Menopausal Transition

Women will have menstruation for at least 40 years of their lives, every month, and every year. After the age of 40, they will enter a transition period, which is also a common symptom of menopause. There will be functional decline, a decrease in ovarian hormones, and extremely unstable phenomena in the pituitary gland and various blood circulation systems. Let us learn about the transition period of menopause.

Symptoms and signs

1. Menstrual changes Menopause means the end of menstruation, but there are often changes in menstrual cycle and menstrual volume during the perimenopause period. It manifests as a shortened menstrual cycle, mainly a shortened follicular phase, anovulation and increased menstrual flow. For example, the rate of anovulatory menstruation in patients aged 26 to 40 is 3% to 7%, and that in patients aged 41 to 50 is 12% to 15%. Many people experience prolonged cycles of 2 to 3 months or longer, while their menstrual periods and blood volume are normal. A small number of people experience loss of menstrual cycles, irregular vaginal bleeding, increased menstrual flow, and even secondary anemia.

2. Hot flashes and sweating Hot flashes and sweating are the most important and specific symptoms of perimenopausal women. The incidence rate is 70% to 80%, and 25% to 50% can persist for more than 5 years. It manifests as bursts of fever, starting from the chest, rushing to the head and neck, and can spread to the whole body, followed by sudden sweating, accompanied by dizziness, palpitations, and fatigue, lasting from tens of seconds to several minutes, and the number of attacks ranges from more than 20 times a day to 1 to 2 times a week.

In the past, some people have measured that skin temperature rises during an attack and returns to normal after the attack. This may be related to the accelerated blood flow rate during the attack and has no further clinical significance. During a hot flash, although blood vessels dilate, there is no change in blood pressure.

Hot flashes are often a sign of ovarian failure. Many women do not have menstrual disorders but may experience hot flashes, which indicates a decline in ovarian function. A small number of women do not have hot flashes during menopause, and the symptoms only appear 10 to 20 years after menopause. In most cases, the symptoms are synchronized with menstrual changes, and the degree of hot flashes also fluctuates.

3. Psychoneural symptoms are mainly manifested as emotional instability, uncontrollable irritability, self-blame after temper tantrums, neurosis, stubbornness, inattention, insomnia, headache, memory loss, neurasthenia, depression and other symptoms. In severe cases, the symptoms are similar to those of mental illness. Its occurrence may be related to neurotransmitters such as serotonin and endorphins, as well as the individual's personality, occupation and cultural background. Sudden events in the family, such as death of loved ones, divorce, retirement, and children leaving home, may aggravate symptoms.

4. Urogenital atrophy After menopause, due to estrogen deficiency, the internal and external genitals, bladder, and urethra will atrophy. The vaginal folds become flat, the epithelium shrinks and becomes thinner, and during examination, capillaries can be seen penetrating the epithelium as scattered red spots, which can easily lead to infection. Therefore, senile vaginitis has become a very common disease in postmenopausal women.

Both the cervix and uterine body shrink, and flattening of the cervix is ​​often seen. The ovaries are atrophied and cannot be felt. If postmenopausal women feel their ovaries, they should be aware of tumors. Atrophy of the urinary system often manifests as frequent urination, urgency, and stress incontinence. Atrophy of the pelvic supporting tissue can cause uterine prolapse and bulging of the anterior and posterior vaginal walls. Genital atrophy can lead to pain during intercourse, difficulty in sexual life, and secondary loss of sexual desire.

5. Changes in secondary sexual characteristics: The breasts lose the cyclical effects of estrogen and progesterone and gradually shrink and sag. The skin loses the effect of estrogen, the mitosis of epidermal cells decreases, and the skin becomes thinner, loses elasticity, and wrinkles appear.