围绝经期妇女抑郁的相关因素

1994年WHO将围绝经期定义为由于卵巢功能衰退。从绝经前出现与绝经有关的内分泌、生物学和临床症状,至绝经后1年的这段时期。围绝经期妇女不仅出现潮热、盗汗、骨质疏松等躯体症状,心理症状也非常突出。围绝经期抑郁是发生于围绝经期的情感障碍性疾病,以情绪忧郁和焦虑紧张为主要表现,严重者有自杀倾向。影响妇女的生活质量,同时也成为家庭和社会的不稳定因素。Dennerstein等对438名45-55岁妇女进行的为期11年的前瞻性研究显示,24％的妇女发生了围绝经期抑郁。     

围绝经期妇女健康调查

为了解围绝经期妇女健康状况,探索围绝经期症状及相关因素,对600名40～60岁妇女进行了健康调查,结果显示绝经年龄为(48.67±3.01)岁。绝经年龄与妊娠次数、职业有关。围绝经期症状表现为月经失调、腰酸腿痛、乏力、潮热等,其程度与妊娠次数、教育程度、月经周期、身体状况有关,围绝经期妇女患病率28.3％。提示要加强围绝经期妇女的健康教育,提高妇女健康水平。     

上海市南京东路社区妇女围绝经期症状分析

目的：了解黄浦区社区围绝经妇女围绝经期症状的发生情况。方法：采用2个阶段随机抽样方法,选取南京东路社区40~60岁妇女作为调查对象,进行问卷调查。结果：被调查677例妇女中自然绝经者386例,平均绝经年龄为49.36±3.71岁。围绝经期症状发生率70.3%。在13项症状中,出现频率最高前5位症状依次为潮热出汗（53.2%）、骨关节痛（47.6%）、性生活障碍（45.2%）、眩晕（41.5%）、疲乏（41.2%）。围绝经期症状的严重程度随年龄的增长而加重。经多元线性回归分析显示,是否工作、性生活满意度及是否患有慢性病与围绝经期症状有相关性。结论：绝大多数妇女在围绝经期存在围绝经期症状,其发病与雌激素水平降低有关。依托社区,加强健康教育;针对病因进行预防,可降低围绝经期症状的发生率,提高妇女生活质量。     

人际关系与围绝经期综合征的相关性分析

更年期是妇女从成年进入老年所必需的阶段,是介于生育期和老年期的一段时期,即妇女从有生育功能到无生殖功能的过渡阶段,包括围绝经期前、后[1]。主要表现为月经紊乱、情绪不稳定、阵发性潮热、头晕、失眠、心悸、抑郁、暂时性血压升高等[2]。为了解河北省城乡妇女围绝经期综合征患病情况,探讨人际关系对围绝经期综合征的影响,对河北省7个地区627名45岁～55岁围绝经期妇女进行调查,结果如下。     

吴克明辨治围绝经期综合征的经验

围绝经期是指妇女自然绝经前和绝经后1年以内的一段年龄时期,多在45～54岁之间,可以提早至40岁开始.而绝经前后则是指围绝经期及绝经1年以上至60岁以前的一段年龄时期,通常又称为更年期.故更年期比围绝经期年龄范围更宽.围绝经期由于卵巢生殖功能减退,雌激素、孕激素水平降低,引起月经不调直至绝经.目前,我国妇女已有1/5进入围绝经期.随着人类寿命的延长,妇女将有30年左右是在绝经后度过的,并承受着身体和心理上发生巨大变化的压力.重视妇女围绝经期及更年期的医疗保健工作,对预防绝经后及老年期疾病、提高妇女健康水平和生活质量,具有重大的现实意义.     

社区妇女围绝经期症状分析及健康教育对策

【】 目的：探讨社区妇女引起围绝经期综合征的影响因素,对其症状进行分析研究,以便更好地开展社区妇女围绝经期的健康教育。方法：采用整群随机抽样方法,选取南京东路社区的732名40~60岁妇女作为调查对象,进行围绝经期妇女保健需求调查。结果：平均绝经年龄49.51?3.55岁,围绝经期症状发生率72.0%。社区妇女围绝经期综合征与年龄、文化程度、丈夫关系、孕产次数、亲友支持、经济收入、围绝经期知识、慢性病等有相关性。结论：患围绝经期综合征的妇女,严重影响了正常的工作和生活,并给社会和家庭造成一定的负担。因此,以妇幼保健进社区为切入点,开展社区妇女围绝经期的健康教育,是防治社区妇女围绝经期综合征的重要措施。     

