Menopause is a necessary stage in the transition from the presence to the absence of female fertility. During this stage, women’s ovarian function decreases significantly, and sex hormones fluctuate substantially and decrease sharply, leading to central nervous system dysfunction, atrophy of sex hormone-dependent organs and a series of related symptoms, called menopausal syndrome. Menopausal syndrome not only affects the quality of life and work, but also has a predictive effect on cardiovascular diseases, osteoporosis, and genitourinary tract atrophic diseases in old age.
I. Signs of menopause
1.Late menstruation
Late menstruation is the most common symptom of menopausal women, mainly manifested as ① gradual lengthening of menstrual cycle, decrease in menstrual volume, and eventually cessation of menstruation. ②Sudden cessation of regular menstruation without post-menopausal vaginal bleeding. The absence of menstruation for 12 months or longer is called menopause.
2. Hot flashes, night sweats and excessive chilliness
Hot flashes and night sweats are typical symptoms of menopause and are a reflection of vasodilation and contraction dysfunction. Hot flashes are characterized by a feeling of heat that starts in the forehead and spreads rapidly to the head, neck and upper extremities, followed by fine or large drops of sweat, accompanied by palpitations, blood pressure fluctuations, dizziness and weakness, when the external temperature is suitable. The hot flashes are usually followed by a cold sensation. Hot flashes that occur at night or in the early morning are called nocturnal sweats and often lead to interrupted sleep. A small number of menopausal women have excessive cold fear, which manifests itself as a local or general feeling of extra cold, such as the need to wear a sweater or even a cotton coat in the third month of the year, very cold in both lower extremities and bouts of hot flashes in the upper body resulting in upper and lower body clothing that is not in the same season.
Factors that contribute to hot flashes include low education level, difficulty in maintaining food and clothing, smoking, lack of exercise, obesity, low weight, unmarried, childless, heavy alcohol use, hot and humid weather, and excessive physical activity; while hot flashes are less likely to occur in women who are active, have a more equal social role, have college or higher education, and have a more positive attitude toward menopause or aging.
The proportion of menopausal women with hot flashes varies by race and geographic area of residence. Blacks have the highest percentage of hot flashes, nearly 80%; whites are next; and only about 30% of yellows experience hot flashes. Asians living in Europe and the United States have hot flashes close to those of Caucasians.
Foreign sources report that the average duration of moderate to severe hot flashes is 10.2 years. If hot flashes are felt just after menstruation begins “late,” the number of years to experience hot flashes is longer, averaging 11.57 years; if hot flashes occur after menopause, the duration of hot flashes is shorter, about 3.84 years. Moderate to severe hot flashes usually begin between the ages of 45 and 49. There are, of course, some menopausal women who do not experience hot flashes. In China, such a percentage is about 70%; in Europe and the United States, it is about 20-40%.
The frequency and severity of hot flashes varies from person to person. Mild hot flashes are transient, while severe hot flashes occur several to dozens of times per hour. Hot flashes last from a few seconds to several minutes. Hot flashes can occur when menstruation is still regular or they can begin several years after menopause. The most frequent and severe hot flashes occur during perimenopause and early menopause.
Women with hot flashes have higher blood lipids (including total cholesterol, LDL, and triglycerides), systolic blood pressure, diastolic blood pressure, fasting blood glucose, body mass index, waist-hip circumference, and increased aortic calcification than women without hot flashes; women with night sweats have increased rates of coronary heart disease.
The mechanism of hot flashes, night sweats and excessive chills lies in the abnormal function of the thermoregulatory center. Under normal conditions, the thermoregulatory center directs peripheral vasoconstriction or diastole to maintain or disperse heat according to the body’s internal temperature, maintaining a relatively constant body temperature. Thermoregulatory commands are transmitted through neurotransmitters. If the thermoregulatory center functions normally and the neurotransmitters are coordinated and precise, the body temperature is regulated normally. However, sex hormones are powerful modulators of neurocircuit function. During menopause, when sex hormones fluctuate and decline rapidly, some women’s central neurotransmitters fail to adapt to such rapid changes and become disordered, resulting in a narrower tolerance range of the thermoregulatory center for changes in body temperature within the body, i.e., heat loss when body temperature is slightly higher and heat production when body temperature is slightly lower, resulting in abnormal hot flashes or chills.
