What are the projects for menopausal health management?

The core is a comprehensive health assessment and personalized intervention during perimenopause. It is far from just drawing blood to check estrogen as everyone thinks.

Last week I saw a 49-year-old sister named Zhang. When she came in, she asked for an estrogen test. She said that she had been sweating for the past six months and couldn't fall asleep until two or three o'clock while making pancakes. Sometimes she felt like losing her temper for no reason. She posted a short video saying that she was in menopause and that she just needed to take some estrogen supplements. I asked a few more questions, and she said that she had been flustered many times before, and that she had gone to the cardiology department three times for electrocardiograms and color Doppler ultrasounds, and there were no problems. Her menstruation had been irregular for almost a year, and sometimes it came once every two or three months, and the amount was sometimes large and sometimes small.

In fact, there are many people like Sister Zhang who come to the clinic. They either think that menopause only requires a hormone test, or they think that it will pass without any care. This is really a misunderstanding. Basic reproductive-related assessment is definitely the first step. Six items of sex hormones and AMH (Anti-Müllerian hormone) can visually show the reserve status of the ovaries. Gynecological ultrasound must also be done together to see the thickness of the endometrium and whether there are any abnormal space occupied by the ovaries. After all, in this age group, there are benign and malignant gynecological tumors. I met a 52-year-old aunt who had hot flashes for two years. She took soy isoflavones at home for two years, and she didn’t take it seriously after menopause for more than half a year. During the final physical examination, it was found that the thickness of the intima was 16mm, and the result was atypical hyperplasia. Fortunately, it was discovered early and it did not develop into malignant disease.

Nowadays, many people say that you can just look at the symptoms during menopause and don’t need to do so many tests. This is actually half right and half wrong. If you already have very typical symptoms of hot flashes, night sweats, menstrual disorders, and emotional loss, you can basically judge that it is a perimenopausal problem. However, it is more important to check for other confounding problems. For example, abnormal thyroid function can also cause panic, sweating, and emotional irritability. Many people just encounter Hashimoto’s thyroiditis during menopause, and menopausal adjustments alone are useless.

In addition to reproductive-related assessments, systemic metabolic and skeletal examinations are also important. Estrogen used to be like a "protective membrane" for blood vessels and bones. Once ovarian function declines, estrogen drops off a cliff, and bone mass is lost every year at a rate 3-5 times that of when they were young. I have seen several people in their 50s. My aunt suffered a broken wrist and a compression fracture of her lumbar spine after a fall. Her bone mass had already fallen into osteoporosis and she didn’t even know it yet. So it’s best to have her bone density checked once a year. Bone metabolism indicators can also be measured at the same time. If you already have frequent low back and leg pain or leg cramps in the middle of the night, don’t bear it. There are also basic metabolic indicators such as blood lipids, blood sugar, and blood pressure. The risk of cardiovascular and cerebrovascular diseases in women after menopause is 2-3 times higher than before menopause. Many people have normal blood lipids before, but they tend to rise once they reach menopause. These all need to be monitored regularly.

There are also emotional and sleep assessments that many people ignore. I previously treated a 51-year-old aunt who was in a very bad state when she came in. She said she didn’t want to do anything and always felt that life was boring. Her family also said that she was idle and had nothing to do. Finally, the scale assessed that she was moderately anxious and depressed. I adjusted the hormone supplement plan and added weekly psychological counseling. I came back for a follow-up visit in half a month. Her overall condition improved. She said she could finally sleep through the night and no longer wanted to lose her temper.

When it comes to hormone supplements, many people will probably immediately think of "whether it causes cancer." This is also the most controversial point now. In fact, low-dose natural or nearly natural hormones are currently used clinically. As long as the contraindications are checked in advance, such as no history of breast malignant tumors and no serious liver and kidney dysfunction. , there are no high risk factors for blood clots, follow the doctor's advice, and check regularly. The benefits far outweigh the risks. It is definitely more reliable than buying health care products that claim to delay menopause. However, if there are indeed contraindications and you cannot use hormones, you can also improve symptoms through plant medicines and lifestyle adjustments. Don't be too anxious.

In fact, menopause is a physiological stage that every woman must go through. It is not something shameful, and there is no need to endure it. Finding the right management program that suits you and making a comfortable transition are more important than anything else.