雌激素对女性认知功能的影响

雌激素对中枢神经系统有许多有利作用,并且参与学习和记忆的脑功能调节。因此有研究推测绝经后雌激素水平的改变是女性认知相关疾病的高危因素。目前对围绝经期或绝经后女性的各项研究得出的矛盾性结果,推测出雌激素在阻止中老年妇女认知功能下降的治疗中存在一个关键的时期。根据这一假说,在人及动物研究中,通过分析与认知相关脑功能区域对雌激素改变的反应,以及补充外源性雌激素对脑功能的影响,来探讨女性雌激素对认知功能的影响以及雌激素治疗开始时间是否是防止或加剧认知功能障碍的重要因素。这对防治绝经后女性认知功能下降有重大意义。     

激素补充治疗与中老年女性骨质疏松症

骨质疏松症是中老年妇女的常见病。雌激素有明确抑制骨吸收的作用。绝经后由于雌激素的缺乏,导致骨量的快速丢失,使中、老年女性患骨质疏松症的危险大大高于男性。绝经后激素治疗能有效阻止骨丢失,维持骨量,降低骨折危险。特别提倡在60岁以前或绝经10年内开始使用激素治疗。此期间启用激素治疗,除对骨骼的保护作用外,还可以明显缓解绝经症状及降低冠心病风险,获益最多,风险最小。选择绝经激素治疗,是基于生活质量、健康优先原则和个人危险因素而做的个人决策。     

日本研究发现：女性雌激素减少可导致脱发

日本狮王公司最近研究发现，女性随着年龄增长，体内雌激素日益减少，这可能是中老年女性易脱发的原因之一。     

观察植物雌激素治疗妇科疾病的疗效

目的观察植物雌激素对于妇女疾病的疗效。方法选取2013年3月~2014年3月来我院治疗妇科疾病的患者68例作为研究对象,按照入选的先后顺序随机分为实验组38例和参照组30例,对两组患者行不同的治疗方法,实验组患者行植物雌激素类药物治疗,参照组患者行化学类药物治疗,比较两组患者的疗效。结果通过治疗,实验组患者的治疗有效率显著高于参照组,差异有统计学意义(P0.05);实验组患者的不良反应发生率也显著低于参照组,差异有统计学意义(P0.05)。结论植物雌激素类药物能够有效治疗妇科疾病,提高女性患者疾病的治愈率,减少不良反应的发生率,改善患者的生活质量,值得临床推广应用。     

围绝经期管理与绝经雌激素治疗

正女性进入围绝经期后,随着卵巢功能的下降,雌激素分泌的减少,会出现近期的症状,包括潮热盗汗、心悸、乏力骨痛、抑郁焦虑、睡眠障碍等;中期会出现阴道干涩、尿频尿急、性生活不适等症状;晚期会出现骨质疏松及骨折、心脑血管疾病等。这些变化严重影响着中老年女性的生活质量,同时还增加了社会和经济负担。上个世纪六七十年代,发达国家和地区的卫生工作者认识到了绝经后雌激素水平下降给患者所带来的危害后,采用了雌激素治疗显著改善了患     

雌激素治疗后尿道细胞学变化

女性张力性尿失禁是由于尿道阻力降低所致。尿道总阻力的33%是由尿道粘膜因素构成。尿道粘膜增生及厚度增加均可增加尿道阻力。绝径妇女尿道粘膜萎缩降低尿道阻力而产生张力性尿失禁。女性尿道及阴道的远端均起源于胎儿的尿生殖窦,女性尿道含高浓度的雌激素受体。尿道及膀胱三角区的雌激素受体含量与阴道相似。因此,给予雌激素后可望尿道产生与阴道相似的雌激素效应。对10例经临床及尿路动力学检查确诊真性张力性尿失禁的绝经妇女进行研究。在给予雌激素阴道霜治疗前及治疗后6周分别对患者进行临床评估并经尿道镜取尿道中段细胞进行细胞学检查。     

