Menopause

Introduction to menopause Menopause refers to a decline in ovarian function and menstruation. Menopause can be divided into natural menopause and artificial menopause. Natural menopause refers to the exhaustion of follicles in the ovary, or the remaining follicles lose their response to gonadotropins. Follicles no longer develop and secrete estrogen, and can not stimulate endometrial growth, leading to menopause. Artificial menopause refers to surgical removal of bilateral ovaries or other methods to stop ovarian function, such as radiation therapy and chemotherapy. Individuals who have had their uterus removed while retaining one or both ovaries are not artificial menopause. A series of syndromes with autonomic nervous system dysfunction and neuropsychological symptoms caused by fluctuations or reductions in sex hormones before and after menopause in women are called peri-menopausal syndrome or menopausal syndrome. basic knowledge Probability ratio: 15% of specific population Susceptible people: women Mode of infection: non-infectious Complications: postmenopausal osteoporosis

Menopausal cause

Age of menopause (10%):

The age of menopause reflects the reproductive life of the ovary. Cell aging is the result of menopause. The factors affecting the age of menopause are genetics, nutrition, fat and thin, altitude in the living area, and smoking.

The impact of genetic factors on postmenopausal women (5%):

The DNA sequence and its variation of the human body reflect the evolutionary process of human beings. Studying the DNA sequence variations (polymorphisms) of different populations and different individuals can help to understand the physiological changes of human beings, the occurrence and development of diseases, and The response to medication.

DNA carrying human genetic information is composed of four different bases. The human genome has about 3.3 billion base pairs. Currently, their order has been basically determined. The order of bases in different human genomes is absolutely large. Most of them are identical, but there are also very small differences, mainly in the base arrangement of DNA at different positions. This genetic variation is called single nucleotide polymorphism (SNP) in the human genome. There are about 10 million SNPs. Different people have different susceptibility to the same disease. Sometimes they will react differently to the same drug, which is related to the difference of SNP. Similarly, SNP also affects to different extents. Differences in the various physiological conditions and diseases of postmenopausal women.

Polymorphisms in many genes are associated with menopause time and the onset of certain diseases after menopause.

Premature menopause, often accompanied by decreased levels of estrogen, has an important impact on postmenopausal health, early menopause, is a high risk factor for cardiovascular disease, osteoporosis and ovarian tumors, and Increasing mortality, so from a clinical point of view, it is important to determine the factors that influence the age of menopause.

A growing number of studies have found that polymorphisms in certain genes are associated with the development of menopausal and postmenopausal diseases.

(1) Estrogen receptor (ER) gene polymorphism:

1 Structure and function of the estrogen receptor (ER).

2 ER gene polymorphism.

The relationship between 3ER gene polymorphism and menopause.

Relationship between 4ER gene polymorphism and postmenopausal bone mineral density.

5ER gene polymorphism and postmenopausal hormone replacement therapy (HRT).

Women who are treated with HRT after menopause have an effect on the dose-effect of HRT because their ER gene polymorphism affects the level of high-density lipoprotein (HDL).

In summary, estrogen receptor gene polymorphism affects menopausal time and bone metabolism from different levels and plays a role in HRT treatment. If clinicians detect ER genotypes to predict the risk of postmenopausal osteoporosis And the response to HRT treatment will play an important role in the early prevention of osteoporosis and the development of HRT personalized treatment options.

(2) Vitamin D receptor gene polymorphism:

1 structure and function of vitamin D receptors.

Polymorphism of the 2VDR gene.

The relationship between 3VDR polymorphism and postmenopausal bone mineral density and osteoporosis.

(3) Other gene polymorphisms:

1 calcitonin receptor (CTR) gene polymorphism.

2 type I collagen (COLIAI) gene polymorphism: COLIAI is associated with bone mass and osteoporotic fracture.

3 Interleukin-6 (IL-6) gene polymorphism.

4 Transferring growth factor beta gene transfer growth factor beta (TGF-) gene polymorphism.

5CYP 17 and CYP19 genes.

(4) Detection of gene polymorphism: The study of gene polymorphism is inseparable from the detection of gene polymorphism sites.

1 Restriction fragment length polymorphism (RFLP).

2 short tandem repeats.

3 amplified fragment length polymorphism.

4 single-strand conformation polymorphism (SSCP).

5 gene chip and SNP map.

