上海市浦东新区妇女绝经年龄及行经年限调查与影响因素分析

目的 调查上海市浦东新区妇女的自然绝经年龄、行经年限,观察初潮年龄与生育次数对自然绝经年龄和行经年限的影响.方法 2007年1月至2008年7月,以参加上海市浦东新区宫颈癌筛查的、年龄≥56岁的15 083例自然绝经妇女为研究对象,采用一对一的问卷方式,调查妇女的初潮年龄、生育次数、自然绝经年龄、行径年限等情况.将研究对象按年龄分为56～60、61～65、66～70和>70岁4个组.采用方差分析方法,比较各年龄组绝经年龄和行经年限的差异;采用多因素回归方法分析年龄组别、初潮年龄、生育次数与绝经年龄和行经年限的关系.结果 (1)自然绝经年龄:最小为29岁,最大为61岁,平均为(50.6±3.7)岁.56～60、61～65、66～70和>70岁4个年龄组的平均绝经年龄分别为(50.9±3.4)、(50.7±3.7)、(50.0±4.1)、(49.6±4.0)岁,随着年龄组的年轻化,平均绝经年龄呈逐渐增加趋势,最小年龄组与最大年龄组比较,平均绝经年龄相差1.36岁.(2)行经年限:最长为48年,最短为12年,平均(34.3±4.1)年.56～60、61～65、66～70和>70岁组的平均行经年限分别为(34.6±3.8)、(34.3±4.1)、(33.9±4.6)、(33.2±4.5)年;随着年龄组的年轻化,平均行经年限呈逐渐延长趋势,最大年龄组与最小年龄组比较,相差1.41年.(3)初潮年龄对绝经年龄和行经年限的影响:相关分析显示,初潮年龄与绝经年龄无明显相关性(r=0.02),初潮年龄与行经年限呈负相关(r=-0.43).(4)生育次数对绝经年龄和行经年限的影响:生育1～2次妇女的绝经年龄明显高于生育0次和≥3次的妇女,差异有统计学意义(P<0.05);但生育1次与2次的妇女及生育0次与≥3次的妇女绝经年龄比较,差异均无统计学意义(P>0.05).生育1次的妇女行经年限明显长于生育1次以上的妇女,生育2次的妇女行经年限明显长于生育0次和≥3次的妇女,差异也有统计学意义(P<0.05);生育0次与≥3次者行经年限比较,差异无统计学意义(P>0.05).(5)行经年限的多因素回归分析:初潮年龄与行经年限呈明显的负相关(r=-0.97,P<0.001);不同年龄组别的行经年限相关分析显示,61～65、66～70和>70岁组与56～60岁组比较,差异均有统计学意义(r=-0.18,P=0.020、r=-0.78,P<0.001和r=-1.23,P<0.001);生育1～2次者的行经年限明显长于生育0次和≥3次者.(6)绝经年龄的多因素回归分析:初潮年龄与绝经年龄无相关性(r=0.02);但不同年龄组别的绝经年龄的多因素分析显示,61-65、66～70和>70岁组妇女的绝经年龄与56～60岁组比较,差异也有统计学意义(r=-0.18,P=0.020、r=-0.78,P<0.001、r=-1.23,P<0.001).生育1～2次的妇女绝经年龄明显高于生育0次和≥3次者,但生育1次与2次,0次与≥3次者间比较,差异均无统计学意义.结论 (1)上海市浦东新区妇女的绝经年龄逐渐增加,行经年限呈延长趋势;(2)初潮年龄和生育次数是影响绝经年龄和行经年限的重要因素;(3)随着初潮年龄的年轻化,行经年限逐渐延长;(4)生育1～2次能明显推迟绝经年龄并且延长行经年限,而多次生育(≥3次)对绝经年龄和行经年限均无明显影响.     

