Menopause plays an important role in the process of female aging. Menopause-related problems seriously affect the health of middle-aged and elderly women. Menopausal symptoms may significantly affect women’s quality of life, whilst the decline of ovarian function and the lack of sex hormones result in an increased rate of degenerative diseases such as osteoporosis and cardio-cerebrovascular diseases. Abundant evidence has shown that comprehensive menopausal management, including lifestyle adjustment, health counseling and appropriate menopausal hormone therapy (MHT), for midlife women can alleviate menopause-related symptoms, effectively reduce the incidence of the above-mentioned chronic diseases in the elderly, improve the life quality of middle-aged and elderly women and improve the general health of aging women with relatively limited medical resources.
In China, the average age of natural menopause in women is 49.2 ± 3.3 years. The number of menopausal women has now exceeded 200 million, and nearly 78.4% of these suffered from menopausal symptoms during the menopausal transition period. However, perhaps because of the influence of traditional beliefs, both the general public and medical workers still have a limited understanding of menopause. They believe that menopause is the natural aging process and have little knowledge of its potentially serious consequences. Because of this and the traditional Chinese fear of hormones, only 1–2% of eligible Chinese women use MHT. In contrast, in western countries, even though the rates of use have fallen from the 30% usage seen prior to initial release of data from the Women’s Health Initiative (WHI), they remain very much higher than in China. As a result, the majority of postmenopausal women in China do not benefit from appropriate menopausal management.
The Chinese Menopause Society, an affiliate of the Chinese Society of Obstetrics and Gynecology and the Chinese Medical Association, was founded in 2001. Since then, the Chinese Menopause Society has been devoted to educating and informing women and health-care workers about menopause and MHT. The Society has conducted a nationwide continuing education program for obstetricians and gynecologists, held multi-level academic conferences, conducted over 100 circuit lectures every year, and provided education for patients and the general public via newspapers, magazines, the TV network and internet. Moreover, the Society has promoted the setting up of more than 200 menopause clinics nationwide via the Menopause Activation Project (MAP). Research on the benefits and risks of MHT has been conducted among the Chinese population, to form a set of norms and guidelines for menopause management concerning the characteristics of Chinese women. Since the first edition of ‘The guideline of Menopause Management in Mainland of China’ was published in 2003, the guidelines have been successively updated in 2006, 2009, 2012 and 2018. Instructions for the use of MHT have been issued. Additionally, the ‘Experts Consensus on Hormone Replacement Therapy for Premature Ovarian Insufficiency’ and the ‘Experts Consensus on the Diagnosis and Treatment of Perimenopausal Abnormal Uterine Bleeding’ have been formulated. These guidelines and consensuses have contributed to the standardization of the treatment of menopause-related diseases and provide a theoretical foundation as well as practical guidance for the development of MHT in China.
Today, thanks to this and other educational programs, the awareness of menopause and MHT among Chinese women and medical workers has greatly improved. A 2013 survey of 194 clinicians from 100 MAP hospitals in 42 cities in China found 90% of physicians were familiar with standard guidelines for menopause management, whilst 70% followed them and complied with recommendations. A majority of physicians reported that most of their patients were compliant with MHT therapy and 92% of patients interviewed in MAP clinics preferred to use MHT for the treatment of menopausal symptoms. A decision to prescribe MHT was influenced by both the physician’s awareness of and attitudes to MHT as well as individual patients’ medical conditions. Another survey, at The Peking Union Medical College, found that, because of continuing medical education programs organized by gynecologic endocrine experts, the hospital staff had a better understanding of indications and complications of MHT. Consequently, the rate of use of MHT amongst hospital staff was 30% and the rate was even higher amongst OBGYN doctors and their families.
The number of menopausal women in China is increasing each year. It is estimated that, by 2030, the number of women over 50 years will exceed 280 million – more than the total population of many countries. Menopause management will be a long-term undertaking and it is hoped that through these efforts a thorough understanding of menopause and its management will be deeply rooted in the hearts of the people, the quality of life of women will be improved, the burden of diseases of aging in the community will be greatly relieved, and the goal of healthy aging will eventually be achieved in the near future.
Potential conflict of interest
The author reports no conflict of interest.