Post-castration syndrome in women: symptoms and treatment methods. Castration of men: what is it and why is it carried out? Sign up for treatment for post-castration syndrome

A necessary condition The appearance of this syndrome is the complete removal of two ovaries. Even if you leave a small part of at least one ovary, post-castration syndrome will not occur. This can only push towards the emergence of pathology.

Complete shutdown of the ovaries is observed when:

• their death due to exposure to radiation (during radiation therapy of tumors in the pelvic area)
• surgical removal of the ovaries due to their damage by a malignant process, purulent inflammation of the uterine appendages, excessive size of benign tumors of the uterus.

What happens after spay removal?

Since the ovaries produce female sex hormones estrogens, there is a sharp decrease in their amount in the blood (hypoestrogenemia). In response to a sharp loss of function of these structures, the pituitary gland begins to produce its hormones in large quantities. Normally, they stimulate an increase in estrogen levels. And since there are many of them, this leads to disruption of the activity of other glands (mainly the adrenal glands, the thyroid gland) and the central nervous system.

Low estrogen levels cause impaired secretion biologically active substances in the brain. This leads to deviations in the regulation of body temperature, the functioning of the heart and blood vessels.

Due to hypoestrogenemia, changes occur in those organs with which estrogens interact. These are mainly structures of the genitourinary system. Atrophy (thinning) occurs in the muscle fibers and epithelial covering of organs, and blood circulation significantly deteriorates.

Since estrogens are involved in the metabolism of calcium and thyroid hormones, bones become weak and brittle. All this leads to osteoporosis.

Post-castration syndrome in women it is often stated in the form of violations mental nature, which manifests itself in the form of depression, frequent nervousness, sudden changes in mood and increased irritability.

Symptoms of post-castration syndrome

Signs are divided into two groups - early and late. The first ones appear within 1-2 weeks after removal of the ovaries, the second ones begin to bother you after some time (after about 2-3 months).

Early signs:

• Signs of vegetative-vascular dystonia are a sudden onset of sweating, fever, rapid heartbeat, headache and increased blood pressure. They arise due to a stress factor (emotional shocks, worries, exposure to cold).
• Psycho-emotional disorders - mood deteriorates for no reason, observed depressive state etc.
• Sleep disorders that manifest themselves as constant awakening in the middle of the night, frequent nightmares and difficulty falling asleep.

Early signs often go away within a few days. This happens because the human body adapts to hypoestrogenemia. That is, the ovaries are no longer able to secrete sex hormones. Now these functions, although on a much smaller scale, are performed by the adrenal glands.

Among the late signs are:

• Impaired fat metabolism in the form of increased cholesterol levels (normally estrogen supported normal level cholesterol).
• Worsening, appearance or exacerbation of heart and vascular diseases. This manifests itself as a tingling or burning sensation in the heart area, high blood pressure due to increased cholesterol levels.
• Weight gain is observed mostly on the face and abdomen.
• Disappearance of sexual desire over time.
• The risk of blockage of blood vessels by blood clots increases, as blood thickening occurs.
• Atherosclerosis of vessels of different localization develops.
• Problems with the bladder appear in the form of frequent visits to the toilet at night.
• Sexual desire disappears.
• Fractures often occur because calcium levels in the blood are low.
• Memory deteriorates, learning ability decreases, and it is impossible to concentrate on anything.

Post-castration syndrome in women does not necessarily have to include all of the above symptoms. If at least a few of these signs are observed, you should seek advice from a specialist.

Post-castration syndrome in men

This pathology also occurs with total and sudden destruction of the testicles. This may happen due to:

• severe damage due to impact, fall;
• surgical removal due to the development of a common malignant process in them;
• destruction of the testicles due to acute purulent inflammatory process;
• effects of radiation therapy.

The first symptoms appear after a few days. This shows up:

• Neuropsychic disorders (aggression, tearfulness, sudden mood swings, depression).
• Signs of demasculinization (when men develop female characteristics). This is a decrease muscle mass, changes in hair growth patterns, high-pitched voice, fat deposits on the sides, abdomen, face and breast growth.
• Complete loss of sexual desire.

Diagnosis of post-castration syndrome

Making a diagnosis goes through several stages:

• Collection of all necessary information about the patient (previously transferred surgical operations, injuries varying degrees severity, was there radiation therapy). Information that there was an operation on the ovaries to remove them allows one to suspect this syndrome.
• The doctor asks the patient about the menstrual cycle (time of the first and last date, regularity, character, etc.).
• A gynecological examination is performed to assess the condition of the cervical canal and the body of the uterus, its mucous membrane and the presence of pathological changes.
• The skin is examined, muscle tone and the level of adipose tissue are assessed. All this is necessary to detect signs of post-castration syndrome.
• Applicable ultrasonography pelvic organs - the condition of the ovaries is determined, namely their presence, size and shape. Usually, once the absence of ovaries is detected, a diagnosis can already be made.

The decisive step in diagnosing this syndrome will be biochemical analysis blood for sex hormones, estrogen and progesterone. Hypoestrogenemia will indicate post-castration syndrome. But low estrogen levels may not only occur due to this syndrome. Therefore, hormone tests are taken at the same time:

• Thyroid gland - to assess calcium metabolism in bone tissue.
• Adrenal glands - high cortisol levels will confirm estrogen deficiency in the blood.
• Pituitary gland - ACTH, gonadotropin (they are responsible for the production of estrogen by the ovaries). Therefore, an increase in their number indicates bad work ovaries.

Additionally, consultations are scheduled with:

• endocrinologist (to correct disorders of the endocrine glands),
• cardiologist (for examination and treatment of cardio-vascular system),
• mammologist (for examining the mammary gland for oncology),
• psychiatrist (treatment of mental disorders).

Treatment of post-castration syndrome

Post-castration syndrome can be eliminated in both men and women with the help of drug and non-drug therapy. Treatment should be started as early as possible.

Drug therapy

Today, an exclusively complex medicinal method is used, which includes:

• Replacement therapy - the use of sex hormones (estrogen or testosterone) in the form of tablets, intravenously, intramuscularly or through an intravaginal coil.
• The use of calcium supplements to strengthen bones and prevent the development of osteoporosis.
• Usage sedatives for mental and emotional disorders, as well as insomnia.
• Purpose acetylsalicylic acid to improve blood flow.

