Menopause refers to the permanent cessation of menstruation due to ovarian failure. It is considered menopause only when menstruation stops for 12 consecutive months. Menopause can be divided into natural menopause and artificial menopause. Natural menopause occurs naturally with age, while artificial menopause is caused by surgery, certain diseases, radiotherapy or chemotherapy. When menopause begins naturally, it often manifests as irregular menstrual cycles, followed by symptoms such as hot flashes, sweating, mood swings, vaginal dryness and pain. The symptoms of this disease can be controlled after treatment, and the prognosis is generally good.
Clinical classification
1. Natural menopause
It refers to the physiological exhaustion (i.e., exhaustion) of ovarian follicles, or the remaining follicles lose their response to gonadotropins, so that the follicles no longer develop and secrete estrogen, leading to menopause.
2. Artificial menopause
Refers to menopause caused by surgical removal of both ovaries or damage to ovarian function due to radiation exposure and chemotherapy.
3. Perimenopause
The transition period from a few years before menopause to one year after menopause is called perimenopause, which includes premenopause, menopause and postmenopause.
(1) Premenopause: Menstrual cycles are irregular but not stopped. Most women enter this stage around the age of 47, and pregnancy is possible during this period.
(2) Menopause: This is the last time you have your menstrual period. It is not until you have not had your menstrual period for a year that you are considered to be in menopause. Common symptoms during this stage include hot flashes, vaginal dryness, and sleep problems.
(3) Postmenopause: Postmenopause begins one year after the last menstrual period. Once this stage begins, the rest of your life can be called postmenopause.
Epidemiology
Infectious
Not contagious.
Prone population
Surveys in most countries show that the average age of natural menopause for women is around 50 years old.
Causes
Overview
For women of childbearing age, the growth of ovarian follicles, ovulation, corpus luteum formation, and secretion of estrogen and progesterone have obvious cyclical characteristics. This cyclical change is called the menstrual cycle. However, with age, the function of the ovaries will gradually decline until failure, and the menstrual cycle will stop, thus forming the so-called “menopause”. In addition, unnatural factors such as bilateral oophorectomy, chemotherapy and radiotherapy can also damage ovarian function, thereby inducing menopause. When the age of menopause is less than 40 years old, it is considered premature menopause. The age of menopause in women is affected by many factors such as genetics, nutrition, smoking, weight, and ethnicity.
Basic Cause
1. Natural decline in hormone levels
As age increases, the estrogen and progesterone secreted by the ovaries begin to decrease, the menstrual cycle gradually shortens, and the menstrual volume gradually decreases, until around age 50 when the ovarian function is exhausted, the follicles are used up, and menstruation stops.
2. Bilateral oophorectomy
A woman who has had both oophorectomies no longer releases eggs and no longer produces estrogen and progesterone, which causes menopause. Menstruation stops immediately, and hot flashes and other menopausal symptoms may occur.
3. Chemotherapy and radiotherapy
Chemotherapy and radiation for cancer treatment can damage ovarian function during treatment, and in severe cases can cause menstruation to stop. However, the cessation of menstruation after chemotherapy is not always permanent.
4. Primary ovarian insufficiency
About 1% of women experience premature menopause before age 40. It may be due to primary ovarian insufficiency, which is when the ovaries do not produce normal levels of hormones, caused by genes or an autoimmune disorder. Often there is no specific cause for primary ovarian insufficiency.
5. Factors affecting menopausal age
(1) Genetics: Women with a family history of early menopause are at a higher risk of menopause earlier than the average age.
(2) Nutrition: Poor nutrition may lead to early menopause. The average age of menopause is earlier in areas with poor nutrition.
(3) Smoking: Smoking may bring menopause forward by about 1.5 years.
(4) Ethnicity: Race and ethnicity may also affect the age of menopause. Studies have found that compared with white women, Hispanic women have earlier natural menopause, while Japanese American women have later menopause.
