What is Menopausal Syndrome?
Menopause refers to the period of approximately 10 years before and after menopause, generally between the ages of 45 and 55. During this time, ovarian function declines, leading to a rapid decrease in estrogen (female hormones), and the various physical and mental symptoms that result from this are collectively known as "menopausal syndrome."
The average age of menopause for Japanese women is around 50. Symptoms are diverse, with over 100 different types, including hot flashes, sweating, palpitations, mood swings, and joint pain. A characteristic feature is the wide range of individual differences, from those with mild symptoms to those with severe symptoms that interfere with daily life.
It's not "just due to age" or "all in your head."
Menopausal symptoms are a medical condition caused by hormonal fluctuations and should not be endured. You can choose a method that suits you from multiple treatment options, including hormone replacement therapy (HRT), herbal medicines, and placenta injections.
Symptoms of Menopause
Symptoms broadly classified into 3 categories
| Category | Representative Symptoms |
|---|---|
| Vasomotor symptoms (autonomic nervous system) | Hot flashes, flushing, sweating, palpitations, shortness of breath, cold sensitivity |
| Neuropsychiatric symptoms | Depressed mood, irritability, anxiety, insomnia, decreased concentration |
| Physical symptoms | Joint pain, muscle pain, headache, back pain, dizziness, fatigue, stiff shoulders |
Other symptoms
- Menstrual irregularities (changes in cycle, menstrual flow)
- Dry or itchy skin
- Vaginal dryness, painful intercourse (GSM: Genitourinary Syndrome of Menopause)
- Frequent urination, urinary incontinence
- Decreased memory and concentration (so-called "brain fog")
- Changes in libido
- Abdominal bloating, indigestion
- Palpitations, feeling of arrhythmia
Symptoms fluctuate like waves.
Menopausal symptoms are characterized by their varying intensity from day to day and hour to hour. This results in a cycle of "today is easy" and "today is difficult." Just like with the menstrual cycle, tracking your physical condition can help you identify your own patterns.
Self-check with the Simplified Menopausal Index (SMI)
Evaluate the severity of your current symptoms for the 10 items below. Higher scores tend to indicate more severe menopausal symptoms.
| Symptom | Strong | Moderate | Weak | None |
|---|---|---|---|---|
| Hot flashes in the face | 10 | 6 | 3 | 0 |
| Prone to sweating | 10 | 6 | 3 | 0 |
| Prone to coldness in lower back and limbs | 14 | 9 | 5 | 0 |
| Shortness of breath, palpitations | 12 | 8 | 4 | 0 |
| Difficulty falling asleep, shallow sleep | 14 | 9 | 5 | 0 |
| Easily angered, irritable | 12 | 8 | 4 | 0 |
| Worrying, feeling depressed | 7 | 5 | 3 | 0 |
| Headache, dizziness, nausea | 7 | 5 | 3 | 0 |
| Easily fatigued | 7 | 4 | 2 | 0 |
| Stiff shoulders, back pain, pain in limbs | 7 | 5 | 3 | 0 |
Total Score Guidelines
- 0-25 points: No problem, maintain current lifestyle.
- 26-50 points: Review diet, exercise, and sleep; consider herbal medicine.
- 51-65 points: Consultation with a doctor recommended; target for treatment.
- 66-80 points: Planned treatment necessary.
- 81 points or more: Detailed treatment required, including coordination with other departments.
Diseases with symptoms similar to menopause (differential diagnosis is important)
Because menopausal symptoms are highly diverse, other underlying diseases may be present. At our clinic, as internists, we rule out physical diseases before initiating treatment.
| Disease | Similar Symptoms | Confirmatory Test |
|---|---|---|
| Thyroid dysfunction (hyper/hypo) | Palpitations, sweating, fatigue, mood swings | TSH, FT3, FT4 |
| Iron deficiency anemia | Fatigue, palpitations, dizziness | CBC, ferritin |
| Depression, anxiety disorder | Depression, insomnia, decreased motivation | Interview, symptom evaluation |
| Diabetes, hypoglycemia | Sweating, palpitations, fatigue | Blood glucose, HbA1c |
| Hypertension, arrhythmia | Palpitations, headache, dizziness | Blood pressure, EKG |
| Autonomic nervous system imbalance | Various physical symptoms | Interview, exclusion of other diseases |
| Polymyalgia rheumatica | Shoulder and hip pain (after age 50) | CRP, ESR |
Examination and Testing at Our Clinic
Key points for medical interview
- Nature, timing, severity, and fluctuation pattern of symptoms
- Menstrual status (last menstruation, cycle, menstrual flow)
- Past medical history (especially gynecological diseases, thrombosis, breast cancer, liver disease)
- Family history (breast cancer, osteoporosis)
- Medications and supplements currently being taken
- Lifestyle and stress factors
Tests
| Test Item | Confirmation Content |
|---|---|
| Blood test (FSH, E2) | Confirmation of ovarian function decline (high FSH + low E2) |
| Thyroid function (TSH, FT4) | Exclusion of thyroid diseases with similar symptoms |
| CBC, ferritin | Exclusion of anemia |
| Lipid, blood glucose, liver/kidney function | Safety evaluation before starting HRT |
| Bone density measurement | Osteoporosis evaluation (referral to specialist if necessary) |
Treatment Options
Based on the type and severity of symptoms, as well as the patient's wishes and risks, we select the most appropriate treatment from multiple options.
