Perimenopausal syndrome is a series of symptoms caused by the decline in estrogen levels, such as: upset and irritability, insomnia and dreams and even emotional abnormalities, which seriously affect the quality of life and health of women, and are the cause of chronic diseases in elderly women, and are also medical problems that need to be solved urgently.
At the 24th All-Army Academic Conference on Endocrine Metabolic Diseases, Professor Xiang Everbright of the Department of Endocrinology of the General Hospital of the Central Theater of the People's Liberation Army introduced the application norms of estrogen after women entered menopause with the topic of "Rational Application of Estrogen".
Definition and clinical manifestations of menopause and perimenopause
"The definition of menopause refers to the permanent cessation of menstruation, which is a retrospective clinical diagnosis, the standard is that women over 40 years old have not experienced menstruation in 12 months after the last menstrual period, and after excluding pregnancy, it is menopause, which essentially refers to the failure of ovarian function, not the presence or absence of menstruation," Professor Xiang Said. "Perimenopause = menopause transition + 1 year after final menstruation."
Perimenopausal syndrome, also known as menopausal syndrome, refers to a series of physical and psychosocial symptoms caused by fluctuations or decreases in sex hormones before and after menopause in women, which is a group of symptoms with neuropsychiatric psychological symptoms that are mainly dysfunctional of the autonomic nervous system. Professor Xiang Pointed out that the main manifestations of perimenopausal syndrome are the following four face-to-face: first, the gradual dynamic decline of ovarian function and the acceleration of the decline of ovarian reserve; second, the decline of fertility, the gradual emergence of menopause; third, the fluctuation of reproductive hormones, the change of menstrual bleeding patterns; and fourth, the increase in the risk of chronic diseases. Near-term effects include menstrual disturbances, hot flashes and hyperhidrosis, depression, anxiety, and insomnia. Long-term effects are manifested as senile vaginitis and urethritis, osteoporosis and fractures, and Senile dementia.
How can I alleviate the symptoms of perimenopausal syndrome?
Professor Xiang Everbright believes that we should start from the following aspects: (1) recommend a reasonable diet: whole grain fiber, sufficient vegetables and fruits, sugar control, less oil, less salt, smoking cessation, alcohol restriction, and adequate drinking; (2) daily regular aerobic exercise: accumulate 150 minutes per week, plus 2 to 3 anti-resistance exercises; (3) increase social and mental activity, healthy exercise; (4) menopausal hormone therapy (MHT).
How can MHT be properly applied?
MHT refers to the individual administration of low-dose estrogen and/or progesterone medications to women with ovarian decline, subject to indications and no contraindications. Professor Xiang Everbright said: "The development of MHT can be described as a twist and turn, from the 60s to the beginning of the application, and because of the risk of hormone therapy stagnation several times, and then to the International Menopause Association (IMS) and other international academic groups have successively formulated HRT reasonable application guidelines and expert consensus, proposed that the rational application of HRT can effectively alleviate menopausal symptoms, prevent postmenopausal osteoporosis, in 2013 formulated the "Global Consensus Statement on Menopausal Hormone Therapy", MHT can be regarded as a 'willow dark flower Ming another village'. "At present, domestic and foreign guidelines point out that MHT is the most effective treatment for relieving menopausal symptoms.
Still, the worries and confusions surrounding MHT treatment remain. Xiang Guangda professor said that due to the lack of common sense, there will be some common sense misunderstandings including hormone horror, hormone fat and so on. In addition, there are some academic controversies, such as estrogen therapy can cause endometrial cancer, breast cancer, other cancers, etc., and also cause some cardiovascular diseases.
In this regard, Professor Xiang Everbright interpreted the "Guidelines for Menopause Management and Menopausal Hormone Therapy in China (2018)". He pointed out that MHT is a medical measure, and the initiation of MHT should be started as soon as possible on the premise that there are indications, no contraindications, and the menopausal woman herself has the subjective intention to improve the quality of life through MHT. The specific content is as follows:
1. Indications for MHT
The benefits of initiating MHT vary in women of different ages, and early initiation after ovarian decline is recommended, and MHT is recommended in patients with early-onset ovarian insufficiency (POI) as long as there are no contraindications.
Menopausal-related symptoms: menstrual disorders, hot flashes, hyperhidrosis, sleep disturbances, tiredness, mood disorders.
Problems related to genitourinary atrophy: vaginal dryness, vulvar-vaginal pain, itching, dyspareunia, recurrent atrophic vaginitis, repeated lower urinary tract infections, nocturia, urinary frequency, urgency, etc.
