不同绝经状态妇女绝经症状与抑郁状态的临床分析

目的:探讨对不同绝经症状妇女的健康保健措施。方法:366例就诊于更年期门诊的妇女按月经状态分成围绝经期组(n=104)、绝经早期组(n=194)、绝经晚期组(n=68),采用改良Kupperman评分法和自评抑郁量表(self-rating depression scale,SDS)对患者进行绝经症状及抑郁症状评分。结果:改良Kupperman评分异常者占46.99%(172/366),Kupperman评分绝经早期组和绝经晚期组比较无显著差异(t=0.393,P>0.05);绝经早期组、绝经晚期组显著高于围绝经期组(t=2.899,P=0.004;t=2.371,P=0.019)。SDS异常者占11.20%,各组间SDS评分无差异。改良Kupperman评分与SDS评分具有相关性(18.58±9.05vs33.60±9.44,Pearson相关系数为0.599,P=0.000)。结论:绝经症状评分绝经妇女高于围绝经妇女,抑郁评分与绝经症状评分存在显著相关性,故需关注妇女的绝经症状,尤其是抑郁症状。     

围绝经期女性的综合保健措施与评价

目的：探讨围绝经期女性的综合保健措施及健康管理模式。方法：选取2010年至2012年就诊于我院妇科门诊的围绝经期女性100例,建立健康档案,采用Greene症状评分法、更年期Kupperman评分法、Zung抑郁量表等进行基线调查,判断并采取综合干预措施,分别行激素补充治疗、健康教育、营养指导、体育运动指导、心理健康辅导等综合保健干预。干预后1、6月及12月随诊,12月后再次问卷进行效果评价。结果：综合干预后的Kupperman评分、Greene症状评分均显著低于干预前（P〈0.01）。干预前后的血胆固醇及高密度脂蛋白水平差异显著（P〈0.05）。结论：实施多方面干预的综合保健措施,可提高围绝经期女性激素补充治疗的接受性;可明显缓解围绝经综合征患者临床症状;改善心理状态及提高围绝经期的生活质量。是值得临床推广的围绝经期管理模式。     

用Kupperman评分评估围绝经期双侧卵巢切除对围绝经期症状的影响

目的:采用改良Kupperman评分系统对围绝经期因妇科良性肿瘤行双侧卵巢切除的患者进行评分,观察双侧卵巢切除对妇女围绝经期症状的影响.方法:2006～2007年在我院因良性疾病行手术治疗同时切除双侧卵巢的围绝经期患者,术后6～12个月发放调查问卷,内容包括患者基本情况和改良Kupperman评分表.询问患者如可以重新选择,是否仍愿意接受双侧卵巢切除手术,根据不同选择将患者分为接受手术组和暂缓手术组,并对Kupperman评分值进行统计学检验.结果:回收有效问卷68份.患者术后Kupperman评分由术前的12.71±9.50增加至20.35±7.84(P=0.000),其中以心悸、性生活质量下降、潮热出汗、疲乏、情绪波动、抑郁多疑等症状的评分增加明显,与术前相比差异有统计学意义(P＜0.05).选择暂缓手术组患者术后情绪波动、头痛及性生活质量下降评分高于接受手术组,差异有统计学意义(P＜0.05).结论:围绝经期双侧卵巢切除后可能会加重妇女的围绝经期症状,进行围绝经期妇科良性疾病手术治疗时,应合理掌握卵巢切除的指征.     

穴位神经刺激仪治疗围绝经期综合征50例临床价值初探

目的:观察穴位神经刺激仪对围绝经期综合征相关症状的影响.方法:选取有围绝经期综合征相关症状的妇女50例,应用穴位神经刺激仪于内关、合谷、三阴交、足三里穴位以4～10 mA的电流刺激30分钟,隔日治疗1次,治疗12 ～ 15次.治疗前与治疗后填写改良Kupperman绝经指数(KMI)评分量表与绝经期生存质量量表.比较治疗前与治疗后两量表的评分.结果:治疗后比治疗前改良KMI评分与绝经期生存质量评分显著降低(P＜0.01).结论:穴位神经刺激仪可显著缓解围绝经期综合征相关症状,具有临床应用价值.     

