更年期大师课：玛丽·克莱尔·哈弗博士谈激素、脑雾、体重与心理健康

绝经后阶段代表了我们一生中必须学会在没有卵巢分泌激素的情况下生活的整个时期。

Post menopause represents the entire lifespan that we have where we have to learn how to live without the hormones produced in our ovaries.

那么，让我们来回答一些问题。

So let's get into some questions.

在《Unpaused》节目中表达的观点和意见仅属于嘉宾本人，仅供信息和娱乐目的。

The views and opinions expressed on unpaused are those of the talent and guests alone and are provided for informational and entertainment purposes only.

本播客或任何相关材料的任何部分均不旨在替代专业的医疗建议、诊断或治疗。

No part of this podcast or any related materials are intended to be a substitute for professional medical advice, diagnosis, or treatment.

我是医生。

I'm Doctor.

玛丽·克莱尔·哈弗，一位经认证的妇产科医生和更年期专业医师。

Mary Claire Haver, a board certified obstetrician, gynecologist, and certified menopause practitioner.

我同时也是德克萨斯大学医学分部妇产科的兼职教授。

I am also an adjunct professor of obstetrics and gynecology at the University of Texas Medical Branch.

欢迎收听《Unpaused》，这档播客旨在打破沉默，探讨女性在人生后半程真正实现蓬勃发展的必要条件。

Welcome to Unpaused, the podcast where we cut through the silence and talk about what it really takes for women to thrive in the second half of life.

欢迎来到我的第一次AMA，也就是‘问我任何问题’环节。

So welcome to my very first AMA or Ask Me Anything.

我在Instagram上征集问题时，收到了非常多提问。

We got so many questions when I solicited on Instagram.

你们想了解些什么呢？

What do you guys wanna know about?

但我觉得我们首先需要从基本的定义开始。

But I think we first really need to start with basic definitions.

那么，更年期是什么？我们如何定义它？

So what is menopause, and how do we define it?

不幸的是，在医学上，我们把更年期定义为最后一次月经后一年。

Unfortunately, in medicine, we define menopause as one year after the last menstrual period.

那如果你的月经不规律怎么办？

Now, what happens if you don't have regular periods?

如果你做过子宫切除术，或者使用了曼月乐宫内节育器，或者因为其他原因没有正常月经周期，你会被落下吗？

If you've had hysterectomy or if you are having a Mirena IUD or some reason why you don't have a normal cycle, do you get left behind?

那如果是闰年呢？

And what if it's leap year?

我们要算多一天，还是三百六十六天？

Do we go one extra day or three sixty six days?

更年期代表的是卵巢停止分泌激素。

What menopause represents is the end of production of hormones from your ovaries.

那为什么会发生这种情况呢？

And why does this happen?

女性人类出生时就拥有了全部的卵子储备。

Human females are born with their entire egg supply.

我认为每位女性都真正需要理解的是，我们为什么会经历更年期。

What I think every woman really, really needs to understand is why we go through menopause.

女性人类在多个层面上与男性人类不同。

Human females are different than human males on multiple levels.

但从内分泌学的角度来看，女性出生时就拥有了全部的卵子储备。

But from an endocrinological perspective, women are born with their entire egg supply.

男性每天在睾丸中都能产生新的精子，直到去世。

Men get to make their stuff fresh every day in the testicles until they die.

所以当我们还在母亲子宫里的时候，医学上称为宫内，当你大约五个月大时，你母亲正怀着你，而你未来孩子的遗传物质，其实已经存在于你的祖母体内了，想想看，这很有趣。

So when we are in our mother's womb, so in medicine we say in utero, when you're about five months along, your mother is pregnant, you're five months along, and the DNA, the genetic material for your children is inside of your grandmother, if you think about that.

这相当令人着迷。

It's kind of fascinating.

你体内有数百万个卵子，但从你还在子宫里时就开始退化，因此到你出生时，卵子数量已经减少到约一百万到两百万个。

So you have several million eggs there, and they start deteriorating immediately while you're still in the womb, so that by the time you're born, you are down to already one to 2,000,000 eggs at birth.

之后你会持续以相对稳定的速度流失卵子，这个过程称为闭锁。

You continue to lose them on a pretty steady state basis, and that is from a process called atresia.

闭锁，我倾向于把它理解为适者生存。

Atresia, I like to think of it as kind of survival of the fittest.

你会逐渐淘汰不够健康的卵子，让最健康、最有活力的卵子留存下来。

You slowly tick off the less healthy eggs so that the most healthy and viable eggs will survive.

等到你开始排卵时，卵子数量大约只剩下十二万个。

By the time you start ovulating, you are down to about 120,000.

到了30岁，你的卵子数量只剩下原始数量的10%。

And then by the time you are 30, you're down to 10% of the original egg supply.

到了40岁，你的卵子数量只剩下原始数量的3%。

And then by the time you are 40, you are down to 3% of the original egg supply.

那么，接下来我们该往哪里看呢？

Now, where do we go from here?

更年期本质上就是你的卵子用完了。

Menopause is basically you run out of eggs.

现在，我们来谈谈排卵以及它是如何发生的。

Now, let's talk about ovulation and how that happens.

在青春期之前，我们还是孩子，身体会抑制排卵系统，以便给你足够的时间成长，达到成年状态。

Before puberty, we're children, there is kind of breaks put on the ovulation system, and that is to give your body a chance to grow and to get to some kind of an adult state.

当这种抑制解除后，我们就开始排卵。

When that break comes off, we begin ovulating.

实际上，对我们女性而言，排卵始于大脑，而不是卵巢。

So ovulation, actually, for us as women, starts in the brain, not in the ovaries.

卵巢只是在那里等待指令，被告知该做什么。

The ovaries are sitting there just waiting for instructions to be told what to do.

大脑中有两个腺体在这里起重要作用。

There's two glands in the brain that are important here.

一个是下丘脑，另一个是垂体腺。

One is called the hypothalamus, and the other is called the pituitary gland.

下丘脑是我们女性荷尔蒙的总调节器。

So the hypothalamus is the master regulator of our hormones as females.

下丘脑就像有一根小手指伸入血液中，像一个探针，持续监测雌激素水平。

So the hypothalamus has, imagine a little finger in the blood supply, a little probe, and it is checking for estrogen levels.

