Menopausal syndrome: possibilities of metabolic therapy

Ilyina I.Yu.

N.I. Pirogov Russian National Research Medical University, Ministry of Health of Russia, Moscow, Russia
Menopause is the physiological transitional period in a woman's life between reproductive age and old age. During this period, there is a gradual decrease and termination of ovarian function. Estrogens are known to play an important role in the biology of adipose tissue: they prevent the distribution of adipose tissue by the visceral type; have a beneficial effect on the neuroendocrine control of eating behavior. Obesity is known to increase the risk of developing many malignant processes, including cancer of the breast, colon, pancreas, bladder, and endometrium. Undoubtedly, the use of menopausal hormone therapy (MHT) reduces the severity of vasomotor and depressive-anxiety disorders and lowers the risk of developing osteopenia/osteoporosis, certain cardiovascular diseases, genitourinary syndrome, and other aging-associated conditions in the presence of estrogen deficiency. However, during this therapy, it is important to take into account all contraindications and risks of developing complications.
Conclusion: Some women have contraindications to the use of MHT drugs or refuse to take them. In this case, metabolic therapy may be recommended as an additional or alternative treatment.

Keywords

menopausal syndrome
menopausal hormone therapy
metabolic therapy
selenium
zinc
vitamin A
vitamin E
vitamin C

