”An introduction to the similarities and differences between menopause, perimenopause and menopause.
Menopause is a transitional period for women when ovarian function gradually declines from a vigorous state to complete disappearance, including menopause and the period before and after menopause. The perimenopausal period refers to the period between the beginning of the decline of ovarian function and one year after menopause, which lasts about 3 to 5 years, according to Zou Shien, Department of Obstetrics and Gynecology, Fudan University. It is calculated according to the average age of 50 years for women to go through menopause, which usually occurs between 45 and 55 years old.
Menopause is defined as the cessation of menstruation for 1 year.
I. Can menopause be carried through by itself?
Surveys show that only 1-2% of people will go to the hospital for menopause treatment. Many people think that menopause and ovarian dysfunction are natural phenomena and that they can just “carry on” and pass. If this natural phenomenon is not treated in time, it can lead to anxiety and depression, which not only affects the quality of life, but is also the culprit of many diseases in women’s lives, such as changes in blood lipids, which can lead to heart disease, and calcium loss, which can lead to osteoporosis and even fractures.
Mood swings such as anxiety and temper tantrums are the most familiar and typical symptoms of menopause, but many people do not pay enough attention to them. In addition, insomnia, sweating, fatigue, palpitations, hot flashes, muscle and joint pain, tinnitus, and abnormal skin sensation are all early symptoms of menopause, which in fact indicate the decline of ovarian function, followed by vaginal dryness, osteoporosis, and cardiovascular disease. Symptoms must be treated by a doctor in time.
Second, why does menopause occur then how should menopausal problems be treated? It starts with the root cause of the menopause problem, which is the decline of female ovarian function. After women reach the age of 40, the reserve of ovarian function decreases dramatically, causing a lack of estrogen. Therefore hormone supplementation therapy is the fundamental solution to many menopause-related problems. Of course, since menopause usually occurs around the age of 50, it is accompanied by many aging-related problems, not all of which are necessarily brought on by menopause, which requires a comprehensive treatment plan that includes lifestyle modification, hormone supplementation therapy, calcium and vitamin D supplementation, targeted treatment of osteoporosis and other related problems, and at different ages, with different concomitant diseases The choice of medication varies by age, concomitant disease, and severity of menopausal problems, and must be done under medical supervision.
Seize the “time window” to go through menopause smoothly
According to the current research results, the earlier the hormone supplementation, the better. Of course, it does not mean that we should supplement when we are young, or that we do not need to supplement if we do not lack it at that time. Many diseases, such as heart disease and Alzheimer’s disease mentioned earlier, there is a so-called window of treatment for the prevention of these diseases. What is meant by “therapeutic window”? It means that the use of estrogen at this age is beneficial, but after this age, there is no benefit, and it may even be harmful to use it later on.
Starting early and taking estrogen supplements in a timely manner can reduce the risk of Alzheimer’s disease to a certain extent. However, if hormone supplementation is used after this “window” is missed, even though estrogen can still improve lipid status, it will not reduce the risk of cardiovascular disease and dementia because atherosclerosis and neurological degeneration have already occurred. Therefore, the “window of time” for hormone supplementation therapy is from the beginning of perimenopause to early menopause. The International Menopause Society and experts from various countries have pointed out that hormone supplementation therapy for symptomatic middle-aged women starting within 10 years of menopause will result in long-term benefits to the cardiovascular and neurological systems.
Fourth, professional help is needed to use hormone supplementation therapy wisely.
Hormone supplementation therapy is a medical measure and therefore its application should be mastered by a physician and not used blindly. People should pay attention to several issues such as.
1. Hormone supplementation therapy is not for everyone: menopause and related symptoms (such as vasodilatory symptoms, genitourinary tract atrophy symptoms, neuropsychiatric symptoms, etc.) and the need to prevent osteoporosis are the primary indications for the application of hormone supplementation therapy, while various estrogen- and progestogen-dependent tumors, severe liver and kidney dysfunction and unidentified obstetrical and gynecological problems are contraindications; 2. Hormone supplementation therapy is not Hormone supplementation therapy can only solve the problems caused by estrogen deficiency, but not the diseases caused by aging; 3. Because of the “window of time” mentioned above, hormone supplementation should be actively sought to be initiated during this time period, and the benefits of starting it after this “window” will be limited. In addition, for women with a uterus, they should not only supplement with estrogen, but also supplement with the appropriate progestin to make it safer.
V. How to supplement hormones.
When menopausal symptoms appear, we can also measure estrogen levels, and if there is a problem of estrogen deficiency, we should supplement estrogen. In the early stages, that is, when menopause has just begun, or when there is just an estrogen deficiency, many people still want to have their periods, so we take the so-called cycle method to supplement estrogen and progesterone. In the earliest stages, if there is no estrogen deficiency and there is only a problem with menstruation, progestin therapy alone is used, and if there is estrogen deficiency, estrogen supplementation is used.
The drugs that can be supplied are now mainly natural drugs, such as GlaxoSmithKline and Clomid, the so-called synthetic ones are basically not used now. On the one hand, they can be used to supplement estrogen, and subsequently, the progesterone added in the second half of the cycle can allow regular menstruation, so these drugs can be used to treat estrogen deficiency and menstruation.
Estrogenic drugs, from the point of view of natural drugs, there are estradiol, estriol, and there are different routes of these drugs, some are oral drugs, and there are those that are absorbed through the skin, such as those that are applied to the skin, and those that are applied in the form of creams, and those that are absorbed through the vagina, and these are for another problem that occurs during menopause or perimenopause, which is the atrophy of the genitourinary system and old age. We also have some methods that specifically target these areas, that is, estrogen preparations that are administered vaginally and absorbed through the vaginal mucosa.
