Meditsinskiy Sovet · May 11, 2026
Comprehensive approach to managing climacteric syndrome considering new pathogenetic mechanisms: Therapy and prevention
By Ivanov I, Tabeeva GI, Александровна СА
Climacteric Syndrome (CS) is a complex condition that extends beyond vasomotor symptoms (VMS) to include psychoemotional disorders, sleep disturbances, metabolic dysfunctions, and increased risks of somatic pathology. These changes affect up to 97.5% of women during peri- and postmenopause, impairing quality of life and elevating the risks of cardiovascular, neurodegenerative, and oncological diseases. This review provides analysis of current data from international electronic bibliographic and scientific databases (PubMed, Scopus, Web of Science, eLIBRARY.RU), as well as Cochrane Library and peer-reviewed medical journals. It focuses on several insufficiently elucidated pathophysiological aspects of postmenopausal disturbances, including the mechanisms of narrowing the hypothalamic thermoneutral zone, dysfunction of the serotonergic and noradrenergic neurotransmitter systems, the role of oxidative stress and decreased antioxidant enzyme activity, DNA damage and carcinogenesis, and the development of dyslipidemia, insulin resistance, and endothelial dysfunction. The review provides a detailed argument for the necessity of implementing a comprehensive therapeutic approach to CS, aimed not at isolated symptom relief but at the simultaneous correction of key interconnected pathogenetic links. It presents a detailed analysis of modern fundamental and clinical data demonstrating the efficacy of various active molecules, including β-alanine, isoflavones, 5-hydroxytryptophan, and vitamins C, E, and B. Their effects are examined in terms of stabilizing the thermoregulation center in the hypothalamus, selective modulation of estrogen receptors, improving lipid profile and insulin sensitivity, as well as restoring serotonin levels, homocysteine balance, and suppressing oxidative stress. This multicomponent patient management strategy ensures not only effective symptomatic control of vasomotor and psychoemotional manifestations of CS but also long-term prevention of cardiovascular, metabolic, and neurodegenerative complications, aligning with the principles of women’s active longevity.