1. Menstrual changes
Changes in the menstrual cycle are the earliest clinical symptoms of perimenopause and are divided into 3 types:
(1) Prolongation of the menstrual cycle with a decrease in the amount of menstrual flow, and finally menopause.
(2) Irregular menstrual cycle, prolonged menstrual period, increased menstrual flow, even heavy bleeding or bleeding drenching, and then gradually decrease and stop.
(3) Sudden cessation of menstruation is less common. Due to the absence of ovulation of ovaries and fluctuation of estrogen level, endometrial cancer is prone to occur. For those with abnormal bleeding, diagnostic scraping should be performed to rule out malignancy.
2. Vasodilatory symptoms
The clinical manifestations of hot flashes and sweating are the manifestations of unstable vasodilatory function, which is the most prominent characteristic symptom of perimenopausal syndrome. Hot flashes start in the forehead, surge to the head and neck, and then spread to the whole body, with a few women confined to the head, neck and breasts. In the area of the hot flash the patient feels burning and redness of the skin, followed by an outbreak of sweating. It lasts from a few seconds to several minutes, and the frequency of attacks ranges from a few times a day to 30 to 50 times a day. They are easily precipitated at night or by stress. This vascular instability can last up to a year, sometimes up to 5 years or longer.
1. Psychotherapy
Psychotherapy is an important part of the treatment of perimenopausal syndrome, and can be supplemented with autonomic function regulating drugs, such as ghrelin and diazepam (Valium) to help regulate autonomic function. You can also take vitamin B6, vitamin B complex, vitamin E and vitamin A, and so on. To give patients mental encouragement, relieve doubts, build confidence, and promote the recovery of health, it is recommended that patients take the following measures to delay psychological aging.
(1) Scientific arrangement of life Maintain a regular life, adhere to the ability of physical exercise, eat less animal fat, eat more vegetables and fruits, to avoid dietary disorders, avoid smoking and alcohol. In order to prevent osteoporosis, peri-menopausal and post-menopausal women should insist on physical exercise, increase sun exposure time, and consume sufficient protein and calcium-containing foods.
(2) adhere to the ability of physical and mental labor Adherence to labor can prevent muscles, tissues, joints, "waste atrophy" phenomenon. Uninterrupted study and thinking, learning new knowledge of science and culture, so that the mind is open, to prevent the brain from "useless atrophy".
(3) Enriching the content of life, such as traveling, cooking, planting flowers, weaving, dancing, etc., in order to obtain the friendship of the collective life, spiritual support.
(4) pay attention to the cultivation of character Menopause is prone to impatience, anxiety, depression, agitation and other emotions, we must be good at restraining, and cultivate a cheerful, optimistic character, and make good use of forgiveness and patience to deal with unsatisfactory people and things, in order to keep the mood and psychological and spiritual state of calm, is conducive to a smooth passage through the perimenopausal period.
2. Hormone Replacement Therapy (HRT)
Perimenopausal syndrome is mainly caused by the decline of ovarian function and the decrease of estrogen, HRT is a clinical medical measure taken to solve this problem, scientific, reasonable, standardized use of medication and regular monitoring, the beneficial effects of HRT will outweigh the potential harm.
(1) Guidelines for the clinical application of HRT are implemented according to the principles for the treatment of perimenopausal and postmenopausal women by the Menopause Group of the Obstetrics and Gynecology Branch of the Chinese Medical Association in 2003.
(2) Drug types and preparations ①Estrogens Natural steroidal estrogen preparations such as estradiol, estradiol valerate, conjugated estrogens, estriol, estrone; partially synthetic estrogens such as ethinyl estradiol, ethinyl estradiol trimethyl ether; synthetic estrogens such as nil estradiol. ② Progestogens Antagonize the effect of estrogen in promoting endometrial growth. There are three types: 19-desmethyl testosterone derivatives (such as norethindrone), 17-hydroxyprogesterone derivatives (such as methylhydroxyprogesterone), natural progesterone (such as micronized progesterone). (iii) Estrogen, progesterone, and androgen combination drugs The breakdown products of tibolone into the body have progesterone, androgen, and weak estrogenic activity and do not stimulate endometrial hyperplasia.
(3) The routes of administration include oral administration, vaginal administration, and dermal administration, which can be chosen according to the condition and the patient's wishes.
(4) Commonly used regimens ①Continuous sequential method 28 days as a therapeutic cycle, estrogen is applied uninterruptedly, and progesterone is applied on the 15th to 28th day of the cycle. Progesterone is applied on days 15 to 28 of the cycle. There is no interruption between cycles. This program is suitable for women within 3 to 5 years of menopause. ② Cycle Sequencing Method A treatment cycle of 28 days, with estrogen given daily on days 1 to 21, progestin given during days 11 to 21, and discontinued on days 22 to 28. Withdrawal bleeding may occur after the end of progestin administration. This regimen is indicated for women in perimenopause and premature ovarian failure. (iii) Continuous combination therapy Both estrogen and progestin are given daily, with a low chance of withdrawal bleeding. It is suitable for women who have been menopausal for many years. ④ Single estrogen therapy For women with low ovarian function after hysterectomy or congenital absence of uterus. ⑤ Single progestin therapy For women with severe symptoms during the menopausal transition or postmenopausal perimenopausal period who have contraindications to estrogen. ⑥ Addition of androgen therapy The addition of a small amount of androgen to HRT can have the effect of improving mood and libido.
(5) Optimal dosage of HRT The lowest effective amount for clinical effect, which can achieve the therapeutic purpose, stop endometrial hyperplasia, and the E2 level in the blood is the level of early premenopausal follicles.
(6) Duration of dosing ① Short-term dosing Continuous HRT for 5 years or less is called short-term dosing. The main purpose is to alleviate perimenopausal symptoms, usually within 1 month of effect, 4 months to achieve stable relief. ② Long-term use For the prevention and treatment of osteoporosis, lasting at least 3 to 5 years.
(7) Side effects and risks Uterine bleeding, sex hormone side effects, side effects of progesterone, endometrial cancer, breast cancer.
3. The following non-hormonal drugs are available for the prevention and treatment of osteoporosis:
(1) Calcium As an adjunct or basic drug to various drug treatments. The appropriate calcium intake for postmenopausal women is 1000mg/d ~ 1500mg/d, and after 65 years of age, it should be 1500mg/d. Calcium supplementation is firstly dietary supplementation, and the part that can't be supplemented is supplemented with calcium, and the clinically applied calcium supplements are calcium carbonate, calcium phosphate, calcium chloride, calcium citrate, and other preparations.
(2) Vitamin D is suitable for perimenopausal women who lack outdoor activities, 400-500U per day orally, combined with calcium supplements is conducive to the complete absorption of calcium.
(3) Calcitonin is a very strong inhibitor of bone resorption and is used in osteoporosis. Salmon calcitonin is an effective agent.
(4) Bisphosphonates can inhibit osteoclasts, have strong anti-resorption effect, used in osteoporosis. Commonly used amino bisphosphonates.