绝经期困难取器26例临床分析

绝经期困难取器２６例临床分析丁慧娟，胡巧玲（南京大学医学院附属鼓楼医院，南京，２１０００８）宫内节育器避孕已被广泛使用。六七十年代放置宫内节育器（ＩＵＤ）的中国妇女已相继步入绝经期。曾经置入的ＩＵＤ因无临床症状常被受术者忽略，加上取器困难又时有发生，...     

尼尔雌醇在绝经后取宫内节育器中的应用

宫内节育器（IUD）是一种高效、简便、安全的节育工具，在我国广大妇女中推广使用已长达30余年，目前带器进入绝经期的妇女日益增多。特别是我县农村山区，部分妇女在绝经后未能将IUD及时取出，给取器手术带来一定困难。为探讨绝经后取宫内节育器前服用尼尔醇片的价值，从而提高手术成功率，我院对2004年10月～2006年12月收治的124例绝经后妇女取IUD困难者进行回顾性分析。     

生殖健康与围绝经期保健

1　正确认识围绝经期与生殖健康的关系　　据ＷＨＯ报道 ,全球老年人口将从 1998年的 5 8亿增加至 2 0 5 0年的 2 0亿 ,所占总人口的比例由 2 0 %增加到3 5 % ,届时每 3个人中即有 1个 60岁以上的老人。发达国家中特别是意大利 ,希腊 ,德国等 ,是平均年龄最大的国家 ,已经面临着人口老化的诸多问题。我国虽为一个人口大国 ,但在成功地推行计划生育政策以来 ,人口的平均年龄也逐渐增大 ,据统计一个妇女的一生中约有 2 0～ 3 0年生活在绝经期和绝经后期。由此可知 ,围绝经期问题实属一个全球化的生殖健康和多学科化的问题 ,它涉及到医学、社…     

大豆异黄酮与围绝经期妇女保健

围绝经期妇女由于卵巢功能衰退、雌激素缺乏会出现一系列激素依赖性症状及疾患。如 :潮热、出汗 ,甚至出现骨质疏松、心血管疾病、老年痴呆等危机身体健康 ,给生活质量带来明显的影响。长时间观察表明 ,应用雌激素补充治疗 (ERT)上述疾病得到了改善 ,但乳腺癌、子宫内膜癌的发病率却有所增高。后来又开始应用性激素替代疗法(HRT) ,即在应用雌激素的同时加用孕激素。虽然子宫内膜癌的发病率降低 ,但乳腺癌、子宫内膜癌、黑色素瘤等雌激素依赖性肿瘤患者仍作为HRT的禁忌证 ,使得HRT的应用在一定范围内受到了限制。大豆异黄酮是一种结构与…     

宫内节育器避孕对围绝经期女性生殖健康的影响分析

目的:探讨分析使用宫内节育避孕器对围绝经期女性生殖健康的影响。方法:采用类型随机抽样法,将使用宫内节育器避孕的围绝经期女性设为第一组;使用其他方法进行避孕的围绝经期女性为第二组。第一组526例,第二组459例,采用问卷调查的方式,比较两组围绝经期女性的经期症状和生殖健康状况,并采取相应的检查措施。采用线性回归方法对两组数据进行比较分析。结果:第一组女性的月经周期比第二组规律,并发症的发生率比第二组低,但经期的腰痛、腹痛症状比第二组严重,而宫内节育避孕器对经期症状的影响将随时间而减弱,不同时期的影响差异存在统计学意义(P<0.05);不同种类的宫内节育避孕器对经期症状的影响有统计学差异(P<0.05);两组女性在经期症状和生殖健康状况等方面的比较无统计学差异((P>0.05);使用宫内节育避孕器对围绝经期女性的经期症状和生殖健康状况无影响(P>0.05)。结论:使用宫内节育避孕器不会对围绝经期女性在生殖健康等方面造成影响。     

2054例围绝经期及绝经后妇女宫内节育器使用年限及取出情况调查

目的:了解围绝经期及绝经后妇女宫内节育器(IUD)的取出情况及实际使用年限。方法:以在黄浦区居住且末次使用避孕方法为IUD的45~60岁妇女为研究对象,于2011.08~12期间开展横断面调查,共调查2 167人,其中2 054人纳入分析。结果:研究对象平均年龄52.4±4.0岁。1 160例已绝经的妇女中,63例(5.4%)使用的IUD仍未取出,其中15例IUD已放置至绝经后5年以上;IUD的平均宫内放置时间为18.9±5.7年,50.2%的IUD使用者宫内放置时间20年。732例未绝经的妇女中,IUD的平均使用年限为17.3±5.7年,有51.1%的女性使用IUD已超出建议使用期限。结论:绝经后IUD过期使用情况严重,相当一部分正在使用的IUD已超过了使用期限。     