References

  1. Сметник В.П., ред. Медицина климактерия. М.: Литера; 2006. 848с. [Smetnik V.P. Medicine menopause. Moscow: Litera. 2006; 848 p. (in Russian)].
  2. Harlow S.D., Karvonen-Gutierrez C., Elliott M.R., Bondarenko I., Avis N.E., Bromberger J.T. et al. It is not just menopause: symptom clustering in the Study of Women’s Health Across the Nation. Womens Midlife Health. 2017; 3: 2. https://dx.doi.org/10.1186/s40695-017-0021-y.
  3. Park S.K., Harlow S.D., Zheng H., Karvonen-Gutierrez C., Thurston R.C., Ruppert K. et al. Association between changes in oestradiol and follicle-stimulating hormone levels during the menopausal transition and risk of diabetes. Diabet. Med. 2017; 34(4): 531-8. https://dx.doi.org/10.1111/dme.13301.
  4. Иванченко Ю.Ф. Эстрогены и катаракта. РМЖ. Клиническая офтальмология. 2017; 17(1): 53-4. [Ivanchenko Yu.F. Estrogens and cataracts. breast cancer. Clinical ophthalmology. 2017; 17(1): 53-4. (in Russian)].
  5. Шалина М.А. Метаболический синдром у женщин старшего возраста. Журнал акушерства и женских болезней. 2019; 68(3): 81-8. [Shalina M.A. Metabolic syndrome in older women. Journal of Obstetrics and Women's Diseases. 2019; 68(3): 81-8. (in Russian)]. https://dx.doi. org/10.17816/JOWD68381-88.
  6. Hodis H.N., Mack W.J. Cardiovascular risk after withdrawal of hormone therapy. Menopause. 2018; 25(4): 365-7. https://dx.doi.org/0.1097/ GME.0000000000001076.
  7. Рекомендации по ведению больных с метаболическим синдромом. Кинические рекомендации. М.; 2013. 44с. [Recommendations for the management of patients with metabolic syndrome. Clinical recommendations. Moscow. 2013; 44. (in Russian)].
  8. Glogowska-Szeląg J. Assessment of the relationship between bmd and body mass index bmi in women with postmenopausal osteoporosis. Wiad. Lek. 2018; 71(9): 1714-8.
  9. Hallajzadeh J., Khoramdad M., Izadi N., Karamzad N., Almasi-Hashiani A., Ayubi E. et al. Metabolic syndrome and its components in premenopausal and postmenopausal women: a comprehensive systematic review and meta-analysis on observational studies. Menopause. 2018; 25(10): 1155-64. https://dx.doi.org/10.1097/GME.0000000000001136.
  10. Шишкова В.Н., Зотова Л.И. Применение D-, L-гопантеновой кислоты в терапии когнитивных и тревожных расстройств у женщин с хронической ишемией головного мозга и климактерическим синдромом. Российский медицинский журнал. 2015; 24: 1470-5. [Shishkova V.N., Zotova L.I. The use of D-, L-hopanthenic acid in the treatment of cognitive and anxiety disorders in women with chronic cerebral ischemia and menopausal syndrome. Russian Medical Journal. 2015; 24: 1470-5. (in Russian)].
  11. Sandoo A., van Zanten J.J., Metsios G.S., Carrol D., Kitas G.D. The endothelium and its role in regulating vascular tone. Open Cardiovasc. Med. J. 2010; 4: 302-12. https://dx.doi.org/10.2174/1874192401004010302.
  12. Соловьева А.В., Дубинина И.И. Особенности развития метаболического синдрома у женщин. Сахарный диабет. 2012; 1: 57-62. [Solov'eva A.V., Dubinina I.I. Features of the development of metabolic syndrome in women. Diabetes mellitus. 2012; 1: 57-62. (in Russian)].
  13. Gershuni V., Li Y.R., Williams A.D., So A., Steel L., Carrigan E. et al. Breast cancer subtype distribution is different in normal weight, overweight, and obese women. Breast Cancer Res. Treat. 2017; 163(2): 375-81. https://dx.doi.org/10.1007/s10549-017-4192-x.
  14. Wise M.R., Jordan V., Lagas A., Showell M., Wong N., Lensen S., Farquhar C.M. Obesity and endometrial hyperplasia and cancer in premenopausal women: A systematic review. Am. J. Obstet. Gynecol. 2016; 214(6): 689.e1-689.e17. https://dx.doi.org/10.1016/j.ajog.2016.01.175.
  15. Dibaba D.T., Ogunsina K., Braithwaite D., Akinyemiju T. Metabolic syndrome and risk of breast cancer mortality by menopause, obesity, and subtype. Breast Cancer Res. Treat. 2019; 174(1): 209-18.
  16. Gathirua-Mwangi W.G., Song Y., Monahan P.O., Champion V.L., Zollinger T.W. Associations of metabolic syndrome and C-reactive protein with mortality from total cancer, obesity-linked cancers and breast cancer among women in NHANES III. Int. J. Cancer. 2018; 143(3): 535-42. https://dx.doi.org/10.1002/ijc.31344.
  17. Коц Я.И., Константинова О.Д., Лискова Ю.В. Рациональная фармакотерапия у женщин с сердечной недостаточностью и менопаузальным синдромом в ранней постменопаузе. Уральский медицинский журнал. 2008; 2: 36-40. [Kots Ya.I., Konstantinova O.D., Liskova Yu.V. Rational pharmacotherapy in women with heart failure and menopausal syndrome in early postmenopause. Ural Medical Journal. 2008; 2(42): 36-40. (in Russian)].
  18. Tenkorang M.A., Snyder B., Cunningham R.L. Sex-related differences in oxidative stress and neurodegeneration. Steroids. 2018; 133: 21-7. https://dx.doi.org/10.1016/j.steroids.2017.12.010.
