RU2564088C1 - Method of treating climacteric syndrome in premenopausal females - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: lateral behavioural asymmetry profile (LBAP) test is conducted. If a patient appears to have a right lateral asymmetry profile, a set of physical exercises recommended include aerobic and anaerobic cyclic loads of lengths related as 1:2. A left lateral profile observed requires performing aerobic cyclic loads combined with respiratory exercises of lengths related as 2:1. If an ambidextrous profile is found, the patient is supposed to perform aerobic cyclic exercises only.

EFFECT: higher clinical effectiveness in treating climacteric syndrome, and also enables conducting the timely simple and accessible treatment ensured by specifying and assessing the lateral behavioural asymmetry profile values.

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Description

The invention relates to medicine, namely to gynecology and neurology, and can be used for non-hormonal treatment of menopausal syndrome in women of perimenopausal age.

Age-related changes in the reproductive system are mainly determined by changes that primarily occur in the central nervous system (primarily in the hypothalamus), and closely related changes in the pituitary and gonads. The onset of menopause is a time-fixed event, indicating the cessation of ovarian function. The most common consequences of menopause are imbalances in the autonomic nervous system, psychological changes, and physiological changes in target organs due to metabolic changes. Menopause has a pronounced effect on the state of the cardiovascular and musculoskeletal systems. Decreased estrogen secretion removes the protective properties of these hormones in relation to coronary heart disease, the development of atherosclerosis, and concomitant changes in lipid metabolism. Osteoporosis resulting from an increase in bone reabsorption rate in comparison with bone formation processes is a common problem for women during menopause.

Changes in estrogen-dependent organs are among the most characteristic manifestations of menopause. Menopausal syndrome, which consists in psychophysical maladaptation and manifested by vegetative crises, sleep disturbances and depressive states, is considered to be one of the most serious complications of pre- and menopause, which significantly reduces the quality of life. In recent years, the pathological course of the menopause (KP) has been increasingly observed (up to 50% of women in the population); 65-70% of pathological menopause occurs in the form of menopause syndrome (Smetnik V.P., 1998). It is this group of socially active women who experiences various problems associated with difficult adaptation to age-related restructuring of the body, changes in social status, loneliness, which is accompanied by an increase in psycho-traumatic situations (Dyukova D.M., 2000; Smetnik V.P., 2006; Zimovina U. IN 2007).

The urgency of the problem is due to the fact that during menopause, the incidence, mortality, frequency of temporary and permanent disability is much higher than in other age groups.

There is a method of treating menopausal syndrome of the neurovegetative form of hormone replacement therapy (Menopause problems / Edited by Aker L.V. - Barnaul, 2003. - 247 p.) By using drugs: "Klimadion", "Klimen", "Klimonorm."

The disadvantage of this method is its high cost. In addition, the known method has a number of contraindications, such as deep vein thrombosis, acute thromboembolic disease, the presence of volumetric processes of any localization, diseases of the gastrointestinal tract (gastritis, gastric ulcer), etc., as well as the reluctance of the woman herself take hormones (Menopause Guide: A Guide for Doctors / Edited by V.P. Smetnik, V.I. Kulakova. - M .: Medical News Agency, 2001), which reduces the use of hormone replacement therapy.

A known method of treating menopausal syndrome (RF patent No. 2192294, 10.11.2002), including laser exposure of the adrenal gland and the 7th cervical vertebra, characterized in that the exposure is carried out by a low-intensity laser (LLLT) with a wavelength of 0.89 μm, a radiation frequency 10-2500 Hz, selected depending on the exposure zone and the severity of the disease and the total exposure time of not more than 25 minutes per session, while additionally affecting the cervicothoracic spine (C3-Th7) in the pool of the vertebral and carotid arteries, zone n Thyroid projections and Michaels rhombus.

The disadvantage of the described method for the treatment of menopausal syndrome is that equipment for its implementation requires high costs.

A known method of treating menopausal syndrome (RF patent No. 2258505, 08/20/2005), characterized in that the coefficient of activity of syntactic adaptation programs (CASPA) is calculated according to a formula that includes indicators: cSt - serotonin concentration in the blood, Aat-III - antithrombin III activity, Aaoa - total plasma oxidative activity, Ssd8 + - concentration of T-suppressors, Sad - concentration of adrenaline in the blood, Ca2 mg - concentration of a2-macroglobulin, Smda - concentration of malondialdehyde, Ssd4 + - concentration of T-helpers, concentration or active It is used to calculate the values expressed in% of the reference values of healthy men and women aged 45-55 years; with CASPA of 0.7, at the same time, pyroroxan is administered at a dose of 0.015 g 2 times a day for 7 days and a 0.005-0.01% solution of phytoecdysterone in 40% alcohol at a dose of 30 drops 3 times a day until food for 2 weeks; with CASPA of 0.5, the same treatment is prescribed, but pyroxan is used for 2 weeks, 14 days after the last dose, the course is repeated.

