Menopause

Introduction Menopause refers to a period in which ovarian function declines further and eventually disappears. The ovaries stop ovulation every four weeks. Menopause usually occurs in women 45-55 years old, and the ovaries can be removed permanently. According to foreign statistics, women who are menopausal before the age of 40 are 39% more likely to die than menopausal women aged 40-44, 60% more likely than menopausal women aged 45-49, and 95% more likely than menopausal women aged 50-54. %. Therefore, understanding the various factors affecting menopause and delaying the age of menopause is a problem that cannot be ignored in the health care work of middle-aged and elderly women.

Cause

Genetic factor

Impact on menopausal women The human DNA sequence and its variation reflect the evolutionary process of humans. Studying DNA sequence variations (polymorphisms) in different populations and individuals can help to understand the physiological changes in humans, the development of diseases, and the response to drug treatment.

2. Ovarian aging

(1) Decreased follicles and ovarian morphological aging There are about 700,000 to 2 million follicles in the ovaries at birth. There are about 400,000 in adolescence. Very few follicles may remain in menopause. Two pathways lead to follicular reduction: ovulation and atresia.

(2) Decline of ovarian function 1 Reproductive function Women's fertility begins to decline at 30 to 35 years of age, and decreases significantly when approaching 40 years old. From regular menstruation to menopause, it usually takes an irregular menstrual period. At this stage, the follicles are irregularly mature, have ovulation or no ovulation, and 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 in the ovarian reproductive function decline, the endocrine function also declines, manifested as the synthesis and secretion of sex hormones in follicular development, mainly changes in estrogen and progesterone. The first is the decline of progesterone, about 40 years old, the degree of follicular development is insufficient, may be the relative deficiency of progesterone (P). The degree of inadequate follicular development can lead to anovulation and absolute deficiency of progesterone. Subsequently, as the number of follicles decreases, the development and deficiency of estrogen, mainly E2 (estradiol), is gradually reduced. In the menopausal transition period, follicular development occurs due to progesterone deficiency due to anovulation. E2 may not be lacking. If the number of follicles develops, the degree is high, or persists, E2 is even relatively excessive. After the menopause, the follicles are not developed and basically do not produce E2. Under the action of increased Gn, interstitial secretion of testosterone (T) increased.

3. Atrophy of the reproductive tract

Change the ability of the vulva to lose most of its collagen, fat and water retention. The gland is atrophied, its secretion is reduced, sebum secretion is also reduced, and the skin becomes thin, dry and cracked. The vagina shortens, narrows, wrinkles decrease, the wall becomes thinner, the elasticity is weakened, and the secretion is reduced. Early congestive changes, brittle and vulnerable to bleeding and bleeding, diffuse or scattered in the ecchymosis, late color pale, increased adhesions.

an examination

1. Determination of blood follicle estrogen (FSH).

2. Determination of luteinizing hormone (LH).

3. Determination of total estrogen (TE).

4. Estrone (E) determination.

5. Estradiol (E2).

6. T3 (total amount of triiodothyronine), T4 (total amount of tetraiodothyronine) and TSH (thyroid stimulating hormone). Exclude 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) assay. Eliminate fat metabolism disorders.

8. Do a urine pregnancy test if necessary.

9. Vaginal or pelvic B-ultrasound to understand the uterus, attachments, and exclude gynecological organic diseases.

10. Vaginal exfoliation cell examination: Observe the cell morphology, which can reflect the level of estrogen in the body.

11. X-ray photograph shows that the cortical bone is thinned, the cortical pores of the tubular bone are enlarged, and the specific trabecular bone structure of the femoral neck and trabecular bone (vertebral body) is lost, which may indicate osteoporosis.

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

Differential diagnosis

Take care 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 and older people with symptoms often atypical symptoms, such as thyroid gland is not swollen, appetite does not increase into heart rate, does not show excitement and manifests depression, apathy, anxiety, and so on. Identification method: Determination of thyroid function indicators, such as TSH lower than normal T4, T3 at normal high limit or even normal should be diagnosed with hyperthyroidism.

2. Coronary atherosclerotic heart disease When the patient is mainly palpitations and chest tightness symptoms, first consider CHD. The identification method is that when the physical examination and the electrocardiogram are difficult to identify, the estrogen test can be used.

3. Hypertension or pheochromocytoma When headache, blood pressure fluctuations or persistent hypertension should be considered, the method of identification is repeated blood pressure measurement and pheochromocytoma related examination, such as abdominal mass, squeezing Is the blood pressure elevated at the block? With or without headache, flustered sweating and other symptoms, blood catecholamine determination and menopause-related blood pressure changes are often mild.

4. neurasthenia Insomnia as the main manifestation may be caused by neurasthenia. The identification method is mainly based on the medical history, that is, the time of insomnia and the change of menstruation? For patients who are difficult to identify, estrogen can also be used for trial treatment or neurological consultation.

5. Psychosis A differential diagnosis is required when mental symptoms are the main manifestations.

6. Others When vaginal inflammation is the main manifestation, it is necessary to exclude fungal trichomoniasis or bacterial vaginal infection for pathogen detection. Urinary tract infections should be excluded when urinary urgency and dysuria are the main manifestations.

1. Clinical diagnosis of natural menopause diagnosis is based on peri-menopausal women for one year of continuous menopause for retrospective judgment, with or without peri-menopausal symptoms, most do not need auxiliary examination, artificial menopause through analysis of menopause It is not difficult to diagnose. 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 examination should be performed to rule out early pregnancy, because perimenopausal women will also have occasional ovulation and conceive, and should not be taken for granted. .

2. Premature ovarian failure For women who are menopausal before the age of 40, they often need to rely on an 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, blood samples can be taken twice a day. E2 levels are low, but there may be fluctuations in the early stages for reference. LH increased by more than 40 U/L after menopause, but its rise was slower than FSH, so FSH/LH>1.

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