绝经后骨质疏松的性激素治疗

正绝经后骨质疏松是女性特有的骨代谢疾病,围绝经期女性雌激素水平降低是致病的主要因素,绝经激素治疗(menopause hormone therapy,MHT)可作为防治绝经骨质疏松和低骨量的一线药物选择。在激素治疗中应充分评估患者健康状态,选择个体化MHT方案,可有效降低用药风险和提高治疗获益。在激素治疗期间需要按规范流程进行监测和随访。1绝经后骨质疏松的特点绝经后女性骨质疏松症发病率为男性的4倍,绝经和年龄增长是女性骨质丢失的两个重要因素。绝     

宫腔粘连分离术后雌激素辅助治疗的研究进展

宫腔粘连可引起女性闭经、继发性不孕和反复流产等一系列症状,经宫腔镜下宫腔粘连分离术治疗后仍有较高的复发率,严重影响女性的生育能力及心理健康。雌激素辅助治疗可通过促进残余子宫内膜增生修复及降低子宫内膜促纤维化因子的表达,有效降低宫腔粘连分离术后的复发率,但目前仍未形成统一的用药方案。临床上常用的方案为戊酸雌二醇片2～4 mg/d或等效激素加用孕激素序贯口服给药2～3个月经周期,大剂量雌激素治疗疗效仍未明确,或可通过检测子宫内膜的雌激素受体表达水平制定个性化的雌激素用药方案,以达到最佳疗效。口服雌激素是宫腔粘连最经典的治疗方式,但近年研究表明雌激素经皮给药及经阴道给药生物利用度更高,不良反应更少,且疗效相当。目前大量的临床研究对雌激素的用法用量仍存在较大差异,因而仍需更多大样本、高质量的研究探讨雌激素的最佳用药方案。     

雌激素对真性应力性尿失禁患者尿道功能的影响

女性尿道及阴道是对雌激素敏感的组织,均来源于泌尿生殖窦,在结构和胚胎发生上有密切联系,均载有雌激素受体。绝经后数年内因雌激素水平降低,尿道及阴道萎缩,粘膜变薄,可发生或加重真性应力性尿失禁(GSUI)。当然给予雌激素治疗也能使尿道粘膜充血变厚,增加尿道压力,使症状有所改善。在此基础上作者通过11例绝经后GSUI 患者每晚使用阴道雌激素霜2g 治疗6周前后的变化,阐明雌激素与临床、尿动力学及尿道细胞学的关系。作者发现雌激素治疗后的 GSUI 患者血     

植物性雌激素对子宫内膜及异位子宫内膜的影响

植物性雌激素(phytoestrogens,PEs)是一类结构及生物学活性类似于雌激素的天然非甾体类化合物,可与雌激素受体结合,对内源性雌激素起双向调节作用。研究表明,植物雌激素可以缓解妇女围绝经期相关症状,且不会引起子宫内膜的复杂型增生及癌变;植物雌激素还能降低子宫内膜癌的发病风险,具有一定抗癌作用;此外,植物雌激素通过其弱的雌激素活性,既能抑制体内异位病灶的生长又能避免发生骨质疏松等副作用,将会给子宫内膜异位症(EMs)患者带来福音。     

Age is not a limiting factor for midurethral sling procedures in the elderly with urinary incontinence

OBJECTIVE: The object was to evaluate clinical outcome of the midurethral sling procedures in the elderly compared with middle-aged women. METHODS: A total of 266 women who underwent midurethral sling procedures with at least follow-up greater than 6 months were included in the study. Patients were divided as the elderly group (65 years old or older, n = 60) and the middle-aged group (45-64 years old, n = 206). RESULTS: Although postoperative urge symptoms were more prevalent in the elderly group (25.0%) than in the middle-aged group (6.3%), there were no significant differences between the two groups for the rates of postoperative urge incontinence (p = 0.159). Stress incontinence was cured by 91.3% in the middle-aged group and 85.0% in the elderly group, respectively (p = 0.158). CONCLUSIONS: Age does not seem to be a significant risk factor for failure of midurethral sling procedures.     

