In recent years, scientific research has found that women have estrogen receptors in more than 400 tissues and organs throughout the body (skin, mucous membranes, bones, internal organs, muscles, blood vessels, nerves, etc.), and that after women reach the age of 40, as ovarian function gradually declines and fades, degenerative changes occur in tissues or organs that have been under estrogen control, and more than 90% of women will experience autonomic dysfunction and metabolic disorders. More than 90% of women will develop a group of syndromes, mainly autonomic dysfunction and metabolic disorders, called menopausal syndrome. Although it is a natural manifestation of physiological aging, some uncomfortable symptoms plague the majority of menopausal women, and about 10-25% of them require special treatment.
(i) Menstrual changes
The earliest symptom that occurs in most women during perimenopause is menstrual changes, often due to ovarian failure to ovulate or fluctuating hormone secretion by the ovaries. Approximately 90% of women experience menstrual changes for about 4-8 years prior to menopause. The changes can take many forms, the most important being whether they occur in comparison to their own menstrual cycle and whether they affect their work and life. According to STRAW (Stages of Reproductive Aging Workshop) 2001 survey report, prolongation of menstrual cycle for more than 7 days or menopause for more than 60 days indicates the beginning of menopausal transition.
(ii) Vasodilatory symptoms
Vasodilatory symptoms such as hot flashes and sweating are usually manifested. Hot flashes are a characteristic manifestation associated with menopause in women, with an incidence of 75-85%, of which 80% of patients can maintain this symptom for more than one year, and sometimes up to about 5 years after menopause. As the number of years of menopause increases, the symptoms may gradually decrease to disappear spontaneously. When hot flashes occur, the blood vessels dilate and contract involuntarily in an irregular manner, typically manifesting as a sudden fever in the upper body, and from this feverish feeling like a rising tide to the head, neck and face, which may be accompanied by headache, head swelling, vertigo, palpitations, chest tightness and irritability, lasting from a few seconds to 30 minutes. Before the symptoms disappear, sweating is often slight, dripping sweat or chill, and sweating at night is more obvious, often called “night sweats”, which can affect sleep and even insomnia. Common causes of hot flashes include increased ambient temperature, work or family stress, hot or spicy foods, alcohol, coffee, and certain medications.
Many medications and non-drug methods can treat hot flashes.
1. engaging in regular physical exercise and improving the quality of sleep.
2.Create a quiet and cool environment, such as the use of cold air and fans in summer.
3, relax and reduce stress. Such as deep breathing, yoga, tai chi, massage, etc..
4.Reducing stimulating foods, such as chili, coffee, alcohol.
5.Prescription drug treatment such as hormone therapy.
6.Over-the-counter drug treatment, such as vitamin E, glutamate.
7.Chinese herbal medicine treatment.
(iii) Neurological symptoms
Usually manifested as insomnia, palpitations, vertigo, headache, etc.. Insomnia is the most common, which can be manifested as not being able to fall asleep or waking up easily after falling asleep and not being able to fall asleep again, or being dreamy, or in severe cases, staying awake all night, and taking sleeping pills are still not effective. Insomnia often aggravates other symptoms of menopause.
The first step in the treatment of insomnia is to develop good sleep habits and pay attention to sleep hygiene. Try to treat with over-the-counter medications first, and use prescription medications only when they are ineffective. Specific measures include.
1. keeping the bedroom cool and wearing light pajamas.
2.Avoid reliance on sleeping pills.
3. adhering to appropriate daily exercise, but not choosing to do so before bedtime
4, avoid drinking coffee, alcohol and smoking at any time.
5.Take a warm bath before going to bed.
6, drink a glass of hot milk before bedtime.
7, eyes closed before bedtime to do deep breathing exercises to relax and ease the tension.
8, try to use the bedroom only during sleep and sex.
9, wait until there is tiredness before going to bed.
10.If you are still not asleep after 10 minutes in bed, get up and do relaxing activities, such as reading, listening to light music, etc., and go to sleep only when you are tired. If another 10 minutes have passed and still not fallen asleep, then repeat.
11.Do not doze off often during the day and keep the total sleep time at 6 to 8 hours.
12.Regardless of the length of sleep at night, turn on the alarm clock every morning to get up on time and develop a regular work and rest schedule.
(iv) Psychiatric symptoms
Its clinical characteristics are the first onset of perimenopause, mostly accompanied by sexual decline, and the main symptoms are depression, anxiety, paranoia, etc. The severity of psychiatric symptoms is related to individual personality characteristics, neurological type, occupation, education level, economic status and environmental factors. Most of the rural women and those with low education level can easily pass through the perimenopause; while women with mental fragility, affluent life, superior conditions, high social status or knowledge level, and high education and culture are prone to mental, emotional and psychological disorders, and they last for a long time. Therefore, for neuropsychiatric symptoms, in addition to hormones and other drugs combined with psychotherapy, it is especially worth emphasizing personal self-adjustment, recognizing that this is a short period of physiological changes, finding ways to divert attention, and actively restoring normal emotions from various aspects.
(V) Reproductive system changes.
1, vulva: perimenopausal women’s vulva tissues gradually degenerate, the subcutaneous fat of the labia majora and minora decreases, the mucous membrane becomes thinner; vascular elastic fiber degenerates, blood perfusion decreases, resulting in short, soft and sparse pubic hair, turning gray, the labia minora and clitoris shrink, glandular secretion decreases, the vulva is thus dry and wrinkled, the vaginal opening narrows.
