Menopause syndrome
1.What is menopause syndrome?
Menopause is the traditional name for the period before and after menopause, a special physiological stage of transition from the reproductive phase to old age, including the period before and after perimenopause. In 1994, the World Health Organization began recommending the term “perimenopause”.
Perimenopause begins in most women after the age of 40, averaging 45 years, and lasts 1-10 years, with an average of 4-5 years. The average age of menopause for Chinese women is 50 years.
2.Why does menopause syndrome occur
The reason why women can have menstruation is that the ovaries have the function of ovulation and the body produces estrogen and progesterone, which act on the endometrium to form menstruation and are cyclical, meaning that menstruation will come once a month. If ovulation does not occur normally, menstrual disorders will occur. When a woman’s ovarian function starts to decline around the age of 40, the quantity and quality of eggs in the ovaries will decline significantly, and she will often fail to ovulate normally.
3.What are the symptoms of menopause syndrome?
The main symptoms of menopause syndrome are
① Menstrual disorders: menstrual cycle starts to be irregular, specifically it can be manifested as sparse menstruation, shortened periods, reduced menstrual volume, and then gradually stop; irregular menstrual cycle, or frequent menstruation, or sparse menstruation, and in severe cases, anovulatory dysfunctional uterine bleeding, and then anemia; menstruation suddenly stops, and then no longer comes.
②Vasodilatory symptoms: flushing, hot flashes, sweating, etc. Hot flashes refer to the patient’s sudden feeling of heat in the upper body, especially in the face, neck and chest, with several episodes per day in mild cases and dozens per day in severe cases.
③Cardiovascular system symptoms: Menopausal women often experience blood pressure fluctuations, palpitations, irregular heart rate, and pseudo-angina. The incidence of coronary heart disease increases significantly as the number of menopausal years increases.
④Neuropsychiatric symptoms: These include palpitations, sleep disturbances, abnormal skin sensations, etc., agitation and irritability, anxiety, depression, mood swings, in addition to possible memory and cognitive decline.
⑤ Bone and joint symptoms: bone and joint pain and muscle pain are common somatic symptoms.
(6) Genitourinary tract symptoms: vaginal dryness, difficulty in intercourse, recurrent vaginitis, urinary tract infections, urinary incontinence, etc. may occur due to lower estrogen levels.
(7) Other symptoms: including skin wrinkles, itching, hair loss, breast sagging, weight gain, abdominal obesity, etc.
4.What harm will menopause bring
The main harm brought by menopause is increased incidence of cardiovascular disease and mortality, and increased risk of osteoporosis. After menopause, the incidence of Alzheimer’s disease is significantly higher in women than in men as they age.
Menopause increases the risk of coronary heart disease in women. The decrease in hormone levels after menopause has a serious impact on cardiovascular function, blood pressure, glucose tolerance, and lipid metabolism. Therefore, in the event of myocardial infarction, treatment is often less effective than in men.
Osteoporosis is another postmenopausal risk, which usually occurs within 5-10 years after menopause. Postmenopausal estrogen deficiency makes osteoclasts active, bone resorption increases, and bone conversion accelerates, resulting in rapid bone loss and susceptibility to fracture. The pain, bone deformation, comorbidities and even death caused by fractures seriously affect the health and quality of life of the elderly and even shorten their life span, and also bring heavy burden to the family and society. Therefore, postmenopausal women must pay attention to menopausal health care.
5.Does menopause syndrome need to be treated?
When women reach menopause, they will more or less experience some menopausal symptoms, but not all women need treatment. For those with mild symptoms, they can go through menopause smoothly through their own regulation, or they can take oral Chinese medicine or botanicals to relieve their symptoms. However, if there are moderate or severe menopausal symptoms, the most effective treatment is hormone supplementation, and the most benefits are seen before the age of 60 or within 10 years of menopause. This is the stage where we become the window for hormone supplementation therapy. Because starting treatment at this stage can reduce the incidence of cardiovascular disease and mortality, reduce the risk of Alzheimer’s disease and other diseases, slow down the rate of bone loss and prevent osteoporosis, etc.
