利维爱对绝经后子宫和卵巢萎缩的影响

绝经后妇女性激素水平不足,导致生殖器官逐渐萎缩,激素替代疗法(hormone replacement therapy,HRT)可延缓萎缩进程。利维爱(livial)具有弱雌、孕、雄3种性激素的生理作用,为探讨该药低剂量对绝经后子宫和卵巢萎缩进程的影响,我们用阴道彩超测量42例绝经后妇女(对照组)和47例绝经后服用利维爱的妇女(利维爱组)的子宫体积、内膜厚度及卵巢面积,现报告如下。1 资料与方法11 临床资料 利维爱组：1998年10月至1999年1月,选择47例服用利维爱13～15个月的健康妇女。入选条件为自然绝经,无绝经后阴道出血,未放置宫内节育器,乳腺及妇科…     

阴道超声及子宫腔细胞学联合检查绝经后妇女子宫内膜病变

目的 评估阴道超声及宫腔细胞学联合检查绝经后妇女子宫内膜病变的价值。方法 应用阴道超声测量143例绝经后子宫出血患者的子宫内膜厚度,并于当日或次日行宫腔细胞学检查及分段诊断性刮宫（诊刮）术,将内膜测量及宫腔细胞学检查结果与诊刮组织病理结果进行比较。结果 阴道超声检查施行率为100．0％,以5mm为临界值诊断绝经后内膜癌及癌前病变的敏感性为100．0％,假阳性率为56．9％;宫腔细胞学检查的施行率为97．9％,取材满意率为73．6％,特异性为96．3％,假阴性率为2．5％。两者联合应用后的假阳性率为43．2％（P＜0．01）,无一例内膜部中前病变漏诊。结论 阴道超声及宫腔细胞学联合检查,是一种较好的筛查内膜癌及癌前病变的方法,可减少诊刮。     

绝经后子宫内膜增厚的阴道超声诊断进展

随着我国女性健康意识的提高,绝经后子宫内膜增厚越来越受到重视。子宫内膜癌是女性生殖器官常见恶性肿瘤之一,在绝经后妇女中常表现为子宫内膜增厚和绝经后阴道出血。经阴道超声测量绝经后妇女的子宫内膜厚度是常用的子宫内膜癌早期筛查手段。在医学上,对于无阴道出血症状的绝经期女性,子宫内膜厚度与子宫内膜癌相关性尚不明确。无症状绝经期子宫内膜增厚的患者要根据是否存在高危因素个体化评估患子宫内膜癌的风险。适当的诊断不仅对子宫内膜病变的早发现早治疗有重要意义,也可避免造成绝经女性的过度恐慌和减少不必要的有创诊疗,在临床中有现实意义。综述绝经后子宫内膜增厚疾病的特点以及经阴道超声检查的评估价值。     

绝经后阴道出血患者诊断性刮宫前B超检测子宫内膜的价值

目的：评估绝经后阴道出血患者应用Ｂ超检测子宫内膜，以减少不必要的诊断性刮宫术（诊刮术）的价值。方法：对１９２例绝经后阴道出血患者，于诊刮术前行Ｂ超检查，测量子宫大小及子宫内膜厚度，然后进行分段诊刮术，标本送病理检查。结果：７７例内膜厚度≤４ｍｍ者中，７４例（９６．１％）子宫内膜属生理性改变，３例为内膜癌；１１５例子宫内膜厚度≥５ｍｍ者中，９２例（８０．０％）子宫内膜属病理性改变，其中５９例（５１．３％）为内膜癌。结论：高分辨阴道Ｂ超检测，可作为绝经后出血患者进行诊刮术前的一种筛选手段，当超声检测内膜厚度≤４ｍｍ时，可考虑避免诊刮术。     

绝经后子宫内膜增厚患者临床总结分析

目的：探讨对绝经后无症状B超子宫内膜增厚的处理原则。方法：对同期48例无症状绝经后B超子宫内膜增厚及62例绝经后出血B超子宫内膜增厚者进行临床与病理分析与比较。结果：无症状绝经后子宫内膜增厚的48例中,正常绝经后改变32例（66．7％）,良性病变16例（33．3％）,无1例恶性及癌前病变;合并出血的62例中,正常绝经后改变28全(45．2％）,良性病变25例（40．3％）,恶性9例（14．5％）。结论：绝经后妇女仅B超子宫内膜增厚,不伴出血等症状时,可考虑免除分段诊刮术。     

