老年妇女激素替代治疗的应用价值

世界人口老龄化的问题已经成为社会关注的焦点之一,老年人口数量的持续增长,随之而来的是进入绝经期妇女数量的逐年增加,预计到2030年中国将有超过2.7亿的妇女进入绝经期。研究发现全身很多部位存在雌激素受体,如:心肌、冠状动脉、颈动脉、主动脉、骨骼、皮肤、肾脏、肝脏、泌尿道等,同时雌激素也参与机体的糖类、脂类、蛋白质、骨的代谢。进入绝经期,卵巢内分泌功能减退,体内雌激素水平降低,患者会不同程度地出现全身性变化:血管舒缩功能障碍、心血管疾病、精神神经症状、泌尿生殖系统症状、骨质疏松等。因此越来越多的妇女采用激素替代治…     

老年妇女相关疾病的诊治——老年妇女生殖器肿瘤的特点与治疗

随着社会人口老龄化，老年妇女患生殖系统肿瘤机会增加。据统计，女性恶性肿瘤患者58％为65岁以上的老年人。由于就诊时多为晚期，且常伴有其他合并症，使老年恶性肿瘤患者预后差，其生存率显著低于年轻患者。[第一段]     

女性生殖系统炎症病原体的变迁

１９８８年曾在《实用妇科与产科杂志》即《中国实用妇科与产科杂志》的前身发表过妇产科感染性疾病的“专题讨论”，题目为“生殖器炎症致病因子的变迁”，与此文的命题基本相同，但１０年的变化，对女性生殖器官炎症病原体的检测技术有了很大进展，尤其对厌氧菌、病毒及...     

生殖系统炎症引起的盆腔痛

盆腔痛是妇科常见的症状之一,生殖系统炎症是引起盆腔疼痛最主要的原因。按炎症发生的部位,大致可分为上、下生殖道炎症。前者即感染侵袭内生殖器,发生于子宫及其周围结缔组织、输卵管、卵巢及盆腔腹膜的炎症,称为盆腔炎;盆腔炎按其起病急缓、病程长短又有急、慢性之分。后者即炎症发生于下生殖道如外阴炎、阴道炎及宫颈炎,一般以外阴瘙痒、白带增多为主。因此,生殖系统炎症引起的盆腔痛主要指由急、慢性盆腔炎所致的急、慢性下腹部及腰骶部疼痛。而慢性盆腔痛是指病程超过６个月以上的非周期性盆腔疼痛。１　生殖系统炎症引起盆腔痛…     

老年妇女骨质疏松症的病理生理和诊治原则

本文阐述了绝经后骨质疏松症的病因学、病理生理过程以及临床诊断和治疗原则。绝经后妇女体内雌激素缺乏引起骨代谢活动异常,骨吸收活动大于骨生成活动,骨质丢失。测定血清碱性磷酸酶、空腹尿钙及空腹尿羟脯氨酸可以反映骨代谢活动,早期预测骨质丢失情况。补充小剂量雌激素加其它辅助治疗能阻止骨质丢失,预防骨质疏松症的发生。     

老年妇女的性问题

绝经显然会对性健康有负面影响,但是由于传统观念的束缚和文化上的偏见,致使这一问题难以得到应有的重视。女性性功能障碍在绝经期会显著增加,引起老年妇女身体不适、情感困扰和社会生活适应不良,从而导致伴侣之间关系恶化,女性自尊丧失和生活质量下降。而且由于绝经期妇女泌尿生殖道的萎缩、阴道干燥和性交困难是因为雌激素的降低而引起,所以老年妇女性功能障碍通常呈进行性发展,是不可逆的。与此同时,老年妇女的性欲和获得性高潮能力却仍然保持,而且规律的性生活有助于健康,所以对老年妇女的性问题提供早期干预应该成为所有临床医生的目标…     

子宫广泛切除术在老年妇女与年轻妇女的比较

为探讨老年妇女行子宫广泛切除术的可行性,回顾性分析了子宫广泛性切除对65岁以上妇女及50岁以下的死亡率与并发症。65岁以上行广泛性子宫切除术者62例,平均70岁,每例配对2例50岁以下进行同样手术的妇女作为比较,50岁以下组共124例,平均36岁。所有病例术前均被诊断为宫颈癌FIGO分期Ⅰ_b期,手术范围为子宫广泛切除及盆腔淋巴结清扫术,所有手术均由同一妇瘤专家操作,麻醉选用全麻气管内插管。统计学方法采用t检验。     

