Menopause syndrome

Introduction to menopausal syndrome Menopausal syndrome refers to a group of syndromes with autonomic nervous system dysfunction and neuropsychological symptoms caused by fluctuations or reduction of sex hormones before and after menopause. The underlying cause of perimenopausal syndrome is ovarian failure due to physiological or pathological or surgical procedures. Once the ovarian function is depleted or removed and destroyed, the estrogen secreted by the ovaries is reduced. There are more than 400 estrogen receptors in women, which are distributed in almost all tissues and organs of the female body. They are controlled and controlled by estrogen. Once estrogen is reduced, it will cause degenerative changes in organs and tissues. symptom. basic knowledge Sickness ratio: 0.0001% Susceptible population: a peri-menopausal woman who is born in 45-55 years old Mode of infection: non-infectious Complications: genital itching, rectal bulging, uterine prolapse, acne, senile plaque, hypertension, arteriosclerosis, coronary heart disease, depression, schizophrenia, renal ptosis

Causes of menopausal syndrome

Vasomotor syndrome refers to a syndrome characterized by a lack of estrogen and autonomic dysfunction caused by paroxysmal episodes, flushing, spontaneous sweating and palpitations. The flushing begins at the face, neck, and front chest. , after the lower abdomen, trunk and limbs, skin vasodilatation, flaky redness and congestion, temperature rise, with headache, dizziness, palpitations, irritability, dry mouth, for heat dissipation, patients undressing, armpits, windows, fans or Going outdoors to drive heat, the flushing lasts for 3 to 4 minutes, followed by sweating, vasoconstriction, and the body temperature returns to normal, ending with a period of 54 ± 10 minutes. At night, the sudden awakening from the dream, and sweating , wet quilt, with insomnia and anxiety, the next day, sorrowful, forgetful, with nausea, vomiting, dizziness and other discomfort.

Mechanism of flushing: 1The GnRH neurons in the preoptic area of the hypothalamus have direct synaptic and neural connections with the adjacent thermoregulatory neurons (Thermoregulatory neurons), so the functional changes of GnRH neurons will affect the latter; 2 postmenopausal estrogen deficiency Feedback-induced increase in norepinephrine activity, thereby stimulating the release activity of GnRH. The nerves cause the activity of the heateoss mechanism. The flushing episode is related to the fluctuation of GnRH and the fluctuation of norepinephrine activity; 3 Central nervous system And dopamine and -endorphin activity decreased in the hypothalamus.

Body aging (25%):

Changes in the body's aging, ovarian dysfunction, and the impact of decreased estrogen levels in the body directly on the body. Physiological changes have a decline in ovarian function, secretion of estrogen and ovulation gradually decrease and lose periodicity until cessation of ovulation; pituitary secretion of follicle stimulating hormone and luteinizing hormone, target organs of estrogen such as vagina, uterus, breast, Changes in the structure and function of the urinary tract, etc., resulting in a series of physiology such as irregular menstruation, hot flashes, sweating, palpitations, frequent urination, urinary incontinence, vaginal dryness, loss of libido, poor sleep, osteoporosis and body weight during perimenopause. Phenomenon, with physiological changes, women may also have some psychological discomfort such as emotional instability, memory loss, suspiciousness, anxiety and depression, although menopause usually occurs naturally, but it may be caused by ovarian surgical resection (this is called For surgical menopause, ovarian function decline from cancer treatment can also cause menopause, such as chemotherapy or radiation therapy.

Mental factors (18%):

Whether the symptoms of menopausal syndrome occur and their severity are closely related to individual quality, health status, social environment and mental factors. In terms of social relations, perimenopausal women face some social problems such as occupational difficulties, divorce, parental illness or death, and children growing up beside them, all of which bring mental stress to them and interfere with it to a certain extent. Menopausal women's life, work and their relationship with others, they often feel that they are getting old, do not like to participate in public activities, easy to lose temper to their families, these situations, if you do not understand the society and family, it is easy Lead to family conflicts and even endanger women's health.

