Perimenopausal syndrome

Introduction to perimenopausal syndrome Peri-menopausal syndrome, also known as menopausal syndrome (MPS), refers to a series of syndromes characterized by autonomic nervous system dysfunction and neuropsychological symptoms caused by fluctuations or reductions in sex hormones before and after menopause. Menopause can be divided into natural menopause and artificial menopause. Natural menopause refers to the use of follicles in the ovary, or the remaining follicles lose their response to gonadotropins. Follicles no longer develop and secrete estrogen, which can not stimulate endometrial growth. menopause. Artificial menopause refers to surgical removal of bilateral ovaries or other methods to stop ovarian function, such as radiation therapy and chemotherapy. Separate removal of the uterus while retaining one or both ovaries, not as artificial menopause, to determine menopause, mainly based on clinical manifestations and hormone determination. Artificial menopause is more prone to intrinsic. The age of menopause is related to the number of follicles stored, follicle consumption, nutrition, area, environment, smoking, etc., but not related to education level, body shape, age of menarche, number of pregnancies, age of last pregnancy, long-term use of contraceptives. The use of contraceptives to suppress ovulation does not delay menopause, because the consumption of eggs does not depend mainly on ovulation, and a large number of follicles disappear through atresia. basic knowledge The proportion of illness: 0.36% Susceptible people: women Mode of infection: non-infectious Complications: insomnia headache vertigo genital itching painful senile vaginitis cystitis urethritis urinary incontinence uterine prolapse angina pectoris hypertension osteoporosis

The cause of perimenopausal syndrome

Ovarian failure (35%):

The underlying cause of climacteric syndrome is ovarian failure caused by physiology or pathology or surgery. Female characteristics and physiological functions are closely related to estrogen secreted by the ovaries. Once ovarian function is depleted or excised and destroyed Estrogen secreted by the ovaries will be significantly reduced. Modern medical research has found that there are more than 400 estrogen receptors in women's body. These receptors are distributed in almost all tissues and organs of the female body, receiving estrogen control and dominance. A decrease in the amount of estrogen secreted in the body causes a degenerative change in organs and tissues, and a series of symptoms appear.

Neurotransmitter levels are reduced (35%):

Related studies of neuroendocrine have shown that the hypothalamic neurotransmitter opioid peptide (EOP) adrenaline (NE) and dopamine (DA) are significantly associated with the occurrence of hot flashes, serotonin (5-HT) is endocrine, heart Vascular, emotional and sexual life have regulatory functions. It has been reported that autonomic dysfunction in patients with perimenopausal syndrome is associated with a significant decrease in 5-HT in the blood. Animal experiments further demonstrate that 5-HT levels in the hypothalamus are in ovariectomy. After a significant reduction, after estrogen can be significantly reversed, it is believed that the symptoms of dysfunction caused by perimenopausal syndrome may be related to the decrease of 5-HT with age. The study found that beta-endorphin in the blood of postmenopausal women The peptide (-EP) and its antibody were significantly lower than those in the reproductive stage, while the decrease in the -EP antibody indicated that the immune system regulates neuroendocrine function disorder and various neuropsychiatric symptoms occur.

Other factors (15%):

It has been reported that 11 pairs of twin sisters have the same start time of perimenopausal syndrome, and the symptoms and duration are also very similar. Individual personality characteristics, neurological type, cultural level, occupation, social interpersonal, family background, etc. are related to the onset and severity of perimenopausal syndrome. A large number of clinical data indicate that the personality is cheerful, the neurological type is stable, and the peri-menopause occurs in manual labor. Symptoms with less syndromes or milder symptoms, and symptoms disappear quickly, unsociable, unstable neurological types, mental depression or mental stimulation, high cultural level, women with superior social status and living conditions Heavier, indicating that the disease may be related to high-level neural activity.

Pathogenesis

The earliest change in perimenopause is the decline of ovarian function, followed by hypothalamic-pituitary function deterioration.

1. Estrogen: The earliest sign of ovarian function decline is the decreased sensitivity of follicles to gonadotropin (FSH); the resistance of follicles to gonadotropin stimulation is gradually increasing, and the early stage of menopause is characterized by large fluctuations in estrogen levels. Even higher than the normal follicular phase, due to excessive FSH stimulation on the excessive secretion of estradiol caused by excessive secretion of estradiol, the whole menopausal transitional estrogen does not gradually decline, but when follicular growth and development cease, estrogen The level of decline is low. After menopause, the ovarian secretion of estrogen is very rare. The low level of estrogen in women is mainly caused by the estrone transformed from the adrenal cortex and the retinoic acid from the ovary through the aromatase in the surrounding tissue. Muscle and fat, liver, kidney, brain and other tissues can also promote transformation, and estrone is also transformed with estradiol in surrounding tissues, but in contrast to women in growth, estrone is higher than estradiol.

2. Progesterone: During the menopausal transition period, the ovary still has ovulation function, so there is still progesterone secretion, but because the follicle development time is long, the luteal function is incomplete, the amount of progesterone is reduced, and the ovary is no longer secreted by progesterone after menopause. Progesterone may be from the adrenal gland.

