Pathogenesis (development of disease)
Synthesis (production) of sex hormones progressively decreases with the onset of climacteric. First, the ovarian (ovary-associated) synthesis of progesterone decreases, followed by that of estrogens (17-β-estradiol) and finally androgens. After menopause, estrogens are no longer produced by the ovaries, but exclusively by adipose tissue. Therefore, estrogen formation in overweight women in menopause can be equal to that of young women in the fertile phase! However, it is then more estrone (estrogen) than estradiol. In postmenopause, androgen production also falls. The most important estrogens are estradiol (17-β-estradiol), estrone and estriol (estriol) – these are important, among other things – along with progesterone – for fertility (fertility) and thus for reproduction. Furthermore, estrogens protect against bone loss (osteoporosis) and atherosclerosis (hardening of the arteries), maintain the elasticity of the skin and strengthen the immune system. Thus, the declining activity of the ovaries increasingly leads to a permanent hormone deficiency, which manifests itself in menopausal symptoms (menopausal symptoms; climacteric syndrome) and can also promote diseases such as osteoporosis and atherosclerosis.
Etiology (causes) of climacteric praecox (premature menopause)
Biographic causes
- Genetic causes – familial clustering
- Genetic diseases
- Turner syndrome (synonyms: Ullrich-Turner syndrome, UTS) – genetic disorder that usually occurs sporadically; girls/women with this disorder have only one functional X chromosome instead of the usual two (monosomy X); et al. Among other things, with an anomaly of the aortic valve (33% of these patients have an aneurysm/diseased bulging of an artery); it is the only viable monosomy in humans and occurs approximately once in 2,500 female newborns.
- Genetic diseases
Behavioral causes
- Nutrition
- Vegetarian diet
- Pleasure food consumption
- Tobacco (smoking) – premature menopause (before age 45; approximately 5-10% of women) is dose-dependent in smokers with respect to nicotine abuse
Disease-related causes
- Autoimmune diseases – these lead to “autoaggressive digestion” of the ovaries.
- Diabetes mellitus
- Viral infections – for example, mumps in childhood.
Medication
- Cytostatics (substances that inhibit cell growth or cell division).
X-rays
- Radiatio (radiotherapy)
Operations
- Surgical procedures that disrupt the blood supply to the ovaries, such as sterilization by coagulation, which means “cooking” the fallopian tubes, uterine extirpation (removal of the uterus).
Other causes
- Consuming general diseases, tumor cachexia.
The incidence of climacteric symptoms is reported to be 50 to 85 percent of all menopausal women. In 25 percent, the complaints are very severe, in 40 percent moderate. In five percent of cases, the discomfort is so severe that incapacity to work occurs.
Etiology (causes) of late menopause
Behavioral causes
- Overweight (BMI ≥ 25; obesity) – increased BMI is associated with later menopause
Etiology (causes) of increased menopausal symptoms
Disease-related causes
- Low estrogen serum levels with concomitant wide fluctuations in the diurnal cycle.
Other causes
- Increased individual sensitivity of the autonomic nervous system.
- Physique and constitution – poor overall condition of the organism.
- Poor mental processing of menopausal symptoms.
- Negative psychological attitude to the climacteric and sexuality in general.