The disadvantages of this method are the complexity and cost: the use of a large number of expensive reagents and the difficulty in calculating the necessary coefficients. In addition, the introduction of pyroxan may cause side effects.

A known method of treating menopausal syndrome (No. 2284827, 10.10.2006), including the impact on the autonomic nervous system by introducing drugs into the cervical spine, characterized in that cortexin and nicergoline are used as drugs in quantities of 10 mg and 4 mg, respectively which are dissolved in 10 ml of a solution of novocaine or saline, the specified amount of solution is divided into 10 parts, which are injected paravertebrally to a depth of 0.7-1.0 cm in the projection of segments C4-C7, the duration of treatment I am 10 days.

The disadvantage of this method is the risk of neurological complications with the introduction of medicinal solutions in the area bordering the spine, and therefore the procedure should be performed in a specialized neurological department, where there is trained personnel.

A known method of treating menopausal syndrome of neurovegetative form (No. 2355445, 05/20/2009), which consists in herbal medicine, characterized in that the patient is additionally given daily general magnetotherapy with an apparatus for general magnetotherapy "ALMA" for 12 min with a left-handed magnetic field, sinusoidal magnetic induction, frequency 107 Hz, induction 30 Oe, induction rise and fall times of 25 s, the number of magnetic induction rise and fall cycles of 15, 12 procedures daily.

The disadvantage of this method is its implementation only in specialized physiotherapy departments, as well as the presence of a large number of contraindications for magnetotherapy in patients with cardiac arrhythmias, heart surgery, the presence of metal structures in the body (jaw and intraosseous pins), diencephalic syndrome, cerebrovascular accident , individual intolerance to this procedure.

A known method of treating menopausal syndrome of a typical form of mild and moderate degree (RF patent No. 2431455, 20.10.2011) by successive exposure to an electric sleep, characterized in that 30 minutes after the electric sleep, a gravitational effect is applied to the patient in the direction of the head - lower limbs, rotation speed 32 rpm, with an increase in the number of revolutions from the second session by 1 revolution with each subsequent session up to 36 rpm and maintaining the maximum number of revolutions until the end of the treatment course, a muscle load of 10 W with a gradual an increase of up to 50 W by the end of the course of treatment, the duration of the procedure is 10-12 minutes, the general course of treatment is 10-15 days for 1 session daily.

The disadvantages of this method are the presence of contraindications to field effects in the age group of 40-55 years, due to the presence of a significant number of patients with transient disorders of cerebral circulation, cardiac arrhythmias by this age, in which the use of gravity is not safe.

A known method of treating menopausal syndrome (RF patent No. 2440155, 01/20/2012), which includes daily transcranial electrical stimulation (TPP) of the brain's defense mechanisms with direct current of 1.5-2.5 mA, lasting 20-30 minutes and the introduction of the drug "Sagen ". Moreover, after every third session of thermal power plants, an electroencephalogram is recorded. With a decrease in amplitude - rhythm below 30 μV, TES sessions do not resume. Treatment is continued with the introduction of the drug “Femoston 1/10” daily, 1 tablet per day for 2-3 weeks until the amplitude of the alpha rhythm is restored above 30 μV, followed by the administration of the drug “Sagenit” 1 tablet per day for 2- 3 months. In the absence of a decrease in the amplitude-rhythm, 9-15 sessions of TPPs are carried out followed by the administration of the Sagenit drug daily 1 tablet per day for 20-30 days.

The disadvantages of this method are: the complexity of the execution, the need to use additional equipment, the inability to determine individual sensitivity to electrical stimulation of the brain, which increases the likelihood of complications, especially in the case of hidden foci of irritative and paroxysmal brain activity.

In recent years, the fact has been established that with aging, as well as with the suppression of the function of the pineal gland by constant lighting, the production of melatonin decreases (Anisimov V.N., Vinogradova I.A. Light regime, melatonin and cancer risk // Vopr. Onkol., 2006.Vol. 5, No. 5. S. 491-498). The resulting melatonin deficiency plays an important role in the development of accelerated aging, age-related pathologies and neoplasms. Normalization of the level of melatonin and the circadian rhythm of its secretion in aging organisms is one of the most important approaches in the treatment and prevention of age-related diseases and cancer, as well as geroprotection (Komarov F.I., Rapoport S.I., Malinovskaya N.K., Anisimov V .N. Melatonin in norm and pathology. M: Publishing House Medpraktika - M. - 2004. 98 p.).