(5) Others: Being thin, living at high altitude, having had a hysterectomy, consuming galactose, having a history of type 1 diabetes, having a history of intrauterine exposure to diethylstilbestrol, and frequently working overtime and staying up late may lead to an early age of menopause.
Symptoms
Overview
The earliest clinical symptom of perimenopause is menstrual changes. Most women before and after menopause mainly experience vasomotor symptoms, psychoneurological symptoms, and physical symptoms in the early stage. Several years after menopause, they gradually develop atrophic changes in the urogenital tract, metabolic changes, cardiovascular diseases, osteoporosis, and other degenerative changes or diseases.
Typical symptoms
1. Recent symptoms
(1) Menstrual changes: These may be the earliest symptoms of perimenopause. They may manifest as a gradual shortening of the menstrual cycle, a decrease in menstrual flow, and finally menopause; irregular menstrual cycles, prolonged cycles and periods, increased menstrual flow, and even heavy bleeding or continuous bleeding that gradually decreases and stops; some women have regular menstruation, but it may suddenly stop, which is rare.
(2) Vasomotor symptoms: mainly manifested as hot flashes, which are characteristic manifestations of estrogen reduction. It is characterized by blushing of the face, neck and chest skin, which often occurs repeatedly, accompanied by sweating, and generally lasts for 1 to 3 minutes. Mild symptoms may occur several times a day, while severe symptoms may occur more than ten times or even more, especially at night or under stress. The symptom can last for 1 to 2 years, sometimes up to 5 years or longer. Severe hot flashes can affect women’s work, daily life and sleep.
(3) Psychoneural symptoms: mainly manifested as irritability, anxiety, suspicion, depression, decreased self-confidence, and emotional instability; some patients may also experience memory loss, inattention, and sleep disorders.
2. Long-term symptoms
(1) Reproductive system: The vaginal mucosa becomes thinner, drier, and less elastic (a condition called vaginal atrophy). These changes can cause pain during intercourse. Other reproductive organs (such as the labia minora, clitoris, uterus, and ovaries) also shrink. As people age, their libido also decreases. Most women still have orgasms, but it takes longer to reach them.
(2) Urinary system: Patients are prone to urinary tract infections, which may manifest as a burning sensation during urination, as well as difficulty urinating, pain, and urgency. Urinary incontinence (involuntary urination) is more common and becomes more severe with age.
(3) Metabolic abnormalities and cardiovascular diseases: Some postmenopausal women experience high blood pressure or blood pressure fluctuations; they may also experience palpitations, arrhythmia, dizziness, fatigue, etc., and their weight may increase significantly.
(4) Bone abnormalities: Estrogen deficiency in menopausal women can increase bone absorption, leading to rapid bone loss and osteoporosis. Degenerative changes in bones and joints can lead to symptoms such as back pain, limb pain, and joint pain.
(5) Skin changes: As estrogen levels decrease, the amount of collagen (a protein that makes the skin tough) and elastin (a protein that makes the skin elastic) also decreases. As a result, the skin becomes thinner, drier, less elastic, and more fragile.
complication
1. Fracture
Postmenopause causes osteoporosis and increased risk of fractures.
2. Alzheimer’s disease
This is commonly known as “Alzheimer’s disease”. Studies have shown that Alzheimer’s disease is related to estrogen deficiency.
examine
Estimated inspection
Patients should seek medical attention promptly when they experience irregular menstruation. The doctor will first conduct a physical examination, and also perform hormone testing, bone density testing, and ultrasound examinations.
Physical examination
The doctor will perform a full-body examination and gynecological examination on the patient, including breast examination, pelvic examination and blood pressure measurement, etc. This will help assess the patient’s overall condition.
Laboratory tests
1. Follicle stimulating hormone (FSH) test
FSH>40U/L indicates ovarian failure.
2. Inhibin B assay
Serum inhibin B ≤ 45 ng/L is the earliest sign of ovarian dysfunction and is more sensitive than FSH.