运动防治中老年女性骨质疏松症

骨质疏松的发病率逐年升高,影响着中老年女性的生活质量,现已成为世界各国日益关注的公共卫生问题,适当的运动可以减缓随年龄的增长而发生的骨质疏松,且无药物的副作用,本文主要介绍运动对中老年女性骨质疏松的影响及其作用机制,防治骨质疏松的运动类型和推荐运动。     

Genetic and environmental influences on urinary incontinence: a Danish population-based twin study of middle-aged and elderly women

BACKGROUND: Familial clustering has been reported for urinary incontinence (stress and urge), but different etiologies for the two types of incontinence have been suggested. OBJECTIVE: The aim of this study was to estimate the relative influence of genetic and environmental factors on stress, urge, and mixed incontinence among elderly and middle-aged women. METHODS: This is a population-based classical twin study of 1168 female twin pairs [548 monozygotic (MZ) and 620 dizygotic (DZ)] from a middle-aged (46-68 years) and an old (70-94 years) cohort identified in the Danish Twin Registry. Urinary incontinence was assessed with the help of two validated questions identifying stress and urge incontinence in interviews. RESULTS: For urge incontinence, the tetrachoric correlation was significantly higher for MZ twins, compared to that for DZ twin pairs in both middle-aged [0.51 (95% CI: 0.26-0.71) versus -0.22 (95% CI: -0.59-0.18)] and elderly [0.50 (95% CI: 0.27-0.68) versus 0.28 (95% CI: 0.02-0.42)], indicating genetic effects. The heritability of urge incontinence was 42% (95% CI: 16-63%) among middle-aged women and 49% (95% CI: 29-65%) among the elderly. Moreover, mixed incontinence had a substantial genetic component. The role of genetic factors was less clear in stress incontinence. CONCLUSIONS: Genetic factors play a substantial role in the development of urge and mixed incontinence, whereas the role of genetic factors in stress incontinence is less prominent.     

Relationship between serum leptin concentrations and bone mineral density as well as biochemical markers of bone turnover in women with postmenopausal osteoporosis

OBJECTIVE: To determine whether leptin is involved in bone remodeling in patients with postmenopausal osteoporosis. DESIGN: Cross-sectional study. SETTING: Department of Obstetrics and Gynecology, Faculty of Medicine, Cairo University. PATIENT(S): Ninety postmenopausal osteoporotic women (37 obese and 53 nonobese) and 30 healthy premenopausal women from the same clinic served as controls. Lumbar spine bone mineral density (LS-BMD) of osteoporotic patients was more than 2.5 SD below the normal mean of healthy premenopausal women. MAIN OUTCOME MEASURE(S): Serum levels of leptin, osteocalcin (OC), bone alkaline phosphatase (B-ALP), urinary deoxypyridinoline (DPyr), and N-telopeptide of type 1 collagen (NTX) as well as LS-BMD using dual energy X-ray absorptiometry (DEXA). RESULT(S): The serum leptin level in obese postmenopausal osteoporotic patients was significantly increased compared with nonobese osteoporotic patients. There were no significant differences of bone formation markers (B-ALP, OC), bone resorption markers (DPyr, NTX), or LS-BMD between the obese and nonobese groups. There were no significant correlations between serum leptin and any biomarkers of bone turnover and BMD. CONCLUSION(S): In postmenopausal osteoporotic patients with increased bone turnover, serum leptin concentration is not correlated with BMD or with the biomarkers of bone formation or bone resorption.     