Herbal Medicines (easy to try, fewer side effects)
| Prescription Name | Suitable Symptoms/Constitution |
|---|---|
| Kamishoyosan | Irritability, insomnia, stiff shoulders, mood disorders |
| Keishibukuryogan | Hot flashes, stiff shoulders, menstrual irregularities (Oketsu type) |
| Tokishakuyakusan | Cold sensitivity, swelling, anemic tendency (frail constitution) |
| Nyoshin-san | Hot flashes, dizziness, palpitations, anxiety |
| Yokukansan | Irritability, anger, insomnia |
| Unkeito | Cold sensitivity, dryness, irregular menstruation |
Hormone Replacement Therapy (HRT)
Symptoms for which HRT is considered most effective
HRT is most effective for hot flashes, sweating, and vaginal dryness. It is also positioned as the first-line treatment for moderate to severe symptoms according to guidelines.
| Drug | Dosage Form | Characteristics |
|---|---|---|
| Julina (Estradiol) + Provera | Oral | Covered by insurance, most common |
| Le Estradiol Gel, Divigel | Transdermal gel | Less burden on liver, reduced risk of thrombosis |
| Estrana Patch | Transdermal patch | Stable absorption, replaced twice a week |
| Women's Health Cream | Vaginal suppository | Local use for vaginal dryness, painful intercourse |
Contraindications and Cautions for HRT
- Contraindications: History of breast cancer or endometrial cancer, history of thrombosis, severe liver dysfunction
- Cautions: Smokers over 40, hypertension, diabetes, obesity, uterine fibroids
- Pre-initiation screening: Mammography, cervical cancer screening (performed by gynecologist)
Be sure to get breast cancer screenings.
Regardless of HRT use, mammography every two years is recommended for women over 40. At our clinic, we will confirm the status of screenings for patients before and during HRT.
Placenta Injections
Human placenta-derived preparations are available as a subcutaneous injection 1-2 times a week, covered by insurance, for menopausal disorders in women aged 45-59. They are expected to regulate the autonomic nervous system and natural healing power.
Addressing Mental Symptoms
- SSRI/SNRI: For severe depression and anxiety
- Sleeping pills: For insomnia (e.g., orexin receptor antagonists with low dependence risk)
- Anxiolytics: For occasional use
Other Options
- Supplements (soy isoflavones, equol, vitamin E)
- Osteoporosis prevention (vitamin D, calcium, exercise)
- Cardiovascular risk management (blood pressure, lipids, weight)
Health Risks to Watch Out for During Menopause
The decrease in estrogen not only causes menopausal symptoms but also affects medium- to long-term health risks. Let's start prevention during this period.
Osteoporosis
- Bone mass rapidly decreases 5-10 years after menopause.
- Prevention: 800mg/day calcium, vitamin D, exercise 3 times a week.
- Bone density measurement every 2-3 years recommended after age 50.
Cardiovascular disease
- Loss of estrogen's cardioprotective effects.
- Management of high blood pressure, dyslipidemia, and diabetes.
- Smoking cessation, moderate alcohol consumption, weight control.
Changes in cognitive function
- Mild memory decline can be a physiological aspect.
- If persistent, differentiation from dementia is necessary.
- Prevention through exercise, social activities, and intellectual activities.
Self-care in Daily Life
Diet and Nutrition
- Consume soy products (natto, tofu, miso) to supplement plant-based estrogen.
- Prioritize calcium (dairy products, small fish) and vitamin D (fish, mushrooms).
- Consume blue fish (EPA, DHA) for cardiovascular protection.
- Eat vegetables, fruits, and fermented foods for antioxidant benefits.
- Limit caffeine and alcohol.
Exercise
- Aerobic exercise (walking, swimming) 150 minutes per week.
- Strength training twice a week (for osteoporosis prevention).
- Yoga, stretching (for autonomic nervous system regulation).
Lifestyle Rhythm and Stress Management
- Regular sleep
- Avoid smartphones and caffeine before bed
- Relax in a lukewarm bath
- Make time for sunlight exposure (Vitamin D, serotonin)
- Cherish hobbies and social connections
- Let go of "perfectionism"
Hot Flash Management
- Layer clothing for easy temperature adjustment.
- Carry a fan or cooling towel.
- Avoid spicy foods, hot drinks, and alcohol.
- Stress relief (deep breathing, mindfulness).
Characteristics of Menopause Treatment at Our Clinic
- As internists, we carefully rule out physical diseases (thyroid, anemia, etc.).
- We use herbal medicines appropriately based on constitution and symptoms.
- We offer HRT (oral, transdermal) after confirming no contraindications.
- We offer placenta injections (covered by insurance for ages 45-59).
- We provide individualized care for mental symptoms with SSRIs, sleeping pills, and anxiolytics.
- We manage osteoporosis and cardiovascular risk prevention.
- If gynecological examination is necessary, we refer to a specialized medical institution.
- No appointment needed / Same-day visits OK / Open 9 AM - 9 PM daily / 1-minute walk from Jujo Station.
Don't suffer in silence; find the treatment that's right for you.
Menopausal symptoms vary greatly from person to person, and there are many treatment options available. Don't resign yourself to "it's just old age"; please consult us. We will work with you to create a personalized plan combining herbal medicine, HRT, placenta, lifestyle improvements, and more.