Low bone mass and osteoporosis: risk factors for osteoporosis and postmenopausal osteoporosis. MHT is a first-line option for the prevention of osteoporotic fractures in women under 60 years of age and within 10 years of menopause.
2. Contraindications to MHT
Known or suspected pregnancy, unexplained vaginal bleeding, hemoporphyria, otosclerosis, known or suspected breast cancer, known or suspected sex hormone-dependent malignancy, current meningioma (progesterone contraindication), active venous or arterial thromboembolic disease within the last 6 months, severe hepatic and renal insufficiency.
3. Use MHT with caution
Caution is not prohibited, before and during application, the corresponding professional doctor should be consulted to jointly determine the timing and method of application of MHT, and closely monitor the condition.
Conditions of caution include: uterine fibroids, endometriosis, endometriosis, propensity to thrombosis, gallbladder disease, systemic lupus erythematosus, benign breast disease and family history of breast cancer, epilepsy, migraine, asthma.
4. Common MHT schemes
For women without a uterus: estrogen replacement therapy alone; for women with a uterus: periodic sequential therapy, continuous sequential therapy, continuous combination therapy.
(1) Monogestogen supplementation program: suitable for the early stage of menopause transition period, adjusting menstrual problems during the decline of ovarian function.
Oral: didraprogesterone 10 to 20 mg/day or micronized progesterone 200 to 300 mg/day or medroxyprogesterone acetate 4 to 6 mg/day for 10 to 14 days from the 14th day of menstrual or withdrawal bleeding;
Intrauterine placement: LNG-IUS, especially in patients with endometrial hyperplasia.
(2) Monoestrogen supplementation program: suitable for women whose uterus has been removed, usually continuously.
Oral: estradiol valerate 0.5-2 mg/day, or 17β-estradiol 1-2 mg/day, or conjugated estrogen 0.3 to 0.625 mg/day;
Transcutaneous: Estradiol hemihydrate patch (1/2-1) patch/7d, or estradiol gel 0.5-1 ruler/d, apply to skin such as arms, thighs, buttocks (avoiding breasts and perineum).
(3) Estrogen-progesterone sequential program: suitable for women with intact uterus, perimenopause or postmenopausal still expect menstrual bleeding.
Continuous sequential: daily medication, continuous sequential compound preparation: estradiol / estradiol destrogesterone tablets 1 tablet / day, a total of 28 days; continuous oral or percutaneous estrogen 28 days, the next 10 to 14 days with progesterone.
Cycle sequence: Each cycle is 3 to 7 days without any drugs. Cycle sequential compound preparation: estradiol valerate tablets / estradiol cyclopropestrol tablets 1 tablet / day, a total of 21 days; can also be used continuously or percutaneous estrogen 21 to 25 days, after 10 to 14 days with progesterone, and then stop the drug for 3 to 7 days before starting the next cycle.
(4) Estrogen and progesterone continuous combination program: suitable for women with a complete uterus and do not want to have menstrual bleeding after menopause.
Daily estrogen (oral or percutaneous) plus progesterone may be administered continuously, or a combination formulation such as estradiol/drospirone tablets may be given continuously at 1/d.
Tibolone: 1.25 to 2.5 mg/day continuous application.
Vaginal local estrogen: estriol cream, prostradiol vaginal capsules or creams, combined estrogen ointment once a day, for 2 weeks, after symptom relief changed to 2 times / week; short-term (3 to 6 months) topical application of estrogen vaginal preparations, no need to add progesterone, but lack of safety data for more than 1 year of use, long-term users should monitor the endometrium.
5. MHT standardizes the overall process of treatment
All women receiving MHT should be given health guidance at the same time, in principle, it is not recommended that women start to use MHT after the age of 60 or more than 10 years of menopause, and should be followed up regularly during treatment and assess the risks and advantages and disadvantages, and individualized adjustment programs should be made.
Professor Xiang Everbright concluded that menopause is a special stage for women and a necessary stage, at this stage, female reproductive function gradually declines, and a series of changes will occur physically and psychologically. MHT in middle-aged women with symptoms in early menopause creates a period of time that has long-term protective effects on the bone, cardiovascular and nervous system, usually within 10 years of menopause or before the age of 60. MHT is like a double-edged sword, how to choose the right population, and in this population early application of individualized solutions, regular follow-up, in the pros and cons of the full balance is the key.
Author: Liu Xueli
Source: The Endocrine Front line of the health community