健康医药

梅奥医疗中心:女性更年期保健品与保养知识

更年期(menopause)通常指女性绝经期和绝经前后的一段时间,常见为40~50岁。如一名女性停经超过连续12个月,即可初步判断已步入更年期。步入更年期后,身体荷尔蒙变化会引起一系列的身体和精神变化,如潮热、焦虑、抑郁、睡眠障碍等,统称为女性更年期综合症。美国最大的医疗集团 Mayo Clinic 在其官网上详述了女性更年期综合症的原因、治疗方法和日常护理。

更年期的临床表现

在绝经前期的数月至数年时间里,女性可能会经历如下症状:

  • 月经紊乱
  • 阴道干燥
  • 潮热
  • 发冷
  • 盗汗
  • 睡眠障碍
  • 情绪波动
  • 体重增加和新陈代谢减缓
  • 脱发、皮肤干燥
  • 乳房萎缩下垂

月经紊乱是更年期最典型的症状,常出现在绝经前期,可表现为间歇性闭经,即月经周期间隔时间延长,月经暂停一至数月后又重回正常;也表现为月经周期间隔时间缩短,即两次月经间隔时间少于正常的20~30天。尽管如此,但由于女性自身性功能的调节作用,女性在绝经前期也可能出现排卵性月经,因此会偶有多年不孕的女性在绝经前期意外怀孕,所以在更年期早期诊断时,也不排除怀孕可能。

出现更年期症状的原因

  • 雌性激素分泌的自然下降。女性在35岁后,卵巢功能开始减退,调节月经的两种女性荷尔蒙(雌性激素和孕激素)分泌减少,生育能力减退。40岁后,月经变得不规律。到51岁上下,女性卵巢功能完全衰退,不理排卵,月经停止。
  • 子宫切除术。若只切除子宫、但不切除卵巢,通常不会导致立即绝经。若子宫和双侧卵巢都切除,术后会立即停经,并出现潮热等更年期症状。与自然出现的更年期症状不同,接受全子宫和双侧卵巢切除术的女性,荷尔蒙会突然变化,更年期症状也就更严重。
  • 放化疗等癌症疗法。接受放化疗的女性,治疗过程中、以及之后,可能出现停经和潮热等更年期症状,但通常只是暂时性,因此节育措施不能停止。
  • 原发性卵巢功能不全。大约1%的女性会在40岁之前就步入更年期,即更年期提前或早更。原发性卵巢功能不全多是由遗传因素、或自身免疫性疾病导致,患病女性因其卵巢无法产生正常水平的生殖激素而提早绝经。

更年期的临床诊断

通常来说,当出现潮热、经期紊乱等明显症状时,就可初步判定该女性已步入更年期。有时医生也会要求患者进行其他测试来确诊。

  • 促卵泡生成激素水平检测(follicle-stimulating hormone / FSH test)。更年期女性的 FSH 水平会升高,同时和雌二醇(E2)水平下降。FSH 测试纸(FSH test kit)也可以让女性在家自行对 FSH 值进行定性检测,但由于 FSH 值在月经周期中会时高时低,因此不能作为准确判定更年期发病的依据。
# 1
Femometer Follicle-Stimulating Hormone Test - FSH Female Fertility/Menopause Test Strip Kits, 5 Tests
  • Contains 5 Female fertility / menopause FSH tests
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  • A positive result (above the cut-off of 25mIU/ml) should be discussed with your doctor/medical...
# 2
Perimenopause Test – at-Home Testing Kit for Women – Measure Estradiol, LH & FSH Levels – Analysis by CLIA-Certified Lab – Verisana
8 个好评
Perimenopause Test – at-Home Testing Kit for Women – Measure Estradiol, LH & FSH Levels – Analysis by CLIA-Certified Lab – Verisana
  • ✅ MEASURE: Check your estradiol (E2), luteinizing hormone (LH) and follicle-stimulating hormone...
  • ✅ SYMPTOMS: If you experience fatigue / feeling tired constantly, irregular periods, night sweats,...
  • ✅ SIMPLICITY: Easy blood spot and saliva test to do at home - once you get your Premenopause test...
  • 促甲状腺激素水平检测(thyroid-stimulating hormone / TSH test)。甲状腺机能减退也可能引起类似更年期的症状,因此需要进一步测试来排除罹患其他疾病的可能。
有折扣# 1
Everlywell Thyroid Test at Home Measures 3 Main Hormones - Discreet, Accurate Blood Analysis - Results Within Days - CLIA-Certified Adult Test - Not Available in NY, NJ, RI 
139 个好评
Everlywell Thyroid Test at Home Measures 3 Main Hormones - Discreet, Accurate Blood Analysis - Results Within Days - CLIA-Certified Adult Test - Not Available in NY, NJ, RI 
  • HELPFUL TEST - Easily measure your levels for the 3 main thyroid hormones (TSH, T3, and T4) plus...
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# 2
Home Thyroid Hormone Function Testing Kit | TSH | FT4 | FT3 | Levels. For Symptoms Like Fatigue, Weight Gain Muscle Weakness & More | Accurate Testing | Results In Days | By Lets Get Checked
69 个好评
Home Thyroid Hormone Function Testing Kit | TSH | FT4 | FT3 | Levels. For Symptoms Like Fatigue, Weight Gain Muscle Weakness & More | Accurate Testing | Results In Days | By Lets Get Checked
  • Discreet at home, accurate based testing kit for your convenience without having to make a medical...
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常见的更年期并发症

