Genitourinary syndrome of menopause: New terminology for vulvovaginal atrophy from the International Society for the Study of Women's Sexual Health and The North American Menopause Society

Background

In 2012, the Board of Directors of the International Society for the Study of Women's Sexual Health (ISSWSH) and the Board of Trustees of The North American Menopause Society (NAMS) acknowledged the need to review current terminology associated with genitourinary tract symptoms related to menopause.

Methods

The 2 societies cosponsored a terminology consensus conference, which was held in May 2013.

Results and conclusion

Members of the consensus conference agreed that the term genitourinary syndrome of menopause (GSM) is a medically more accurate, all-encompassing, and publicly acceptable term than vulvovaginal atrophy. GSM is defined as a collection of symptoms and signs associated with a decrease in estrogen and other sex steroids involving changes to the labia majora/minora, clitoris, vestibule/introitus, vagina, urethra and bladder. The syndrome may include but is not limited to genital symptoms of dryness, burning, and irritation; sexual symptoms of lack of lubrication, discomfort or pain, and impaired function; and urinary symptoms of urgency, dysuria and recurrent urinary tract infections. Women may present with some or all of the signs and symptoms, which must be bothersome and should not be better accounted for by another diagnosis. The term was presented and discussed at the annual meeting of each society. The respective Boards of NAMS and ISSWSH formally endorsed the new terminology—genitourinary syndrome of menopause (GSM)—in 2014.     

心理干预对更年期妇女初次复杂活动义齿修复效果的影响

目的研究修复诊疗过程中心理干预对初次佩戴复杂活动义齿的更年期妇女修复效果的影响。方法选择初次进行复杂活动义齿修复的更年期妇女98例,随机选取49例为试验组,修复过程中进行心理干预;其余49例为对照组,常规修复。修复后1个月和3个月后分别调查患者对义齿美观、语音、咀嚼、固位效果和舒适性的满意度,并比较2组修复后的调改次数。结果修复后1个月和3个月,试验组患者对义齿语音、咀嚼效果和舒适性的满意度均高于对照组,差异有统计学意义（P〈0．05）。试验组调改次数少于对照组,差异有统计学意义（P〈0．05）。结论在更年期妇女初次行复杂活动义齿修复时,根据其心理特点进行心理干预可以有效提高其对义齿的适应性及满意度。     

Stellate ganglion blockade and verbal memory in midlife women: Evidence from a randomized trial

ObjectivesIn a pilot randomized clinical trial of active stellate ganglion blockade (SGB) versus sham control, SGB significantly reduced the frequency of reported moderate to severe vasomotor symptoms (VMS) and the frequency of physiologic VMS measured using ambulatory skin conductance monitors. Here we examine secondary effects of SGB on verbal learning and memory.Study designIn a randomized, sham-controlled study, 36 women met eligibility criteria for cognitive assessments, of whom 17 were randomized to receive fluoroscopy-guided SGB and 19 to sham control.Main outcome measuresAt baseline and three months post-treatment, women completed tests of verbal learning and memory (primary outcome) and other cognitive measures and also wore an ambulatory monitor for 24 h to measure physiologic VMS and VMS reported in real time.ResultsVerbal learning improved following active SGB (p < 0.05) but not sham treatment; however, the interaction between group and time was not significant (p values 0.13-0.20). Two secondary cognitive measures improved only in the sham group. Improvements in physiologic VMS correlated significantly with improvements in verbal learning (r = 0.51, p < 0.05).ConclusionsSGB might confer benefits to memory in relation to the magnitude of improvement in physiologic VMS. Broadly these findings suggest a possible link between physiologic VMS and memory problems in midlife women.     

Progestins in HRT: Sufferance or desire?

While the benefits of progestins in hormonal replacement therapy are well recognized as far as endometrial protection is concerned the data on breast tissue and the cardiovascular system are contentious. Following the Women's Health Initiative study, the Million Women Study and The Women's International Study of Long-duration (O)estrogen after Menopause the question can be raised: When dealing with optimal hormonal therapy after the menopause, is the progestin component accepted here on sufferance or is it desired? The answer is partly made up by the fact that the recent epidemiological data may have been not only wrongly translated in relation to the clinical settings, but also to the whole class of therapies. The various progestins available for hormonal therapy exert different partial effects at cellular level according to the biochemical composition. Due to the structural differences the progestins result in a variety of tissue transforming changes as well as metabolic and hemostatic changes. Since no single test or algorithm presently serves as golden standard for all desired hormonal effects the least changes or no changes from the premenopausal physiology may often be advantageous. In our opinion targeting this goal includes a sustained desire for an estrogen/progestin combination as optimal future hormone therapy. Moreover the strategy not only includes evaluation of the specific steroidal formula, but also a titration of the dose and choosing the optimal route of administration. With special reference to cardiovascular disease this review therefore makes a plea for differentiating between the array of chemically and functionally distinct progestins used therapeutically after the menopause in combination therapy.     

