Levonorgestrel intrauterine system (LNG-IUS) with conjugated oral equine estrogen: a successful regimen for HRT in perimenopausal women

BACKGROUND: This study was designed to assess the long-term efficacy (5 years) of the levonorgestrel-releasing intrauterine system (LNG-IUS) in protecting the endometrium from hyperplasia during estrogen replacement therapy in perimenopausal women. METHODS: Prospective, open, outpatient clinical trial in London and Oxford. Eighty-two women received oral conjugated equine estrogen 1.25 mg daily and LNG-IUS releasing 20 mug levonorgestrel per 24 h. Endometrial biopsy and histological assessment were performed annually. Endometrial thickness was measured by vaginal ultrasonography. RESULTS: Non-proliferative endometrium was present at the end of cycles 12, 24, 36, 48 and 60 in 98.6, 98.6, 95.5, 96.8 and 95.2% of the participants respectively. No endometrial hyperplasias were confirmed throughout a period of 60 cycles. The proportion of amenorrhoeic women increased from 54.4% at 12 cycles to 92.7% at the end of the study. The continuation rate per 100 women at 60 cycles was 79.84 (95% CI 71.0-88.6). CONCLUSIONS: The LNG-IUS with estrogen supplementation in perimenopausal women suppresses endometrial proliferation resulting in amenorrhoea and relieves vasomotor symptoms. The treatment regimen is well tolerated and provides an alternative strategy for perimenopausal women with the likelihood of increasing compliance.     

Uncertainty during perimenopause: perceptions of older first-time mothers

morgan p., merrell j., rentschler d. & chadderton h. (2012) Uncertainty during perimenopause: perceptions of older first-time mothers. Journal of Advanced Nursing68(10), 2299-2308. ABSTRACT: Aim. This article is a report of a study exploring older first-time mothers' perceptions of health during their transition to menopause. Background. Increasing numbers of women world-wide are delaying motherhood, yet little is known about the unique phenomenon created when midlife motherhood is closely followed by the transition to menopause. A literature search revealed that the effect of these overlapping life transitions on women's health was unknown. Design. A hermeneutic phenomenological approach utilizing Gadamer's philosophical underpinnings guided the study. Method. A purposive sample of thirteen women aged 45-56?years who were mothering children aged 12?years or younger and experiencing symptoms of perimenopause was recruited. Two in-depth interviews were conducted with each woman and meaning was mutually negotiated through participative dialogue with the women, ongoing construction and thematic analysis of data collected between 2004 and 2007. Findings. The key theme 'Perimenopause as a State of Uncertainty' is an interpretation of older first-time mothers' perceptions of health during perimenopause and is the focus of this article. Hermeneutic interpretation culminated in the construct 'uncertainty' as theoretical embodiment of the women's lived experience. An uncertain temporality, projection of the lifespan and valuing health as precious enabled these women to transform uncertainty into opportunities for health promotion to 'be there' for their children. Conclusion. Nurses, nurse practitioners and midwives will increasingly be caring for midlife mothers and need to understand the unique issues of older mothers to offer education and health promotion that support healthy transitions to menopause.     

Associations of resting and peak fat oxidation with sex hormone profile and blood glucose control in middle-aged women

Background and aimsMenopause may reduce fat oxidation. We investigated whether sex hormone profile explains resting fat oxidation (RFO) or peak fat oxidation (PFO) during incremental cycling in middle-aged women. Secondarily, we studied associations of RFO and PFO with glucose regulation.Method and resultsWe measured RFO and PFO of 42 women (age 52–58 years) with indirect calorimetry. Seven participants were pre- or perimenopausal, 26 were postmenopausal, and nine were postmenopausal hormone therapy users. Serum estradiol (E2), follicle-stimulating hormone, progesterone, and testosterone levels were quantified with immunoassays. Insulin sensitivity (Matsuda index) and glucose tolerance (area under the curve) were determined by glucose tolerance testing. Body composition was assessed with dual-energy X-ray absorptiometry; physical activity with self-report and accelerometry; and diet, with food diaries. Menopausal status or sex hormone levels were not associated with the fat oxidation outcomes. RFO determinants were fat mass (β = 0.44, P = 0.006) and preceding energy intake (β = ?0.40, P = 0.019). Cardiorespiratory fitness (β = 0.59, P = 0.002), lean mass (β = 0.49, P = 0.002) and physical activity (self-reported β = 0.37, P = 0.020; accelerometer-measured β = 0.35, P = 0.024) explained PFO. RFO and PFO were not related to insulin sensitivity. Higher RFO was associated with poorer glucose tolerance (β = 0.52, P = 0.002).ConclusionAmong studied middle-aged women, sex hormone profile did not explain RFO or PFO, and higher fat oxidation capacity did not indicate better glucose control.     

