”Aigoo Hey, it’s amazing how all of a sudden I feel so hot and sweaty without moving! Really menopause, alas ……” “I do not know what is going on, how the temper is so bad lately, not moving to quarrel with the husband and daughter, it will not be menopause it …… “”Recently how to always feel back pain, sleep and sleep is not good, must be to ‘more’!”
The above conversation is not feel déjà vu it? In fact, menopause syndrome really happens to all of us, plagued by women, perhaps it is also plagued by your wife, your mother, or even you yourself. Let’s learn more about this annoying disease.
Perimenopause, or “perimenopause” as it is medically known, is the period when women transition from regular menstruation during their reproductive years to menopause, which includes the onset of endocrine, biological and clinical features associated with the decline in ovarian function until one year after their last menstrual period.
Menopausal syndrome refers to a group of syndromes caused by the decline in ovarian function to complete disappearance in women before and after natural menopause, and can also be caused by surgical removal of the ovaries and radiation damage. The average age of menopause for women in China is 49.5 years in urban areas and 47.5 years in rural areas. Note that the average age mentioned here does not mean that menopause is abnormal before this age. In medical terms, amenorrhea or significantly lower than normal estrogen occurs before the age of 40 is called premature ovarian failure.
Etiology.
1, physiological menopause: natural menopause, refers to women entering menopause, follicles significantly reduced, ovarian function decline, ovulation stop, while the synthesis of estrogen, progesterone reduced, causing menstrual disorders to menopause and autonomic dysfunction and other symptoms.
2. Pathological menopause: due to congenital or acquired hypothalamic-pituitary-ovarian axis lesions (ovarian insufficiency, tumor, inflammation, injury, radiation, drugs, etc.) and systemic diseases (thyroid, adrenal diseases, diabetes, anemia, tuberculosis and malnutrition, etc.) affecting this axis.
3.Artificial menopause: It is induced by artificially suppressing the function of hypothalamic-pituitary-ovarian axis based on the need for treatment of certain diseases. For example, ovarian decompensation in breast cancer, perimenopausal endometriosis and pseudopregnancy therapy, etc.
Clinical manifestations.
When it comes to the symptoms of menopause, everyone should be able to tell one or two, such as irritability, hot flashes, osteoporosis, etc. But the clinical manifestations of perimenopause are much more than that, its symptoms can be mild or severe, some people have no obvious discomfort, while some people have very serious symptoms, even affecting normal work and life.
1, menstrual disorders: menstrual changes vary, some menstrual volume becomes less, time is shortened, the interval between periods becomes longer until complete menopause, there are also increased menstrual volume, prolonged periods or irregular bleeding and finally menopause, a few directly appear menopause. However, we should not attribute any menstrual disorder to menopause, not knowing that many patients with endometrial lesions or even endometrial cancer have irregular vaginal bleeding as their main symptom, and the age of onset of endometrial cancer is also concentrated around 50-65 years old. The experienced gynecologist will determine whether it is a normal perimenopausal symptom.
2. Paroxysmal hot flashes: Paroxysmal hot flashes are the earliest and most characteristic symptom. Each hot flash often occurs suddenly, starting on the face and then extending to the neck and chest with red patches of skin and sweating. The sensation of heat can last from a few seconds to tens of minutes or even up to 1h, usually 1 to 2 min, and can occur 30 to 50 times a day. It can be accompanied by an increase in skin surface temperature, so the patient feels unbearable discomfort and irritability, and at the same time may feel a slight headache, dizziness, palpitations, nausea, etc. There is also a slight sweat on the forehead, palms moist, and therefore anxious to untie the lapel, open the window, this phenomenon is obvious at night, commonly known as “night sweat”, can affect sleep. Hot flashes mostly occur in the years before and after menopause, which is a manifestation of the dysregulation of the heat regulation mechanism when estrogen is lacking, with an incidence of 75% to 85%, and its true physiological mechanism is not yet clear.
3, cardiovascular disease and metabolic abnormalities: menopause vasodilator function is unstable, hypertension is characterized by increased systolic blood pressure and fluctuations and accompanied by hot flashes. At the same time, the incidence of atherosclerosis and coronary heart disease increases, and patients often complain of palpitations, and paroxysmal tachycardia or bradycardia. Changes in metabolism in postmenopausal women lead to significant weight gain and increased abnormalities in glucose and lipid metabolism.
4. Performance of the genitourinary system: The external genitalia of postmenopausal women begin to atrophy, the vulva and vaginal folds disappear, the vagina becomes shorter, the mucous membrane becomes thinner, the acidity decreases, the vaginal discharge decreases, and it is easy to co-infection with senile vaginitis, vulvovaginal itching, painful intercourse and vaginal bleeding. The uterus, fallopian tubes and ovarian tissues also gradually shrink, and the breasts flatten and sag; the urethra and bladder triangle shrink after menopause due to the decrease of estrogen, and symptoms such as frequent urination, urinary urgency, urinary incontinence and repeated urinary tract infections and even pain in the suprapubic area appear.