3. Androgen: The androgen produced by the ovaries is testosterone and androstenedione. Before menopause, 50% of androstenedione and 25% of testosterone in the blood are from the ovary; postmenopausal androstenedione production is about premenopausal. Half of them, 85% from the adrenal gland, 15% from the ovarian interstitial cells, postmenopausal ovary mainly produces testosterone, and the amount increased compared with premenopausal, due to a large number of gonadotropin stimulation of ovarian mesenchymal cells.

Due to the significant decrease in estrogen after menopause, the ratio of androgen to estrogen in the circulation is significantly increased; the reduction of sex hormone binding protein increases the free androgen, and some women appear mildly hairy after menopause.

4. Gonadotropin: Women who still have ovulation during menopausal transition, their FSH increases in most cycles, while LH is still in the normal range, but FSH/LH is still less than 1. After menopause, FSH and LH are significantly increased, FSH The increase is more significant, FSH/LH>1. In 1 year of natural menopause, FSH can increase by 13 times, while LH only rises by 3 times. Within 2 to 3 years of menopause, FSH/LH reaches the highest level, and then gradually decreases with age. .

5. Gonadotropin-releasing hormone (GnRH): Increased secretion of peri-menopausal GnRH and parallel to LH.

6. Inhibin: The concentration of blood inhibin in postmenopausal women is decreased, which is earlier and more obvious than that of estradiol, which may be a more sensitive marker reflecting the decline of ovarian function. Inhibin has feedback to inhibit the synthesis and secretion of FSH by pituitary and inhibits GnRH against itself. The upregulation of the receptor, so that the concentration of statin is negatively correlated with the level of FSH, the postmenopausal follicle statin is extremely low, and the FSH is elevated.

Perimenopausal syndrome prevention

1. Health care providers should educate and educate menopausal women about health care knowledge, help them acquire the necessary scientific knowledge, eliminate fears and doubts, and treat menopause with optimism and positive attitude.

2. For the families of menopausal women, mainly their husbands should also publicize health care knowledge to help them understand the symptoms of women's menopause. In the event of certain neurological disorders, care and comfort should be given. Encourage and sympathize.

3. Menopausal women should have a physical examination from half a year to one year, including gynecological examinations and anti-cancer examinations, and selective endocrine examinations. Health care providers should provide quality counseling services to menopausal women to help them prevent menopausal syndrome. Occur, or relieve symptoms, shorten the course of the disease.

4. Patients undergoing bilateral oophorectomy before menopause should be supplemented with estrogen at the appropriate time.

Perimenopausal syndrome complications Complications Insomnia, headache, vertigo, genital itching, sympathetic pain, senile vaginitis, cystitis, urethritis, urinary incontinence, uterine prolapse, angina, hypertension, osteoporosis

1. Symptoms of autonomic nervous system dysfunction with neuropsychological symptoms

Psychotic symptoms: The clinical features are the first episode of perimenopausal, mostly accompanied by sexual decline, and there are two types:

(1) Excitatory type: manifested as emotional irritability, irritability, insomnia, headache, inattention, multi-lingual, loud crying and other neurotic symptoms.

(2) Depression: irritability, anxiety, inner uneasiness, even panic and fear, memory loss, lack of self-confidence, slowness of action, severe coldness to the outside world, loss of emotional response, and even development of severe depressive neurosis, according to statistical menopause The incidence of neuropsychiatric symptoms in women is 58%, including 78% depression, 65% apathy, 72% aversion, 52% insomnia, about one-third of headaches, head tightness, occipital and neck pain to the back. Radiation, there are also people with abnormal feelings, common floating, rising vertigo, skin scratches, itching and ants walking, throat foreign body obstruction (commonly known as plum nuclear gas).

2. Genitourinary symptoms

(1) vulva and vaginal atrophy: when the vulva and vaginal atrophy, the skin of the vulva is gradually thinner, the subcutaneous fat is reduced, the pubic hair on the haze is scarce, and the vaginal epithelial cells gradually shrink with the decrease of estrogen, and the epidermal cells contain The cells of glycogen disappeared, the pH was 6.0-8.0, the vaginal elasticity was reduced, the length was shortened, the wrinkles were flattened, the drainage volume was reduced, the lubrication was lacking, and a series of symptoms occurred in the clinic, such as: genital itching, painful intercourse, senile Vaginitis and so on, causing great pain and anxiety, and even affecting family harmony.

(2) Symptoms of the bladder and urethra: When estrogen is deficient, some women may develop a series of symptoms caused by atrophy of the bladder and urethra, such as atrophic cystitis, urethritis, urethral valgus, flesh and tension. Urinary incontinence, and because the bladder capacity decreases with age, about 500ml at the age of birth, only about 250ml at the age of 60, so the accumulation of urine slightly exceeds the capacity will cause involuntary bladder contraction, and sense of urine, frequent urination, Urinary urgency, nocturia increased, although elderly women have these symptoms, but there is no obvious evidence of infection, no pathogenic bacteria in the culture, but due to decreased bladder muscle contractility, it can also cause poor urination, residual urine, and The urethral mucosa is thin and brittle and easy to damage, so postmenopausal women are also prone to recurrent urinary tract infections, which can improve symptoms after estrogen.