All this normalizes metabolism, the activity of the nervous and hormonal systems.

Non-drug therapy

For general strengthening of the body and normalization of activity, the following are prescribed:

• Neurosedative massage.
• Therapeutic herbal baths.
• Physiotherapy.

Prevention and prognosis of post-castration syndrome

The manifestations of post-castration syndrome can be significantly reduced with timely treatment. Today, despite the absence of ovaries, a woman can become pregnant through artificial insemination.

After complete removal of the ovaries, the woman is under the supervision of a gynecologist, endocrinologist and cardiologist. Constant ultrasound monitoring of the mammary glands, cholesterol levels, liver condition and the amount of hormones in the blood is also required.

Row gynecological problems requires a radical approach. It is most often used for malignant neoplasms that threaten not only a woman’s reproductive function, but also her health in general. Oncology is an indication for surgical removal of the ovaries and uterus, and sometimes both organs at once. The procedure for complete excision of the gonads is called oophorectomy. It is also used as hormonal therapy for breast cancer.

If the operation is performed on a woman of reproductive age, then such a radical approach is often accompanied by the development of complications, united under the concept of post-castration syndrome. It is associated with significant changes in the functioning of both the genital organs and the nervous system. Hormonal changes lead to psychological and vegetative disorders, as well as other serious problems. Wherein similar disease characteristic not only of the fair sex. In men, removal of the testes is accompanied by changes in the activity of the central nervous system. Since restore the previous characteristic hormonal levels After castration is not possible, treatment is aimed only at correcting unpleasant symptoms. Over time, the body gets used to new working conditions.

Causes of post-castration syndrome

The pathogenesis of the development of the disease is associated with metabolic changes and transformations in the function of the hypothalamus and pituitary gland, which normally control the functioning of the gonads. The main indication for castration is malignant neoplasms of the reproductive organs. Ovariectomy is also performed in premenopausal women. It is preventive in nature, as it reduces the likelihood of breast and uterine cancer.

Most often, post-castration syndrome in gynecology is associated with a patient’s history of endocrine diseases. These include transformations in the functioning of the thyroid and pancreas. During surgical removal of the ovaries, metabolic disruptions only worsen, which contributes to the development of complications.

There are also problems not related to surgical treatment. In such cases, the occurrence of symptoms of post-castration syndrome is provoked by disturbances in the functioning of the follicular apparatus in women. The ovarian tissue does not perform its natural function, ovulation does not occur, and the production of hormones, in particular estrogens, is disrupted. It is hypoestrogenism that is the main triggering factor for the development of castration syndrome in women. Moreover, similar transformations occur in the body of representatives of the fair sex normally, during menopause. However, in physiological process shutdown of the ovaries occurs gradually, although in such cases the development of unpleasant complications is possible. It is the sharp decline in estrogen concentration that causes disruption of the central nervous system and the formation of post-castration syndrome.

The disease may also be associated with hysterectomy - surgical removal uterus. It is performed for severe endometriosis, ruptures and cancer of the organ. It is important to know that such radical methods are resorted to only in cases where conservative treatment does not give the desired effect.

Symptoms of the pathological condition

The clinical picture of the disease is specific. The main signs of the disease are:

1. Vegetative-vascular disorders, which occupy a leading position among the symptoms of post-castration syndrome. “Hot flashes” occur, characterized by heat and sweating, the heart rate increases, and drops in blood pressure also occur. Many patients complain of dizziness and migraines.
2. Endocrine changes are among the common manifestations of post-castration syndrome. They arise due to the close connection of the endocrine glands with each other. Metabolic transformations increase the risk of developing diabetes mellitus and obesity, and also lead to increased deposition of cholesterol in the lumen of blood vessels.
3. Dystrophic processes reproductive system, which are a natural reaction of the body to a decrease in estrogen levels. They are manifested by dryness of the vaginal mucous membranes, the appearance of dysbacteriosis and discomfort during sexual intercourse.
4. Psycho-emotional and cognitive disorders associated with malfunctions of the central nervous system, which are also caused by changes in a woman’s hormonal levels. Patients suffer from insomnia, depression, increased irritability and tearfulness.

Common complaints during post-castration syndrome are pain in the spine, mainly in the lumbar region. These symptoms develop when osteoporosis occurs, which is associated with calcium metabolism disorders.

The intensity of the consequences of oophorectomy also depends on the patient’s medical history. If there are previous gynecological and endocrine ailments, the risk of developing complications and worsening the woman’s well-being increases.

Diagnostics

In the presence of characteristic symptoms of the disease and the preceding surgical intervention Confirming the problem is not difficult for doctors.

Initially, the patient is examined in a gynecological chair. Castration syndrome in women is manifested by dryness of the mucous membranes, their redness and thickening. Over time, the integument, on the contrary, becomes pale and thinned. In many cases, an imbalance in the microflora of the genital tract is also detected, which is accompanied by pathological discharge, pungent odor and itching.

One of the specific tests that can confirm the development of the disease is blood tests. The most informative is measuring the level of gonadotropins and pituitary hormones. Thyroid function and glucose concentration are also assessed.

If the patient has complaints about disorders of the cardiovascular system, an ultrasound examination is performed. Carrying out an ECHO and taking an ECG is important in the future symptomatic treatment post-castration syndrome.

Before using hormone replacement therapy, bacteriological tests of genital tract discharge are also carried out, general tests blood and breast examination.

The tactics to combat the problem are determined by the doctor based on the diagnostic measures. Both the severity of pathological changes and the individual characteristics of the patient are important. Treatment is mainly symptomatic, since it is not possible to restore normal functioning of the reproductive system after removal of the ovaries. Both medications and physiotherapeutic procedures are used. Traditional methods also have good reviews.

The basis of pharmacological support for patients with severe symptoms is hormone replacement therapy. Treatment of post-castration syndrome in women in this case comes down to increasing the level of estrogen, which is key in the development of complications. The duration of use of oral contraceptives, as well as the order of their administration and the specific drug is chosen by the doctor. There are also contraindications to the use of these funds. These include diseases of the mammary glands, liver and disorders of the blood coagulation system. At the same time, the use of hormonal medications can only facilitate the restructuring of the body to a new type of work, but does not in any way restore the function of the reproductive system. Monotherapy is indicated more when the uterus is removed. If a hysterectomy has not been performed, then they resort to the use of two- or three-phase medications, which have a combined effect on the body.