  • 心血管疾病:更年期女性雌性激素分泌减少,罹患心血管疾病的概率就会增加。
  • 骨质疏松症:绝经后几年,骨密度会迅速下降,脊柱、髋关节、手腕骨折的风险随之增高。
  • 尿失禁:更年期阴道和尿道组织会因失去弹性而导致尿失禁,尿路感染的风险也随之增高。
    延伸阅读:《美国防治尿路感染的非处方药和保健品》。
  • 性衰老:雌性激素分泌减少,导致阴道粘膜萎缩、干燥,阴道保湿剂和润滑剂可以缓解改善。
# 1
IntiMD Personal Lubricant Moisturizer Water Based Lube, FDA 510K Cleared, Long Lasting, Sensitive Skin Friendly - 8.5oz
1,190 个好评
IntiMD Personal Lubricant Moisturizer Water Based Lube, FDA 510K Cleared, Long Lasting, Sensitive Skin Friendly - 8.5oz
  • IntiMD Lubricant Moisturizer is a personal lubricant, intended to moisturize and lubricate, to...
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# 2
Tight as a Virgin Vaginal Tightening Gel Bundle with Do Me Water-Based Lube (2oz)
1,491 个好评
Tight as a Virgin Vaginal Tightening Gel Bundle with Do Me Water-Based Lube (2oz)
  • SUPER EXTRA SLIPPERY Yeah, we got your back!
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# 3
genneve Personal Lubricant, Water Based, All-natural Lube for Sensitive Skin, pH-balanced, Non-sticky, Free of Parabens, Glycerin, Hormones, Fragrance, Travel-sized (2 Ounces)
270 个好评
genneve Personal Lubricant, Water Based, All-natural Lube for Sensitive Skin, pH-balanced, Non-sticky, Free of Parabens, Glycerin, Hormones, Fragrance, Travel-sized (2 Ounces)
  • DESIGNED BY WOMEN who want women to enjoy sex and feel great in their bodies…no matter their age!
  • pH BALANCED, which makes it perfect for the most sensitive vaginal environments. Our lubricants...
  • GLYCERIN-FREE, PARABEN-FREE, HORMONE-FREE, FRAGRANCE-FREE so it never burns or provokes yeast...
  • 增重:更年期很多女性体重增加;更年期之后,由于新陈代谢减慢,体重仍会继续上升。