6.What conditions are not suitable for hormone supplementation therapy
Not all menopausal women are able to undergo hormone supplementation therapy, and there are contraindications to hormone supplementation therapy. If the following conditions exist, hormone therapy is not suitable
(1) You are pregnant or suspected to be pregnant.
② Have unexplained vaginal bleeding.
③ Known or suspected to have breast cancer.
④ Known or suspected to have sex hormone dependent malignancy.
⑤ Active venous or arterial thromboembolic disease, severe liver and renal dysfunction, hematoporphyria, otosclerosis, meningioma, etc. within the last 6 months.
After starting hormone therapy, the patient may be followed up within 1-3 months, and then at intervals of 3-6 months, and at intervals of 6-12 months after 1 year. If abnormal vaginal bleeding or other adverse effects occur, the patient should be seen again at any time. A careful history and other relevant questions should be asked at each follow-up visit. The above examinations are recommended once a year, and bone mineral density is measured every 3-5 years. Depending on the patient’s condition, the frequency of examination may be adjusted as appropriate.
Many patients are concerned about the duration of treatment. In fact, there is no specific duration limit for postmenopausal hormone supplementation therapy, which is individualized and requires the use of the lowest effective dose that can achieve the therapeutic goal under the premise of comprehensive consideration of the therapeutic purpose and risk, and there is no need to limit the duration of treatment. The individualized risk/benefit assessment should be performed at least once a year during the treatment process, and the length of the menopausal treatment course should be decided according to the assessment, and the treatment can be continued when the benefits outweigh the risks.
7.How should hormone supplementation therapy be selected
Hormone supplementation therapy should first consider two situations, i.e. whether the patient has a uterus or not and the patient’s wishes.
If the patient has a uterus, estrogen and progestin or progestin alone are needed; if the uterus has been removed, the patient can usually just use estrogen alone (except for patients with endometriosis). If the patient is relatively young or has not been menopausal for a long time and still wishes to have menstruation, she can choose to have menstruation, i.e. estrogen and progestin sequential therapy. If the patient has been menopausal for more than one year and does not wish to have menstruation, she can use a continuous combination program. The doctor will give a specific plan on how to do this during the visit.
There are oral, skin patch and transvaginal cream preparations. Commonly used oral monoestrogen preparations such as: Tonic Glaxo; monoestrogen patch such as: Song Qi; compound preparations (containing estrogen and progestin) such as: Clomid, Fentanyl, Anjingyi, etc., and also Levitra which has androgenic activity; commonly used progestins are: Dextran, Progesterone capsules, Angioprogesterone; vaginal preparations are: Ovidin, Oxytocin and Geprofen ointment. The vaginal preparations are: Ovidin, Geprofen ointment and Geprofen capsules.
Patients can express their ideas to the doctor, who will choose the treatment plan and the route of medication according to the results of the patient’s examination and the patient’s wishes.
8.How to have a difficult sex life after menopause
The lack of estrogen after menopause can lead to atrophy of the genitourinary tract, such as vaginal atrophy, dryness, painful intercourse, as well as frequent urination, urinary urgency, nocturia, urinary incontinence and recurrent infections, which are common embarrassing problems that plague postmenopausal women.
Many menopausal women have symptoms of genitourinary tract atrophy but are reluctant to use oral medications, and such patients may consider topical treatment options. Topical vaginal application of estrogen can effectively relieve symptoms of genitourinary tract atrophy and improve symptoms of stress urinary incontinence. Commonly used medications include estriol ointment (trade name: Ovitene) and progesterone cream (trade name: Geprofen). The measurement of estriol ointment medication varies from person to person and should be individualized, applying the lowest effective dose, usually starting with daily use and changing to once every 2-3 days after symptoms disappear for about 2 weeks.
9.What about breast pain or irregular vaginal bleeding after taking medicine?
With the gradual increase of people’s health awareness, many women start hormone supplementation therapy just after entering perimenopause, believing that hormone supplementation therapy can not only improve menopause-related symptoms, but also prevent related diseases. However, some people have breast swelling or irregular vaginal bleeding after taking the medication, so they get scared and worry that they will get breast cancer or endometrial cancer, which is understandable.