Among the recommendations for the treatment of post-castration syndrome are the use of vitamin complexes. They allow you to normalize metabolic processes and facilitate the functioning of the central nervous system. These drugs are often combined with antiplatelet therapy if indicated. The use of sedatives, antipsychotics and tranquilizers is also widespread. They help restore normal psycho-emotional state, greater resistance to stress, and also help fight insomnia. Traditional methods are based on the use of decoctions and infusions of plants that have a calming effect.

Physiotherapeutic methods such as massage, galvanization and the use of microwaves also have a therapeutic effect. These techniques help women cope with stress and also normalize the functioning of the central nervous system.

The symptoms that form post-castration syndrome in women have much in common with the clinical manifestations of menopause. In medicine, when organs of the reproductive system are removed, it is customary to talk about surgically induced menopause. At the same time, doctors recommend preparing for such a process:

1. Constant communication with the doctor is important. The specialist will explain everything in detail so that the patient has no questions or uncertainty about her own condition.
2. It is better to start adjusting your lifestyle before the operation, since in this case the adjustment will not cause so much stress.
3. Patients will also need help from loved ones and relatives during the rehabilitation period, both physical and emotional. After surgery, a woman is prohibited from lifting heavy objects. It is recommended to exercise extreme caution when driving vehicles.
4. Communication with other patients who have also gone through similar procedure, significantly facilitates psychological recovery after surgery. In some cases, to correct the emotional state, they resort to the use of medications.

Prognosis and prevention

The course and outcome of the problem depend on the intensity of the manifestation of clinical signs. At timely application If you go to the doctor, you can deal with the disease in the shortest possible time. The prognosis is cautious with a significant degree of severity of vegetative and mental disorders. In such cases, therapy can be serious and lengthy.

As a rule, it is not possible to avoid the manifestation of post-castration syndrome after an oophorectomy or removal of the uterus. However, following your doctor’s recommendations will help prevent the occurrence of more severe and dangerous complications. Moderation is important physical exercise and balanced nutrition. The diet should include a large number of vegetables and fruits, as well as foods rich in calcium. This approach allows us to normalize work internal organs and reduce the risk of developing dysbiosis and osteoporosis. Reducing the impact of stress also has a positive effect on women's well-being during this difficult period.

The sudden cessation of activity of any organ or system in our body negatively affects the functioning of other parts of the body. In addition, such a violation may be accompanied by a pronounced change in well-being (for the worse) and require close attention and adequate correction. Thus, the cessation of activity of the organs of the reproductive system due to operations, radiation exposure, etc. leads to the development of the so-called post-castration syndrome. Let's talk about what post-castration syndrome is, treatment for men and women, let's discuss it in a little more detail.

Post-castration syndrome in men

This pathological condition can develop in representatives of the stronger sex after traumatic, surgical or radiation castration. It can also be caused by destruction of testicular tissue due to acute or chronic infectious diseases.

Any of these conditions lead to sudden loss endocrine function testicles, as a result of which the activity of the hypothalamic, endocrine and neurovegetative regulatory systems is disrupted. The level of androgens in the blood significantly decreases, which is why a man faces many unpleasant symptoms.

Thus, post-castration syndrome in men is manifested by demasculinization: a change in the nature of hair growth, a decrease in muscle volume, and a redistribution of fat deposits according to the eunuchoid type. Pathological processes lead to the gradual progression of obesity, and osteoporosis also occurs.

Patients facing this problem are advised to undergo androgen replacement therapy. In most cases, doctors use long-acting sex hormones - Sustanon, Testenate, etc. Sometimes short-acting drugs and oral medications are used, for example, Methyltestosterone or Testobromlecite. However, such means are less effective.

In addition, doctors can use other medications, focusing on clinical symptoms. So the drugs of choice often become sedatives, cardiovascular drugs, antihypertensive drugs and other medicines.

The duration of androgen use and dosage are selected individually, depending on the symptoms of post-castration syndrome and the age of the patient. However, such drugs cannot be used for prostate cancer.

The prognosis for post-castration symptoms in men depends on the individual characteristics of the patient. Medicines most often help to reduce the severity of unpleasant symptoms over time, but therapy should be long-term.

Causes of post-castration syndrome in women

This pathological condition in the fair sex develops after a total or subtotal oophorectomy - removal of the ovaries. After this surgical intervention Post-castration syndrome occurs in eighty percent of patients, and sometimes it can be especially severe - with loss of ability to work.

With this disorder, patients experience various unpleasant symptoms. They may be bothered by vegetative-vascular problems, represented by hot flashes, facial redness, sweating, palpitations, hypertension, pain in the heart and headaches. The frequency and intensity of hot flashes is a determining factor in the severity of post-castration syndrome.

Also, cessation of ovarian activity can cause obesity and hypercholesterolemia. In patients, lipid metabolism is often disrupted and atherosclerosis occurs.

Common metabolic disorders are strophic changes that occur in both the external and internal genital organs, in the bladder, and also in the urethra. In the mammary glands connective tissues change from glandular to connective and fatty.

Post-castration syndrome can also cause osteoporosis over time.

The first manifestations of this disorder appear a couple of weeks after surgery, and after two to three months they reach their peak.

Post-castration syndrome in women also causes psycho-emotional disorders.

How is post-castration syndrome corrected in women, what treatment is effective?

The basis of treatment for post-castration syndrome in women are drugs that contain estrogens. The drugs of choice are often oral contraceptives, represented by Bisekurin, Non-ovlon, Ovidon, etc. Three- or two-phase drugs can also be used; they are advised to be used in cycles - as with contraception. Doctors usually advise using these drugs for three to four months, then take a break for a month or two to three weeks. The treatment regimen is selected taking into account the woman’s condition, the presence and resumption of unpleasant symptoms of post-castration syndrome.

The drugs of choice for such a disorder also become drugs for general restorative therapy, vitamin preparations, especially B vitamins, ascorbic acid and vitamin PP. In some cases, doctors advise using tranquilizers, for example, Mezapam or Phenazepam.