莉芙敏治疗宫颈癌患者更年期综合征的临床观察

目的探讨宫颈癌放化疗期间出现更年期综合征的患者应用莉芙敏治疗的作用及安全性。方法 26例宫颈癌合并更年期综合征患者,放化疗期间予以莉芙敏治疗,选择年龄大小、治疗方法、临床期别、复发部位、身体状况、更年期症状相近、同期治疗的26例宫颈癌患者作为对照组,对比分析两组患者的KMI评分、放化疗不良反应、近期疗效。结果莉芙敏组治疗4周和6周的KMI总分和各单项分均优于对照组。莉芙敏组胃肠道反应低于对照组,差异有统计学意义(P=0.029)。肝功能损伤及骨髓抑制两组无统计学差异。结论莉芙敏治疗宫颈癌患者的更年期症状是安全有效的,同时增强患者对放化疗的耐受性。     

Abnormal bleeding in postmenopausal hormone users—What do we know today?

Whilst use of estrogen-containing hormone therapy (HT) has declined in recent years, it is still used by a significant minority of women and remains the most effective way of treating menopausal vasomotor symptoms and vaginal dryness. Unscheduled vaginal bleeding and spotting is a common unwanted effect of combined HT. This abnormal bleeding is inconvenient and commonly leads to invasive tests to exclude underlying pelvic pathology. The mechanisms underlying unscheduled bleeding with HT are poorly understood and there are no evidence-based treatment options. Relatively few studies have investigated how combined hormone therapy induces changes in the endometrium which may predispose to increased bleeding. The available evidence suggests that combined HT induces changes in endometrial blood vessels and stroma which may increase vascular fragility. An improved understanding of how combined HT changes the endometrium to induce bleeding may lead to targeted therapies to effectively prevent or resolve bleeding in postmenopausal women. This will improve the acceptability of combined HT and have personal benefits for postmenopausal women and financial benefits for healthcare providers. This review will discuss current evidence and potential mechanisms underlying unscheduled bleeding with combined HT.     

组织选择性雌激素活性调节剂辅助钙剂治疗绝经后骨质疏松症

目的:观察绝经后妇女口服组织选择性雌激素活性调节剂加钙剂治疗骨质疏松症的效果。方法:将90例绝经后骨质疏松症患者随机分为2组,治疗组口服组织选择性雌激素活性调节剂加钙剂,对照组口服钙剂,追踪观察6个月,观察临床症状及骨密度的变化情况。结果:治疗组总有效率93%,明显高于对照组的73%(P<0·05)。治疗组治疗后的骨密度显著增加(P<0·05),与对照组同期比较差异显著(P<0·05)。结论:口服组织选择性雌激素活性调节剂加钙剂治疗绝经后骨质疏松症优于单用钙剂治疗。     

单纯性肥胖女性绝经前后血管内皮功能和胰岛素抵抗的变化

目的探讨单纯性肥胖女性绝经前后血管内皮功能和胰岛素抵抗的变化及其影响因素。方法单纯性肥胖女性197例分为绝经前组113例和绝经后组84例，测定两组血管内皮依赖性舒张功能（血流介导）和内皮非依赖性舒张功能（硝酸甘油介导），并测定体脂、血压、血糖、血脂和胰岛素抵抗指数（HOMA-IR）等指标进行对比分析。结果绝经后内皮依赖性舒张功能降低较绝经前更明显[分别为（5．7±5．2）％和（7．8±5、7）％，P〈0．05]，并且与腰臀比和血浆内皮素（ET-1）呈显著正相关（分别为r=0．325和r=0．228，均P〈0．05），与血清NO显著负相关（r=-0．263，P〈0．05）。2组HOMA-IR无统计学意义。结论绝经后肥胖女性血管内皮功能较绝经前显著降低；绝经前后胰岛素抵抗无变化。