Ovarian aging (40%):

(1) Decreased follicles and morphological changes of ovary: There are about 700,000 to 2 million follicles in the ovaries at birth, and about 400,000 in puberty. There may be a small number of follicles remaining in menopause, and two pathways lead to follicular reduction: ovulation and atresia From puberty to menopause, only 400 follicles can mature and ovulate, and most follicles are naturally locked. The mechanism is still unknown, whether it is due to apoptosis, remains to be studied.

(2) Decline of ovarian function:

1 Reproductive function: Women's fertility begins to decline at 30 to 35 years old, and decreases significantly when they are close to 40 years old. From regular menstruation to menopause, they usually go through an irregular menstrual period. During this period, the follicles mature irregularly, with ovulation or anovulation. The cycle is normal, long, short or completely unpredictable. Therefore, the length of the cycle and its changes can also be used to reflect ovarian function. When there is no follicular development, menopause, reproductive function is terminated.

2 Endocrine function: At the same time of ovarian reproductive function decline, endocrine function also declines, manifested as the synthesis and secretion of sex hormones in follicular development, mainly female, progesterone changes, first of all, the decline of progesterone, about 40 years old, follicular development Insufficient degree, may be the relative deficiency of progesterone (P), increased degree of insufficient follicular development, can lead to anovulation, absolute deficiency of progesterone, followed by hypoplasia, hypoplasia, production and secretion The total amount of estrogen, mainly E2 (estradiol) is gradually reduced; in the menopausal transition period, E2 may not be lacking in follicular development due to lack of ovulation, and if the number of follicles is high, the degree is high. Or persistence, E2 is even relatively excessive, postmenopausal follicles are not developed, and basically no E2 is produced. Under the action of increased Gn, interstitial secretion of testosterone (T) increases, and another type of hormone-peptide hormone secreted by the ovary, such as inhibition. The inhibitor gradually decreases, and its decline precedes E2.

Atrophic changes in the reproductive tract (25%):

The vulva loses most of its collagen, fat and ability to retain water, glandular atrophy, reduced secretion, reduced sebum secretion, thinned skin, dry, cracked, shortened vagina, narrowed, reduced wrinkles, thinned walls, weakened elasticity Reduced secretion, early congestive changes, brittle and vulnerable to bleeding and bleeding, diffuse or scattered in the ecchymosis, late color pale, increased adhesions.

Pathogenesis

Ovarian aging is a relatively complex biological process. Ovaries are part of the body. Neuroendocrine changes may be the main cause of ovarian aging. When most of the body's endocrine function changes only slightly and slowly, ovarian function declines rapidly. The aging, the most fundamental characteristic of perimenopausal period is the aging of the ovary. It is widely believed that the cause of ovarian aging is egg consumption, that is, the number of follicles in the ovary determines the age of menopause, and the mechanism of ovarian aging in the past 10 years. With continuous development, there is evidence that the content of free radicals in the body is closely related to aging. Free radicals react with other substances in the body (such as proteins, lipids, nucleic acids, etc.) to form oxides or peroxides of such substances. Damage to the body causes death of the organism, and there is an antioxidant enzyme system in the organism. These enzymes have scavenging to prevent the formation and accumulation of free radicals to protect cells from toxicity. Animal experiments have shown that the activity of antioxidant enzymes has decreased. Increased oxygen free radical content can cause luteal dissolution and progesterone production Oxygen free radicals can also cause follicular atresia. Qkatani et al. measured the antioxidant activity of oxidative enzymes in the peri-menopausal ovarian homogenate with increasing age. The mitochondria are the central source of cellular energy, in the mitochondrial inner membrane. In the matrix, there are two to three mitochondrial DNA (mtDNA) fragments, that is, there are thousands of mtDNA in the same cell. The oxidative phosphorylation of mitochondria is weakened with age, and Suganuma et al found a peri-menopausal period by PCR gene amplification. Deletion of ovary mtDNA, and it is believed that ovarian mtDNA mutations are closely related to dysfunction caused by aging of ovary, and the accumulation of mtDNA deletion and the reduction of mtDNA-encoded protein synthesis products may affect ovarian function.

The aging autoimmune system believes that aging is not a passive process of cell death and shedding, but the most active process of self-destruction. As the detection rate of aging autoantibodies increases, the ovary is part of the body and its aging is also The aging of the body is the same. Immunofluorescence can be used to detect anti-ovarian antibodies in the serum of patients with premature ovarian failure. Immunoglobulin and complement C3 are present in the ovary, which confirms the relationship between premature ovarian failure and autoimmunity, and whether normal ovarian aging is also related to itself. Immunity-related, in general, the mechanism of ovarian aging is likely to be the result of a combination of multiple factors.

