中年女性围绝经期症状及影响因素的研究现状分析

围绝经期由于激素水平下降出现潮热、心悸、失眠、记忆力下降、性欲减退、烦躁、抑郁、阴道干涩及泌尿系统疾病等身体和心理的不适症状。不同种族、不同地域和个人经历的女性,在围绝经期的症状存在差异,不同程度地影响其健康。本文作者通过文献分析,探讨女性围绝经期症状及影响因素的研究趋向。发现围绝经期症状直接影响女性的身心健康状况、生活质量水平,我国大多数围绝经期女性的自我保护意识尚低。因此,明确围绝经期女性的症状特点和影响因素,有助于提供适宜有效的健康干预。     

Progress and prospects in treating postmenopausal vaginal atrophy

Anatomically described as a “potential space,” the vagina is a highly estrogen-responsive organ, and its biology changes dramatically at menopause. After menopause, many women experience vaginal dryness and/or dyspareunia, which are caused primarily by regression of the vaginal epithelium.Unlike vasomotor symptoms, which typically resolve overtime, vaginal atrophy remains a persistent consequence of the menopausal transition. This article discusses current trends and potential future treatments that may improve choices for menopausal and postmenopausal women.     

A pilot study to examine a combination botanical for the treatment of menopausal symptoms

OBJECTIVE: Hormone replacement therapy has become a controversial treatment for symptoms of menopause, leading many women and their physicians to search for safer, effective alternatives. Certain botanicals are known to contain phytoestrogenic activity, which may be helpful in alleviating menopausal symptoms. We report the results of a study using a combination botanical supplement to treat menopausal symptoms. DESIGN: Prospective pilot study. SETTING/LOCATION: Family practice medical center, Phoenix metropolitan area. SUBJECTS: Eight (8) women with moderate vasomotor and somatic symptoms of menopause. INTERVENTION: Combination botanicals daily for 3 months. OUTCOME MEASURES: Modified Kupperman Index (KI), daily hot flashes severity, and overall quality of life (QoL) using the SF-36 index, which were collected at enrollment, during treatment, and at the end of treatment. RESULTS: Mean KI total symptoms decreased from 30.3 +/- 7.5 to 22.9 +/- 8.4 (95% CI, 25-34), p = 0.0028. Daily hot flashes decreased from 68.1 +/- 14.3 to 39.6 +/- 9.7 (95% CI, 38-46), p = 0.0003, and the overall QoL also improved at the end of treatment. CONCLUSIONS: This pilot study demonstrates the potential benefit of a combination botanical for improving moderate menopausal symptoms in women. The efficacy and role of combination botanicals for long-term use to reduce menopausal symptoms requires further exploration.     

联合应用不同剂量经皮雌二醇与口服孕激素缓解更年期症状的效果

目的 比较0.75 mg及1.5 mg两种经皮雌二醇剂量联合不同孕激素缓解更年期症状的效果.方法 随机将60例绝经早期妇女分为4组,分别给予不同剂量的经皮17-β雌二醇(E2)凝胶、黄体酮(MP)和甲羟孕酮(MPA),每周期连用25d.观察4组更年期症状、不规则阴道出血等不良反应.结果 用药后所有更年期症状均有改善(P<0.01),组间比较差异无统计学意义(P>0.05).其中潮热、睡眠及情绪症状缓解较快,疲倦、注意力不集中、性欲缺乏等改善较慢.MP 100 mg/d组不规则阴道出血发生率低于MPA 2mg/d组(P<0.01).结论 0.75 mg及1.5 mg两种经皮雌二醇剂量长期周期连续联合不同孕激素均可有效改善更年期症状,且潮热、睡眠及情绪症状较性症状改善更早.联合MP 100 mg/d在避免阴道不规则出血方面优于MPA 2 mg/d,临床应用应个体化.     

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。     

绝经激素治疗与女性恶性肿瘤

医学的快速发展显著提高了恶性肿瘤患者的生存率和生存时间,因此,越来越多的女性恶性肿瘤幸存者将经历自然绝经或由于肿瘤治疗导致的早发性卵巢功能不全(premature ovarian insufficiency,POI).自然绝经或POI带来的雌激素水平缺乏,可引起潮热、出汗、失眠、泌尿生殖道萎缩等一系列症状,远期负面影响...     