Soon after surgery, patients are indicated for physiotherapeutic treatment. Microwave therapy with centimeter waves on the area of ​​the adrenal glands has an excellent effect. At the same time, hardening and toning procedures are also carried out. It will also be beneficial Spa treatment.

In some cases, castration is the only path to recovery. And deal with her negative consequences It is possible, you just need to follow the recommendations of a qualified doctor.

Additional Information

Post-castration syndrome in men and women often causes different negative symptoms and is quite serious problems with health. Among them is osteoporosis, which threatens health and can lead to disruption of the integrity of the skeletal system. To correct this pathological condition You can use not only medicines, but also drugs based on traditional medicine.

Thus, an excellent effect for osteoporosis is obtained by taking an infusion based on ordinary dandelion, which contains a lot of calcium and a number of antioxidants that protect bones from aggressive damage. To prepare it you need to prepare a tablespoon of herb of this plant, brew it with one glass of just boiled water. Infuse the mixture for half an hour, then strain. Take this medicine one third of a glass three times a day.

Even with osteoporosis, you can make a salad from medicinal plant – ordinary dream. To do this, prepare seven tablespoons of dream, twenty-five grams of horseradish and twenty grams of sour cream. Also use a pinch of salt and a couple of glasses of water. First of all, boil the mushrooms in boiling water for two minutes, then chop. Grate the horseradish, add the prepared horseradish and sour cream and salt. Eat this salad once a day.

To treat and prevent osteoporosis, you can prepare a couple of tablespoons of honey, five chicken eggs, five medium lemons and fifty milliliters of Cahors or cognac.

Break the eggs and mix with honey. Dry the remaining shells and grind them to a powder. Squeeze the juice from the lemons and pour it over the prepared shells. After five days, combine both mixtures, pour cognac or Cahors into them and mix. Take this remedy twenty-five to thirty milliliters once a day exactly until it runs out. Take three courses, taking a break of three days between them.

Folk remedies can also be used to increase hormone levels in the body. The advisability of such treatment should be discussed with your doctor, especially if you are taking hormone-containing medications.

So, to increase the amount of estrogen in the blood, you can eat flax seeds. They are the leader in phytoestrogens content. In total, you should eat up to sixty grams of this product per day; the seeds can be added to various dishes, or you can make jelly from them, etc.

To increase estrogen in the body, you can prepare a medicine based on red clover. Brew forty grams of grass or thirty grams of inflorescences with a glass of boiling water. Leave this product to steep for an hour, then strain. Take it fifty milliliters three or four times a day.

Sage can also help patients with post-castration syndrome. A tablespoon of dried herb should be brewed with half a liter of just boiled water. Infuse for ten to fifteen minutes, then strain and drink as tea in three doses per day. Take this drink every day.

Cessation of the activity of the organs of the reproductive system can lead to the development of serious disorders, including post-castration syndrome. Its correction should be carried out exclusively under the supervision of a doctor using various medicines, in addition, traditional medicine recipes will be beneficial.

Characterized by cessation menstrual function as a result of bilateral removal of the ovaries or uterus with ovaries (panhysterectomy). Synonyms for post-castration syndrome in gynecology are “postovariectomy syndrome” and “surgical (induced) menopause.” The incidence of post-castration syndrome is about 70-80%; in 5% of cases, postovariectomy syndrome occurs with severe manifestations leading to loss of ability to work. The severity of post-castration syndrome is influenced by the patient’s age at the time of surgery, premorbid background, functional activity of the adrenal glands and other factors.

Causes and pathogenesis of post-castration syndrome

The development of post-castration syndrome is preceded by total or subtotal oophorectomy with or without removal of the uterus.

Total oophorectomy with leaving the uterus is often performed for tubo-ovarian (piovara, pyosalpinx) and benign ovarian tumors in women who have not realized reproductive function. In the future, pregnancy in this category of women is possible with the help of IVF.

The most common cause of post-castration syndrome in the reproductive period is panhysterectomy performed in connection with endometriosis or uterine fibroids. Total oophorectomy with hysterectomy in premenopausal women is usually performed for oncological considerations.

A probable non-surgical cause of post-castration syndrome may be the death of the follicular apparatus of the ovaries due to gamma or X-ray irradiation.

It has been noted that post-castration syndrome often develops in patients with aggravated background - thyrotoxic goiter, diabetes mellitus.

The leading pathogenetic and triggering factor in post-castration syndrome is abruptly occurring hypoestrogenism, causing a wide range of pathological manifestations. In the subcortical structures, the secretion of neurotransmitters that regulate cardiovascular, respiratory and temperature reactions is disrupted. This is accompanied by the appearance of pathological symptoms similar to those during the development of menopausal syndrome.

Hypoestrogenism causes changes in estrogen-receptive tissues: in genitourinary system the phenomena of atrophy of connective and muscle fibers increase, the vascularization of organs worsens, and thinning of the epithelium develops.

After surgical shutdown of ovarian activity according to the mechanism feedback The level of gonadotropic hormones increases, which leads to disruption of the functioning of peripheral glands. In the adrenal cortex, the synthesis of glucocorticoids increases and the formation of androgens decreases, which further aggravates the maladaptation of the body. With post-castration syndrome, the formation of thyroxine (T4) and triiodothyronine (T3) in the thyroid gland is disrupted; The secretion of parathyroid hormone and calcitonin decreases, which leads to disturbances in calcium metabolism and contributes to the development of osteoporosis.

Thus, if during natural menopause the function of the ovaries fades away gradually, over several years, then with post-castration syndrome there is a sharp, immediate shutdown of the hormonal function of the ovaries, which is accompanied by a breakdown of adaptive mechanisms and disorganization of the body’s biological adaptation to the new state.

Symptoms of post-castration syndrome

The onset of manifestations of post-castration syndrome is observed 1-3 weeks after oophorectomy and reaches its full development after 2-3 months.

In the clinic of post-castration syndrome, the leading ones are disorders of vegetative-vascular regulation - they occur in 73% of cases. Vegetative-vascular reactions are characterized by attacks of hot flashes, sweating, facial flushing, palpitations (tachycardia, arrhythmia), pain in the heart, headaches, and hypertensive crises. As with menopause, the severity of post-castration syndrome is determined by the frequency and intensity of hot flashes.

