I. What is menopause and menopause syndrome? The human organism is an organically integrated whole. As a woman ages, her reproductive organs, the ovaries, gradually move from activation and vigor to decline. Menopause is the period from the decline of ovarian function to one year after menopause. Menopause is the old term for perimenopause, which is generally considered to have a derogatory connotation. It usually begins at age 40 and lasts for 10 to 20 years, during which time the body’s estrogen levels gradually decline due to the decline in ovarian function, eventually leading to menopause. As the target tissues of estrogen: the genitourinary system, cardiovascular and bones (especially long bones), a series of clinical changes occur, mainly urinary tract infections, vaginal dryness or vaginitis, uterine prolapse, the development of cardiovascular disease, as well as bouts of hot flashes, irritability and psychological abnormalities, which is known as menopausal syndrome. Menopausal syndrome refers to a series of physical and psychological symptoms caused by the gradual decline of ovarian function and fluctuating or declining estrogen levels during the perimenopause and postmenopausal period. Generally, these symptoms begin to appear when menstrual disorders occur during the perimenopausal period and can last until 2 to 3 years after menopause, and in a few women, the symptoms may not decrease or disappear until 5 to 10 years after menopause. The symptoms vary in severity and duration for each person, and the lighter ones do not affect daily life, while the heavier ones can significantly affect work and life, and even develop into menopausal diseases. Second, what are the clinical manifestations of menopause syndrome? 1. Menstrual change: It is the early clinical manifestation of menopause, and is divided into three types. The menstrual cycle is irregular, the menstrual period is prolonged, the menstrual flow is increased, or even heavy bleeding or continuous bleeding, and the patient may have severe anemia; (3) menstruation suddenly stops, which is rare. 2. vasodilatory symptoms: manifested as hot flashes and sweating, which are the most prominent characteristic symptoms of menopausal syndrome. It is characterized by recurrent brief bursts of redness, booming heat and sweating on the skin of the face and neck and chest, lasting 1-3 minutes. The episodes range from several to dozens of times a day. In severe cases, they seriously affect women’s life, work and sleep and require active treatment. 3, psychoneurological symptoms: manifested as inattentiveness, memory loss, emotional instability, paranoia, depression, insomnia, key forgetfulness, agitation and irritability, dizziness, headache and tinnitus, dry mouth, burning sensation in the throat, numbness and itching of the skin, sometimes with a sense of ants, and even hysteria-like attacks. 4, genitourinary tract symptoms: manifested as vulvar itching, vaginal dryness and pain, loss of libido, difficulty in sexual intercourse, stress urinary incontinence, frequent urination, recurrent urinary tract infections, etc. 5, cardiovascular disease: may appear palpitations, increased blood pressure or blood pressure fluctuations, arrhythmia or with mild cardiac insufficiency, etc. 6.Osteoporosis: Starting from perimenopause, bone resorption is greater than bone formation, and osteoporosis may occur gradually. It is manifested as joint, limb and back pain, and in severe cases, hunchback or fracture. What are the endocrine changes during menopause? The most obvious change is the decline of ovarian function. The most obvious change is the decline of ovarian function. 1. Estrogen changes: The estrogen level fluctuates greatly in the early perimenopausal period, and can even be higher than the normal follicular level, due to the decrease of ovarian sensitivity and the increase of FSH overstimulation. The level of estrogen does not decline gradually throughout menopause, only when the follicles stop developing does estrogen drop rapidly. The estrogen in postmenopausal women mainly comes from the adrenal glands and peripheral tissue conversion. 2. Progesterone changes: The ovaries still have ovulation function and progesterone secretion in the early perimenopausal period, but most of them have reduced progesterone secretion due to luteal malfunction and no progesterone secretion after menopause. Androgenic changes: The secretion of androstenedione by the adrenal glands and ovarian follicular membrane cells decreases in menopausal women, resulting in a decrease in the total androgen level in women’s bodies. At the same time, the high level of LH stimulates the secretion of testosterone from ovarian interstitial cells, and the level of sex hormone-binding protein in blood decreases, which increases the level of free testosterone in the blood of menopausal women and enhances androgen activity, thus adversely affecting lipid metabolism and glucose metabolism. 4. Gonadotropins: The level of FSH is elevated during perimenopause and fluctuates, while LH is still in the normal range and FSH/LH is still <1. After menopause, FSH and LH are both elevated, with FSH elevated more significantly and FSH/LH >1. 4. What are the signs and predictors of entering menopause? Most women will show certain symptoms before entering menopause, such as fear of heat and easy sweating; or they will have accurate menstruation and no special discomfort before menstruation, but suddenly they will have premenstrual tension syndrome such as breast pain, emotional instability, insomnia and dreaminess, and swollen limbs before menstruation; in addition, emotional changes such as irritability, anxiety and suspiciousness are also precursors of entering menopause. 