Treating hot flashes in breast cancer survivors: a review of alternative treatments to hormone replacement therapy

As the number of breast cancer survivors continues to grow, factors associated with quality of life are receiving increased clinical and research attention. This attention is imperative given the aftermath of psychological and physiologic side effects that commonly result from a cancer diagnosis and cancer-related treatments, including menopausal symptoms. Hot flashes, the most prevalent of these symptoms, have been shown to significantly decrease quality of life in women. Although manageable with hormone replacement therapy (HRT), hot flashes often are especially problematic in breast cancer survivors, a population that typically is not treated with HRT because of controversial evidence of a relationship among estrogen and/or progesterone and breast cancer recurrence and mortality. Furthermore, hot flashes commonly are more severe in premenopausal women who experience acute menopause as a result of chemotherapy treatment. In recent years, several treatment alternatives to HRT have been investigated. Given the significant number of women affected by breast cancer and the negative impact that hot flashes can have on their quality of life, this article reviews alternatives to HRT for reducing hot flash symptoms in breast cancer survivors.     

Morning/evening menopausal formula relieves menopausal symptoms: a pilot study

OBJECTIVE: The purpose of the study was to determine the efficacy of a morning/evening menopause formula (morning capsule contains panax ginseng, black cohosh, soy, and green tea extracts; evening capsule contains black cohosh, soy, kava, hops, and valerian extracts) for relieving menopausal symptoms such as hot flashes and sleep disturbance. METHODS: Healthy postmenopausal women, between 45 and 65 years of age, were asked to take the menopause formula orally, one capsule of the morning formula every morning and one capsule of the evening formula every evening for 2 months. The Greene Climacteric Scale (GCS) and the Pittsburgh Sleep Quality Index (PSQI) were used to determine the efficacy. RESULTS: Morning/evening menopause formula significantly reduced the number of hot flashes. The reduction in the number of hot flashes was observed as early as at the end of the second week. At the end of the second week, the number of hot flashes was reduced by 47%. The morning/evening menopause formula also significantly reduced the GCS total and subscale scores. At the end of the eighth week, the vasomotor, anxiety, and depression scores of GCS were reduced by 50%, 56%, and 32%, respectively. Furthermore, the morning/evening menopause formula significantly reduced global PSQI score and scores in five components (sleep quality, sleep latency, sleep duration, sleep disturbance, and daytime dysfunction) by 18%-46%. CONCLUSIONS: This study suggests that the morning/evening menopausal formula is safe and effective for relieving menopausal symptoms including hot flashes and sleep disturbance.     

Update on nonhormonal approaches to menopausal management

The risk-benefit evaluation for managing vasomotor symptoms and other menopause-related health issues should be tailored to each individual woman, taking into account her own assessment of the most bothersome symptom(s) and her personal weighting of risks versus quality of life. For most symptomatic menopausal women, hormone therapy (HT) remains the best treatment, but various nonhormonal options are available for treating menopausal symptoms and bone loss in women who are unable or unwilling to take HT. Low doses of local vaginal estrogen remain an option for treatment of vaginal atrophy in these women. This article reviews alternatives to systemic HT for treating menopausal symptoms and related health issues.     

A practical guide to the management of menopausal symptoms in breast cancer patients

Breast cancer is the most frequently diagnosed cancer in Canadian women. As a result of increased screening and improved treatment, more women are becoming long-term breast cancer survivors. However, due to either their treatment or prolonged survival, many of these women now have to face the consequences of premature menopause and prolonged estrogen deprivation. Hormone replacement therapy/estrogen replacement therapy (HRT/ERT) has, in the past, been recommended to healthy women at menopause not only for relief of short-term menopausal changes, particularly hot flashes, but also for its benefits on bone density, fracture reduction, and genitourinary symptoms. Recent studies have demonstrated that not only is HRT associated with an increased risk of developing breast cancer, but it also has been shown to increase the risk of recurrence in those with a breast cancer history. Until the safety of HRT/ERT in breast cancer patients can be more fully clarified, it would be wise to develop alternative strategies for the management of menopausal symptoms in these patients. This paper will discuss nonestrogen-based therapies for hot flashes, osteoporosis, and genitourinary symptoms, with emphasis on efficacy and safety in breast cancer survivors.     