Hormone regulation function degradation (24%):

Degradation of hormonal regulation results in patients with emotional instability, irritability, nervousness, insomnia, multiple dreams, memory loss and other symptoms.

Lack of loss (8%):

Osteoporosis is caused by calcium loss, which is also a common cause of menopausal syndrome.

Climacteric syndrome prevention

1. Improve self-care knowledge and self-care ability of menopausal women.

2. Self-regulating emotions and maintaining a healthy mental state.

3, reasonable nutrition, develop good eating habits.

4, participate in physical exercise, enhance physical fitness.

5. Maintain a harmonious sex life.

Complications of climacteric syndrome Complications, genital itching, rectal bulging, uterine prolapse, acne, age spots, hypertension, arteriosclerosis, coronary heart disease, depression, schizophrenia, renal ptosis

First, the reproductive system

1, sexual deterioration and genital atrophy: dry vulva, pubic hair loss, white lesions, genital itching, secondary infection, sexual dysfunction, bladder, rectal bulging, uterine prolapse, etc., some women appear hairy, seborrheic, hemorrhoids Such as masculinity.

2, breast atrophy, sagging, nipple areola hypopigmentation: breast stiffness is weakened, tissue collapse.

3, skin and mucous membranes: dry, wrinkled, hair loss, pigmentation and age spots, prone to skin diseases, dry mouth, angina and hoarseness.

4, cardiovascular system: including hypertension, arteriosclerosis and coronary heart disease, the incidence of embolic disease increased with postmenopausal age, the incidence of coronary heart disease in women 55 years old is 5 to 8 times lower than men of the same age.

Second, the spirit, the nervous system

Menopausal women are prone to mental depression, forgetfulness, obsessive attitudes, paranoia, emotional inversion, emotional instability, persecution delusions, anxiety, suspiciousness, abnormal feelings, conscious incompetence and aversion, partial madness, confusion and schizophrenia .

Third, the tumor tends to tend to develop

According to statistics, the incidence of gynecological tumors increases with age, such as 219. It is 770.84~782.14/100,000, 70 years old is 1120.711129.90/100,000, 80 years old is 1490.591657.08/100,000 (New York State 1960), cervical cancer, uterine cancer, ovarian cancer peak is 40~ 60 years old, cervical invasive cancer between 41.8 ~ 48.7 years old (Noda 1983), urinary tumor sex ratio: 40 years old M: F = 1: 0.6 40 ~ 60 years old 1:1, including renal cancer 2: 1, urethra Cancer 1:3 ~ 5, especially in women 50 years old.

Fourth, the urinary system

Frequent urination, urgency, tension or urinary incontinence (urgemt incontineuce), urethral mucosa prolapse, urethral meat sputum, renal ptosis, renal pelvis - ureteral effusion and urinary retention and infection.

Five, skeletal muscle system

Bone joints (wrist, elbow, shoulder, hip and waist), ligaments, muscle atrophy, soreness, dysfunction, osteoporosis and prone to fractures, as detailed in the Osteoporosis section.

6. Endocrine metabolic changes

(1) Hyperlipidemia: manifested as elevated cholesterol, LDL, TG, VLDL, and decreased HDL and HDL2, so it is easy to cause atherosclerosis and hypertension.

(2) Diabetes propensity: -cells are caused by decreased insulin secretion and enhanced insulin resistance in peripheral tissues.

(C) edema: may cause mucinous edema, angioedema, or hypoproteinemia, dystrophic edema.

(D) immune dysfunction: easy to concurrent infection and tumor.

Symptoms of menopausal syndrome Common symptoms Menopause, suspicious, forgetfulness, anxiety, persecution, irritability, sleep, body sweating, temper, bad emotion, inversion, hoarseness

Early menopause is mainly characterized by vasomotor syndrome; late stage (>5 years) successively appear aging diseases of various organ systems.

