopausal melatonin deficiency syndrome

Abstract

Introduction. Climacteric syndrome (CS) significantly reduces the quality of life (QOL) of peri— and postmenopausal women. Along with sex steroid deficiency in KS, there is a change in the synthesis of the epiphysis hormone melatonin (MT), which leads to the formation of perimenopausal melatonin deficiency syndrome (SPDM) (Patent 2019118500/14(035525) of 16.05.2020). The aim of the work was to evaluate clinical efficacy and QOL dynamics in women against the background of personalized treatment of CS in combination with SPDM. Methods and Materials. The study included 163 women. Groups 1, 2, 3 and 4 consisted of patients with CF and SPDM, control group 5 consisted of women with a normal course of the menopausal period and the absence of clinical manifestations of MT deficiency. After collecting medical history, determining the degree of CS severity with the help of the modified menopausal index (MMI) (H. Kuppermanetal. 1959, modified by E.V. Uvarova 1983), CS was assessed by the SF-36 general questionnaire and special women's health questionnaire (WHQ). The presence of MT deficiency was determined by the MT deficiency test-questionnaire and the WHQ scales. According to the «Stratification Algorithm for Women in the Menopausal Transition and Postmenopause with CS in Combination with SPDM for Selecting Differentiated Therapy» that we developed, Group 1 patients received MT monotherapy, Group 2 — synthetic gynestein, Group 3 — menopausal hormone therapy in combination with MT, and Group 4 — synthetic gynestein with MT for 5-6 months. The data were statistically processed using SPSSv13.0 software. The χ2 criterion was determined at baseline and the Wilcoxon test was used for dynamic follow-up. Results. Patients in groups 1, 2, 3, and 4 experienced relief of both the clinical manifestations of CS and SPDM and an increase in the physical and psychological components of QOL according to the SF-36 general questionnaire and the vast majority of the scales of the special WHQ questionnaire. Discussion. We hypothesized that the lack of complete efficacy of CS therapy in peri— and postmenopausal women is associated with the absence of a differentiated approach based on the active detection of SPDM. In the course of the study, it was proved that individual selection of CS therapy taking into account the presence of MT synthesis deficiency allows to achieve a 100% positive result of treatment in women of all four groups. Conclusions. Against the background of personalized treatment of CS in combination with SPDM in women, not only CS has been stopped, but also the level of QOL has been increased.