Menopausal symptom experience: an online forum study

Title.  Menopausal symptom experience: an online forum study
Aim.  The aim of the study was to explore the menopausal symptom experience of White midlife women.
Background.  Recent cross-cultural investigations have indicated important ethnic differences in menopausal symptoms and have challenged the universality of these symptoms. Currently available cultural knowledge on menopausal experience, however, is inadequate to guide appropriate and adequate care even for White women in the menopausal transition.
Method.  A cross-sectional qualitative online forum study was conducted in 2007 with 23 midlife women who self-identified as non-Hispanic Whites using convenience sampling. Seven topics related to menopausal symptom experience were used to guide the online forum for 6 months. The data were analysed using thematic analysis.
Results.  The experiences of menopause caused women to redefine themselves within their busy daily life schedules. They were optimistic about their symptoms, and tried to laugh at the experience to boost their inner strength and motivate themselves to persevere. Many thought that both generational and life-style differences were much more important than ethnic differences in menopausal symptom experiences. In seeking assistance with the symptoms of menopause, women were not satisfied with the guidance of their physicians.
Conclusion.  Nurses need to listen carefully to what women themselves say about their own experiences with menopausal symptoms and avoid imposing predetermined symptom management strategies. Further studies of women's perceptions of life-style influences are needed to guide symptom management. In addition, studies of generational changes in menopausal symptom experience are needed.     

The effect of oral capsule of curcumin and vitamin E on the hot flashes and anxiety in postmenopausal women: A triple blind randomised controlled trial

ObjectiveThe decline and eventual cessation of estrogen production cause a variety of symptoms during menopause, affecting each woman differently. Most women reported severe hot flashes and night sweats during menopause. The present study aimed to determine and compare the efficacy of curcumin and vitamin E on hot flashes and anxiety (primary objectives), sexual function, menopausal symptoms and adverse effects (secondary objectives).Materials and methodsThis was a triple-blind randomized controlled clinical trial. The participants consisted of 93 postmenopausal women in Ahar city-Iran. They were assigned into three groups (two intervention groups and one control group). The first intervention group received oral capsule of curcumin (500 mg), the second intervention group was given oral tablets of vitamin E (200 IU/day), and the third group (control) received placebo twice a day for eight weeks. The participants completed the hot flash checklist one week before the intervention, and 4 weeks and 8 weeks after the intervention. They also filled out the Anxiety Scale, the Female Sexual Function Index (FSFI), the Greene Climacteric Scale before the intervention, and 4 weeks and 8 weeks after the intervention. One-way ANOVA, repeated measures ANOVA and ANCOVA tests were used for data analysis.ResultsThere was no statistically significant difference between groups in terms of demographic characteristics, mean number of hot flashes, mean score of anxiety, sexual function index and menopausal symptoms before the intervention (p > 0.05). The mean age of participants was 51.7 years. Mean number of hot flashes in the curcumin group (adjusted mean difference = −10.7, 95%confidence interval = −3.6 to −17.9, P = 0.001) and in the vitamin E group (−8.7, −0.6 to −15.0, P = 0.029) was significantly lower than the placebo group after the intervention. The first significant effect of curcumin on hot flashes was observed after four weeks (P = 0.027). However, there was no significant difference between vitamin E group and placebo four weeks after intervention (P = 0.052) and the first significant effect of vitamin E on hot flashes was observed after eight weeks (P = 0.025). There was no statistically significant difference between the groups in terms of sexual function index, anxiety and menopausal symptoms (P > 0.05).ConclusionThe results of this study showed that oral intake of curcumin and vitamin E significantly reduced hot flashes in postmenopausal women but had no significant effect on anxiety, sexual function and menopausal symptoms.     

Anxiety attacks following surgical menopause: a case report

Acute onset of surgical menopause rarely complicates a woman's psychological state. Although most women with acute surgical menopause have associated menopausal symptoms, few psychological consequences have been reported. This article presents the case report of a woman who developed immediate postoperative symptoms of severe anxiety that significantly impacted her quality of life. Physiological and psychological changes associated with surgical menopause and hormone replacement therapy are also discussed.     

Is naturopathy as effective as conventional therapy for treatment of menopausal symptoms?

