老年妇女泌尿生殖系统感染的诊治

绝经后老年妇女由于雌激素缺乏可发生泌尿生殖道萎缩、局部抵抗力低下,细菌易于侵入繁殖引发炎症,主要表现为阴道分泌物异常、外阴瘙痒以及尿频、尿急及尿路感染等,易反复发作,且病程长,严重影响生活质量,因此老年妇女的泌尿生殖系统感染问题值得重视。1老年妇女生殖系统感染老     

结合雌激素治疗绝经后妇女泌尿生殖雌激素缺乏综合征的临床观察

随着雌激素水平的降低,对雌激素敏感的泌尿生殖器官发生萎缩性变化,泌尿生殖雌激素缺乏综合征是指下生殖道与泌尿道雌激素缺乏萎缩而致的泌尿生殖功能失调的一系列症候群.它是绝经后妇女尤其是老年妇女常见的一种病症,大大影响了老年妇女的生活质量.本文拟观察结合雌激素(倍美力)[片和(或)软膏]对绝经后泌尿生殖雌激素缺乏综合征妇女的疗效,为提高此人群的生活质量提供临床依据.     

阴道来源的乳杆菌抑菌物质研究进展

乳杆菌是大多数健康女性阴道微生态中的优势菌群,对预防泌尿生殖系统感染性疾病起重要作用。能产生乳酸、过氧化氢、细菌素和生物表面活性物质等抑菌物质是乳杆菌成为潜在益生菌的重要基础。本文对阴道来源的乳杆菌抑菌物质相关研究进展作一综述。     

绝经、激素替代治疗与代谢综合征

一、绝经与代谢综合征绝经是指由于卵巢功能衰退进而雌激素下降导致的永久性无月经状态。雌激素下降带来潮热、盗汗、睡眠障碍、泌尿生殖道萎缩、骨质疏松等,严重影响绝经后妇女生活质量。大量的临床研究结果表明,绝经是代谢综合征的危险因素,     

卵巢功能早衰的病因学研究进展

绝经年龄以末次月经为标准,平均50.7岁[1],受环境和遗传因素共同影响.卵巢功能早衰（POF）通常指月经初潮正常或者青春期延迟、第二性征发育正常的女性,在不足40岁出现持续性闭经和性器官萎缩,同时伴有卵泡刺激素（FSH）和黄体生成激素（LH）升高,而雌激素降低的综合征.表现为闭经,缺乏雌激素所致的神经精神症状、血管舒缩症状或泌尿生殖道症状,包括性欲低下、不孕、潮热多汗、骨质疏松、心血管疾病等,影响生活质量.     

口腔微生态失衡与牙周病孕妇妊娠结局的研究进展

牙周菌群中致病菌比例增大、有益菌比例下降所引起的口腔微生态失衡是导致牙周病发生的重要原因,亦是心血管疾病、糖尿病等全身疾病的重要诱因。研究发现,患有牙周病的孕妇发生流产、早产等不良妊娠结局(adverse pregnancy outcomes, APOs)的风险较口腔健康者更高。尽管口腔菌群失衡被视为APOs的危险因素,但其具体作用机制迄今尚不明确。故为提高对APOs的防控能力,了解孕妇妊娠期口腔微生物变化及对APOs的影响机制尤为重要。本研究从妊娠对孕妇口腔微生态的影响、口腔菌群变化和牙周病的关系、牙周病引起APOs的相关机制、胎盘菌群和口腔微生态的关联性、牙周病治疗对妊娠结局改善作用等5个方面入手进行总结,旨在为未来制定行之有效的举措预防APOs的发生提供指导。     

老年妇女雌激素应用与尿路感染

众所周知,妇女随着年龄增长泌尿生殖道会出现若干生理性改变,如阴道pH升高及其菌群改变,阴道和尿道上皮萎缩等。这些改变可造成膀胱病菌的潴留及尿路感染。绝经后妇女外源性给予雌激素可部分乃至完全地扭转这些改变,故有报道称雌激素可减少绝经妇女的尿路感染。但也有若干相反的实验室资料证明雌激素可抑制机体的免疫应答,使整个机体的抵抗力下降而易感染。因此、为探索老年妇女尿路感染与使用外源性雌激素的关系,作者于89、90两年期间在播及全美国276个医疗网点,对50～69岁的老年妇女进行了病例对照研究,根据诊断标准把首次确诊为尿路感染的4165名老年妇女     

