Postovariectomy syndrome is a complex of symptoms containing disorders associated with the endocrine, vegetative-vascular system. It is formed due to complete surgical castration in girls of childbearing age. It is worth getting a consultation with a gynecologist and an endocrinologist to sort out the problem.
Signs
The clinic of post-castration syndrome in women is characterized by the following symptoms:
- Tides.
- Tachycardia.
- Sweating.
- Arrhythmia.
- Hypertensive crises.
- Transformation of metabolic processes.
- Mental disorders (tearfulness, frequent irritability, hostile-suppressed states, shift to the worse side of sleep and attentiveness).
- Urogenital signs.
Diagnosis of post-castration syndrome is based on a complete gynecological examination, a study of hormone levels.
Description
Post-castration dysgenitalism is characterized by a stop of monthly function due to the removal of the ovaries or the uterus with ovaries. Another post-castration syndrome in gynecology is called "postovariectomy dysgenitalism" and "surgical (caused) menopause." The frequency of formation is approximately 60-75%; in 3% of cases, postovariectomy dysgenitalism resolves with severe manifestations leading to disability. The level of severity of post-castration syndrome is greatly influenced by the age of the girl during the procedure, the multifunctional dynamism of the adrenal glands and other conditions.
Manifestations have every chance to appear both immediately after the removal of the ovaries, and after 2 - 3 months. The younger the age group, the less often this syndrome is formed. Usually, in many patients, the manifestation of the syndrome lasts for six months, but in a quarter of patients it can last up to 3 years.
The occurrence of PCS can be explained by a sudden decrease in the degree of estrogens and a stop in the functions of the glands of the genital organs. However, it must be emphasized that not all girls with a low degree of estrogen and a high level of gonadotropins will suffer from PCS. When it appears, high hypothalamic-pituitary dynamism matters. Includes this process and other tropic hormones (ACTH, TSH). Already after the increase in the active hypothalamic-pituitary system occurs, the functions of the thyroid gland, adrenal glands - peripheral endocrine glands are disrupted, and they, in turn, are as energetic as possible in organizing adaptation and homeostasis.
This often explains the polysymptomatic nature of PCS and why it is formed not instantly after castration, butafter a certain period, after which secondary modifications are formed. For this reason, many believe that in aging women, PCS is formed much earlier than in young girls, and this is associated with age-related intensive work of the hypothalamic centers. Even if you pay attention to the course of this syndrome, then in young girls it is much more difficult and problematic than in older ones. However, in more dangerous forms, it is expressed in girls who previously suffered from psychological disorders, protracted infectious diseases, intoxication of the body.
Symptoms
The clinical picture of post-castration syndrome includes the following pathologies:
- About 71% - vegetovascular pathologies ("hot flashes", arrhythmia, hyperhidrosis, pain in the heart, tachycardia).
- 13% - metabolic and endocrine pathologies (problems with excess weight, hyperglycemia).
- 16% - psycho-emotional deviations (unsatisfactory sleep, tearfulness, nervousness, hostile-suppressed states, attention disorder).
All signs of post-castration syndrome can be divided into early (appear 1-3 days after castration) and late (appear 1-3 years later).
Early
There are early (appearing 1-3 days after the operation to remove the ovaries) and late (formed after 1-3 years) signs in post-castration syndrome. To the early signsbelong to:
- mental disorders - depression, unexpected tantrums, annoying thoughts, fear of closed places, suicidal ideation;
- vegetoneurotic pathologies (pathologies in the nervous regulation of organs and reactions of the whole organism) - fever, chills, a feeling of crawling, terrible tolerance of hot weather;
- sleep disturbance - lethargy, asomnia, light drowsiness with frequent waking up, restless dreams;
- disorders of the heart - palpitations, irregular heart rate, pain, increased blood pressure.
Early signs tend to be fairly rapid over a period of months as the girl's body adjusts to stop the ovarian secretion of sex hormones, and the adrenal glands take over the function of producing estrogen, of course, on a smaller scale. (endocrine glands located in the kidney zone).
Later
Late signs of post-castration syndrome are:
- Increase in cholesterol, the occurrence of a predisposition to obesity.
- Development of atherosclerosis (layering of fatty plaques in the walls of blood vessels, spoiling the movement of blood through them).
- Blood thickening, increasing the risk of creating blood clots (blood clots that can enter blood arteries and block the flow of blood through them).
- Increased risk of myocardial infarction.
- Increase in pressure.
- Frequent urination, enuresis (involuntary urination during physiological stress orlaughter).
- Sensation of dryness and overthrow in the genital area and vagina, discomfort and pain during sexual intercourse.
- Osteoporosis is a decrease in the amount of calcium in the bones, as a result of which their fragility increases, and the risk of fractures increases.
- Reduced attraction (sexual desire).
- Deterioration of attentiveness, memory, mastering information.
- Reduced quality of life and love relationships.
