Prof. Dr. Zdravko Kamenov: Menopause provokes cardiovascular diseases

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Prof. Dr. Zdravko Kamenov: Menopause provokes cardiovascular diseases
Prof. Dr. Zdravko Kamenov: Menopause provokes cardiovascular diseases
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Prof. Dr. Zdravko Kamenov is the head of the Clinic for Endocrinology and Diseases of the Exchange at the "Alexandrovska" University Hospital and the head of the Department of Internal Medicine at the Medical University - Sofia. He has acquired speci alties in endocrinology and metabolic diseases and internal diseases, and a master's degree in "He alth Management" at the Faculty of Public He alth of the Medical University - Sofia. Has Bulgaria's first qualification in sexual medicine from the Examination Committee of the European Society for Sexual Medicine. He specialized in the field of endocrinology in Great Britain, Denmark, Japan, Austria, Italy and the USA. He is the first Bulgarian doctor to receive the medal of the American Association of Clinical Endocrinologists for his work in the field of endocrinology. Prof. Kamenov has over 320 scientific works cited in more than 1,500 medical journals and books abroad.

Prof. Kamenov, what is menopause and why should a woman be more careful about her he alth during this period?

- Menopause is a precise moment in a woman's reproductive history. And this is the date of the last menstruation associated with hormonal activity, after which there is no menstruation for a year, i.e. this diagnosis is made retrospectively. Before menopause, there is a period of four to six years called premenopause. After it, there is another period, which is called postmenopause. These two periods, which together cover 6-12 years, are summarized by the concept of perimenopause, which acquires citizenship as climacteric - a transitional period of a woman's life, connecting her reproductive age with advanced age.

Hormonal changes in a woman's body begin significantly earlier - one can say after her 40th year, and at the beginning a progesterone deficiency syndrome is formed - a hormone that is involved in pregnancy, the menstrual cycle and embryogenesis in women. Menstruation becomes irregular, may be more abundant, and already after 45 years, estrogen production - the other hormones produced in the ovaries - begins to decrease. So, on average, around 50, the Bulgarian woman realizes menopause. However, it can be earlier. When it is under 45 years old - we are talking about early menopause. When it is under 40, we are talking about premature ovarian failure. I say this because there are also young women - 30-35 years old - who stop menstruating. Then the reasons for this should be sought. A number of pathological conditions can be behind a stopped menstruation, such as increased production of prolactin by a tumor in the pituitary gland. Generally, these tumors appear in women at a younger age.

You said that one of the symptoms of menopause is irregular periods. What else can tell a woman that she is entering such a period and what are its consequences?

- A number of symptoms of estrogen deficiency can appear, generally grouping them into three large groups. One includes the neurovegetative and neuropsychic complexes. These are short-term manifestations occurring in the majority of women and associated with hot flashes, sweating, nervousness, tension, dizziness, insomnia, deterioration of concentration and cognitive functions, unexplained anxiety and irritability. These symptoms tend to diminish after menopause and disappear over time. Some women may have no complaints at all.

Others develop these usual complaints but disappear within 3-5 years. But there are also women (about 5%) in whom they persist for 10 years or more, i.e. practically do not disappear.

Further after menopause we have medium-term manifestations. They are associated with changes in the urogenital system and occur in a quarter to half of women. On the one hand, after the reduction and disappearance of estrogens, there is atrophy and thinning of the vaginal mucosa. Its acidity and bacterial composition change. Protective bacteria decrease, pathogenic bacteria increase, the mucous membrane becomes more vulnerable, inflammations often develop - colpitis, which manifests itself in irritation, pain during intercourse, dryness of the vagina, etc. These changes also lead to sexual disorders. Sexual dysfunctions in women (decreased sexual desire, arousal, orgasm, or pain during intercourse) are more common than in men, but they rarely receive the necessary medical attention. Changes also occur in the urinary tract, the lower urinary tract - frequent urination, recurrent inflammation of the bladder and urethra, burning during urination. Often later, especially when we have previously had some more difficult births, traumas, falls, etc., incontinence may appear - involuntary leakage of urine.

We also have long-term manifestations, which are actually the biggest problem after menopause. The main thing that leaves an impression on a woman's he alth and life expectancy are the changes in the metabolism, the cardiovascular system and in the bones. A metabolic syndrome develops with an increased incidence of obesity, arterial hypertension, diabetes mellitus, disorders in fat metabolism. Women generally have a lower cardiovascular risk than men, but after menopause, within ten years, this risk levels off. After menopause, skin changes also occur. Approximately 2% per year decreases the collagen content in the skin, about 1% per year decreases the thickness of the skin, it becomes drier, wrinkles and all other unpleasant skin manifestations appear.