3. Anti-Müllerian hormone (AMH) assay
AMH as low as 1.1ng/ml indicates a decrease in ovarian reserve function (referring to the number and quality of follicles remaining in the ovaries); if it is lower than 0.2ng/ml, it indicates impending menopause; AMH is generally undetectable after menopause.
4. Estradiol (E2) determination
Estradiol levels in postmenopausal women are lower than 150 pmol/L, but E2 levels in women during the menopausal transition period may fluctuate.
Imaging tests
Ultrasound examination can observe the relevant conditions of the uterus and ovaries. Menopause can cause a decrease in the number of ovarian follicles, a decrease in ovarian size, and a thinning of the endometrium, which generally does not exceed 5mm. Ultrasound can also help rule out organic gynecological lesions.
Other tests
Bone density measurement can be used to determine whether or not you have osteoporosis.
diagnosis
Diagnostic principles
Women over 40 years old who have not had menstruation for 12 months after the last menstrual period can be clinically diagnosed as menopausal after excluding pregnancy. During diagnosis, attention should be paid to distinguishing from diseases such as hyperthyroidism, coronary artery atherosclerotic heart disease (CHD), hypertension or pheochromocytoma.
Differential Diagnosis
1. Hyperthyroidism
It can occur at any age, but when it occurs in older people, the symptoms are often atypical, such as no thyroid enlargement, no hyperphagia, no fast heart rate, no excitement, but depression, indifference, suspicion, anxiety, etc. It can be identified by measuring thyroid function indicators. For example, when TSH is lower than normal, T4 is elevated, and T3 is at the upper limit of normal or even normal, hyperthyroidism should be diagnosed.
2. Coronary artery atherosclerotic heart disease (CHD)
When the patient’s main symptoms are palpitations, arrhythmias, and chest tightness, CHD is considered first. The doctor will carefully perform a physical examination and electrocardiogram to make a distinction. If the distinction is difficult, estrogen test treatment or a cardiology consultation can be used.
3. Hypertension or pheochromocytoma
It should be considered when there is headache, large fluctuations in blood pressure or persistent hypertension. The identification method is to measure blood pressure repeatedly and perform relevant examinations for pheochromocytoma, such as whether there is a mass in the abdomen, whether blood pressure rises when squeezing the mass, whether there are symptoms such as headache, palpitations, sweating, etc., and blood catecholamine measurement. Blood pressure changes associated with menopause are often mild.
treat
Treatment principles
Due to the different mental states and living environments of menopausal women, the severity of their symptoms varies greatly. Some women do not need treatment, while others need medical intervention to control their symptoms, mainly with medication. The goal of treatment is to relieve short-term symptoms and to detect and prevent osteoporosis, arteriosclerosis and other geriatric diseases at an early stage.
General treatment
To prevent osteoporosis, you should insist on physical exercise, increase sun exposure time, and consume adequate protein and calcium-rich foods.
Drug treatment
1. Hormone replacement therapy (HRT)
Hormone supplementation is a necessary medical measure for health problems related to the menopausal transition and postmenopause. Hormone treatment can be used when menopausal symptoms such as hot flashes, excessive sweating, irritability and other diseases occur and exist.
(1) Commonly used drugs
The main drug is estrogen, supplemented by progesterone. Estrogen therapy alone is only suitable for those who have had their uterus removed, and progesterone therapy alone is suitable for dysfunctional uterine bleeding during the menopausal transition period. Commonly used estrogens include estradiol valerate, conjugated estrogens, 17β-estradiol transdermal patch, and nialstradiol; progesterone commonly used is medroxyprogesterone acetate (MPA), and in recent years, natural progesterone preparations have tended to be used, such as micronized progesterone. Tissue-selective estrogen activity modulators, such as tibolone, can also be used selectively.
(2) Contraindications
① Known or suspected pregnancy, unexplained vaginal bleeding.