1. Anatomical changes: The follicles in the ovary begin to develop and degenerate from 7 months after the fetus, and the number of follicles in childhood is greatly reduced. During the growth period, some follicles are lost in each menstrual cycle, and a large number of follicles lose their function due to atresia. The number of follicles is 400,000 to 500,000. The number of follicles at the age of 30 begins to decrease, and the number of follicles at the age of 35 begins to decrease. At 40 years old, there are only 10,000 to 20,000. At the age of 50, the follicles basically disappear, and women only have about 400 in their lifetime. The follicles develop to ovulation, and more than 90% of the primordial follicles are locked, the oocytes are aging and necrotic, and finally the phagocytic cells are cleared, the granule cell layer is decomposed, the cell steatosis is collapsed, the follicles collapse, and the follicular membrane invades the follicles and finally fibrosis. After the menopause, the number of follicles gradually decreased, and the weight of the ovary gradually decreased. The maximum average weight of the ovary at the age of 20 was 10 g. The ovary weight decreased from the age of 30, and the 40-year-old age was less than the peak of 1/3, 60 years old. The segment is less than 1/2 of the age of 20.

The follicles and functional corpus luteum that can develop into gametes in the premenopausal period gradually disappear, becoming the white body of the atresia follicles, hardening of the arteries, decreased blood circulation, and fibrous tissue formation.

The number of follicles after menopause is more reduced, but there are still a small number of primordial follicles and follicles of varying sizes at different stages of atresia.

After the disappearance of follicles in the late menopause, the ovarian interstitial becomes a part of the sex hormone production, and the cells in the cortex are continuously increased. When the cortical cell layer exceeds 1 mm, it can be called cortical interstitial proliferation. At this time, the activity of the cortical interstitial cell enzyme persists. Even increased, and there is cholesterol deposition, the medulla is also relatively increased, and the portal cells become more prominent after menopause.

After the menopause, the vascular wall of the ovarian and medulla is thickened, the lumen becomes narrower and becomes more sclerotic, and there is a glassy change, so that it is completely occluded.

2, peri-menopausal sex hormone changes: With the increase of age, women's aging changes first manifested as the decline of ovarian tissue, followed by a gradual decline in function, the emergence of follicular maturation, sensitivity to gonadotropins, Estrogen levels drop sharply, and even can not ovulate, ovarian function begins to decline in 35 to 40 years old, follicle growth hormone (FSH) secretion is increased, luteinizing hormone can still maintain normal levels, but due to the body's own stable function to the ovaries - The regulation of the pituitary axis, sometimes FSH can be restored to normal levels, the ovary can still have irregular ovulation cycle after several periods of high gonadotropin level anovulatory cycle, still possible to conceive, with ovarian tissue The gradual decline is gradually approaching the menopause. When the ovary no longer undergoes follicular maturation, the levels of estrogen and progesterone in the blood are significantly reduced, and the balance between the hypothalamic-pituitary-ovarian axis is changed. The feedback inhibition of the pituitary by estrogen The effect is weakened, and the FSH is increased again, and the LH is subsequently increased, although the follicle continues to grow.

(1) Gonadotropin-releasing hormone: GnRH is released in a pulsed manner in women during the growth period. After menopause, the level of LHRH is as high as that of LH, and it is also periodically released. At this time, the LH level is higher, but if given By intravenous injection of GnRH, the levels of FSH and LH in the blood can still be elevated, indicating that the hypothalamic and pituitary still maintain a certain function after menopause.

(2) Gonadotropin: FSH begins to appear in about 10 years before menopause, and LH levels are still normal. When the follicles in the ovary gradually no longer mature, the FSH rises again and LH rises. The level of estrogen was significantly reduced. When FSH>100mU/ml, the concentration of LH increased, and FSH/LH>1, indicating follicular failure.

When menopause is 2 to 3 years, FSH and LH can reach the highest level, FSH level is about 13 to 14 times of normal early follicular phase, LH is about 3 times, lasting for 5 to 10 years and then starting to decline again, 20 ~ It will also remain above the childbearing age after 30 years.

(3) Estrogen: The total amount of urinary estrogen in the menstrual cycle varies greatly, with an average of 13-56 g/24 h and an individual value of 4-150 g/24 h.

There is a large individual difference in estrogen secretion in premenopausal women. Estrogen remains at or below normal levels, but there is no longer a change in the normal cycle. The relative ratios of the three major estrogens are unchanged.