在我们的自然周期中，当周期末尾雌激素水平下降时，大脑会说：‘我的雌激素去哪儿了？’

And in our natural cycle, when the estrogen levels get low at the end of the cycle, the brain says, Hey, where's my estrogen?

它会向垂体腺发送一种叫做促性腺激素释放激素（GnRH）的信号，说：‘垂体，我们需要雌激素。’

It sends a signal called GnRH to the pituitary gland that says, Pituitary, we need estrogen.

向卵巢发送信号，这基本上就会引发排卵。

Send your signals down to the ovary, and that basically causes the ovulation.

因此，我们最终看到了一种如心电图般优美的激素波动：来自垂体的FSH和LH，以及来自卵巢的雌二醇和孕酮。

So we end up with this beautiful EKG like ebb and flow of our hormones, FSH and LH from the pituitary gland, and then estradiol and progesterone from the ovaries.

在排卵中期，我们看到雌激素激增，为怀孕做准备，随后在周期的后半段，孕酮水平上升。

Mid cycle, we see the surge of estrogen basically in preparation for a pregnancy, and then we have progesterone that rises in the second half of the cycle.

这一美妙的过程在健康女性体内月复一月、年复一年地精准运转，直到她进入下一个阶段——围绝经期。

And that beautiful process in a healthy female goes like clockwork month after month after month after month until she reaches our next definition, perimenopause.

围绝经期是指你达到某个关键的卵子数量阈值，这个阈值因人而异，此时来自大脑的信号不再有效。

Perimenopause is you reach some critical egg threshold level, and it's different for every woman, where the signals coming from the brain don't work.

卵巢变得对信号产生抵抗。

The ovaries become resistant.

我们不再有足够的卵子以以往的方式作出反应。

We don't have enough eggs to respond in the same manner that we used to.

于是信号传来，大脑察觉雌激素水平低，立刻开始向卵巢发送FSH和LH，但卵巢却难以作出回应。

So signals come, the brain's like low estrogen, boom, start sending that FSH and LH down to the ovary, and the ovary's struggling to respond.

大脑变得焦虑不安。

The brain becomes agitated.

下丘脑在想：我的雌激素去哪儿了？

Hypothalamus is like, Where's my estrogen?

垂体在说：老板，我已经发送信号了。

The pituitary is like, Boss, I sent the signal.

下丘脑又说：再发多一点。

And the hypothalamus is like, Send more.

我们必须把雌激素水平提上去。

We've got to get this estrogen up.

因此，垂体会开始向卵巢发送越来越高的促性腺激素（LH和FSH），以强制排卵。

So what happens is the pituitary starts sending higher and higher levels of those stimulating hormones, the LH and the FSH, to the ovaries to force the ovulation.

这在大脑中造成了混乱，而大脑讨厌混乱。

That creates chaos in the brain, and the brain hates chaos.

所以，我们通常在围绝经期最早看到的症状并不是月经周期紊乱。

So quite often, the first sign that we see in perimenopause is not cycle dysregulation.

月经周期紊乱是围绝经期后期才出现的。

That is late in perimenopause.

是脑雾、情绪变化，有时只是感觉：我不像我自己了。

It is brain fog, mental health changes, and sometimes just feeling, I don't feel like myself.

有什么地方不对劲。

Something's not right.

从临床角度看，当我那些患者前来就诊时，回想我真正理解围绝经期和绝经期及其对全身多器官系统影响之前的二十多年、十五年行医经历。

Clinically, when my patients come in and I think about the twenty ish years, fifteen years that I practiced before I truly understood perimenopause and menopause, and the whole multi organ system effects that it could have.

我知道人们会有阴道干涩。

I knew that people had vaginal dryness.

我知道人们会出现潮热。

I knew that people would have hot flashes.

我知道她们的月经周期会变得不规律，然后停止。

I knew that their cycles would become irregular and then stop.

但我当时并不真正了解她们大脑里发生了什么。

But what I didn't really understand was what was happening in their brain.

对大多数患者而言，当你真正关注大脑中开始出现的变化——疲劳、睡眠紊乱、情绪变化，以及那种说不清道不明的不对劲感——那就是围绝经期。

And for most patients, when you really look at the things starting in the brain, the fatigue, the sleep disruption, the mental health changes, the just not feeling something is wrong and you can't put your finger on it, that is perimenopause.

所以，请记住我们对绝经的定义：最后一次月经后的第一天。

So remember our definition of menopause, one day after your last menstrual period.

记住，就是一天，仅仅一天。

Remember one day, just one.

那就是绝经。

That is menopause.

从那之后的接下来三十年、四十年，甚至五十年——如果我们幸运的话——都是绝经后阶段。

Everything after that, the next thirty to forty to fifty years, if we're lucky, is post menopause.

因此，绝经后阶段代表了我们一生中必须学会在没有卵巢分泌的激素情况下生活的整个时期。

So, post menopause represents the entire lifespan that we have where we have to learn how to live without the hormones produced in our ovaries.

那么，让我们来探讨一些问题。

So, let's get into some questions.

雌激素缺乏或绝经会影响哪些器官系统？

Which organ systems are affected by estrogen deprivation or menopause?

这是一个非常好的问题。

Well, that's a really good question.

我之前提到过我所接受的教育中关于更年期会发生什么，所以我了解生殖泌尿系统的改变，主要是膀胱和阴道。

I talked earlier about what I was taught would happen, so I knew genital urinary changes, the bladder, the vagina mostly.

我知道月经会紊乱，也知道我们的骨骼会开始疏松，但我并不理解。

I knew about the period disruptions, and I knew that our bones would begin to crumble, but I did not understand.

直到三四年前，才有人告诉我大脑、心脏、骨骼、肌肉骨骼系统、肝脏和关节会发生什么变化。

No one taught me until three or four years ago about what happens in the brain, what happens in the heart, what happens in the bones, what happens in the musculoskeletal system, what happens in the liver, what happens in our joints.

因此，真正改变我人生的论文之一是研究人员绘制出了体内雌激素受体的分布图，这让我震惊不已。

So one of the papers that truly changed my life was researchers mapped out where the estrogen receptors were in the body, and that took my breath away.

我完全不知道会有这么多器官系统受到影响，像心悸、冻结肩、胆固醇升高、胰岛素抵抗、前期糖尿病等症状都与更年期有关。

I had no idea that so many organ systems could be affected, that symptoms like palpitation, like frozen shoulder, like elevated cholesterol, like insulin resistance, prediabetes are all having to do with menopause.