First, the symptoms associated with estrogen deficiency

(A) vasomotor syndrome: the incidence rate of 75 to 85% after 1 to 5 years after menopause, <25 years after double ovarian resection, the incidence of 1 to 6 weeks is 76%.

Vasomotor syndrome refers to a syndrome characterized by a lack of estrogen and autonomic dysfunction caused by paroxysmal episodes, flushing, spontaneous sweating and palpitations. The flushing begins at the face, neck, and front chest. , after the lower abdomen, trunk and limbs, skin vasodilatation, flaky redness and congestion, temperature rise, with headache, dizziness, palpitations, irritability, dry mouth, for heat dissipation, patients undressing, armpits, windows, fans or Going outdoors to drive heat, the flushing lasts for 3 to 4 minutes, followed by sweating, vasoconstriction, and the body temperature returns to normal, ending with a period of 54 ± 10 minutes. At night, the sudden awakening from the dream, and sweating , wet quilt, with insomnia and anxiety, the next day, sorrowful, forgetful, with nausea, vomiting, dizziness and other discomfort.

Mechanism of flushing: 1The GnRH neurons in the preoptic area of the hypothalamus have direct synaptic and neural connections with the adjacent thermoregulatory neurons (Thermoregulatory neurons), so the functional changes of GnRH neurons will affect the latter; 2 postmenopausal estrogen deficiency Feedback-induced increase in norepinephrine activity, thereby stimulating the release activity of GnRH. The nerves cause the activity of the heateoss mechanism. The flushing episode is related to the fluctuation of GnRH and the fluctuation of norepinephrine activity; 3 Central nervous system And dopamine and -endorphin activity decreased in the hypothalamus.

(2) aging diseases of various organ systems

1, sexual deterioration and genital atrophy: dry vulva, pubic hair loss, white lesions, genital itching, secondary infection, sexual dysfunction, bladder, rectal bulging, uterine prolapse, etc., some women appear hairy, seborrheic, hemorrhoids Such as masculinity.

2, breast atrophy, sagging, nipple areola hypopigmentation: breast stiffness is weakened, tissue collapse.

3, skin and mucous membranes: dry, wrinkled, hair loss, pigmentation and age spots, prone to skin diseases, dry mouth, angina and hoarseness.

4, cardiovascular system: including hypertension, arteriosclerosis and coronary heart disease, the incidence of embolic disease increased with postmenopausal age, the incidence of coronary heart disease in women 55 years old is 5 to 8 times lower than men of the same age.

Second, the spirit, nervous system menopausal women are prone to mental depression, forgetfulness, obsession, paranoia, emotional inversion, emotional instability, persecution delusions, anxiety, suspicious, paresthesia, conscious incompetence and aversion, some are rampant, Thinking disorder and schizophrenia.

Third, the tumor tends to tend to develop

It is related to the decline of immune surveillance function and aging. According to statistics, the incidence of gynecological tumors increases with age, such as 219.93~245.39/100,000 for 40 years old, 433.82450.45/100,000 for 50 years old, 60 years old 770.84782.14/100,000, 70 years old is 1120.711129.90/100,000, 80 years old is 1490.591657.08/100,000 (New York State 1960), cervical cancer, uterine body cancer, ovarian cancer peaks are 40~60 Age, cervical invasive cancer between 41.8 ~ 48.7 years old (Noda 1983), urinary tumor sex ratio: 40 years old M: F = 1: 0.6 40 ~ 60 years old 1:1, including renal cancer 2: 1, urethral cancer 1:3 ~ 5, especially in women 50 years old.

Fourth, the urinary system

Frequent urination, urgency, tension or urinary incontinence (urgemt incontineuce), urethral mucosa prolapse, urethral meat sputum, renal ptosis, renal pelvis - ureteral effusion and urinary retention and infection.