山东省泰安地区妇女月经初潮年龄百年变化的万例调查

目的：了解泰安妇女百年月经初潮年龄变化,分析变化的原因。方法：随机抽样面对面调查询问登记,分析求出平均初潮年龄。结果分析：共调查1万例,按20岁为一个年龄组,发现80岁以上年龄组初潮年龄为17．1岁、20岁以上年龄组为13．2岁、20岁以下年龄组为12．9岁。后两组与80岁以上年龄组有显著差异,呈现出年龄变小的趋势。分析原因可能与建国、改革开放、生活及文明程度提高有关。结论．山东泰安地区妇女初潮年龄有逐渐变小的趋势,现平均已达12．9岁,与发达国家水平相近。     

初潮及绝经年龄等因素与绝经后骨质疏松症发病的关系

目的探讨初潮年龄和绝经年龄、生育次数及哺乳时间与绝经后骨质疏松症发病的关系。方法1999年5月至2003年4月,对已绝经的1472例妇女进行骨密度测定,并对不同月经初潮年龄、绝经年龄、生育次数及哺乳时间妇女的骨质疏松症发生率及骨密度进行分析比较。骨质疏松症的诊断标准为骨密度值低于或等于正常年轻妇女平均骨密度峰值减去2.5个标准差。结果1472例中,共发生骨质疏松症861例,发生率为58.5%。其中绝经年限为1~10年、初潮年龄≥17岁者336例,发生骨质疏松症119例(35.4%);初潮年龄≤13岁者276例,发生骨质疏松症75例(27.2%)。1472例妇女中,初潮年龄11~13岁者,腰椎骨密度为(0.83±0.16)g/cm2;14~16岁者为(0.82±0.16)g/cm2;17~19岁者为(0.80±0.14)g/cm2;初潮年龄11~13岁者与17~19岁者比较,差异有统计学意义(P<0.05)。1472例妇女中,年龄为55~65岁、绝经年龄≤48岁者156例,发生骨质疏松症98例(62.8%);绝经年龄≥54岁者80例,发生骨质疏松症33例(41.3%),两者比较,差异有统计学意义(P<0.01)。1472例妇女中,生育次数≥4次者225例,腰椎、大转子及W ard三角区骨密度分别为(0.76±0.16)、(0.49±0.10)及(0.38±0.19)g/cm2;生育次数≤1次者475例,分别为(0.85±0.15)、(0.57±0.10)及(0.52±0.11)g/cm2,两者各部位骨密度比较,差异均有统计学意义(P<0.05)。1472例妇女中,哺乳时间≥36个月者249例,腰椎、W ard三角区骨密度分别为(0.76±0.16)及(0.40±0.10)g/m2;哺乳时间≤6个月者418例分别为(0.83±0.17)及(0.48±0.12)g/m2,两者各部位骨密度比较,差异均有统计学意义(P<0.05)。结论月经初潮时间晚及绝经时间早的妇女,骨质疏松症的发生率高;生育次数多,哺乳时间长的妇女的骨密度低于生育次数少、哺乳时间短的妇女。     

2008年辽宁省汉族育龄妇女月经现况的调查

目的 了解辽宁省汉族育龄妇女的月经现况.方法 2008年4至12月,采取流行病学整群抽样的方法,抽取辽宁省沈阳市、营口市、本溪县及彰武县共1611例年龄19～45岁的健康育龄妇女为研究对象,通过现场问卷形式进行调查,调查内容包括:月经初潮年龄、月经规律性、月经周期及痛经情况.结果 在接受调查的1611例育龄妇女中,平均月经初潮年龄为14.4岁,其中城市女性的初潮年龄为(14.2±1.5)岁,县乡女性的初潮年龄为(14.6±1.5)岁,城乡女性初潮年龄比较,差异有统计学意义(t=6.58,P<0.01).对被调查者年龄和初潮时间进行回归分析,可以得出其直线回归方程为:Y=0.074X+11.855,即初潮年龄平均每年提前0.074岁.月经周期正常(21～35 d)且规律者占86.34%(1391/1611),月经稀发(周期>35 d)者占11.05%(178/1611),月经频发(周期<21 d)者占2.61%(42/1611),其中初潮后周期即规律者占65.67%(1058/1611),初潮后两年内规律者占94.97%(1530/1611).痛经者占42.09%(678/1611),其中重度痛经92例(13.6%,92/678),中度痛经147例(21.7%,147/678),轻度痛经439例(64.7%,439/678).结论 辽宁省汉族育龄妇女月经初潮年龄呈逐年降低趋势,城市较县乡女性初潮年龄更低;初潮后95%的育龄妇女在两年内月经逐渐规律.     