2. Predictive indicators of menopause: ① Family genetic history: Since the age of menopause is related to genetic factors, the age of menopause of grandmother, mother and sibling can be used as a predictive indicator of the age of menopause of women. Of course, this indicator can also be influenced by acquired living conditions, environment, climate, social factors, drugs, diseases and other factors, which can make menopause earlier or later. ② Age of menarche: The age of menarche is negatively correlated with the age of menopause, that is, the earlier the age of menarche, the later the age of menopause (menopause); on the contrary, the later the age of menarche, the earlier the age of menopause. ③Menstrual disorders: Menstrual disorders are the form of menstrual expression before the final menopause, and menopause is one of the important indicators of entering menopause. Through the above prediction methods and their own physical and mental specific feelings, most women can know whether they have entered menopause. Menopause is known as an eventful time in a woman’s life history. Lack of awareness of its physiological changes and manifestations, overstressing or indulging in them can seriously affect a woman’s quality of life and physical health. If you have enough knowledge and make effective adjustments, most women can go through menopause safely, enter menopause smoothly and fully enjoy the happiness of women’s “second spring”. 1, maintain optimism: actively engaged in life and work, maintain a good mood and positive attitude. This can improve and coordinate the excitability of the cerebral cortex and nervous system, give full play to the body’s potential, so that people are full of energy, full of energy, increased appetite, sleep peacefully, and live a vibrant life. This is beneficial for improving resistance to disease, promoting health, and adapting to the changes of menopause. 2, pay attention to dietary nutrition: For people who have symptoms of dizziness, insomnia and emotional instability during menopause, choose foods rich in B vitamins, such as coarse grains (millet, cereals), beans and lean meat, milk. Milk contains tryptophan, which has a calming and sleeping effect; leafy greens and fruits are rich in B vitamins. These foods have a role in maintaining the function of the nervous system and promoting digestion. In addition, eat less salt (half the amount of common salt is appropriate) and avoid stimulating foods, such as wine, coffee, strong tea, pepper, etc. People with frequent menstruation and anemia caused by heavy menstrual blood can choose foods with high protein content, such as eggs, lean meat, (cattle, sheep, pigs, etc.), beans, etc. Usually, you should also eat more pig liver, vegetables and fruits. If you have a poor appetite and aversion to grease, you can use red dates and cinnamon with brown sugar to make red dates and cinnamon soup to drink, or use red dates and red beans to cook porridge as a snack, which can play a role in strengthening the spleen and replenishing blood. Those who are fat and have high cholesterol should choose foods with high quality protein and low cholesterol, such as lean meat, duck meat and fish. Eating more beans and soy products is also beneficial to reduce menopausal symptoms. 3, pay attention to grooming dress: good instrumentation, manners, poise will make people confidence, full of confidence. Menopausal women are appropriately groomed to make you look as mature and beautiful as possible. 4, strengthen sports and exercise: choose appropriate exercise, such as running, walking, taijiquan, health exercises, and so on, and persistently. Appropriate exercise can not only promote blood circulation, increase metabolism, reduce the occurrence of osteoporosis, but also eliminate the melancholy mood, so that physical and mental pleasure. Here to recommend several activities for: ① jump rope: people in jumping rope, the whole body are activities, the brain must also be fully non-stop movement, hand-held rope head constantly rotating will stimulate the thumb points on the brain, and then more increase the vitality of brain cells to improve thinking and imagination; ② long-distance running: long-distance running can produce a large number of catecholamine substances, improve the sensitivity of people to stimulation, so that people’s spirit The long-distance running: long-distance running can produce a large number of catecholamines, improve people’s sensitivity to stimuli, make people feel happy, feel good about themselves, increase appetite, and have a better regulation of mental depression. Regular health check-ups: The incidence of many diseases in menopausal women will increase, and regular health check-ups can detect and treat some diseases early. For example, monthly breast examination and annual ultrasound and uterine smear examination can help to diagnose breast cancer, cervical cancer and endometrial cancer early and improve the chance of cure. If you are unwell and cannot adjust yourself well, you should seek medical help. Studies have shown that proper hormone supplementation for menopausal women can do more good than harm to their health. The treatment of menopausal syndrome: 1. Psychological treatment: Generally, for menopause whose symptoms are mild, no medication is needed to make them understand the health care knowledge of menopause, eliminate unnecessary worries and fears, establish optimism and treat some reactions of menopause correctly. At the same time, actively participate in some appropriate physical exercise, such as running, walking, gymnastics, qigong, taijiquan, etc. Through these activities, the symptoms can be reduced or eliminated to avoid aggravating the symptoms and causing adverse consequences. 