Incubation period
Early signs of post-castration syndrome occur a couple of days after the procedure. Late signs express themselves after a while, for their formation it may take at least six months after surgery.
Shapes
According to the level of severity of signs, the following types of the course of the post-castration syndrome are distinguished:
- easy;
- medium;
- heavy.
Reasons
Total oophorectomy (bilateral removal of the ovaries) is considered a factor in the formation of the disease, less often - one-sided removal. In addition, such a condition can appear as a result of prolonged irradiation of the pelvic organs during radial therapy (in the treatment of malignant diseases), rarely when taking antitumor substances. With subtotal oophorectomy, sex hormones (estrogen and progesterone) abruptly stop entering the body, which were secreted by the ovaries in the right amount before the procedure.
Actually, the sudden cessation of these hormones makes the symptoms moremanifested than they are during menopause (age-related decline in ovarian function and the end of menstruation), sometimes a decrease in the release of sex hormones occurs over time, and the body has time to adapt.
Diagnosis
PKD is diagnosed based on:
- Complaints of the girl (he alth complications, mood changes, hot flashes, feeling of temperature, hyperhidrosis, heart failure) and analysis of the medical history (the onset of symptoms after the procedure to remove the ovaries).
- Analysis of chronic diseases (past illnesses, operations, injuries, etc.).
- Analysis of menstruation (the period of the onset of the first menstruation, the regularity and duration of the monthly cycle, the day of the last menstruation, etc.);
- Analysis of obstetric and gynecological history: the number of pregnancies and childbirth, past illnesses and gynecological procedures.
- The data of the cumulative and gynecological examination (the doctor is able to detect distinctive signs - a decrease in tone, a change in nutrition and dryness of the mucous membranes of the external genital organs in girls).
- Pelvic ultrasound data - you can detect the absence of ovaries (if one ovary is missing, the state of the second is examined), assess the state of the endometrium.
- Blood test data - establishing the concentration of the degree of hormones in the blood (a decrease in the degree of sex hormones estrogen and progesterone will be monitored with a significant increase in the degree of pituitary hormones - brain glands,controlling the hormonal activity of absolutely all glands of the body), determining the content of cholesterol in a biochemical blood test, detecting high blood clotting (creating blood clots) in a coagulogram (a specially designed blood test that demonstrates changes in blood clotting).
- Electrocardiography data - makes it possible to reveal pathologies in the work of the heart.
- The data of bone radiography and densitometry (determination of bone density) - make it possible to identify the symptoms of osteoporosis (high fragility of bones due to a decrease in the presence of calcium in them).
- The results of a mental sample survey and testing - in order to reveal the change in the psychological state of the girl.
- Perhaps, another consultation with a gynecologist-endocrinologist, psychiatrist, psychotherapist, psychologist.
Treatment
The severity of the course of this syndrome is determined by the timeliness of the start of therapy and prevention of pathologies, the volume of the procedure, the age of the patient, and the premorbid background. Preoperative therapy must begin with psychotherapeutic preparation. The girl needs to be explained the essence of the procedure and the probable postoperative consequences, because completely female - menstrual and sexual functions will be lost.
Non-drug therapy
Non-drug treatment (stage I):
- morning exercise;
- massage;
- therapeutic physical culture;
- proper diet;
- music forcalm the nerves;
- physiotherapy procedures (electroanalgesia, galvanization of the brain, collar with novocaine, exercises);
- spa therapy - radon baths, hydrobalneotherapy, hydrotherapy.
Medicines
Drug non-hormonal treatment in case the uterus was removed (stage II):
- Vitamins A, E - they will serve to improve the state of the brain and can even help with initial signs.
- Neuroleptic substances are components of the phenothiazine series - Triftazin, Meterazin, Frenolon. Their influence occurs at the level of the brain, in the subcortical textures, many believe that they have a pathogenic effect. First, small doses are used, and after 2 weeks, the result is evaluated. Reduce the dose over time.
- Tranquilizers - Elenium, Sibazon.
Hormones
Hormonotherapy (stage III). Hormone therapy threats:
- may form hyperplastic processes in the uterus;
- estrogen-progestin substances - they are mainly used when the girl is still of childbearing age, may contain contraindications - thromboembolic pathologies, diabetes mellitus.
Hormone therapy will eliminate the causes of tearfulness in women. After all, it occurs against the background of changes in hormonal levels.
It is acceptable to replace hormone therapy under the circumstance that a woman being treated for PCD is over 45 years old and has no contraindications to estrogen-histogenicsubstances. Already after the arrival of the menopause stage (often after 50 years), a very large number of girls simply do not want to prolong menstruation.
Two-, three-phase substances ("Divina", "Klimen", "Femoston", "Trisequens", etc.) are used in a repetitive order of contraception in patients with a preserved uterus.
Hormone replacement therapy is not prescribed, and it is generally contraindicated, even if a tumor of the uterus or mammary glands, liver disease, thrombophlebitis has been detected.
