menopauseThe time of occurrence can be expressed as the final menstrual period 1 year (or longer) before amenorrhea.Menopause includes menopause transition period and post menopause period.Menopause transition period refers to the period from the beginning of menstruation to the final menstrual period;Postmenopause refers to the period after the final menstrual period.Perimenopause refers to the period from the time when the endocrinological, biological and clinical characteristics related to menopause begin to appear before menopause to the time within one year after menopause.It is reported that the menopausal age of women around the world is basically the same, which is about 51 years old on average in developed countries and 50 years old in most developing countries.[1]
(1) Menstrual disorder: Irregular menstruation often occurs during the menopausal transition period. As ovulation is rare or even absent, the body shows irregular menstrual cycle, prolonged menstruation and increased or decreased menstruation volume.
(2) Vascular dyskinesia: Vascular dyskinesia is mainly manifested by hot flashes, which is characterized by recurrent redness of the face and neck skin, and general fever, followed by sweating, which generally lasts for 1-3 minutes, and is easy to trigger at night and under stress.Severe hot flashes can affect the work, sleep and life of patients, which is the main reason for the need for sex hormone treatment.
(3) Nervous and mental symptoms: ① Sleep disorder: manifested as difficulty in falling asleep or not sleeping deeply, etc. ② Inattention: accompanied by a decline in memory, it is mainly related to age growth and sleep disorders ③ Large emotional fluctuations: manifested as inability to control emotions, perimenopausal women often have emotional symptoms such as depression, anxiety, anxiety or irritability.
Long term changes
(1) Urogenital postmenopausal syndrome: more than half of menopausal women will have this symptom, which is manifested as atrophic changes in the urogenital tract, prone to vaginal infection, vaginal dryness, difficulty in sexual intercourse, dysuria, urinalgia and other urinary tract infection symptoms.
(2) Osteoporosis: More than half of women will have postmenopausal osteoporosis, which is due to the lack of estrogen in postmenopausal women, resulting in increased bone absorption and rapid loss of bone mass, manifested as osteoporosis.
(3) Other symptoms: postmenopausal women are more likely to suffer from Alzheimer's disease, cardiovascular disease and other diseases, which may be related to the low level of estrogen in the body.[2-3]
Treatment mode
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1. Symptomatic treatment: patients with insomnia can take a small amount of the sedative estazolam as prescribed;Patients with osteoporosis should actively take effective measures to deal with it, such as calcium supplementation;Patients with vasomotor syndrome should take effective measures in a timely manner, learn to adjust the diet structure, avoid or reduce the intake of "three high diets", enhance exercise, and conduct regular physical examination.
2. Improve lifestyle[1]：
(1) Diet and nutrition: appropriately reduce the intake of carbohydrates and increase the intake of dietary fiber. The diet should be characterized by low calorie, low salt, low sugar and low fat.
Dietary fiber intake is 20-30g per day.Coarse grain and fine grain should be eaten together. It is best that coarse grain and coarse grain can reach 50~100g per day, 5~7 times per week.
Recommended daily intake of trace elements: 1000 mg calcium;Iron 15mg;Sodium is less than 6g, and less than 5g is appropriate for patients with hypertension and coronary heart disease.
Recommended daily supplement of vitamins
(2) Stop smoking: There are a lot of harmful substances and carcinogens in the smoke, whether smoking or smoking second-hand smoke will lead to an increased risk of lung cancer, breast cancer and other cancers in women, and may also lead to early menopause.
(3) Weight management: the normal body mass index of menopausal women should be 18.5~23.9 kg/㎡.Female obesity complicated with menopausal syndrome has become common clinically, which is more likely to weaken the body's resistance and increase the mortality.Therefore, calorie intake should be controlled at any time.
(4) Sexual life: premature termination of sexual life by menopausal women will not only affect their physical and mental health, but also affect the feelings of husband and wife and family harmony.They should actively communicate with their spouses and properly maintain sexual life.
3. Hormone therapy (MHT):
4. Domestic and foreign guidelines unanimously point out that hormone supplementation is a necessary medical measure for menopause related health problems.The starting time of hormone therapy is after the ovarian function begins to decline and related symptoms appear.The window period for emphasizing treatment is generally within 10 years of menopause or before the age of 60.Grasping this "time window" and timely supplementation of hormones are important health measures to improve their quality of life.
5. In clinical, hormone supplementation includes single estrogen, sequential treatment of estrogen and progesterone [such as compound preparation of estradiol valerate+cyproterone acetate], and continuous treatment of estrogen and progesterone.
6. MHT is a medical measure, which requires physical examination during treatment, and can be implemented only when there are clear indications and no contraindications.It is necessary to treat according to the doctor's prescription, and it is forbidden to buy drugs for treatment without permission.Individualization is an important principle of MHT. Not only the choice of drugs should be individualized, but also the dose should be individualized, and the lowest effective dose that can achieve the therapeutic effect should be selected[3]；It also needs to be assessed regularly to make sure that the benefits outweigh the risks.If MHT is used again after 10 years of menopause, the risk of adverse reactions will increase.
(1) Contraindications: ① known or suspected pregnancy; ②Vaginal bleeding of unknown cause; ③Known or suspected to have breast cancer; ④Known or suspected to have sex hormone dependent malignant tumor; ⑤Active venous or arterial thromboembolic disease in the last 6 months; ⑥Severe liver and kidney dysfunction or porphyria, otosclerosis and meningioma related to progesterone.
(2) Cautious use[4]Note: Caution is not a contraindication and treatment should be carried out after consulting relevant professional doctors.
① Hysteromyoma; ②Endometriosis; ③History of endometrial hyperplasia; ④Uncontrolled diabetes; ⑤Severe hypertension; ⑥Thrombosis tendency; ⑦Gallbladder disease; ⑧Epilepsy; ⑨Migraine; ⑩Asthma; ≮HyperprolactinemiaSystemic lupus erythematosusFamily history of benign breast disease and breast cancer.
(Xu Xiaoyang Second Affiliated Hospital of Chongqing Medical University; Tu Teng West China Clinical Medical College of Sichuan University)