在我们仍健康排卵时，体内自然产生的雌激素对整个人体具有很强的保护作用。

The natural estrogen in our systems while we're still ovulating healthy is very protective of the human body.

它保护我们的关节。

It protects our joints.

它保护我们的肝脏功能。

It protects our liver function.

它保护我们处理葡萄糖的方式。

It protects the way we process glucose.

它决定脂肪在体内的储存位置和方式。

It determines where and how we store fat.

这让我大为震惊。

And that was mind blowing to me.

让我们来谈谈症状。

So let's talk about symptoms.

当我为《新更年期》做研究时，我努力寻找尽可能多的医学证据和相关论文，实际上有不少研究从器官系统到器官系统，展示了女性在围绝经期因雌激素缺乏可能经历的各种症状。

When I was researching for the new menopause, I was trying to find as much medical evidence and papers that were written, and actually there's quite a few, that demonstrated from organ system to organ system what symptoms might be experienced by a woman going through perimenopause from the estrogen deprivation.

你准备好了吗？

And are you ready for this?

乳房胀痛、脑雾、关节炎、胃酸反流、体成分变化、腹部脂肪、脆甲、关节痛、体味、哮喘、腹胀、焦虑、抑郁、口腔或舌头灼烧感、自身免疫性疾病新发或加重、皮肤干燥、睡眠障碍、慢性疲劳、头晕、干眼、性欲减退或性功能障碍、口干、湿疹、疲劳、头痛、纤维肌痛、冻结肩、潮热、心悸、尿失禁、胰岛素抵抗、腹胀、胃肠道问题、皮肤电击感、心律不齐（也称为心悸）、泌尿生殖综合征、阴道干涩、反复尿路感染、注意力难以集中、高胆固醇、高甘油三酯、易怒、关节疼痛、耳痒、皮肤瘙痒、肾结石、记忆力减退、心理健康障碍、偏头痛，等等，不胜枚举。

Breast tenderness, brain fog, arthritis, acid reflux, body composition changes, belly fat, brittle nails, arthralgia, body odor, asthma, bloating, anxiety, depression, burning sensation in the mouth or tongue, autoimmune disease, new or worsening, dry skin, sleep disruption, chronic fatigue, dizzy spells, dry eyes, decreased desire or libido issues, dry mouth, eczema, fatigue, headaches, fibromyalgia, frozen shoulder, hot flashes, palpitations, incontinence, insulin resistance, bloating, gastrointestinal problems, electric shock sensations in the skin, irregular heartbeat, also known as palpitations, genital urinary syndrome, vaginal dryness, recurrent UTIs, difficulty concentrating, high cholesterol, high triglycerides, irritability, joint pain, itchy ears, itchy skin, kidney stones, memory issues, mental health disorder, migraines, and the list goes on and on.

我还想补充一点：听觉更敏感，因为现在我丈夫咀嚼食物的声音让我完全无法忍受。

And I need to add heightened hearing, because my husband chewing is absolutely intolerable to me at this point.

围绝经期通常在月经停止前七到十年就开始了，至少是这样。

Perimenopause begins seven to ten years before your period stops, at least.

所以请记住，女性绝经的平均年龄是51岁。

So remember, the average age of menopause is 51.

正常范围，也就是在正常曲线内，是46到55岁。

Normal, meaning under the normal curve, is 46 to 55.

我们来算一算，往前推七到十年。

Let's do math and back that up seven to ten years.

对于一位年仅35或36岁的女性来说，出现我前面列出的任何或所有症状，都是完全合理、可预期且普遍存在的。

It is completely reasonable and expected and predictable for a woman as young as 35 to 36 to begin having any or all of the symptoms that I listed before.

所以，医生。

So, Doctor.

哈弗，跟我聊聊体重增加和更年期的关系。

Haver, talk to me about weight gain and menopause.

当我谈到体重增加和更年期时，你会发现，我在社交媒体上经常看到，很多健康领域的人声称更年期并不会导致体重增加。

So when I talk about weight gain and menopause, you will see, I see it on social media all the time, a lot of the wellness crowd saying menopause does not cause weight gain.

这意味着，当我们比较同龄患者时，无论是否进入更年期，他们都在增重。

What that means is that when we look at age matched patients, regardless of their menopause status, they are all gaining weight.

因此，很难把这归咎于更年期。

So it's hard to blame menopause on that.

然而，我们确实观察到身体成分的变化，即肌肉流失。

However, what we do see is body composition changes, loss of muscle.

众所周知，肌肉比脂肪重，但脂肪占据的空间更大。

So muscle weighs more than fat, as we all know, but fat takes up more space.

因此，我们看到体脂部分在扩张，尤其是在医学上称为内脏脂肪的部位，也就是你们所说的腹部脂肪。

So, we are seeing expansion of the body fat compartment, especially in what we call the viscera in medicine, which you would call belly fat.

这是一种非常特殊的脂肪，包裹在我们的内脏器官周围，其作用与皮下脂肪截然不同。

This is a very specific type of fat that wraps around our internal organs, and it acts very differently than subcutaneous fat.

皮下脂肪是位于皮肤下的脂肪。

Subcutaneous fat is the fat under our skin.

它与我们年轻时储存脂肪的方式和部位密切相关，主要由遗传决定。

It's heavily tied to our genetics of how and where we store fat when we are younger.

皮下脂肪本身并不危险，除非其数量达到一定程度，对关节造成磨损。

And subcutaneous fat is not inherently dangerous unless you have a critical mass that is causing wear and tear on your joints.

它并不具有明显的代谢活性，远不如内脏脂肪那样活跃。

It's not really metabolically active, not nearly to the degree that visceral fat is.

在绝经过渡期，内脏脂肪会显著增加，这一点不容否认。

Visceral fat expands dramatically across the menopause transition, and there is no denying this.

例如，绝经前的女性，其总体脂肪中约有8%是内脏脂肪。

So, for example, a premenopausal woman, on average, of her total body fat, about 8% is visceral.

当她经历绝经过渡期并进入绝经后，内脏脂肪比例会从8%上升到约20%至23%。

Take her through the menopause transition, put her into menopause, we now go from 8% to about 20%, to 23%.