围绝经期妇女抑郁症相关因素及预防策略

目的了解围绝经期妇女抑郁症的发病率、发病相关因素及预防策略。方法采用汉密顿抑郁量表、改良围绝经期症状评分表、生活事件量表、改良社会支持评定量表和一般资料调查表,于2007年1月至6月期间对广东地区112名围绝经期妇女进行调查。结果围绝经期妇女抑郁症的发生率为41.07%。经前期综合征、痛经程度、绝经、居住环境、抑郁史、生活事件量表总分、改良社会支持评定量表总分及Kupperman绝经指数是围绝经期妇女发生抑郁症的主要影响因素。结论围绝经期妇女抑郁症的发生率较高,除与性腺功能减退有关外,还与社会、家庭及精神因素有关。针对病因进行预防,可减少围绝经期妇女抑郁症的发生,提高妇女生活质量。     

文化程度及生育情况对女性围绝经期症状的影响

目的:探讨围绝经期女性文化程度及生育情况与其发生围绝经期症状的关系。方法:选取2013年1月—2017年12月在浙江地区相关医院妇科门诊就诊的2 917例围绝经期女性,采用问卷方式调查其基本情况、改良Kupperman评分法评估女性围绝经期症状。结果:最终纳入的2 479例研究对象中,有721例(29.08%)已自然绝经,绝经年龄为(49.42±3.57)岁。不同文化程度女性在绝经年龄、分娩次数、流产次数、妊娠次数、腰臀比、感觉异常、情绪波动、抑郁疑心和性生活问题方面比较,差异均有统计学意义(均P0.05)。不同文化程度、分娩次数和妊娠次数间改良Kupperman评分总分的差异均有统计学意义(均P0.05)。结论:文化程度越低,分娩及妊娠次数越多,改良Kupperman评分总分越高,围绝经期症状越严重。不同文化程度及生育情况的围绝经期女性临床处理应个体化。     

文化程度及生育情况对女性围绝经期症状的影响

目的：探讨围绝经期女性文化程度及生育情况与其发生围绝经期症状的关系。方法：选取2013年1月-2017年12月在浙江地区相关医院妇科门诊就诊的2 917例围绝经期女性,采用问卷方式调查其基本情况、改良Kupperman评分法评估女性围绝经期症状。结果：最终纳入的2 479例研究对象中,有721例（29.08%）已自然绝经,绝经年龄为（49.42±3.57）岁。不同文化程度女性在绝经年龄、分娩次数、流产次数、妊娠次数、腰臀比、感觉异常、情绪波动、抑郁疑心和性生活问题方面比较,差异均有统计学意义（均P＜0.05）。不同文化程度、分娩次数和妊娠次数间改良Kupperman评分总分的差异均有统计学意义（均P＜0.05）。结论：文化程度越低,分娩及妊娠次数越多,改良Kupperman评分总分越高,围绝经期症状越严重。不同文化程度及生育情况的围绝经期女性临床处理应个体化。     

雌激素联合低频电刺激与生物反馈治疗围绝经期妇女压力性尿失禁的临床研究

目的:探讨围绝经期妇女压力性尿失禁有效的治疗方法.方法:选取36例围绝经期压力性尿失禁妇女进行治疗.随机分为A组、B组和C组,每组12例患者.A组给予雌激素加低频电刺激加生物反馈治疗,B组给予低频电刺激加生物反馈治疗,C组给予低频电刺激加生物反馈加安慰剂口服治疗.结果:尿失禁量与Kupperman评分呈正相关(r=0.741,P＜0.01).与治疗前比较,治疗1个月、3个月后Kupperman评分A组、B组、C组均显著降低(p＜0.01);与B组比较.治疗1个月后,A组Kupperman评分明显降低(P＜0.01),治疗3个月后进一步降低(P＜0.01);B组与C组比较差异无统计学意义.与治疗前比较,治疗1个月、3个月后尿失禁量A组、B组、C组均显著降低(P＜0.01);与B组、C组比较,A组尿失禁量治疗1个月、3个月后显著降低(P＜0.01).结论:雌激素联合电刺激与生物反馈疗法可以明显减轻围绝经期妇女压力性尿失禁的症状.     