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Prof. Kamenov

But statistically women live longer than men

- Yes, that's right, and this difference in developed countries is about 5 years, in Bulgaria - 7 years. However, cardiovascular disease, which is the number one cause of death in women as well, progresses, especially after the cessation of menstruation.

There is a lot of talk "for" and "against" hormone treatment. Should hormone treatment be used and when should it be started?

- Hormonal treatment is a very big topic. It has undergone a rapid evolution over the past three decades. About thirty years ago, when I started my career as an endocrinologist, we observed the effects and prescribed hormones with great enthusiasm. The percentage of estrogen prescriptions in some developed European countries was around 30, and in the USA it reached almost 50% of postmenopausal women. It was believed that this was the way for a woman to keep her he alth and stay forever young. Then some data started to accumulate, there were studies that came out at the beginning of this millennium, 2002, that showed that hormones don't actually have as much cardiovascular benefit as they were supposed to. A little later, the data from a large study in the USA - the Women's He alth Initiative - came out, the results of which were quite surprising in an unfavorable aspect.

In this study, in addition to things that were known or assumed, it turned out that after hormone replacement therapy there is some increase in the risk of heart attacks and strokes. Until then, we thought that estrogens had a protective effect - what we talked about at the beginning of our conversation. And we began to wonder why this happens. Before the Women's He alth Initiative, there was a large observational study of nurses in the US that showed exactly the opposite effect - that if a woman was treated with hormones, the risk of a cardiovascular event was cut in half. Upon closer analysis, both studies were found to be correct in their own way.

The second study in the sisters looked at younger women who started hormone treatment around menopause. While in the Women's He alth Initiative study, the age range of participants starting hormones was 50 to 79 years. Thus, almost a quarter of these women started hormones after age 70. It then became clear that the further the period of hormone initiation after menopause, the fewer the benefits and the greater the risks of this treatment. And this is easily explained, because the vessels change, they begin to react paradoxically to the hormones, which otherwise have a beneficial effect. The impression of the sensational negative news of the "Women's He alth Initiative" led to unjustified neglect of some very interesting and long-awaited results. This study showed that timely hormonal treatment reduces the risk not only of vertebral fractures of the spine, but also of the femur. The risk of diabetes is reduced by 18%. When treated with only estrogens (without progestogens), the risk of breast cancer also decreased by 23%. With each decade, the percentage of women who have osteoporosis increases and the fractures that can occur lead to a reduction in life expectancy. In particular, these are hip fractures. After a hip fracture, a small number of women fully regain their functional capacity, about 20% do not survive the end of the first year, and 60% of the remaining women remain disabled to varying degrees.

So if I had to summarize - the conclusions that could be drawn from the analysis of these studies are that if a woman starts her hormone treatment around and soon after menopause, she has far more benefits than risks Naturally, no one can escape from their heredity, from their genes. Hormones should be started after a comprehensive assessment of the expected benefits and risks of the particular woman, i.e. to have an individualized approach.

Is there a cure for osteoporosis?

- Hormone replacement therapy has proven beneficial effects. There are many "preparations", mostly from various herbs, that are advertised, and if they contain phytoestrogens, they probably have some beneficial effect. Of course, to prove it, relevant clinical trials must have been conducted - we doctors trust evidence-based medicine. But the hormones themselves have the most powerful effect, because the main reason for the development of postmenopausal osteoporosis is the deficiency of hormones. Based on what has been shown to reduce fracture risk, they can serve both to prevent osteoporosis and to treat it. Today we have enough powerful and non-hormonal agents that increase bone density and strength that they are the first line of treatment. But hormones given even with other indications also have this beneficial effect.

Can we delay menopause?

- We can to some extent by reducing the risk factors. For example, smoking causes premature menopause. Any stressful conditions, tensions, other diseases can also lead to early termination of the cycle. When we talk about a very early process, then a number of autoimmune mechanisms of ovarian damage are often involved. So a he althy lifestyle with a normal body weight, with sufficient physical activity, without it being too much, reflects well in this aspect as well. A harmony of the soul, if you will, harmony with the partner at home, with the children, at work, etc.n. There is no definitive data in this regard, but these few factors that I have listed for you are related to a certain delay of menopause and its negative consequences. I have many female patients who are treated with hormones and who maintain a good condition.

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