Perimenopausal syndrome is a group of syndromes caused by fluctuations or decreases in sex hormones in women around the time of menopause, mainly due to dysfunction of the autonomic nervous system, accompanied by neuropsychological symptoms. The underlying cause of perimenopausal syndrome is ovarian failure due to physiological or pathological causes or surgery. Once the ovaries have failed or have been removed and destroyed, the production of estrogen by the ovaries is reduced. There are more than 400 estrogen receptors distributed throughout the female body in almost all tissues and organs of the female body that receive control and domination from estrogen. Once estrogen decreases, it will trigger degenerative changes in organs and tissues and a series of symptoms will occur.
Early menopause mainly manifests as vasodystrophic syndrome; late menopause (>5 years) is followed by aging diseases of various organ systems.
I. Symptoms related to estrogen deficiency
(a) Vasodystrophic syndrome: the incidence is 75-85% between 1 and 5 years after menopause, and 76% between 1 and 6 weeks after double oophorectomy at the age of <25.
Vasodilator syndrome is a syndrome characterized by paroxysmal episodes of fever, flushing, spontaneous sweating and palpitations due to estrogen deprivation and phytonadic dysfunction, which starts in the face, neck, anterior chest and then spreads to the lower abdomen, trunk and extremities. The flushing lasts for 3-4 minutes and then ends with sweating, vasoconstriction, and return to normal body temperature. The attack cycle is 54±10 minutes.
(B) Senile diseases of various organ systems
1, degeneration of sexual characteristics and sex organ atrophy: vulva dryness, pubic hair loss, white lesions, vulva itching, secondary infection, sexual hypogonadism, bladder, rectal bulge, uterine prolapse, etc., some women appear hairy, seborrhea, acne and other masculine symptoms.
2, breast atrophy, sagging, nipple areola pigmentation loss: breast firmness is weakened, tissue soft collapse.
3, skin and mucous membranes: dryness, wrinkling, hair loss, hyperpigmentation and age spots, prone to skin diseases, dry mouth, pharyngitis and hoarseness.
4, cardiovascular system: including hypertension, atherosclerosis and coronary heart disease, the incidence of embolic disease increases with postmenopausal age, the incidence of coronary heart disease in women ≤ 55 years of age is 5 to 8 times lower than that of men of the same age.
Psychiatric and nervous system Menopausal women are prone to psychotic depression, amnesia, obsessive-compulsive ideas, paranoia, emotional inversion, emotional instability, persecutory delusions, anxiety, paranoia, abnormal feelings, self-consciousness and anhedonia, some of them are manic, delusional thinking and schizophrenia.
Third, tumor-prone tendency
According to statistics, the incidence of gynecological tumors increases with age, such as 219.93~245.39/100,000 for ≥40 years old, 433.82~450.45/100,000 for ≥50 years old, 770.84~782.14/100,000 for ≥60 years old, 1120.71~1129.90/100,000 for ≥70 years old, and 1495.09/100,000 for ≥80 years old. ≥(New York State 1960), cervical cancer, uterine body cancer, ovarian cancer incidence peak at the age of 40-60 years, cervical invasive cancer between 41.8 to 48.7 years (Noda 1983), urological tumor sex ratio: ≤ 40 years old M:F = 1:0.6 40 to 60 years old 1:1, including kidney cancer 2:1, urethral cancer 1:3 ～5, especially in women aged ≥50 years.
Urinary system
Urinary frequency, urinary urgency, tension or acute urinary incontinence (urgemt incontineuce), urethral mucosal prolapse, urethral caruncle, renal prolapse, pelvic-ureteral effusion and easy urinary retention and infection.
V. Skeletal muscular system
Bone joints (wrist, elbow, shoulder, hip and lumbar), ligaments, muscle atrophy, soreness, dysfunction, osteoporosis and susceptibility to fracture, see section on osteoporosis for details.
VI. Endocrine metabolic changes
(a) Hyperlipidemia: manifested as increased cholesterol, LDL, TG, VLDL, and reduced HDL and HDL2, so prone to atherosclerosis and hypertension.
(ii) Diabetic tendency: decreased secretion of insulin by β-cells and increased insulin rejection by peripheral tissues are the cause.
(iii) Edema: it can be mucinous edema caused by hypothyroidism, angioneurotic edema, or hypoproteinemia, malnutrition edema.
(iv) Hypoimmune function: easily complicated by infections and tumors.