年龄绝经年限和绝经后雌二醇水平对心血管功能的影响

本文分析年龄、绝经年限和绝经后血清雌二醇水平与妇女心血管功能的关系。结果发现；年龄与心率、二尖瓣口舒张早期流速和Ｅ／Ａ比值呈负相关，与血压、二尖瓣口舒张晚期流速呈正相关，与左心室舒张末期容积、收缩末期容积、左心室每搏输出量、每分输出量、射血分数、外周血管总阻力、二尖瓣口最大流速和平均流速无关。绝经年限与血压呈正相关，与其它指标无关。绝经后血清雌二醇水平与收缩末期容积呈负相关，与二尖瓣口最大流速、二     

绝经后卵巢子宫内膜异位囊肿16例临床分析

目的:分析总结16例绝经后卵巢子宫内膜异位囊肿的诊治。方法:回顾分析本院15年间16例绝经后卵巢子宫内膜异位囊肿的病例资料。结果:绝经后卵巢子宫内膜异位囊肿占同期病例的2.85%。患者术前多无明显症状,9例术中发现卵巢正常甚至萎缩但病理证实为子宫内膜异位,其中5例盆腔包块为对侧卵巢巨大囊肿。6例检测血清CA125值均在正常范围内。治疗均采用手术治疗。结论:绝经后子宫内膜异位症是一不容忽视的疾病,发病率有增加趋势,其临床表现不典型,适宜采用手术治疗。     

绝经前子宫切除卵巢缺失现象与冠心病的危险

本文通过对照研究,观察了８２例患者术后出现的更年期症状及血脂的改变。旨在探讨绝经前妇女子宫切除术后发生冠心病的危险及雌激素治疗的必要性。１资料与方法１．１研究对象选择１９９２年１月至１９９５年１２月因妇科良性疾病在我院施行子宫切除、保留一侧或两侧卵巢...     

普罗雌烯治疗绝经后萎缩性阴道炎的安全性

.8±2.4)分,治疗后12周为(12.0±2.4)分,各指标治疗前后比较,差异均有统计学意义(P<0.01).(3)不良事件:主要包括阴道出血6例、乳房结节3例、宫颈息肉1例,与用药关系不明确.结论 普罗雌烯可以安全、可靠地治疗妇女绝经后萎缩性阴道炎.     

普罗雌烯治疗绝经后萎缩性阴道炎的安全性

.8±2.4)分,治疗后12周为(12.0±2.4)分,各指标治疗前后比较,差异均有统计学意义(P<0.01).(3)不良事件:主要包括阴道出血6例、乳房结节3例、宫颈息肉1例,与用药关系不明确.结论 普罗雌烯可以安全、可靠地治疗妇女绝经后萎缩性阴道炎.     

Adnexal Torsion in Postmenopausal Women: Clinical Presentation and Risk of Ovarian Malignancy

Study ObjectiveTo investigate the clinical presentation, operative outcome, and incidence of malignancy in postmenopausal women who were diagnosed with adnexal torsion.DesignRetrospective cohort study (Canadian Task Force classification II-2).SettingTertiary university-affiliated hospital.PatientsPostmenopausal women diagnosed with adnexal torsion between 1995 and 2014 (study group) were reviewed and compared with 220 premenopausal patients diagnosed with adnexal torsion during the same time period.InterventionDemographic data, clinical signs and symptoms, and intra- and postoperative characteristics were compared between the 2 groups.Measurements and Main ResultsDuring the study period 44 postmenopausal women were diagnosed with adnexal torsion. Continuous dull pain was the most common presenting symptom in the postmenopausal group (57%), whereas acute-onset sharp pain was the predominant symptom in the premenopausal group (86%). The time interval from admission to surgery was significantly longer in the postmenopausal group (24 vs 6 hours, p < .001). Laparoscopic surgery was performed in 84.5% of the cases in the premenopausal group, whereas it was carried out in only 50% of cases in the postmenopausal group (p < .001). Four women in the postmenopausal group were diagnosed with malignancy, whereas only 1 case of malignancy was found in the premenopausal group (9% vs .4%, respectively; p = .003).ConclusionsAdnexal torsion in postmenopausal women is an uncommon event with a unique presentation. Because ovarian malignancy is not an uncommon finding in this group of patients, preparation for more extensive surgery should be contemplated.     