Menopause syndrome
It has been recorded in books more than a hundred years ago that there are as many as 135 symptoms of menopause. In addition to the typical symptoms such as hot flashes, night sweats and excessive chilliness mentioned above, symptoms can occur in many organs and systems throughout the body, and the type, degree and time of occurrence vary from person to person and are complex and variable. More than half of all menopausal women experience a variety of menopausal symptoms. It is because of the wide range of symptoms that they are collectively referred to as the menopausal syndrome.
The many manifestations of menopausal syndrome are often difficult to explain in terms of organic disease, and symptomatic treatment does not provide satisfactory relief, leading to repeated visits to the doctor. Moderate and severe symptoms significantly affect work and quality of life, affect family harmony, and increase the risk of doctor-patient disputes.
The occurrence of menopausal symptoms depends on several factors, including physical, psychological and social. Where there is an optimistic attitude toward aging and a better social support system for aging, the population has less severe menopausal symptoms and psychoneurological symptoms are less common than physical symptoms. Physiological factors are the underlying factors of menopausal symptoms, which are reflected in the large fluctuations and rapid decline of sex hormones and the failure of the central nervous system to make timely adaptive adjustments, resulting in the loss of precision and coordination of various neurotransmitters such as 5-hydroxytryptamine, norepinephrine, and dopamine, leading to the diversity and variability of symptoms. Organs or systems that are sex hormone-dependent or sensitive are atrophied due to lack of sex hormones. The mammary glands and female reproductive tract are dependent on sex hormones and gradually atrophy with prolonged lack of sex hormones.
1.Vasodilatory symptoms, i.e. hot flashes, night sweats, chills, etc., are the manifestations of abnormal function of the thermoregulatory center and abnormal contraction and diastole of peripheral blood vessels.
2, psychoneurological symptoms
Neuropsychiatric symptoms such as irritability, depression, irritability, insomnia, anxiety, paranoia, headache, dizziness, forgetfulness, etc. are commonly seen during menopause, and occasionally panic attacks. These symptoms are closely related to various social, physical and psychological factors, such as shouldering professional responsibilities, working under great pressure, leaving the familiar working environment due to retirement, children growing up and leaving the family, poor relationship between husband and wife, illness or death of friends and relatives, new illnesses, fear of aging, etc., as well as hot flashes and night sweats leading to interrupted sleep, all of which can trigger psychoneurotic symptoms. Depression, anxiety, and insomnia in menopausal women increase the risk of coronary heart disease in old age.
Basic research has shown that psychoneurological symptoms are closely related to abnormalities in central nervous function. The hypothalamus contains important thermoregulatory centers as well as centers regulating mood, feeding, sleep-wake, circadian rhythm, and hormone metabolism, which are involved in the regulation of various physiological functions of the body. In the case of neurotransmitter disorders, the function of these areas may also become abnormal, and therefore the corresponding symptoms appear. Clinically, 5-hydroxytryptamine reuptake inhibitors, 5-hydroxytryptamine and norepinephrine reuptake inhibitors are used to treat depression and improve the corresponding symptoms, and the mechanism is to regulate neurotransmitters.
3. Cardiovascular system symptoms
About 1/4 of menopausal women experience palpitations, unstable blood pressure, and occasionally severe symptoms such as chest pain and feelings of near death, leading to repeated emergency visits to the doctor. After several specialized tests, even including 24-hour electrocardiogram monitoring, 24-hour blood pressure monitoring, and coronary angiography, it is difficult to explain such symptoms.