Five, skeletal muscle system

Bone joints (wrist, elbow, shoulder, hip and waist), ligaments, muscle atrophy, soreness, dysfunction, osteoporosis and prone to fractures, as detailed in the Osteoporosis section.

6. Endocrine metabolic changes

(1) Hyperlipidemia: manifested as elevated cholesterol, LDL, TG, VLDL, and decreased HDL and HDL2, so it is easy to cause atherosclerosis and hypertension.

(2) Diabetes propensity: -cells are caused by decreased insulin secretion and enhanced insulin resistance in peripheral tissues.

(C) edema: may cause mucinous edema, angioedema, or hypoproteinemia, dystrophic edema.

(D) immune dysfunction: easy to concurrent infection and tumor.

Seven, 10 to 15 years after oophorectomy, the incidence of cardiovascular disease is significantly increased: such as 45 to 55 years old cardiovascular disease proportion, female: male = 4.29: 2.29; coronary heart disease 3.78: 2.73; cerebrovascular disease 3.89: 0.32, Women are significantly higher than men of the same age, the incidence of osteoporosis is 4 times that of men of the same age (Tataro Taro 1982), natural menopause, there is no significant difference in the incidence of sex from the age of 65, less than 40 years old menopause, the incidence of coronary heart disease is advanced And the incidence rate is 2.4 times higher than that of non-menopausal people of the same age.

8. Premenopausal oophorectomy and menopausal syndrome : The earlier the premenopausal women resected the bilateral ovaries, the early and frequent frequency of ovarian shedding symptoms, and the symptoms are obvious. <25 years old ovarian resection, 1 to 6 weeks after surgery Symptoms of female deficiency appear, the incidence rate is 76%, 40 years old resection of the symptoms from June to 18 months.

Retaining one side of the ovary secondary benign tumor rate was 13.7%, malignant tumor was 8.2%, and the average was seen in 5.8 years after surgery.

After the ovariectomized women, plasma T, A, E also decreased, but the symptoms of hormone shedding were not obvious. Based on the above analysis, whether in premenopausal or postmenopausal women, benign lesions should be taken with caution.

Examination of menopausal syndrome

Physical examination

Physical examination.

Pay attention to cardiovascular, liver and kidney disease, obesity, edema, malnutrition and mental-neural function.

Gynecological examination should be routinely performed for cervical cytology, and attention should be paid to the presence or absence of sexual organ inflammation, tumors, postmenopausal bleeding, should be treated as a segmental diagnosis and endometrial disease, cytology abnormalities, should be for cervical multi-point biopsy and Cervical canal scraping, ovarian enlargement, should pay attention to exclude tumor, routine breast examination.

Special inspection

Implemented when there are indications.

(1) Hormone determination: Hormone determination including HPO axis, adrenal axis, thyroid axis, and pancreatic function.

(B) blood chemistry: including blood calcium, phosphorus, blood sugar, blood lipids, BUN, liver and kidney function, urine sugar, urine protein, Ca + + / C, hydroxyproline / C ratio.

(C) medical imaging examination: the focus is to diagnose osteoporosis, including bone density, cortical thickness single / multi-beam light absorption measurement, neutron activity measurement, CT and MRI.

Diagnostic identification of climacteric syndrome

diagnosis

First, medical history: carefully ask about menstrual history, marriage and childbirth history, age of menopause, ovarian and hysterectomy time, history of post-menopausal bleeding and family history (cardiovascular disease, diabetes, cancer) and history of treatment (hormone and drugs).

Second, physical examination: physical examination, pay attention to whether there is cardiovascular, liver and kidney disease, obesity, edema, malnutrition disease and mental-nerve system functional status, gynecological examination should be routine for cervical cytology examination, and pay attention to the presence or absence of sexual organ inflammation , tumor, postmenopausal bleeding, should be used for segmental diagnosis and endometrial disease examination, cytology abnormalities, should be for cervical multi-point biopsy and neck tube scraping, ovarian enlargement, should pay attention to exclude tumor, breast routine an examination.

