What is the diagnosis of menopause?

The diagnosis of menopause is also very important. The diagnosis of menopause generally includes the marriage and childbearing history of the parents, family history, past medical history, personal development history and menstrual history, amenorrhea time, etiology, inducements and accompanying symptoms (such as galactorrhea and pelvic masses), marriage and childbearing history (sexual life, pregnancy and delivery, breastfeeding), family planning history (use of contraceptives and artificial abortion), and outpatient treatment and whether there are systemic diseases. The following editor will introduce it to you in detail.

Diagnostic points

(I) Asking about medical history: The patient should be asked in detail whether the mother had acute infectious diseases such as rubella and other viral infections during pregnancy, whether she received hormones or other teratogenic drugs, radiation and other treatments. Whether the patient and her relatives have a history of sexual development abnormalities during their growth and development. For patients with secondary amenorrhea, the menstrual situation should be understood, such as the age of menarche, previous menstrual cycles, menstrual volume, amenorrhea period, and the absence of cyclical abdominal pain. Whether there is a history of surgical removal of the uterus or ovaries, whether there are systemic chronic diseases such as tuberculosis, malnutrition, and hyperthyroidism or hypofunction of the thyroid gland or adrenal glands. Whether there are inducements such as mental stimulation or changes in living environment, whether the patient has received hormone treatment, the type of drug, dosage, course of treatment, effect, last time of medication, whether the patient has received antipsychotic drugs, etc. Married women should also pay attention to whether they have taken contraceptives, whether they have a history of rough or multiple curettage and postpartum hemorrhage. In addition, it is necessary to pay attention to whether there is a history of increased hair, obesity, galactorrhea, headache, vision changes, etc.

(B) Physical examination

1. General examination: Pay attention to general development and nutritional status (psychoneural type), intellectual development, and physical deformities. If necessary, measure height, weight, finger span, development of secondary sexual characteristics, and whether there is obesity, hirsutism, galactorrhea, etc.

2. Gynecological examination: Pay attention to the development of the vulva, whether there are any vulva deformities such as clitoral hypertrophy, the amount and distribution of pubic hair, whether there is a vagina, whether the vagina and hymen are obstructed or deformed, whether there is a uterus and its size, whether the ovaries are enlarged, etc.

(III) Special inspection

Due to the complex causes of amenorrhea, there are also many auxiliary special examination items, which should generally be selected as needed based on the depth of the diagnostic steps.

1. Hypothalamic-pituitary-ovarian-uterine axis hormone function test: The purpose is to monitor and evaluate the functional status of reproductive hormone target organs to determine the pathological division and cause of amenorrhea and guide treatment.

(1) Progesterone test: The purpose is to evaluate the endogenous estrogen level and endometrial responsiveness to distinguish the degree of amenorrhea and uterine or ovarian amenorrhea. Progesterone 20 mg/d intramuscular injection for 3 to 5 days. Stop the drug and observe the withdrawal bleeding (withdrawal bleeding). If there is withdrawal bleeding, it is positive, indicating that there is a certain amount of endogenous estrogen secretion and good endometrial responsiveness, and pregnancy and uterine amenorrhea are excluded, and it can be diagnosed as ovarian dysfunction amenorrhea. If there is no withdrawal bleeding, it is negative, indicating that the endometrium is not responsive or the endogenous estrogen secretion is insufficient to cause endometrial hyperplasia, so an estrogen test should be performed after excluding pregnancy.

(2) Estrogen test: The purpose is to detect the reactivity of the endometrium in order to distinguish between uterine amenorrhea and ovarian amenorrhea. Take 1 mg/d of ethinyl estradiol for 20 consecutive days, or intramuscularly inject 1 mg/d of estradiol benzoate for 10 times. Stop the drug and observe the bleeding situation. Progesterone can also be used for blood withdrawal, that is, intramuscular injection of progesterone 20 mg/d is added on the last 4 days of estrogen use. This is actually an artificial cycle experiment. If there is a positive test result with blood withdrawal, it means that there is a lack of endogenous estrogen secretion and the endometrium responds well. This is amenorrhea, and it can exclude uterine amenorrhea and pregnancy, indicating that the amenorrhea is above the ovarian level. If there is no blood withdrawal, the test result is negative, which indicates uterine amenorrhea.

(3) Gonadotropin test: The purpose is to detect the responsiveness of the ovaries to gonadotropins in order to differentiate between ovarian and pituitary amenorrhea. hMG150U/d intramuscular injection for 10-14 days, or pFSH75U/d for 10-14 days, to observe the development of follicles and hormone changes. Those with follicular development or ovulation are hormonal amenorrhea, and those without are ovarian amenorrhea. Those with no follicular development after repeated high doses are ovarian insensitivity syndrome.

(4) Pituitary stimulation test: GnRH test, including the classic method and Combes method test, aims to detect the responsiveness of the anterior pituitary to GnRH and the storage and release function of the two LH reservoirs, so as to distinguish hypothalamic and pituitary amenorrhea. The normal reaction is that 15 to 60 minutes after intravenous injection of GnRH, the LH value is 2 to 4 times higher than that before injection (classic method): or after intravenous infusion, there is a biphasic secretion of LH rising within 60 minutes and a second rise of LH within 2 to 4 hours (Combes method). The normal reaction indicates that the pituitary function is normal and amenorrhea is caused by hypothalamic lesions. Slow or low reaction is pituitary amenorrhea. It should be noted that when the pituitary is not completely destroyed, it can still release a lot of LH. On the contrary, the normal pituitary can also become inert after losing the stimulation of endogenous GNRH for a long time. Therefore, multiple measurements are required to draw a correct conclusion.

(5) Chlorophenamine test: The purpose is to detect the integrity and functional status of the positive and negative feedback mechanisms of the HPO axis to distinguish between hypothalamic and pituitary amenorrhea. A positive test indicates that the hypothalamic function is not damaged and the cause of amenorrhea is in the pituitary gland; a negative test indicates that amenorrhea is caused by hypothalamic dysfunction.