  19. Куликов В.Ю. Роль окислительного стресса в регуляции метаболической активности внеклеточного матрикса соединительной ткани. Медицина и образование в Сибири. 2009; 4: 5. [Kulikov V.Yu. The metabolic activity role of oxidixing stress regulation in non-cellular matrix connective tissue. Medicine and education in Siberia. 2009; 4: 5. (in Russian)].
  20. Senoner T., Dichtl W. Oxidative stress in cardiovascular diseases: still a therapeutic target? Nutrients. 2019; 11(9): 2090. https://dx.doi.org/10.3390/nu11092090.
  21. Maggioni F., Maggioni G., Mainardi F. Migraine, triggers, and oxidative stress: Be careful of the pharmacological anamnesis! Headache. 2016; 56(4): 782-3. https://dx.doi.org/10.1111/head.12809.
  22. Мадянов И.В. Поведенческие типы у больных с экзогенноконституциональным ожирением и метаболическим синдромом. Здравоохранение Чувашии. 2016; 3: 10-4. [Madyanov I.V. Behavioral types in patients with exogenously constitutional obesity and metabolic syndrome. Healthcare of Chuvashia. 2016; 3: 10-4. (in Russian)].
  23. Андреева Е.Н., Шереметьева Е.В. Психические аспекты и нарушение жирового обмена в климактерии. Акушерство и гинекология. 2019; 9: 165-72. [Andreeva E.N., Sheremetyeva E.V. Mental aspects and fat metabolic disturbance in menopause. Obstetrics and Gynecology. 2019; 9: 165-72. (in Russian)]. https://dx.doi.org/10.18565/aig.2019.9.165-172.
  24. Nudy M., Chichilli V.M., Foy A.J. A systematic review and meta-regression analysis to examine the ‘timing hypothesis’ of hormone replacement therapy on mortality, coronary heart disease, and stroke. Int. J. Cardiol. Heart Vasc. 2019; 22: 123-31. https://dx.doi.org/10.1016/j.ijcha.2019.01.001.
  25. Poblete-Aro C., Russell-Guzmаn J., Parra P., Soto-Munoz M., Villegas-Gonzalez B., Cofre-Bolados C. et al. Exercise and oxidative stress in type 2 diabetes mellitus. Rev. Med. Chil. 2018; 146(3): 362-72. https://dx.doi.org/10.4067/s0034-98872018000300362.
  26. Tan B.L., Norhaizan M.E., Liew W.P. Nutrients and oxidative stress: friend or foe? Oxid. Med. Cell. Longev. 2018 Jan 31: 20189719584. https://dx.doi.org/10.1155/2018/9719584.
  27. Бериханова Р.Р., Миненко И.А. Возможности комплексных нелекарственных программ в коррекции психоэмоциональных климактерических расстройств у пациенток с метаболическим синдромом. Вопросы курортологии, физиотерапии и лечебной физической культуры. 2019; 96(3): 50-9. [Berihanova R.R., Minenko I.A. The possibilities of complex non-drug programs in the correction of psychoemotional climacteric disorders in patients with metabolic syndrome. Questions of balneology, physiotherapy and therapeutic physical culture. 2019; 96(3): 50-9. (in Russian)].
  28. Григорян О.Р., Андреева Е.Н. Ожирение и менопауза. В кн.: Мельниченко Г.А., Никифоровский Н.К., ред. Ожирение у женщин. М.: МИА; 2017:233-68. [Grigoryan O.R., Andreeva E.N. et al. Obesity and menopause. Obesity in women. Edited by G.A. Melnichenko, N.K. Nikiforovsky. M.: Medical Information Agency. 2017: 233-68. (in Russian)].
  29. Piepoli M.F., Hoes A.W., Agewall S., Albus C., Brotons C., Catapano A.L. et al. 2016 European Guidelines on cardiovascular disease prevention in clinical practice: The Sixth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of 10 societies and by invited experts)Developed with the special contribution of the European Association for Cardiovascular Prevention & Rehabilitation (EACPR). Eur. Heart J. 2016; 37(29): 2315-81. https://dx.doi.org/10.1093/eurheartj/ehw106.
  30. Mentese A., Guven S., Demir S., Sumer A., Yaman S.O., Alver A. et al. Circulating parameters of oxidative stress and hypoxia in normal pregnancy and HELLP syndrome. Adv. Clin. Exp. Med. 2018; 27(11): 1567-72. https://dx.doi.org/10.17219/acem/74653.
  31. Ванько Л.В., Короткова Т.Д., Кречетова Л.В. Роль индуцируемого гипоксией фактора -1α и трансформирующего ростового фактора-β1 в развитии оксидативного и иммунного дисбаланса при эндометриозе. Акушерство и гинекология. 2019; 6: 14-22. [Vanko L.V., Korotkova T.D., Krechetova L.V. Role of hypoxia-inducible factor-1 alpha and transforming growth factor-beta 1 in the development of oxidative stress and immune dysbalance in endometriosis. Obstetrics and Gynecology. 2019; 6: 14-22. (in Russian).]. https://dx.doi.org/10.18565/aig.2019.6.14-22.
  32. Балан В.Е., Ковалева Л.А., Рафаэлян И.В. Роль негормональной терапии в лечении симптомов климактерического синдрома. Вопросы гинекологии, акушерства и перинатологии. 2012; 12(5): 67-71. [Balan V.E., Kovaleva L.A., Rafaelyan I.V. The role of non-hormonal therapy in the treatment of symptoms of menopausal syndrome. Issues of gynecology, obstetrics and perinatology. 2012; 12(5): 67-71. (in Russian)].
  33. Юренева С.В., Моисеев С.В. Негормональные методы лечения вазомоторных симптомов менопаузы с позиции медицины, основанной на доказательствах. Клиническая фармакология и терапия. 2010; 2: 69-74. [Yureneva S.V., Moisseyev S.V. Evidence-based nonhormonal treatment of menopausal vasomotor symptoms. clinical pharmacology and therapy. 2010; 2: 69-74. (in Russian)].