In 15% of patients with post-castration syndrome, endocrine and metabolic disorders, including hyperglycemia, hypercholesterolemia, atherosclerosis. Against this background, it develops over time diabetes, obesity, ischemic heart disease, hypertonic disease, thromboembolism.

To the number metabolic disorders also include dystrophic processes in genitourinary organs. Phenomena of atrophic colpitis, leukoplakia and kraurosis of the vulva, cracks in the mucous membranes, cystitis, cystalgia, replacement of the glandular tissue of the mammary glands with fatty and connective tissue are noted.

With post-castration syndrome, osteoporosis develops and progresses, which is manifested by local pain in the thoracic and (or) lumbar spine, in the area of ​​the shoulder, wrist, knee joints, muscles, and an increase in the frequency of bone fractures. Weakening of the reparative mechanisms of gum regeneration often causes the development of periodontal disease.

In 12% of women, their well-being suffers due to psycho-emotional disorders - tearfulness, irritability, sleep disturbances, deterioration of attention, and depressive states.

In the first 2 years with post-castration syndrome, a predominance of neurovegetative symptoms is noted; subsequently the severity of endocrine metabolic disorders increases; psychoemotional disorders usually persist for a long time.

The clinic of post-castration syndrome is similar to the manifestations of post-hysterectomy syndrome, but is more pronounced. The severity of post-castration syndrome correlates with the presence of a history of infectious and gynecological diseases, pathologies of the hepatobiliary system.

Diagnosis of post-castration syndrome

The diagnosis of post-castration syndrome is established taking into account the gynecological history (previous oophorectomy) and typical manifestations.

At gynecological examination atrophic changes in the mucous membrane of the vulva and vagina are determined. Gynecological ultrasound allows you to dynamically monitor processes in the pelvis after total oophorectomy.

Of great diagnostic importance in post-castration syndrome is the study of the level of gonadotropins (FSH, LH), pituitary hormones (ACTH), thyroid gland (T4, T3, TSH), bone metabolism (parathyroid hormone, osteocalcin, etc.), blood glucose. Densitometry is performed to assess the severity of osteoporosis. In case of changes in the cardiovascular system, an ECG and EchoCG are indicated.

Before prescribing HRT, mammography, colposcopy, smear examination for oncocytology, liver tests, coagulogram, cholesterol and lipoprotein levels are required to identify contraindications.

Gynecologists-endocrinologists, neurologists, mammologists, cardiologists, urologists, and endocrinologists are involved in the examination of patients with post-castration syndrome.

Treatment of post-castration syndrome

In the treatment of post-castration syndrome, clinical gynecology uses non-drug and medicinal methods aimed at normalizing the regulation of the processes of adaptation, compensation and hormonal balance.

Therapy for post-castration syndrome begins with general restorative measures by prescribing exercise therapy, ultraviolet irradiation, cervicofacial and endonasal galvanization, microwave therapy in the area of ​​the adrenal glands, general and neurosedative massage, general medicinal baths(coniferous, marine, sodium chloride, radon), climatotherapy. It is also advisable to prescribe vitamin therapy (B, PP C, A, E), hepatoprotectors, disaggregants and anticoagulants (aspirin, trental, chimes) taking into account the results of the coagulogram.

Patients with psychoemotional manifestations of post-castration syndrome are advised to take sedatives (valerian, motherwort, novopassit, etc.), tranquilizers (phenazepam, Relanium, etc.), antidepressants (Coaxil, Aurorix, etc.).

The main method in the treatment of manifestations of post-castration syndrome is the administration of sex hormones. The choice of regimen and drug for HRT depends on the duration of the planned treatment and the presence of contraindications. HRT can be performed different ways: by oral administration of tablets or dragees or parenteral (transdermal, intravaginal, intramuscular) administration.

In the treatment of post-castration syndrome, various HRT regimens can be used. Monotherapy with estrogens (Proginova, Estrofem, Ovestin, Premarin, patches, gels) is indicated for hysterectomy. In women with a intact uterus, two- and three-phase drugs (Klimonorm, Femoston, Klimen, Divina, Trisequence, etc.) are used in a cyclic contraceptive mode.

Absolute contraindications for prescribing HRT are the detection of uterine or breast cancer, coagulopathies, liver diseases, and thrombophlebitis.

Forecast and prevention of post-castration syndrome

Timely administration of therapy after oophorectomy allows one to prevent and significantly reduce the manifestations of post-castration syndrome.

Women after total oophorectomy are under dispensary observation gynecologist, endocrinologist, mammologist, neurologist, cardiologist. Patients with post-castration syndrome, especially those on HRT, require systematic monitoring of the condition of the mammary glands (ultrasound, mammography), examination of the hemostatic system, liver tests, cholesterol, and densitometry.

The severity of post-castration syndrome is determined by age, pre-orbid background, the extent of the operation, the timeliness of the start of corrective therapy and the prevention of disorders.

Post-castration syndrome is a complex of disorders (vasomotor, neuropsychic, metabolic) that arise after removal of the ovaries in a mature woman.

The essence of post-castration syndrome

The most common and painful symptom of post-castration syndrome is tides, occurring as a result of a sharp expansion blood vessels skin of the face and upper body. In addition to hot flashes, neurovegetative disorders can manifest as sweating, dizziness, headaches, especially in the occipital region, and insomnia.

The incidence of post-castration syndrome varies , according to the authors, in the range of 50-80%. In some women, its symptoms disappear without therapeutic effects within two years after removal of the ovaries, in others it lasts much longer. The initial state of the organs that regulate the most important factors plays a role in the occurrence of the syndrome. life processes nervous and endocrine systems, the age of the patient, as well as the ability of protective and adaptive mechanisms to quickly adapt to new conditions of existence of the body. Somatic diseases, as well as factors that adversely affect a woman’s psyche, complicate the course of post-castration syndrome.

The symptoms of the syndrome occur suddenly and in different time after removal of the ovaries. Most often this occurs 2-3 weeks after surgery.

The severity of its course depends to a certain extent on the cause of castration. So, with chronic inflammatory disease uterine appendages, including the ovaries, the symptoms of the disease are less pronounced. In cases of malignant neoplasms of the uterus or mammary glands, when the ovaries are not involved pathological process, their removal entails a more violent manifestation of the syndrome.