Before the menopause, 90% of estradiol (E2) and 50% of estrone (E0) are mainly from the ovary, and the rest are converted to estrone by the androstenedione in other tissues outside the ovary, and androstenedione is derived from the ovary and adrenal gland.

Shortly after menopause, estrogen secretion also showed a large individual difference, but at this time estrogen replaced the cyclical changes with a relatively stable low level.

The average level of estrone is (107 ± 7) pmol [(29 ± 2) pg / ml], estradiol is (48 ± 4) pmol [(13 ± 1) pg / ml], the total amount of estrogen is equivalent 1/2 of the early follicular phase of the menstrual cycle is 1/10 of the late follicular phase, which is maintained for about 10 years.

The estrogen content in the blood circulation of postmenopausal women is mainly estrone (E1), and its biological effect is only 1/3 of that of estradiol (E2). Most estrone is from androstenedione (mainly in adipose tissue). Peripheral conversion, this conversion, with age and obesity increased, a small part of estrone derived from the ovarian cortex interstitial increased response to elevated levels of gonadotropin, resulting in a small amount of androstenedione.

Peri-menopausal ovarian function changes are also reflected in the vaginal smear cell changes, early good estrogen effects can be seen significantly increased in the middle and superficial cells, vaginal smear proliferation period changes, when the ovarian function further decline, can appear In the middle and bottom cells, the presence of superficial cells indicates the presence of estrogen. For example, expressed by the maturity index, the maturity index is 0-40-60 before the menstruation in normal ovulation (bottom-middle-skin), menopause. Shortly afterwards, it is 5-70-15, and 25-56-0 after menopause for more than 30 years. There are individual differences in the content of estrogen in postmenopausal, and some still have a certain amount of estrogen after menopause for a good time. The proliferative phase affects, but some can see obvious atrophic changes soon after menopause.

(4) Progesterone: Postmenopausal women discharge trace amounts of progesterone, which is 0.9-2.8mmol/24h (0.3-0.9mg/24h). Most scholars believe that it is a metabolite of progesterone or other steroids secreted by the adrenal gland.

(5) Androgen: Androgen in women of childbearing age is androstenedione, which decreases slowly during peri-menopause, from 1500pg/ml before menopause to 800-900pg/ml after menopause, and ovary provides about 20%. Androstenedione, the remainder is produced by the adrenal gland. The postmenopausal ovarian stromal and portal cell regions still secrete a significant amount of androstenedione, but the peripheral plasma androgen are mainly derived from the adrenal cortex. These androstenediones may be external. Weekly conversion to estrone is the main source of postmenopausal estrogen.

(6) Prolactin: The decrease of prolactin after menopause is parallel with the decrease of estrogen. If the amount of estrogen taken after menopause is small, it can eliminate the symptoms such as hot flashes, but does not cause prolactin to increase.

Menopause prevention

In order to improve the quality of life of women, menopause health promotion and guidance according to different situations, including the following aspects: introduction of menopausal physiology, causes, changes in the body before and after menopause, in order to eliminate their fear of menopause And prepare for the changes that will occur; introduce methods to reduce symptoms before and after menopause, and measures to prevent postmenopausal diseases, for example, the significance and methods of supplementing sex hormones, trade-offs between advantages and disadvantages, post-menopausal women insist on exercise and make up for calcium The importance of the quantity, the correct treatment of sexual life, etc., doctors should provide services for perimenopausal and postmenopausal women on the basis of fully understanding the physiological and pathological changes after menopause and postmenopausal and the principles of disease prevention and treatment.

1. Menopausal proper aerobic exercise, strength training and flexibility training. With the increase of age, menopausal women's cardiovascular function, muscle strength and flexibility are reduced, aerobic training, also called patient training can mobilize large Most muscles carry out continuous, rhythmic movements, and their forms of exercise are worth promoting, such as walking, swimming, cycling, boating, skipping, skating, skiing, etc. Each exercise should last for 15 to 60 minutes. Reasonable exercise should include : 5 ~ 10min warm-up exercise; 10 ~ 60min of aerobic exercise, exercise intensity of 3 ~ 6 metabolic equivalent (motor metabolic rate / resting metabolic rate) or heart rate to reach the maximum heart rate of 60% ~ 90%; 5 ~ 10min Relaxation exercise, aerobic exercise can enhance heart and lung function, increase heart stroke volume and output per minute, decrease heart rate, reduce oxygen consumption, and increase aerobic exercise while lowering very low density lipoprotein Density lipoprotein, serum HDL-CH has the effect of limiting the uptake and accumulation of cholesterol by cells of arterial smooth muscle; it also promotes the deposition of deposited cholesterol out of the arterial wall and competitive inhibition of LDL receptors. Protecting peripheral blood vessels from lipid attack, long-term regular exercise can cause elevated serum HDL-CH, which may be due to increased lipoprotein lipase activity in muscle and adipose tissue during exercise. LDL-CH has a significant atherogenic effect caused by the transfer of cholesterol and phospholipids to HDL-CH, while HDL-CH antagonizes LDL-CH, prevents the formation and development of AS, and improves HDL by exercise. The ratio of -CH in serum TC can thus reduce the risk of atherosclerosis and coronary heart disease.

