With the changing social structure, stressful rhythms, noisy environments, and increasing mental stress, these long-term or chronic stimuli put the human organism in a state of chronic stress and have many effects on the body’s endocrine and rhythmical functions. Nowadays, perimenopausal syndrome has become a topic of tension for many women, and it is imperative for clinicians to give better help and guidance to their patients.
I. Perimenopause is a necessary path for every woman
The perimenopause is an inevitable physiological process for women, following the irreversible laws of nature. Due to the decline of ovarian function during this period, sex hormones fluctuate greatly and decrease sharply, resulting in disorders of central neurotransmitters, making women prone to psychological and physiological dysfunctions, leading to a series of symptoms and subclinical diseases, which seriously affect the health and quality of life of middle-aged and elderly women.
The fluctuating hormone levels during perimenopause, with an overall declining trend, and the decline in ovarian function lead to disruptions in central nervous system function, resulting in a wide range of symptoms. Therefore, an integrated medical approach is needed to manage patients from an integrative medical perspective, integrating psychological, family, social and environmental factors to re-establish a healthy order for women.
II. Integrated perimenopausal management is the responsibility of physicians
Through the establishment of the One-Day Clinic for Integrated Perimenopausal Management, the patient’s physical and psychological state is evaluated as a whole, psychological counseling is provided, nutritional recipes are developed, medication is guided, and rational education is provided. The physician’s role is to make decisions, provide a comprehensive assessment of the patient, and provide individualized treatment plans;
Nurses assist in the assessment and implementation of supervised treatment measures and provide guidance on exercise; dietitians provide objective evaluation of the diet of perimenopausal women, reasonable guidance on the composition and quantity of the diet, and monitor the effectiveness of diet control; clinical pharmacists provide drug counseling, medication guidance, medication education, monitoring of adverse reactions, and help patients with individualized treatment.
Third, a comprehensive management model is essential
Health education is particularly important in the comprehensive management of perimenopause. Teaching patients the scientific way of exercise and reasonable diet has a positive effect on the health of perimenopausal women. The survey showed that 52.1% of perimenopausal women do not have the habit of regular exercise (≥3 times a week, ≥30 minutes per exercise).
For perimenopausal women, there are three main forms of exercise: one is aerobic exercise, the model is “healthy stride”, the standard is 100-120 steps per minute, through the exercise for physical improvement has obvious effect; two is simple exercise, such as 1 minute rubbing hands, one minute up and down rubbing hands 150 times pass, 200 times Excellent; third is Kegel exercise, through the self-training of pelvic floor muscles, the pelvic floor muscle strength of can be significantly improved, in the perimenopause actively promote pelvic floor rehabilitation, reduce the risk of elderly urinary incontinence and pelvic organ prolapse. Regular exercise habits have a positive effect on the health of the elderly.
Dietician analysis of the dietary structure shows that perimenopausal women have a significantly higher intake of poultry, meat and oil, and a significantly lower intake of cereals, potatoes and beans, fish and shrimp, soy and nuts, and milk and dairy products. The principles of menopause diet are appropriate energy, low salt, low fat, adequate protein, ensure the supply of vitamins and inorganic salts, reasonable food combination, plant-based, not picky, not partial food, coarse and fine, regular meals, regular life, less fried, barbecued and smoked food, moderate physical exercise and sports or recreational activities to maintain a normal weight.
Fourth, the correct point of view, reasonable drug treatment “more good than harm”
Comprehensive management of perimenopause should be all-round, three-dimensional and whole process. In addition to health education, pharmacotherapy is the key point of comprehensive management of menopause. In addition to health education, pharmacological treatment is the key point of comprehensive management of menopause. For patients who meet the indications for pharmacological treatment, pharmacological interventions should be actively taken after excluding contraindications and followed up at the appropriate time. Patients are evaluated according to their Kupperman menopause score, with a diagnosis of mild menopausal syndrome at 15 or higher, moderate menopausal syndrome at 25 or higher, and severe menopausal syndrome at 35 or higher, with pharmacological treatment strongly recommended for moderate and severe menopausal syndrome.
If a patient’s single symptom is so prominent that it affects work and quality of life, or is often difficult to tolerate, medication is recommended if three of the KMI scores are moderate, even though the total score does not reach 15.
Patients with menopausal symptoms and evidence of estrogen depression should initiate sex hormone therapy. Sudden onset of severe chest pain, dyspnea or hemoptysis, unexplained severe edema of the lower extremities or severe pain in the lower extremities, severe stomach pain, more severe neurologic symptoms; chronic headache, especially if it is first or progressively worse, with or without partial or total visual field loss, hearing or perception abnormalities, seizures, etc., hepatitis, jaundice, liver enlargement, elevated blood pressure systolic greater than 160 mmHg, or diastolic Systolic blood pressure greater than 160 mmHg, or diastolic blood pressure greater than 95 mmHg, should be immediately discontinued from sex hormone therapy.
Commonly used drugs are Tibolone 1.25mg or 2.5mg, QD; Tegretol 0.5mg or 1mg, QD; Clomid 1 tablet, QD; Daphne 10mg, QD; Imazine 50mg, QD. The route of administration can be oral, vaginal and transdermal. These drugs are based on natural or synthetic estrogens and progestins, with natural estrogens being the preferred choice for menopausal women.
In addition to estrogen, there are non-estrogenic agents such as Livermin, whose main components are triterpenoids and phenolic acids that directly modulate the central nervous system to improve symptoms. In a meta-analysis, the efficacy of Livermin is rated A. It has clear recommendations for the treatment of menopausal symptoms and has significantly fewer adverse effects than tibolone.
V. Integrated medicine and comprehensive management
For perimenopausal management, drug therapy is reasonably recommended, but it should be accompanied by healthy lifestyle and health education. For patients with perimenopausal symptoms, an integrated medicine approach is used for comprehensive management, advocating a hierarchy of services from different medical institutions, including family, community medicine, hospitals and specialists.
The family is the most basic environment for medical services, and the support and care of family members is very important; community health care is responsible for regular follow-up and education; hospitals should provide all medical services to serve patients as a whole; and specialists should conduct targeted assessments and propose and develop individualized treatment plans. The one-day clinic is a worthwhile management approach. Through holistic thinking, we can provide services for middle-aged women to improve their health status and prepare them for old age.