因此，在饮食和运动没有任何改变的情况下，脂肪量几乎增加了两倍。

So almost tripling the amount of fat with not one single change in diet and exercise.

那么，为什么会出现这种腹部脂肪呢？

So why does this belly fat happen?

这是个很好的问题。

That's a great question.

当我们从体内移除雌激素时，一系列变化开始发生。

So when we take estrogen away and out of the system, several things start happening.

雌激素是一种强大的抗炎激素。

Estrogen is a powerful anti inflammatory hormone.

因此，我们看到全身性炎症标志物上升。

So we see systemic inflammatory markers rise.

像白细胞介素、C反应蛋白这样的物质，在缺乏雌激素抑制的情况下会升高。

Things like interleukin, things like C reactive protein go up without estrogen there to kind of hold them back.

当我们的身体处于更多炎症状态时，脂肪更容易堆积在内脏腔和腹部。

When our body is more inflamed, we tend to drive fat to the visceral cavity, to the abdomen.

当腹部有脂肪时，脂肪越多，它本身就会释放出更多的炎症性细胞因子，这些化学信使会提高我们血液中的炎症水平。

When we have fat there, the more fat we have, that fat itself pumps out more inflammatory cytokines, these chemical messengers that raise our blood levels of inflammation.

于是陷入了一个非常糟糕的恶性循环：更多炎症促使更多脂肪堆积在腹部，而腹部脂肪又引发更多炎症。

So, end up in this really crazy negative feedback cycle, more inflammation driving more fat to the abdomen, causing more inflammation.

我们还观察到肝脏功能的变化，即身体处理胆固醇的方式，LDL水平显著上升，而HDL水平略有下降。

Second thing we also see is effects in the liver, how our body processes cholesterol, we see a dramatic increase in our LDL levels and a slight decrease in our HDL levels.

如果你还不知道，LDL是坏胆固醇，更可能与心血管疾病相关，而HDL是好的、具有保护作用的胆固醇。

And if you haven't learned this, LDL is the bad cholesterol more likely to be related to cardiovascular disease, and HDL is the good and protective cholesterol.

最后一点要记住的是，绝经期过渡期间，身体处理葡萄糖的方式会发生显著变化。

One final thing to remember is how your body processes glucose changes dramatically across the menopause transition.

我们观察到胰岛素抵抗、前期糖尿病和完全型糖尿病的发生率上升。

We see elevations in insulin resistance, prediabetes, and full diabetes.

例如，一位处于围绝经期、患有前期糖尿病的女性，如果开始接受激素替代疗法（不是避孕药，而是绝经期激素疗法），她发展为完全型糖尿病的风险比未接受HRT的女性降低百分之五十。

For example, a woman with prediabetes who is started on hormone therapy, not birth control pills, but menopausal hormone therapy in perimenopause, who is prediabetic, has a fifty percent decreased risk of developing full diabetes versus a woman not on HRT.

荷尔蒙的影响不仅仅关乎你的感受。

Hormones affect more than how you feel.

它们也会影响你的皮肤。

They affect your skin too.

随着中年时期雌激素水平下降，你的皮肤可能会失去胶原蛋白、水分和弹性。

As estrogen drops in midlife, your skin can lose collagen, hydration, and elasticity.

这就是Alloy Health的用武之地。

That's where Alloy Health comes in.

Alloy 让基于证据的更年期护理变得触手可及，帮助女性连接更年期专家。

Alloy makes evidence based menopause care accessible, connecting women with menopause experts.

现在，他们通过 M4 系列重新定义了护肤，该系列产品含有雌三醇——一种仅作用于皮肤的雌激素形式。

And now they're redefining skincare with M4, their line made with estriol, a form of estrogen that only works on the skin.

最初推出的是 M4 面霜处方版，如今 Alloy 又推出了两款突破性产品：M4 面部精华处方版和 M4 眼霜处方版。

It started with the M4 Face Cream Rx, and now Alloys added two game changers, the M4 Face Serum Rx and the M4 Eye Cream Rx.

开始使用非常简单。

Getting started is easy.

访问 myalloy.com。

Head to myalloy.com.

那就是 myalloy.com。

That's myalloy.com.

回答几个简单问题，持证医生将审核您的信息。

Answer a few quick questions, and a licensed physician will review your info.

使用代码 MCH20。

Use code MCH20.

输入代码 MCH20，首单立减 20 美元。

That's m c h two zero for $20 off your first order.

您的个性化护肤产品将直接配送到家。

Your personalized skin care ships right to your door.

无需预约，无需排队取药，因为您的皮肤正在变化，您的护理routine也应随之改变。

No appointments, no pharmacy lines because your skin's changing and your routine should too.

访问 myalloy.com 并使用代码 MCH20。

Visit myalloy.com and use code m c h 20.

代码是 MCH20。

That's m c h two zero.

在中年时期，许多女性饱受疲劳、脑雾、体重变化和潮热的困扰，但她们仍被告诉这些症状只是变老的正常部分。

In midlife, so many women struggle with fatigue, brain fog, weight changes, hot flashes, and they're still being told these symptoms are just a part of getting older.

我每天都能听到女性们在寻找真正的解答，却得不到应得的护理。

I hear about it every day from women who are searching for real answers and not getting the care they deserve.

这种更年期护理的空白，正是 MediHealth 旨在填补的。

That gap in menopause care is exactly what MediHealth is here to close.

MediHealth是一家为中年女性提供专业、循证护理的远程医疗诊所。

MediHealth is a telehealth clinic serving women in midlife with expert evidence based care.

他们的临床医生和医疗领导者都是我信赖的专业人士，致力于全面治疗患者。

Their clinicians and medical leaders are professionals I trust, committed to treating the whole person.

作为唯一一家被主要保险公司覆盖的全国性女性远程医疗诊所，他们让高质量的护理变得可及且负担得起。

And as the only national women's telehealth clinic covered by major insurance, they make high quality care accessible and affordable.

当你与Midi合作时，你会获得一个围绕你独特需求量身定制的个性化方案。

When you work with Midi, you'll get a personalized plan built around your unique needs.

这可能包括激素治疗、营养建议、生活方式指导或体重管理支持。

This might include hormone therapy, nutrition, lifestyle guidance, or support for weight management.

所有措施都旨在帮助你当下感觉更好，并保护你的长期健康。

Everything is designed to help you feel better now and protect your long term health.