年龄、绝经年限与骨代谢指标相关性研究

目的 :探讨妇女不同年龄段、绝经年限、初潮年龄的骨代谢指标的变化。方法 :随机选择年龄 2 0～ 75岁的妇女 2 10例 ,测定血清钙 (Ca)、磷 (P)、碱性磷酸酶 (ALP)、性激素 ,尿钙 /肌酐 (Ca/Cr)值。结果 :骨代谢指标与年龄、绝经年限、初潮年龄均呈正相关 ,40岁以上的妇女的骨代谢指标明显高于 40岁以下的妇女 (P <0 0 5 ) ;初潮年龄在 18岁以上的妇女骨代谢指标明显增高 (P <0 0 5 ) ;绝经后E2 水平较绝经前降低 (P <0 0 5 ) ,但不同绝经年限间差异无显著性 (P >0 0 5 ) ;绝经后骨代谢指标较绝经前增高 (P <0 0 5 ) ,尤其在绝经后 10年以上增高更明显。结论 :妇女在围绝经早期出现骨转换率增高 ,可能与雌激素下降有关 ,因此对围绝经早期妇女 ,尤其是初潮年龄晚者 ,应进行骨代谢指标测定 ,筛查并及时预防骨质疏松症     

年轻妇女子宫内膜癌的临床与病理特点

子宫内膜癌( endometrial carcinoma)是发生于子宫内膜的一组上皮性恶性肿瘤,占女性生殖道恶性肿瘤20％～30％,平均发病年龄为53岁,高发年龄40～65岁.年轻妇女子宫内膜癌,目前国内外文献定义有年龄≤40岁,也有年龄≤45岁.考虑到与目前国内外专家探索保留生育功能治疗的指征一致,目前多数主张以年龄≤40岁的子宫内膜癌为年轻妇女子宫内膜癌.据报道,≤40岁的子宫内膜癌所占比例为1％ ～15％,近20多年来子宫内膜癌发病率在世界范围内呈上升趋势,在40岁以下妇女中发病数由2/10万上升至40～50/10万[1].     

青春期功能性子宫出血预后的远期追踪

本文就病程超过3年的21例青春期功能性子宫出血的预后作了远期追踪,并把恢复正常月经周期者与持续月经异常者分作两组,进行比较。 21例中病程最短3年,最长11年,平均5.8年;发病时的体重为标准体重的97.1±10.5%;初潮年龄平均12.3岁,发病距初潮的时间平均38.9个月,初潮至发病月经规律者6例,不规律15例。21例中有9例恢复正常月经周期(正常组);12例持续月经异常(异常组),其中月经稀发3例,持续功能性出血3例,Ⅰ度闭经6例。21例中有4例继发重度贫血,并须输血治疗。调查结果:发病至今的时间、体重、初潮年龄、发病距初潮的时间,两组无明显差异。但初潮     

初潮年龄对女性绝经年龄及围绝经期综合征影响的横断面研究

目的分析不同月经初潮年龄对女性绝经年龄及围绝经期综合征的影响。方法:采用多阶段整群随机抽样方法,以在甘肃省居住≥1年的40~55岁女性为研究对象,于2016年3—11月期间展开横断面调查。结果 (1)共调查8 500人,最终纳入分析7 236人。初潮年龄≤12岁者461例(6.4%),13~14岁初潮者2 335例(32.3%),15~16岁初潮者2 838例(39.2%),≥17岁初潮者1 602例(22.1%)。(2)共1 673例女性绝经,平均绝经年龄为(47.9±3.3)岁。随着初潮年龄的增加,绝经年龄增加,单因素方差分析显示组间数据差异有统计学意义(F=12.741,P=0.000),多因素Cox回归分析显示,初潮年龄早是绝经年龄提前的危险因素。(3)随着初潮年龄增加,围绝经期综合征发生率增加,并且中、重度围绝经期综合征发生率增加(P=0.000)。(4)多因素logistic回归分析显示,初潮年龄与围绝经期综合征的严重程度发生无相关性。结论月经初潮年龄越早,绝经发生越早;随着初潮年龄增加,围绝经期综合征发生率增加,初潮年龄与围绝经期综合征严重程度无相关性。     