It is believed that young women have a harder time withstanding castration. After the age of 40, in some cases, the disorders inherent in post-castration syndrome do not occur at all (E. Teter, 1968; S. Milku, Danile-Muster, 1973). It is likely that castration performed in women of fertile age with a preserved menstrual cycle leads to more sharp fall the amount of estrogen in the body than in women during menopause and menopause. Research by O. N. Savchenko (1964, 1967) showed that in women operated on at the age of 23-35 years, the amount of estrogen excreted in the urine is only 4.6 mcg/day, and at the age of 39-51 years - 7.7 mcg/day. Significant difference was also found in the secretion of individual estrogen fractions: in young women, estradiol and estrone predominated, and estriol accounted for only 21.8%, while in women senior group estriol accounted for 61% of the total amount of estrogens.

More mild course also observed after castration caused by x-rays or radium rays. It is assumed that in such cases, estrogens can be formed in atretic and primordial follicles, which are less sensitive to radiation exposure than mature ones. This is partly confirmed by the results indicating the presence of estrogenic influence. In the urine of women who have undergone X-ray castration, an increase in the level of gonadotropins occurs no earlier than after 6-12 months.

In the first years after castration, neuro-vegetative disorders, mainly hot flashes, predominate. Subsequently, trophic changes in tissues and shifts in neuro-endocrine correlation develop. A sharp decrease in the amount of estrogen leads to atrophic processes in the reproductive system. With age-related decline in ovarian function, atrophic changes primarily occur in the external genital organs and gradually spread to the internal genital organs. After surgical castration, the uterus first atrophies, and the process of reverse development spreads simultaneously to the myometrium and endometrium. The cervix decreases in size, takes on a conical shape, the glands disappear, cervical canal closes. The cytological picture of the vaginal contents changes: the number of superficial cells, especially eosinophilic ones, decreases; after six months, intermediate and even basal cells are found. The pH of the vaginal environment increases, the vagina narrows, its mucous membrane becomes dry and easily vulnerable. Subsequently, the process of atrophy also affects the external genitalia. The glandular tissue of the mammary glands is gradually replaced by adipose tissue.

There is a tendency towards the occurrence of cardiovascular diseases (Novotny and Dvorak, 1973). Metabolic processes are disrupted. Body weight increases, mainly due to the deposition of fat in the abdomen and thighs. I. G. Grigorieva (1972), having examined 177 women castrated at childbearing age, with a duration of time elapsed after castration of 5-28 years, found hypercholesterolemia in 74% of cases, obesity in 55%, and hypertension in 61%. In the group of women aged 40-54 years, the frequency of hypertension was statistically significantly higher (57.2%) than in persons of the same age. age group with natural menopause (17.9%). One of the types of metabolic disorders due to castration is osteoporosis - the formation of bone tissue defects mainly in the area of ​​the Div-Dvn vertebrae.

Pathogenesis

The pathogenesis of post-castration syndrome is complex and has not yet been fully studied. Removal of the ovaries introduces dissonance into the system of endocrine glands. This primarily concerns the hypothalamic-pituitary region. As a result of castration, the functional state nuclei of the hypothalamus, which take part in the formation of tropic hormones of the pituitary gland. Experimental studies have established an increase in the anterior lobe of the pituitary gland and the appearance of specific eosinophilic cells in it, which are called “castration cells.” Their formation is explained by an increase in the function of the anterior pituitary gland, but the cells appear provided that the connection between the adenohypophysis and the cerebral cortex is maintained, which indicates the presence of a certain relationship between the cerebral cortex and the gonads.

In response to a significant decrease in the amount of estrogen in the body, the release of FSH increases. According to V. M. Dilman (1968), after bilateral oophorectomy, the excretion of gonadotropins increases by more than 2 times. The effect of castration on serum levels in women was reported by Czygan and Maruhn (1972). On the 2-4th day after extirpation of the uterus and appendages and bilateral oophorectomy, both before and after the onset, the FSH level increases significantly, and on the 6-8th day the LH level increases. According to Aukin et al (1974), as time increases from the moment of castration, the release of gonadotropins in the urine progressively increases. However, it is not yet clear whether this is a consequence of overproduction of FSH or the excess is formed as a result of the fact that its use by the ovaries has ceased. There have been cases where, despite a high titer of gonadotropins in the urine, post-castration syndrome did not develop and, conversely, in patients with a severe form of the syndrome, a small amount of gonadotropins was detected in the urine. There is an assumption that hot flashes occur not so much due to an increase in the release of FSH, but as a result of a decrease in the amount of LH. Introduction human chorionic gonadotropin(LH) it is possible to achieve a reduction in neuro-vegetative changes.

Probably, after castration, the release of not only gonadotropic, but also other tropic hormones of the pituitary gland, including adrenocorticotropic and thyroid-stimulating, is disrupted.

Manifestations of post-castration syndrome such as arthrosis and diabetes are common. It is suggested that there may be an excess of growth hormone and its role in the pathogenesis of these disorders (S. Milku, Danile-Muster, 1973). Some women experience thyrotoxicosis, which is explained by increased production of thyroid-stimulating hormone by basophilic cells of the adenohypophysis.

With the help of numerous studies and clinical observations, a close connection has been established between the ovaries and the adrenal cortex, so castration cannot but affect the condition of the adrenal glands. Their bark contains small amounts of steroids, similar in their action to sex hormones. The administration of female experimental animals causes an increase in the concentration of corticosteroids in the blood (A. V. Antonichev, 1968). Zondek and Burstein (1952) noted cyclicality in the excretion of corticoids in the urine in guinea pigs, which is closely related to the astral cycle; During estrus, corticoid excretion increases. After ovariectomy, low and acyclic secretion is observed. The administration of estrogen causes an increase in the amount of corticoids in the urine in both unspayed and castrated females. The authors believe that they stimulate the release of adrenocorticotropic hormone by the pituitary gland. After removal of the ovaries, hypertrophy of the adrenal cortex occurs. The relationship between its functional state and the severity of post-castration syndrome was shown by I. A. Manuilova (1972). The development of the syndrome is accompanied by a relative decrease in the function of the adrenal cortex and a weakening of the body’s compensatory reactions. In patients who do not have hot flashes, as well as with the reverse development of post-castration syndrome, as a rule, an increase in the function of the adrenal cortex, mainly glucocorticoid, is detected.

