Objective The aim of this study was to assess the dynamical interaction between the cardiovascular autonomic control and sex hormones in perimenopausal women under menopausal hormone therapy (MHT).Patients and methods Seventy women (age: 51.6 ± 2.1 years) were treated with MHT. Standard time and frequency domain measures of heart rate variability (HRV) and index S of synchronization between the slow oscillations in HRV and photoplethysmographic waveform variability were studied during a 6-week treatment with MHT. We assessed also the dynamics of the following sex hormones: estradiol, follicle-stimulating hormone, dehydroepiandrosterone sulfate, and testosterone.Results MHT increased estradiol and decreased folliclestimulating hormone. Hot flashes and index S were significantly decreased under MHT (P < 0.05). Other autonomic indices were not significantly changed (P > 0.05). Changes of index S did not correlate with changes of sex hormones and hot flushes (P > 0.05). ConclusionThe obtained results may indicate the independence of heart autonomic control (assessed by HRV measures) from women's hormonal status. However, any changes in sex hormones contribute to changes in the systemic control of circulation, which is assessed by index S.

; Караваев Анатолий Сергеевич, канд. физ.-мат. наук, cт. научн. сотр., доцент; Прохоров Михаил Дмитриевич, доктор физ.-мат. наук, вед. научн. сотр.; Бобылева Ирина Владимировна, аспирант; Гриднев Владимир Иванович, доктор мед. наук, руководитель Центра продвижения новых кардиологических информационных технологий; Киричук Вячеслав Федорович, доктор мед. наук, профессор, заслуженный деятель науки РФ, заведующий кафедрой; Рогожина Ирина Евгеньевна, доктор мед. наук, профессор, заведующий кафедрой Цель. Изучение особенностей вегетативной регуляции сердечно-сосудистой системы у женщин в перименопаузе с учетом различий их клинического статуса. Материал и методы. В одномоментное исследование были включены 185 женщин в постменопаузе (59,3 ± 8,5 года) и 104 женщины с сохраненным менструальным циклом (45,1 ± 5,8 года). Был оценен общий клинический статус, наличие приливов, тяжесть климактерического синдрома (индекс Купермана), уровни половых гормонов (эстрадиол, фолликулостимулирующий гормон, дегидроэпиандростерон сульфат и тестостерон), показатели вариабельности сердечного ритма (средняя частота сердечных сокращений, SDNN, RMSSD, PNN50, коэффициент вариации, а также спектральные мощности низко-и высокочастотного спектральных диапазонов, выраженные в абсолютных единицах и в процентах от общей мощности спектра) и синхронизованности низкочастотных (около 0,1 Гц) колебаний в вариабельности сердечного ритма и фотоплетизмограмме (показатель S). Результаты. Не было выявлено статистически значимых различий между группами женщин с сохраненным менструальным циклом и в менопаузе по большинству показателей вегетативной регуляции кровообращения (кроме среднего уровня частоты сердечных сокращений). Большинство оцененных показателей вариабельности сердечного ритма коррелировали (коэффициент корреляции r составлял 0,17-0,24) со сроком естественной менопаузы. С давностью наступления хирургической менопаузы коррелировал только показатель синхронизованности колебаний с частотой около 0,1 Гц-S (r =-0,41, р = 0,039). Также выявлены статистически (но не клинически) значимые корреляции между некоторыми показателями вегетативной регуляции и уровнями половых гормонов. Заключение. Не было выявлено клинически значимых ассоциаций показателей вегетативной регуляции сердечно-сосудистой системы и характеристик менопаузального статуса женщины (уровни половых гормонов, приливы, индекс Купермана). Однако были показаны статистически (но

The mechanisms of the emergence of "hot flashes" are actively considered, but still insufficiently studied. A woman's body weight is a modifiable risk factor, that is, amenable to both non-drug and drug correction. Therefore, the relevance of studying this risk factor for hot flashes is high. The purpose of this study is to study the relationship between vasomotor symptoms and body mass index in women. The study included 228 women with vasomotor complaints in the early postmenopausal period. The average age at the onset of menopause was 51.6 years (47.2; 53.4), while the median duration of menopause was 4.1 years (2.2; 5.0). Our results indicate the possibility of hot flashes in women with different body mass index. In obese women, severe menopausal syndrome (MS) is less common (5.7%) than in women with overweight (8.3%) or normal body weight (6.1%); while the average degree of MS is most often observed in patients with normal body weight (21.5%), less often with obesity (14.9%) and overweight (10.1%); mild MS is most often observed in patients with normal body weight (18%), less often with obesity (10.1%) and overweight (5.3%). It was found that in women with obesity, the severity of the initial signs of MS is not high (on average, up to 5-6 hot flashes per day), severe MS is less common than in women with overweight or normal body weight. Thus, hot flashes occur in women regardless of the woman's body weight and "obesity" is not able, as previously thought, to "protect" a woman from the appearance of hot flashes.

The decline in the quality of life due to various menopausal disorders in the early postmenopausal period is actually the main reason that leads a woman to seek medical help. Despite this, not enough attention is paid to this problem. Currently, the concept of the formation of individual menopausal symptoms into clusters is emerging to optimize treatment and diagnostic algorithms for managing this category of patients. The aim was a comparative analysis of the menopausal disorders most associated with a decrease in the quality of life. Included were 230 women with climacteric disorders (95 with bilateral oophorectomy; 135 with natural menopause). The assessment of the severity of climacteric disorders was carried out according to the Kuperman index modified by E.V. Uvarova. The SF-36 Health Status Survey was used to assess the quality of life. The average age of patients with surgical menopause was 47.9±2.2 years, with natural menopause - 53.6±3.5 years (p˂0.05). The duration of the estrogen deficiency state in the groups was comparable - 2.8 ± 0.6 years (p>0.05). All patients had a moderate degree of menopausal syndrome (p>0.05), however, the values of the modified menopausal index differed significantly: with postovarectomy syndrome - 57.8±1.1 points, with menopausal syndrome - 49.7±0.9 points (р <0.05). In both groups, a decrease in the quality of life was observed: the total physical component (with postovarectomy syndrome up to 57.2 (36.6; 72.7), with menopause - up to 68.4 (49.3; 83.5)) and the total psychological component (up to 53.9 (42.9; 76.7) and 64.1 (47.3; 84.5), respectively). In contrast to our approach, the formation of clusters of menopausal symptoms, based on the generally accepted approach to the analysis of climacteric disorders (psychological, vasomotor, somatic), provided a significantly smaller sample coverage (with surgical menopause - 68.5%, with natural - 62.6% variance) With a duration of estrogen deficiency of 2.8 ± 0.6 years, the cluster of menopausal disorders, which has the maximum negative effect on the quality of life, includes symptoms: hot flashes, cognitive disorders, sleep disturbances, anxiety, and covers 80.3% of the variance in postovarectomy syndrome, in menopausal - 73.6%. Knowledge of this fact contributes to the identification of risk groups and allows formulating new algorithms for the management of postmenopausal women.

Аннотация. В статье рассматривается возможность повышения качества жизни у пациенток при климактерическом (КС) и постоварэктомическом (ПОЭС) синдромах. Включено 95 женщин с ПОЭС (основная IА (n=48), сравнения IB (n=47)) и 135 -с КС (основная IIА (n=68), сравнения IIB (n=67)). Всем проводилась менопаузальная гормональная терапия (МГТ), в основных группах -в сочетании с ритмической транскраниальной магнитной стимуляцией (рТМС). Доказано, что включение в лечение КС и ПОЭС наряду с МГТ рТМС повышает качество жизни, в большей степени психологического компонента.