Appropriate physical exercise can not only reduce blood viscosity and erythrocyte aggregation, but also promote the establishment of collaterals, thereby improving organ perfusion and slowing blood pressure. The proper amount of exercise can lower plasma catecholamine levels and prostaglandin E (both expansion) Increased levels of renal blood vessels and diuretic effects reduce sympathetic activity, peripheral blood vessels dilate and cause blood pressure to drop. In addition, moderate exercise can reduce the weight of obese hypertensive patients and lower blood pressure.

2, menopausal nutrition

(1) Nutritional needs for perimenopausal: At present, the reference intake of dietary nutrients for Chinese residents proposed by the Chinese Nutrition Society in 2000 is mainly used. It is recommended that recommended daily dietary nutrient reference intake is recommended. Nutritional needs should be taken from a normal and reasonable diet, rather than relying on supplements of various nutrients.

(2) Correct nutrition concept:

1 control weight: weight gain, fat deposition in the abdomen, waist and hips, back shoulders, arms, breasts, etc., not only increase the burden on the heart, but also susceptible to arteriosclerosis, coronary heart disease, osteoporosis and other diseases.

Body mass index (BMI) can usually be used to evaluate body weight, BMI = body weight (kg) / height (m2), normal body weight range BMI value is 18.5-25, less than 18.5 is low weight, 25 to 29.9 is overweight, More than 30 for obesity, pay attention to the choice of food, should eat more lean meat, milk, vegetables, fruits and cereals, eat less fat and other foods with high fat content, the total intake of food for three meals a day should also be controlled, to prevent Hunger, can eat foods with high cellulose content, but should pay attention to ensure that the intake of protein, vitamins and minerals reaches the level of reference intake to meet the normal physiological needs of the body, if necessary, the amount of vitamins and minerals Formulations are required.

2 Prevention of osteoporosis: From a nutritional point of view, diet patterns can affect bone density, research suggests that calcium supplementation in food, eating vegetables, fruits and cereals, quitting smoking, reducing oral steroids can help Prevention of osteoporosis, there are phenomena that dieting, lack of sun exposure and lack of exercise are important factors in women's osteoporosis in large cities and developed areas. Some people blindly dieting to lose weight will cause calcium deficiency. In order to maintain the skin, excessive avoidance of the sun, causing a lack of vitamin D, and lack of exercise leads to increased bone loss.

Studies have shown that supplementation of calcium and vitamin D is an effective way to prevent osteoporosis. In China, it is recommended that adults take 800 mg of calcium per day. For menopausal women to prevent osteoporosis, daily calcium intake is 50. 800mg before age, 1000mg after 50 years old, the demand for vitamin D is 5g before 50 years old, and 10g after 50 years old.

Women can be supplemented by eating calcium-rich foods, drinking milk and taking calcium supplements.

Calcium supplements are also very effective. There are many kinds of commercially available calcium supplements, such as calcium citrate and calcium carbonate, calcium lactate, calcium phosphate, etc. It should be noted that the weight of the tablet is not equal to The amount of calcium must be noted when taking it. In addition, there are some natural calcium preparations, such as bone powder, which are called natural calcium supplements. However, it has been reported that natural products contain other harmful substances such as lead. Or other heavy metals, so the choice of calcium preparations must pay great attention to the quality of the product.

In addition, when supplementing calcium, attention should be paid to the composition of the diet, because there are absorption components that affect calcium in the diet. Some vegetables (such as spinach, leeks, bamboo shoots, etc.) contain more oxalic acid, and they can combine with calcium to form salts that are difficult to absorb. Excessive dietary fiber also interferes with the absorption of calcium. Excessive fat can cause fatty soap and calcium to form calcium soap, which also affects the absorption of calcium. Such foods should not be excessive in dietary composition.

