When you were young, you might have heard the grandmothers and aunts from the neighborhood quietly complain about “hot flashes” and “insomnia.” Little did you know that as time goes by, even your own mother and you in the future will have to face this day.
At some point, the term “menopause” has been completely stigmatized, becoming a synonym for “irritability, anger, and disruption of family harmony,” yet turning a blind eye to the suffering that women silently endure behind these negative descriptions.
As a result, “menopause” has increasingly been labeled as “embarrassing” and “shameful,” making many women feel ashamed to face it and seek help, missing out on opportunities that could make their lives better.
Menopause is not a disease,
nor should it be stigmatized
Menopause is a common term, and in 1994, the World Health Organization (WHO) recommended replacing the term “menopause” with “perimenopause” to better describe this stage.
The average age of menopause for Chinese women is around 49 years old, but there is still a significant variation in the age at which individuals enter perimenopause. According to data published by The Lancet in 2024:
2-4% of women experience a decline in ovarian function before
40 years old,
8-10% of women have reached menopause by the age of
40-44;
●
50% of women begin perimenopause at
45 years old, and around
51 years old
50% of women have reached menopause, with the rest in perimenopause.
The duration of perimenopause varies from person to person, ranging from 3-4 years to as long as 8-10 years.
Because the primordial follicles in a woman’s ovaries are non-renewable. At seven months of fetal development, the number of primordial follicles in a woman’s ovaries reaches its peak(a total of 6 to 7 million), and at this stage, the reproductive stem cells in the ovaries begin to stop replicating, and the primordial follicles start physiological consumption(yes, the internal consumption begins before birth), about 10,000 left at the age of 45.
Estrogen and progesterone, which are very important for women, are secreted by the developing follicles. As the follicles are consumed, the ovarian function gradually declines, and during the perimenopausal stage, there is a cliff-like drop, leading to significant changes in hormone levels and a series of health impacts.
Due to the above reasons, menopause for women is a necessary natural stage of the life cycle, not a disease. However, the discomfort and troubles accompanying this stage need attention.
Figure: The change in the number of oocytes
|
Before birth, at 7 months of pregnancy, it reaches its peak |
6-7 million |
|
At birth |
2-3 million |
|
At the onset of puberty |
300,000-400,000 |
|
At 45 years old |
Less than 10,000 |
Those “uncomfortable” symptoms deserve to be seen
The variety of symptoms is numerous, and the occurrence and duration of various symptoms also vary greatly over time.
We refer to the issues that appear at the beginning of perimenopause as
short-term symptoms of hormone deficiency. These symptoms include hot flashes, insomnia, mood swings, irritability, decreased libido, headaches, urinary incontinence, vaginal pain, and depression, all of which are relatively common.
The incidence of short-term symptoms is shown in the figure below:
In addition to short-term symptoms, long-term issues related to perimenopause also include: osteoporosis, cardiovascular and cerebrovascular diseases, urinary-genital atrophy symptoms, and cognitive function decline.
These discomforts affect women’s health and quality of life to varying degrees, and behind the simple names of symptoms are countless days and nights of silent endurance.
This short-duration heat process is very similar to tidal waves, hence the term “hot flash.” Hot flashes can occur several times a day, a few times a day at the least, and more frequently around the clock, every hour. They are especially common at night and in the afternoon, and can also appear at other times.
During the early stages of the menopausal transition, about 40% of women will experience hot flashes, and in the late stages and early postmenopause, this proportion increases to 60%-80%.
The occurrence of hot flashes is due to the fact that when estrogen levels decrease, the temperature regulation function of the hypothalamus in women becomes overly sensitive. Reproductive-age women only initiate heat dissipation mechanisms when their core body temperature rises by 0.4°C or more (peripheral vasodilation and increased skin blood flow, profuse sweating leading to rapid heat loss, until the core body temperature drops below normal, followed by possible chills), while menopausal women initiate heat dissipation mechanisms when their body temperature rises by less than 0.4°C.
The most direct impact of hot flashes on women is to increase the incidence of insomnia. Just imagine, waking up in the middle of the night hot and drenched, who can still sleep? According to some studies monitoring the overnight polysomnography of perimenopausal women, when hot flash symptoms occur, 69% of women will wake up, and nocturnal hot flashes are more common in the first four hours of sleep.
For women, hot flash issues are more like a signal of entering perimenopause, reminding us that we need to start paying attention to related issues.
Women without a history of depression have a relatively lower incidence, but also 20-30%.
Therefore, it is not appropriate to attribute anxiety, depression, paranoia, schizophrenia, or even suicidal tendencies during this stage solely to the lack of estrogen during perimenopause. This simplistic and stereotyped impression can easily lead to a misconception: “It’s just a lack of estrogen, just endure it for a few years and it will pass.” This can result in delayed diagnosis and effective psychiatric treatment for depressive symptoms and major depressive disorders, causing potential harm to women.
For emotional issues during this stage, due to stigmatization, embarrassment, and poor communication, many women choose to suffer in silence rather than actively seek help and support.
So, if you have significant insomnia, anxiety, or depression issues, it is necessary to actively assess and intervene.
What else can we do?
Let’s start with the good news: The placebo effect can reduce the number of hot flashes by 20%-50%. The idea that comfort is also a form of treatment seems incredibly powerful at this moment. It is worth noting that compared with no treatment, placebo treatment can also reduce the psychological impact of hot flashes and night sweats and improve sleep.
After comparison, alternative treatments that are about as effective as placebos include:
(e.g., spicy foods), physical exercise, yoga, mindfulness intervention, various plant estrogens
(e.g., isoflavones, coumestans, or lignans, red clover), cannabis substances, acupuncture, and clonidine.
All of the above methods are not recommended, with conclusions stating that the therapeutic effects are no better than placebos.
However, due to the historical ups and downs of hormone therapy (for details, see the popular science article “Improving the Plight of Women’s Suffering Begins with Discovering the Suffering”), it is necessary to fully assess the risks of cardiovascular diseases, breast cancer, and thrombotic diseases based on the patient’s personal situation and medical history before treatment.
Women with the following conditions may not be suitable for hormone replacement therapy:
History of breast cancer;
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Cardiovascular diseases;
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History of thrombotic diseases or stroke;
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Active liver disease;
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Unexplained vaginal bleeding;
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High risk of endometrial cancer or transient ischemic attack.
These patients need to choose non-hormonal drug treatment plans.
Before using medication, it is necessary to discuss the risks and benefits with a doctor based on individual circumstances, choose the appropriate medication plan, and undergo regular monitoring and evaluation.