2. Vagina: In perimenopausal women, the estrogen level in the body decreases, the vaginal mucosa epithelium gradually thins, the surface layer is round or oval cells or boat-shaped cells in the middle layer, the folds and elasticity of the wall disappear, the vagina becomes narrow and short, and the fornix gradually disappears. As the glycogen content in the mucosal epithelium decreases, the lactic acid produced by lactobacilli in the vagina also decreases, and the pH value rises from acidic to neutral or alkaline, resulting in the destruction of the local physiological defense mechanism and a decrease in resistance to the invasion of external bacteria and infection.
3. Cervical: The cervix starts to atrophy, harden, and the surface becomes pale, the mucous membrane secretion of the cervix decreases, the cervical canal narrows, and adhesions easily occur. The squamous epithelial migration moves up to the endocervix, and anatomical changes make it difficult to locate the cervix in the elderly.
4, uterine body: the myometrium gradually undergoes fibrous degeneration and degeneration, collagen and elastin are reduced, so the uterus gradually atrophies and loses weight. If there is a fibroid, it shrinks and atrophies with it. The endometrium loses estrogen support and becomes atrophied. However, in some women, the imbalance of estrogen and progesterone secretion before and after menopause can cause endometrial hyperplasia or localized hyperplasia to form polyps.
5. Ovaries: The most prominent change in perimenopausal women is the aging of the ovaries. The weight of the ovaries gradually decreases from about 10g to 4g, the volume decreases to 1/2 to 1/3 of that of fertile women, the surface is wrinkled and uneven, the texture becomes hard, and the follicles in the ovaries are exhausted or the remaining follicles lose their response to gonadotropins.
(vi) Decreased fertility
As ovarian function declines and menstrual cycles become disrupted, women’s fertility decreases. The decline in female fertility begins around the age of 35 to 38, and the incidence of miscarriage gradually increases. The incidence of miscarriage increases to 50% by the age of 45; the incidence of fetal chromosomal abnormalities also increases significantly at the age of 40, which is one in forty; after the age of 40, women have a significantly higher chance of pregnancy complications, such as premature delivery and stillbirth, and the rate of cesarean section increases significantly.
(vii) Urinary system symptoms
The mucosa of the vesicourethra and the vaginal mucosa are of the same origin during the embryonic period. When estrogen is lacking, the mucosa of the vesicourethra also becomes thinner and shows different degrees of atrophic changes, resulting in atrophic cystitis, which is prone to cystitis and urinary tract infections due to decreased resistance, resulting in urinary frequency, urinary urgency, painful urination and hematuria.
(H) Symptoms of the cardiovascular system
1. Elevated blood pressure or blood pressure fluctuations.
Blood pressure is related to a variety of factors such as genetics, age, gender, smoking and alcohol. The relationship between blood pressure and age shows that systolic blood pressure increases with age until the age of 80, and diastolic blood pressure increases with age until the age of 50. The relationship between blood pressure and gender shows that women have higher systolic and diastolic blood pressure than men after middle age, and is characterized by higher systolic blood pressure and obvious fluctuations.
2. Cardiovascular symptoms.
Common cardiovascular symptoms are palpitations, arrhythmia, chest tightness and pseudo-angina, etc. The onset is related to psychosomatic factors. They are characterized by more complaints and fewer signs, heart rate does not increase when palpitations occur, and arrhythmias are mostly anterior contractions, and heart rate returns to normal after estrogen treatment or the frequency of arrhythmias is less and the number of episodes is reduced, suggesting that palpitations and arrhythmias are related to the lack of estrogen.
3. Increased incidence of coronary heart disease.
Changes in lipids and lipoproteins in perimenopausal women are characterized by an increase in cholesterol, triglycerides and atherogenic lipoproteins and a decrease in lipoproteins that prevent atherosclerosis. Hyperlipidemia is likely to lead to atherosclerosis, hypertension and coronary heart disease.
(ix) Changes in sexual function
The main manifestations of sexual dysfunction in perimenopausal and postmenopausal women include loss of sexual desire, sensual indifference, no sexual excitement response, vaginal cramps and pain during sexual intercourse, etc. Menopause marks the end of fertility, but it does not mean the loss of sexual response and sexual function. Modern medical research believes that the elderly have normal and lasting sexual function, is a good sign of a long and healthy life, is the performance of the elderly energetic. Appropriate and harmonious sex life helps to increase the immune function of the body, to avoid the disuse atrophy of reproductive organs, the elderly physical and mental health, prolong life has a positive effect. And the elderly long-term sexual repression, can lead to lower immunity, the occurrence of many diseases. Sexual repression to a certain extent, will appear anxiety, depression, etc.. This women’s health care workers and the whole society should pay attention to the sexual health care of elderly women, and actively promote the popularization of scientific knowledge of mental health of the elderly, correct the misconception that “the elderly do not have sexual function”, “the elderly should not have sex”, remove the shackles that bind the elderly To remove the shackles that bind the good spiritual life of the elderly, and actively carry out sexual health consultation for the elderly, so as to create good conditions for improving the interest and quality of life of the elderly.
(X) Skin, muscle and joint changes
A series of aging phenomena appear on the skin, such as wrinkles, which first appear on the forehead, corners of the eyes and around the lips. Since menopause, epidermal thickness decreases by 1.2% and collagen content decreases by 2.1% per year, so epidermis gradually becomes thinner, subcutaneous fat also begins to atrophy, sweat gland function decreases, so the skin is dry, loose and inelastic. Due to the abnormal calcium absorption and mineral metabolism, it is easy to cause joint pain, mostly in the shoulder, neck, lumbar, sacroiliac and other joints, manifested as posterior head, collar and back pain, low back pain or wandering joint pain, and sometimes only heel pain.