年轻妇女子宫内膜癌临床病理分析

目的探讨年轻妇女子宫内膜癌的临床病理特征,指导个体化治疗.方法对15例年龄＜40岁的年轻妇女子宫内膜癌(研究组)与同期的122例年龄≥40岁的子宫内膜癌(对照组)进行回顾性对照研究,比较两组的临床病理特征.结果年轻妇女子宫内膜癌占同期子宫内膜癌总数的10.95%;研究组和对照组刮宫病理检查,未提示子宫内膜癌者所占比例,分别为13.33%和4.10%(P＞0.05),Ⅰ型子宫内膜癌所占比例分别为93.33%和77.87%(P＞0.05);研究组和对照组G1级所占比例分别为86.67%和48.36%(P＜0.05),Ⅰ期所占比例分别为93.33%和61.48%(P＜0.05);研究组雌、孕激素受体阳性率均高于对照组(P＜0.05).结论年轻妇女子宫内膜癌具有不同于一般子宫内膜癌的临床病理特征,具有较好的预后因素,保守治疗有望改善其生活质量.     

妊娠早期不同水平同型半胱氨酸与自然流产的相关性研究

目的:探讨在不同年龄组妊娠妇女中,妊娠早期不同水平同型半胱氨酸(Hcy)暴露对自然流产(SA)的影响,为妊娠妇女SA的早期识别提供临床依据。方法:选择2017年1～11月在北京大学国际医院就诊并建档的妊娠妇女887例为研究对象。SA定义为妊娠在28周前自行终止。根据入组妊娠妇女Hcy水平的四分位数间距分为4组:A组(209例)Hcy5.7μmol/L;B组(216例)Hcy 5.7～6.4μmol/L;C组(201例)Hcy 6.4～7.2μmol/L;D组(261例)Hcy7.2μmol/L。比较不同Hcy水平的SA发生情况及不同年龄(35岁,≥35岁)Hcy水平对SA的影响。结果:妊娠早期健康妊娠妇女Hcy中位数为6.30μmol/L,四分位数间距为5.60～7.25μmol/L。A、B、C和D组SA率分别为6.2%、8.8%、10.0%和11.9%,4组SA率随着Hcy水平升高而呈现升高趋势(P0.05)。以SA为因变量,进行Logistic回归分析,在调整了体质量指数、产次、不良孕产史、游离甲状腺素和促甲状腺激素后,D组SA风险高于A组(OR 2.603,95%CI 1.246～5.440)。将年龄进行分层后分析:年龄35岁,D组SA风险高于A组(OR 3.891,95%CI 1.371～11.039);而在年龄≥35岁中,未发现Hcy水平升高是SA发生的高危因素。结论:随着Hcy水平的升高,SA的发生率呈逐渐升高的趋势。在年龄35岁的妊娠妇女中,Hcy7.2μmol/L是SA的危险因素。妊娠早期关注Hcy水平可能为早期识别SA提供帮助。     

Age at Menarche and Its Association with Excess Weight and Body Fat Percentage in Girls in the Southwestern Region of the Brazilian Amazon

Study ObjectiveTo analyze age at menarche and its association with excess weight and body fat percentage.DesignSchool-based cross-sectional survey.SettingSouthwestern region of the Brazilian Amazon.ParticipantsThe sample was made up of 727 girls, in the 8- to 16-year age range, divided into 3 groups: early, normal, and late menarche, from public and private schools, selected through proportional stratified random sampling.Interventions and Main Outcome MeasuresBioimpedance was used to measure body fat percentage and body mass index, applying the Global School-Based Student Health Survey questionnaire to categorize behavior variables. Age at menarche was determined using the status quo method. Sexual maturity was assessed through self-assessment according to criteria described by Tanner.ResultsOverall age at menarche was 11.52 (±1.35), early 10.48 (±0.78), normal 12.39 (±0.50) and late 14.27 (±0.51) years. Prevalence of excess weight and body fat was 28.3% (206/727) and 44.3% (322/727), among those with menarche. There was a positive association between excess weight and body fat with age at early menarche (P = .000 and .015).ConclusionAge at menarche among girls from the Amazon region is similar to that of industrialized countries. Prevalence of excess weight and body fat was high, and there was evidence of an association between age with early menarche and excess weight. Trends in age at menarche and stage of sexual maturation should be monitored with related factors, to adopt obesity control strategies from an early age.     

