Menopause

　　Menopause is the result of the natural decline in ovarian function, indicating the termination of ovarian reproductive function. Women's ovaries generally begin to age in the middle stage of life, and the termination of fertility is significantly earlier than a distinct biological characteristic unique to humans.

　　1. Age of menopause
　　The age of menopause reflects the reproductive lifespan of the ovaries. Cell aging is the result of menopause and factors affecting the age of menopause include genetics, nutrition, body weight, altitude of the living area, smoking, etc.

　　2. The impact of genetic factors on post-menopausal women
　　The DNA sequence of humans and its variation reflects the process of human evolution. Studying the variation of DNA sequences (i.e., polymorphisms) in different populations and individuals helps to understand human physiological changes, the occurrence and development of diseases, and the response to drug treatment.

　　3. Ovarian aging
　　The decrease in follicles and the aging of ovarian morphology, as well as the decline in ovarian function.

　　After menopause, there will generally be a variety of complications, the common ones are as follows:

　　1. Senile vaginitis
　　Normal women of childbearing age secrete estrogen from the ovaries, causing the vaginal mucosal epithelium to proliferate and thicken, with strong antibacterial ability. After menopause, the ovarian function declines, the level of estrogen decreases, the content of glycogen in the epithelial cells decreases, the vaginal pH value rises, changing from acidic to alkaline, which is unfavorable for the survival of vaginal lactobacilli, leading to weakened self-cleaning function of the vagina. At the same time, due to the atrophy and thinning of the vaginal wall, insufficient blood supply, the local resistance decreases, making it susceptible to infection by other parasitic flora in the vagina, causing senile vaginitis. It is often caused by general pathogenic bacteria, such as staphylococcus, streptococcus, Escherichia coli, or anaerobic bacteria, etc.

　　2. Osteoporosis
　　After menopause, the lack of estrogen can cause increased bone resorption, impaired intestinal calcium absorption, reduced secretion of calcitonin, reduced bone formation, and weakened inhibition of osteoclasts, leading to increased bone mass loss. Starting from the perimenopausal period, the average annual rate of bone mass loss is 1% to 3%, even 5%, and it lasts for 5 to 10 years. Then, the bone mass is relatively stable with less loss for about 10 to 20 years, and after the age of 70, there is an accelerated loss of bone mass due to aging.

　　3. Osteoarthritis
　　The loss of sex hormone protection and abnormal levels of related cytokines in post-menopausal women play an important role in the pathogenesis of osteoarthritis. Hormone replacement therapy (HRT) after menopause has a certain relieving effect on the pain symptoms of knee osteoarthritis.

　　4. Urinary incontinence during menopause
　　From perimenopause to menopause, women gradually enter old age, and changes occur in all organs of the body, with changes in the urinary and reproductive systems becoming increasingly significant. The lack of estrogen causes the pubococcygeal muscles, fascia, and ligaments to relax, the function of supporting tissues to decline, and the inability to maintain the normal position of the urethra and bladder tension. When increased abdominal pressure is applied due to coughing, straining, constipation, and other factors, urine may be involuntarily discharged. The characteristic is that there is no urinary incontinence in normal conditions, but urine is automatically discharged when abdominal pressure suddenly increases.

　　5. Urinary tract infections in perimenopausal women
　　The causes of urinary tract infections in elderly women include the reduction of keratinized cells, which reduces the self-cleaning function of the vagina, making it easier for bacteria to reproduce in the vestibule and vagina. Although women are prone to urinary tract infections, whether they occur mainly depends on the intrinsic factors of the body, which are closely related to the weakening of the body's resistance, changes in the anatomical and physiological characteristics of the urethra, and abnormalities in the internal environment.

　　Menopause represents the decline of ovarian function, the exhaustion of estrogen secretion, the cessation of menstruation, and the termination of reproductive function. Generally, it is divided into three stages: the pre-menopausal period, the menopausal period, and the post-menopausal period. Menopause is calculated based on the time of the last menstrual period in women over 40 years old, with most women experiencing menopause between the ages of 45 to 55.
　　After menopause, due to the sudden and significant lack of estrogen, some discomforts and diseases may occur, and some may occur before the menopausal period. Patients often show changes in mood and emotions, such as irritability, excitability, insomnia, anxiety, inner restlessness, depression, episodic facial flushing, hot flashes, and sweating. In addition, there is also dry skin, and the skin loses elasticity, wrinkles increase, muscles become loose, and fatigue or weakness, headache, dizziness, and unstable blood pressure may occur.

　　To prevent early menopause, it is necessary to adhere to a habit of drinking milk and consuming foods such as fish and shrimp regularly. Regular physical exercise is encouraged, as well as advocating a healthy and beneficial lifestyle, especially in public places and at home, to quit smoking and avoid passive smoking. In addition, postpartum breast-feeding is encouraged, and the duration of lactation should be extended as much as possible. Women of childbearing age can use oral contraceptives for contraception to avoid the harm to health caused by early menopause.