Western medical treatment for menopausal syndrome
I. Sex hormone therapy, i.e. estrogen/progestin replacement therapy.
(I) Indications: vasodystrophy syndrome, osteoporosis, atrophic vaginitis, early menopause, recurrent or intractable urethral D cystitis; Lipoproteinaemia.
(II) Contraindications: history of embolism, chronic hepatic and renal insufficiency, sex hormone-dependent tumors (uterine fibroids, endometrial cancer, breast cancer, ovarian cancer), pyrrole violet deposition (prophyria), severe hypertension, diabetes mellitus, severe varicose veins, addiction to smoking, and inability to adhere to long-term follow-up.
(C) Methods: Oral administration is recommended, and subcutaneous implantation and myeloablative injection are discarded. Topical medication is limited to geriatric vaginitis and should not be applied for a long time.
(1) Estro D progestin cycle therapy: for normative replacement therapy. The combined estrogen 0.625mg/d x 25 days (or equivalent to that dose of other estrogen) is supplemented with a secreted dose of progestin for a total of 10 days on days 16 to 25. 3 to 6 cycles is a course of treatment. In case of periodic blood withdrawal, progestin should be added continuously. If there is no withdrawal of blood for 3 consecutive cycles, progestin can be stopped.
2.Estrogen-only cycle therapy: i.e., substitute dose of estrogen for 25 days per month. It is limited to those who have undergone hysterectomy and have obvious menopausal symptoms. For those who have not undergone hysterectomy and have negative progesterone withdrawal, although pure estrogen therapy can be tried, progesterone withdrawal must be performed once every 2-3 months. If the withdrawal is positive, the treatment should be changed to estrogen-progestin cycle therapy. If the progesterone withdrawal is negative for 3 consecutive times, estrogen-only cycle therapy can be continued, but the principle should not exceed 3 to 6 cycles.
3. Nylestriol therapy: suitable for all menopausal women. 5mg, orally once a month. After the symptoms improve, change to 1~2mg once or twice a month, total efficiency 75.8~98.4%. The advantages are: simple, long-lasting, and little lining irritation. The symptoms of senile vaginitis and urethritis improve significantly.
4.Estrogen D androgen therapy: It is suitable for women with breast pain and hypogonadism. Estrogen with methyltestosterone 5-10mg/d. Contains chemistry. And has the effect of curbing estrogen pro-endothelial hyperplasia.
(IV) therapeutic effect
1, estrogen D progestin treatment, can significantly improve the mental D somatic symptoms. Total effective rate 84-97%. Curbing flushing efficiency: 96% for single D estrogen, 95% for estrogen D progestin, 91% for estrogen D androgen, and ≥56% for single D progestin. Headache relief rate: 93% for estrogen or estrogen D androgen.
2. Estrogen treatment significantly improved osteoporosis: reduced its fracture rate from 50-70% to 3%. While androgen or anabolic steroid treatment fracture rate was still 40%. However, after discontinuation of estrogen therapy, the fracture rate rose again to 25%. The urinary Ca++/C and hydroxyproline/C ratios decreased during estrogen therapy, and the ratios decreased further after supplementation with progestin, indicating the importance of estrogen-progestin therapy.
3. Estrogen-progestin cycle therapy: 97% of women have cyclic bleeding that can last until the age of 60. 60% of those treated between the ages of 60 and 65 still have withdrawal, but the volume of menstruation is decreasing. There are also cases where the withdrawal is still normal after 17 years of treatment.
(E) Side effects: Gastrointestinal side effects are related to the dose and dosage form of estrogen. However, they are well tolerated by women. In order to reduce side effects, the principle of individualization should be followed by using the minimum effective dose and reducing or stopping the dose once the symptoms and signs are relieved.
(vi) Prognosis and follow-up: The focus is on preventing excessive endometrial hyperplasia and carcinoma, mastoproliferative reactions and abnormal systemic metabolic changes. Anyone receiving sex hormone replacement therapy should have an outpatient review or a letter visit every 3 months. 1 gynecological examination every 6 months, as well as ultrasound and endometrial biopsy when necessary. Breast examination to note the presence of lobular hyperplasia or masses, and monitoring of heart, liver, biliary and blood functions.
II. Drug therapy
Including: α2 agonists, β adrenergic blockers, sedative D anxiolytics and antidepressants.
Clonidine, an imidazoline derivative, α2 agonist, central anti-hypertensive drug, and better curb flushing episodes, especially for nocturnal episodes, insomnia of decubitus sweating. The initial dose is 0.075mg x 3/d and can be gradually increased to 0.45-0.9mg/d. Side effects are dizziness, drowsiness and dry mouth.
