Perimenopausal syndrome

　　Perimenopause refers to the period when women transition from the reproductive age to old age, a period of gradual decline in ovarian function. Previously, the term 'menopause' was used to describe this changing period, but in 1994, WHO proposed to废除 this term. Perimenopause includes endocrine disorders related to menopause, lasting about 10 years, from 1 year after the last menstrual period, with menopause as an important marker. During this period, due to the decrease in sex hormone secretion, a syndrome characterized mainly by autonomic nervous system dysfunction occurs, known as the perimenopausal syndrome.

　　1. Physiological menopause, also known as natural menopause, refers to the period when women enter the menopausal period, with a significant reduction in follicles, ovarian function decline, cessation of ovulation, and a decrease in the synthesis of estrogen and progesterone. Symptoms include menstrual irregularity, amenorrhea, and autonomic nervous system dysfunction.

　　2. Pathological menopause is caused by congenital or acquired lesions of the hypothalamus-pituitary-ovary axis (ovarian hypoplasia, tumors, inflammation, injury, radiation, drugs, etc.) and systemic diseases (thyroid, adrenal diseases, diabetes, anemia, tuberculosis, and malnutrition, etc.) affecting the hypothalamus-pituitary-ovary axis.

　　3. Artificial menopause is based on the need for treatment of certain diseases, which artificially inhibits the hypothalamus-pituitary-ovary axis function to induce menopause. For example, oophorectomy in breast cancer, perimenopausal endometriosis, and pseudopregnancy, etc.

　　The complications of perimenopausal syndrome include the following:

　　Menstrual irregularity

　　Menstrual irregularity, also known as irregular menstruation, is a common gynecological disease. It is characterized by abnormal menstrual cycle or blood volume, as well as abdominal pain and systemic symptoms before or during menstruation. The cause may be organic lesions or functional disorders. Abnormal emotions can lead to menstrual irregularity, and long-term emotional suppression, being upset, or suffering major emotional stress and psychological trauma can all lead to menstrual irregularity, dysmenorrhea, or amenorrhea.

　　Insomnia

　　Insomnia refers to the inability to fall asleep or maintain sleep, leading to insufficient sleep. Also known as sleep and maintenance sleep disorders, it is caused by various reasons, such as difficulty falling asleep, insufficient depth or frequency of sleep, early awakening, insufficient sleep time, or poor sleep quality.

　　Palpitations

　　Palpitations refer to a group of symptoms where patients feel palpitations in their hearts, even unable to control them. When they occur, patients feel their heartbeat is fast and strong, accompanied by discomfort in the precordial area. This condition falls under the category of 'startle' and 'palpitation' in traditional Chinese medicine. This disease can be seen in various disease processes, often coexisting with insomnia, forgetfulness, dizziness, tinnitus, and so on. Any abnormality in heart rate or rhythm caused by various reasons can lead to palpitations.

　　Memory decline

　　Memory decline, especially common in 40-60-year-old professional women, who are eager for knowledge updates but often feel inadequate. Some middle-aged and young male adults, due to social pressure, feel work stress, anxiety, and irritability, leading to decreased memory. Some knowledge women or retirees in the elderly population also report memory impairment.

　　Depression

　　Depression is a common mood disorder caused by various reasons, characterized by significant and persistent mood depression, which is not commensurate with their situation. Severe cases may develop suicidal thoughts and behaviors. Most cases have a tendency to recur, with most episodes being alleviated, and some may have residual symptoms or become chronic.

　　Osteoporosis

　　Starting from perimenopause, women's bone resorption rate is greater than bone formation rate, leading to bone loss and osteoporosis. Osteoporosis usually appears about 9-13 years after menopause, with about 1/4 of postmenopausal women suffering from osteoporosis. Patients often complain of back and limb pain, develop humpback, and may experience fractures, most commonly in the vertebral bodies, other parts such as the distal radius and femoral neck are also prone to fractures.

　　1. Menstrual disorders: Menstrual cycle prolongation with a gradual decrease in menstrual flow; or menstrual cycle shortening with an increase in menstrual flow; or irregularity in cycle, duration, and menstrual flow; or sudden cessation of menstruation.

　　2. Sudden hot flashes, sweating, accompanied by headaches, dizziness, palpitations, chest tightness, nausea, and so on.

　　3. Mental symptoms such as lack of concentration, irritability, insomnia, excessive worry, and depression.

　　4. Varying degrees of atrophy of the reproductive organs.

　　5. Breast ptosis, atrophy, frequent urination, and incontinence.

　　6. Osteoporosis, back and waist pain, and an increased risk of fractures.

　　7. Susceptible to cardiovascular diseases such as atherosclerosis, hyperlipidemia, and hypertension.

　　Measures for the prevention of perimenopausal syndrome:
　　1. Healthcare personnel should actively and proactively carry out health education for perimenopausal women, helping them master the necessary scientific knowledge, eliminate fears and doubts, and face menopause with an optimistic and positive attitude.
　　2. For the family members of perimenopausal women, mainly their husbands, health care knowledge should also be promoted to help them understand the possible symptoms of women's menopause and provide care, comfort, encouragement, and sympathy when certain neurological dysfunction symptoms occur.
　　3. Perimenopausal women should have a physical examination, including gynecological examination and cancer screening, once every half year to one year. Endocrine examination should be done selectively. Medical and health care personnel should provide high-quality consulting services to perimenopausal women to help them prevent the occurrence of perimenopausal syndrome or alleviate symptoms, shorten the course of the disease.
　　4. For those who have undergone bilateral oophorectomy before menopause, estrogen should be supplemented in a timely manner.