围绝经期和绝经后IUD取出时机和注意事项

宫内节育器(intrauterine device IUD)作为一种有效的避孕措施已被广泛使用多年,因方法简便、安全性高、易于接受,是目前国内应用较广的避孕方法之一.在我国大多数的育龄妇女采用IUD避孕,占各种措施的40%以上.IUD取出是计划生育的小手术,一般都能顺利取出,但近年来绝经后取器妇女增加,取器的难度不断增高.     

围绝经期与绝经后期妇女性激素补充疗法的进展

围绝经期是指绝经过渡期及绝经后一年内的一段时期 ;而绝经过渡期是指包括临床上、内分泌学及生物学开始出现绝经趋势的迹象 (40岁左右 ) ,也就是卵巢功能衰退的征兆至最后一次月经。绝经后期是指最后一次月经以后到生命终止这一整个时期。1　对绝经问题的认识和发展在 6 0年代 ,西方医学界认为“绝经是一种疾病” ,是一种雌激素不足性疾病 ,认为给予雌激素可预防绝经后所有疾病 ,导致一时普遍使用雌激素。 70年代初 ,美国 5 0岁以上妇女有 1/ 3常规使用雌激素 ,随后发现雌激素可能引起子宫内膜癌 ;进一步的研究发现同时加用孕激素 ,可对抗…     

围绝经期妇女预防性卵巢切除意义的探讨

预防性卵巢切除(prophylacticoophorectomy,PO)一般指因良性疾病行子宫切除或其他腹部手术的同时切除正常无病变的卵巢。该术式已有2个世纪的历史,在130年中,应用指征逐渐发生了改变,人们越来越认识到卵巢的重要性。但在医学界对围绝经期妇女是否实行PO仍是争论的焦点。本文旨在对围绝经期卵巢的功能及其去留价值进行探讨,以帮助临床医师做出恰当的决策,提高妇女的生活质量。围绝经期是指从接近绝经,出现与绝经有关的内分泌、生物学和临床特征起至绝经1年内的期间。总结国外资料,围绝经期开始的年龄平均为46岁,95%的妇女开始的年龄为3…     

笑气与米索前列醇联合应用于绝经期妇女取环术临床效果分析

绝经期妇女取环术是常见的计划生育手术之一。近年来，随着生活水平的提高，人们对生活质量、生殖健康需求也越来越高，惧怕手术疼痛是影响取环手术效果的重要因素之一。为此，我院应用笑气与米索前列醇联合应用于绝经期妇女取环术中，取得了良好的临床效果。[第一段]     

Hyperandrogenism in premenopausal women

Androgens are a family of steroids hormones secreted by the adrenal glands and the ovaries in women. The adrenal secretion of androgens becomes significant around the age of 7, at the onset of adrenal activity, and increases until ovarian puberty. The excess of adrenal androgens, of which the main products are dehydroepiandrosterone and its ester sulfate (DHEAS), is unrelated to a classic deficiency of steroid biosynthesis. Blocking with small doses of dexamethasone (0.5 then 0.25 mg at night), demonstrates that the DHEAS may be blocked and rules out a tumor of the adrenal cortex. This treatment, which presents tolerance problems, is effective on acne, but ineffective on hirsutism which requires the use of antiandrogens. In addition to this idiopathic adrenal hyperandrogenism, the late manifestations of a congenital deficiency in 21-hydroxylase in a clinical picture varying from a mere obesity to moderate hirsutism, but may evolve to a syndrome of polycystic ovaries, is easy to diagnose with a basic 17-hydroxyprogesterone assay. In this case, adrenal blocking by dexamethasone often gives a spectacular clinical result. Isolated ovarian hyperandrogenism, is found in the various clinical forms of the polycystic ovaries syndrome. Usually, this syndrome is suggested by the anovulation, cause of sterility, hirsutism and overweight. Ovarian ultrasonography is often difficult to explain, particularly because of the non-univocal macroscopic appearance of the ovaries. Therefore, a great deal of emphasis is placed on the hormonal exploration which shows an elevated concentration of serum testosterone (T) and mostly of delta-4 androstenedione (A), combined with an elevated luteinizing hormone (LH) which should be determined on several successive samples.(ABSTRACT TRUNCATED AT 250 WORDS)     

Endometrial carcinoma in premenopausal women: A clinicopathological study

A clinicopathological review of 106 cases of premenopausal endometrial carcinoma has confirmed the good prognosis in such patients. Women less than 40 years old were more likely to be nulliparous, over 80 kg in weight, and to present with irregular or heavy and irregular bleeding, than women 40 years or older. Seven patients developed malignancies at other sites. A detailed pathological review of 32 cases revealed poor prognostic features in 30% of patients; corpora lutea were identified in the ovaries of 13 patients. It is suggested that factors other than anovulation are related to the development of endometrial cancer in the over 40 age group.     