The effect of hormone supplementation therapy on the breast varies from person to person. Breast swelling and pain is one of the most common adverse effects of hormone supplementation therapy. Breast swelling and pain are related to the density of the breast. Changes in breast density occur mainly in the first year of medication, and breast swelling and pain occur mainly in the early years of medication.
Patients using the non-menstrual regimen may experience irregular bleeding during the first six months of treatment, which generally does not require special treatment. There are also other conditions that may cause vaginal bleeding, such as missing medication or taking other medications or supplements at the same time, so if abnormal bleeding occurs it is important to seek medical attention.
10.How to adjust the lifestyle of menopausal syndrome patients
Maintaining a good lifestyle can significantly improve menopausal symptoms, lower blood lipids, and prevent osteoporosis and cardiovascular disease, which are important for health at all times. Specifically, this includes the following aspects.
① Eat a reasonable and healthy diet. Eating at least 250g of fruits and vegetables daily, whole grain fiber, fish food twice a week, a low-fat diet, limiting salt intake (less than 6g/day), and drinking no more than 20g/day of alcohol.
② regular exercise to maintain normal body weight; the best way to exercise is at least 3 times a week for at least 30 minutes at moderate intensity, adding 2 additional resistance exercises per week would be more beneficial.
③ Strict cessation of smoking.
④ Self-adjustment, maintaining an optimistic state of mind and healthy emotions; strengthening psychological support from society and family; maintaining a moderate sex life.
11.How to deal with several problems that bother menopausal women
Menopausal women are often troubled by these problems.
① Menopause can be tolerated and passed without treatment. Menopausal symptoms can be mild or severe, and those with mild symptoms can go through menopause more smoothly through self-regulation, but those with severe symptoms have a significantly lower quality of life and can be treated with medication to relieve their symptoms.
②Hormone supplementation treatment can cause cancer. Some patients immediately think of cancer when hormones are mentioned. Available evidence-based medical data show that estrogen and/or progestin supplementation therapy for 3-5 years does not significantly increase the risk of breast cancer, and the risk of breast cancer is uncertain for those treated for more than 5 years. Women should be reassured that the risk of breast cancer with hormone supplementation is less than the risk posed by lifestyle factors such as obesity and alcohol abuse.
In addition, different types of estrogen, progestin and androgens have different effects on the breast. The available data suggest that natural or near-natural progestins do not increase the incidence of breast cancer.
③ Menopausal hormone supplementation therapy can lead to weight gain. Many people immediately think of gaining weight just by mentioning hormones. In fact there are many kinds of hormones in the human body, and the hormones that people would associate with gaining weight from hormones would be glucocorticoids, not the hormones used in menopausal treatment. The results of the meta-analysis showed that those who had applied menopausal hormone therapy did not gain weight compared to those who did not, but menopause itself caused weight gain.
④Can menopausal hormone supplementation be dependent? Drug dependence is a state of psychological or physical dependence on a drug caused by repeated use of the drug, such as drug addiction.
After most patients start menopausal hormone supplementation therapy, recent symptoms such as hot flashes and sweating will be significantly reduced or even disappear within a short period of time, but once the medication is stopped, the symptoms will appear again, which only indicates the need to continue the therapy, not the compulsion to take the medication continuously.
⑤ Menopausal hormone supplementation therapy can keep you young, and whether you should use it as early as possible. Many women who love beauty are worried about their aging and want to use hormones as early as possible to stay young, and sometimes they want to rush on the medication when their menstrual flow has just decreased. However, menopausal hormone therapy cannot be abused, it has indications and contraindications for treatment, and must be applied only under the guidance of a professional doctor. When menstrual irregularities or related symptoms occur, you need to go to the hospital and start menopausal hormone therapy only when it is clear after examination that you have entered menopause and there are no contraindications to the use of medication.
For menopausal hormone supplementation, we should not over-exaggerate its benefits or worry too much about its adverse effects, but should use the medication under the guidance of a doctor with a good attitude and follow up on time.