There’s a lot of hype around perimenopause. Don’t buy it.
There’s a lot of hype around perimenopause. Don’t buy it.
关于围绝经期的炒作很多，别轻信。
EXECUTIVE SUMMARY 执行摘要
Perimenopause has entered the chat. Perimenopause—and its better-known relative, menopause—used to be considered taboo. Not anymore, thanks at least in part to TV doctors and social media influencers. Perhaps it’s my age, but these days, both my algorithm and my conversations with friends increasingly swing toward perimenopause. 围绝经期（Perimenopause）已经成为热门话题。围绝经期及其更为人所知的“亲戚”——绝经期（Menopause），过去曾被视为禁忌。但现在情况不同了，这至少部分归功于电视医生和社交媒体网红。也许是因为我的年龄到了，如今，我的算法推荐和与朋友的谈话内容都越来越多地转向了围绝经期。
Menopause is defined as the life stage that occurs a year after a person has had their last period. Perimenopause is the sometimes years-long period before that point, which can also feature all the symptoms we’d typically associate with menopause. Today, information about perimenopause is more prevalent and accessible than ever. If you’re a woman in your 40s and you’re not feeling 100%, chances are there’ll be someone online ready to tell you you’re in perimenopause. And that you might want to start spending your money on blood tests, apps, and supplements or demanding hormone replacement therapy. But as regular readers might have guessed by this point, it’s not that simple. 绝经期被定义为女性最后一次月经后一年所处的人生阶段。围绝经期则是指在此之前的几年时间，这一阶段也可能出现我们通常与绝经期联系在一起的所有症状。如今，关于围绝经期的信息比以往任何时候都更普遍、更容易获取。如果你是一位 40 多岁的女性，且感觉身体状态不佳，网上很可能会有人告诉你，你正处于围绝经期，并建议你花钱去做血液检查、使用相关应用程序、购买补充剂，或者要求进行激素替代疗法（HRT）。但正如老读者们可能已经猜到的那样，事情并没有那么简单。
Perimenopause tends to start around the age of 46 or 47. It’s during this time that many women start to experience some symptoms like hot flashes, irregular or unusually heavy periods, or anxiety, for example. And it can be heavy going. “Often symptoms are at their worst in the perimenopause,” says Mary Ann Lumsden, former president of the International Menopause Society. That’s because hormones can fluctuate wildly. Levels of estrogen, progesterone, luteinizing hormone, and follicle-stimulating hormone can roller-coaster before leveling off after menopause. 围绝经期通常始于 46 或 47 岁左右。在此期间，许多女性开始出现一些症状，例如潮热、月经不规律或经量异常增多，以及焦虑等。这可能是一段艰难的时期。国际绝经学会前主席玛丽·安·拉姆斯登（Mary Ann Lumsden）表示：“围绝经期的症状往往是最严重的。”这是因为激素水平会剧烈波动。雌激素、孕激素、黄体生成素和卵泡刺激素的水平在绝经后趋于平稳之前，可能会像过山车一样起伏不定。
And that’s why, despite what some marketers will claim, there is no test for perimenopause. “You can’t interpret hormone [measures] because they change so much,” says Lumsden. “And that is quite normal.” That doesn’t mean women should have to put up with symptoms. But exactly how those symptoms are treated is another topic that has been clouded by misinformation. 正因如此，尽管一些营销人员声称有相关检测，但实际上并没有针对围绝经期的检测方法。拉姆斯登说：“你无法解读激素（测量值），因为它们变化太大了，而这完全是正常的。”这并不意味着女性必须忍受这些症状，但究竟该如何治疗这些症状，是另一个被错误信息笼罩的话题。
Last week, I told a friend about some unusually bad pelvic pain I’d experienced. Her immediate advice was to find out if I was perimenopausal and, if I was, to request hormone replacement therapy (HRT) as soon as possible. If my doctor wouldn’t prescribe it, she continued, I should simply find another doctor who would. This line of thinking has been heavily promoted on social media platforms, says Paula Briggs, a former chair of the British Menopause Society who currently leads the menopause service at Liverpool Women’s Hospital. But it’s not helpful. 上周，我告诉一位朋友我经历了一些异常严重的盆腔疼痛。她立刻建议我查清楚自己是否处于围绝经期，如果是，就尽快要求进行激素替代疗法（HRT）。她还说，如果我的医生不给我开药，我就应该直接换一个愿意开药的医生。英国绝经学会前主席、目前在利物浦妇女医院负责绝经服务的保拉·布里格斯（Paula Briggs）表示，这种思维方式在社交媒体平台上被大肆宣传，但它并无益处。
