What are the early symptoms of menopause?

When women reach a certain age, their menstrual flow will gradually decrease until it stops completely. Especially when the menstrual flow decreases particularly quickly, women will find that they are aging quickly, their skin condition will become very poor, their mood will become very irritable, and they will often experience tension, anxiety and many other emotions. These are standard manifestations of menopause. In addition, menopausal women will also experience the following symptoms.

What are the early symptoms of menopause?

Thirty percent of women will experience menstrual disorders during the premenopausal period, characterized by irregular menstrual cycles and variable menstrual flow. In addition, during the menopausal period, there will be symptoms of autonomic nervous system disorders such as hot flashes and sweating. In addition, as estrogen levels gradually decrease, some patients will frequently experience inflammation of the urogenital tract.

What are the early symptoms of amenorrhea?

(1) Uterine amenorrhea and cryptomenorrhea:

① Imperforate hymen: Clinical symptoms appear gradually. Initially, one may feel periodic lower abdominal distension and pain, which progressively worsens. The hematoma compresses the urethra and rectum, which can cause difficulty in urination and defecation, spasmodic pain above the pubic bone, anal distension, frequent urination, urgency, pain when urinating, and even dripping urination. When a large amount of blood accumulates in the uterine cavity, it may cause ureteral displacement, twisting, hydronephrosis, and even hydronephrosis. When menstrual blood flows back into the pelvic cavity, it can irritate the peritoneum and cause severe abdominal pain. During abdominal examination, a tender mass can be felt with deep tenderness. A few patients may have mild muscle tension and rebound tenderness. During the gynecological examination, it was found that the hymen was thin and bulging, with no opening and a purple-blue surface. Rectal examination revealed vaginal hematoma, enlarged and tender uterus, and sausage-like masses and tenderness in both adnexa. Patients with a long course of disease may have irregular thickening and varying numbers of tender nodules. B-ultrasound or CT examination can detect barrel-shaped cystic and solid masses in the vagina, and fluid accumulation in the uterine cavity and fallopian tubes.

② Congenital absence of vagina: This disease is often discovered during medical examination due to the absence of menstruation during adolescence, or periodic lower abdominal pain, or difficulty in sexual intercourse after marriage, or infertility. The breasts, secondary sexual characteristics and external genitalia are normally developed, and the ovarian function is normal; the basal body temperature (BBT) is biphasic, and the blood reproductive hormone measurements show cyclical changes in women of childbearing age. If accompanied by absent uterus or primordial uterus, there may be no symptoms; if there is functional endometrium of the uterus, there may be progressive and aggravated cyclical lower abdominal pain due to blood accumulation in the uterine cavity. During a gynecological examination, it may be found that there is no vaginal opening on the vulva. If the patient seeks medical attention a long time after marriage, a shallow pit may be found in the vestibule area due to sexual intercourse. In most patients, a cord-like trace of the uterus can be felt in the pelvic cavity. If the patient has a functional endometrium and is relatively young, the clinician may find a small uterus during examination, or may palpate a normal or enlarged painful uterus and sometimes a sausage-like enlargement of the fallopian tubes. Imaging examinations such as B-ultrasound and CT can confirm the above findings and detect urinary system malformations.

③ Transverse vaginal septum: In cases of incomplete transverse septum, there is no amenorrhea because menstrual blood can flow out through small holes. Patients with complete transverse septum may experience primary amenorrhea, cyclical lower abdominal pain, etc. due to menstrual blood discharge disorders.

In patients with complete transverse septum in the middle and upper parts of the vagina, gynecological examination may reveal a lower vagina of certain length and width, with a closed top and a diaphragm that feels fluctuating. The vagina above it is dilated and seems to have a cystic feeling. The lower vaginal septum is sometimes difficult to distinguish from vaginal atresia. A careful gynecological examination combined with puncture of the posterior septum is an effective method of identification.

④ Vaginal atresia: Clinical manifestations include primary amenorrhea, cyclical lower abdominal pain, etc. Gynecological examination revealed that the vulva was hypoplastic and the hymen was imperforate, but the surface color was normal and there was no outward bulging sign. During rectal examination, a vaginal cystic mass protruding into the rectum was found about 3 cm above the vulva. The mass was tense when there was abdominal pain. Transabdominal or transrectal ultrasound examination can detect a cystic barrel-shaped mass 3 to 4 cm above the anus. Under the guidance of ultrasound, puncture the mass through the vulva can extract old dark red blood or chocolate-like paste. In type II, the vagina is completely closed, and the clinical manifestations include primary amenorrhea and cyclical lower abdominal pain. Gynecological examination revealed a mass with a diameter of 4 to 8 cm on one side or higher in the pelvic cavity, which was a malformed uterus or adnexal tumor.

⑤ Cervical atresia: If the patient has no endometrium, only primary amenorrhea will occur. If there is endometrium, the clinical manifestations are similar to congenital absence of vagina.

⑥ Congenital absence of uterus: The clinical manifestation is primary amenorrhea. The uterus cannot be palpated during anal and abdominal examination. Ultrasound, CT and MRI cannot detect the existence of the uterus.

(2) Pituitary amenorrhea:

① Pituitary tumor and hyperprolactinemia: Clinical manifestations include amenorrhea or irregular menstruation; lactation; if the pituitary tumor is large, it may cause headache and visual impairment; if it is empty sella syndrome, there may be pulsating headache; hyperprolactinemia caused by medication is excluded.

② Pituitary failure: Clinical manifestations may include a history of postpartum hemorrhage or pituitary surgery; weight loss, fatigue, chills, paleness, no milk secretion after delivery, no sexual desire, no follicular development, and reproductive tract atrophy; examination shows low sex hormone levels and symptoms and signs of hypothyroidism and hypoadrenalism.