2, general treatment: for menopause syndrome symptoms are more serious, according to the different symptoms of the appropriate use of some drug therapy. If there are mental and neurological symptoms such as headache, dizziness, apprehension, insomnia and other symptoms, autonomic function regulating drugs can be given, such as glutathione 20mg orally, 3 times a day. To prevent osteoporosis, take calcium and vitamin D preparations such as calcium or calcium Lolicon, 1 tablet daily. 3.Hormone supplementation therapy (HRT): Menopausal syndrome is a series of clinical symptoms caused by the decrease of estrogen level due to the diminished ovarian function. HRT is a clinical medical measure to solve this problem, and if it is applied with indications and no contraindications, and if it is used scientifically, rationally and standardized, the benefits of HRT will outweigh its potential harms. Indications for HRT: ① menopause and menopause-related symptoms; ② genitourinary tract atrophy symptoms; ③ low bone mass and postmenopausal osteoporosis Contraindications for HRT: ① known or suspected pregnancy; ② unexplained vaginal bleeding or endometrial hyperplasia; ③ known or suspected breast cancer; ④ known or suspected sex hormone-related malignancy; ⑤ thrombotic disease within 6 months; ⑥ severe liver and kidney dysfunction (7) Hematoporphyria, otosclerosis, systemic lupus erythematosus; (8) Meningioma. Caution: ① uterine fibroids; ② endometriosis; ③ uncontrolled diabetes mellitus and severe hypertension; ④ history of thromboembolism or tendency to thrombosis; ⑤ cholecystitis, epilepsy, migraine, asthma, hyperprolactinemia; ⑥ benign breast disease; ⑦ family history of breast cancer. Timing of initiation: The hormone should be applied after the onset of ovarian dysfunction, i.e., the onset of symptoms. The following factors should be considered when choosing a hormone application regimen: ① the presence of a uterus; ② age; ③ ovarian decline (transitional, early or late menopause); ④ risk factors. Individualized dosing regimens are developed according to the different conditions of each woman. The duration of progestin dosing in the sequential regimen should be 10-14 days to allow adequate transformation of the endometrium and prevent the occurrence of endometrial cancer. Use the lowest effective dose that lasts no more than 5 years to become a short-term dose. For the prevention and treatment of osteoporosis, it should last at least 3-5 years. Commonly used hormone supplementation regimen: 1. Cycle sequential method: 28 days as a treatment cycle, giving estrogen daily on days 1-21, and progestin simultaneously on days 11-21, with withdrawal bleeding occurring at the end of the medication, and starting the next cycle of medication on the 5th day of bleeding. This regimen is suitable for women in perimenopause and premature ovarian failure. 2.Continuous sequential method: 28 days as a treatment cycle, estrogen is applied uninterruptedly, progestin is applied on 15-28 days of the cycle, with no interruption between cycles. It is suitable for women who are within 3-5 years of menopause. 3.Continuous combination method: Daily administration of estrogen and progestin, with a low chance of withdrawal bleeding, for women who have been menopausal for many years. 4.Single estrogen therapy: daily estrogen is given to women who have had a hysterectomy or who have congenitally low ovarian function. 5.Single progestin therapy: progestin is given daily during the second half of menstruation, for women with menopausal transition or postmenopausal menopausal symptoms and contraindications to estrogen. Side effects and risks of HRT: HRT can cause certain side effects and risks of disease while relieving menopausal symptoms, so attention should be paid to observation and timely diagnosis and treatment. ① Uterine bleeding: Most of them are breakthrough bleeding during the medication period, so attention should be paid to any medication errors, ultrasound examination of the endometrium, and scraping if necessary to exclude endometrial lesions; ② Estrogen side effects: atrial distension and pain, increased leucorrhea, headache, edema, pigmentation, etc., which can be adjusted by reducing the dosage or taking Chinese medicine as appropriate; ③ Progestin side effects: including depression, irritability, breast pain or swelling, etc., which can be reduced by changing the type of progestin; ④ Endometrium side effects: endometrium can be reduced by changing the type of progestin. ④Endometrial cancer: long-term estrogen alone can increase the risk of endometrial hyperplasia and endometrial cancer by 6-12 times, and women with uterus must add progestin when using HRT, which can reduce the relative risk of endometrial cancer to 0.2-0.4; ⑤Breast cancer: long-term estrogen-progestin combination therapy increases the risk of breast cancer, while other regimens do not significantly increase the risk of breast cancer. Breast examination should be conducted every year during the medication period, and if there is any abnormality, the medication should be stopped in time. Chinese medicine: Chinese medicine believes that menopause syndrome is caused by the deficiency of liver and kidney and the imbalance of yin and yang. The kidney is not strong enough, the yang is not hidden, the yin and the yang are not maintained, the yang is not floating and goes up, and the lack of kidney essence causes the water not to contain the wood, and the fever is caused by depression. Therefore, in the treatment of menopause syndrome, Chinese medicine practitioners mainly focus on nourishing liver and kidney yin deficiency, and common drugs include Liu Wei Di Huang Wan, Yi Yao Wan, etc.