BACKGROUND: Although the use of alternative medicine in the United States is increasing, no published studies have documented the effectiveness of naturopathy for treatment of menopausal symptoms compared to women receiving conventional therapy in the clinical setting. OBJECTIVE: To compare naturopathic therapy with conventional medical therapy for treatment of selected menopausal symptoms. DESIGN: A retrospective cohort study, using abstracted data from medical charts. SETTING: One natural medicine and six conventional medical clinics at Community Health Centers of King County, Washington, from November 1, 1996, through July 31, 1998. PATIENTS: Women aged 40 years of age or more with a diagnosis of menopausal symptoms documented by a naturopathic or conventional physician. MAIN OUTCOME MEASURES: Improvement in selected menopausal symptoms. RESULTS: In univariate analyses, patients treated with naturopathy for menopausal symptoms reported higher monthly incomes ($1848.00 versus $853.60), were less likely to be smokers (11.4% versus 41.9%), exercised more frequently, and reported higher frequencies of decreased energy (41.8% versus 24.4%), insomnia (57.0% versus 33.1%), and hot flashes (69.6% versus 55.6%) at baseline than those who received conventional treatment. In multivariate analyses, patients treated with naturopathy were approximately seven times more likely than conventionally treated patients to report improvement for insomnia (odds ratio [OR], 6.77; 95% confidence interval [CI], 1.71, 26.63) and decreased energy (OR, 6.55; 95% CI, 0.96, 44.74). Naturopathy patients reported improvement for anxiety (OR, 1.27; 95% CI, 0.63, 2.56), hot flashes (OR, 1.40; 95% CI, 0.68, 2.88), menstrual changes (OR, 0.98; 95% CI, 0.43, 2.24), and vaginal dryness (OR, 0.91; 95% CI, 0.21, 3.96) about as frequently as patients who were treated conventionally. CONCLUSIONS: Naturopathy appears to be an effective alternative for relief of specific menopausal symptoms compared to conventional therapy.     

Genitourinary Syndrome of Menopause and the Role of Nurse Practitioners

Genitourinary syndrome of menopause (GSM) encompasses menopausal genital and urinary symptoms associated with estrogen declines, which can have a negative impact on quality of life. Several options are available for treatment, with over-the-counter vaginal lubricants and moisturizers as first-line therapy, followed by local vaginal estrogens that treat the underlying condition. Nurse practitioners are positioned to help diagnose GSM as they are comfortable initiating the conversations necessary to put women at ease to disclose information necessary for an accurate diagnosis. They can then effectively communicate various options for treating the symptoms of GSM.     

The prevalence and pattern of gastroesophageal reflux symptoms in perimenopausal and menopausal women

PURPOSE: To determine the prevalence and describe the pattern of gastroesophageal reflux disease (GERD) symptoms in premenopausal-, perimenopausal-, and menopausal-age women. DATA SOURCES: Three tools were used to collect data: the Menopause Rating Scale, a standardized, self-administered 11-item scale that assesses the presence of menopausal symptoms and their impact on quality of life; the Gastrointestinal Symptom Rating Scale, a standardized, self-administered 15-question survey that inquires about both lower and upper gastrointestinal (GI) symptoms; and the Reflux Disease Questionnaire (RDQ), a self-administered 14-question survey currently being evaluated in the United States as a specific diagnostic tool for GERD that specifically addresses upper GI symptoms of discomfort. Additionally, GERD were correlated with vasomotor, vaginal, genitourinary, and other menopausal symptoms using multiple regression analysis to assess the relationships between GERD and menopausal symptoms. CONCLUSIONS: Approximately 497 women between the ages of 25 and 60 years completed the surveys. The prevalence of GERD symptoms was high in this sample. Almost 42% of perimenopausal and 47% of menopausal participants complained of upper GI symptoms. Although perimenopausal and menopausal women had higher percentages of GERD diagnosis as compared to premenopausal women, 80% of the perimenopausal and menopausal groups had never been diagnosed with an upper GI disorder. A post hoc analysis of RDQ results demonstrated that patients with menopause had significantly more upper GI discomfort. Overall, this study found that menopausal women were 2.9 times more likely to have GERD symptoms. IMPLICATIONS FOR PRACTICE: These findings are strongly suggestive of a hormonal link between perimenopausal and menopausal states and increasing GERD symptoms. Women of all ages should be screened for symptoms of GERD, especially in the perimenopausal and menopausal population of women because diagnosis of GERD is often not made or misdiagnosed. The impact on the quality of life of women experiencing GERD symptoms cannot be underestimated.