Many authors see the solution to this problem in substitution therapy with melatonin - the drug "Melaxen". For the treatment of women with mild menopausal syndrome, Melaxen was used at a dose of mg per day for 1 month (Anisimov V.N., Vinogradova I.A. Aging of the female reproductive system and melatonin. - St. Petersburg: Sistema Publishing House, 2008. - 44 p.).

However, this pharmaceutical product, as well as a number of drugs used in HRT, has both significant contraindications and side effects that cause such ailments as allergic reactions, headache, nausea, vomiting, diarrhea, morning drowsiness, and swelling.

In recent years, a healthy lifestyle has been actively promoted, regardless of a person’s age, including active physical activity and the need to form motivation for constant and systematic physical exercises, various sports, hardening, recovery and psycho-regulatory activities.

Noteworthy is the organization of physical therapy for women in menopause at the Kiev Medical Institute (Prof. G.I. Krasnoselsky) (http://www.medical-enc.ru/10/klimaks/menopauza/lfk.shtml). The essence of the method is that the four-month cycle of classes in therapeutic gymnastics is divided into three stages. The first stage (preparatory) lasts 2-3 weeks. At this time, women are preparing for the load of the next, main cycle of treatment. Careful monitoring of patients (pulse, blood pressure, well-being and ability to assimilate and perform physical exercises) is carried out, the reaction of the body to a particular exercise is studied, a technique for the upcoming exercises is developed. The second stage (medical and training) lasts 2-3 months. In this period, classes in therapeutic gymnastics are conducted, aimed at removing the pathological manifestations of menopause. The third stage (final) lasts 1-2 weeks, it gives exercises that a woman should do at home.

The disadvantages of this method are the generalized approach to prescribing physical exercises in women of the premenopausal period, without taking into account the individual characteristics of the lateral behavioral profile.

A known method of personalized prevention of estrogen-dependent diseases in women 45-60 years old with metabolic disorders (RF patent No. 2527357, 08.27.2014), including measuring the waist circumference (OT), height and weight, to calculate body mass index (BMI), determining glucose level and lipids; and for RTs over 80 cm, a moderately hypocaloric diet is used - a calorie restriction of the diet by 500-600 kcal per day, the daily diet is based on the following: total fat intake less than 30% of the total calories; carbohydrates - up to 50%; the protein content in the diet is 15-20%; dietary fiber - 20-30 mg; raw fruits and vegetables - 400-500 g; nuts, grains, legumes - 30 g; table salt - less than 5 g; 1000 mg of calcium per day for women taking hormonal contraception or hormone replacement therapy (HRT), and 1500-2000 mg not taking hormonal contraception or HRT; vitamin D - 800 ME, polyunsaturated fatty acids 0.5-1.0 g, folic acid - 400 μg, vitamin C - 60 μg, vitamin E - 30 units; physical activity - at least 40 minutes per day and at least 5 times a week; alternation of aerobic and anaerobic exercises.

The disadvantages of this method are the inclusion of HRT and a generalized approach to the appointment of physical exercises in women of the premenopausal period, without taking into account the individual characteristics of the lateral behavioral profile.

This method is chosen by us for the prototype.

We have developed and proposed a highly effective method for the prevention and treatment of menopausal syndrome of a neurovegetative form, aimed at preventing exacerbation of this disease, which does not require expensive equipment and hormone replacement therapy.

The present invention solves the problem of increasing clinical efficacy and reducing the drug load of the method for the prevention and treatment of menopausal syndrome.

This object is achieved in that in the present method, in addition to drug therapy, patients are preliminarily determined by the indicators of the lateral behavioral profile of asymmetries (LPAA) and when the right lateral behavioral profile of asymmetries is detected, the complex of physical exercises includes anaerobic and aerobic loads of a cyclic nature with a duration of 1: 2, with left lateral profile include cyclic aerobic exercise in combination with breathing exercises prod With a duration of 2: 1, with an ambidextral profile, only cyclic aerobic loads are included in the complex of physical exercises.

The technical result of the claimed invention is to increase the effectiveness of the treatment of menopausal syndrome (CS) of the neurovegetative form due to the simplicity, accessibility of the method. The method allows to prevent the development of COP moderate and severe with timely use.

From a biorhythmic point of view, menopausal syndrome is a clinical realization of maladaptation of a woman’s body in conditions requiring increased activity of the body’s adaptive system (Maltseva, 2007). In violation of the processes of adaptation to an estrogen-deficient state in perimenopause, a characteristic symptom complex can develop - menopause syndrome, characterized not only by hot flashes, hyperhidrosis, palpitations, sleep disturbances, but also by various mental, behavioral and emotional-affective disorders. The pathological course of menopause leads to a significant decrease in the quality of life of women (V.P. Smetnik, 2006).