If, with age-related decline in ovarian function, the body gradually gets used to new hormonal conditions, then as a result of surgical castration characteristic symptoms grow very quickly. Therefore, in establishing homeostasis after castration, it is especially great importance has a state of protective-adaptive mechanisms.

The sympathetic-adrenal system takes an active part in adaptation processes. Perhaps the occurrence of post-castration disorders is associated with irritation of the sympathetic nervous system as a result of hyperfunction of the adrenal medulla (M. G. Futorny, I. V. Komissarenko, 1969). This assumption is confirmed by the studies of I. A. Manuilova (1972), who studied the excretion of catecholamines (adrenaline and norepinephrine). The author found in almost all the examined patients an increase in the content of adrenaline in the urine and a decrease in the concentration of norepinephrine, which is an indicator of activation of the sympathetic-adrenal system. Particularly high numbers of adrenaline excretion were obtained in patients with a severe form of post-castration syndrome, which is probably due to stronger irritation of the hypothalamic nuclei.

Many authors consider the main cause of post-castration syndrome to be the disappearance or significant decrease in the amount of estrogens, based on the fact that their exogenous administration eliminates hot flashes. However, it is not. With the removal of the ovaries, the amount of estrogen hormones decreases sharply in all women, and post-castration disorders do not develop in all cases. In addition, I. A. Manuilova (1972) did not find a strict parallelism between the level of estrogen and the severity of post-castration syndrome. There was also no relationship between the level of estrogen excretion, the nature of the cytological picture of the vaginal smear and the duration of the operation.

Removal of the ovaries entails changes in the central nervous system, which I. P. Pavlov showed in an experiment. In the experiments of B. A. Vartapetov and co-authors (1955), the course of experimentally induced neurosis in dogs always worsened after castration. Removal of the ovaries in women entails changes in higher nervous activity, expressed in a weakening of inhibitory processes and a slowdown in differentiation processes.

Electroencephalographic studies in patients with a severe form of post-castration syndrome indicate a sharp excitation of the subcortex and an increase in the activating influence of the reticular formation on the cerebral cortex, as a result of which it is also involved in the pathological process (I. A. Manuilova, 1972).

Not only bilateral removal of the ovaries, but also unilateral oophorectomy in some cases leads to the development of vegetoneurosis, obesity, and menstrual dysfunction (A. P. Galchuk, 1965; N. I. Egorova, 1966; F. E. Petersburgsky, 1968; A. E. Mandelstam, 1970, etc.). N.V. Kobozeva and M.V. Semendyaeva (1972) observed neuro-endocrine disorders that arose in the first 6 months after surgery in almost all women who underwent unilateral oophorectomy.

There are many reports of the occurrence of disorders similar to post-castration in patients after removal of the uterus with preservation of the ovaries. These disorders vary in nature, time of onset, intensity and duration. Their frequency, according to the literature, ranges from 47 to 82%. Hysterectomy causes more pronounced functional disorders than supravaginal amputation, which some authors explain by the exudative process in the stump area that often develops after surgery, which also involves the ovaries, resulting in their function being disrupted. According to M. L. Tsyrulnikov (1960), functional disorders after supravaginal amputation, the uterus is present in 40.9% of women, and after its complete removal - in 75%.

Perhaps among the causes neuro-vegetative syndrome After removal of the uterus, the disruption of the normally existing close relationship between the ovaries and the uterus, which is the point of application of the action of sex hormones, is of a certain importance. Probably, the limitation of the sphere of influence of ovarian hormones due to the removal of the organ that consumes them, as well as the switching off of a larger or smaller number of interoreceptors causes certain shifts in neuro-endocrine relationships. The importance of the uterus in the regulation of the gonadotropic function of the pituitary gland and the reproductive cycle is shown by experimental studies by O. P. Lisogor (1955). Mechanical irritation of the uterine mucosa leads to an increase in the content of gonadotropic hormones in the pituitary gland, an increase in frequency and prolongation of estrus. In many women, after diathermocoagulation of the cervix in the first half of the menstrual cycle, the content of pregnanediol in the urine significantly increases, which can be explained by a reflex effect on the adenohypophysis and ovaries (M. A. Pugovishnikova, 1954).

The influence of ovarian hormones extends to all parts of the reproductive system, providing their inherent functions. Violation of the integrity of the reproductive apparatus and interoceptive connections at any link can lead to functional changes not only in the genital organs, but also in other organs and systems of the body. In this regard, the observations of S. N. Davydov and S. M. Lipis (1972) are interesting. They showed that with unilateral tubectomy, 42.3% of women developed hot flashes, sweating, increased excitability, sudden palpitations, insomnia, and with bilateral tubectomy similar phenomena, that is, symptoms of post-castration syndrome, were observed in 60% of women. In addition, these patients showed an increase in body weight, diffuse increase thyroid gland, painful engorgement of the mammary glands in the premenstrual period.

Treatment

Treatment methods for post-castration syndrome are varied and include various techniques influence both on individual organs and on the entire body as a whole in order to slow down the development of changes that inevitably occur after surgery to remove the ovaries, and to enable compensatory mechanisms to equalize the disturbed balance.

Based on modern ideas about the pathogenesis of post-castration syndrome, treatment should be comprehensive: restoratives and sedatives, vitamin therapy, hormone therapy. One of the elements of treatment is the impact on the patient’s psyche. In some cases, a change in situation, introduction to regular work or its resumption have a beneficial effect. Special attention should be given a hygienic regime, including gymnastics and water procedures.

Vitamins are widely used in the treatment of patients with post-castration syndrome. There are reports that vitamin B1 reduces the secretion of FSH (M. Yules, I. Hollo, 1963). Vitamin Be has the same effect. Received good therapeutic effect as a result of a course of treatment with vitamins and PP with a 2% solution of novocaine (K.N. Zhmakin, I.A. Manuilova, 1966). Vitamins and novocaine are administered intramuscularly in one syringe; Duration of treatment - 25 days. In combination with other methods, it can be prescribed multivitamin preparations in the form of dragees.

