绝经期

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概述

绝经标志着您的月经周期结束。连续 12 个月没有月经期便可确诊更年期。绝经一般发生在 40 多岁或 50 多岁，但美国的平均年龄为 51 岁。

绝经是自然的生物学过程。但诸如潮热之类的身体症状和绝经的情绪症状可能会扰乱您的睡眠，让您精力不充沛或影响情绪健康。有许多有效的治疗方法，从生活方式调整到激素治疗。

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症状

在绝经前数月或数年中（围绝经期），您可能出现以下体征和症状：

  • 经期不规律
  • 阴道干涩症
  • 潮热
  • 寒战
  • 盗汗
  • 睡眠问题
  • 情绪变化
  • 体重增长、新陈代谢减缓
  • 头发稀疏、皮肤干燥
  • 乳房不再丰满

体征和症状，包括月经变化可能因人而异。最可能发生的是，在绝经前月经可能变得不规律。

围绝经期跳过经期很常见，也很正常。通常情况下，月经可能会暂停一个月，然后恢复正常，或者暂停几个月，然后再开始按每月一次的周期重新循环几个月。月经周期也会缩短，因而更为接近。即使月经不规律，也能怀孕。如果您的月经暂停了一个月，但您不确定是否开始绝经过渡，请考虑进行妊娠测试。

何时就诊

定期去看医生，以获得预防性保健，了解任何医疗问题。在绝经期间和之后继续进行这些预约。

根据年龄，预防保健可能包括推荐的健康筛查，如结肠镜检查、乳房 X 光照相术和甘油三酯筛查。医生可能也会建议您做其他的检查，包括根据您的病史做甲状腺检查，以及乳房和盆腔检查。

如果在绝经期后有阴道出血，请咨询医生。

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病因

绝经的原因包括：

  • 生殖激素自然下降。30 多岁时，卵巢分泌的雌激素和黄体酮（调节月经的激素）减少，生育能力下降。

    40 多岁时，月经期可能会延长或缩短，经期出血加重或减轻，出血频率增加或减少，直到最终（平均到 51 岁）卵巢停止释放卵子，并停经。

  • 卵巢切除术（切除卵巢的手术）。卵巢产生激素，包括雌激素和黄体酮，以调节月经周期。手术切除卵巢会立即导致绝经。停经后，可能会出现潮热和其他更年期体征和症状。体征和症状可能很严重，因为激素变化是突然发生的，而不是在几年内逐渐发生的。

    子宫切除术（只切除子宫而不切除卵巢的手术）通常不会立即引起绝经。虽然不会再出现月经，但您的卵巢仍然会释放卵子，分泌雌激素和黄体酮。

  • 化疗和放射疗法。这些癌症治疗可诱导绝经，在治疗期间或治疗后不久引起潮热等症状。化疗后月经（和生育能力）停止并但并不是永久停止，因此仍可能需要采取避孕措施。放射疗法只有在辐射针对卵巢时才会影响卵巢功能。身体其他部位，如乳腺组织或头颈部的放射治疗不会影响绝经。
  • 原发性卵巢功能不全。大约有 1% 的妇女在 40 岁前就会绝经（过早绝经）。遗传因素或自身免疫病会导致卵巢不能产生正常水平的生殖激素（原发性卵巢功能不全），从而造成过早绝经。但往往找不到过早绝经的原因。对于这些女性，通常建议至少在自然绝经年龄前进行激素治疗，以保护大脑、心脏和骨骼。

风险因素

People assigned female at birth go through menopause. The main risk factor is reaching the age of menopause.

Other risk factors include:

  • Surgery to remove the ovaries.
  • Certain cancer treatments.

并发症

绝经后，您患某些疾病的风险会增加。例如：

  • 心脏和血管（心血管）疾病。当您的雌激素水平下降时，您患心血管疾病的风险就会增加。心脏病是女性和男性死亡的主要原因。因此，定期煅炼、健康饮食以及保持正常体重很重要。向医生咨询如何保护您的心脏，比如如果胆固醇或血压过高，如何降低胆固醇或血压。
  • 骨质疏松症。这种疾病会让骨骼变得脆弱，导致骨折的风险增加。在绝经后的前几年，您的骨密度可能会迅速降低，增加患骨质疏松症的风险。患有骨质疏松症的绝经后女性特别容易发生脊柱、髋关节和手腕骨折。

  • 尿失禁。当阴道和尿道的组织失去弹性时，您可能会感觉频繁、突发、强烈的尿意，随后会出现非自主的尿失禁（急迫性尿失禁），或咳嗽、大笑或提重物时尿失禁（压力性尿失禁）。您可能更容易患尿路感染。

    通过凯格尔运动加强盆底肌和使用局部阴道雌激素可能有助于缓解尿失禁的症状。更年期尿路和阴道变化会导致尿失禁，激素治疗可能是一种有效的治疗选择。

  • 性功能。由于体液分泌量减少和失去弹性导致的阴道干涩症会引起性交过程中的不适和轻微出血。另外，感觉减退可能会降低您对性生活的欲望（性欲）。

    水性阴道保湿剂和润滑剂可能有所帮助。如果阴道润滑剂效果不佳的话，采用局部阴道雌激素治疗可能对很多女性有所帮助，比如可使用阴道膏、片剂或环。

  • 体重增长。许多女性在更年期过渡期和更年期后由于新陈代谢减慢，会导致体重增加。为了保持目前的体重，您可能需要少吃多动。

来自妙佑医疗国际员工
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诊断与治疗
May 25, 2023
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