Postcostation syndrome - Causes, symptoms and treatment. MF.

Postcardation Syndrome( PKC) is a complex of vegetative-vascular, neuroendocrine and neuropsychiatric symptoms that arise after total or subtotal ovariectomy( castration) in combination with removal of the uterus or without removal.

Symptoms of Post-Stastic Syndrome

Symptoms of PKC occur 1-3 weeks after surgery and reach full development in 2-3 months.

The clinical picture is dominated by:

• vegetative-vascular disorders( 73%) - hot flashes, sweating, tachycardia, arrhythmia, heart pain, hypertensive crises;
• metabolic-endocrine disorders( 15%) - obesity, hyperlipidemia, hyperglycemia;
• psychoemotional( 12%) - irritability, tearfulness, bad sleep, impaired concentration, aggressively depressive conditions.

In subsequent years, the frequency of metabolic-endocrine disorders increases, and neurovegetative disorders decreases. Psychoemotional disorders persist for a long time.

After 3-5 years, there are symptoms of estrogen deficiency in the organs of the genitourinary system: atrophic colpitis, cystitis, cystalgia, as well as osteoporosis.

Changes in hormonal homeostasis lead to severe metabolic disturbances: a change in the lipid profile of the blood in the direction of increasing factors of atherogenicity, which leads to atherosclerosis and cardiovascular diseases;activation of procoagulant hemostasis contributes to thromboembolic complications, microcirculation disorders.

The most recent manifestation of metabolic disorders associated with ovariectomy is osteoporosis. Clinical manifestations of it are atraumatic or minor traumatic fractures;Parodontosis often develops as a result of the weakening of the processes of reparative gingiva regeneration.

Causes of Postastrial Syndrome

Postastratsionny syndrome develops in 60-80% of operated women after total or subtotal oophorectomy with the uterus or without the uterus. The latter variant is extremely rare in women of reproductive age, operated on for tubo-ovarian tumors and benign ovarian tumors. Removal of the uterus without appendages is justified in women who have not performed a generative function. Recovery of fertility in such women is currently possible with the help of assisted reproduction methods. The most frequent operation, after which the post-stroke syndrome occurs, is a hysterectomy with ovariectomy for uterine myoma and / or adenomyosis. The removal of ovaries in women older than 45-50 years in the conduct of such operations is more often due to "oncological alertness".In addition, there was a high incidence of repeated laparotomy for the adnexa in women who had undergone a hysterectomy in the past without appendages.

The variety of symptoms that occur after surgical ovarian function cutoff is explained by the wide range of biological effects of sex hormones. After switching off the function of the ovaries by the mechanism of negative feedback, the level of gonadotropins naturally increases. In the development of post-stroke syndrome, the entire neuroendocrine system, responsible for the mechanisms of adaptation in response to ovariectomy, participates. A special role in the mechanisms of adaptation is given to the adrenal cortex, in which the synthesis of glucocorticoids and androgens occurs in response to stress( in particular, castration).Postastratsionny syndrome develops in women with a burdened premorbitic background, functional lability of the hypothalamic-pituitary system. The incidence of PKC increases in premenopausal women, since ovariectomy during the natural age involution exacerbates the biological adaptation of the organism and leads to the disruption of protective adaptive mechanisms.

Thus, in contrast to natural menopause, in which the fading of the ovarian function takes place gradually over several years, with oophorectomy( PKC ), the steroidogenic function of the ovaries is instantaneously abruptly cut off.

Diagnosis of Post-Stastastic Syndrome

The diagnosis of difficulty is not presented and is established based on the history and clinical picture.

The examination shows atrophic processes of the vulva and vaginal mucosa.

Blood hormones are characterized by an elevated level of gonadotropins, especially FSH, and a decreased E2, which is characteristic of postmenopausal age.

Treatment of Post-Stastastic Syndrome

The main method of treatment of post-stroke syndrome is hormone replacement therapy( HRT).With a mild form of post-stroke syndrome, absence of complaints, preserved performance and rapid reverse development of HRT symptoms can not be performed. In such cases, vitamin therapy( vitamins A and C), changes in diet( predominance of plant foods, reduction in the consumption of animal fats in favor of plant), tranquilizers for sleep disturbance and a labile mood are shown. Movement activity( walking) and exercise are desirable if during a woman's life she was engaged in gymnastics, skiing, etc.

In recent years, HRT has been widely used for femostone, in which the estrogen component is represented by micronized 17β-estradiol, and progestogenic - by djufastone. Duphaston( dydrogesterone) is an analog of natural progesterone, is deprived of androgenic effects, does not cause an increase in body weight, potentiates the protective effect of estrogens on the lipid profile of the blood and does not affect glucose metabolism. Against the background of femoston, the level of total cholesterol, triglycerides, LDL decreases, the level of HDL is increased, which is extremely important with insulin resistance, often associated with obesity. All these advantages of femostone put it on the first place among a variety of drugs for HRT, especially with prolonged use for the prevention of atherosclerosis, cardiovascular diseases, osteoporosis.

Most drugs used for HRT are biphasic( the first 11 tablets contain estradiol, the next 10 are estradiol + gestagens).Also used are deposited drugs.

Duration of treatment is determined individually, but should not be less than 2-3 years, during which the vegetovascular symptoms usually disappear.

Absolute contraindications for HRT:

• breast cancer or endometrium,
• coagulopathy,
• , liver function abnormalities,
• thrombophlebitis,
• uterine bleeding, unspecified genesis.

These contraindications are valid for any age and for any manifestations of post-stroke syndrome.

In addition to hormonal treatment, symptomatic therapy is performed: sedatives, tranquilizers, neurotransmitter metabolism regulators in the central nervous system, vitamins, hepatoprotectors, disaggregant and anticoagulant therapy( aspirin, quarantil, trental), taking into account the coagulogram data.

Women are subject to regular follow-up. Mandatory monitoring is carried out for the condition of the mammary glands( ultrasound, mammography), hepatobiliary tract and blood coagulation system.

The prognosis depends on the age, premorbit background, the volume of the operation and the course of the postoperative period, the timeliness of the initiation of therapy and the prevention of metabolic disorders.