This is of particular relevance in connection with modern methodological approaches to assessing women's health from the standpoint of a functional state and norm theory. A dynamic assessment of the functional state and adaptive capabilities of the body allows us to formulate the principles of maintaining human health (Konovalova G.M., 2004; Razumov A.N., Borovnitsky I.P., 2007; Bykov A.T., 2009). This approach, focused not only on treatment, but on the formation and preservation of health, involves the development and implementation of modern health technologies for the prevention of dysfunctional abnormalities, increase physical performance, increase the period of active longevity (Sokolov A.V., 2004; Bykov A.T. , 2009; Vyalkov A.I., Razumov A.N., Borovnitsky I.P., 2001).

In order to prevent complications in women with mild to moderate severity of the neurovegetative form of menopause, phytoestrogens, vitamins, nootropic and vascular preparations are widely used (“Menopause Medicine”, edited by V. P. Smetnik, M., 2006, p. 847). According to our studies, the most effective drugs include phytoestrogens, nootropics, phospholipids, fat-soluble vitamins, drugs that reduce anxiety (for example, a prevention regimen that includes Klimalanin, Lutsetam, Afobazol, Essentiale-forte, Triovit). This scheme is aimed at the prevention of autonomic dysfunctional disorders and is recommended for women in the alternating period even in the absence of menopausal syndrome. Klimalanin - Beta-alanine + excipients (not a hormonal drug, does not contain hormones or hormone-like substances). Indicated for hot flashes during menopause (including during artificial menopause, during pre- and perimenopause) / Source: http://instrukciva-otzyvy.ru/1004-klimalanin-po-primeneniyu-analogi-tabletki-beta-alanin -prilivy-klimaks-gormony.html / . Lucetam (active ingredient piracetam) - a nootropic drug that improves cognitive processes / reference book of medicines "Vidal" /. Afobazole relieves anxiety in adults with the following conditions and diseases: neurocirculatory dystonia; premenstrual syndrome. Essential Forte promotes the regeneration of cell membranes, increases the level of detoxification capabilities of the liver, normalizes its function. Triovit contains antioxidant vitamins C and E, betacarotene (provitamin A), and the trace element selenium. Thus, it becomes possible to exclude the use of hormone replacement therapy.

Exercise during menopause plays a huge role, especially with menopause. Exercising gymnastics makes the body more resilient, helps it withstand hormonal disorders caused by metabolic disorders or malfunctions in the nervous system. Carefully normalized loads do not bring fatigue, but strengthen the neuromuscular and ligamentous apparatus of the genitals, as well as the abdominal press and pelvic floor. Physical education improves the mobility of the uterus and its appendages, helps restore normal anatomical relationships between all organs of the abdominal cavity. In addition, physical activity helps prevent typical age-related problems with urination and digestion. Under the influence of therapeutic exercises, intestinal motility improves, the tone of the muscles of the bladder - its wall and sphincters increases.

With a large number of publications on the importance of physical exercises, only a few works are devoted to the physiological substantiation of daily physical activity modes necessary for the long-term preservation of the functional capabilities of the aging female body during menopause, compatible with the current optimal state of health (M. Savenko, 2009; Golubeva E .YU., 2009-20011).

A contradictory point of view has developed in the literature on the effect of motor activity on the age-related dynamics of the functional state of the body. It is believed that regular exercise at all age stages of ontogenesis is one of the most effective ways to maintain health and active longevity (Tsarik A.V., 2002; Matveev L.P., 2005; Apanasenko G.A., 2006: Romashin A .N., 2007; Ivko I.A., 2009). According to other authors, in conditions of total enthusiasm for fitness programs, without a preliminary assessment of the functional state of the body, there are negative consequences of unbalanced physical activity (Berdichevskaya EM, 2006; Konovalova GM, 2014; Myakotnykh VV, 2013) .

Tasks of physical therapy during menopause and menopause: 1) by influencing the trophic function of the nervous system by improving metabolism and enhancing redox processes to prevent the development of atrophic and degenerative processes; 2) to fight against circulatory disorders, in particular with circulatory disorders in the pelvic cavity (pelvic pletor); 3) by strengthening the abdominal muscles and the pelvic floor to prevent the development of general enteroptosis and enteroptosis of the pelvic organs; 4) by improving the functions of the cardiovascular, respiratory, nervous and other body systems to combat vegetoneurotic phenomena. Physiotherapy exercises in the menopause can be used as an independent method of treatment or, more often, as one of the ingredients of a complex of therapeutic measures for pathologically developing menopause (G.I. Krasnoselsky, L.A. Malinovskaya et al., 2003).

