What are the projects for menopausal health management?

Menopausal health management has never been as simple as "drawing blood to check hormones" as everyone thinks. The core is a full-cycle action of "early screening to hide risks + personalized symptomatic intervention + long-term dynamic follow-up". The ultimate goal is to relieve current discomfort and reduce the risk of chronic diseases in the elderly.

Last week, a 47-year-old lady came to my clinic. When she came in, she said that she had been having hot flashes, night sweats, and couldn't sleep well, so she wanted to get her estrogen checked to see if she needed to take supplements. I added a bone density and pelvic floor function screening to her, and the results showed that her bone mass was close to osteoporosis. An abdominal B-ultrasound also found a newly grown endometrial polyp. She had not noticed it at all before, and thought that her back pain and leaking urine were caused by taking care of her grandson.

If you are doing menopausal management for the first time, you must do a regular basic physical examination first. Don’t think that these have nothing to do with menopause. I have seen too many people whose blood lipids and blood pressure were normal before menopause, but suddenly spiked six months after menopause. In fact, the decline in estrogen affects lipid metabolism and blood vessel elasticity. These basic indicators are the bottom line for all subsequent interventions. Then comes the targeted specialist examination. In addition to the six commonly heard sex hormones, it is best to also test the anti-Mullerian hormone, also known as AMH. You can understand this indicator as the "remaining power" of the ovary, which can more accurately reflect the decline of ovarian function than a single hormone level. ； Gynecological TCT, HPV, breast ultrasound, and pelvic ultrasound are must-dos. They can screen out lesions that may be caused by hormone fluctuations at the first time. There are two other items that are particularly easy to be ignored: bone density and pelvic floor function assessment. The bone loss rate in the first 5 years after menopause is 3-5 times that of usual. It will be too late to supplement calcium after a fall and fracture. And early rehabilitation training for mild pelvic floor relaxation and leakage can completely avoid the trouble of needing surgery when you are older.

When it comes to intervention, the most controversial one is hormone supplementation therapy. Some people think that hormone supplementation will cause cancer and will not touch it until death. Some people think that hormone supplementation is necessary to prevent aging during menopause. In fact, both of these ideas are too extreme. The current academic consensus is that as long as there are clear indications and no contraindications, treatment should be initiated within 10 years of menopause or before the age of 60. The benefits of hormone supplementation far outweigh the risks. It can relieve hot flashes, improve bone mass, and reduce the risk of cardiovascular disease at the same time. However, if you have a family history of breast cancer, unexplained vaginal bleeding, or active liver disease, you must not use it. You must find a specialist to evaluate which plan is suitable. Do not buy health care products or follow the trend of taking medicine.

Not all problems need to be solved by taking medicine. For many people with mild symptoms, lifestyle adjustments are enough. I usually give such patients a very simple plan: drink more than 300ml of pure milk every day, eat a pound of vegetables and half a pound of fruits, walk for 40 minutes three days a week, plus 10 minutes of pelvic floor muscle training every day. For many people, if they insist on it for two months, the symptoms of hot flashes and insomnia are relieved by more than half. By the way, many people still ignore the evaluation of mood and sleep. I once had a patient who suffered from insomnia for more than half a year, and even taking sleeping pills did not help. Later, the evaluation found that it was a sleep disorder caused by menopausal hormone fluctuations. I added some low-dose phytoestrogens to her, combined with a small method of breathing adjustment before going to bed, and she was able to sleep through the night in three weeks.

The 47-year-old sister I just mentioned had a minor surgery for endometrial polyps, and she took some calcium and vitamin D supplements. She followed my diet and exercise plan for three months. She came for a follow-up check last week and found that her hot flashes were reduced by 80% and her waist no longer hurts. She also said that she no longer leaks urine during square dancing. In fact, many people think that menopause is just a matter of "getting through it once and for all." However, if you really manage it well, you will not only suffer less in the present, but also lay a good physical foundation for the next 20 to 30 years of old life. No matter how you calculate it, it is cost-effective.