Menopause health management project

Menopausal health management is by no means a meaningless intervention that “let it go”, and there is no “one-size-fits-all formula” suitable for everyone. Personalized layered intervention based on different symptom levels, physical foundations, and personal wishes can increase the relief rate of menopausal-related symptoms to more than 85%, while reducing the long-term risk of osteoporosis and cardiovascular disease by about 30%.

When I met Aunt Zhang at a community free clinic last week, she took out three things from her cloth bag: a palm-sized fan, a washed white cotton handkerchief, and a neatly folded pure cotton bottoming shirt. 52 years old, menopausal for 1 and a half years, I have hot flashes at least a dozen times a day, and my back suddenly becomes wet while walking. I toss and turn at night and sleep for up to 3 hours. My wife said that she is "old and has nothing to do", so my daughter bought her a popular online product. After taking soy isoflavones for three months, her hot flashes didn’t go away. Last month’s physical examination revealed that the breast nodules had increased from category 2 to category 3. She was so frightened that she stopped taking the medicine. She sat in front of the free clinic and asked me: “Doctor, can I really only survive as long as I want?” ”

We have met nearly 2,000 patients like Aunt Zhang in the past three years. They either regard menopause as a "normal physiological process" or they have stepped on a lot of pitfalls. The original intention of this project was to help everyone avoid detours.

Nowadays, everyone’s understanding of menopausal intervention is very different. Different medical systems also have different emphasis on their plans. No one is absolutely correct. Menopausal hormone therapy (MHT), which is mainstream in Western medicine, is currently recognized as the most effective means of relieving moderate to severe hot flashes, vaginal atrophy and other symptoms. It has also been controversial: many people are terrified when they hear the word "hormone" and think they will get breast cancer. In fact, according to the latest guidelines of the International Menopause Society in 2024, as long as it is used within 10 years of menopause and during the "window period" of people younger than 60 years old, and for people without a history of estrogen-dependent tumors and severe liver and kidney dysfunction, the benefits far outweigh the risks. Most of the aunts in our project who meet the indications can reduce the number of hot flashes by 70% in about one month after using it. However, there are indeed many people who are not eligible for hormone use, or who are resistant to hormones themselves. At this time, there are also non-hormonal options to choose from: using selective serotonin reuptake inhibitors to relieve hot flashes and emotional problems, and using calcium and vitamin D to prevent osteoporosis. The effect is also very stable.

There is no term "menopause" in the traditional Chinese medicine system. It is collectively referred to as "pre- and post-menopausal syndromes". The core logic is the decline of kidney qi and the imbalance of yin and yang. Many people take Xiaoyao Pills when they feel uncomfortable. In fact, it is completely wrong: People with kidney yin deficiency have hot flashes, night sweats, dry mouth and tongue, so they need to use prescriptions such as Zhibai Dihuang Pills to nourish yin. ； People with kidney yang deficiency are afraid of cold, have cold hands and feet, and have loose stools. They should take prescriptions such as Yougui Pills to replenish yang. ； There are also people who have hot and cold symptoms, which means that both yin and yang are deficient, so they need syndrome differentiation and prescription. There are also many people who think that traditional Chinese medicine is too slow and useless. We don’t argue with this. For people with mild symptoms, simply using moxibustion, auricular acupoints, and traditional Chinese medicine combined with lifestyle adjustments is highly acceptable, has few side effects, and is more effective than medication. There used to be a 48-year-old middle school teacher who was particularly resistant to taking medicine. He came to auricular acupuncture once a week. After drinking syndrome differentiation prescriptions for more than a month, his insomnia problem was basically solved.

When we work on projects, we never just prescribe medicines. The first step is to conduct a comprehensive assessment: fill in the modified Kupperman score sheet to understand the severity of symptoms, and then do basic tests such as six hormones, bone density, breast and gynecological B-ultrasound, liver and kidney function, etc., plus an emotional screening, and divide the population into three levels: light, medium and severe to connect different plans.

People with mild symptoms with a symptom score below 15 basically do not need to take medicine. They just need to adjust their lifestyle: replace the white rice porridge in the evening with low-glycemic cereals, take 20 minutes a day to walk briskly or practice Baduanjin, and avoid irritating things such as coffee and milk tea. We have also established a sister group where everyone can chat about gardening flowers and raising grandchildren. Aunts who have been treated are volunteers to share their experiences. Within a month, many people have gone away from the occasional hot flashes and difficulty falling asleep.

For moderate people with a score of 15 to 30, we will give the user the right to choose: those who are willing to use hormones will do another round of screening to determine the dosage; those who are resistant to hormones will use non-hormonal drugs and Chinese medicine conditioning, and there will be dedicated personnel to follow up on the implementation of diet and exercise. The Aunt Zhang mentioned at the beginning followed this path, using plant-extracted black cohosh preparations, plus Sanyinjiao moxibustion twice a week, and companion volunteers chatting with her twice a week. Now it is almost two months, she has hot flashes at most once a day, she can sleep for 6 hours at night, and her breast nodules have not grown since the last review.

For severe cases with a score of 30 or above, or even problems such as depression, severe osteoporosis, and stress urinary incontinence, we will directly initiate a multidisciplinary consultation, and doctors from gynecology, endocrinology, orthopedics, and psychiatry will work together to come up with a plan. There was an aunt who always felt that life was boring and had obvious symptoms of depression. We worked with the psychiatrist to adjust mood medication and cooperate with hormone intervention. It improved in more than two months, and now she has actively signed up to be our companion volunteer.

In the past few years of doing projects, I have seen many things go astray: some people believed that "the medicine is three parts poisonous" and took it hard. As a result, they suffered from severe osteoporosis and suffered a fracture of their femoral neck after a fall.； Some people think that "natural is safe" and eat deer fetus ointment and skin care products with unknown ingredients sold online. The endometrium thickens to 16mm after eating, and they finally have to undergo diagnosis and curettage. In fact, there is really no absolute good plan, and there is no need to force yourself to accept any one. The one that suits your physical condition and meets your personal wishes is the best.

Now this project has been implemented in three communities in the jurisdiction. To be honest, it is not a high-end medical project. It just wants more women at this stage to know: your inexplicable irritability, hot flashes, and sleepless nights are not pretentious. They are signals from your body. There is no need to endure it. Find the right method, and you can spend this period of time comfortably.