Delayed menarche following early onset of athletic sports training

To investigate the effect of athletic sports training on the onset of menarche, we submitted questionnaires to college students at University of Tsukuba. 311 students (174 college athletes and 137 non-athlete control students (group C) completed the questionnaires. The college athletes were divided into hard physical activity (group A) and moderate physical activity (group B) groups. The average age was similar in each group. The physical profile showed that group A and B were significantly (p less than 0.001) taller and heavier than those of group C. There was no significant difference among the average menarcheal age of group A (12.9 +/- 1.1 years, Mean +/- S.D.), group B (12.8 +/- 1.1 years) and group C (12.6 +/- 1.0 years). However, some of athletes in group A who had begun sports training before menarche had a later menarcheal age (13.1 +/- 1.1 years, p less than 0.001), and others who had begun training after menarche had a significantly earlier menarcheal age (12.1 +/- 0.9 years, p less than 0.001) whereas in group B the average menarcheal ages of premenarche-trained (12.9 +/- 1.1 years) and postmenarcheal-trained (12.3 +/- 1.1 years) students were similar to that of group C. These data indicate that early beginning of hard athletic training delays the onset of menarche.     

Age at menarche in girls with celiac disease]

OBJECTIVES: Delayed menarche, amenorrhea, early menopause have been sporadically reported in patients with CD. But control group matched was drawn from healthy individuals. DESIGN: The aim of this study was to investigate the age at menarche in patients with CD and in mothers of patients. MATERIALS: 59 mother/daughter pairs; daughter with coeliac disease: 49--treated with a gluten-free diet [FGD (+)] and 10 with untreated or late onset coeliac disease [FGD (-)]. METHODS: CD was diagnosed on the basis of ESPGAN criteria. All patients and mothers were asked for information on the age at menarche. RESULTS: The mean age of menarche was significantly higher in FGD (-): girls--mean 16.16 years and mother's--mean 15.49 years, than in FGD (+) patients. The mean age of menarche in FGD (+) patients and mother's were: 12.33 and 13.82 years respectively in the country (11 pairs), 13.08 and 13.49 years respectively in the little town (19 pairs), 12.90 and 13.33 years respectively in the town (19 pairs). CONCLUSIONS: The age at menarche in patients with CD and FGD is decreased to age at menarche in mother's, but is higher in the untreated CD patients and mother's. These findings support the hypothesis that the age at menarche in girls with coeliac disease is regulated by gluten-free diet and by other genetic and environmental factors.     

Early menarche is associated with insulin resistance in advanced maternal age before delivery

Abstract

Purpose: With the wide implementation of the universal two-child policy in China, the number of pregnant women in advanced maternal age (AMA) will increase gradually. We aimed to assess the association between age at menarche (AAM) and insulin resistance (IR) before delivery in AMA. Methods: A total of 80 pregnant women in AMA were consecutively enrolled before delivery in Zhongda hospital. Pregnant women were stratified into early menarche group and late menarche group according to the age of regular menstruation (about 13?years). At delivery, serum glucose and lipid levels were measured. IR was calculated by the method of homeostasis model assessment 2(HOMA2). Results: The fasting blood insulin (17.68(9.72–36.71) and 10.35(7.76–15.10), respectively; p?=?.006) and HOMA-IR (2.08(1.18–4.37) and 1.24(0.89–1.78), respectively; p?=?.005) were higher in early menarche group than in late menarche group. AAM was inversely associated with HOMA-IR in AMA (r=??0.27, p?=?.014). In the multivariable analysis, AAM in late menarche group was negatively related to the level of HOMA-IR compared to those in early menarche group (β=??2.275, p≤.0001). Conclusions: Taken together, our findings suggest that AAM was inversely associated with HOMA-IR in AMA. Furthermore, pregnant women in AMA with early menarche might have higher HOMA-IR levels than those with late menarche.

