Post-castration syndrome is the termination of menstrual function, the cause of which may be bilateral removal of the ovaries or even the uterus together with the ovaries. Also, instead of post-castration syndrome, synonyms can be used to characterize such a condition, which are actively used in gynecology, for example, “postovariectomy syndrome”, as well as the concept of “surgical menopause”. The concept of “induced menopause” is less commonly used.
The content of the article:
Pathogenesis of post-castration syndrome
Symptoms of post-aging syndrome
Diagnosis of post-castration syndrome
Treatment of post-castration syndrome
Prevention and prognosis after treatment of post-castration syndrome
Post – castration syndrome
Post-castration syndrome manifests itself very often, in 70-80% of cases, and in 5% it proceeds quite heavily, bringing complications and severe consequences. In rare cases, it may be disability. The severity of the disease may depend on a number of causes and features, in particular, on the age of the patient and the time of the operation, the functional activity of the adrenal glands and the premorbid background.
Pathogenesis of post-castration syndrome
In most cases, the development of post-castration syndrome is affected by total or subtotal ovariectomy, with possible further removal or non-removal of the uterus. Total ovariectomy implies the abandonment of the uterus in cases where the woman did not realize the reproductive function. But this category of women will be able to get pregnant in the future only after a number of procedures and IVF.
The cause of the post-castration period is most often a pangisterectomy. This is the most common cause for women of reproductive age, which is associated with the performance of uterine fibroids and endometriosis. If a woman who has been diagnosed with such a diagnosis is at an age that is characterized by menopause, then a total ovariectomy with hysterectomy is performed, only for reasons of oncological alertness.
Among the non-surgical causes, post-castration syndrome in women can be caused by the extinction of the ovarian follicular apparatus, which could be caused by gamma or X-ray irradiation. It was also noticed that post-castration syndrome is many times more common in patients who suffer from thyrotoxic goiter, diabetes mellitus. Such a burdened background can negatively affect the treatment.
The pathogenetic factor that triggers the disease and affects its development is the sudden appearance of hypoestrogenism in the body, which can occur as a result of a fairly wide range of pathological manifestations. The secretion of neurotransmitters, which are responsible for regulating cardiovascular, respiratory, and temperature reactions, is disrupted in subcortical structures. The violation is accompanied by the appearance of pathological symptoms that are very similar to those that develop with menopausal syndrome.
It is impossible not to mention the changes that cause hypoestrogenism on the part of estrogen-receptive tissues. Changes may manifest themselves by an increase in atrophy of muscle and connective fibers in the genitourinary system, the development of thinning of the epithelium, as well as deterioration of vascularization of organs.
The activity of the ovaries after surgical shutdown may increase by the feedback mechanism due to the release of more gonadotropins. This leads to disruption of the peripheral glands. The cortical layer of the adrenal glands also enhances the synthesis of glucocorticoids, but the formation of androgens decreases, which worsens the overall picture of the disease and maladaptation of the body.
With post-castration syndrome, a complete or partial violation of the formations of thyroxine and triiodothyronine, which are produced by the thyroid gland, is possible. At the same time, the secretion of parathyroid hormone, as well as calcitonin, decreases. Such a decrease leads to the fact that calcium metabolism is disrupted and the development of osteoporosis is provoked.
The function of the ovaries fades after a while, gradually and slowly, the process can last for several years, provided that the natural menopause occurs. But with post-castration syndrome, a sharp and simultaneous shutdown of the hormonal system and all functions of the ovaries is not excluded. This can lead to disruption of adaptive mechanisms in the body, as well as disorganization of biological adaptation to a new state.
Symptoms of post-aging syndrome
Post-castration syndrome begins to manifest itself approximately 7-21 days after ovariectomy, and reaches its full development in 8-12 weeks. The clinical leading manifestation in post-castration syndrome will be a violation of vegetative-vascular regulation. It is this violation that occurs most often, in about 75% of cases.
The reactions of the vegetative-vascular system manifest themselves as hot flashes and excessive sweating, frequent palpitations, sudden redness of the face, pain in the heart, tachycardia, headaches, arrhythmias, hypertensive crises. If post-castration syndrome occurs during menopause, then its severity increases, determined only by the frequency and intensity of tides.
The number of patients who have endocrine problems and metabolic disorders due to the post-castration period: hypercholesterolemia, hyperglycemia and atherosclerosis is steadily increasing. Against the background of post-castration syndrome, women may experience diabetes mellitus and coronary heart disease, obesity and thromboembolism, hypertension, and so on.