I. A. Manuilova (1972) noted a much longer course of post-castration syndrome in patients treated with sex hormones. With long-term administration of both estrogens and androgens, the production of glucocorticoids and estrogens decreases, which may be associated with the development of functional inertia of the adrenal cortex.

When prescribing hormonal therapy, it is necessary to take into account the patient’s age and the nature of the disease, which required the use of such an extremely radical method of treatment as castration. If it was made due to malignant neoplasm genitals or mammary glands, then hormonal therapy is contraindicated regardless of age. If the operation was performed for other indications, then in women young(up to approximately 38-39 years) combinations of estrogens and progestins are used as replacement therapy, introducing them cyclically until the endometrium loses the ability to respond in the form of menstrual-like bleeding.

Replacement therapy involves reproducing the endometrial cycle by administering estrogens and progestins. To do this, estrogens are first used to produce changes in the endometrium similar to the proliferative phase. Subsequent administration of progestins should ensure secretory transformations of the endometrium. There are various options for sex hormone therapy regimens. Prescribe 1 ml of 0.1% estradiol dipropionate once every 3 days (5-6 injections in total) or 0.1% sinestrol solution or 10,000 units of folliculin daily. After this, 10 mg of progesterone is administered daily for 7 days. Long-acting preparations are more convenient - 1 ml of 0.5% diethylstilbestrol propionate once every 7 days (2-3 injections in total), then 2 ml of 12.5% ​​oxyprogesterone capronate. When removing the ovaries while preserving the uterus, it is recommended to administer 100,000 units of estrogen and 30-40 mg of progesterone monthly (S. Milku, Danile-Muster, 1973). Currently, combinations of estrogens and progestins are used, including long-acting ones. In some cases, this makes it possible to restore not only the menstrual cycle, but also its rhythm (Schneider, 1973), but long-term results in terms of the duration of the therapeutic effect, which largely depends on the ability of the endometrium to respond to exogenous hormonal stimulation, are still unknown.

After bilateral oophorectomy with removal of the uterus, the goal of treatment is to relieve vasomotor disorders and prevent the atrophic process in tissues and osteoporosis. For this purpose, both estrogenic hormones and their combinations with progestins or androgens are used. Doses are selected individually.

Long-acting estrogen preparations are recommended for young women to prevent vasomotor complications. The administration of 2 ml of 0.6% dimestrol solution has a therapeutic effect for several months. The most convenient use of estrogen drugs orally in the form of tablets. Treatment begins with small doses: ethinyl estradiol is prescribed at 0.01-0.02 mg; synestrol - 0.5-1 mg/day; octestrol - 1 mg; the dose of diethylstilbestrol is two times less; sigetin has a weak estrogenic effect, inhibits the gonadotropic function of the pituitary gland, it is used orally at 0.01-0.05 g 2 times a day, the course of treatment is 30-40 days.

Ohlenroth et al (1972), determining the content of estrogen in the urine of women with ovaries and uterus removed after administration of estriol, came to the conclusion that the hormone should be administered 2 times a day orally in an amount of 1-2 mg or 1 time a day intramuscularly.

Ta-Jung Lin et al (1973) studied colpocytological changes in castrated women with an atrophic type of vaginal smear under the influence of an estrogenic drug (Premarin), which was administered at a dose of 1.25 mg daily for 21 days, followed by a 7-day break. Every 2 months there was a one-month break. The hot flashes disappeared on the second day, but resumed immediately after stopping treatment. In the vaginal smear, basal cells disappeared, the number of intermediate cells increased, and cells of the superficial layer were found in very small quantities.
The authors did not establish a connection between the nature of vaginal contents and the clinical manifestations of post-castration syndrome.

Estrogenic hormones are widely used to treat post-castration metabolic disorders. Rauramo (1973) reports their beneficial effect on skin trophism in castrated women. Using autoradiography, thinning of the epidermis and a decrease in its mitotic activity that developed as a result of castration were detected. The use of estriol succinate and estradiol valerate led to the restoration of the thickness of the epidermis and the activation of mitotic processes in it. For atrophic disorders in the tissues of the vulva and vagina, globulin containing 2000 units of folliculin is prescribed after 2-3 days, and folliculin ointment (S. Milku, Danile-Muster, 1973).

The administration of estrogens (agofollindepo Spof) has a pronounced therapeutic effect in the treatment of patients with developed after castration coronary atherosclerosis and dyslipoproteinemia. The content of serum lipids such as cholesterol and 6-lipoproteins is normalized (Novotny Dvorak, 1973).

Apply combination treatment estrogens and androgens in a ratio of 1: 20 and 1: 10 - 1 ml of 0.1% estradiol dipropionate or 10,000 units of folliculin along with 2 ml of 1% testosterone propionate. Injections are given once every 3 days (3-5 injections), and then the intervals are increased to 10-12 days. In this case, after 2-3 months, the phenomena of post-castration syndrome completely disappear (G. A. Kusepgalieva, 1972) and proliferation of the vaginal epithelium is observed according to the type of the middle follicular phase with the initial atrophic type of smear.

Most women, after stopping hormones, very quickly experience hot flashes and other post-castration disorders again. Therefore, hormonal therapy must be carried out over a long period of time. Implantation of crystalline estrogens into the subcutaneous fatty tissue, the resorption of which occurs in approximately 4-6 months, carries the danger of hyperplastic processes in the endometrium and. In this case, it is impossible to stop further absorption of the hormone.

Ovarian transplants also function for a limited time (6-12 months), and the results of their use are not always satisfactory. The possibility of ovarian tissue transplantation is currently being studied. To reduce the intensity of immunological reactions in the recipient's body, Yu. M. Lopukhin and I. M. Gryaznova (1973) used amniotic membranes as a semi-permeable membrane. The graft took root in all patients and was actively functioning for 6-10 months.

For the treatment of neuro-autonomic disorders, thyroid preparations that have a sedative and antigonadotropic effect can be used (S. Milku, Danile-Muster, 1973).

Long-term hormonal treatment, in addition to monitoring the hormonal balance of the body (using mainly colpocytological studies), also requires periodic determination of liver function, body weight, the state of the blood coagulation system, and blood pressure.