我们正在见证Midi在各地患者身上带来的改变，女性们正获得真正影响日常生活的答案、缓解和护理。

We're seeing the difference Midi is making with patients everywhere, and women are getting the answers, relief, and care that truly makes an impact on their daily lives.

这对女性健康来说是一个令人鼓舞的时刻。

It's such an encouraging moment for women's health.

我们终于看到更年期护理正朝着应有的方向发展——更加体贴、知情，并以女性的真实体验为中心。

We're finally seeing menopause care evolve into what it should be, thoughtful, informed, and centered on women's real experiences.

我非常高兴看到MIDI Health正在帮助女性获得支持与力量。

I'm so thrilled by what MIDI Health is doing to help women feel supported and empowered.

你值得拥有既能支持你现在、又能保护你长期健康的服务。

You deserve care that supports you now and protects your long term health.

访问joinmidi.com，与MIDI医生见面，开启未来几年的最佳状态。

Visit joinmidi.com to meet with a MIDI clinician and start feeling your best for the years ahead.

那么，医生。

So Doctor.

您曾跟我谈过围绝经期和更年期期间的心理健康变化。

Haver talked to me about mental health changes across perimenopause and menopause.

为什么我的焦虑感越来越强？

Why am I having increasing anxiety?

这是个很好的问题。

That's a great question.

有几方面原因。

There's a few things going on.

大脑中存在一片混乱区域，炎症水平升高，同时雌激素、孕激素，以及可能的睾酮，都会直接影响我们的神经递质。

The zone of chaos, increasing levels of inflammation in the brain, also estrogen and progesterone, and likely testosterone, all have direct effects on our neurotransmitters.

神经递质包括多巴胺和血清素等物质。

And neurotransmitters are things like dopamine and serotonin.

这些是神经元之间传递信号的化学信使。

These are the chemical messengers that go from neuron to neuron in the brain.

例如，当我们治疗抑郁症时，会给你服用药物来改变这些神经元之间的神经递质水平。

For example, when we're treating depression, we are giving you medication that changes the level of these neurotransmitters between those neurons.

所以，想象一下，你的大脑原本非常习惯于每月内激素水平的规律波动，而且状态良好。

So, imagine all of a sudden, your brain is very used to having certain amounts of hormones come and go throughout the month, and you're doing great.

或者说，你之前有抑郁或焦虑病史，且通过药物得到了良好控制，但突然进入围绝经期，大脑经历激素紊乱，你的血清素、去甲肾上腺素和多巴胺水平开始变化，不仅出现认知变化，如脑雾、找词困难、语无伦次，还可能新发抑郁或焦虑，或者原本有效的药物不再能提供所需的症状缓解。

Or say you had a previous history of depression or anxiety that was well controlled on your medications, and all of a sudden, you get to perimenopause, the brain's going through its hormonal chaos, your serotonin and norepinephrine and dopamine levels are starting to shift, and you are starting to have not only cognitive changes like brain fog, difficulty finding words, word salad, but you are also having a new onset of depression or anxiety, or previously well controlled medication is no longer giving you the symptom relief that you need.

我在研究围绝经期新进展时发现，对于围绝经期女性，将激素疗法作为一线治疗，或在已服用抗抑郁药的基础上作为辅助治疗，这如今已成为金标准。

What we found when I was researching for the new perimenopause is that women who are treated with hormone therapy in perimenopause as a first line therapy or an adjunct if they're already on antidepressants, this is really the gold standard now.

不要让原本生活顺遂的人，突然在围绝经期出现新的抑郁和焦虑。

Not to start someone who is doing great in life, all of a sudden has new depression and anxiety in perimenopause.

我们希望通过激素疗法稳定激素水平，这些患者的情况通常会显著改善。

We want to stabilize from hormones with menopause hormone therapy, and those patients are doing quite well.

因此，一线治疗应为激素疗法，如有需要，再酌情加用抗抑郁药。

So first line therapy should be hormone therapy, and then if needed, secondarily adding an antidepressant if needed.

抗抑郁药不应该是首选治疗。

Should not be first line therapy.

值得注意的是，我们在向临床医生普及围绝经期与心理健康知识方面做得非常糟糕。

It's also worth noting that we're doing a terrible job educating our clinicians about menopause and mental health.

实际上，我们在向医生普及围绝经期及其相关知识方面整体表现都很差。

We're actually doing a terrible job educating them about menopause and anything.

最近一项调查显示，仅有约8%的住院医师在完成妇产科培训时感到自己有能力治疗围绝经期，仅有约23%的人承认自己接受过任何围绝经期相关培训。

Recent survey done, only about eight percent of residents felt competent to treat menopause when they graduated from OBGYN training programs, and only about twenty three percent admitted that they got any training in menopause at all.

而这还只是妇产科的情况，尚未包括全科医学和内科——这些科室的医生才是直接面对女性患者的第一线力量。

And that's just OBGYN, that's not including family medicine and internal medicine, all of the people who are seeing women on the front line.

所以，当你听到我说将激素疗法作为围绝经期精神健康变化的首选治疗时，这可能是你的医生第一次听到这些内容，因为即使在完成培训和住院医师阶段后，我们仍需通过继续医学教育（CME）来维持执照认证，通常每年都需要重新认证，以跟上最新的进展。

So you hearing me say giving hormone therapy as first line for mental health changes in the perimenopause transition may be the first time your clinician hears any of this, because even with CME, the continuing medical education once we get out of our training and our residencies, we are required to keep our board certification up by recertifying on usually a yearly basis, which means keeping up with the latest changes.

但各专业委员会并未选择围绝经期相关的文章提供给临床医生，而且许多人仍在使用非常陈旧的指南。

But the boards are not selecting menopause related articles to put in front of their clinicians, and many of them are using guidelines that are very, very dated.

因此，你可能需要向你的医生普及这些知识，或者寻找一位接受过围绝经期专业培训的医生，以获得你需要的治疗。

So you may have to educate your clinician or seek out a menopause educated clinician to get the care that you need.

我们被要求讲解的最热门话题之一，是关于阴道、膀胱和外阴的变化，在我的专业领域中，我们统称为生殖泌尿综合征（GSM）。

One of the most popular topics that we were asked to cover was concerning changes to the vagina, the bladder, the vulva, something we lumped together in my world called GSM or genital urinary syndrome of menopause.