Clinical trial registration: Chinese Clinical Trial Registry (No. ChiCTR-RRC-16008714), retrospectively registered     

孕妇年龄与妊娠高危因素及妊娠结局的关系

目的:探讨孕妇年龄与妊娠高危因素、妊娠结局的关系。方法:通过对2015年1月1日至2016年10月31日期间,在南方医科大学珠江医院分娩的所有产妇作为研究分析对象,按年龄划分为4组,≤24岁组543例(13.76%)、25~29岁组1648例(41.18%)、30~34岁组1208例(30.61%)、≥35岁组547例(13.86%)。统计4组不同年龄孕妇妊娠合并症、并发症的发生率和妊娠结局,将25~29岁组设为对照组(OR=1),进行二元Logsitic回归分析年龄与妊娠合并症、并发症及妊娠结局等的相关性。结果:在年龄30岁孕妇中,不良孕产史、本次辅助生殖助孕妊娠、妊娠合并子宫肌瘤、妊娠期糖尿病、瘢痕子宫OR值均1,且随年龄组增加,OR值递增。前置胎盘、多胎妊娠、产后出血,分娩巨大儿、低体质量儿、早产儿,在年龄≥35岁组中OR值1。子痫前期中年龄≤24岁组、≥35岁组OR值均1。在30~34岁组出生缺陷儿的OR值1。结论:对不同年龄孕妇,要有针对性地采取围生期检查及保健工作,及时对高危孕妇进行干预,积极治疗相关合并症,预防并发症,适时选择最佳分娩方式,综合保障母婴健康。     

Relationship of age at menarche and subsequent fertility.

We investigated retrospectively the relationship between the age at menarche and reproductive ability in 2278 married women. Those who had a pregnancy experienced menarche at a mean age (+/- SEM) of 13.7 +/- 0.1 years, and those who were infertile had menarche at a mean age of 14.0 +/- 0.2 years, difference in the times of onset of menarche being significant (P less than 0.05). Moreover, a group in whom menstruation started after the age of 18 years had a significantly higher rate of infertility (15.7%) than the others (5.0%). Irregular menstruations during the first few years after menarche was also related to decreased reproductive ability. These findings indicate the importance of menarche before the age of 18 for normal reproductive functioning.     

20例早发型子宫内膜癌的临床特点分析

目的：探讨40岁以下子宫内膜癌患者的临床及病理特征。方法：对2004年12月—2012年12月收治的子宫内膜癌病例进行回顾性分析,其中≤40岁的患者（早发组）20例（占4%,20/498）,＞40岁的患者（普通组）478例,比较2组患者的多项临床指标,分析患者的临床特征、高危因素、治疗方法、病理类型、组织学分级、肌层浸润深度、淋巴结转移与附件转移的关系。结果：早发组原发不孕发病率为30.0%（6/20）,普通组为4.2%（20/478）,差异有统计学意义（χ2=25.855,P=0.000）。普通组合并高血压率高于早发组（χ2=7.954,P=0.003）。早发组患者病理类型均为子宫内膜样腺癌,普通组子宫内膜样腺癌78.5%（375/478）,2组患者病理类型差异有统计学意义（χ2=5.433,P=0.020）。早发组、普通组患者细胞分化为G1者分别占90%和49.8%。早发组、普通组临床病理Ⅰ期者分别占80%和74.1%,2组患者细胞分化程度及临床病理分期差异有统计学意义（Z分别为－8.259和－9.488,均P=0.000）。2组患者肌层浸润、宫颈累及、淋巴结转移、附件累及和腹水细胞学检查比较差异均无统计学意义（均P＞0.05）。结论：在子宫内膜癌患者中年轻妇女有着一定的比例,不孕不育是40岁以下子宫内膜癌患者的高危因素,年轻子宫内膜癌患者以子宫内膜样腺癌为主,细胞分化级别高,手术病理期别较早,深肌层浸润、淋巴结转移以及附件转移等情况与年长者相似。