围绝经期女性的自我保健

围绝经期是妇女生命中必经的生理过程，指从接近绝经、出现与绝经有关的内分泌生物学临床特征起，至绝经1年内的时间，表明卵巢功能的衰退和生殖能力的终止，呈渐进性发展^[1]。由于体内雌激素的缺乏，出现一系列临床症状，包括月经紊乱、血管舒缩症状（常见为潮热、多汗、心悸、眩晕、胸闷、日间潮热和夜间出汗）、     

围绝经期妇女健康状况调查及治疗策略

目的 调查郑州市管城区围绝经期妇女健康状况,探讨健康教育对策及保健措施,以提高妇女的健康水平及生活质量.方法 采用统一调查问卷和分层整群随机抽样方法,对郑州市第一人民医院妇科门诊就诊的郑州市管城区632例围绝经期妇女进行问卷调查.结果 围绝经期妇女85.8%有不同程度的围绝经期症状,人工绝经者症状严重;对激素替代治疗及盆底肌肉锻炼知晓率低,62.6%的围绝经期妇女希望获得围绝经期相关知识的教育和保健治疗需求.结论 针对围绝经期妇女实施科学、实效的健康教育及医疗服务,以促进中老年妇女的身心健康,提高其生活质量.     

基于自我调节模型的围绝经期妇女认知及影响因素研究

[目的]探讨基于自我调节模型的围绝经期妇女对绝经的认知情况及影响因素。[方法]采用一般情况调查表和改编的围绝经期妇女认知量表对417例围绝经期妇女进行调查。[结果]大多数围绝经期妇女认为记忆减退(61.2%)和情绪波动(59.5%)是由绝经引起,而典型的绝经症状潮热却只有38.4%人认为是由绝经引起,且大多数人对绝经持中立态度。家庭关系、有无事件突发是影响绝经认知4个方面(症状识别、结果、原因、时间、应对)的共同因素。此外,影响绝经症状识别的因素还有痛经与否、是否绝经及绝经状态,影响绝经应对认知的因素还有教育水平、职业、户口、收入、是否绝经。[结论]认知会影响绝经症状与管理,针对绝经认知的影响因素对围绝经期妇女实施个性化干预,提高和转变其认知,可改善其症状。     

基于《黄帝内经》探讨从肝主疏泄论治女性围绝经期潮热盗汗

潮热盗汗是女性围绝经期综合征的典型临床症状,严重干扰围绝经期女性的健康生活。女性在进入围绝经期后,出现潮热盗汗、情志不舒、月经不调、头晕目眩、眼目干涩等多种症状,而其中潮热盗汗因其多发于夜间,使人难以入眠,对女性造成严重困扰,故该文针对潮热盗汗进行分析探讨。目前西医对于其治疗多采用激素疗法,表现出明显的不良反应,且疗效有限。而从中医角度进行辨证论治,可减少产生不良反应,提高临床疗效。现中医临床多认为女性围绝经期潮热盗汗的发生与阴虚津亏密切相关,却易忽视肝失疏泄也是女性围绝经期发病的重要因素。该文基于《黄帝内经》及其他经典著作从生理、病理方面分析“肝主疏泄”理论,进一步探讨女性围绝经期的生理特点及潮热盗汗产生的病因病机,发现女性围绝经期产生潮热盗汗的重要原因在于肝失疏泄所导致的肝气郁结,气血瘀积化热,引起血热妄行、迫津外泄,以及肝失疏泄所引起的津液输布失常。故以此为依据,从恢复肝之疏泄功能进行论治,以疏肝理气为主要方法,柔肝滋阴、补肝养肾等为辅助手段,致力于为临床治疗女性围绝经期潮热盗汗提供学习和借鉴。     

A multicenter study of women's self-reported reproductive health after spinal cord injury