阴道毛滴虫感染对男性生殖系统的影响及其机制

阴道毛滴虫是一种有鞭毛的寄生原虫,是世界上最常见的性传播病原体之一。女性感染后阴道毛滴虫多寄生于阴道,导致滴虫性阴道炎。阴道毛滴虫也可感染男性,男性感染后虫体可经泌尿生殖道逆行至膀胱、前列腺、精囊、睾丸、附睾等组织,对精子细胞或其他组织造成严重损伤,引起尿道炎、前列腺炎、前列腺癌、弱精或无精,进而影响男性的生育能力。由于男性感染的临床症状较轻或无临床症状,因此常常被忽视。本文就近年来男性感染阴道毛滴虫造成精子、睾丸以及前列腺功能异常,进而导致男性不育的相关机制作一综述。     

绝经泌尿生殖综合征的阴道环境变化及间充质干细胞在其中的应用进展

绝经泌尿生殖综合征(GSM)患者由于雌激素的下降, 导致阴道环境的变化, 包括阴道组织结构、阴道微生物群和阴道黏膜免疫的改变, 从而出现一系列症状和体征。制定针对GSM的有效治疗方法, 需要全面理解这些变化的潜在分子机制。间充质干细胞(MSCs)具有促进衰老组织再生、高生长因子分泌活性、优异的免疫调节和抗炎能力, 是针对生殖衰老的一种有力的候选治疗。因此, 有必要了解GSM患者的阴道环境变化及MSCs的应用进展, 为GSM的治疗研究提供参考。     

心理弹性及社会支持对老年绝经后妇女心理困扰和绝经后症状的调控及交互作用

目的探讨心理弹性及社会支持对绝经后女性心理困扰和绝经后症状的影响及交互作用。方法采用方便抽样法对本院附近的5个居民区进行问卷调查,共获得有效问卷1 352份。采用一般资料问卷、凯斯勒心理困扰量表(K10)、弹性量表简化版(CD-Risc10)、领悟社会支持量表(PSSS)分别测量受试者的一般人口学资料、心理困扰、心理弹性、社会支持水平;以K10=22分为绝经后心理困扰的截断值,分为无心理困扰组(K10<22分)、心理困扰组(K10≥22分)。结果心理困扰组日常不锻炼、患有慢性病的女性比例明显高于无心理困扰组(P<0.05)。两组年龄、教育程度、职业、婚姻状况、家庭月收入差异均无统计学意义(P>0.05)。心理困扰组绝经后症状评分及各维度评分均高于无心理困扰组,心理弹性总分和社会支持及各维度均低于无心理困扰组(均P<0.01)。Logistic回归分析显示,绝经后躯体、心理、泌尿生殖道症状与心理困扰呈正相关,是独立危险因素;而心理弹性、社会支持与心理困扰呈负相关,是保护因素。分层回归分析显示,心理弹性在绝经后症状和心理困扰方面发挥缓冲作用;但社会支持与绝经后症状间不存在对心理困扰的交互作用。结论本市绝经后症状女性心理困扰发生率较高,绝经后症状是心理困扰发生的危险因素,社会支持和心理弹性是其保护因素;心理弹性与绝经后症状间存在对心理困扰的交互作用,可缓冲绝经后症状对心理困扰的不良影响。     

The vaginal flora after natural or surgical menopause.

A study was made of the cervical and upper vaginal flora in menopausal women, in an attempt to determine whether such women are predisposed to infections when undergoing gynecologic operations. The series comprised 72 women (age range, 44-80 years) classified as follows: a) 35 with a natural menopause, b) 18 with a surgical menopause induced by abdominal panhysterectomy, and c) 19 postmenopausal women after vaginal hysterectomy performed for genital prolapse. The vaginal flora of these menopausal women consisted predominantly of Gram-positive bacteria which, together with the Gram-negative bacteria, conformed to the normal pattern of microorganisms in the vagina. Such bacteria also are found in women of child-bearing age, but occasionally they can be pathogenic. Despite the inherent biohormonal changes of the memopause, expressed especially by the low estrogen level, 26.4 percent of the cultures in our study were sterile, even after major vaginal operations. Thus, the pattern of the vaginal flora, even though occasionally pathogen, should not be a contraindication to gynecologic surgical procedures in postmenopausal women. Even when vaginal cultures show the presence of these bacteria, it does not seem necessary to use prophylactic antibiotic and hormonal therapy routinely. Rather, it should be given selectively, depending upon the local state of the tissues and upon the postoperative course.     