Testosterone therapy in premenopausal women

Testosterone therapy for postmenopausal women and women with surgical menopause, albeit controversial, is becoming more widespread. However, only limited data are available to support its use in premenopausal women. Androgens have important biological roles in young women, influencing bone and muscle mass, mood and well-being, and libido. Pathophysiological states affecting ovarian and adrenal function or both may result in androgen deficiency in premenopausal women. Young women with hypothalamic amenorrhea, premature ovarian failure, oophorectomy, premenstrual syndrome, acquired immunodeficiency wasting syndrome, adrenal insufficiency, and hypopituitarism may have testosterone deficiency. Young women with loss of libido may also have testosterone deficiency. Medications that may lead to testosterone insufficiency include oral estrogen, oral contraceptives, and corticosteroids. Testosterone deficiency in young women may be underdiagnosed because the symptoms generally are nonspecific and the measurement of total and free testosterone is inaccurate with commonly used techniques. Only a few studies investigating the effects of testosterone therapy have been performed thus far in premenopausal women. Long-term trials evaluating safety and effectiveness of testosterone therapy in premenopausal women are lacking. Common adverse effects include hirsutism and acne, which reverse with discontinuation of treatment. The availability of testosterone regimens specifically designed for women is expected to help maintain testosterone levels within the normal range and clarify whether the apparent beneficial effects of testosterone therapy are physiological or pharmacological.     

Genital bacteriology: a comparative study of premenopausal women with postmenopausal women.

Premenopausal women are reportedly at a higher risk than postmenopausal women of postoperative infection following vaginal hysterectomy. A study was designed to determine whether a relationship exists between bacterial flora and patient age that may explain the difference in the risk of postoperative infection. No statistically significant difference was found in the number or type of bacterial species isolated from the cervix or vagina of premenopausal and postmenopausal women. Postmenopausal women on a regimen of conjugated estrogens had genital flora similar to that of the other women studied.     

Vulvar dystrophies in young and premenopausal women

Eighty-six cases of vulvar dystrophy in young and premenopausal women (age range, 6-53 years) were studied clinically and histopathologically. The most frequent symptom was pruritus associated with burning. Clinical examination showed the presence of white areas in 73% of the patients, red areas in 9% and other signs (such as melanosis) in 18%. Hyperplastic dystrophy was the most frequent type of dystrophy in these patients and was observed in 63% of cases. Cellular atypia was observed in 9.8% of the cases and was found almost exclusively in hyperplastic dystrophy. Epithelial changes suggestive of human papillomavirus infection were found in 4 of the 86 cases of dystrophy, and they were observed only in atypical dystrophies.     

Benign ovarian cysts in premenopausal women

Benign ovarian cysts are a common gynaecological presentation seen in both the elective and emergency setting. Up to 10% of women will have surgery for an ovarian cyst in their lifetime. When an adnexal mass is diagnosed the differential diagnosis is wide and up to 10% may be non-ovarian in origin. The goal of management is to determine the underlying pathology and to risk stratify patients to guide further management. Transvaginal ultrasound scanning remains the imaging modality of choice and the use of simple rules as well as benign and malignant features should form the basis for diagnosis, with serum markers used as an adjunct. Cross-sectional imaging with other modalities including magnetic resonance imaging are useful in the management of indeterminate masses. The vast majority of ovarian cysts are benign in nature and most functional and simple cysts are likely to resolve spontaneously without intervention. This review will demonstrate four clinical scenarios with different underlying pathologies and their management.     

Vulvar carcinoma in premenopausal Jamaican women

Between the years 1958 and 1973, 119 patients with primary invasive cancer of the vulva were treated at the University Hospital of the West Indies, Kingston, Jamaica. Seventy-seven (64.7%) were premenopausal women. Because the pattern of the disease differed from that in late middle and older aged Jamaican women, the results of the disease are presented. The analysis stresses that vulvar carcinoma before menopause in our community is rare in the absence of various sexually transmitted granulomatous diseases of the vulva.