3. Special inspections shall be carried out at the time of indication.

(1) Hormone determination: Hormone determination including HPO axis, adrenal axis, thyroid axis, and pancreatic function.

(B) blood chemistry: including blood calcium, phosphorus, blood sugar, blood lipids, BUN, liver and kidney function, urine sugar, urine protein, Ca + + / C, hydroxyproline / C ratio.

(C) medical imaging examination: the focus is to diagnose osteoporosis, including bone density, cortical thickness single / multi-beam light absorption measurement, neutron activity measurement, CT and MRI.

Menopause is a good age for many organic diseases. The symptoms of some menopausal syndromes are often the aura of certain organic diseases. Therefore, it is very important to carry out differential diagnosis seriously.

Differential diagnosis

(1) Coronary heart disease: Menopausal syndrome due to autonomic dysfunction, vasomotor dysfunction can also occur in the precordial area, palpitations and other symptoms similar to coronary heart disease angina, but it is not difficult to identify according to the following aspects:

1 angina pectoris is characterized by sudden compression or asphyxiating pain in the lower chest or anterior region of the chest, and radiation to the left arm, the duration is rarely more than 10 to 15 minutes, pain can be relieved within 1 to 2 minutes after oral administration of nitroglycerin Or disappear, the pain in the anterior region of the menopausal syndrome is persistent dull pain, and the pain cannot be relieved after oral administration of nitroglycerin;

2 angina is related to physical activity and emotional excitement, while menopausal syndrome has nothing to do with physical activity, only related to emotion and spirit.

3 electrocardiogram examination, coronary heart disease has many changes, no change in menopausal syndrome.

(2) Hypertension: There are many patients with elevated blood pressure in menopausal syndrome, but unlike hypertension, the main points of identification are:

1 Hypertensive patients with elevated blood pressure were persistent, systolic blood pressure, diastolic blood pressure exceeded normal levels; menopausal syndrome only increased systolic blood pressure, normal diastolic blood pressure, fluctuations during the day, blood pressure often fell to normal range after sleep.

2 Hypertension is often accompanied by dizziness, headache, palpitations and other cardiovascular symptoms; and menopausal syndrome is accompanied by hot flashes, hyperhidrosis and other symptoms of autonomic dysfunction.

3 Hypertension often has elevated cholesterol, changes in fundus or ECG; menopausal syndrome has decreased estrogen (or testosterone) levels, and there are no changes in fundus and electrocardiogram.

(3) Esophageal cancer: Some patients with menopausal syndrome often feel a foreign body sensation in the throat, can not swallow, can not spit, but does not affect swallowing, although organic examination can not find organic lesions, this kind of The phenomenon is due to endocrine dysfunction, which makes the central nervous system control disorder, causing abnormal pharyngeal or esophageal muscle contraction caused by autonomic dysfunction. At this time, it should be differentiated from esophageal cancer. The symptoms of esophageal cancer are progressive dysphagia. Patients with progressive weight loss, esophageal barium meal X-ray examination, fiber esophagoscopy or esophageal pull net examination can be found pathological changes.

(4) Cervical and uterine tumors: Female climacteric syndrome occurs mostly in premenopausal period. At this time, it is the age of cervical cancer and uterine fibroids. Therefore, it should also be noted for identification. As long as regular gynecological examination, if necessary, do cervical smear Biopsy and endometrial biopsy are not difficult to rule out.

These are common diseases that are easily misdiagnosed, and many diseases such as senile psychosis and neurosis are not repeated. It should be noted that climacteric syndrome often coincides with the above-mentioned diseases, or begins to be a menopausal syndrome. In the future, I will suffer from organic diseases. I am highly vigilant about these situations. Regular comprehensive inspections are necessary.

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