更年期综合症的治疗

更年期综合症通常不需要用药,治疗重点在于缓解具体症状带来的不适,此外预防那些随着年龄而增加的发病风险,主要是各类慢性疾病。

  • 雌激素疗法是已知的缓解更年期潮热最有效的办法。根据女性个人和家族病史,雌激素还可以配合孕激素进行治疗。此外,雌激素对防止骨质流失也同样有益。尽管长期使用激素会增加罹患心血管疾病和乳腺癌的风险,但在更年期发病初期应用激素疗法还是有着积极作用的。
  • 阴道雌激素(vaginal estrogen),有阴道霜、阴道片或药环等形式,在阴道里释放少量雌激素,缓解更年期阴道干燥、性交不适和其它泌尿症状,对治疗绝经后阴道萎缩也有积极作用。
  • 低剂量抗抑郁药物,如选择性5-羟色胺再摄取抑制剂(SSRIs)类抗抑郁药物,也可用于缓解更年期潮热。对于那些由于个人健康原因而无法接受雌激素疗法、或患有情绪障碍疾病的更年期女性来说,低剂量抗抑郁药物也可作为更年期综合症的治疗用药。
  • 加巴喷丁(神经氨酸酶抑制剂、缓释片剂 Gralise 等)是一种治疗癫痫的药物,可乐定是一种降血压药物,二者都已被证明有助于缓解更年期潮热。
  • 预防和治疗骨质疏松的药物也是更年期治疗的常见用药,配合维他命 D 使用可以促进钙吸收来达到强化骨骼的目的。普通成人和儿童也需要摄入足量的维他命 D。
# 1
NatureWise Vitamin D3 5000iu (125 mcg) 1 Year Supply for Healthy Muscle Function, Bone Health and Immune Support, Non-GMO, Gluten Free in Cold-Pressed Olive Oil, Packaging May Vary (360 Mini Softgels)
73,990 个好评
NatureWise Vitamin D3 5000iu (125 mcg) 1 Year Supply for Healthy Muscle Function, Bone Health and Immune Support, Non-GMO, Gluten Free in Cold-Pressed Olive Oil, Packaging May Vary (360 Mini Softgels)
  • most active form: NatureWise Vitamin D3 in certified organic olive oil helps to support teeth and...
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除常规治疗手段外,也有一些针对具体症状的替代疗法,但其效用和安全性大都尚不明确,在使用前需咨询医生。常见的一些手段有:

  • 催眠:据美国国家补充和综合健康中心(NCCIH)的一项研究,催眠可以降低绝经期女性潮热的发生频率,进而改善睡眠,对更年期女性有一定帮助。
  • 瑜伽:尽管没有证据表明瑜伽对更年期症状有直接作用,但如瑜伽、太极等侧重锻炼身体平衡性的运动方式可以增强肌肉力量,间接地可以减少意外摔伤。
  • 黑升麻(Black Cohosh),又称北美升麻,毛茛科,产于美国北部地区,是改善更年期潮热的膳食补充剂的常见成分之一。NCCIH 资助了针对黑升麻的相关研究,研究重点在于辨识黑升麻中的活性成分并了解它们对人体的作用。就目前来说,黑升麻对更年期症状的研究结果并不一致,不足以证明黑升麻对更年期综合症有积极作用。同时,在黑升麻产品的使用人群中还出现了肝损伤的病例,虽然没有证据表明黑升麻与肝损伤之间有直接关系,但 NCCIH 建议,任何人如出现如腹痛、暗尿或黄疸等肝病症状,就应避免或停止使用黑升麻或含有黑升麻成分的产品,并尽快就医 []

延伸阅读:《美国卫生研究院:黑升麻的功效和副作用》。

有折扣# 1
Nature's Bounty Black Cohosh Root Pills and Herbal Health Supplement, Natural Menopausal Support, 540 mg, 100 Capsules
4,211 个好评
Nature's Bounty Black Cohosh Root Pills and Herbal Health Supplement, Natural Menopausal Support, 540 mg, 100 Capsules
  • MENOPAUSE SUPPORT Black Cohosh has traditionally been used to help alleviate the symptoms of...
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有折扣# 2
Nature's Way Black Cohosh Root, 540 mg per serving, Non-GMO, Gluten Free, 180 Capsules
8,376 个好评
Nature's Way Black Cohosh Root, 540 mg per serving, Non-GMO, Gluten Free, 180 Capsules
  • SUPPORTS MENOPAUSE*: Black Cohosh is a traditional herbal for women that is especially helpful...
  • AUTHENTIC TRU-ID CERTIFIED BLACK COHOSH: With TRU-ID validation, you can be sure that the Black...
  • NON-GMO PROJECT VERIFIED: Nature's Way Black Cohosh is produced according to the best practices for...
  • 与黑升麻类似,红三叶草、卡瓦、冬菜、脱氢表雄酮、月见草油和野生山药等也是更年期保健药品中的常见成分,它们都声称对改善更年期症状有效,但均缺乏明确的临床数据,服用前也需咨询医生。
  • 植物雌激素、生物等同激素替代物和针灸也被作为治疗更年期综合症的替代疗法,但就目前已知的研究来看,这些办法并没有呈现出显著的效果。

