Risks and prevention of stroke in menopause

Climacteric period (menopause) is the time period preceding the ageing process. Depending on the termination of menstruation, this period is divided into three stages: pre-menopause, menopause and post-menopause. Climacterium is a normal condition and is characterized by the appearance of the expressed signs of ageing. Among the pathologies of menopause are same name syndrome, osteopenia, cardiovascular disorders, osteoporosis, hypotrophic manifestations in the genitourinary system, etc. Pathologies, as a rule, are due to the termination of the ovarian function and ageing of the female body.

Basically one third of a woman’s life accounts for the menopause. Research conducted in recent years proved the possibility to improve a woman’s life quality during this period with the help of hormone replacement therapy. This method of treatment makes it possible to reduce the likelihood of developing cardiovascular pathology, urinary incontinence and osteoporosis by 40-50%.

Pre-menopause

Pre-menopause is a period prior to menopause, which is manifested by psychological and somatic changes, caused by the extinction of the ovarian function. Early detection of such changes makes it possible to prevent the development of a pronounced climacteric syndrome. Typically, pre-menopause begins after the age of 45 and initially manifests minor symptoms that are associated with mental overexertion.

The most typical manifestation of pre-menopause is menstrual irregularities - for 4 years, which precede menopause. This symptom is observed in 90% of women. Hypoestrogenism should also be excluded in all patients who complain of weakness, fatigue and irritability.

Menopause

Menopause is a part of the natural process of ageing characterized by the termination of menstruation and extinction of the ovarian function. The average age which women experience the onset of menopause 51 years of age. The condition doesn’t depend on the nationality and nutrition peculiarities. However, it has been noted, that menopause starts earlier in women who didn’t not give birth to the children and were smoking.

Post-menopause

This is a period following menopause and lasting approximately one third of the woman’s life. The consequences of hypoestrogenism are serious enough, because of their health implications. They are similar to the consequences of adrenal insufficiency and hypothyroidism. Despite this, doctors often do not pay enough attention to hormone replacement therapy in postmenopausal women, although it is one of the most important components of prevention and treatment of various pathologies in elderly women.

Most likely, this state of affairs is due to the fact that the effects of hypoestrogenism develop slowly enough, so they are often attributed to natural ageing.

Stroke and menopause

Cardiovascular diseases are pathologies with a large number of predisposing factors, the most important of which is the age of the patient. As you age, the risk of stroke increases in both men and women, but there is a significant nuance. It is proved that the risk of death from stroke in women of childbearing age is on average three times less than in men of the same age group. As women enter into post-menopause, this risk increases dramatically.

Earlier, the increase in the incidence of cardiovascular disease in general and stroke in particular during the post-menopause was explained only by age. Today it is proved that hypoestrogenism plays a big role in the development of stroke. It is one of the simplest risk factors to eliminate of atherosclerosis.

According to a study conducted by the authors from the University of Hopkins, women who experience the first phase of the climacteric period at the age under 46, suffer from cardiovascular diseases twice as often.

Also, American doctors conducted an analysis of the health status of 2,509 women who participated in a multinational study aimed at studying atherosclerosis. The age of the participants ranged from 45 to 84 years, the data was collected from 2000 to 2008. Consideration was given to such issues as diet, bad habits, ethnic diversity and physical activity.

The results of the study showed that in 28% of patients the climacteric period began before the age of 46 years. At the same time, 18% of them underwent surgical intervention on the genitals, and the remaining 10% smoked. Stroke developed in 37 women, and in 50 patients issues relating to the functioning of the cardiovascular system was experienced. The authors argue that, despite the relatively small, actual number of stroke cases among participants in the study, the risk of developing this acute condition in patients in the menopausal period remains high.

The head of the study, Professor Danaway Vaidai, states the following:

«The connection between the early onset of the climacteric period and the development of cardiovascular disease is becoming more prominent - especially if you take into account other risk factors. Unfortunately, most young women do not pay due attention to the prevention of such pathological conditions, considering probability of cardiovascular diseases occurrence only in the elderly age. In connection with this, doctors need to educate women, and, if a patient finds signs of an early menopause, give her recommendations for the prevention of the development of ischemic diseases.»

Hormone Replacement Therapy

To prevent these and other complications of the climacteric period, the most effective means is hormone replacement therapy. In women who receive estrogens in post-menopause, the risk of developing a stroke and myocardial infarction decreases by more than 50%. A doctor who consults with a woman in post-menopause should necessarily inform her about cardiovascular diseases and the need for their prevention - this is especially important if the patient refuses hormone replacement therapy.

In addition to the treatment of hypoestrogenism to reduce the likelihood of stroke, one should strive to eliminate other risk factors of atherosclerosis. The most significant of them are smoking and arterial hypertension as the consumption of cigarettes increases the chance of stroke also increased 3 times over, and arterial hypertension – by 10 times. Also among the risk factors should be noted such markers as sedentary lifestyle, hyperlipidemia and diabetes.

Climacteric syndrome, which is most often observed in the pre-menopausal phase, is characterized by neurologic, vegetative-vascular, neurological and metabolic manifestations. Instability of mood, hot flushes, propensity to depression can be observed. Diabetes mellitus of the second type often progresses during this period, hypertension is aggravated. There are exacerbations of lung pathologies and peptic ulcer. Gradually, the hypotrophic processes of the urethra, vaginal mucosa and bladder are progressing, the risk of vaginal and urinary infections increases, and the probability of fracture increases. Progression of atherosclerosis, significantly increases the risk of stroke.

Hormone replacement therapy, started with the first manifestations of climacteric syndrome, showed good results in 80-90% of cases. The course of treatment halves the risk of stroke and prolongs life expectancy even in patients with narrowing of the coronary artery lumen, which is determined by angiography. Estrogens effectively prevent the appearance of atherosclerotic plaques. Also in recent years, favorable effects of HRT on Alzheimer's disease have been identified.

It is important to note that HRT also has a negative effect on the body: estrogens increase the risk of developing uterine body cancer and hyperplasia, but the simultaneous administration of progestogens to the patient can prevent the development of these diseases.

Despite all the advantages of hormone replacement therapy, this technique has not really received a wide clinical spread yet. It is believed that no more than 30% of women in the postmenopausal period are taking estrogens. This state of affairs is explained by the significant number of women who have limitations and relative contraindications to HRT. In adulthood, many patients are faced with uterine myoma, hyperplastic processes of the reproductive organs, endometriosis, fibrocystic mastopathy, etc. All this leads to the need to look for alternative ways of treating menopausal disorders.

See also similar articles on the subject:

• Stroke affects more young people each year
• Magnesium and potassium in the stroke prevention
• Transient Ischemic attack

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