Sixth, the safety of hormone therapy.
We often say that medicine is toxic in three ways. As for estrogen, the occurrence of its side effects depends mainly on its dose. If the amount used is particularly large, there will definitely be problems, but the dose of drugs used for hormone supplementation is actually very small. This estrogen level is sufficient to prevent these symptoms, to protect the bones, to protect the nervous system and the cardiovascular system. We are not going to seek to completely replace the function of the ovaries, all we are going to do is to supplement a little bit of estrogen and then prevent these diseases of old age. The dose of supplementation is only equivalent to the dose of estrogen on the day of the lowest estrogen level in a menstrual cycle when you are young, so it is very safe.
However, even at these doses, we have done quite adequate studies. Because of the long duration of the drug, several years or even a decade, will there be any problems with using it for such a long time? Some people have a lot of concerns, such as heart problems, the heart must be used during the window period. Then some people ask about weight gain, but in fact estrogen does not have an effect on this. Some people worry about the occurrence of endometrial cancer, but endometrial cancer is indeed related to estrogen. Even with estrogen and progestin, the incidence of endometrial cancer can be reduced.
As for whether other cancers will occur, in fact, most cancers are not related to estrogen, and even estrogen can reduce the occurrence of some cancers, such as colon cancer, which is reduced by the application of estrogen, and is much less than that of people who do not use estrogen. Of course, we don’t use hormone supplements to prevent colon cancer, but it is true that fewer people get colon cancer after using hormone supplements. In fact, more people are more concerned about breast cancer.
As far as breast cancer is concerned, there is no definite conclusion from either large clinical studies or small clinical studies, and by definite conclusion, I mean whether hormone supplementation increases breast cancer, decreases breast cancer, or does not change anything. There is a clear conclusion that if hormone supplementation therapy does not increase breast cancer within five years, no matter which drug is used, including all estrogen and progestin preparations, almost the same result is obtained, which is a relatively certain conclusion. As for whether there will be an increase in breast cancer after five years, it depends on the type of drug used. At present, some natural progestin preparations that are being developed can be said not to increase breast cancer, and using them for seven or eight years will not increase breast cancer.
It is worth mentioning that if the person has had her uterus removed, if she had her uterus removed before menopause for some reason, she has no endometrium, so in the process of hormone supplementation, there is no need to add progestin, and estrogen supplementation alone is enough. Estrogen supplementation alone, as far as the results of the current study are concerned, does not increase the occurrence of breast cancer. So, now our task is, one is to find a better progestin, and we will see if we can use it for a longer period of time, and it will not have any effect on the occurrence of breast cancer; the other is to encourage people that it is safe for each person to use it for at least five years. As for other cancers, they have nothing to do with estrogen.
In fact, we can see from a basic fact that hormone supplementation has a history of 60 years, and in the process of practical application, there have been countless studies over the past 60 years to study whether hormone supplementation has anything to do with breast cancer. It’s clear, so you don’t have to worry about it. In contrast, it brings very many benefits, osteoporosis, reduce fractures, at least reduce the death of more than 1/4 people due to fractures, the pros and cons are very clear, certainly the benefits are much higher than the possible risks.
Seven, the follow-up problem after the use of drugs.
In the first few months after the treatment, the patient should be allowed to come a little bit more diligently. After the first few months of treatment, we can let the patient have a longer interval after determining a dose of drug treatment. In fact, such treatment does not add more trouble to the patient, once a year this routine medical examination, it is completely fine, such a medical examination will not exceed the scope of the usual medical examination, so it does not add too much trouble to the patient, then the cost of medical drugs is actually relatively low.
After this, let the patient do a medical checkup once a year, so that the patient can persist in the treatment, the benefits should be told to the patient, so that the benefits are very huge, and after the age of sixty-five can be very different from those who do not use hormone supplementation treatment, from the appearance, from the mental state, from the occurrence of disease, there is a very big difference.
Eight, the so-called health care products.
Nowadays, many women who experience menopausal symptoms seek health care products to treat them. No matter what the drug claims to be, as long as it can really reduce your menopausal symptoms and prevent the so-called osteoporosis and blood lipid changes, it must contain estrogen. The danger is that some so-called health supplements have estrogen added to them or contain estrogen, and if estrogen alone causes some lesions, progestin should be added to the medical treatment. We don’t know how much estrogen is in it, and whether progesterone is added, and they may not even know it themselves, which is a certain danger.
Many people have a misconception that these supplements are harmless, that they are natural products, that they are not harmful to the body, and that they would rather spend a high price to buy these supplements, but in fact estrogen is very cheap, so the medicine does not cost much, and the so-called safety, she goes to these supplements instead of going to the doctor for scientific help, which is actually a misconception.
But there is a health product, I think it should be used, because now all the calcium tablets, calcium preparations do not need a doctor’s prescription, this as a health product for menopausal women, perimenopausal women after menopause is still very important, I personally think that at least after 40 years old should start to supplement some calcium preparations.
IX. Summary.
At present, the average life expectancy of human beings is close to 80 years, and women who are entering menopause around the age of 50 should be in the golden age of middle age. You are the backbone of your family, the backbone of your workplace and the elite, and you have heavy social responsibilities. Under the guidance of your doctor, you can reduce the worries of menopause, improve your quality of life, reduce the risk of chronic diseases in old age, and spend the last 30 years of your life more healthily and peacefully by adopting comprehensive and proper health measures and receiving hormone supplementation therapy at the right time.