It was noted that in middle-aged and elderly people there is a decrease in proteins and a decrease in enzymatic systems in the body, which leads to a decrease in the functional capabilities of the most important organs and tissues: heart, lungs, liver, etc. (V.N. Cheremisinov “Biochemical substantiation of physical training exercises with people of different ages ”, 2012). These changes in protein metabolism are based on two main reasons. Firstly, a decrease in the content of nucleic acids in tissues that carry genetic information about the order of amino acids in tissue proteins and play an important role in protein synthesis processes; secondly, a decrease in the intensity of oxidative reactions that give the energy necessary for biosynthetic processes. A decrease in the intensity of oxidative processes at rest and a decrease in the body's ability to enhance aerobic metabolism during work, resulting in a decrease in the capabilities of the functional systems responsible for oxygen transport and its use in tissues. The decrease in oxygen supply to tissues occurs mainly as a result of a decrease in cardiac performance, hemoglobin in the blood, and a deterioration in the blood supply to tissues due to a decrease in the number of capillaries and their permeability.

Along with a decrease in aerobic capacity, there is a decrease in anaerobic. Due to a decrease in creatine phosphate reserves and a decrease in the activity of the corresponding enzymes, the metabolic capacity and power of the alactate anaerobic process decreases. This is one of the reasons for the decrease in the ability to perform speed and speed-strength exercises and decrease in speed endurance.

In connection with the foregoing, studies aimed at studying the influence of various modes of motor activity on the functional state of women in the perimenopausal period depending on the stereoisomerism of their body, and the subsequent development of new approaches to the correction of menopausal disorders, which improves the quality of life of women of this age group, become relevant. A comparison of the indicators of female teachers of the second period of adulthood as a whole indicates that any regular physical education classes contribute to an increase in physical activity; increase functional fitness and physical performance; improving physical fitness; optimization of well-being, activity, mood (Vengerova N.N. Pedagogical technologies of the fitness industry for maintaining the health of mature women: monograph / N.N. Vengerova; National State University of Physical Culture, Sports and Health named after P. F. Lesgaft, St. Petersburg .-- SPb .: [b.i.], 2011 .-- 251 p.).

The lateral behavioral phenotype is a correlate of interhemispheric asymmetries (NN Bragina, T.A. Dobrokhotova, 1988), which, to a large extent, modulate the activity of the subcortical structures of the brain and affect the level of hormonal secretion of the epiphyseal-hypothalamic-pituitary link. The modified Annette test allows one to identify the nature of motor and sensorimotor asymmetries, various signs of which significantly correlate with various physiological and pathological conditions of the female reproductive system (A.B. Poroshenko, 1984; A.V. Chernositov, 1996; V.I. Orlov, T. L. Botasheva, 1999). For example, inversion of motor asymmetries of the lower extremities significantly increases the likelihood of lateral ovarian lesions (VV Logachev, 1991), and the left phenotype “width of the nail bed of the little fingers of the hands” in pregnant women with the right phenotypic symptoms is accompanied by an increased likelihood of threatening premature birth (T.L. Botasheva; R.A. Gamaeva, 2010). When studying the peculiarities of the course of the premenopausal period, we found a reliable relationship between the likelihood of menopausal syndrome, indicators of the lateral behavioral phenotype and melatonin metabolism: the occurrence of menopausal syndrome is more often observed in women with a contra-orientation of sensory motor visual and auditory symptoms that characterize the so-called “center competition”. In the same category of women, a decrease in the level of melatonin in daily urine was detected. The determination of the asymmetry of sensorimotor signs is carried out during tests for the "leading eye" and "leading ear". For this, the woman is invited to answer the following questions and demonstrate: “with which ear do you listen to the telephone?”, “Which ear do you put the shell on?”, “With which eye do you aim?” And “with what eye do you look into the keyhole?”. In the presence of one of the right signs on the “leading eye” and the left sign of the test on the “leading ear” (or vice versa), additional therapy is prescribed using light deprivation (O. Zavodnov, 2013).

The literature data also indicate that, depending on interhemispheric asymmetry, which can be established using the lateral behavioral profile of asymmetries, there are significant differences in the adaptive reactions of professional athletes involved in speed-strength and game sports: it has been revealed that right-handed and left-handed people show the best adaptive properties in sports requiring a reaction speed, while ambidextra better adapt to cyclic endurance exercises (B Erdichevskaya E.M., 2002-2012; Shakhanova A.V. et al., 2009). However, studies aimed at studying the influence of LPAA on the choice of physical activity in women in the premenopausal period, we have not identified in available sources of information.

Based on multilevel multifunctional studies of the characteristics of the psycho-emotional, neuro-vegetative and endocrine-metabolic status, central hemodynamics and regional blood flow of the female body, we have established physiological mechanisms of adaptation to various modes of motor activity in menopausal women depending on constitutional features and an additional non-drug method has been developed treatment of menopausal disorders in the perimenopausal period.