Soy isoflavones are phytoestrogens with estrogen activity similar to estrogen, so increasing soybean intake will help reduce menopausal syndrome.

3. Prevention and treatment of sexual dysfunction in menopausal and postmenopausal women:

(1) Sexual life is an integral part of the life activities of middle-aged and elderly women: human health, not only physical health and mental health, but also sexual health. Middle-aged and elderly women must eliminate all kinds of prejudices and misconceptions about sexual life, sexual life. It is a component of the life activities of middle-aged and elderly women and can alleviate the aging rate of various systems.

(2) topical treatment: due to the decline of sex hormone levels, middle-aged and elderly women vaginal dryness, and vaginal secretions during sexual intercourse also decreased; perimenopausal women, especially women after menopause for many years, there are senile vaginitis, and some vulva, The vaginal mucosa is also congested and even damaged, causing pain in sexual intercourse and failure of sexual intercourse. In this case, local medication is effective, and commonly used drugs:

1 human disinfectant lubricant: has a lubricating and anti-inflammatory effect, can be used for both male and female genitalia, can also be injected into the female vagina.

2 times conjugated estrogens vaginal cream: contains 14g, contains 0.625mg combined estrogen per gram, commonly recommended dose, 0.5 ~ 2g / d, intravaginal administration, the highest dose is 2g, injected with plastic applicator The vagina can also be applied to the vulva and vaginal opening with a cotton swab.

3 ovestin estriol cream: containing 15g, containing 1mg of estriol per gram of ointment, usage: 1 time / d at the beginning, then reduced, 2 times a week, 0.5g each time, pushed by the applicator vaginal.

4 Estreol suppositories estriol suppository: 7 capsules per box, 1 capsule each time (containing 0.5 mg of estriol).

(3) Sex hormone supplementation therapy: estrogen is the material basis for maintaining normal sexual function. Androgen is closely related to female sexual initiation. Clinical use of sex hormone supplementation therapy can improve and treat sexual dysfunction in perimenopausal and postmenopausal women. Commonly used drugs:

1 Weinian: Long-acting estriol, there are three kinds of tablets, respectively 1mg, 2mg, 5mg, usage: 2 ~ 5mg per month, once every 2 weeks, 1 ~ 2mg each time, there is a uterus Women add progesterone every 3 months, commonly used medroxyprogesterone (Angong progesterone), 6 ~ 8mg / d, and even served for 10 to 14 days.

2 Tianda Gevrine Capsule: Each capsule contains 0.0025mg of ethinyl estradiol, 0.625mg of methyltestosterone, and trace elements and calcium, once/d, 1~2 capsules each time. Add progesterone for 3 months.

3 Livial: 2.5mg per tablet, 1 tablet per day or every other day, even for 28 days or continuous use, its metabolites have female, pregnant, androgenic effects, suitable for women after 1 year of menopause.

4 Kliogest: Each tablet contains 17-E2 2mg and norethisterone acetate 1mg, 1 tablet / d, even for 28 days or continuous, suitable for postmenopausal women.

5 grams of Climen: calendar-style packaging, each plate contains 11 tablets of estradiol valerate (each containing 2 mg of estradiol valerate tablets) and 10 tablets of estradiol valerate combined with cyproterone acetate Tablets (each containing 2 mg of estradiol valerate tablets and 1 mg of cyproterone acetate), starting from the beginning of the label ("start"), taken in the direction of the arrow, 1 tablet / d, until 21 days The tablets should be taken with water and taken from the 5th day of the menstrual cycle.

6 estogel gel (Oestrogel estradiol), natural estradiol transdermal absorption agent, each 30g, each dose amp equivalent to 2.5g, containing estradiol 1.5mg, starting on the fifth day of menstruation, 1 Times / d, for 25 days, for 5 days, every morning or evening applied to the arms, shoulders, neck, abdomen and thighs, menopausal women use 1.25 ~ 2.5g / d each time, for 25 days, 5 days, On the 14th day of the cycle, the progesterone-Anchitan capsule (Vtrogestan) was added at 100-300 mg/d.

7 Oestrogel estradiol: Each film contains 5mg, 10mg17-E2 two preparations, release 25g, 50g 17-E2 to the body every day, 2 stickers per week, attached to the hip, hip, thigh, arm Etc., the same part can not be attached to 2 tablets, each treatment 7 to 8 stickers, stop for 2 to 7 days, there are uterine women in the second half of each course of treatment plus progesterone for 10 to 12 days.