Among metabolic diseases and disorders, dystrophic processes that occur in a woman’s body, in particular in the genitourinary organs, can be distinguished. These may be cracks in the mucous membranes, atrophic colpitis, cystitis, replacement of glandular tissue with fatty tissue in the mammary glands and vice versa, and much more.
Also, when post-castration syndrome appears in the body, osteoporosis may begin to progress. Local pains in the chest area, in the lumbar region, in the area of knee joints, shoulder and wrist joints will tell you about its manifestation. Muscle pain and an increased number of bone fractures may also indicate that osteoporosis has progressed. At the same time, the reparative mechanisms of regeneration, for example, of the gums, may weaken. In this case, periodontal disease will develop.
According to statistics, about 12% of women suffer from psychological and emotional disorders, sleep disorders and general irritability, the appearance of depressive states and deterioration of attention.
In the first years of post-castration syndrome, neurovegetative symptoms may prevail in the body, which lead to a subsequent increase in endocrine-neurovegetative problems. Psychoemotional disorders are of a longer nature.
Clinical manifestations in post-castration syndrome may be similar to post-hysterectomy, but with a more pronounced character. The severity of the acquired disease is expressed and compared with the presence in the anamnesis of gynecological or infectious diseases, as well as various pathologies of the hepatobiliary system.
Diagnosis of post-castration syndrome
It is possible to diagnose the post-gastric syndrome under the condition of a gynecological history and its typical manifestations. Directly at the gynecological examination, it is possible to determine atrophic changes in the mucous membrane of the vulva, as well as the vagina. During gynecological ultrasound, it is possible to reliably identify the dynamics of the development of processes in the pelvis immediately after total ovariectomy.
The most important thing in the diagnosis of post-castration syndrome is an additional study of the level of gonadotropins, as well as the amount of pituitary and thyroid hormones, blood glucose and bone metabolism. To fully assess the severity of osteoporosis, it is necessary to perform a densitometry procedure. To determine changes in the functioning of the cardiovascular system, it is necessary to do an ECG and an EchoCG.
Examination of patients suffering from post-castration syndrome is carried out by gynecologists and endocrinologists, neurologists, cardiologists and mammologists, as well as urologists.
Treatment of post-castration syndrome
Clinical gynecology for the treatment of post-castration syndrome uses both medicinal and non-medicinal methods, which are more aimed at normalizing and regulating those processes that help the body adapt, compensate for hormonal balance.
The active phase of post-castration syndrome treatment is accompanied by restorative procedures, for example, UV and microwave therapy in the adrenal glands, cervical-facial galvanization, taking therapeutic baths, climatotherapy and other measures. Coniferous, marine, radon, sodium chloride baths, vitamin therapy, taking vitamins B, A, E, PP and C, as well as hepatoprotectors, anticoagulants and disaggregants are considered especially useful.
Patients who suffer from psychoemotional manifestations of post-castration syndrome can take sedatives, which include valerian and motherwort, novopassit and others, as well as tranquilizers, including phenazepam, relanium and antidepressants such as aurorix and coaxil.
And yet, among the main methods of treatment for the manifestation of symptoms of post—castration syndrome, one can single out the main one – this is the appointment of sex hormones. The regimen of administration, as well as the drug, is prescribed by a doctor depending on the duration of treatment that is planned, as well as the presence of contraindications to certain medications. Treatment can be carried out by oral medication, parenteral, intravaginal, transdermal, intramuscular administration of the treating drug.
Post-castration syndrome is treated using different modes: monotherapy with estrogens, using gels, patches, and other healing substances that can be used during hysterectomy. Women who have retained the uterus are required to take two- or three-phase medications with a cyclic contraception regimen. Such drugs usually include femostol, divin, klimen, trisequence and others. Contraindications that can serve to cancel HRT may be liver diseases and detected uterine or breast cancer, coagulopathy, thrombophlebitis.
Prevention and prognosis after treatment of post-castration syndrome
Post-castration syndrome in women, the treatment of which should be timely, is a very unpleasant diagnosis, but you should not despair. The early start of treatment and effective prescription of therapeutic agents, the ovariectomy procedure significantly prevent and reduce the degree of development of post-castration syndrome. After a total ovariectomy, a woman should be under the careful supervision of doctors: an endocrinologist, gynecologist, mammologist, neurologist and cardiologist, who should constantly monitor her health and fix any violations.