戊酸雌二醇/醋酸环丙孕酮片治疗围绝经期症状的效果研究

目的 探讨戊酸雌二醇/醋酸环丙孕酮片在改善围绝经期女性更年期症状的效果。方法对2012年1月1日至2012年10月30日,在上海交通大学医学院附属第六人民医院更年期专病门诊就诊的围绝经期女性,在排除雌激素应用禁忌症后,使用戊酸雌二醇/醋酸环丙孕酮片治疗围绝经期症状,每日1片,连续服用21d停药,于停药出血后第5天开始第二周期服药,共3个月经周期。比较治疗前及治疗3个周期后患者更年期症状的改善情况。采用改良kupperman评分表评估更年期症状的改善程度、采用MRS评分法评估更年期症状对更年期生活质量的影响。结果 135例围绝经期接受戊酸雌二醇/醋酸环丙孕酮片的HRT方案妇女中有101例坚持治疗,依从性为74.8%,其中纳入研究的34例均能按医嘱定期服药、随访者,另有33例因各种原因未定期随访但坚持HRT。34例纳入研究患者的平均年龄47.3±3.76岁。经过3个周期戊酸雌二醇/醋酸环丙孕酮片治疗后,kuppeman总分由治疗前18.5±3.2降至11.9±5.2(P＜0.01),感觉异常,眩晕、头痛心悸及泌尿生殖道症状外其余症状评分均显著改善。MRS评分由治疗前10.9±4.2降至6.7±3.5(P＜0.01)。结论戊酸雌二醇/醋酸环丙孕酮片能显著改善围绝经期症状,未发现严重不良反应;患者依从性良好,值得临床进一步推广。     

葆宫止血颗粒联合炔诺酮治疗围绝经期功能失调性子宫出血的临床研究

目的探讨葆宫止血颗粒联合炔诺酮治疗围绝经期功能失调性子宫出血的临床效果。方法选取2015年3月—2018年3月唐山市丰润区中医医院收治的围绝经期功能失调性子宫出血患者95例,随机分成对照组(47例)和治疗组(48例)。对照组口服炔诺酮片,5 mg/次,1次/8 h,连用3 d;而后减量至5 mg/次,1次/12 h,连用7 d,再以1次/d维持治疗。治疗组在对照组基础上口服葆宫止血颗粒,15 g/次,2次/d。两组均连续治疗22 d。观察两组患者临床疗效,同时比较治疗前后两组患者止血效果、外周血血红蛋白(HGB)水平、子宫内膜厚度、血清性激素水平和36项健康调查简表第二版(SF-36 v2)评分。结果治疗后,对照组和治疗组患者临床有效率分别为81.3%和95.7%,两组比较差异有统计学意义(P0.05)。治疗后,治疗组控制出血时间和完全止血时间均明显早于对照组(P0.05)。治疗后,两组患者外周血HGB水平均显著升高(P0.05),而子宫内膜厚度均显著变薄(P0.05),且治疗组外周血HGB水平显著高于同期对照组(P0.05),子宫内膜厚度则显著薄于对照组(P0.05)。治疗后,两组患者雌二醇(E2)、促卵泡刺激素(FSH)、促黄体生成素(LH)、睾酮(T)的血清浓度均显著降低(P0.05),且治疗组上述性激素指标血清水平明显低于对照组(P0.05)。治疗后,两组患者SF-36v2生理领域总分和心理领域总分较治疗前均显著升高(P0.05),且治疗组SF-36 v2评分明显高于对照组(P0.05)。结论葆宫止血颗粒联合炔诺酮治疗围绝经期功能失调性子宫出血的整体疗效确切,可迅速控制患者急性出血,改善贫血状态,提高患者生命质量。     

Lipid profile,inflammation, and oxidative status in peri- and postmenopausal women

Objective: To evaluate the effect of perimenopause and postmenopause on lipid profile, inflammation, and oxidative stress in women.

