Menopausal syndrome

Author: Cai Shu'tao
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Publishing Date: 2005-04-01
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(III) Differential Diagnosis During the 45-55 age range, some women may experience symptoms of menopausal syndrome, such as hot flashes, excessive sweating, and physical discomfort. However, some symptoms may also be manifestations of other organic diseases of the body and must be carefully differentiated.
1. Neurosis in Menopause
Menopause is the transitional period from middle age to old age, during which the body's metabolism and endocrine functions, especially gonadal function, gradually transition to aging and remain in an unstable stage. This makes it easier for the body to become unbalanced under the influence of psychological or physical factors. Menopausal syndrome is the result of this imbalance, with clinical manifestations primarily being symptoms of endocrine and autonomic nervous system disorders. Patients often experience headaches, dizziness, insomnia, trembling hands, sensitivity to sound and light stimuli, emotional irritability, excitability, and fatigue. Additionally, patients exhibit significant symptoms of autonomic and endocrine dysfunction, such as palpitations, blood pressure fluctuations, chest tightness and shortness of breath, episodic facial flushing, alternating hot and cold sensations, excessive sweating, and numbness in the limbs. Gastrointestinal dysfunction is manifested as reduced appetite, discomfort in the stomach, and constipation. Most patients have menstrual irregularities and decreased sexual function, though occasionally, some may experience hypersexuality. Under unpleasant psychological stimulation, some patients may have hysterical episodes, characterized by the body becoming rigid, limb convulsions, and later, loud complaints of distress. The symptoms of this condition can persist for a long time before gradually improving. However, some patients may further develop into more severe menopausal depression or menopausal paranoid states. Since menopausal syndrome often accompanies symptoms similar to neurosis, it is often easily confused with neurosis. However, this syndrome occurs during menopause and is accompanied by significant autonomic and endocrine dysfunction, especially changes in sexual function, which can help distinguish it from neurosis.
2. Hypertension
Some women may experience elevated blood pressure during menopause, but primarily systolic pressure rises, while diastolic pressure remains relatively stable. Blood pressure fluctuates significantly throughout the day, often returning to normal range after sleep. It is commonly accompanied by hot flashes and excessive sweating. Fundoscopic and electrocardiogram examinations show no changes. In contrast, hypertension often presents with persistent elevated blood pressure, with both systolic and diastolic pressures exceeding normal levels, and is often accompanied by symptoms such as dizziness and palpitations. The heart, brain, and kidneys may also suffer varying degrees of damage.
3. Coronary Heart Disease
During menopause, autonomic nervous system dysfunction can disrupt vascular contraction and relaxation, leading to chest pain characterized by persistent dullness. Sublingual nitroglycerin is ineffective. In contrast, angina pectoris in coronary heart disease occurs in the lower sternum or chest area, with pain being compressive or suffocating, radiating to the left arm. Sublingual nitroglycerin can relieve the pain, and the onset is related to emotional activity and physical exertion.
4. Esophageal Cancer
Women in menopause often feel a foreign body sensation in the throat, unable to swallow or vomit it, but without affecting swallowing. All examinations are normal. In esophageal cancer, dysphagia is progressive, and the patient experiences gradual weight loss. Barium meal X-ray examination and esophageal smear tests can reveal pathological changes.
5. Cervical Cancer and Uterine Fibroids
Menopausal syndrome often occurs in the premenopausal stage, during which menstrual disorders may arise. This is also the peak age for cervical cancer and uterine fibroids. Therefore, regular gynecological examinations are necessary, and cervical scraping biopsies and endometrial biopsies may be required when necessary. Women with menstrual abnormalities should seek medical attention promptly for a clear diagnosis to avoid delayed treatment.
### Related Diseases of Menopausal Syndrome
#### (I) Vaginitis
1. Trichomoniasis
Trichomonas vaginalis is a small single-celled organism visible under a microscope. It is about two orders of magnitude larger than human white blood cells and has four flagella at its tip, allowing it to move in place. It has strong adaptability to the environment and can survive for several hours outside the human body, making it highly contagious. It can survive, multiply, and reproduce in areas with less oxygen, such as the deep vagina. The vaginal pH becomes more suitable for trichomonas during the premenopausal period before menstruation and during pregnancy. During menopause, ovarian function declines, affecting the thickness of the vaginal mucosa and the content and metabolism of glycogen, which benefits the survival of trichomonas. Therefore, menopausal women are more susceptible to trichomoniasis. However, trichomoniasis is primarily transmitted through sexual contact; indirect transmission through contaminated bathtubs, toilet seats, or instruments is also possible. If everyone takes precautions, avoiding unsterilized or unclean bathtubs and using others' instruments, towels, clothing, bedding, and other items that may carry trichomonas, transmission can be prevented. If the male partner has urethral trichomoniasis, both should be treated simultaneously. The drug for treating vaginal trichomoniasis is metronidazole, which can be taken orally at 200 mg per dose. Vaginal suppositories are more effective. However, multiple follow-up examinations are necessary after recovery to monitor for recurrence. Locally applied acidic or alkaline drugs can also kill trichomonas. Additionally, estrogen treatment for menopausal syndrome can enhance the resistance of the vaginal mucosa, benefiting the prevention and treatment of trichomoniasis.
2. Candidiasis
Candidiasis is caused by Candida albicans, a fungus that can in normal human skin or mucosa. It may not cause inflammatory symptoms in daily life, but when the body's resistance decreases or long-term use of antibiotics or corticosteroids disrupts vaginal flora, leading to reduced infection resistance, it can cause prominent vulvovaginal itching, excessive vaginal discharge, redness, swelling, or even erosion of the vulva and vagina. Young girls and menopausal women, due to low estrogen levels, experience faster Candida growth and more severe vulvar itching. Prevention is key. Avoid using antibiotics casually, especially broad-spectrum antibiotics and corticosteroids. Diabetic patients should lower blood sugar and pay attention to skin and vulvar hygiene. Both trichomoniasis and candidiasis are classified by the World Health Organization as sexually transmitted diseases, making sexual hygiene particularly important. During treatment, sexual intercourse should be avoided until tests return negative. While taking medication daily, change underwear frequently, and use methods such as sunlight exposure or boiling to eliminate pathogens, avoiding reinfection during treatment.
3. Atrophic Vaginitis
Atrophic vaginitis, previously referred to as senile vaginitis, is a common condition in menopausal women. In adult women, estrogen promotes the presence of a certain amount of glycogen in the vaginal epithelium. Under the action of lactobacilli, some glycogen is converted into lactic acid, creating an acidic vaginal environment. Except for lactobacilli, no other bacteria can survive in this acidic environment. This is the vagina's natural protective mechanism. If this protection is weakened, various bacteria can invade the vagina and multiply, causing vaginal mucosal inflammation, which is vaginitis. Postmenopausal elderly women, due to declining ovarian function and estrogen levels, experience atrophy of the reproductive organs, reduced glycogen content in the vaginal mucosal epithelium, and insufficient production of lactic acid. This leads to a decrease in vaginal acidity (sometimes even neutralizing it), significantly weakening local resistance, making it easier for external bacteria to invade and multiply, causing vaginal mucosal infection and inflammation, known as atrophic vaginitis. This condition primarily affects elderly women, with 30% of postmenopausal women suffering from it. It can also occur in individuals undergoing artificial menopause or prolonged breastfeeding without reaching menopause. Therefore, referring to this condition as atrophic vaginitis is more appropriate than senile vaginitis.