盆底修复手术后流行病学调查

盆底功能障碍是中老年女性常见病、多发病,严重影响患者生活质量;主要发病机制是盆底支持结构薄弱或损伤,治疗主要依靠手术修复。近年来,采用多种植入物进行替代与修复的盆底重建外科手术得到越来越多地应用,这类手术创伤较小,疗效较高,但临床应用时间尚短,总结资料少,手术疗效、并发症、与传统手术的比较等需要通过术后流行病学研究进行总结,以加强技术培训,促进临床发展。     

Similar efficacy of low and standard doses of transdermal estradiol in controlling bone turnover in postmenopausal women

Objectives.?To investigate the effects of a low transdermal estradiol dose on bone metabolism and to compare it with both the standard dose and absence of treatment.

Methods.?In this study performed in a third-level academic center, 66 healthy postmenopausal women underwent hormone therapy (HT) with patches containing estradiol at standard (0.050 mg/day, HT50, 33 women) or low dosage (0.025 mg/day, HT25, 33 women) and 70 women were without treatment (NT). The values (mean of three samples) of several bone biochemical parameters were compared between groups after adjusting for confounding factors. Bone mineral density (BMD) was assessed (by dual-energy X-ray absorptiometry) in the spine and hip in all cases, and a second densitometry scan was performed in 44 women.

Results.?Bone turnover markers tended to show lower values in the treated groups, but significance was restricted to total alkaline phosphatase (NT vs. HT25, p < 0.05) and cross-linked N-telopeptides of type I collagen (NTX) (NT vs. HT25, p < 10^?6; NT vs. HT50, p < 10^?5). The loss of BMD observed in NT women, as assessed by the annual percentage change, was blocked in both the HT25 and HT50 women. No significant differences were detected between both HT groups.

Conclusions.?Low and standard dosages of transdermal estradiol were equally effective in controlling bone metabolism, as assessed by turnover markers. Additionally, NTX was confirmed as the most sensitive marker for detecting changes in bone resorption.     

The impact of age in the outcome of patients with advanced or recurrent cervical cancer after platinum-based chemotherapy

OBJECTIVES: Cervical cancer is a disease of middle-aged and elderly but still there are young women diagnosed with advanced disease that is incurable with local treatment and is treated with platinum-based combination chemotherapy. It is unknown whether these young patients have a poorer outcome compared to older patients or whether elderly patients have inferior outcome than younger patients when treated with combination chemotherapy. METHODS: We compared the outcome between young (<35), elderly (>70) and middle-aged (35-70) women who were treated with platinum-based combination chemotherapy for advanced, recurrent or persistent disease. RESULTS: Two hundred and eighteen patients were included in our database. The baseline clinical and disease characteristics were not different between age groups but anemia and thrombocytosis were more frequent in younger patients. Median survival for all patients was 13.4 (95%CI 11-15.8) months while survival of patients<35 years of age was 9 months (95% CI 5.8-12), of patients older than 70 was 10 months (95% CI 6.9-13) of patients 35 to 70 years of age was 14.5 months (95% CI 11-18) (p=0.004). Multiple factors were significant for survival in univariate analysis but only weight loss, pain score and relapse inside an irradiated filed were significant predictors of outcome in multivariate analysis. CONCLUSIONS: Very young (<35) and elderly (>70) patients have a worse prognosis after treatment with combination chemotherapy for advanced or recurrent cervical cancer. Nevertheless, this difference is not significant when adjusted for other prognostic factors.     

Relationship between bone resorption and adrenal sex steroids and their derivatives in oophorectomized women

OBJECTIVE: To clarify the role of adrenal sex steroids and their derivatives on bone resorption in oophorectomized women. DESIGN: Cross-sectional study. SETTING: Department of Obstetrics and Gynecology, Graduate School of Medical Sciences, Kyushu University. SUBJECT(S): Forty-eight women who were within one year of bilateral oophorectomy were recruited for this study. INTERVENTION(S): None of the subjects were treated with the drugs affecting bone metabolism. MAIN OUTCOME MEASURE(S): Urinary deoxypyridinoline (Dpyr) as marker of bone resorption and serum DHEAS, androstenedione (A-dione), testosterone (T) and estrone (E1) levels as adrenal sex steroids and their derivatives. RESULT(S): There was an inverse correlation between urinary Dpyr and serum concentrations of E1, DHEAS, or A-dione. There was no significant relationship between urinary Dpyr and T. CONCLUSION(S): These results suggest that adrenal steroids and their derivatives may influence the bone resorption in oophorectomized women.     

