Patient's question:
Female, 49 years old. Menopausal hypertension. Unstable blood pressure. Tried many antihypertensive drugs (Captopril, Eprosartan, Nifedipine), but none were very effective. Currently experiencing frequent headaches, overall weakness, and insomnia. Any good solutions?First follow-up question: Currently, blood pressure is generally around 80/140 after medication during the day, but it rises to 100/150 in the evening, and this pattern is almost the same every day, so the head often hurts. Is there any good way to solve this? (Currently taking Nifedipine)
Doctor's answer:
Hello: Then could you please ask what the current blood pressure is? During menopause, the body needs a self-regulating adaptation period. At this time, it is important to arrange life reasonably, ensure adequate sleep, and properly address the physical changes that occur during menopause, without overly worrying about the discomforts of menopause. Generally, special treatment is not required. If the symptoms are more pronounced, such as headaches, dizziness, insomnia, or emotional instability, symptomatic treatment with sedative and hypnotic drugs can be used. For example, diazepam 2.5–5 mg, taken three times daily, or 5–10 mg taken at bedtime. Gamma-oryzanol has the effect of regulating the function of the autonomic nervous system. A common dosage is 10–30 mg, taken three times daily. Vitamin B6, vitamin E, and compound vitamin B can be used as appropriate. Oral traditional Chinese medicine such as Menopause Comfort Tablets (3 tablets each time, three times daily) and Schisandra Syrup or Modified Xiaoyao Pills can also be effective in reducing symptoms.If the symptoms of menopausal syndrome are severe and the above treatments are ineffective, or if vaginal infections and sexual dysfunction occur due to decreased estrogen levels, estrogen supplementation can be appropriately used to alleviate some menopausal symptoms. However, long-term estrogen use may stimulate endometrial growth and increase the risk of cancer, so it should be used with caution. Dosage:
① Estriol 1–4 mg, taken once daily, for 3 weeks, followed by a 1-week break.
② Nylestrin 5 mg, taken monthly orally. After symptom improvement, the dose can be reduced to 1–2 mg, taken twice monthly.
③ For women with menopause accompanied by excessive menstrual bleeding, it is best to undergo a diagnostic D&C to rule out other conditions. Additionally, androgens such as methyltestosterone (10 mg daily, taken twice under the tongue, for 10–15 days) or testosterone propionate can be used.