更年期的生活调理

  • 很多办法都有助于缓解潮热,比如穿宽松衣服、喝冷饮、待在凉爽的环境中等等。热饮、咖啡、辛辣食物、饮酒、过度压力、炎热的天气甚至一个温暖的房间都可能诱发潮热,因此更年期女性要留意这些外因并尽量避免。
  • 非处方水基阴道润滑剂和硅酮基润滑剂、保湿剂可以缓解阴道不适(如 Astroglide、K-Y Jelly 等),但注意不要使用含有甘油成分的产品。某些女性可能对化学制剂过敏,而甘油成分容易引起灼烧或刺痛感。保持一定频率的性生活也可以促进血液流向阴道,对缓解阴道干燥也有益处。
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Astroglide Liquid, Water Based Personal Lubricant, 5 oz.
19,902 个好评
Astroglide Liquid, Water Based Personal Lubricant, 5 oz.
  • PREMIUM LUBE - Water-based and toy-friendly personal lubricant enhances the comfort and ease of...
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K-Y Jelly Lube, Personal Lubricant, Water-Based Formula, Safe to Use with Latex Condoms, For Men, Women and Couples, 4 FL OZ (Pack of 5)
4,532 个好评
K-Y Jelly Lube, Personal Lubricant, Water-Based Formula, Safe to Use with Latex Condoms, For Men, Women and Couples, 4 FL OZ (Pack of 5)
  • GET WHAT YOU WANT: K-Y Jelly is our classic water-based lube that can help you glide into a wetter,...
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  • WATER-BASED FORMULA: Gives you the confidence to enjoy sex
  • 充足的睡眠对更年期女性来说也非常重要。有入睡困难的女性要避免摄入咖啡因和酒精,同时睡前也不要从事体育活动。此外,潮热也常会导致睡眠中断,更年期女性要采取必要的缓解措施来保证完整的睡眠,让自己得到充分的休息。

延伸阅读:《美国卫生研究院:治疗失眠的方法、保健品与安眠药》。

  • 很多放松身心的技巧对缓解更年期症状也很有效,比如深呼吸、起搏呼吸、引导想象、按摩和渐进式肌肉放松训练等。
  • 凯格尔运动(骨盆运动)有助于强化盆底肌,改善尿失禁。
  • 均衡饮食。每日膳食中要有水果、蔬菜和全谷物,同时限制饱和脂肪、油和糖的摄入量,少食多餐,维持正常体重,并对胆固醇和血压进行严格管理使其处于正常指标范围内。根据个人情况,也可同时补充钙或维生素D来帮助满足日常需求。
  • 戒烟。吸烟会增加心脏病、中风、骨质疏松、癌症等的风险,还可诱发潮热、令更年期提前。

延伸阅读:《美国辅助戒烟产品和 FDA 的戒烟建议》。

  • 更年期女性要养成锻炼身体的习惯。身体锻炼对预防心脏病、糖尿病、骨质疏松症和其他与衰老相关的疾病都有帮助。

更年期发病时间和饮食的关系

英国利兹大学食品科学与营养学院的研究人员,基于英国妇女队列研究数据,对英国妇女饮食与更年期发病时间的关系进行了初步研究,原文参见《流行病学和社区健康》。

研究显示:多吃豆类可将更年期发病时间推迟近1年;油性鱼类因含有丰富的ω-3脂肪酸,可以提高人体的抗氧化能力,多食油性鱼类可将自然绝经推迟约3年;摄入维生素B6和锌也可以退迟更年期的到来;相反地,食用白米和精制面则可能将绝经期提早1.5年;而长期吃素的女性较非素食女性而言,其更年期也会较早发生。

更年期常被看作女性衰老的开始而被万千女性所恐惧,但并没有证据表明延迟更年期会给女性的健康带来好处。不过,有研究表明,更年期提前易导致骨密度下降、骨质疏松、抑郁甚至早逝 [12],心血管和冠状动脉疾病的发病风险也会增加 [12];而更年期发病时间较晚的女性中,乳腺癌、卵巢癌和子宫内膜癌的发病几率也相对更高 []。因而,女性在步入更年期后的健康管理和生活调理更应该受到关注。