但这个名称可能并不理想，因为产后、围绝经期，或任何雌激素水平降低的时期，都可能出现泌尿系统的一般性变化。

That name is probably not the best because you can have general urinary changes from being postpartum, from being perimenopausal, from any time that your body is experiencing low estrogen.

我们的身体，正如我们前面所说，全身遍布雌激素受体，尤其是在膀胱、尿道（连接膀胱通向体外的管道）、外阴等部位，数量尤其多，对这些部位的健康至关重要。

Our bodies, remember as we said earlier, have estrogen receptors everywhere, but really, really lots and lots and lots of them and are critical to the health of our bladder, our urethra, which is the tube that drains the bladder out into the world, the vulva.

你现在应该已经知道外阴是什么了，但如果还不清楚，它指的是大阴唇、小阴唇，以及盆腔区域所有的外部皮肤，还有阴道。

You should know what a vulva is by now, But if not, it is the labia majora, the labia minora, all of the kind of outside skin in our pelvic area, and the vagina.

当我们体内的雌激素被移除，或在围绝经期开始波动并下降，随后被完全剥夺时，皮肤和黏膜——内层称为黏膜，外层称为皮肤——都会变薄。

When we take estrogen away or it begins to fluctuate and decline in perimenopause and then we take it away, the skin, the mucosa, you know, the inside skin is called mucosa, the outside is just called skin, becomes thinner.

绝经后的头五年里，我们会失去大约30%的皮肤胶原蛋白。

We lose about 30% of all of our skin's collagen in the first five years of menopause.

我不必告诉女性这一点，她们自己都知道。

And I do not have to tell a woman that, she knows that.

关于皱纹的问题，我们可以在另一个播客里聊。

And we can talk about wrinkles on another podcast.

我们会失去经表皮水分，导致产生黏液的能力下降，组织变薄，弹性丧失，因此阴道在正常性生活时极易受损，而以前从不会感到疼痛的事情现在却会了。

We lose transepidermal water, so our ability to make mucus, the tissue thins, we lose elasticity, so the vagina becomes very easily damaged from regular intercourse, things that never hurt you before.

我们容易反复发生尿路感染，因为雌激素能保护微生物群，从而阻止肠道细菌上行进入尿道。

We recurrent UTIs because estrogen protects the microbiome, which protects the poop bugs from making it up into the urethra.

让我告诉你，预防反复尿路感染的首选治疗方法并不是抗生素。

And let me tell you, the number one treatment for the prevention of recurrent urinary tract infections is not antibiotics.

你不应该把抗生素作为一线治疗方案。

You should not be on antibiotics as a first line therapy.

你应该使用阴道雌激素。

You should be on vaginal estrogen.

阴道雌激素是一种局部治疗。

Vaginal estrogen is local therapy.

正如凯利·卡斯珀森医生所说，

It is, to quote Doctor.

这是对私处的护肤。

Kelly Kaspersen, It is skincare for down there.

它不会被全身吸收。

It does not absorb systemically.

因此，适用于全身雌激素的警告标签和注意事项不适用于阴道雌激素。

So the warning labels and everything that applies to systemic estrogen does not count for vaginal estrogen.

在我的观念中，在更年期阶段，我们许多人认为所有围绝经期及之后的女性都应使用预防性阴道雌激素。

In my world, in the menopause, many of us believe that all women in perimenopause and beyond should be on prophylactic vaginal estrogen.

为什么我们要等到阴道受损了才决定治疗呢？

Why would we wait until the vagina breaks before we decide to treat it?

为什么我们要等到女性承受了某种程度的痛苦后，才为她们提供治疗？

Why are we waiting for women to have a certain level of suffering before we offer them treatment?

你实际上根本不应该忍受任何痛苦。

You actually should never suffer at all.

预防性阴道雌激素是安全的。

Prophylactic vaginal estrogen is safe.

即使你患有活动性乳腺癌，也可以使用它。

Even if you have active breast cancer, you can use it.

它可能是整个盆腔器官区域中最被低估的英雄，我推荐给所有人。

It is probably the most undersung hero of the entire pelvic organ area, and I recommend it for everyone.

所以我曾在与科琳·门的播客中讨论过这个话题，你应该回去看看。

So I did talk about this on a podcast with Corinne Menn, and you should go back and watch it.

但如果你错过了，那我就来讲讲我的阴道雌激素故事。

But in case you missed it, so here's my vaginal estrogen story.

我在确诊更年期或意识到自己进入更年期后，大约有六个月的时间才开始激素治疗。

I had maybe six months between diagnosing menopause or figuring out it was menopausal and starting hormone therapy.

再说一次，我开始激素治疗时，仍然对它心存恐惧。

Again, I started hormone therapy in the era where I was still afraid of it.

我仍然相信2002年的那项研究。

I still believed the 2002 study.

美国妇产科医师学会尚未更新他们的指南。

The American College of OBGYN had not updated their guidelines.

指南仍然写着：仅用于严重症状，使用最低剂量，持续时间最短。

It still says for severe symptoms only, for the lowest dose for the shortest amount of time.

如今，绝经学会自2022年以来已更新了他们的指南，我遵循了这些指南。

Now, the Menopause Society has updated their guidelines since 2022, and I followed those guidelines.

但当时，我甚至不知道绝经学会的存在。

But at the time, I didn't even know the Menopause Society existed.

它最初是由一群关切的医生组成的非正统组织，因为他们认为美国妇产科医师学会没有充分重视绝经问题，于是想成立自己的学会——但这是一场我们以后再聊的政治话题。

It kind of started as a rogue organization of a bunch of concerned physicians that the American College of Objen was not addressing menopause adequately, and they wanted to make their own society, but that's a whole political conversation we'll have later.

然而，我勉强开始接受激素治疗，并认为我不需要阴道雌激素。

However, I'm on, reluctantly, on hormone therapy and thought, I don't need vaginal estrogen.

我已经得到了充分的覆盖。

I'm covered.

我正在接受系统性雌激素治疗。

I'm on systemic estrogen.

我为什么还需要它？

Why would I need it?

而且我当时没有任何症状。

And I was having no symptoms.

所以，快进到后来，我没有任何能察觉到的症状。

So, fast forward, no symptoms that I could recognize.