Under this method, according to the data of the studies, the right-oriented lateral behavioral profile of asymmetries is most effective mainly in the field of high-speed physical exertion, left-oriented LPAA requires the integration of aerobic and static exercises with an interest in the respiratory component, ambidextral LPAA is most adaptable to cyclic aerobic loads.

A detailed description of the method and examples of its clinical implementation

The method is as follows. The vegetative state and severity of menopausal women are evaluated before and after treatment according to the following data: modified menopausal index (MMI) in points; blood flow in the ovaries, assessed by the Doppler method, including resistance index (IR) in arbitrary units (cu) and pulsation index (PI) in (cu); cerebral blood flow, evaluated by reencephalography (REG) according to indicators, bioelectrical activity of the brain by electroencephalography (EEG), hormonal profile in the 1st phase of the menstrual cycle (6th day).

Treatment is carried out on an outpatient basis. Dynamic monitoring of patients is carried out for six months. Assessment of the condition of patients according to the above data is performed after 1 month and 6 months after treatment.

To determine the initial lateral behavioral phenotype, a modified Annette test is used, which allows one to determine sensorimotor asymmetries, which are a marker of behavioral skills associated with simple emotionally colored movements, which are fixed already in early ontogenesis (M. Kinsbourn, 1978). Judging by the literature, they have a significant relationship with the functional state of the female reproductive system (A.B. Poroshenko, 1985). Researchers are offered the following questions:

- Test “interweaving of fingers”;

- Test "crossing arms on the chest";

- Test "applause";

- A test to determine the leading leg;

- Test to determine the jogging leg;

- Test "foot to foot";

- Test with a phone to identify the leading ear;

- Test with a sink to determine the leading ear;

- Test "keyhole" to determine the leading eye;

- Aiming test to determine the leading eye;

- Test "stick now";

- Test "stick in childhood";

- Test "family synistrality."

The prevalence of right signs in all the proposed tests (except for the “jerk leg”; this indicator should be left) in the patient determines the right lateral asymmetry behavioral profile (LPAA). In the case of a predominance of left signs (under the condition of the right push leg), the left LPPA is established in the subjects. Combined versions of the test results for the levels of "leading eye", "leading ear", "leading hand" and "leading leg" indicate ambidextral LPPA.

For patients with a right lateral behavioral profile of asymmetries, anaerobic and aerobic loads of a cyclic nature are included in the complex of physical exercises (in a ratio of 1 to 2), patients with a left lateral profile are included in a complex of physical exercises of an aerobic load of a cyclic nature in combination with breathing exercises (in a ratio of 2 to 1), patients with an ambidextral profile include only cyclic aerobic loads in the complex of physical exercises.

Additionally, in order to prevent complications, in women with a mild to moderate neurovegetative form of menopause, drugs from the group of phytoestrogens, nootropics, phospholipids, as well as fat-soluble vitamins, drugs that reduce anxiety (Klimalanin, Lutsetam, Essentiale-forte, Triovit can be used , Afobazole).

After a course of complex prevention by using anaerobic and aerobic loads of a cyclic nature (in a ratio of 1 to 2) (in patients with a right lateral profile), aerobic loads of a cyclic nature in combination with breathing exercises (in a ratio of 2 to 1) (in patients with a left lateral profile) and cyclic aerobic loads (in patients with an ambidextral lateral behavioral profile of asymmetries), an improvement in the general condition of patients was noted, the frequency of tides and sweating decreased, the head decreased servation, normalization of blood pressure and a night's sleep.

According to rheoencephalography, there was an improvement in cerebral hemodynamics, an increase in pulse blood supply, and also an improvement in blood supply in the vessels of the brain and, to a greater extent, in the carotid pool.

According to cardiointervalography, there was a favorable dynamics in the normalization of autonomic tone, especially in women with pronounced activity of the parasympathetic division of the ANS, a decrease in the tension of compensatory mechanisms, and an increase in adaptive and adaptive reactions.

The results of a study of the psychoemotional status of patients showed positive changes in the psychoemotional sphere, which was expressed in a significant decrease in anxiety and depression, hypochondriac mood, pessimism, increased mood and overall activity. The hormonal profile tended to normalize.

Clinical example 1

Patient L-eva, 47 years old, complained of headache, a feeling of hot flashes to the head and upper body, and poor (intermittent) sleep. The severity of menopausal syndrome before treatment by the proposed method was evaluated by MMI, amounting to 62 points, which corresponds to the severe course of menopausal syndrome. According to rheoencephalography, a decrease in pulse blood supply was recorded, which indicated a violation of the blood supply to the hypothalamic-pituitary system. According to cardiointervalography, a predominance of the tone of the parasympathetic division of the ANS was noted, which indicated the tension of the compensatory mechanisms, a decrease in adaptive-adaptive reactions. Diagnosis: menopause syndrome, neurovegetative form of moderate severity.