Norplant皮下埋植剂使用者生殖激素水平及卵泡发育特征研究

本研究对69例皮下埋植避孕者根据阴道出血类型不同分为月经规则组、月经紊乱组、闭经组，并对其分别进行生殖激素测定，监测卵泡生长发育及宫颈评分。结果表明：埋植期间月经规则组除黄体期P水平较正常对照组降低外（P＜0．01），其它生殖激素均在正常范围内波动；月经紊乱组及闭经组P和E2低于正常对照组黄体期，相当于正常对照组卵泡期低水平。B超监测卵泡表现三种类型：1．卵泡逐渐成熟并排卵；2．卵泡逐渐长大并在整个周期内持续存在；3.卵泡未发育。研究结果提示黄体功能不足是皮下埋植避孕的作用机理之一，并说明皮下埋植者月经失调和生殖激素及卵泡发育特征之间的变化与LNG的抑制有关，研究结果进一步证实皮下埋植剂具有高效、安全的优点，对扩大推广应用皮下埋植避孕法起到指导作用。     

围绝经期妇女应用7-甲基异炔诺酮进行激素替代治疗顺应性调查

目的 探讨围绝经期妇女应用７－甲基异炔诺酮进行激素替代治疗的顺应性。方法 调查１３４例围绝经期处方７－甲基异炔诺酮者的用药状况,包括医嘱遵从性、中断比例及其原因以及体得改变、阴道出知、胃肠道反应等副作用。１３４例妇女平均５５．２岁,绝经６．７年,９７．０％因围绝经期症状就诊。结果 ９０．３％接受处方即开始治疗,治疗时间≤１年者５３例,治疗〉１年,≤３年者５５例,〉３年、≤５年者１０例,,５年者４全     

Use of Stimulated Serum Estradiol Measurements for the Prediction of Hyperresponse to Ovarian Stimulation in in Vitro Fertilization (IVF)

PURPOSE: In ovarian stimulation an exaggerated ovarian response is often seen and is related to medical complications, such as ovarian hyperstimulation syndrome (OHSS), and increased patient discomfort. If it were possible to identify hyperresponders at an early stage of the stimulation phase, adaptation of the stimulation protocol would become feasible to minimize potential complications. Therefore, we studied the usefulness of measuring stimulated serum estradiol (E2) levels in predicting ovarian hyperresponse. METHODS: A total of 109 patients undergoing their first IVF treatment cycle using a long protocol with GnRH agonist was prospectively included. The E2 level was evaluated on day 3 and 5 of the stimulation phase. Two outcome measures were defined. The first was ovarian hyperresponse (collection of > or = 15 oocytes at retrieval and/or peak E2 > 10000 pmol/L, or cancellation due to > or = 30 follicles growing and/or peak E2 > 15000 pmol/L, or OHSS developed). The second outcome measure comprised a subgroup representing the more severe hyperresponders. named extreme-response (cancellation or OHSS developed). RESULTS: The data of 108 patients were analyzed. The predictive accuracy of E2 measured on stimulation day 3 towards ovarian hyperresponse was clearly lower than that of E2 measured on stimulation day 5 (area under the receiver operating characteristic curve (ROCAUC) 0.75 and 0.81, respectively). For extreme-response the predictive accuracy of E2 measured on stimulation day 3 or 5 was comparable (ROCAUC 0.81 and 0.82, respectively). For both outcome measures the stimulated E2 tests yielded only acceptable specificity with moderate sensitivity at higher cutoff levels. Prediction of extreme-response seemed slightly more effective due to a lower error rate. CONCLUSIONS: There is a significant predictive association between E2 levels measured on stimulation day 3 and 5 and both ovarian hyperresponse and extreme-response in IVF. However, the clinical value of stimulated E2 levels for the prediction of hyperresponse is low because of the modest sensitivity and the high false positive rate. For the prediction of extreme-response the clinical value of stimulated E2 levels is moderate.     