大约两年前，我开始注意到自己在性高潮方面遇到困难。

About two years ago, I started noticing that I was struggling with orgasm.

以前只需几分钟就能完成的事，现在却越来越耗时。

What used to take just a few minutes was taking longer and longer and longer.

我们试了所有常规方法来促成这一神奇时刻，但这让人非常沮丧。

We were doing all the usual things to bring out this miraculous event, and it was so frustrating.

我只记得自己感到无比、无比沮丧。

I just remember being incredibly, incredibly frustrated.

我没有干涩的问题，不过我们一直使用润滑剂，所以我其实也说不准是否真的有干涩。

I wasn't having dryness, we always use lubricant though, so I wouldn't really know if I was having dryness.

我没有出现任何典型症状，而我自己作为一名整天在互联网上谈论更年期的更年期专家，竟然没有意识到我延迟的高潮可能是女性泌尿生殖综合征的表现。

I wasn't having any of the classic symptoms, and I myself, as a menopause expert who talks about menopause all day on the internet, did not realize that my delayed orgasms could be and were a sign of genitourinary syndrome of menopause.

我可能因为雌激素无法通过血液充分到达泌尿组织，导致阴蒂萎缩，并且该区域的血流也较差。

I was probably having clitoral atrophy from not enough estrogen making it through my bloodstream to get to the general urinary tissues, and I was having poor blood flow to the area.

于是我打电话给我的闺蜜、我的‘Minnow’好友科琳·门，跟她聊了聊这件事，以及这有多让人沮丧。

So, I'm on the phone with my bestie, my Minnow bestie, Corinne Men, talking to her about this and how frustrating it is.

当时我们还聊到了振动器。

And we were talking about vibrators at the time.

我对这个振动器不太了解。

And I was like, I don't know about this vibrator.

它不起作用。

It's not working.

我花的时间太长了。

I'm taking forever.

我不知道发生了什么。

I don't know what's going on.

她问：‘你正在用多少阴道雌激素？’

And she's like, Well, how much vaginal estrogen are you on?

我开始笑起来，然后自嘲地说：‘一点都没用。’

And I started laughing, and I was like calling myself out saying, None.

她问：‘什么？’

And she said, What?

玛丽·克莱尔。

Mary Claire.

我的意思是，她笑得特别厉害。

I mean, she laughed so hard.

让我告诉你，按照医嘱使用一个月后，情况就自己好转了。

And let me tell you, within a month of using it as prescribed, the situation had rectified itself.

所以，如果你也有这个问题，我知道一定有人正在听或看，心里想着：天哪，这说的就是我。

So, if you are having this issue, and I know there's someone out there listening or watching who's going to be, Oh my God, that is me right now.

另外，关于润滑剂的一些说明。

And then a note about lubricants.

即使使用了阴道雌激素，我也强烈推荐使用润滑剂，有时还需要保湿剂，具体视患者情况而定。

Even on vaginal estrogen, I really recommend lubricants and maybe moisturizers, depending on the patient.

每次亲密接触时， definitely 要使用润滑剂。

Definitely a lubricant for every intimate encounter.

我怎么强调这一点都不为过。

I cannot hype this up enough.

我们永远无法完全恢复绝经前的阴道健康、组织强度和弹性等。

We're never going to get back 100% our premenopausal vaginal health, tissue strength, elasticity, etcetera.

那艘船已经开走了。

That ship has kind of sailed.

我的意思是，阴道雌激素确实能起到很大作用，但性交对组织来说是一种创伤。

I mean, vaginal estrogen can go a long way, but intercourse is traumatic to the tissues.

所以我只说：多用润滑剂，多用润滑剂，多用润滑剂，多补水。

And so I just say lubricate, lubricate, lubricate, hydrate.

所以我喜欢用阴道保湿剂。

And so I like a vaginal moisturizer.

这两者的主要区别在于，阴道保湿剂能吸水。

So the big differences between the two, a vaginal moisturizer pulls water.

它通常含有大量透明质酸。

It's usually made heavily with hyaluronic acid.

明白吗？

Okay?

透明质酸能锁住水分，我认为能锁住一百倍甚至一千倍的水分，紧紧吸附，从而为该区域增加湿度。

Hyaluronic acid holds, I think, a 100 or a thousand X, some ridiculous amount of water it clings, so it adds moisture to the area.

很多护肤品都含有透明质酸用于保湿。

There's a lot of skincare products with hyaluronic acid for hydration.

我喜欢这个。

I like that.

我喜欢徒步旅行。

I love to hike.

如果你关注我，就知道我总是去山里徒步、徒步、徒步。

If you follow me, you know I'm always in the mountains hiking, hiking, hiking.

当我没有穿瑜伽裤时，那里的一切都不会被收束和固定，随着年龄增长、地心引力作用，我的身体结构已经和25岁时大不相同了。

And when I'm not in yoga pants where everything's kind of tucked up and held, definitely my anatomy has changed with age, gravity, and things are in places that they weren't when I was 25.

关于这一点，我就留给你自己去想象了。

I'll just let you use your imagination for that.

所以当我穿着瑜伽裤，一切都被妥帖地支撑着时，我基本没什么问题。

So when I'm in yoga pants and everything's kind of there, I don't have much of a problem.

但当我穿短裤，比如带内置内裤的耐克短裤时，徒步几小时后，某些部位就会开始磨擦。

But when I have shorts on, like Nike shorts with the built in underwear, after a few hours of hiking, I start getting chafing in certain areas.

所以，使用保湿剂对这种情况简直是奇迹般的解决方法。

So, a moisturizer is miraculous for that.

在那个区域增加一些水分，我真的很喜欢。

Adding some hydration in the area, I just love it.

润滑剂是用来润滑的。

Lubricant is something you want to lubricate.

它增加了滑润感，明白吗？

It's adding slipperiness, okay?

通常这些产品含有维生素E，是一种非常滑润的油基润滑剂，或者是硅基润滑剂。

And typically the products are something that is vitamin E based, which is a really slippery, an oil based lubricant, or a silicone based lubricant.

如果你使用像震动器这样的性玩具，使用某些硅基润滑剂时要小心。

Now, if you're using toys like vibrators, you have to be careful with some of the silicone based lubricants.

它可能会损伤设备表面的皮肤。

It can mess with the skin on the apparatus.

