围绝经期潮热的非激素治疗

潮热是围绝经期妇女最常见症状。长期以来，人们使用激素替代疗法(HRT)治疗包括潮热在内的绝经期综合征。但近来学者对长期使用HRT利弊存在争议，这使得人们寻求非激素治疗来缓解潮热症状，改善生活质量，该文就围绝经期潮热的非激素治疗作一综述。     

绝经期妇女激素补充治疗的新进展

女性一生中约有1/3,甚至更长的时间是在围绝经期与绝经期度过的。由于卵巢功能的逐渐衰退,造成雌激素不足,绝经后的妇女会出现一系列的身心症状,影响个人的生活质量,给家庭和社会带来巨大的压力和负担。激素补充治疗对缓解更年期综合征,减少骨质疏松和骨折,改善妇女的生活质量,减少社会和家庭的压力与负担起了很重要的作用。该文肯定了激素补充治疗(HRT)对绝经期妇女的益处多于不良作用,强调每年评估利与弊,不断总结应用HRT的特点,扬长避短,为绝经期保健提供科学的依据。     

绝经相关症状及疾病的非激素治疗

绝经意味着卵巢功能的衰竭,其所致雌激素缺乏、内分泌失衡可产生一系列绝经相关问题或疾病,如围绝经期综合征、泌尿生殖道萎缩、绝经后骨质疏松症等,代谢综合征与心血管疾病的风险明显增加,此严重影响广大中老年妇女的身心健康和生活质量。近年来,除激素补充治疗(hormone replacement therapy,HRT)外,选择性5羟色胺再摄取抑制剂、中药、植物药及植物雌激素等非激素治疗方法也被用于绝经症状和疾病,尤其对于那些不能应用或不愿意接受激素补充治疗的女性。本文对目前非激素治疗的有效性和安全性作一分析。     

围绝经期激素治疗的适应证及变化

围绝经期是指女性卵巢功能开始衰退的生殖衰老阶段,包含了绝经过渡期和绝经后12个月.2018年发表的一项对于234 811例女性进行研究的汇总分析显示,自然绝经的中位年龄为50.0岁[1].生殖衰老STRAW+10分期(stages of reproductive aging workshop+10)中提出进入围绝经期的...     

绝经期激素治疗中不同孕激素制剂的比较

绝经后长期激素治疗的受益和风险不仅决定于患者的选择、用药时机、还与所用激素的制剂、剂量、用药途径有关。尤其是孕激素种类很多,对各靶器官的作用有差别。本文比较了临床上常用的4种孕激素制剂的基础医学资料;介绍近年来对代谢、心血管系统、乳腺癌影响的相关研究结果及国际绝经协会的推荐意见。     

绝经妇女非酒精性脂肪肝病及绝经激素治疗的研究进展

非酒精性脂肪肝病(nonalcoholic fatty liver disease,NAFLD)是指除外酒精和其他明确肝损害因素所致的,以大泡性肝细胞脂肪变性为主要特征的临床病理综合征,根据进展程度不同可分为单纯性脂肪肝病,脂肪性肝炎,脂肪性肝纤维化和肝硬化。NAFLD是发达国家引起慢性肝病最常见的原因,随着肥胖和代谢综合征在全球范围的流行,亚洲地区NAFLD发病率也在迅速增高。临床和流行病学研究表明,NAFLD在两性中发病趋势不同,绝经前女性患病率低于男性,而绝经后女性高于男性。本文综述绝经妇女NAFLD流行特点和雌激素的保肝作用,并讨论激素补充治疗是否能够对NAFLD发挥预防和治疗作用。     

吸烟对围绝经期应用激素替代治疗妇女雌激素水平及疗效的影响

目的探讨吸烟对围绝经期应用激素替代治疗妇女雌激素水平及疗效的影响。方法选择50例应用激素替代治疗期间吸烟的围绝经期妇女（观察组）与50例不吸烟应用激素替代治疗的围绝经期妇女（对照组）的雌激素水平及疗效作比较。结果观察组雌激素水平显著低于对照组,且绝经综合征症状缓解程度显著低于对照组。结论吸烟与围绝经期妇女激素替代治疗雌激素水平及疗效呈负相关。     

健康教育对绝经激素补充治疗围绝经期综合征效果的影响

目的 探讨健康教育对绝经激素补充治疗围绝经期综合征临床效果的影响。方法 选择2013年1月-2015年7月温州市中医院妇产科门诊收治的围绝经期综合征患者160例为研究对象,将入选研究对象随机分为观察组和对照组各80例。两组患者均给予绝经激素补充治疗(HRT)治疗,观察组患者则在HRT治疗的基础上进行健康教育干预。比较两组患者干预前及干预后3、6个月的绝经症状变化(Kuppernann)评分、血清性激素水平及子宫内膜厚度。结果 (1)干预后3、6个月,两组患者的血清E2比干预前均明显升高(均P＜0.05),而血清FSH和LH的表达水平则明显较干预前下降(均P＜0.05),且两组患者的血清性激素表达水平之间比较,观察组E2升高、FSH及LH下降程度较对照组更明显(均P＜0.05)。(2)干预后3、6个月,两组患者的子宫内膜厚度均显著增大,较干预前比较差异均有统计学意义(均 P＜0.05),但两组在3、6个月时子宫内膜厚度之间比较,观察组厚度(3.7±0.4 cm, 5.1±0.8 cm)明显大于对照组(2.9±0.5 cm, 4.3±0.5 cm),差异均有统计学意义(均P＜0.05)。(3)干预后3、6个月,两组患者的Kuppernann 评分均较干预前明显下降(P＜0.05),且观察组患者在3、6个月Kuppernann 评分分别为(11.6±3.7)、(7.6±2.8),较对照组(16.3±4.5,10.5±2.5)下降更明显,差异均有统计学意义(均P＜0.05)。结论 健康教育应用于HRT治疗围绝经期综合征患者的过程中,能够促进患者的血清性激素表达水平和子宫内膜厚度的恢复,促进患者内分泌的稳定,并更好地改善患者的症状,提高患者的生活质量。     