OBJECTIVE: Little attention has been given to women's reproductive health issues in the disabled population. This study documents the unique reproductive health conditions, complications, and behaviors in women with spinal cord injury (SCI). SUBJECTS: A total of 472 women at least 18 years of age who were at least 1 year post-SCI. Their average age at injury was 32 years. DESIGN: An extensive questionnaire regarding gynecologic, sexual, obstetric, and menopausal health issues was developed and piloted. The questionnaire was then administered by a trained woman health care clinician to women who agreed to participate in the study. SETTING: Private outpatient clinics at 10 regional model SCI systems of care. RESULTS: Women reported similar gynecologic problems in both preinjury and postinjury time periods. Exceptions were urinary tract infections and vaginal yeast infections. Sexually transmitted infections appear to be less common after injury, but the difference was not statistically significant. The number of hysterectomies was similar both before and after injury, but reasons differed greatly. Women with SCI were less likely to have routine mammograms. They reported similar preventive practices such as performing self-breast examinations and obtaining Papanicolaou smears. Almost 14% of women with SCI became pregnant after injury (101 pregnancies). Complications from pregnancy, labor, and delivery were reported to be more frequent in their postinjury than in their preinjury obstetric experiences. They tended to have babies of lower birth weight and with more complications at time of delivery. Of the sample, 87% reported having sexual intercourse before injury, with only 67% having intercourse after injury. Years postinjury and level of injury were predictive of intercourse; extent of injury was not. Experience of orgasms and methods of contraception varied among the two groups. There were significant complaints of dysreflexia and bladder incontinence with sexual function. Menopause after injury was reported by 14.6% of the women. Postinjury menopausal symptoms were of low frequency, but more than those reported by women who had undergone menopause before injury. Only 19% of women who had menopause after SCI were placed on hormone replacement therapy. Almost one third of the women who had menopause after injury reported new bone fractures. CONCLUSION: This study illustrates the unique reproductive health concerns of women with SCI. Many pregnancy, labor, and delivery experiences in these women are different. Sexual activity and function have several disability-related consequences and the effects of menopause are still unknown, but may be more problematic than for able-bodied women.     

A menopause center: bridging the midlife gap.

As women 40-60 years of age become the fastest growing segment of the population, it is time for women's health care providers to identify the health care needs of these women and provide the appropriate services. In 1985, Northwestern Memorial Hospital developed the Menopause Center to address these concerns. The objectives of the Menopause Center are to inform women of the natural bodily changes menopause creates, dispel common myths about the menopause, identify risk factors for osteoporosis and heart disease, provide information regarding hormone replacement therapy, and provide a forum for women experiencing the menopause to share information.     

A study of midlife women's reasons for changing healthcare providers

PURPOSE: The purpose of this study was to examine the reasons midlife women report for changing healthcare providers and to determine if there were any differences in reasons given for the change based on gender or ethnicity. DATA SOURCES: This was an analysis of data collected from a healthy community-based sample of midlife women as part of a longitudinal 5-year study of changes in health outcomes during transition to menopause. Women were queried about their experience in changing healthcare providers. CONCLUSIONS: Over 42% indicated that they had changed health providers because of dissatisfaction with care. The component accounting for the majority of the variance was related to communication issues. There were no significant differences across ethnic groups in decision to change providers or in reasons for their dissatisfaction with care. However, their reports of experiencing racism in the healthcare system were troubling. IMPLICATIONS FOR PRACTICE: The ability of the provider to communicate with women may have implications in women's choices in health care later in life.     

妊娠期糖尿病孕妇产后转归及保健情况调查

目的：了解妊娠期糖尿病（GDM）孕妇产后2年转归情况、保健现状和产后保健需求,为完善GDM孕妇产后保健、减少不良转归提供参考。方法：通过便利抽样对2年内在天津市某三级甲等医院产科分娩的妊娠期糖尿病孕妇产后转归现状及保健需求进行问卷调查。结果：13.6%GDM孕妇出现产后体质量滞留;56.5%GDM孕妇产后从未监测过血糖,4.2%GDM孕妇在产后不同时间出现了糖耐量受损,1例GDM孕妇产后2年内已确诊2型糖尿病;59.7%GDM孕妇在产后42天内进行了产后保健,34.6%GDM孕妇从未进行过产后保健,36.1%GDM孕妇没有得到任何相关专业人士的指导;GDM孕妇更希望由妇产科医生、助产士、社区保健医生通过孕妇学校课程、宣传手册、微信公众号等线上形式提供新生儿保健指导、膳食指导、运动指导、主要照护者健康教育等保健内容。结论：目前GDM孕妇对血糖变化重视程度较低,自我监测意识较差;产后保健不够系统、规范,未来应进一步加强筛查与管理,以减少GDM产后不良转归的发生。     

Unmet contraceptive needs among refugees: Crossroads Clinic experience

ObjectiveTo describe what women of reproductive age who received primary care at a refugee health clinic were using for contraception upon arrival to the clinic, and to quantify the unmet contraceptive needs within that population.DesignRetrospective chart review.SettingCrossroads Clinic in downtown Toronto, Ont.ParticipantsWomen of reproductive age (15 to 49 years) who first presented for care between December 1, 2011, and December 1, 2012. To be included, a woman had to have had 2 or more clinic visits or an annual health examination. Exclusion criteria for the contraception prevalence calculation were female sexual partner, menopause, hysterectomy, pregnancy, or trying to conceive.ResultsOverall, 52 women met the criteria for inclusion in the contraceptive prevalence calculation. Of these, 16 women (30.8%) did not use any form of contraception. Twelve women were pregnant at some point in the year and stated the pregnancy was unwanted or mistimed. An additional 14 women were not using contraception but had no intention of becoming pregnant within the next 2 years. There were no women with postpartum amenorrhea not using contraception and who had wanted to delay or prevent their previous pregnancy. In total, 97 women were married or in a union, or were sexually active. Unmet need was calculated as follows: (12 + 14 + 0)/97 = 26.8%.ConclusionThere was a high unmet contraceptive need in the refugee population in our study. All women of reproductive age should be screened for contraceptive need when first seeking medical care in Canada.     