Bacterial vaginosis in climacteric and menopausal women

The objective was to determine how frequently an abnormal vaginal flora occurred in women attending a menopause clinic and whether any abnormality might be related to a particular risk factor. Women completed a questionnaire on their gynaecological, sexual and medical history. Whether they were perimenopausal or postmenopausal was determined on the basis of symptomatology, duration of amenorrhoea and on a follicle-stimulating hormone (FSH) assay when clinically indicated. A speculum examination of the vagina was undertaken, at which time a smear of vaginal secretion was Gram stained and the bacterial flora graded as follows: grade 1, normal; grade 2, intermediate, and grade 3, bacterial vaginosis (BV). Of 100 women examined, 44 had grade 1 flora, 17 had grade 2 flora and 18 had BV. An apparent absence of, or very scanty, vaginal bacteria in which grading was not possible was found in 21 women. Women with BV had had more sexual partners than the others, but otherwise there were no discernible factors associated with the occurrence of BV. Women with vaginal atrophy were more likely to have an apparent absence of vaginal bacteria, but a few had BV.     

Vaginal symptoms and urinary incontinence in the elderly women

Urogenital symptoms of vaginal dryness, urogenital irritation and itching, vaginal discharge, and urinary incontinence are common among postmenopausal women. Several studies have documented a lower rate of treatment-seeking behavior with increasing age in patients with urinary symptoms, and our clinical experience indicates a need for physician-initiated queries on vaginal/urinary symptoms. These urogenital conditions are amenable to treatment with pharmacotherapy and behavioral and/or surgical treatment.     

Gynecologic complications of bacterial vaginosis: Fact or fiction?

Bacterial vaginosis is a complex alteration of vaginal flora causing mild symptoms in women characterized by a milky vaginal discharge associated with a fishy odor worsened after unprotected vaginal coitus. It is the most common cause of vaginitis. It is now clear that this seemingly harmless disorder causing nuisance symptoms is linked to a number of important adverse reproductive tract sequelae, including the obstetrical sequelae of preterm labor and delivery. Literature published over the past year continue to support the association of bacterial vaginosis with adverse gynecologic sequelae in women.     

Postmenopausal hypertension

Cardiovascular disease is the leading cause of morbidity and mortality in postmenopausal women. Hypertension is a major risk factor for cardiovascular disease. The mechanisms responsible for postmenopausal hypertension have not been completely elucidated. However, various mechanisms have been implicated to play a role. For example, there is evidence that changes in estrogen/androgen ratios favoring increases in androgens, activation of the renin-angiotensin and endothelin systems, activation of the sympathetic nervous system, metabolic syndrome and obesity, inflammation, increased vasoconstrictor eicosanoids, and anxiety and depression may be important in the pathogenesis of postmenopausal hypertension. There is also evidence that hypertension is less well controlled in aging women than in aging men, but the reasons for this gender difference is not clear. Postmenopausal hypertension is likely multifactorial. Future studies will be necessary to determine the contribution of these systems listed above in mediating postmenopausal hypertension and to design treatment strategies that encompass these mechanisms to improve the quality of life of postmenopausal women as they age.     

Postmenopausal vaginitis

The importance of vaginitis in postmenopausal women will increase as the US population ages. With the withdrawal of estrogen, the vaginal environment changes dramatically. Along with physical changes, an overall decrease in the normal Lactobacillus-dominant flora and Candida colonization occurs. Trichomoniasis, vulvovaginal candidiasis, and bacterial vaginosis still occur in menopausal women but probably less commonly than in younger women. The effects of exogenous estrogen on these conditions remain unknown. Less common conditions such as desquamative inflammatory vaginitis and lichen sclerosus gain relative importance in this population.     