Methods: This cross-sectional study included 117 women (47?±?6 years) classified as perimenopausal (n?=?47), postmenopausal (n?=?40), or non-menopausal (n?=?30). In serum, we analyzed lipid profile, tumor necrosis factor-alpha (TNF-α), interleukin-1α (IL-1α), and C-reactive protein (CRP). Pro-oxidant status was assessed by thiobarbituric acid reactive substances (TBARS) and protein carbonyls. Antioxidant defense was performed by analysis of superoxide dismutase (SOD) and catalase activities.

Results: Compared to non-menopausal women, triacylglycerols (TG) were similar, total cholesterol and LDL-C were higher in perimenopausal and postmenopausal women, while HDL-C concentrations were decreased. TNF-α and IL-1α were higher in postmenopausal women, while CRP concentrations were elevated in both peri-and postmenopausal women (p?p?p?Conclusion: Menopausal transition and postmenopause were associated with dyslipidemia, inflammation, and unbalanced oxidative status exposing women to cardiovascular risk.     

护理干预对围绝经期妇女心血管危险因素的影响

目的探讨护理干预措施对围绝经期妇女心血管功能的影响。方法将2012年1月-2013年1月来深圳妇幼保健院妇科门诊就诊,并诊断为围绝经期综合征200例患者随机分为常规口头宣教的对照组和进行围绝经健康教育、运动指导、饮食指导、心理护理等护理干预的实验组。干预前后测定两组患者的体质指数（BMI）、绝经症状评分、缺血性心血管疾病（ICVD）10年发病危险评估、踝肱指数（ABI）、总胆固醇、甘油三脂、血压的变化。结果实验组患者在护理干预治疗1年后绝经症状评分、ICVD评分、血压、总胆固醇等指标明显低于对照组及治疗前,差异均有统计学意义（P〈0．05）,其他指标没有明显改变。结论通过对围绝经期妇女采取护理干预措施,不仅能减轻患者的围绝经期症状,同时使ICVD评分、血压、总胆固醇均下降,从而降低围绝经妇女心血管疾病的发生率。     

针刺治疗阴虚型围绝经期综合征的临床观察

目的观察针刺治疗阴虚型围绝经期综合征的疗效。方法本研究采用随机对照的临床研究方法,观察针刺疗法治疗阴虚型围绝经期综合征的临床疗效。将阴虚型围绝经期综合征患者分为针刺组和更年安对照组,观察两组治疗前后的Kupperman指数,并进行疗效评价。结果针刺和更年安治疗均能改善阴虚型围绝经期综合征患者的临床症状,针刺组疗效优于更年安对照组。结论针刺治疗阴虚型围绝经期综合征疗效肯定。     

47例绝经前期妇女常规应用小剂量利维爱临床观察

[背景]探讨利维爱对绝经前期妇女围绝经期综合征的预防作用.[病例报告]选择2001年1月—2003年12月就诊的43~47岁绝经前期妇女79例,给予观察组患者口服小剂量利维爱,对照组患者不予处理,观察开始时及3年后分别测定所有患者外周血中性激素水平,并观察临床症状.治疗后观察组患者血中性激素水平无明显改变,未出现明显的围绝经期综合征症状;对照组患者血中E2水平明显下降,FSH,LH含量明显升高,且出现诸多卵巢功能衰竭症状.[讨论]绝经前期口服小剂量利维爱可有效地延缓进入绝经期,且可预防围绝经期综合征的发生.