② Known or suspected of having breast cancer, or known or suspected of having sex hormone-dependent malignant tumors.
③ Patients who have suffered from active venous or arterial thromboembolic disease, severe liver and kidney dysfunction, porphyria, otosclerosis, meningioma (progestin is contraindicated) within the last 6 months.
(3) Use with caution
These include uterine fibroids, endometriosis, history of endometrial hyperplasia, uncontrolled diabetes and severe hypertension, thrombotic tendency, gallbladder disease, epilepsy, migraine, asthma, hyperprolactinemia, systemic lupus erythematosus, benign breast diseases, family history of breast adenocarcinoma, and some sex hormone-dependent gynecological malignancies that have completely remitted, such as endometrial cancer and ovarian epithelial cancer. If these conditions exist, the medication should be used under close monitoring by a doctor.
(4) Side effects and risks
① Uterine bleeding: Abnormal bleeding during medication should be investigated to see if there is any medication error. Ultrasound examination of the endometrium should be performed and endometrial lesions should be scraped out if necessary.
② Side effects of estrogen: Excessive doses of estrogen may cause breast tenderness, excessive vaginal discharge, headache, edema, pigmentation, etc. Reducing the dose may reduce its side effects; or changing the type of estrogen may reduce its side effects.
③Side effects of progesterone: depression, irritability, breast tenderness and edema. A very small number of patients may even be intolerant to progesterone.
④ Androgens: There is a risk of hyperlipidemia, atherosclerosis, and thromboembolic diseases. Large-scale use may cause weight gain, hirsutism, and acne. Oral administration may affect liver function.
2. Sedatives
If you have sleep disorders that affect your quality of life, you can choose to take estazolam, alprazolam, etc. before bedtime.
3. Selective serotonin reuptake inhibitors
Such as venlafaxine and paroxetine hydrochloride, which can effectively improve vasomotor symptoms and neuropsychiatric symptoms.
4. Calcium supplements
Taking amino acid chelated calcium capsules orally daily can slow down bone loss.
5. Vitamin D
It is suitable for women who lack outdoor activities. Taking it together with calcium supplements is beneficial to the complete absorption of calcium.
Related drugs
Estradiol valerate, conjugated estrogens, 17β-estradiol transdermal patch, nialstradiol, medroxyprogesterone acetate, tibolone, estazolam, alprazolam, venlafaxine, paroxetine hydrochloride, amino acid chelated calcium, vitamin D
Surgery
Surgery is usually not required.
Psychotherapy
Natural menopause is a natural physiological process. Patients should adapt to this change with a positive attitude. Psychological therapy is an important part of menopausal treatment.
Treatment cycle
The treatment cycle may vary from person to person due to factors such as the severity of the disease, treatment plan, timing of treatment, age and physical condition.
Treatment costs
The specific costs depend on the selected hospital, individual treatment plan, medical insurance policy, etc.
Prognosis
General Prognosis
The prognosis of this disease is generally good, and the symptoms can be controlled after treatment.
Hazards
If the symptoms are not controlled, it may have an adverse effect on the patient’s daily life; it may also make fractures more likely to occur due to osteoporosis.
Curative
With active and effective treatment, symptoms can usually be controlled.
Cure rate
There is no research with large sample data.
daily
Overview
Patients can alleviate clinical symptoms and help recover from the disease by exercising regularly, eating a balanced diet, quitting smoking and limiting alcohol, and maintaining a happy spirit in their daily lives. Adverse reactions of the drug should be monitored during medication, and those who find abnormalities should seek medical attention in a timely manner.
Psychological care
A happy spirit is the core of health and can enhance the body’s resistance. Patients should maintain an optimistic and open-minded mood, establish new concepts of self-confidence, self-reliance, and self-improvement, and maintain a young mentality. They can appropriately increase social activities and cultivate hobbies, such as learning painting, calligraphy, and chess, to cultivate their sentiments.