　　The diagnosis of menopause, in addition to clinical manifestations, is also an indispensable diagnostic method. The commonly used examinations are as follows:
　　1. Sex hormone measurement 主要包括血卵泡雌激素(FSH)、黄体生成素(LH)、雌激素总量(TE)、雌酮(E)以及雌二醇(E2)测定。
　　2. Vaginal or pelvic ultrasound Understand the condition of the uterus and adnexa, and exclude gynecological organic diseases.
　　3. Vaginal smear examination Observing the cell morphology can reflect the level of estrogen in the body.
　　4. X-ray photographs It can be seen that the cortical bone becomes thin, the interstitial pores of the cortical bone of the tubular bones become larger, the special trabecular bone structure of the femoral neck and the trabecular bone (vertebral body) is lost, which can indicate osteoporosis.

　　In addition to conventional treatment, diet is also an indispensable auxiliary treatment measure for menopause. The main dietary precautions are as follows:

　　First, suitable diet
　　1. It is necessary to consume more vegetables, fruits, and root vegetables like potatoes and carrots to supplement vitamins, fiber, inorganic salts, and water. It is also necessary to consume more foods rich in thiamine and niacin, such as mixed grains, brown rice, and legume products. Thiamine has a certain calming effect, while niacin can dilate blood vessels, which is beneficial for lowering blood pressure.
　　2. Some foods like kelp, seaweed, mushrooms, black fungus, onions, and garlic can help lower blood lipids. When cooking, it is necessary to use vegetable oil and reduce the consumption of fried foods. In addition, attention should be paid to reducing the intake of salt, with no more than 10 grams per day as a general guideline.
　　3. Adequate intake of foods rich in B vitamins should be ensured, such as oatmeal, barley, corn, and other cereal grains, as well as green leafy vegetables like spinach, which are rich in B vitamins. Other foods like onions and garlic not only contain abundant B vitamins but also contain minerals and have good lipid-lowering effects, so they can be consumed more. In addition, fresh vegetables and fruits with high vitamin content and low cholesterol should be consumed more, especially fruits like kiwi, apple, and pineapple, which can be consumed more.
　　4. Due to the decrease in estrogen levels in women during menopause, osteoporosis is prone to occur. Therefore, women during menopause should frequently consume high-calcium foods, such as tofu, bean curd, soy milk, and bean jelly, as well as algal foods.

　　Second,禁忌饮食
　　4. Reduce the consumption of fatty meats and foods high in cholesterol, such as fish roe, chicken skin, and duck skin.
　　5. Reduce the intake of caffeine-containing foods, such as coffee, alcohol, and strong tea.
　　3. It is necessary to control salt intake and reduce the consumption of sweets. This is because women during menopause have changes in endocrine function, disturbances in water and salt metabolism, which are prone to edema and may further lead to increased blood pressure. Therefore, the amount of salt should be controlled as much as possible. Since the sugar and fat metabolism of women during menopause are often disrupted, it is easy to have elevated blood sugar, elevated blood lipids, obesity, and the risk of diabetes. Therefore, it is necessary to control the intake of sugar and reduce the consumption of sweets.

　　The treatment of menopause should be aimed at maintaining the health of the body, and long-term medication is required for the prevention of degenerative diseases after menopause. The specific treatment methods are as follows:

　　1. Etiological Treatment
　　During the reproductive period, due to the cyclic changes of estrogen and progesterone in the blood, they participate in coordinating the physiological activities of the body and become an important factor in stabilizing the internal environment of women and maintaining health. After menopause, due to the sustained low level of estrogen and progesterone, women's physical and mental functions are out of balance, leading to a series of degenerative changes that cause some women to have poor physical health. Appropriate etiological treatment is given to these health problems caused by the lack of estrogen.

　　2. Physiological Supplementation
　　The purpose is to allow the organs of post-menopausal women to function physiologically as much as possible, to maintain health, and not to restore the endocrine status to the level of the ovarian cycle during the reproductive period, which is physiological supplementation. Physiological supplementation mostly advocates the use of natural estrogens, that is, estrogens with the chemical structures of estrone, estradiol, and estriol.

　　3. Hormone Replacement Therapy (HRT) during the perimenopausal period should focus on progesterone supplementation
　　The growth and development disorders of follicles gradually increase during the perimenopausal period, and finally, the functional follicles disappear from the ovary. The corresponding changes in estrogen and progesterone during this period are: first, a relative deficiency of progesterone, then a lack of it; estrogen deficiency shows no periodic changes, although there may be transiently relatively high levels, the total amount gradually decreases, and finally becomes deficient, forming a relatively excessive or single estrogen stimulation without opposition for a long period of time. Some women may experience varying degrees of endometrial proliferative changes, leading to malignancy. Therefore, this period should focus on cyclically supplementing progesterone to adjust the menstrual cycle and prevent proliferative changes of the endometrium. With the gradual lack of estrogen, it is also necessary to supplement estrogen and other hormones.

　　4. The post-menopausal period should focus on estrogen supplementation
　　The early ovarian follicular activity basically stops after menopause. The concentration of estradiol in the blood decreases from about 150 to 1500 pmol/L during the reproductive period to below 80 pmol/L within 1 to 2 years, which is lower than the basic level to maintain the physiological function of the organs. The atrophy of the endometrium is completed within 2 to 3 years after menopause, and the rate of bone loss is the fastest within 1 to 3 years after menopause, with corresponding degenerative changes in all organs of the body. Therefore, to prevent degenerative changes after menopause, it is necessary to supplement estrogen in a timely and long-term manner. To counteract the side effects of estrogen on the endometrial hyperplasia, those with uterus need to add progesterone.