Relationships among sexual behavior,hot flashes,and hormone levels in perimenopausal women

Forty-three perimenopausal women kept daily records of menstrual cycles and sexual activity. Data on hot flashes and plasma estradiol and testosterone levels were obtained at two points during the menopausal transition. The prospective data yielded a significant negative association between hot flash ratings and regularity of sexual intercourse at both time points. A significant negative correlation was found between estradiol (in the early part of the cycle) and hot flashes ratings at the first data point only, and positive correlations were found between hot flashes and ratio of testosterone to estradiol (T/E) at both. Frequency of sexual intercourse and level of plasma estradiol were higher, and T/E and hot flash ratings were lower in early perimenopausal women who were still having cycles at least once every 30 days, as compared with late perimenopausal women who were cycling less often. It was concluded that a close association exists between increasing irregularity of menstrual cycles, hot flashes, declining estradiol levels, and declining frequency of intercourse during the perimenopause. Causal relationships remain to be established.Supported by NIH Grant AG1437.     

An epidemiological study of factors associated with perimenopausal hot flushes

A sample of women from general-practice registers were studied by means of a postal questionnaire which enquired about 18 physiological, personal and sociodemographic characteristics in relation to perimenopausal hot flushes. Eighty-three per cent of 242 women aged from 53 to 60 years reported having experienced hot flushes in the perimenopause. Five variables were found to exert a significant influence on the development of this symptom. Factors found to increase the predisposition towards flushing were: low age at birth of first child; one or more miscarriages, terminations of pregnancy, or stillbirths; previous dysmenorrhoea for which medical help was sought; migraine; and a high blushing tendency in adolescence. Apart from age, none of the sociodemographic characteristics showed a significant association with flushing.     

大豆异黄酮对绝经相关问题的临床循证研究

通过对大豆异黄酮应用于围绝经期和绝经后妇女的38项试验的总结,特别是针对潮热多汗、骨丢失和血脂改变3方面作了多项临床研究,发现其中作用优于对照组的有21项,与对照组相似的有17项,说明大豆异黄酮对围绝经期和绝经后妇女有一定的作用.     

探讨陕西农村妇女更年期潮热症状发生隋况与影响因素

目的探讨陕西农村更年期妇女潮热症状的发生情况及影响因素。方法采用多阶段整群抽样方法抽取陕西省陕南、陕北、关中5个县的825名40～60岁农村妇女进行问卷调查,在回收的问卷中,790份问卷合格,合格率达95．8％。结果①陕西农村更年期妇女潮热的发生率为55．7％（440例）,潮热发生的平均年龄为（47．45±6．55）岁,平均持续时间为（3．58±2．76）年。在潮热妇女中轻、中、重度潮热分别占48．2％（212例）、42．9％（189例）和8．9％（39例）,潮热发生至少每日1次者占35．5％（156例）。②潮热组与无潮热组妇女在年龄、婚姻状况、职业、收入、月经不调、饮食、乳制品消费、吸烟、饮酒量及更年期知识的获得方式等因素无关（P〉0．05）。潮热组与无潮热组妇女比较,潮热组文化程度偏低（Х2=37．613,P〈0．01）,生产次数（Х2=9．391,P=0．02）、食用豆制品（Х2=12．724,P〈0．01）、体育锻炼（Х2=44．730,P〈0．01）、对更年期的了解（Х2=46．202,P〈0．01）较无潮热组少,家人对妇女的态度（Х2=16．343,P〈0．01）较无潮热组差,性生活满意度（Х2=10．518,P〈O．01）较无潮热组低,身体质量指数（Х2=8109,P=0.02）和腰臀比（Х2=20．469,P〈0．01）较无潮热组高,差异有统计学意义（P〈O．05）。③农村更年期妇女的文化程度与潮热程度呈负相关（P〈0．05）。结论陕西农村妇女更年期潮热的发生率相对较高;其文化程度、生育情况、豆制品食用情况、是否体育锻炼、对更年期认识程度、性生活情况、家人对更年期妇女的态度、身体质量指数和腰臀比等因素与潮热症状的发生有关。     

Red clover extracts not effective for hot flushes

Both red clover extracts and placebo equally reduce the frequency of hot flushes. Providers should encourage patients to avoid spending money on supplements and instead add soy to their diet. In general, however, if patients are already convinced that something works, don't discourage them.     

The limitations of a negotiation model for perimenopausal women

The clinical negotiation model proposed by Katon and Kleinman (1981) puts culture at the very heart of the patient-doctor relationship. As opposed to the asymmetric model that stresses an unequal power relationship between a dominant physician and a powerless patient, this transactional model suggests that we view the clinical encounter as the locus of a negotiation that takes place between two kinds of knowledge (lay and professional), and between two agendas: the doctor's and the patient's. According to such a model, the doctor is taught to listen to the patient's own explanatory model of disease. Using an in-depth analysis of clinical encounters between perimenopausal women and female physicians, and of separate interviews with individual doctors and patients concerning their respective explanatory models, this pilot study puts emphasis on both the limitations of a transactional model and on the strategies deployed by doctors for enhancing the credibility of hormonal replacement therapy.