HRT is essentially designed to top up or replace hormones like estrogen and progesterone, which naturally decline around menopause. There are lots of different drugs that can be taken in lots of different ways and at various doses. While it does come with some risks and won’t suit everyone, HRT can be immensely helpful for many menopausal women. Not only can it help with many of the common symptoms of menopause, but it can also help prevent osteoporosis and maintain muscle strength. HRT 的本质是补充或替代在绝经前后自然下降的雌激素和孕激素等激素。目前有许多不同的药物，可以通过多种方式和剂量服用。虽然它确实存在一些风险，且并不适合所有人，但对于许多绝经期女性来说，HRT 非常有帮助。它不仅能缓解许多常见的绝经期症状，还能帮助预防骨质疏松并维持肌肉力量。
But these drugs were trialed in, and approved for, menopausal women, says Lumsden. They won’t have the same effects in perimenopausal women. “If you give standard HRT, it may well get swamped by [the woman’s] own hormone production,” she says. HRT can also cause abnormal bleeding in perimenopausal women, says Briggs. She’s concerned about the messaging on perimenopause that is being promoted on social media. Particularly worrisome, she says, is the way younger women are being encouraged to assume they are perimenopausal and seek out HRT treatment. “It’s almost cult-like, this idea that everybody must have HRT,” she says. 但拉姆斯登指出，这些药物是在绝经期女性身上进行试验并获批的，它们在围绝经期女性身上不会产生同样的效果。“如果你给予标准的 HRT，它很可能会被（女性）自身产生的激素所淹没，”她说。布里格斯补充说，HRT 还可能导致围绝经期女性出现异常出血。她对社交媒体上关于围绝经期的宣传信息感到担忧。她说，尤其令人担忧的是，年轻女性被鼓励去假设自己处于围绝经期并寻求 HRT 治疗。“这种‘每个人都必须进行 HRT’的观念几乎像是一种邪教，”她说。
And then there are the supplements. There’s been an explosion in marketing for vitamins and supplements specifically targeted to middle-aged and menopausal women. But the evidence for these, too, is either limited or nonexistent. “I can’t see a mechanism for a lot of them,” says Lumsden. Women who take these supplements don’t always know what they’re getting. Some of Lumsden’s patients have told her they take testosterone supplements to manage their symptoms. But blood tests revealed no increase in testosterone levels. “Whatever they’re getting, it’s not testosterone,” she says. 此外还有补充剂。针对中年和绝经期女性的维生素和补充剂营销呈爆炸式增长。但这些产品的证据要么有限，要么根本不存在。拉姆斯登说：“我看不出其中许多产品的作用机制。”服用这些补充剂的女性并不总是知道自己摄入了什么。拉姆斯登的一些病人告诉她，她们服用睾酮补充剂来控制症状，但血液检查显示睾酮水平并没有增加。“无论她们买到的是什么，那肯定不是睾酮，”她说。
At any rate, not all the symptoms women experience in midlife can be blamed on hormones. The lengthy lists of perimenopause symptoms shared on social media include fatigue, brain fog, aches and pains, digestive issues, and more. “These do not link closely to the obvious menstrual cycle changes and hormone changes … across menopause,” says Nanette Santoro, a professor of obstetrics and gynecology at the University of Colorado Anschutz who studies menopause. 无论如何，女性中年经历的所有症状都不能归咎于激素。社交媒体上分享的冗长的围绝经期症状清单包括疲劳、脑雾、疼痛、消化问题等。科罗拉多大学安舒茨医学校区研究绝经期的妇产科教授南内特·桑托罗（Nanette Santoro）表示：“这些症状与绝经期明显的月经周期变化和激素变化并没有紧密的联系。”
If you’re experiencing any symptoms, it’s worth getting them checked out to make sure they’re not being caused by something else. My own pelvic pain, for example, is almost definitely the result of endometriosis—a condition that can be made worse by HRT, Lumsden tells me. At any rate, by the time women reach their 40s, many are already juggling care for children and aging parents, often while holding down a job (and dealing with pressures from societies that don’t appear to value older women). It’s an exhausting time—and not all of that exhaustion can be blamed on hormones. As Santoro puts it: “Attributing everything unpleasant that happens to a woman over 35 to perimenopause is not based on any scientific evidence.” 如果你有任何症状，值得去检查一下，以确保它们不是由其他原因引起的。例如，拉姆斯登告诉我，我自己的盆腔疼痛几乎肯定是子宫内膜异位症的结果——而 HRT 可能会加重这种疾病。无论如何，当女性到了 40 多岁时，许多人已经在照顾孩子和年迈父母的同时还要兼顾工作（并应对社会对年长女性缺乏重视的压力）。这是一个令人精疲力竭的时期，而这种疲惫并非全部源于激素。正如桑托罗所言：“将 35 岁以上女性身上发生的所有不愉快的事情都归咎于围绝经期，是没有任何科学依据的。”