老年妇女生殖器肿瘤的特点与治疗

随着社会人口老龄化,老年妇女患生殖系统肿瘤机会增加。据统计,女性恶性肿瘤患者58%为65岁以上的老年人。由于就诊时多为晚期,且常伴有其他合并症,使老年恶性肿瘤患者预后差,其生存率显著低于年轻患者[1]。1女性生殖系统良性肿瘤常见以下几种。(1)子宫肌瘤:老年妇女发现子宫肌瘤一般不需治疗,但如发生变性、感染、扭转或肌瘤生长迅速不能排除恶变者应手术治疗,并行快速病理检查。(2)卵巢泡膜细胞瘤:65%的患者为绝经后妇女。表现为附件区有实质性肿物,如雌激素水平增高则伴有阴道不规则流血。术前应行诊断性刮宫明确有无子宫内膜癌,无子宫内…     

老年妇女盆腔器官脱垂的诊断和治疗

盆腔器官膨出又称为盆腔器官脱垂(pelvic organ pro-lapse,POP),是盆底障碍性疾病(pelvic floor dysfunction,PFD)的主要病种,其诊治是新兴的医学亚学科妇科泌尿学与盆底重建外科学的重要内容。临床上主要包括阴道前壁(膀胱、尿道、阴道旁)、阴道顶端(子宫、穹窿)、阴道后壁(直肠、小肠)膨出等多种形式。60%以上的POP发生于绝经后妇女,发病率随年龄增长而升高,对广大老年妇女的生活质量造成了很大威胁,是我们妇科工作者应该再学习、挑战的新领域。1诊断1.1病史与症状POP是一种慢性疾病,最常见的症状是阴道口脱出块物,伴或不伴腰部疼痛…     

Predicting suitable timing for artificial reproductive technology treatment in aged infertile women

It has been widely accepted that the age of women plays a fundamental role in fecundity, and age-related fertility decline has one of the most significant and detrimental effects on the success rate of infertility treatment. Therefore, treatment cycles of non-in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) treatment for infertile women of advanced aged have been limited due to their lack of efficacy, and they are often optimized, compared to IVF/ICSI treatment. Recent trends in infertility treatment apparently indicate that IVF/ICSI treatment, including egg donation, is frequently offered to aged women for first-line management, despite its heavy burden, but hasty IVF/ICSI treatment should be avoided, considering its socioeconomic problems. It is important to distinguish women who could conceive by non-IVF/ICSI treatment, although the optimization of non-IVF/ICSI treatment protocols remains poorly understood. This review focuses on extracting aged patients who have higher chance of conceiving with non-IVF/ICSI treatment and providing necessary and sufficient infertility treatment. After initial evaluation for fertility, including tubal factor, male factor, the presence of endometriosis and/or adenomyosis, and ovarian reserve, the outcomes of fertility treatment can be predicted to some extent in aged infertile women.     

The diagnosis and treatment of syphilis in women

Syphilis is a sexually transmitted diseage with a known cause and an effective cure. Unfortunately, during the past decade syphilis has resurfaced as a major public health problem. This resurgence of cases has paralleled the rise of crack cocaine abuse and the attendant risky sexual behaviors associated with drug-seeking. Syphilis, as a leading cause of genital ulcer disease, enhances human immunodeficiency virus transmissibility. Syphilis has returned to damage our most vulnerable patients, the developing fetus and newborn. The eradication of this disease awaits the solution of the stubborn social problems of ignorance, poverty, drug abuse, and prostitution.     

Assisted reproductive techniques in women aged 38 years or more

OBJECTIVE: More and more young women are delaying childbearing until the fourth decade of life: thus, Assisted Reproductive Techniques centres receive more and more requests from ageing women. The aim of the study is to analyse the purpose of these requests, the biological and clinical features of these patients and the results in our infertility centre. PATIENTS AND METHODS: A retrospective study was carried out at the CHU of Saint-Etienne from 01.01.01 to 31.12.04. We analysed the social, clinical and biological features of 84 couples when the woman's age was equal or superior to 38 years, representing 218 cycles. A questionnaire was used to collect social data. RESULTS: Several factors can explain the increasing number of ageing women consulting for infertility: extend university time and professional career, professional stability, contraception and late meeting of the partner, false reassuring information concerning progress in ART, second child desire after a late first pregnancy, but also second marital unions and child desire in the redefined couple. In our study, above 40 years old, the pregnancy (19.4 versus 10.5%) and delivery rates (16.7 versus 5.8%) clearly decreased in IUI. Thus, most of the clinicians propose, in first choice, an IVF cycle to a 40 year-old woman. The ultrasound measurement of antral follicle count can accurately evaluate the prognosis in terms of pregnancy (P<0.01) and delivery rate (P=0.03). For patients with unfavourable prognosis, oocyte donation, embryo donation, or adoption can be considered. DISCUSSION AND CONCLUSION: ART cannot compensate for the natural decrease in pregnancy rates and the increase in early miscarriages in ageing women. Therefore, it is essential to inform young women of the negative effects of age on their potential fertility.     