Risks versus benefits in the clinical application of aromatase inhibitors

Third-generation aromatase inhibitors are able to reduce circulating plasma estrogen concentrations in postmenopausal women to below detectable limits and significantly inhibit aromatase, the enzyme responsible for estrogen synthesis, in normal breast tissue and breast tumors. Their role in the treatment of advanced breast cancer is well established and their use in adjuvant therapy is currently being explored. On the basis of these trials, evaluation of these inhibitors in the prevention of breast cancer may be appropriate. Aromatase inhibitors have non-specific toxic side effects including (but not limited to): asthenia, headache, nausea, peripheral edema, fatigue, vomiting and dyspepsia. In addition, certain endocrinological side effects in postmenopausal women are notable, namely hot flushes and vaginal dryness. In advanced breast cancer, these side effects result in treatment withdrawal in few (<4%) women. Of concern, however, are the potential long-term endocrinological side effects in women receiving treatment as first-line adjuvant therapy or in sequence or combination with tamoxifen or other selective estrogen receptor modulators (SERMs). Current studies of adjuvant treatments for breast cancer in healthy women are carefully evaluating, in addition to general toxicities, the effects on bone, lipid metabolism, cardiovascular risk, quality of life and menopausal symptoms. Careful evaluation of all-cause morbidity and mortality is necessary to plan trials and justify long-term use of aromatase inhibitors in the treatment or prevention of breast cancer in healthy women.     

Prevention for the older woman. A practical guide to hormone replacement therapy and urogynecologic health

Decisions to begin or continue hormone replacement therapy (HRT) are individualized, depending on a woman's anticipated benefits and risks from HRT. Estrogen, especially when begun early in menopause, has been shown to be beneficial in the prevention and treatment of osteoporosis. Potential risks of HRT include gallbladder disease, thromboembolism, and breast cancer. Systemic or topical estrogen can improve postmenopausal vaginal atrophy, vasomotor symptoms, and cervical cytologic changes. Treatment of other urogynecologic changes, such as vulval dystrophy and urinary incontinence, can relieve symptoms and improve the older woman's quality of life.     

Which is the better choice, estrogen or SERMs in postmenopausal women?

Hormone replacement therapy (HRT) increases the bone mineral density (BMD) and reduces the risk of vertebral and hip fractures in postmenopausal women. But, long term HRT slightly increases the risk of breast cancer. Raloxifene is a selective estrogen receptor modulator that has estrogen agonist effects in the skeleton and cardiovascular system and estrogen antagonist effects in the uterus and breast. Raloxifene effectively prevents bone loss and significantly, increases lumbar spine, hip, and total body bone mineral density, raloxifene reduces the risk of vertebral fracture. Raloxifene treatment leads to no increase in vaginal bleeding or mastaigia and to greater than 70% reduction in risk for invasive breast cancer. But raloxifene increases the hot flashes in postmenopausal women. In conclusion, HRT is optimal therapy for prevention and treatment of osteoporosis in postmenopausal women with menopausal symptoms, raloxifene is optimal therapy for prevention and treatment of osteoporosis in postmenopausal women without menopausal symptoms.     

Relationship of health related quality of life to prevalent and new or worsening back pain in postmenopausal women with osteoporosis

OBJECTIVE: To examine the association between back pain and health related quality of life (HRQOL) in postmenopausal women with osteoporosis. METHODS: The Fracture Prevention Trial was a prospective double blinded, placebo controlled study designed to compare the proportion of women receiving teriparatide who experienced a new fracture to the proportion of women receiving placebo who experienced a new fracture. Subjects were ambulatory postmenopausal women with osteoporosis and prior vertebral fracture. As part of this trial, English-speaking women from Canada, New Zealand, Australia, and the United States participated in a HRQOL substudy using the Osteoporosis Assessment Questionnaire (OPAQ). OPAQ was administered at baseline, 12 months, and at study termination (median treatment duration 19 mo). Back pain data were collected as part of the adverse event monitoring during the trial. Subjects considered to have experienced back pain reported this event spontaneously and were not queried specifically. We examined the influence of prevalent back pain on HRQOL after controlling for spine deformity index score, and the influence of new or worsening back pain on HRQOL after controlling for incident vertebral fracture. RESULTS: Of 471 women who completed OPAQ at baseline, 172 reported back pain that was associated with a mean decrease in all OPAQ dimension scores (p < 0.05). Of 429 women who completed OPAQ at all timepoints, 88 experienced new or worsening back pain that was associated with a mean decrease in physical function, emotional status, and symptoms scores (p < 0.01 for each). In a subset of 65 women who experienced moderate to severe back pain, all OPAQ dimensions were significantly reduced (p < 0.05). CONCLUSION: Both prevalent back pain and new or worsening back pain affected HRQOL negatively. Osteoporosis therapies that prevent the development of back pain in postmenopausal women may also prevent decreases in HRQOL.