When determining the lateral phenotype in a woman, mainly right signs were identified according to the signs “leading ear”, “leading eye”, “leading leg” and “leading hand” with the left sign “pushing leg”, which testified to the right lateral behavioral profile of asymmetries.

The patient is prescribed a medication complex

1. Klimalanin 1 table. (400 mg) 2 times a day;

2. Triovit 1 cap. 2 times a day;

3. Essential Fort for 2 caps. 2 times a day;

4. Lucetam - 800 mg per 1 tablet. on day 9 in the morning;

5. Afobazole 1 tablet. the night.

In addition to traditional therapy, cyclic anaerobic and aerobic loads are recommended. The complex included classes 3 times a week: 2 workouts (lasting 45 minutes) on weight training machines (for 15 minutes) and walking in alternation with jogging on a treadmill (for 30 minutes), with a gradual increase in recommended walking speed and duration running, as well as a change in the ratio of walking and running upward; 1 training - swimming for 45 minutes at an average pace (distance - at least 100 meters).

Within a month, the patient significantly reduced the number of complaints of a feeling of hot flashes. And also improved night sleep. According to rheoencephalography, an increase in the rheographic index in the frontastomastoid and occipitomastoid leads was noted, as well as a decrease in the diastolic index in the same leads, which indicates an improvement in the blood supply to the hypothalamic-pituitary system. According to cardiointervalography, an increase in IN occurred, which indicated the normalization of vegetative tone. The level of the main metabolite of 6-sulfatoximelatonin increased to 57.8 ng / ml.

Clinical example 2

Patient K-ova, 40 years old, complained of headache, a feeling of hot flashes to the head and upper body, sweating, palpitations, irritability. The severity of menopausal syndrome before treatment by the proposed method was evaluated by the MMI of 69 points, which corresponds to the severe course of menopausal syndrome. The blood flow in the ovaries, determined by dopplerometry, according to the indicators of IR, amounted to 0.53 cu, and a PI of 1.24 cu The bioelectric activity of the brain according to the EEG data was as follows: cerebral manifestations with increased activating effect of the reticular formation and stem structures with desynchronization of cortical rhythm, epi-activity was not registered. According to rheoencephalography, a decrease in pulse blood supply was recorded, which indicated a violation of the blood supply to the hypothalamic-pituitary system. According to cardiointervalography, a predominance of the tone of the parasympathetic division of the ANS was noted, which indicated the tension of the compensatory mechanisms, a decrease in adaptive-adaptive reactions. Diagnosis: menopause syndrome - severe course.

When determining the lateral phenotype in a woman, the directivity of the sensorimotor visual and auditory signs was revealed according to the gradation of the test “leading eye”, “leading ear” and “leading arm”, which indicated an ambidextral lateral asymmetry profile.

The patient was prescribed drug therapy, including:

1. Klimalanin 1 table. (400 mg) 2 times a day;

2. Triovit 1 cap. 2 times a day;

3. Essential Fort for 2 caps. 2 times a day;

4. Lucetam - 800 mg per 1 tablet. on day 9 in the morning;

5. Afobazole 1 tablet. the night.

Additionally recommended are aerobic loads of a cyclic nature. The complex included classes 4 times a week: walking at an average pace 3 times a week for 30 minutes (without increasing the recommended walking speed); swimming - once a week for 30 minutes at a slow pace (distance of at least 100 meters).

After 1 month, the patient significantly reduced the number of complaints of a feeling of hot flashes, sweating, irritability. And also the heart rate returned to normal (up to 74 beats per minute). The blood flow in the ovaries has improved, as evidenced by a decrease in IR by 6% and an increase in PI by 7.2%. The positive dynamics of clinical symptoms was also confirmed by an improvement in REG indices, which indicates an improvement in cerebral blood flow. The bioelectrical activity of the brain according to the EEG data has also improved: even with exercise tests, cerebral pathological activity was absent, and epi-activity was also not observed. According to cardiointervalography, an increase in IN occurred, which indicated the normalization of vegetative tone. All of the above indicates the normalization of the activity of the sympathetic-adrenal system and the effectiveness of the therapeutic measure and wearing glasses.