Medication care
Patients should pay attention to whether they have symptoms such as vaginal bleeding, breast tenderness, nausea, vomiting, etc. during the medication process. If any abnormalities occur, they should return for a follow-up visit in time so that the doctor can adjust the medication according to the specific situation.
Life Management
1. Long-term appropriate physical activities, such as walking, jogging, Tai Chi, etc., can enhance lung function, improve lipid metabolism, alleviate symptoms to a certain extent, prevent osteoporosis and enhance immunity.
2. Ensure adequate sleep and avoid consuming caffeinated beverages.
3. Learning and practicing relaxation techniques, such as deep breathing, massage, and progressive muscle relaxation, can help relieve symptoms.
4. Quit smoking and avoid inhaling secondhand smoke.
Follow-up consultation instructions
After taking the medicine for 1 month, 3 months and 6 months, you should go to the hospital for a follow-up examination so that the doctor can evaluate the treatment effect. After taking the medicine for 1 year and at least once a year thereafter, you should have a follow-up examination. If the bone density is normal before treatment, you should have a check-up every 2 to 3 years.
diet
Diet
A scientific and reasonable diet can ensure the normal functioning of the body, assist in controlling the disease, maintain the treatment effect, and promote recovery from the disease.
Dietary advice
1. Eating more foods rich in calcium and vitamins, low in salt and with appropriate amounts of protein can help prevent and treat osteoporosis.
2. Ensure food diversity, mainly whole grains, less oil, a combination of coarse and fine foods, eat more fresh vegetables and fruits, a light diet with less salt, appropriate hunger and fullness, and three meals a day.
Dietary taboos
Try to avoid eating spicy and irritating foods.
prevention
Precautions
There is currently no effective measure to delay the onset of natural menopause, but related symptoms can be alleviated or reduced by strengthening self-care or seeking help from a doctor.
Medical Guide
Outpatient Indications
1. Menstruation stops or becomes irregular;
2. Frequent hot flashes and excessive sweating;
3. Feeling irritable, angry, and having memory loss;
4. Dryness or itching of the vulva and vagina, difficulty or pain in sexual intercourse, and low libido;
5. Other severe, persistent or progressive symptoms and signs occur.
All of the above require prompt medical consultation.
Department
The patient first considers visiting a gynecologist.
Medical preparation
1. Make an appointment in advance and bring your ID card, medical insurance card, medical card, etc.
2. A pelvic ultrasound examination may be required, and you can hold your urine in advance.
3. Blood tests may be performed, and it is best to have the visit in the morning on an empty stomach.
4. If you have had medical treatment recently, please bring relevant medical records, examination reports, test results, etc.
5. If you have taken some medicine to relieve symptoms recently, you can carry the medicine box.
6. Family members can be arranged to accompany the patient to seek medical treatment.
7. Patients can prepare a list of questions they want to ask in advance.
Questions your doctor may ask
1. What discomforts do you currently have?
2. When was your last menstrual period?
3. Is your menstrual cycle regular?
4. How long have you been experiencing this condition?
5. Are your symptoms persistent or intermittent? Is there any pattern?
6. Have your symptoms gotten worse or better since you became ill? Is there any reason for this?
7. Have you ever had similar symptoms before?
8. Have you ever been treated before? How was it treated? What was the effect?
9. Is there any history of hysterectomy or ovarian removal?
10. Do you have a history of cardiovascular disease or cancer?
11. Are you taking any medication?
12. Do you smoke? How long have you been smoking? How many cigarettes do you smoke on average per day?
Questions Patients Can Ask
1. Is my condition serious? Can it be cured?
2. Why does this happen to me?
3. How should I be treated? Do I need to be hospitalized? How long will it take to recover?
4. Are there any risks with these treatments?
5. If you take medication, what are the usage, dosage, and precautions?
6. What tests do I need to take? Are they covered by medical insurance?
7. I have other diseases. Will this affect my treatment?
8. How should I take care of myself after returning home?
9. Do I need follow-up examinations? How often?