5, psychoneurological symptoms: mainly including emotional, memory and cognitive function symptoms. After women enter menopause, due to the influence of family and social environment, they are prone to unhappy mood, agitation and irritability, insomnia, anxiety, suspiciousness and depression, sometimes even moody and unpredictable, resembling mental abnormalities. Memory loss, inattention and sleep disorders are also more common.
6, osteoporosis: women from the perimenopause, the rate of bone resorption than bone production, prompting bone loss and osteoporosis, after menopause with age, osteoporosis gradually obvious, about 1/4 of postmenopausal women suffer from osteoporosis, once inadvertent falls or injuries, very easy to fracture, such as femoral neck, wrist bone, etc., vertebral compression fractures can be spontaneous or after minor activities, patients can Patients may feel back pain, crestal deformation, shortened body or hunchback. Serum calcium and phosphorus levels are generally normal, but about 1/3 of patients have a negative calcium balance, which may be related to intestinal calcium malabsorption.
7. Other: dry skin, loss of elasticity, increase in a few lip hairs and chin hairs, low voice, edema, related to endocrine disorders such as relative increase in androgens.
Diagnosis.
Menopausal women with the above symptoms can be diagnosed as menopausal syndrome after general and gynecological examination and exclusion of organic pathologies such as cardiovascular, psychoneurological and endocrine glands; decreased estrogen and prolactin in blood and urine and increased FSH (follicle stimulating hormone) and LH (luteinizing hormone) are the diagnostic basis. the average secretion of FSH is about 13 to 14 times that of fertile age, while LH is about 3 times. In cases of irregular vaginal bleeding, diagnostic curettage and gynecologic ultrasound may be performed to exclude organic lesions.
Treatment.
1. Adjust your mentality and develop good living and eating habits. Low-fat and low-salt diet, more vegetables, calcium supplement, avoid stimulants such as tobacco, alcohol, coffee and strong tea, cultivate a wide range of interests, learn to transfer conflicts and optimize the relationship between husband and wife.
2, hormone therapy, once you hear the word “hormone”, you are not frowning, or even immediately shake their heads? Indeed, due to the people’s long-standing and deep-rooted concepts, they always talk about “hormones” – easy to get fat, easy to get all kinds of cancer, and even confused with glucocorticoids (such as dexamethasone, methylprednisolone, etc.). In fact, hormone therapy is very safe and its effects are irreplaceable by other treatments, as long as it is used appropriately under the guidance of doctors.
(1) Estrogen therapy: Depending on the type of estrogen, it includes Neil estrol (Vernon), combined estrogen (Bemelia), estradiol valerate (Tocopherol), 17β-estradiol, ethylene estradiol, and so on. Because estrogen alone has an increased risk of endometrial lesions, it is necessary to combine it with progestin to counteract this effect. In view of this, estrogen therapy should not be used indiscriminately but should be taken under the supervision of an experienced gynecologist. In addition, there are many topical ointments containing estrogen for perimenopausal genitourinary tract symptoms, such as Bemelia Ointment and Ovitene Ointment. Other dosage forms include estradiol skin patches (Songe patches), estradiol gel, etc.
(2) Progestin: applied alone has the effect of relieving autonomic symptoms. Such as methylhydroxyprogesterone, norethindrone, methyldiprogesterone, etc.
(3) Estrogen, progestin and androgen therapy: Tibolone (Leviare) is widely used at present. It is a steroid hormone with weak estrogen and both androgen and progestin activity. It can prevent the loss of bone mass and is effective for the treatment of menopausal symptoms without causing endometrial irritation.
3.Non-hormonal treatment
(1) General treatment: Encourage patients to eliminate ideological concerns, lead a regular life, adjust their diet appropriately and insist on physical exercise to enhance their physical fitness.
(2) Medication: glutamate, vitamin A, vitamin B, vitamin E, appropriate sedatives, sleeping pills and calcium.
4.TCM treatment: Chinese medicine divides menopausal syndrome into 4 types.
①Yin deficiency of kidney: use Qiju Dihuang Pill with addition and subtraction.
②Yang deficiency of kidney: add or subtract Right Return Pill.
③Liver depression and qi stagnation type: add and subtract with Prosperity San.
④Ying and Wei disharmony: Gui Zhi Tang with addition.
Through the above introduction, you should have a more comprehensive understanding of the perimenopausal syndrome, I hope that women can smoothly pass this special period, and manage their own health with care!