Clinical example 3

Patient M-va, 53 years old, complained of a headache, a feeling of hot flashes to the head and upper body, sweating, palpitations, irritability. The severity of menopausal syndrome before treatment by the proposed method was evaluated by the MMI of 70 points, which corresponds to the severe course of menopausal syndrome. The blood flow in the ovaries, determined by dopplerometry, according to the indicators of IR, amounted to 0.55 cu, and a PI of 1.26 cu The bioelectric activity of the brain according to the EEG data was as follows: cerebral manifestations with increased activating effect of the reticular formation and stem structures with desynchronization of cortical rhythm, epi-activity was not registered. According to rheoencephalography, a decrease in pulse blood supply was recorded, which indicated a violation of the blood supply to the hypothalamic-pituitary system. According to cardiointervalography, a predominance of the tone of the parasympathetic division of the ANS was noted, which indicated the tension of the compensatory mechanisms, a decrease in adaptive-adaptive reactions. Diagnosis: menopause syndrome - severe course.

When determining the lateral phenotype in a woman, the predominance of left sensorimotor visual and auditory signs was revealed according to the levels of the “leading eye”, “leading ear”, “leading leg”, “Leading hand” test with the right sign of the “push leg” test, which testified to the left lateral asymmetry profile.

The patient was prescribed drug therapy, including:

1. Klimalanin 1 table. (400 mg) 2 times a day;

2. Triovit 1 cap. 2 times a day;

3. Essential Fort for 2 caps. 2 times a day;

4. Lucetam - 800 mg per 1 tablet. on day 9 in the morning;

5. Afobazole 1 tablet. the night.

Additionally recommended are aerobic loads of a cyclic nature in combination with breathing exercises. The complex included classes 3 times a week for 45 minutes: walking at an average pace 2 times a week for 30 minutes (with a gradual increase in the recommended walking speed) followed by breathing exercises (within 15 minutes); swimming - once a week for 30 minutes at a slow pace (distance of at least 100 meters).

After 1 month, the patient significantly reduced the number of complaints of a feeling of hot flashes, sweating, irritability. Also, the heart rate returned to normal (up to 76 beats per minute). The blood flow in the ovaries has improved, as evidenced by a decrease in IR by 7% and an increase in PI by 7.6%. The positive dynamics of clinical symptoms was also confirmed by an improvement in REG indices, which indicates an improvement in cerebral blood flow. The bioelectrical activity of the brain according to the EEG data has also improved: even with exercise tests, cerebral pathological activity was absent, and epi-activity was also not observed. According to cardiointervalography, an increase in IN occurred, which indicated the normalization of vegetative tone. All of the above indicates the normalization of the activity of the sympathetic-adrenal system and the effectiveness of the therapeutic measure and wearing glasses.

Thus, the changes in MMM described in clinical examples, dopplerometry of the ovaries, and REG and EEG data, and the level of melatonin in women with menopausal syndrome in dynamics can be regarded as objective indicators of the improvement of the patient's condition during treatment.

Our study included 165 women between the ages of 40 and 55 who are in pre- and menopause, with menopausal syndrome of moderate and severe severity, mainly of a neuro-vegetative form. The comparison group consisted of 45 healthy women of late reproductive age from 40 to 50 years old without manifestations of menopausal syndrome.

As follows from our research, when using the proposed method for the treatment of menopausal syndrome in 96% of patients, a prolonged therapeutic result is achieved, which is noted by a decrease in MMI, an increase in IR and PI indicators 1 month and 6 months after the end of treatment.

The proposed method for the prevention and treatment of menopausal syndrome has high clinical efficacy due to the long-term therapeutic result, simple, has no contraindications.

The duration of remission depends on the severity of the climacteric syndrome. The claimed method will find wide application in medical institutions, as it is effective, does not require additional expensive equipment and can be used as a complementary method in the treatment of menopausal syndrome.

Treatment of CS according to the proposed method favorably affected the general condition of patients. Complications and deterioration of health are not registered. The method allows for an individual approach to each patient, taking into account the severity of her condition.

When using this method, the drug load is reduced, hormonal therapy is completely excluded, which is expressed in the savings on the money spent on treatment.

Thus, the claimed method of treatment of menopausal syndrome with a predominance of neurovegetative menopausal disorders is highly effective, simple and affordable to use and allows it to be used both in primary health care (outpatient, clinic, hospital) and in sanatorium-resort institutions, increasing the effectiveness of rehabilitation events.

Claims (1)

A method of treating menopausal syndrome in women of the premenopausal period, including physical exercise and drug therapy, characterized in that the lateral behavioral profile of asymmetries (LAPA) is preliminarily determined and, when the right lateral behavioral profile of asymmetries is detected, the complex of physical exercises includes cyclic anaerobic and aerobic loads in a ratio of 1: 2, with the left lateral profile include aerobic loads cyclically character in combination with breathing exercises lasting in the ratio 2: 1, with an ambidextral profile, only cyclic aerobic loads are included in the complex of physical exercises.