Symptoms of the cardiovascular system can be very worrisome. After repeated visits to the doctor, it is difficult to explain these symptoms satisfactorily by “vegetative dysfunction” or “cardiac neurosis”, which can easily lead to doctor-patient disputes. In fact, the stability of cardiovascular function depends on the coordination of autonomic (sympathetic and parasympathetic) function, and estrogen also acts directly on the vascular endothelial system to stabilize vasomotor activity.
4. Skeletal muscle system symptoms
Vertical spinal muscle soreness is a typical manifestation of early osteoporosis. The two long, powerful muscles in the back near the spine are important muscles to maintain the body from hunching over, commonly known as the “internal spine”. In the early stage of vertebral bone loss, when the bones tend to be compressed, the vertical spinal muscles contract with great effort to maintain the external appearance of the person, resulting in the accumulation of lactic acid and making the person feel sore. In advanced, severe osteoporosis, fractures are frequent and difficult to heal, and half of the patients are deformed or disabled for life as a result. The soreness and stiffness of large and small joints may also be related to menopause.
5. Abnormal sensation
The ankylosis of the skin is a typical symptom of menopause. Some menopausal women feel a localized cold or burning sensation in the skin without any abnormal skin appearance. Burning mouth syndrome is also closely related to menopause. Some abnormal symptoms of the respiratory and digestive tracts, such as total throat distress and strong hunger, which cannot be explained by physiological conditions or organic diseases, should also be considered to be related to menopause.
6. Atrophy and prolapse of the genital tract
The female reproductive tract is sensitive to sex hormones. After the lack of sex hormones lasts about 3-5 years, there may be thinning of vaginal epithelium, decrease of vaginal elasticity, almost disappearance of vaginal discharge, shrinking of cervix, shallow vaginal vault, shrinking of uterine volume, thin endometrium, ultrasound suggests that the uterus becomes smaller in the meridian and the thickness of endometrium is less than 5 cm. postmenopausal women often have vulvar itching, vaginal dryness, painful intercourse and even burning sensation, thus affecting the relationship between husband and wife . The lack of glycogen in the vagina decreases the proportion and activity of lactic acid bacteria, raises the pH level, and causes a dysbiosis of the flora, making the micro-ecological environment “poor” for the growth of pathogenic bacteria, which can lead to senile vaginitis, manifested as increased leucorrhea with a bad odor and yellow color, and even retrograde infection, leading to pelvic inflammatory disease.
The muscles and fascia of the perineum are important tissues that maintain the normal position of the pelvic organs. Due to various factors such as pregnancy, childbirth, long-term constipation, chronic cough, obesity, and aging, they lose strength and are difficult to support, and the position of the uterus, urethra and bladder, and rectum gradually moves down and even prolapses outside the perineal opening, i.e. pelvic organ prolapse. At the beginning of prolapse, there is no discomfort; when the organs prolapse out of the perineal opening, you will feel friction and discomfort, and you can return it in the morning, and gradually prolapse from the afternoon to the night gradually aggravate; when the prolapse is serious, the above organs completely prolapse out of the vaginal opening, and it is extremely inconvenient to move, which greatly affects the quality of life.
7.Recurrent urinary system infection and urge incontinence
The urethra and bladder are the close neighbors of the reproductive tract. When estrogen is lacking for a long time, the supporting tissues around them and the mucous membrane of the urethra become thinner, and the substances secreted by the urethral epithelium to resist retrograde bacterial infections are reduced, making retrograde urinary tract infections easy to occur. After menopause, there are more pathogenic bacteria in the vagina, which collect in the perineum and are the main pathogenic bacteria causing retrograde urinary tract infections. About 1 in 10 postmenopausal women suffer from recurrent urinary tract infections, which seriously affects the quality of life and is one of the main causes of renal insufficiency in older women.