598例妇女围绝经期症状调查

目的:了解围绝经期妇女的有关围绝经期症状及相关症状年龄分布。方法:采取随机整群抽样的方法,对598例40~65岁石家庄市妇女进行问卷调查和Greene评分。随机抽取其中的100例对象进行双能X线右前臂远端骨密度检查。结果:绝经平均年龄(48.38±5.36)岁。绝经症状发生率84.1%,45岁后骨密度显著下降,56岁后骨质疏松症发生率逐渐增加。围绝经期妇女所处年龄段不同其症状也不同。46~50岁多见潮热出汗;61~65岁多见肌肉关节痛、复发性生殖泌尿系统感染,差异均有统计学意义(P0.05)。结论:绝经及其相关疾病给妇女生理和心理带来很大困扰,在进行围绝经期妇女的保健治疗中不能忽视这些相关疾病的防治,应根据不同年龄制定防治措施。     

上海市围绝经期门诊就诊妇女治疗效果的随访研究

目的分析影响围绝经期综合征妇女选择治疗方法的相关因素。方法将连续2个月内因围绝经期症状在上海市城乡二三级医院绝经专病/妇科门诊就诊且接受治疗的妇女纳入本研究,并开展1年随访,通过问卷调查收集妇女的社会人口学信息,围绝经期综合征程度采用改良Kupperman评分(modified Kupperman index,KMI)判断。结果就诊的349例妇女中共有161例接受治疗并进入队列,其中108例(67.1%)选择激素替代疗法(menopausal hormone therapy,MHT)。治疗后KMI评分正常的女性比例(37.9%)显著高于治疗前(13.0%,P=0.000),治疗后KMI总分(17.3±10.0)显著低于治疗前(10.6±8.2,P=0.000),治疗后13个症状单项得分均显著降低于治疗前(P0.005)。多因素logistic回归分析提示,同时患有1种[调整OR(a OR)=0.277]和2种及以上(a OR=0.249)慢性疾病的妇女接受MHT治疗的可能性显著低于无慢性病共患妇女。月经不规则(a OR=5.317)和已停经(a OR=11.070)妇女更可能接受MHT治疗。结论上海市围绝经期综合征妇女治疗效果较好,其是否接受MHT受自身健康状况和当前月经状态的影响。     

Greene Climacteric Scale: norms in an Australian population in relation to age and menopausal status.

OBJECTIVES: The aim of this study was two-fold: to assess climacteric symptoms and provide normative data for the Greene Climacteric Scale during the menopause transition, and to investigate the prevalence of climacteric symptoms in a representative sample of postmenopausal Australian women. METHOD: A cohort of 500 premenopausal, perimenopausal and postmenopausal women aged 40-80 years participated in the Longitudinal Study of Ageing in Women (LAW study) at the Royal Brisbane and Women's Hospital, Brisbane, Australia. In year 1 of the study (2001), all participants completed the Greene Climacteric Scale and information regarding their menopausal status and the use of hormone therapy (HT) was obtained through a clinical interview with a qualified medical practitioner. RESULTS: The 50-59-year age group achieved the highest scores on the vasomotor and the depression scales in comparison to other age groups. Significant differences were also evident on the vasomotor and the depression scales on the basis of menopausal status, especially in perimenopausal women. Approximately 10% of women in the 60-79-year age group continued to experience vasomotor symptoms. CONCLUSION: Vasomotor symptoms, as assessed by the Greene Climacteric Scale, are common during the menopause transition and remain elevated for some years in a minority of older postmenopausal women. The norms presented in this study are appropriate for use in an Australian population.     

医护人员围绝经期情况调查

目的了解北京大学人民医院女性医护人员的围绝经期相关情况及自我认知。方法选取于2012年7月在北京大学人民医院行常规体检的女性职工共596位,年龄在40~60岁之间,以问卷形式调查其围绝经期月经状况、围绝经期症状发生程度以及对围绝经期的自我认知。结果①本次收回有效问卷557份。被调查者平均年龄（46.3±3.7）岁,其中已绝经者63人,自然绝经者45人,平均自然绝经年龄（47.7±4.7）岁;手术绝经（切除卵巢者）10人;药物绝经2人。从出现月经紊乱到绝经平均（1.6±1.5）年;②557名职工中,出现围绝经期相关症状者331人,其中对于更年期症状可治疗表示＂完全知道＂者45（13.6%）;对围绝经期症状＂知道一些＂的281人（84.9%）,表示＂完全不了解＂者5人（1.5%）。绝经远期危害中,知道＂骨质疏松＂者291人（52.2%）,知道＂心脑血管疾病＂者170人（30.5%）,知道＂阿尔兹海默症＂者59人（10.6%）,知道＂反复泌尿系感染＂者162人（29.1%）。所有受调查者中正在使用药物治疗围绝经期症状者69人（12.4%）,其中33人使用性激素类药物治疗（5.9%）,39人使用中药类药物治疗（7.0%）,其中3人两者均用（0.5%）;③557例中有围绝经期症状者331人,占59.4%,平均Kupperman绝经指数为11.9分（量表最高63分）。331人中有症状但未绝经者291人,平均绝经指数为11.1分;有症状且已经绝经者40人,绝经指数为16.5分。在有围绝经期症状的人群中,各项症状发生率从19.9%~77.6%不等。大多数发作者症状为轻至中度,重度者仅占0.6%~3.3%。结论女性医护人员围绝经期状况应引起重视。从事医疗行业女性对围绝经期的自我认知优于一般妇女群体,寻求药物治疗控制围绝经期症状的人群比例也高于一般妇女人群,但仍需加强相关知识的宣传和普及。     