　　1. Laboratory examination

　　⑴Examination of blood and urine estrogen levels.

　　⑵Examination of prolactin, FSH, and LH.

　　⑶Determination of trace elements such as calcium, phosphorus, and iron.

　　2. Other auxiliary examinations

　　⑴Pelvic ultrasound and/or vaginal ultrasound.

　　⑵Bone mineral density test.

　　⑶Electrocardiogram or dynamic electrocardiogram examination.

　　⑷Vaginal smear, TCT examination.

　　⑸If necessary, perform a diagnostic curettage.

　　Milk and soy products can prevent and treat perimenopausal syndrome. The average age of menopause for postmenopausal women is about 49 years old. The incidence rate of perimenopausal syndrome is 68.15%, with varying degrees of symptoms, which困扰 many perimenopausal women and affect their quality of life. However, only 28.16% of women seek medical help. In daily life, if we pay attention to eating more milk and soy products, it may reduce or avoid the occurrence of perimenopausal syndrome.

　　Research has found that the prevalence of perimenopausal syndrome in those who often drink milk and eat soy products is lower than that in those who do not, and the symptoms are milder. That is to say, if perimenopausal women can persist in drinking milk and eating soy products, it can reduce the occurrence of perimenopausal syndrome and alleviate symptoms such as insomnia, hot flashes, and depression. Both milk and soy products are high-quality proteins. A large number of studies have found that soy contains soy isoflavones - plant estrogens, soy lecithin, and plant sterols are beneficial to lipid metabolism, and have the effects of lowering blood lipids and preventing cardiovascular diseases. Milk contains a relatively rich amount of natural calcium, with high absorption rate, making it an ideal source of calcium.

　　Therefore, in addition to medication, changing the lifestyle of patients, such as dietary habits, and increasing the intake of milk and soy products can reduce or alleviate the occurrence of perimenopausal syndrome. Studies have also found that the occurrence of perimenopausal syndrome and joint pain in those who often drink tea is lower than that in those who do not drink tea, which may be related to the rich flavonoids in tea (including plant estrogens and isopropylflavones), as well as the fluorine in tea leaves, which can slow down osteoporosis, thereby enhancing the protective effect on bone density.

　　The survey also found that the proportion of people who often drink milk or eat soy products is related to their educational level. Those with higher education have a stronger awareness of self-care and pay more attention to the reasonable matching of nutrition, with higher intake of dairy and legume foods. Therefore, strengthening the education of women on nutritional health knowledge is also an important means to improve the symptoms of perimenopausal syndrome.

　　The following are the Western medical treatment measures for perimenopausal syndrome:

　　Hormonal Therapy

　　Estrogen therapy has been widely used in the treatment of perimenopausal syndrome and is considered to be the most effective method for treating hot flashes at present. Estrogen promotes the transfer of amino acids to the brain, regulates the production and metabolism of bioamine and enzymes in the central nervous system, which is conducive to a healthy mental state. Estrogen can improve memory and behavioral ability, which may be related to the increased action of estrogen on excitatory amino acids in the brain.

　　Hormone and Antidepressant Combination Therapy

　　A large number of studies have shown that the combination of estrogen and antidepressants is superior to the use of estrogen or antidepressants alone in the treatment of perimenopausal depression. Many studies have shown that depression during perimenopause is not simply due to changes in sex hormones within the body, and moderate to severe depression may have a more complex pathogenesis. Fluoxetine hydrochloride and estrogen may have a synergistic effect in the treatment of perimenopausal depression.

　　Non-pharmacological Treatment

　　In addition to medication, psychological treatment and social support are often neglected by clinical workers, and it is also very important to do a good job in these two aspects. Psychological treatment affects, changes the patient's feelings, cognition, emotions, and behavior through the influence of language, expression, attitude, behavior, and the surrounding environment, thereby improving the patient's psychological state, behavior patterns, and various somatic symptoms caused by them, making their personality develop in a more positive direction. In addition, for most women in this special physiological and psychological change period, entering the perimenopausal period itself is a stress, and good social support can provide protection and buffer the adverse effects of various life events on their mental health for those in a state of stress, which is conducive to health.

　　Comprehensive Treatment

　　The modern medical model advocates for individualized treatment methods. Although the use of various single treatment methods is effective for some patients, an increasing number of severe patients need comprehensive treatment to achieve the best efficacy.