Before using sex hormones, contraindications should be excluded. It is best to use estrogen and androgen-containing drugs. Regular monitoring should be carried out according to the patient's specific conditions during use.

(The above information is for reference only, ask the doctor for details)

Menopausal complications Complications Postmenopausal osteoporosis

1. Postmenopausal osteoporosis

Estrogen has an inhibitory effect on bone metabolism. Women's postmenopausal bone metabolism accelerates, bone resorption is dominant, bone loss occurs, and osteoporosis gradually develops. Postmenopausal osteoporosis is a very common senile disease, 60 years old. The prevalence rate of women can reach 25% to 50%, Chinese people are prone to suffer, and the main complication is fracture. The fracture rate of women aged 50-70 can be increased by 10 times compared with that of young women, thus reducing the quality of life and self-care ability. Even shortened life.

2, cardiovascular disease and blood lipid changes

Coronary heart disease occurs in men over 40 years old, but the incidence and mortality of women after menopause have increased significantly, close to or even more than men. In many countries, it has become the first cause of death for women. Yang Chaoyuan once was 60 years old in Beijing. The above 663 elderly people were followed up for 8 years and found to be the third leading cause of coronary heart disease.

Menopausal symptoms Common symptoms Menopause vaginal irregular bleeding fatigue emotional ups and downs of insomnia attention distraction dizziness palpitations depression

1, menstrual changes: menopause means termination of menstruation, but peri-menopausal often have menstrual cycle and menstrual changes, the performance of the menstrual cycle is shortened, with the reduction of follicular phase, no ovulation and increased menstrual flow, such as 26 ~ 40 The age of anovulatory menstruation is 3% to 7%, 41 to 50 years old is 12% to 15%, many people show a prolonged period, 2 to 3 months or longer, while menstruation and blood volume are normal, a few people show For menstrual loss of the cycle, irregular vaginal bleeding, increased menstrual flow, and even secondary anemia.

2, hot flashes and sweating: hot flashes are the most important and most specific symptoms of perimenopausal women, the incidence rate is 70% to 80%, 25% to 50% can last more than 5 years, manifested as bursts of fever, From the chest, from the head and neck, can spread to the whole body, followed by sudden sweating, accompanied by dizziness, palpitations, fatigue, lasting for tens of seconds to several minutes, the number of attacks from more than 20 times a day to weekly 1 to 2 times, some people have measured the skin temperature rise during the attack, and fell to normal after the attack, which may be related to the increase of blood flow velocity at the time of onset. There is no more clinical significance. Vasodilatation, but no blood pressure changes, hot flashes are often a sign of ovarian failure, many women have no disorder of menstruation, but there may be hot flashes, indicating a decline in ovarian function; there are also a few women without menstruation, hot flashes, menopause 10 It only appeared after 20 years; most of them are synchronized with menstrual changes, and their degree is also fluctuating.

3, mental and neurological symptoms: mainly manifested as emotional instability, temper irritability and can not control, after tempering, there are self-blame, nervousness, stubbornness, inattention, insomnia, headache, memory loss, neurasthenia, depression and other symptoms, Severe cases are like psychotic manifestations, which may be related to neurotransmitters such as serotonin and endorphin, as well as individual personality, occupation and cultural background. Sudden events in the family, such as death of relatives, divorce, retirement, If children leave home, they may aggravate the symptoms.

4, genitourinary atrophy: postmenopausal due to lack of estrogen, internal and external genital and bladder, urethra will shrink, vaginal folds flattened, epithelial atrophy and thinning, examination can be seen through the epithelium through the epithelium scattered red spots, easy to cause infection Therefore, senile vaginitis becomes a very common disease in postmenopausal women. The cervix and uterus are atrophied. It is often seen that the cervix is flattened and the ovary is atrophied and cannot be touched. Postmenopausal women should touch the ovary and should pay attention to the tumor. Atrophy of the urinary system often manifests as frequent urination, urgency and stress incontinence. Atrophy of the pelvic support tissue can cause uterine prolapse and anterior and posterior vaginal bulging. The genital atrophy can lead to sexual pain, and sexual life is difficult. Loss of sexual desire.

5, the second sexual characteristics changes: the mammary gland loses the cyclical action of estrogen and progesterone and gradually shrinks, and sagging, the skin loses the role of estrogen, epidermal cells mitosis is reduced and thin, loss of elasticity, wrinkles.