(3) uterine prolapse and vaginal wall bulging: especially in the history of multiple births and severe perineal tears, estrogen deficiency is prone to pelvic floor muscles and fascia relaxation, the current elderly uterine prolapse cases are quite See, pessary or surgical treatment can be used as appropriate, depending on age and constitution.

3. Cardiovascular symptoms

(1) 28.9% of patients have pseudo-angina pectoris, sometimes with palpitations, chest tightness, symptoms often affected by mental factors, and variability: more symptoms, less signs, good heart function, no improvement with vasodilator drugs, has been tracked Some patients have negative coronary angiography results, some scholars have described such a group of cardiovascular syndromes in menopausal women similar to X syndrome in cardiovascular disease.

(2) 15.2% of patients developed mild hypertension, characterized by elevated systolic blood pressure, diastolic blood pressure, paroxysmal attack, dizziness, headache, chest tightness, palpitation, and estrogen treatment in some cases. After the decline, peri-menopausal and postmenopausal women survive in complex physiological changes in the body's environment and pathological changes, different family factors, social influences, personal personality characteristics, mental factors, autonomic nerves The symptoms of disordered syndromes vary widely, and can be light or heavy. Some people have no obvious discomfort. They are safely used, and 10% to 15% of patients have more severe symptoms, affecting daily work and life, and need medication.

4. Osteoporosis: Women start from perimenopause, bone absorption rate is greater than bone formation, promote bone loss and osteoporosis, osteoporosis occurs about 9 to 13 years after menopause, about 1/4 of menopause After the woman suffers from osteoporosis, the patient often complains of the back, pain in the limbs, hunchback, severe fractures, most commonly in the vertebral body, other such as the distal radius, femoral neck and so on are prone to fracture.

Symptoms of perimenopausal syndrome Common symptoms Menopausal menstrual cycle changes sexual interest loss, menstrual period, and more...

The most typical symptoms in menopausal syndrome are hot flashes, flushing, and menopausal syndrome mostly occur in 45-55 years old. 90% of women may have symptoms of mild to severe symptoms. Some people have begun to appear in the menopausal transition period and continue to menopause. After 2 to 3 years, a few people can continue to reduce or disappear after 5 to 10 years of menopause. Artificial menopause often develops menopausal syndrome 2 weeks after surgery, reaching a peak 2 months after surgery. 2 years old.

1. Menstrual changes: menstrual cycle changes are the earliest clinical symptoms of perimenopause, roughly divided into three types:

(1) The menstrual cycle is prolonged, the amount of menstruation is reduced, and finally menopause.

(2) The menstrual cycle is irregular, the menstrual period is prolonged, the menstrual volume is increased, even the major bleeding or bleeding is continuous, and then gradually reduced and stopped.

(3) Sudden stop of menstruation, less common, because of ovulation without ovulation, estrogen levels fluctuate, prone to endometrial cancer, for abnormal bleeding, should be diagnosed curettage, exclude malignant transformation.

2. Vasomotor symptoms: mainly characterized by hot flashes, sweating, is an unstable manifestation of vasomotor function, is the most prominent characteristic symptom of menopausal syndrome, about 3 / 4 of natural menopause or artificial menopausal women can Appears, hot flashes from the front chest, flocked to the head and neck, and then spread throughout the body, a few women are limited to the head, neck and breasts, in the flushing area patients feel hot, red skin, followed by explosive sweating, lasts for a few seconds The frequency of seizures varies from several times to 30 to 50 times per day. It is easy to trigger at night or stress. This unstable vascular function can last for 1 year, sometimes as long as 5 years or longer.

Peri-menopausal syndrome

1. Increased follicle stimulating hormone (FSH).

2. Estradiol (E2) and progesterone levels decreased.

3. Luteogenesis or hormone (LH) menopause can be unchanged, can be elevated after menopause.

4. Segmental diagnosis and endometrial pathology except for endometrial tumors.

5. Pelvic ultrasound, CT, magnetic resonance examination can display the whole uterus and ovary to exclude gynecological organic diseases, B-mode ultrasound can exclude uterus, ovarian tumors, and understand the endometrial thickness.

6. Determine bone density, etc., to see if there is osteoporosis.

Diagnosis and diagnosis of perimenopausal syndrome

The intrinsic symptoms are complex, and the main symptoms should be given a correct estimate, and the organic disease can be diagnosed early.

1. History: Careful inquiry about symptoms, hormones used in treatment, drugs; menstrual history, age of menopause; history of marriage and childbirth; past history, whether to remove the uterus or ovaries, history of cardiovascular disease, history of cancer and family history.

2. Physical examination: including general examination and gynaecological examination, for those who have not undergone gynecological examination for 3 months, they must be reviewed.

3. Laboratory tests: mainly the determination of hormone levels.

Women in the peri-menopausal period are prone to high blood pressure, coronary heart disease, tumors, etc., therefore must exclude cardiovascular disease, organic diseases of the genitourinary organs, should be identified with neurasthenia, hyperthyroidism.

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