Urge incontinence is a condition closely related to estrogen deficiency. Patients need to urinate as soon as they feel the urge to urinate; many women have wet their pants before they have time to go to the toilet. Urinary frequency and urgency are the characteristic symptoms of urge incontinence. The decrease in the function of the nerve center for answering the urge to urinate and controlling urination, as well as the local atrophy of the perineum, are the main causes of urge incontinence.
8. Thinning of the skin and atrophy of the mammary glands
The mammary gland is an estrogen-sensitive organ. After menopause, breast tissue atrophies, breast volume shrinks, and different degrees of sagging and relaxation occur. The elasticity of the skin depends on estrogen, and the ratio of elastic fibers and collagen fibers decreases when estrogen is lacking; the secretion of sebaceous glands depends on androgen, and the skin becomes dry when androgen decreases. Itchy skin and skin allergies are also more common during menopause.
Three, easy through menopause, to meet the healthy old age
1.Good details
Staying optimistic, mastering the rhythm of life, and quitting bad habits are the elements of keeping menopause healthy. Women who have reached middle age are either successful in their careers and have the burden of work, so they need to combine work and rest, especially to pay attention to proper stress reduction; or gradually retire and stay at home, so they need to cultivate more fun in life, and play their residual energy for their past work appropriately, instead of being overly attached to it. Master the rhythm of life, try to have a half-hour nap at noon, put down work and entertainment before eleven o’clock at night, enter the rest state; encounter stress, tension, especially to take the initiative to relieve emotions; if the mood is excited, temper suddenly difficult to control, it is necessary to take the initiative to realize the sudden change in their emotions, deep and long and steady breathing has the effect of calming emotions; to be adjusted to a better state, and then deal with those difficult After the emotions have adjusted to a better state, then deal with those difficult things. At this time, most of the children at home have grown up, or they are preparing for the midterm or entrance exams and every family member is extremely nervous, or they have gone out to study or work and the family has returned to the “two-person world”, women in menopause must leave a share of care for themselves when they care for their husbands and children, and be aware of their inner feelings and physical changes. The change of the body, make appropriate adjustments, will add a lot of warmth, harmony and happiness to the family.
2, exercise smart
Ensure that at least three times a week, each time more than 30 minutes of aerobic exercise can maintain a healthy body. Healthy stride is a good way to aerobic exercise, the standard posture is to hold your head high, 60-70 cm per step, swing your arms significantly, it is best to alternate fists at the same time to increase the grip; recommended to wear flat sneakers, fitted and sweat-absorbing cardigan tops are conducive to feel hot and sweaty time to take off; preferably in the early morning or evening, in the light suitable, open view of the flat walk, the speed is maintained at 100 meters per minute. Walking distance of 2 kilometers, about 3500-4000 steps; in order to lose weight, you must walk 45 minutes a day. When ending a healthy stride, the sum of heart rate and age should reach 170. special advice is to gradually increase the intensity depending on your physical condition until you reach the standard, but also remind everyone that loitering, skating is not an effective exercise. Effective exercise can reduce bone loss, enhance muscle strength, increase body balance, reduce falls and fractures; it can also balance neurotransmitters, improve mood, and is also an effective measure to maintain body weight, or a basic measure to prevent cardiovascular disease and osteoporosis. Swimming, jogging, yoga, etc., is also a good exercise method.
3, diet wonderful
In the menopause stage, blood lipids, blood sugar will occur adverse to the quiet change of health; the body’s basal metabolic rate decreases, fat is easy to accumulate in the middle part of the body, the occurrence of centripetal obesity. Controlling the diet and maintaining a reasonable dietary ratio is an important task at this stage. And at this time, women are usually well-fed, a little attention to control the diet, will soon enter the ranks of obesity. Eating regularly and leaving food when you feel slightly full is the first step to “keep your mouth shut”. Some menopausal women, because of the central nervous system disorder, obviously just eaten, the sudden onset of hunger, if not immediately eat something very uncomfortable, then you can drink some plain water or eat some cucumbers, tomatoes and other low-calorie food, and start to do something else to interest themselves, to guide the thinking from the “eat”. Some menopausal women who love to eat fried foods or snacks and other sweets should strictly control their intake and set themselves up to eat a small amount of these foods for a month or two to satisfy their cravings. Sugary drinks are not good for menopausal women’s health and should be avoided as much as possible.
