Patient's question:
I always feel sleepy, don't eat much, sleep is okay, and my bowel and bladder functions are normal. In October 2009, could it be menopause?Doctor's answer:
Based on the information you provided, you may have entered the premenopausal stage.Guidelines:
(1) Changes in menstruation
1. Menstrual frequency refers to cycles shorter than 21 days, often accompanied by spotting before menstruation or prolonged bleeding. The primary cause is usually luteal phase deficiency.
2. Menstrual infrequency refers to cycles longer than 35 days, caused by sparse ovulation, often accompanied by reduced menstrual flow.
3. Irregular uterine bleeding occurs due to functional dysmenorrhea caused by the cessation of ovulation.
4. Amenorrhea occurs when ovarian synthesis of hormones decreases significantly, leading to the atrophy of the endometrium under the influence of estrogen and progesterone, resulting in no proliferation or shedding.
(2) Vasomotor instability
Symptoms include hot flashes and sweating, sometimes accompanied by headaches. Hot flashes are a characteristic symptom of perimenopausal and postmenopausal women, though only about 15%-25% of women experience them, with severe symptoms affecting approximately 10%-20%. Symptoms may occur at any time, with about 41% appearing after age 39, especially during menstrual irregularity, being most severe 1-2 years before menopause. About 10% experience daily recurrence or frequent daily episodes, with 50% reporting distress. Fewer cases occur after menopause. About 85% of women experience symptoms for more than a year, with 25%-50% for 5 years. Symptoms may gradually improve or disappear naturally as menopause progresses, though about 10%-15% persist for 10-15 years or longer.
Typical manifestations:
Sudden heat in the upper body, spreading from the chest to the head, sometimes accompanied by a stuffy head, dizziness, or weakness, lasting from seconds to 30 minutes. Profuse sweating or chills often follow before symptoms subside. Due to frequent nighttime occurrences, sleep is disrupted, leading to fatigue, poor concentration, and memory loss. Mild cases recur every few days, while severe cases may recur dozens of times daily.
Signs of recurrent hot flashes:
Redness of the face, neck, and chest; increased temperature in the upper limbs; normal or slightly decreased body temperature; and unchanged blood pressure.
(3) Autonomic nervous system instability
Symptoms include palpitations, dizziness, insomnia, and abnormal skin sensations. These often accompany hot flashes, though some women experience only one or a few of these symptoms without hot flashes.
(4) Mental and psychological symptoms
Such as depression, anxiety, suspicion, reduced self-confidence, poor concentration, irritability, fear, or even psychogenic-like symptoms.
(5) Cardiovascular symptoms
1. Elevated or fluctuating blood pressure.
2. Palpitations or irregular heartbeat.
(6) Changes in libido
Perimenopausal women often report decreased libido but no pain or difficulty during intercourse. A few may experience increased libido. The reasons for decreased libido are often attributed to "getting older and not needing it," which reflects a misconception and psychological. Some believe sexual activity is only for reproduction, leading to lack of initiative or interest, or even self-doubt about sexual attractiveness, disrupting harmony.
Sexology views sexual behavior as a product of physiology and psychology, and human libido does not necessarily align with hormone levels. Thus, many women experience increased libido after age 50. From a medical perspective, regular sexual activity benefits both men and women's physical and mental health.
II. Postmenopausal clinical manifestations
(1) Atrophy of the urinary and genital organs
Generally occurs after menopause and worsens with age. Without treatment, atrophic changes persist lifelong.
1. Symptoms
(1) Dryness or itching of the external genitalia and vagina. Increased vaginal discharge or odor may occur with infection.
(2) Hemorrhagic vaginal discharge or postmenopausal bleeding.
(3) Dyspareunia.
(4) Urgency or incontinence.
2. Signs
(1) Atrophy of the external genitalia.
(2) Atrophy of the vagina.
(3) Atrophy and shrinkage of the cervix and uterus.
(4) Reddening or presence of papillae at the urethral orifice due to atrophy.
(2) Changes in body shape
1. Sagging and soft breasts.
2. Enlarged abdomen and buttocks.
3. If combined with osteoporosis, height may decrease, leading to hunchback and an anteriorly protruding abdomen. Walking may involve outward-pointing feet and a staggering gait.
Don’t worry—it’s not another disease!