老年妇女骨质疏松症的防治

骨质疏松症是一种以骨量低下,骨微结构破坏,导致骨脆性增加,易发生骨折为特征的全身性骨病(世界卫生组织WHO)[1]。2001年美国国立卫生院提出骨质疏松症是以骨强度下降、骨折风险性增加为特征的骨骼系统疾病,骨强度反映了骨骼的两个主要方面,即骨矿密度和骨质量。骨质疏松症分为     

The role of preimplantation genetic diagnosis in women of advanced reproductive age

PURPOSE OF REVIEW: More than half of in-vitro fertilization patients are of advanced reproductive age and at risk for producing offspring with age-related aneuploidies, which contribute significantly to spontaneous abortions and implantation failure. RECENT FINDINGS: Fluorescent in-situ hybridization analysis of thousands of oocytes and preimplantation embryos obtained from these patients revealed an aneuploidy rate of over 50%, suggesting practical relevance of preimplantation genetic diagnosis for aneuploidy to women of advanced reproductive age. The overall preimplantation genetic diagnosis experience for age-related aneuploidies comprising more than 3000 clinical cycles indicates the positive impact of preselection and transfer of aneuploidy-free embryos on implantation and pregnancy rates and outcome of pregnancies in women of advanced reproductive age. SUMMARY: These patients will need to be informed about preimplantation genetic diagnosis availability, in order use this option to improve their relatively poor chances of becoming pregnant, especially with the current tendency of limiting the number of transferred embryos to avoid complications due to multiple pregnancies. This may contribute significantly to improving standards of assisted reproduction technology, substituting the current practice of selection of embryos for transfer using morphological parameters with the preselection of aneuploidy-free embryos with a higher potential to result in pregnancy.     

The impact of cancer treatment on reproductive health in young women

The diagnosis of cancer can precipitate a re-evaluation of life at all ages. In children, adolescents and young adults, a cancer diagnosis and its treatment poses specific challenges that can affect all aspects of reproductive health resulting in considerable physical, psychological and psychosexual burden. Improved survival means that this cohort of patients is expanding and with an improving life span, the resulting morbidity is also extended. The demands of this group of patients are often not fully integrated in the operational functions of the health service with considerable variation in care. This review discusses the common reproductive morbidities amongst survivors of childhood, adolescent and young adult cancer whilst planning, delivering and following cancer treatment. This includes the current issues on the assessment of ovarian reserve and preservation of fertility.     

The influence of chlamydial infection on the reproductive function in women with cervicitis

The objectives of the present study were to determine the reproductive capacity and the most likely target groups for chlamydial infection in women with clinically manifested cervicitis. 2 To establish the impact of chlamydial infection on the reproductive function of the women with cervicitis. Chlamydial infection was diagnosed by direct immunofluorescence (DIF) in cervical smears. 553 sexually active women in reproductive age with clinically manifested cervicitis were examined. According to their chief complaint the patients were classified as: 1. Women with infertility 2. Oral contraceptive users 3. IUD users 4. Women with vaginal discharge and clinically manifested cervicitis 5. Pregnant women with signs of cervicitis. 6. Women with accompanying sexually transmitted infections. The results show that the predominant part of the women with chlamydial infection are in the age group 20-29 years (32,7% - 181/553). In this group chlamydial infection was most prevalent in oral contraception pill users /64/181 - 35,4%/ and those with vaginal discharge and clinically manifested cervicitis. 66/181 - 36,5%. Chlamydial infection as a cause of cervicitis was found in 14,6% of the pregnant women with cervicitis. Most of the positive for Chlamydia trachomatis patients had not given birth to a child and have not realized their reproductive potential.