Menopause Health Management Archives

Improve your quality of life without causing additional health risks.

Last week, a 48-year-old middle-level lady from a state-owned enterprise came into my clinic. She took off her scarf to wipe her sweat as soon as she walked in. On a northern day in November, she was only wearing a thin shirt. She said she had just had a department meeting and just stood up to speak when suddenly a wave of heat rushed from her chest to her head. Sweat flowed down the back of her neck. All her subordinates were staring at her, and she wanted to find a crack in the floor to crawl in. She endured it for almost a year. She always heard people say that menopause is a normal physiological process and that she can just wait until menopause. As a result, not only have the hot flashes become more frequent recently, she can't sleep all night long, and even the joints in her bones have started to ache. However, the physical examination was normal. Finally, her daughter dragged her to my place.

There is indeed a lot of controversy about menopausal intervention, and there is no absolute right or wrong. Mainstream guidelines in the field of obstetrics and gynecology clearly state that as long as the patient is within 10 years of menopause, is younger than 60 years old, and has no contraindications to menopausal hormone therapy (MHT) (such as estrogen-dependent tumors, unexplained vaginal bleeding, active thrombotic diseases, etc.), the benefits far outweigh the risks with hormone supplementation at the lowest effective dose. It can not only quickly relieve physical symptoms such as hot flashes and insomnia, but also prevent long-term osteoporosis and cardiovascular disease. ； However, many practitioners, including some Chinese medicine practitioners, believe that external hormones will interfere with the body's original rhythm of decline. "It is a medicine that is three parts poison." If you can't use it, don't use it. It is also recommended to use traditional Chinese medicine and adjust your diet and rest to get through it smoothly. ； There is also a group in the middle that focuses on mild intervention, using ingredients such as black cohosh extract and phytoestrogens to improve symptoms, and can achieve good results without hormones.

I have been doing menopausal health management for almost 8 years and have saved almost 2,000 files. To be honest, I have prescribed all three options to patients. It all depends on individual suitability. For example, Sister Zhang has grade 3 breast nodules and is particularly resistant to hormones. I did not prescribe her hormones. I prescribed her purified black cohosh extract and asked her to do weight-bearing strength training for half an hour three days a week, and to do 10 minutes of mindful breathing before going to bed every day. She came for a follow-up visit this month and said that the number of hot flashes had dropped from 12 times a day to 2 times. She was able to sleep through the night and never sweated again during meetings. There was a 49-year-old sister Li who had stopped menstruating for half a year. Her menopausal symptoms were so severe that she didn’t even want to go downstairs. Her bone density had reached a low level. She had no contraindications to hormones. She was willing to try it, so she was given the lowest dose of combined estrogen and progesterone regimen. After three months of follow-up, her bone density was stable. Now she goes hiking with friends every day, and her spirits are much better than before.

People often ask me based on online posts, can drinking soy milk every day supplement estrogen? Can it be an alternative to medicine? In fact, the estrogen-like activity of soy isoflavones is only one thousandth to one ten thousandth of human estrogen. If your symptoms are very mild and you feel comfortable drinking one cup a day, that’s absolutely fine. If you have such hot flashes that you can’t go to work normally, it doesn’t matter how much soy milk you drink. Don’t delay things. Some people also ask whether practicing yoga and square dancing are useful? I have a 51-year-old patient who dances square dance for an hour every morning and practices yoga for half an hour at night. He takes no medicine and has almost no obvious reaction to menopause. Do you think it helps?

Many people tend to ignore psychological adjustments. They always think that bad temper and crying during menopause are just "middle-aged women's pretentiousness". This is not true. I once met a 52-year-old aunt who was a kindergarten principal before retiring. She had a very cheerful personality. After retirement, she suddenly didn’t want to go out. She sat on the sofa and cried every day. Her family thought she was just looking for something to do. Finally, I checked and found out that she was suffering from moderate depression associated with menopause. She later received psychiatric anti-anxiety treatment and a small dose of hormone adjustment. After half a year, she returned to work as a volunteer kindergarten principal. She was as chatty and laughing as before. Hormone fluctuations will directly affect neurotransmitter secretion. Poor mood is really not your problem. If you need help, seek help.

There is also a common misunderstanding that people will gain weight and become ugly during menopause. My patient who started to exercise at the age of 50 gained 10 pounds during menopause. Later, he practiced strength with a coach three times a week and slightly controlled his high oil and sugar intake. Now his body fat rate is 22%, and his waistcoat line is visible. He wore a waist-revealing dress last time for a follow-up visit, and he looked more energetic than many 30-year-old young people. In fact, gaining weight is not caused by menopause. It is caused by the loss of muscle mass and the decrease of basal metabolism with age. If you retain the muscle mass, you will not gain weight out of thin air.

Now every time I update a patient's file, I handwrite a note at the end: "Comfort is the most important thing." To put it bluntly, menopause is a signal sent by your body, telling you that you were busy taking care of your family and working hard in the first half of your life, and forgot to take care of yourself. Now it is time to turn your attention back to yourself. There is no need to compare with others. Just because others are fine without medication does not mean that you are right. Others have good results with hormones, which does not mean that you are also suitable. How to feel comfortable is better than any standard answer.