所以一定要仔细阅读说明书。

So always read the instructions on that.

但每次亲密接触，我都强烈建议使用润滑剂。

But every intimate encounter, I really recommend using a lubricant.

现在，还有一种单独的处方药可用，当我们谈论阴道激素时，它叫普拉斯特龙。

Now, there's a separate prescription that is available, and it's called Prasterone when we're talking about vaginal hormones.

这个产品不同，因为它是DHEA的处方形式。

This one is different because it is the prescription form of DHEA.

DHEA是睾酮和雌激素的前体。

DHEA is a precursor to both testosterone and estrogen.

当我们把孕激素放入阴道时，它会自然转化为雌激素和睾酮。

And when we put the progesterone in the vagina, it converts naturally to both estrogen and testosterone.

阴道中不仅有雌激素受体，还有睾酮受体。

Not only do we have estrogen receptors in the vagina, we have testosterone receptors in the vagina.

在性医学领域的同行们都非常推崇这种药物，因为她们不仅获得了阴道部位的雌激素补充，还同时获得了睾酮。

And my friends in the sexual medicine world are huge fans of this medication, because they're not only getting that boost of estrogen there, they're also getting testosterone.

我有几个患者正在使用它，而且非常喜欢。

I have a few of my patients who are on it and absolutely love it.

我本人从未尝试过。

I've never tried it personally myself.

问题是目前还没有仿制药，价格可能比较高。

The problem is there's no generic available for it yet, and it can be on the pricier side.

阴道雌激素，一管只要10.15美元，可以用上几个月。

Vaginal estrogen, you can get for $10.15 bucks a tube, that'll last you for a couple of months.

所以，普拉斯特龙应替代阴道雌激素使用，而不是与阴道雌激素一起使用。

So, prastarone would be used in place of vaginal estrogen, not along with your vaginal estrogen.

它将是阴道雌激素的替代品。

It would be an alternative to it.

最后一种药物是，我总是念不对这个名字，奥西芬。

One final medication is, I never can say this correctly, osfamine.

我还没开过这种药，但它叫做阿塞姆。

I've not prescribed it yet, but it is something called Asserm.

它是一种口服药物，作为雌激素激动剂，对阴道组织有促雌激素作用，但在乳腺组织中起拮抗作用。

It's an oral medication that acts as an estrogen agonist, meaning it's pro estrogen in vaginal tissues, but is an antagonist in breast tissue.

它是一种口服制剂，能让雌激素在阴道中发挥作用，同时在乳腺组织中起阻断作用。

It is an oral formulation that allows estrogen to work its magic in the vagina, but blocks in the breast tissue.

因此，对于乳腺癌幸存者来说，这可能是一个值得考虑并和医生讨论的好方案。

So for breast cancer survivors, this may be a great formulation for you to consider and talk to your doctor about.

现在，许多女性和许多临床医生遗憾地没有跟上最新的指南，误以为阴道雌激素与乳腺癌有关。

Now, many women and many clinicians, sadly, haven't kept up with the latest guidelines and are under the assumption that vaginal estrogen somehow is associated with breast cancer.

让我现在就立刻停止这种无稽之谈。

Let me just stop that nonsense right here and right now.

即使在活动期乳腺癌患者或康复者中，也从未发现使用阴道雌激素会增加复发风险——这一点已经经过大量数据验证。

There has never, even in active breast cancer patients, even in survivors, ever shown, and they've looked at the data extensively, there was no elevated risk of recurrence for a patient to use vaginal estrogen.

最权威的研究表明，使用阴道雌激素的康复者比未使用者的生存期更长。

And the greatest studies showed that patients who had vaginal estrogen versus those who did not, who were survivors, lived longer.

阴道雌激素能挽救生命。

Vaginal estrogen saves lives.

为什么？

Why?

因为它能降低复发性尿路感染的风险，而尿路感染可能引发败血症，进而致命。

Because it decreases the risk of recurrent UTIs, which can lead to sepsis, which will kill you.

因此，总体而言，泌尿系统症状不仅仅是衰老或干燥造成的。

So big takeaway in general urinary symptoms is it's not just aging, it's not just dryness.

如果你已经感到干涩和疼痛，说明你的组织状况已经达到了第九十分位。

If you are getting to the point where you are dry and hurting, your tissue is at the ninetieth percentile.

在你获得任何形式的激素治疗之前，不需要忍受任何程度的痛苦。

There is no amount that you need to suffer before you can earn hormone therapy in any form.

每年年初，我都会重新开始，问自己：我真正穿着的是什么？

At the start of the year, I always hit reset and ask myself, what am I actually wearing?

我希望我的衣橱简单、优雅，并且充满我可以真正信赖的单品。

I want my wardrobe to feel simple, elevated, and full of pieces I can actually rely on.

无需过度思考。

No overthinking required.

这正是Quince成为我衣橱必备品的原因。

That's exactly why Quince has become a staple for me.

Quince的每一件单品都恰到好处。

Everything from Quince just works.

精致、自然，且每天穿着都轻松舒适。

Polished, effortless, and easy to wear day after day.

这些是你会一再选择的单品。

These are the pieces you will reach for again and again.

他们的蒙古羊绒毛衣柔软舒适，穿上立刻有种被宠爱的感觉。

Their Mongolian cashmere sweaters, soft, cozy, and instantly feel like a treat.

他们的丝绸上衣和裙子让穿衣变得轻松，而牛仔裤和外套剪裁得体、精工细作，却能经受住一个又一个季节的考验。

Their silk tops and skirts make getting dressed easy, and their denim and coats, perfectly cut, beautifully tailored, but built to last season after season.

我最欣赏的是每一件单品都如此用心。

What I love most is how thoughtful everything is.

从面料到版型，都散发着高品质的质感，却不会有天价奢侈品的负担。

From the fabric to the fit, it feels high quality without the crazy luxury price.

而且所有产品都来自道德可靠的工厂，让你穿得安心。

And with ethical trusted factories behind it all, you can feel good about what you wear.

如果你想让每天穿衣变得毫不费力，Quince 就是你的选择。

If you want your wardrobe to make getting dressed feel effortless, Quince is it.

一旦试过，这些单品就会成为你每天最先挑选的衣物。

Once you try it, these are the pieces you'll grab first every single day.

用 Quince 重新焕新你的衣橱。

Refresh your wardrobe with Quince.