Minodronic acid suppresses gonadotropin-releasing hormone agonist-induced bone remodeling biomarkers: a retrospective pilot study

Background: Estrogen deprivation therapy for myoma/adenomyosis decreases bone mineral density and can only be applied in the short term, as temporizing measures in the premenopausal woman.

Objective: To examine the effects of bisphosphonate minodronic acid on markers of bone turnover over a 6-month period in women receiving gonadotropin-releasing hormone agonist (GnRHa).

Methods: We retrospectively analyzed the medical records of 19 premenopausal patients with myoma/adenomyosis, who received GnRHa (leuprolide acetate, 1.88?mg/month or buserelin acetate, 900?µg/day) for 6 months from January 2014 to December 2014. Eight patients concomitantly received minodronic acid 50?mg every month during GnRHa therapy, and 11 treated with GnRHa alone. To compare these data in a case-controlled study, we analyzed an age-matched group of seven (premature or natural) menopausal women treated with minodronic acid. The primary outcome was percent changes in bone turnover markers in urine at 6 months.

Results: In menopausal women group, minodronic acid (50?mg once-monthly) for 6 months decreased urinary deoxypyridinoline (DPD) and cross-linked N-telopeptides of type 1 collagen (NTX). Women receiving a GnRHa had a significant increase in urinary DPD and TNX at 6 months while minodronic acid during GnRHa therapy improved urinary levels of DPD and NTX to near baseline.

Conclusion: Minodronic acid treatment appears to be promising in women with secondary bone loss receiving GnRHa treatment.     

Bone metabolism in postmenopausal women who were treated with a gonadotropin-releasing hormone agonist and tibolone

OBJECTIVE: To study the bone metabolism in postmenopausal women who have been treated with gonadotropin-releasing hormone agonist (GnRH-a) and tibolone. DESIGN: Prospective, open, controlled clinical trial. SETTING: Department of Gynecology and Obstetrics, University of Catanzaro, Catanzaro, Italy. PATIENT(S): One hundred twenty perimenopausal women with symptomatic uterine leiomyomas (groups A and B), and 40 healthy control women who underwent a normal spontaneous menopause (group C). INTERVENTION(S): Treatment for 12 months with leuprolide acetate plus tibolone (group A) or hysterectomy with bilateral oophorectomy (group B). MAIN OUTCOME MEASURE(S): Lumbar spine bone mineral density (BMD) and bone turnover markers at entry into the study, after medical treatment (only group A), and 12 months after discontinuation medical treatment (group A) or after surgery (group B). The same parameters were noted in healthy women before and 12 months after menopause (retrospective control group, group C). RESULT(S): At the women's entry into the study, no significant difference in BMD and bone turnover markers was detected between groups A and B. In group A, no significant variation in BMD or bone turnover markers was observed 12 months after medical treatment in comparison with baseline. At 12 months after discontinuation of treatment (in women who had achieved menopause) and after surgery, we observed a statistically significant decrease in BMD and in bone turnover markers in both groups in comparison with baseline. At 12 months after they became menopausal, we also observed a statistically significant reduction in BMD and in bone turnover markers in control group C. At the same 12-month follow-up visit, a statistically significant difference in BMD and in bone turnover markers was detected when comparing groups A and B with group C. CONCLUSION(S): Women previously treated with GnRH-a and tibolone similar to women who are menopausal as a result of surgery, have higher bone loss after menopause.