It is also important to eat as lightly as possible. Reducing the intake of food fats and oils is very beneficial in keeping blood lipids normal. Women in menopause are particularly sensitive to sodium and are prone to blood pressure fluctuations and increased blood pressure. Reducing salt intake is beneficial in reducing menopausal hypertension. Spicy and hot foods tend to induce hot flashes, so women with hot flashes should eat less of such foods. Strong coffee has a refreshing effect, but be careful if it causes insomnia; and coffee will increase the number of night urination, which may affect the quality of sleep.
4.Good use of medicine
Sex hormone therapy is an important measure to relieve menopausal symptoms, which can effectively improve hot flashes and sweating, psychoneurological symptoms, genitourinary tract atrophy and many other menopausal symptoms, and is beneficial to improve the quality of life and bone metabolism and lipid composition. Sex hormone therapy has a history of nearly 100 years, and doctors have accumulated a wealth of experience and many consensus in clinical practice. It is now believed that the active application of sex hormones before the age of 60 and within 10 years of menopause may benefit the cardiovascular system while relieving menopausal symptoms. It should be emphasized that for menopausal women, sex hormone supplementation should not be considered as a necessity, and it should not be treated in the same way as “thyroid hormone supplementation for low thyroid function”. The fundamental purpose of sex hormone supplementation is not to increase the body’s sex hormone level with drugs, and it is not to make women feel young by menstruating. If sex hormones are abused, they are bound to endanger women’s health. A professional doctor will fully communicate with each patient to understand her specific situation and prescribe the medication in order to maximize the benefits and avoid the risks of sex hormone therapy.
Black Asclepias root isopropyl alcohol extract Livermin is a natural botanical medicine that can relieve menopausal symptoms by regulating neurotransmitters, not sex hormones or phytoestrogens, and can effectively relieve menopausal symptoms, avoid the side effects of sex hormones, have low adverse effects, and be safe for the breast and endometrium. Traditional Chinese medicine also has many drugs used to relieve menopausal syndrome.
5.Communication is unlimited
The many symptoms of menopause often distress women at this time due to many unpleasant symptoms, the cause of which cannot be identified by repeated visits to the doctor. Some middle-aged women are even sent to the emergency room several times by family members and colleagues because of sudden cardiac symptoms, and the conclusion after a thorough examination is “neurosis” or “menopausal syndrome”. In this case, you should actively accept the doctor’s advice and use reasonable medication to improve your menopausal symptoms, but also listen to your inner feelings and don’t be ashamed to discuss them with your family and friends, so that you can establish a channel for emotional relief. It is important to attend medical checkups on time to detect subtle changes in the body during menopause, which often indicate the first signs of future diseases.
The Department of Obstetrics and Gynecology at Peking University First Hospital has set up a “One-Day Menopause Health Guidance Clinic” for menopausal women. During this day, more than ten menopausal friends who arrived by appointment had ample time to communicate with doctors, nurses and nutritionists, and learned that menopause is not synonymous with “pessimism” and “aging”, but the beginning of a wonderful old age. The awareness of self-care was greatly improved, and the meticulous exercise and diet guidance made it more feasible to improve health, and the live demonstration and personal experience impressed everyone. During the day, a comprehensive menopause physical examination can be completed, and experts will answer each individual’s various results to improve lifestyle and supplement medication to curb the seeds of future diseases and maintain a healthy mental and physical state. The attentive menopause one-day clinic staff will also return to patients at the appropriate time to understand the effects of interventions and to urge the maintenance of good health. There is reason to believe that attention to menopause will enlighten a more exciting life for the elderly.