  34. Якушевская О.В. Возможности применения фитоэстрогенов в терапии климактерического синдрома. Медицинский совет. 2020; 13: 99-104. [Yakushevskaya O.V. The possibilities of using phytoestrogens in the treatment of menopausal syndrome. Medical Council. 2020; 13: 99-104. (in Russian)]. https://doi.org/10.21518/2079-701X-2020-13-99-104.
  35. Леваков С.А., Кедрова А.Г., Ванке Н.С., Кожурина Е.В., Кагановская Л.М. Применение витаминов и минералов для уменьшения симптомов менопаузы после овариэктомии у женщин позднего репродуктивного возраста. Клиническая практика. 2011; 3(7): 34-40. [Levakov S.A., Kedrova A.G., Vanke N.S., Kozhurina E.V., Kaganovskaya L.M. Vitamins and minerals as an altrernatives to reduce the symptoms of menopause after oophorectomy in women over 45 years old. Clinical practice. 2011; 3(7): 34-40. (in Russian)].
  36. Дружинин П.В., Новиков Л.Ф., Лысиков Ю.А. Основы нутрициологии. Часть I. Концепция рационального и сбалансированного питания. Оптимизация питания с помощью БАД. М.; 2009. [Druzhinin P.V., Novikov L.F., Lysikov Yu.A. Fundamentals of nutritionology. Part I. The concept of rational and balanced nutrition. Optimization of nutrition with dietary supplements. M., 2009. (in Russian)].
  37. Бериханова Р.Р., Миненко И.А. Негормональная коррекция климактерических расстройств у пациенток с метаболическим синдромом. Вестник новых медицинских технологий. Электронный журнал. 2015; 2. [Berihanova R.R., Minenko I.A. Safety evaluation of the non-hormonal correction of climacteric disorders in patients with metabolic syndrome. Bulletin of New Medical Technologies. 2015; 2. (in Russian)]. https://doi.org/10.12737/11913.
  38. Ильина И.Ю., Доброхотова Ю.Э. Роль окислительного стресса в развитии гинекологических заболеваний. Акушерство и гинекология. 2021; 2: 150-6. [Ilyina I.Yu., Dobrokhotova Yu.E. Role of oxidative stress in the development of gynecological diseases. Obstetrics and Gynecology. 2021; 2: 150-6. (in Russian)]. https://dx.doi.org/10.18565/aig.2021.2.150-156.
  39. Lloret A., Esteve D., Monllor P., Cervera-Ferri A., Lloret A. The effectiveness of vitamin E treatment in Alzheimer's disease. Int. J. Mol. Sci. 2019; 20(4): 879. https://dx.doi.org/10.3390/ijms20040879.
  40. Miyazawa T., Burdeos G.C., Itaya M., Nakagawa K., Miyazawa T. Vitamin E: regulatory redox interactions. IUBMB Life. 2019; 71(4): 430-41. https://dx.doi.org/10.1002/iub.2008.
  41. Bizerea T.O., Dezsi S.G., Marginean O., Stroescu R., Rogobete A., Bizerea-Spiridon O., Ilie C. The link between selenium, oxidative stress and pregnancy induced hypertensive disorders. Clin. Lab. 2018; 64(10): 1593-610. https://dx.doi.org/10.7754/Clin.Lab.2018.180307.
  42. Adriani M., Diarry V.I., Abdulah R., Wirjatmadi B.J. Selenium intake in hypertensive and normotensive post-menopausal indonesian women. Nutr. Sci. Vitaminol. (Tokyo). 2015; 61(4): 322-5. https://dx.doi.org/10.3177/jnsv.61.322.
  43. Olechnowicz J., Tinkov A., Skalny A., Suliburska J. Zinc status is associated with inflammation, oxidative stress, lipid, and glucose metabolism. J. Physiol. Sci. 2018; 68(1):19-31. https://dx.doi.org/10.1007/s12576-017-0571-7.
  44. Ahmadi H., Mazloumi-Kiapey S.S., Sadeghi O., Nasiri M., Khorvash F., Mottaghi T., Askari G. Zinc supplementation affects favorably the frequency of migraine attacks: a double-blind randomized placebo-controlled clinical trial. Nutr. J. 2020; 19(1): 101. https://dx.doi.org/10.1186/s12937-020-00618-9.
  45. Bakker M.F., Peeters P.H., Klaasen V.M., Bueno-de-Mesquita H.B., Jansen E.H., Ros M.M. et al. Plasma carotenoids, vitamin C, tocopherols, and retinol and the risk of breast cancer in the European Prospective Investigation into Cancer and Nutrition cohort. Am. J. Clin. Nutr. 2016; 103(2): 454-64. https://dx.doi.org/10.3945/ajcn.114.101659.
  46. Giani M., Montoyo-Pujol Y.G., Peirо G., Martinez-Espinosa R.M. Halophilic carotenoids and breast cancer: from salt marshes to biomedicine. Mar. Drugs. 2021; 19(11): 594. https://dx.doi.org/10.3390/md19110594.

Received 09.06.2022

Accepted 20.06.2022

About the Authors

Irina Yu. Ilyina, Dr. Med. Sci., Professor, Therapeutical Faculty, Obstetrics and Gynecology Department, N.I. Pirogov RNRMU, Ministry of Health of Russia, +7(495)722-63-99, iliyina@mail.ru, https://orcid.org/0000-0001-8155-8775, 117513, Russia, Moscow, Ostrovitianov str., 1/9.

Conflicts of interest: The author declares that there are no possible conflicts of interest.
Funding: The article is published with financial support from PRO.MED.CS.Praha a.s.
For citation: Ilyina I.Yu. Menopausal syndrome: possibilities of metabolic therapy.
Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2022; 6: 163-168 (in Russian)
https://dx.doi.org/10.18565/aig.2022.6.163-168

Similar Articles

By continuing to use our site, you consent to the processing of cookies that ensure the proper functioning of the site.