Optimizing soy isoflavones effect in postmenopausal women: the impact of timing on climacteric symptoms

Background.?The most common complaints during climacteric are vasomotor symptoms. A circadian rhythm has been observed when hot flashes start; however, not much information is available in this field.

Aims.?To analyze whether the time (morning/evening) of administration of a compound containing 60 mg of dry soy seed extract (glycine max) with 40% of total isoflavones, primrose oil and α-tocopherol modifies the effect on the climacteric syndrome.

Trial design.?Multicentric, observational, open, prospective, longitudinal and cross-sectional study.

Subjects and methods. One thousand six hundred eighty-two postmenopausal women with climacteric symptoms were allocated in two groups in order to receive the treatment in the morning (Group 1) or in the evening (Group 2), switching administration time after 3 months. Clinical evaluation was carried out at 0, 3 and 6 months of follow-up using Blatt–Kupperman and Greene scales

Results.?233 (13.9%) women dropped out from the study. Both administration times improved the climacteric symptoms after 3 and 6 months of treatment, showing a reduction in the scores of Blatt–Kupperman and Greene scales (p?<?0.001). No differences between both groups during the follow-up were identified.

Conclusions.?The time of administration of isoflavones does not modify its effect on climacteric symptoms.     

Eszopiclone in patients with insomnia during perimenopause and early postmenopause: a randomized controlled trial

OBJECTIVE: To evaluate eszopiclone 3 mg for treatment of insomnia in perimenopausal and early postmenopausal women, as well as the impact of insomnia treatment on mood, menopause-related symptoms, and quality of life. METHODS: This was a double-blind, placebo-controlled study with 410 women (aged 40-60; perimenopausal or early postmenopausal) who reported insomnia defined as sleep latency of at least 45 minutes and total sleep time less than or equal to 6 hours per night for at least 3 nights per week over the previous month. Patients were randomly assigned to eszopiclone 3 mg or placebo nightly for 4 weeks. Sleep data were collected once a day. Physician global assessments of menopause, menopause-specific questionnaire, Greene Climacteric Scale, the Montgomery Asberg Depression Rating Scale, and the Sheehan Disability Scale were collected at baseline and end of treatment. RESULTS: Patients receiving eszopiclone reported improvements in sleep induction, sleep maintenance, sleep duration, sleep quality, and next-day functioning relative to placebo (P<.05). Patients receiving eszopiclone reported fewer total awakenings and awakenings due to hot flushes (P<.05). Eszopiclone use led to greater improvement in Montgomery Asberg Depression Rating Scale scores (P<.05) and physician global assessments of menopause scores (P<.001); total Greene Climacteric Scale score and the vasomotor and psychological sub-scores (P<.05); vasomotor and physical domains of the menopause-specific questionnaire (P<.05); and family life/home domain of the Sheehan Disability Scale (P<.05). CONCLUSION: In this study, eszopiclone provided significant improvements in sleep and positively impacted mood, quality of life, and menopause-related symptoms in perimenopausal and early postmenopausal women with insomnia. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov www.clinicaltrials.gov NCT00366093 LEVEL OF EVIDENCE: I.     

Efficacy of standardized isoflavones extract (Soyfem) (52-104 mg/24h) in moderate and medium-severe climacteric syndrome