β-adrenergic blocking agents, such as liothyronine, can relieve palpitations. Sedatives such as Valium and Phenobarbital, and antidepressants such as promethazine and doxepin are only used when psychiatric D neurological symptoms are evident.
Calcium, vitamin D, calcitonin, and fluoride with sex hormones are effective in halting the development of osteoporosis and reducing fracture rates.
Psycho-spiritual treatment: The mental and physical health of menopausal women is a task for the whole society. Social health education and health care measures should be strengthened, health care consultation clinics should be opened, regular checkups should be conducted, and psychosomatic diseases prone to menopause should be actively prevented and treated early for cardiovascular diseases, osteoporosis, endocrine metabolic diseases and tumors. Organize self-care for menopausal women to reduce the incidence of menopausal syndrome.
Other treatments: Transcranial microcurrent stimulation therapy is a treatment method completely different from traditional medication and psychotherapy. It is used to stimulate the brain through low-intensity microcurrent to change the abnormal brain waves of the patient’s brain, prompting the brain to secrete a series of neurotransmitters and hormones that are closely related to menopausal insomnia, anxiety and other diseases, thus realizing the treatment of these diseases.
Chinese medicine treatment for menopausal syndrome
Chinese medicine treatment can be divided into the following categories
Kidney yin deficiency: The symptoms are characterized by late menstruation, low menstrual flow or absence of menstruation, vaginal dryness, painful and unpleasant intercourse, and low menstrual flow, and systemic symptoms such as dizziness and tinnitus, insomnia and dreaminess, fever and sweating, restlessness, soreness and weakness of the waist and knees, itchy skin or insect crawling discomfort, red tongue with little coating and fine pulse. Treatment should be based on nourishing Yin in the kidney, and commonly used prescriptions such as (Zhi Bai Di Huang Wan), Zuo Gui Drink, etc. should be added and subtracted according to the symptoms. If the kidney yin is insufficient, water and fire do not help, the heart fire is delusional, the evidence is palpitations, insomnia, dreaminess and forgetfulness, then it is appropriate to nourish the heart and kidney, use Tian Wang Tonic Heart Dan plus or minus formula to treat.
Kidney Yang deficiency: Its symptoms are characterized by excessive menstruation, menstrual leakage or absence of menstrual bleeding in gynecology, soreness and weakness of the waist and knees, swelling of the face and limbs (especially the lower limbs), fear of cold, easy diarrhea, frequent urination or incontinence, pale tongue with thin coating, and sunken and weak pulse in the body. The principle of treatment for this condition is to warm the kidneys and spleen, which can be treated with the formula of Right Return Pill plus or minus.
Yin and Yang deficiency: This type of patient is quite common, and its symptoms are a combination of some of the above two typical symptoms, such as head and body fever, sometimes cold, dizziness and tinnitus, lumbar weakness, thin tongue coating and thin pulse.
The treatment is to tonify the kidneys and support Yang, nourishing the flushing. Depending on the severity of clinical Yin and Yang, either nourish Yin mainly and warm up Kidney-Yang, or warm up Yang mainly and nourish Yin, the prescriptions for the two typical types of symptoms mentioned above should be added or subtracted appropriately.
The above-mentioned herbal treatment of nourishing Yin and tonifying Yang may be effective through the regulation of neurohormones and the influence of the autonomic neurovascular system. However, as mentioned above, the factors affecting the pathogenesis of this disease are complex, so when prescribing medication, the doctor should listen carefully to the condition, as this is the important basis for the correct identification of the symptoms and prescription of medication to obtain good results.
Commonly used Chinese medicines include:
Liou Wei Di Huang Wan, Zhu Zhu Di Huang Wan, Zhi Bai Di Huang Wan, Wu Zi Zhuan Zong Wan, Jin Kui Kidney Qi Wan, Tian Wang Tonic Heart Dan, Qian Nian An Capsule —–, etc., should be taken under the guidance of a doctor. This disease is a chronic conditioning disease in Chinese medicine should adhere to the medication, can not be quick results. You can also use food therapy with conditioning treatment. Such as (snapper wolfberry soup, mulberry glutinous rice porridge, walnut porridge, lamb chestnut stew), etc., according to the different types of symptoms choose food therapy prescriptions to promote the balance of the kidney’s yin and Yang.