Menopause check

1. Determination of blood follicle estrogen (FSH).

2. Determination of luteinizing hormone (LH).

3. Determination of total estrogen (TE).

4. Determination of estrone (E).

5. Estradiol (E2).

6, T3 (total triiodothyronine), T4 (total amount of tetraiodothyronine) and TSH (thyroid stimulating hormone) determination, exclusion of endocrine and metabolic disorders, hyperthyroidism and other diseases.

7, total blood lipids, total cholesterol (Ch), triglyceride (TG), high-density lipoprotein-cholesterol (HDL-C) low-density lipoprotein-cholesterol (LDL-C) determination, to rule out fat metabolism disorders.

8. Perform a urine pregnancy test if necessary.

9, vaginal or pelvic B-ultrasound: understand the uterus, attachments, exclude gynecological organic diseases.

10, vaginal exfoliation cell examination: observe the cell morphology, can reflect the level of estrogen in the body.

11, X-ray photos: visible cortical bone thinning, increased cortical pores of the tubular bone, femoral neck and trabecular bone (vertebral body) specific trabecular bone structure loss, can suggest osteoporosis.

12. Quantitative measurement of bone mineral density (BMD): an important basis for reflecting the degree of osteoporosis and predicting the risk of fracture.

Menopausal diagnosis

Diagnostic criteria

1. Clinical diagnosis:

The diagnosis of natural menopause is based on the continuous menopause of menopausal women for one year to retrospectively judge, with or without peri-menopausal symptoms, most of which do not require auxiliary examination, artificial menopause is not difficult to diagnose by analyzing the causes of menopause .

For women with short menopause time, pelvic examination must be performed to understand the size of the uterus; if necessary, urine pregnancy test and B-ultrasound should be performed to exclude early pregnancy, because perimenopausal women will also have occasional ovulation and conceive, and should not be taken for granted. Menopause.

2, premature ovarian failure:

For women who are menopausal before the age of 40, they often need to rely on auxiliary examination to confirm the diagnosis. Generally, the blood FSH>40U/L is used as the diagnosis basis. In order to avoid the influence of FSH pulse secretion, the blood samples can be taken twice a day, and the E2 level is higher. Low, but there may be fluctuations in the early stage, for reference, LH rises, up to 40U/L after menopause, but its rise is slower than FSH, so FSH/LH>1.

Differential diagnosis

If LH is significantly elevated, FSH is normal or slightly higher, FSH/LH<1, then attention should be paid to secondary amenorrhea caused by polycystic ovary syndrome. This patient has higher androgen levels, E2 is early, medium follicle Stage level, but no cyclical fluctuations, prolactin levels in patients with premature ovarian failure are normal or slightly lower. If there is a significant increase, pituitary secretion of mastoid tumors should be considered. Patients with Shehan syndrome have low FSH, LH, and E2, and may With the dysfunction of other endocrine organs, hypothyroidism can also be secondary to amenorrhea, attention should be paid to the levels of T3, T4 and TSH in the blood.

Care should also be taken to rule out organic diseases or to determine if there are concurrent organic diseases, such as:

1. Hyperthyroidism: This disease can occur at any age. When the older one is onset, the symptoms are often atypical. For example, the thyroid is not swollen, the appetite is not hyperthy, the heart rate is not fast, and the state of excitement is not depressed. Suspicion, anxiety, etc., identification method: determination of thyroid function indicators, such as TSH is lower than normal, T4 is elevated, T3 is normal high or even normal, that is, should be diagnosed with hyperthyroidism.

2, coronary atherosclerotic heart disease: When patients with palpitations, arrhythmia and chest tightness symptoms, first consider CHD, the identification method is careful physical examination and electrocardiogram examination, when identification is difficult, estrogen test can be used.

3, hypertension or pheochromocytoma: when headache, blood pressure fluctuations or continuous high blood pressure should be considered, the identification method is repeated blood pressure and pheochromocytoma related examination, such as abdominal mass, squeeze Whether the blood pressure is elevated when the mass is pressed, whether there are headaches, palpitation, sweating and other symptoms, blood catecholamines, blood pressure changes associated with menopause are often mild.

4, neurasthenia: insomnia as the main manifestation, may be caused by neurasthenia, the identification method is mainly based on the history, that is, the time of insomnia and menstrual changes are related, for patients who are difficult to identify can also be used for experimental treatment or nerve Consultation.

5, mental illness: when the main symptoms of mental symptoms, a differential diagnosis is required.

6, other: vaginal inflammation as the main performance, the need to rule out fungal, trichomoniasis, or bacterial vaginal infection, pathogens can be determined, with frequent urination, urgency and dysuria as the main performance, need to exclude urinary tract infection.

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