INTRODUCTION: In recent years, considerable attention has been paid to isoflavones and their proprieties to alleviate the climacteric symptoms. The goal of this study was to evaluate the efficacy of standardized isoflavones extract (Soyfem) in moderate and medium-severe climacteric syndrome. MATERIAL AND METHODS: 555 postmenopausal women were recruited for the study. Out of this group, 169 women completed the study (12-month observation period). The patients were classified according to the intensity of climacteric symptoms (< or = 34 points in Kupperman index). 1 or 2 tablets of Soyfem were administered twice a day. RESULTS: A regular decrease of Kupperman index value and improvement of life quality were observed in the group of 169 postmenopausal women. We have noted a decrease in the intensity and number of hot flushes, diaphoresis (p < 0.05), diminished sleep disturbances (p < 0.05), decreased headache, dizziness, and arthrosis pain. The diminished intensity of tiredness, palpitation and breathlessness have been also observed (p < 0.05). 80% of all investigated women noted the regression of paresthesis, 20% indicated the decreased number of paresthesis (p < 0.05). Influence of Soyfem on the variability and moderation of depressive mood (p < 0.05) have been also positive evaluated by patients. CONCLUSIONS: Administration of Soyfem in the dosage 52 to 104 mg/24 hours (2 times daily 1 or 2 tablets) is a safe and effective therapy in the postmenopausal women with moderate and medium-severe climacteric syndrome evaluated according to the Kupperman index. Administration of Soyfem is connected with a good compliance and correlated with well-being in the investigated women allowing a long-term administration.     

The safety and tolerance of isoflavones (Soyfem) administration in postmenopausal women

INTRODUCTION: In recent years, considerable attention has been paid to isoflavones and their proprieties to alleviate the climacteric symptoms. The goal of this study was to evaluate the efficacy of standardized isoflavones extract (Soyfem) in moderate and medium-severe climacteric syndrome. MATERIAL AND METHODS: 555 postmenopausal women were recruited for the study. Out of this group, 169 women completed the study (12-month observation period). The patients were classified according to the intensity of climacteric symptoms (< or =34 points in Kupperman index). 1 or 2 tablets of Soyfem were administered twice a day,. RESULTS: A regular decrease of Kupperman index value and improvement of life quality were observed in the group of 169 postmenopausal women. We have noted a decrease in the intensity and number of hot flushes, diaphoresis (p < 0.05), diminished sleep disturbances (p < 0.05), decreased headache, dizziness, and arthrosis pain. The diminished intensity of tiredness, palpitation and breathlessness have been also observed (p < 0.05). 80% of all investigated women noted the regression of paresthesis, 20% indicated the decreased number of paresthesis (p < 0.05). Influence of Soyfem on the variability and moderation of depressive mood (p < 0.05) have been also positive evaluated by patients. CONCLUSIONS: Administration of Soyfem in the dosage 52 to 104 mg/24 hours (2 times daily 1 or 2 tablets) is a safe and effective therapy in the postmenopausal women with moderate and medium-severe climacteric syndrome evaluated according to the Kupperman index. Administration of Soyfem is connected with a good compliance and correlated with well-being in the investigated women allowing a long-term administration.     

The symptomatology of climacteric syndrome: whether associated with the physical factors or psychological disorder in perimenopausal/postmenopausal patients with anxiety–depression disorder

Purpose

To explore whether the symptoms of climacteric syndrome associated with its physical factors or psychological disorder in perimenopausal/postmenopausal patients with anxiety–depression disorder.

Methods

We recruited 78 climacteric patients with anxiety–depression disorder and 72 control participants in perimenopausal/postmenopausal without anxiety–depression disorder for this study. We measured symptoms using the Greene Climacteric Symptom Scale in all cases. We also collected demographic data and tested sexual hormone, blood pressure, bone density, cognitive, estrogen receptor-alpha (ERα) gene polymorphism as physiological factors, using HARS-14 and CHDS assessed psychological disorder degree.

Results

C-MMSE scores as well as Estradiol and progesterone levels in the anxiety–depression disorder group were significantly lower compared to the control group (P < 0.01). In addition, the anxiety–depression disorder group had significantly higher Greene Climacteric Scale scores, as well as somatic symptoms compared to controls (P < 0.01). Moreover, the anxiety, depression and somatic symptoms of the Greene Climacteric Scale were positively correlated with HARS-14 and CHDS scores (P < 0.001) and negatively with estrogen level and C-MMSE scores (P < 0.05) in the anxiety–depression disorder group. Greene Climacteric Scale Symptoms were not significantly correlated with blood pressure, bone density or other factors (P > 0.05). There was no significant change in the allele frequency or the estrogen receptor-alpha gene polymorphisms, between the two groups (P > 0.05); however, the Pp genotype was negatively associated with C-MMSE scores (r = appraises, P = 0.033).

Limitations

The sample size was relatively small.

Conclusions

The symptoms of somatic symptoms in patients with climacteric syndrome and anxiety–depression disorder are associated with the emotional disorder but not with a physical disease. The Pp ERα polymorphism Pvu II is associated with a cognitive decrease.