Menopause health science

Menopause is not a "necessary ordeal for women". More than 90% of the uncomfortable symptoms can be alleviated through scientific intervention. There is no need to force it or take random folk prescriptions. The gynecological endocrinology department of a regular hospital can solve most problems.

Last week, the clinic just received a 48-year-old middle-level lady named Zhang. She used to be famous for her good temper in the workplace and was reluctant to say harsh words to employees even when they did something wrong. But in the past six months, she has become a completely different person: she bangs the table with her subordinates at every turn, slams the door with her husband when she gets home over trivial matters, wakes up at two in the morning, her back is so wet with sweat that it can wrung out, and even her menstrual flow is irregular. At first she thought she was suffering from stress and depression, so she went to a psychiatrist to take antidepressant medicine for two months, but it was of no use at all. She came to the gynecologist for a check-up after a friend reminded her. When the six hormone items came out, her FSH (follicle-stimulating hormone) soared to 42IU/L, a typical perimenopausal state. She was evaluated and found to have no contraindications, and was prescribed the lowest dose of estrogen and progesterone compound tablets. She came for a follow-up visit last week, and her makeup was even more exquisite than last time. She said that she and her husband went to see Jay Chou's concert last week, and she didn't feel irritated even after two hours. Before, she would have been halfway home.

Some people may frown upon seeing this: Didn’t they say that taking hormone supplements will cause cancer? My relatives said before that they were diagnosed with breast cancer after taking hormone supplements, but they dared not touch it. This is actually the most controversial point in the current field of menopausal intervention: the older generation always believes that "menopause is a normal physiological process, and it will pass if you tolerate it." Even many non-specialist doctors will tell patients this. There are also many people who are frightened by the rumors of side effects of high-dose hormone use in their early years, and would rather eat messy "ovarian maintenance" health products than regular hormone treatment. However, according to the clear conclusion of the 2023 version of the "China Menopause Management and Menopausal Hormone Therapy Guidelines", as long as women are under 60 years old, have been through menopause for less than 10 years, and have no contraindications such as breast cancer history and unexplained vaginal bleeding, if they use the lowest effective dose of hormone supplementation therapy, the new risk of breast cancer is less than 2 in 10,000, which is lower than the cancer risk of drinking milk tea every day and staying up late.

Of course, not everyone needs to take hormones. I have also met many patients who have concerns about hormones and want to adjust their hormones on their own, which is not impossible. Last month, I had a 50-year-old aunt who only had hot flashes two or three times a day. She was just a little short-tempered and did not affect her normal life. I did not prescribe her any medicine and asked her to dance square dance with her sisters for 40 minutes after dinner every day. She drank 300ml of milk every day, took regular calcium supplements and vitamin D, and drank less strong tea and coffee. She came for a follow-up checkup last month and said that her symptoms had basically disappeared and she had even lost three pounds. There is also a girl with milder symptoms who started to have menstrual irregularities at the age of 39 and occasionally has hot flashes. I asked her to eat more soy products, not to stay up late, and to have her hormones checked regularly, and no special intervention was needed.

To be honest, many people have a too narrow understanding of menopause. They always think that only hot flashes, sweating and bad temper are the symptoms of menopause. In fact, there are many problems hidden underneath. Last month, I had a 52-year-old aunt. She had frequent and urgent urination for almost a year. She went to the urology department for seven or eight routine urinalysis tests, all of which were fine. She took a lot of anti-inflammatory drugs and even had a cystoscopy. There were no problems. Finally, a colleague from the urology department referred her. , a check-up showed that the urethral mucosa was atrophic due to low estrogen, and I was prescribed a topical estrogen ointment worth tens of yuan, which was cured after two weeks. When my aunt came for a follow-up consultation, she said that now she no longer has to go to the toilet first. She didn’t even dare to dance in the square before. There are also people who have joint pain all over their body, but no problems at all when they go to the orthopedic department to take X-rays. After two months of hormone supplementation, the pain symptoms disappear. In fact, it is the bone loss caused by the decrease in estrogen that is to blame.

I have been working as a gynecological clinic for 12 years, and I have seen too many patients who suffered from osteoporosis. Some suffered from osteoporosis and fell and fractured their femoral necks. Some suffered from high blood pressure and anxiety after suffering from insomnia for five or six years. There are also some who believed in the "menopausal elixir" in the circle of friends and had irregular bleeding after half a year. When they came to check, they found that the endometrium had thickened to 12mm, and they were cured. It turned out to be atypical endometrial hyperplasia, which almost turned into cancer. Those health care products that boasted of "ovarian care" and "delaying menopause" were most likely secretly added with excessive estrogen. The dose was not accurate, and it was more likely to cause problems if taken. It was really not as reliable as going to a regular hospital and spending tens of dollars to check the six hormones.

In fact, to put it bluntly, menopause means that the ovaries, the "little factories" that produce estrogen, are about to retire as you age, and their production capacity slowly decreases. Your body has been accustomed to the state of estrogen for decades, and if the supply suddenly becomes insufficient, you will definitely have a "withdrawal reaction." If you are willing to use hormone supplements, you should find a doctor to evaluate the normal use. If you don’t want to use hormones, just adjust your lifestyle. If you have symptoms, you can also use botanical medicine and traditional Chinese medicine to treat them. No matter what, it is better than trying to deal with it. In the past, people were embarrassed to mention menopause, thinking it was "pretentious because of age". Now many young people take the initiative to accompany their mothers for consultation. Last month, a little girl who was born in 1997 came with a popular science post I posted before and said that her mother has been secretly crying at home recently and asked if she could prescribe some medicine for her mother. She is more understanding than many elders themselves.

There is really no need to regard menopause as a scourge, and don't think that being uncomfortable after 40 means you are "old." Just talk about it if you feel uncomfortable and go to a specialist to see a doctor. Being comfortable is better than anything else.