Cross-cultural menopausal experience: comparison of Australian and Taiwanese women

A more universal approach to the understanding of menopause can offer health professionals a broader view of the phenomenon. The present study's objectives were to describe and explain the menopausal experiences of Asian and Occidental women, and to examine the relationship between social/cultural factors and women's menopausal symptoms. Questionnaires were used to investigate psychosocial and cultural factors and menopausal symptoms in 45-55 years old Taiwanese (n = 105) and Australian (n = 450) women. The variables investigated included: social demography; menopause status; attitudes toward menopause; mental health; vitality; social functioning; and menopausal symptoms. Significant differences were found between Taiwanese and Australian women in their attitude towards menopause, menopausal symptoms and vitality scores. No significant differences were seen in the areas of social functioning, mental health and menopause status. The results suggest that cultural factors may influence the experience of menopause for women. These findings may improve health professionals' understanding of cultural beliefs relating to menopause so that culturally appropriate care can be provided.     

Sexual dysfunction in young women with breast cancer

Objectives

The objective of this study was to determine the prevalence of sexual dysfunction in young women with breast cancer in the Netherlands, and to assess the relationship between sexual dysfunction, treatment methods and treatment-related complaints. Also, the interest among women with breast cancer in receiving care for sexual dysfunction was determined.

Methods

Data on sexual functioning were collected through an internet questionnaire. Respondents were included if they had been diagnosed with breast cancer within the past 6?years and were currently 45?years of age or younger. Results were compared with a representative sample of the general Dutch population

Results

Of the women who were still undergoing treatment, 64?% had a sexual dysfunction. In women who had completed treatment, this was 45?%. All assessed dysfunctions were more common among these young women with breast cancer in comparison with women in the Dutch population. Particularly, early menopause and hormone therapy caused long-term occurence of genital arousal disorder. Radical mastectomy caused long-term occurrence of female orgasmic disorder, and early menopause dyspareunia. Half of the women reported that the topic ??changes in sexual functioning?? had been brought up during treatment, mostly on the initiative of the health professional. Six out of 10 women with a sexual dysfunction who felt a need for care did not consult a health professional.

Conclusion

Sexual dysfunctions are highly prevalent among young women with breast cancer. This appears to improve after treatment has been completed, but women are far from recovered. The initiative to discuss sexuality should lie with the health professional. Including sexuality within treatment guidelines will prevent women with breast cancer from being deprived of care.     

Carrying on: the experience of premature menopause in women with early stage breast cancer

BACKGROUND: The survival benefit of adjuvant chemotherapy for breast cancer is established but the experience of organ system toxicity for women, specifically ovarian toxicity, is not fully known. OBJECTIVES: Th e purpose of the study was to develop asubstantive theory that would describe and explain women's responses to chemotherapy-induced premature menopause within the context of breast cancer. METHODS: Qualitative inquiry with Grounded Theory methodology was used to collect, code, and analyze the data. The purposive sample consisted of 27 women with early stage breast cancer who received adjuvant chemotherapy. The majority of women were married, well educated, and employed with a mean age of 41 years. Amenorrhea was reported by 24 women, a peri-menopausal pattern of bleeding was described by two women, and one woman had return of normal menses. Women participated in interviews ranging from 45 minutes to 2 hours and other data sources, such as informal discussions with oncology care providers, and lay women's writings about menopause and midlife women's health were used to increase interpretation of the data. RESULTS: Vulnerability was identified as the basic social psychological problem for women. Carrying On is the basic process that explains how women respond to vulnerability as they attempt to assimilate drug-induced premature menopause into their breast cancer experience. The stages of Carrying On (Being Focused, Facing Uncertainty, Becoming Menopausal, and Balancing) progressed from minimizing the early menopause experience to developing an awareness to balancing the dynamic relationship of menopause and cancer in their lives. CONCLUSIONS: This study described the complexity of the experience of chemotherapy-induced premature menopause in women with early stage breast cancer and identified gaps in knowledge about menopausal symptom distress and factors influencing symptom management and outcomes in this population. Future research is needed to evaluate interventions during and after adjuvant therapy to improve the quality of survival of women who experience ovarian toxicity related to early stage breast cancer treatment.