Ms. Wang, 48, was recently troubled: she had two fibroids in her uterus, which were not treated because they were asymptomatic and were only observed regularly. However, in the past year, her menstrual period sometimes comes once every two months and sometimes twice a month, accompanied by menopausal symptoms such as hot flashes and panic attacks. Ms. Wang wanted to know if she could treat her menopausal symptoms by supplementing with estrogen because she had fibroids.
A health survey of more than 10,000 menopausal women in Guangdong Province showed that the average age of menopause in Guangdong women is 49 years old, and about 30% of them have menopausal symptoms that seriously affect their health and quality of life but are not treated in a timely manner due to the limitations of disease awareness or other concerns. Clinically, examples like Ms. Wang’s are also common. On the one hand, they experience typical menopausal symptoms – hot flashes and sweating, insomnia, mood swings, bone pain, atrophy of the genitourinary tract, etc. On the other hand, they are worried that estrogen supplementation will stimulate the existing fibroids.
Since estrogen therapy has its own indications and contraindications, in the face of complex symptoms such as Ms. Wang’s, it is necessary to “tailor the treatment to the individual”, and the specialist will adopt the approach of “examination + medication + monitoring”. In addition, symptomatic medication and Chinese herbal medicine are also available.
Before hormone supplementation, a series of tests must be conducted to determine whether the symptoms are due to menopausal hormone deficiency. For example, if the patient has insomnia or fatigue, hypothyroidism or hyperthyroidism should be ruled out, and blood tests should be taken to determine whether the relevant indicators are normal. In short, we should rule out non-menopausal “menopausal symptoms” as much as possible. Avoid making up for hormone deficiencies and avoid making up for “mistakes”. Careful testing prior to the use of medication can help diagnose and rule out contraindications.
”At present, almost all gynecological endocrine disease treatments involve hormone testing, and the reproductive hormone tests routinely performed include follicle stimulating hormone, luteinizing hormone, prolactin, estradiol, testosterone and progesterone. Of these, increased follicle stimulating hormone and luteinizing hormone are commonly associated with premature ovarian failure and menopause. Ovarian reserve function has received much attention recently, and as one of the common indicators in clinical studies, anti-mullerian hormone test can predict menopause, so it is widely used in the examination and diagnosis of menopausal syndrome treatment.” The incidence of uterine fibroids in Chinese women is 20%, and estrogen therapy can be applied if the fibroid is less than 3 cm; if the fibroid is more than 3 cm, doctors will apply estrogen therapy with caution.
The principle of “minimum effective dose” is commonly adopted for estrogen supplementation, and it is important to follow up after one or two months to let the doctor know the effect of the medication and adjust the medication and dose in time. Patients should work closely with their doctors in order to find the best treatment plan. For hormone-dependent benign diseases such as uterine fibroids, endometriosis and endometrial hyperplasia, low dose supplementation can be chosen under the close monitoring of the doctor and close follow-up examinations.
What tests are required for estrogen supplementation?
1.Checking ovarian function reserve (blood sampling and ultrasound).
2.Checking the reproductive organs (ultrasound)
3.Checking liver and kidney functions (blood sampling)
4.Checking the breast (mammogram or ultrasound)
5.Checking thyroid function (blood sampling).
Which women should not take estrogen supplements?
1.Tumors of reproductive organs, sex hormone-dependent tumors (e.g. endometrial cancer, breast cancer)
2. Severe liver and kidney function abnormalities.
3. Systemic systemic lupus erythematosus, connective tissue disease (active stage).
4, patients with unstable heart disease, hypertension, diabetes mellitus.
5, patients with meningioma.
6, with thrombotic disease in the last six months.
7, with hematoporphyria, otosclerosis.