使用国产长效避孕皮下埋植剂妇女第一年血清中左旋18甲基炔诺酮、雌二醇及孕酮水平

10例妇女在月经周期开始的7天内,皮下埋植国产长效避孕埋植剂。埋植后第一年内每周定时抽血一次,用RIA 测定血清中左旋18甲基炔诺酮(LNG),雌二醇(E_2)和孕酮(P)的浓度。血清中LNG 浓度在埋植后开始两周内下降较快,随后两周较缓慢地下降,在埋植后第一年内LNG 浓度几乎呈平稳状态,但显示有明显的个体差异。血清中E_2峰值频繁出现,但随后未见典型的黄体期P 值升高,在高的E_2峰值突然下降时,常伴随阴道流血出现。干扰月经是此埋植剂的主要副反应。     

性激素替代治疗对手术绝经患者血管内皮功能的影响

目的 :探讨性激素替代治疗对手术绝经患者血管内皮细胞的保护作用。方法 :5 1例手术绝经患者分为性激素替代治疗组和对照组 ,治疗组给予雌激素加孕激素联合口服 9月。两组在实验前后测定血浆总胆固醇 (Tch)、甘油三酯(TG)、高密度脂蛋白 (HDL)、低密度脂蛋白 (L DL) ,一氧化氮 (NO) ,血管性假血友病因子 (v WF) ,FSH、E2 。超声多普勒进行肱动脉充血试验。结果 :治疗组用药后 ,与对照组相比 ,Tch、L DL、v WF、FSH明显降低 ,HDL、E2 、NO明显升高 ,肱动脉内径舒张百分比明显增加。结论 :性激素替代治疗可以改善手术绝经患者血管内皮细胞功能     

炔雌醇对绝经后妇女糖代谢的影响

目的：探讨合成雌激素炔雌醇对绝经后妇女糖代谢的影响。方法：将绝经后妇女１９例随机分为两组，口服炔雌醇（ＥＥ）０．０２５ｍｇ９例为Ａ组，口服ＥＥ０．０５ｍｇ１０例为Ｂ组，共服药３个月。服药前后均进行口服葡萄糖耐量试验和多样本的静脉葡萄糖耐量试验，同时测定血糖、胰岛素和计算曲线下面积（ＡＵＣ）以及胰岛素敏感指数（ＳＩ）。结果：两组均可有效降低空腹血糖、胰岛素水平，明显减少胰岛素ＡＵＣ，提高胰岛素ＳＩ。Ａ组血糖ＡＵＣ无多大变化，Ｂ组血糖ＡＵＣ明显增加。结论：炔雌醇可有效降低绝经后妇女的空腹血糖、胰岛素水平，减弱胰岛素抵抗。０．０５ｍｇＥＥ可损害糖耐量。     

重复性早期流产患者雌、孕激素及其受体研究

本文采用定量的生化法测定重复性早期流产患者子宫内膜组织中雌、孕激素受体（ＥＲ、ＰＲ）含量．并结合血清激素水平和子宫内膜病理学变化，探讨了ＥＲ、ＰＲ含量，子宫内膜发育和血清激素水平三者之间的关系。我们发现，重复性早期流产患者黄体期的雌激素水平明显低于对照组，而增生或子宫内膜ＥＲ和分泌期ＰＲ含量明显低于对照组。重复性早期流产患者蜕膜组织中的ＰＲ也明显减低，ＰＲ的分布也异常。由于子宫内膜的ＥＲ、ＰＲ减少所致的重复性流产在本组资料中占４０％。本研究进一步明确了重复性流产的病因，可用以指导临床治疗。     

The Marketing of Estrogens for Menopausal and Postmenopausal Women

Menopausal and postmenopausal women are a targeted consumer group in the promotion of hormone drugs. The marketing of these plutrmaceutical products aims directly at prescribing medical professionals and indirectly at women. The promotion seems intended to creating a collective consciousness that women over 40 need medical and pharmacological treatment.