其他缓解更年期症状的保健品

下面这些都是美国市场上常见的品牌,另可参见《美国药剂师推荐的女性更年期保健品》。

# 1
Estroven Complete Menopause Relief | Reduce Multiple Menopause Symptoms*1 | Reduces Hot Flashes and Night Sweats* | One Per Day | 60 Count (Pack of 1)
2,204 个好评
Estroven Complete Menopause Relief | Reduce Multiple Menopause Symptoms*1 | Reduces Hot Flashes and Night Sweats* | One Per Day | 60 Count (Pack of 1)
  • RELIEF - Estroven Complete Menopause Relief is clinically shown to relieve all menopause symptoms...
  • PLANT-DERIVED RHUBARB - Estroven Complete Menopause Relief contains naturally sourced rhapontic...
  • ALL-IN-ONE MENOPAUSE RELIEF – Relieve your most bothersome menopause symptoms with once daily...
# 2
Menopause Relief Supplement for Women - Support for Hot Flushes, Sweats, Mood, and Insomnia - Windsor Botanicals Estrogen Balance Multivitamin, Mineral, and Naturals Formula - 60 Vegetarian Capsules
2 个好评
Menopause Relief Supplement for Women - Support for Hot Flushes, Sweats, Mood, and Insomnia - Windsor Botanicals Estrogen Balance Multivitamin, Mineral, and Naturals Formula - 60 Vegetarian Capsules
  • Feel like you again. Powerful, cruelty-free support for body and mind. A combination of high-potency...
  • Relief from symptoms. Every experience is unique, so this formula is scientifically blended to...
  • Cool hot flashes. Contains cooling herbs, and minerals including St John’s wort, soy isoflavones...
有折扣# 3
Estroven Menopause Relief + Mood Once-Daily Supplement - Helps Reduce Hot Flashes & Night Sweats - Helps Manage Mood Swings & Menopausal Anxiety - 30 Caplets
3,813 个好评
Estroven Menopause Relief + Mood Once-Daily Supplement - Helps Reduce Hot Flashes & Night Sweats - Helps Manage Mood Swings & Menopausal Anxiety - 30 Caplets
  • HELPS MANAGE MOOD, MEMORY, AND STRESS. * Menopause can come with all sorts of symptoms – daily...
  • SAFE MULTI-SYMPTOM RELIEF: hot flashes, night sweats, daily stress, manage mood, manage memory. *
  • SAFE AND EFFECTIVE dietary supplement that is both drug free and estrogen free. **
# 4
Amberen: Safe Multi-Symptom Menopause Relief. Clinically Shown to Relieve 12 Menopause Symptoms: Hot Flashes, Night Sweats, Mood Swings, Low Energy and More. 1 Month Supply
6,898 个好评
Amberen: Safe Multi-Symptom Menopause Relief. Clinically Shown to Relieve 12 Menopause Symptoms: Hot Flashes, Night Sweats, Mood Swings, Low Energy and More. 1 Month Supply
  • AMBEREN MENOPAUSE SUPPLEMENT SAFELY RELIEVES UP TO 12 MENOPAUSE SYMPTOMS: hot flashes, night sweats,...
  • HELPS RESTORE HORMONAL BALANCE: Amberen is estrogen-free, soy-free and herb-free and helps get to...
  • NOTICEABLE RESULTS WITHIN 30 DAYS with clinically significant results occurring between 30-90 days
# 5
Estroven Menopause Relief + Weight Management Caps-Helps Reduce Hot Flashes & Night Sweats, Original Version, 30 Count
4,457 个好评
Estroven Menopause Relief + Weight Management Caps-Helps Reduce Hot Flashes & Night Sweats, Original Version, 30 Count
  • HELPS MANAGE WEIGHT DURING MENOPAUSE.* During menopause, your serotonin levels naturally decline...
  • SAFE MULTI-SYMPTOM RELIEF: hot flashes, night sweats, manage weight.*
  • SAFE AND EFFECTIVE dietary supplement that is both drug free and estrogen free.**

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