Use of hormonal contraceptives in perimenopause: A systematic review

Hormonal contraceptives have been used in perimenopausal women to manage a variety of symptoms and prevent unintended pregnancy. However, it is unclear what contraceptive regimen is best for these women. To evaluate hormonal contraceptive methods in women experiencing perimenopause using two prespecified outcomes: perimenopausal symptom management and long-term effects. A literature search of PubMed and EMBASE databases was performed (January 1990 to October 2021) using search terms “perimenopause” and “contraception.” Relevant full-text articles in English were included. Fifteen clinical articles were reviewed: Fourteen were internationally based, and one study was conducted in the United States. Nine articles evaluated symptom resolution, and six of these nine reported statistically significant changes in favor of treating perimenopausal women with hormonal contraceptives compared with no treatment. Seven studies evaluated long-term outcomes including bone loss and metabolic parameters, and six of these seven showed statistically significant improvements with hormonal contraceptives. Based on limited data and a lack of comparative studies, the use of a levonorgestrel intrauterine device with supplemental low-dose menopausal estrogen has positive results for the management of disruptive perimenopausal symptoms and long-term outcomes. Hormonal contraception in perimenopausal women improves symptom management and long-term outcomes if patients do not have contraindications. When selecting a contraceptive for women in perimenopause, clinicians and pharmacists need to address specific patient risk factors, symptom profiles, long-term risks and benefits, and patient preferences.     

燮理阴阳汤治疗围绝经期综合征的临床疗效

目的探讨燮理阴阳汤治疗围绝经期综合征的临床疗效。方法选择我院门诊围绝经期综合征患者318例,随机分为治疗组212例,对照组106例。治疗组应用燮理阴阳汤1剂,po,bid;对照组应用更年安片4片,pD,谢。两组疗程均为21d。对治疗组和对照组患者治疗前后的临床症状进行评分,判断疗效。分别测定治疗组治疗前后患者血清中促卵泡生成素（咖）和雌二醇（砀）的浓度。结果总有效率治疗组为98．60％,对照组为91．50％,P〈0．0l。治疗组治疗前后血清中FSH浓度分别为（58．79±30．86）、（59．34．-I-29．33）mIU·L^-1,P〉0．05;E质量浓度分别为（30．18±42．16）、（40．60±42．16）Pg·L^-1,P〈0．05。结论燮理阴阳汤能有效提高血中E浓度,改善围绝经期综合征症状。     

坤泰胶囊与激素替代疗法对绝经早期妇女认知功能及心理状态影响的随机对照临床研究

背景：结合雌激素（conjugated equine estrogen,CEE）是激素替代疗法常用药物之一,在围绝经期和绝经后妇女中应用由于安全性问题而受到限制。对于有激素替代疗法禁忌证和慎用证的患者,中药治疗成为另一选择。目的：比较中成药坤泰胶囊和CEE对绝经早期妇女认知功能及心理状态的影响并评估其安全性。设计、场所、对象和干预措施：收集四川大学华西妇女儿童医院绝经早期门诊患者57例,将其随机分为坤泰组28例和激素组29例,治疗并观察1年。坤泰组给予坤泰胶囊（每粒0.5 g）,2 g/次,3次/d;激素组给予CEE 0.6 mg/d与0.3 mg/d交替使用（平均0.45 mg/d）,有子宫者,加用醋酸甲羟孕酮,2 mg/d。主要结局指标：自给药日起每3个月评价一次认知功能及心理状态,记录不良反应,以意向性分析（intentionto treat,ITT）法和符合方案集（per-protoeol set,PPS）法分别分析。结果：两组治疗后各时点简易智能精神状态量表（Mini-Mental State Examination,MMSE）的认知功能、Kupperman指数及绝经后生存质量（quality of life,QOL）量表的心理状态评分与治疗前相比,差异有统计学意义（P〈0.05）,但激素组与坤泰组治疗后上述评分比较,差异无统计学意义（P〉0.05）。两组MMSE评分呈逐步上升趋势,Kupperman指数与QOL心理症状评分呈逐步下降趋势。治疗过程中两组均无严重不良事件发生,除阴道出血发生率激素组（39.3%）高于坤泰组（11.1%）,且差异有统计学意义（x~2=5.750,P=0.029）,其余不良反应比较,两组差异均无统计学意义。结论：坤泰胶囊与CEE在维持绝经早期妇女的正常认知功能和改善心理症状方面有一定作用。     

围绝经期抑郁症前扣带回的磁共振波谱研究

目的 探讨围绝经期抑郁症前扣带回区γ-氨基丁酸(GABA)含量的变化.方法 40例围绝经期女性为实验组,10例健康女性为对照组,随访18~24个月,采用氢质子磁共振波谱(1H-MRS)技术检测其大脑前扣带回区GABA浓度,实验组分别于绝经前及绝经后各测量1次,对照组分别在入组时及出组时各测量1次.实验组于绝经后根据中国精神障碍分类与诊断标准第3版(CCMD-3)及汉密尔顿焦虑量表(HAMA-14)、汉密尔顿抑郁量表(HAMD-17)的评分结果分为焦虑组和抑郁组,分别比较3组GABA的差异.结果 焦虑组及抑郁组绝经后GABA水平较绝经前显著降低(P<0.05),并均较健康对照组低(P<0.05);抑郁组患者绝经后GABA水平较焦虑组患者绝经后低(P<0.05).结论 前扣带回GABA水平改变与围绝经期抑郁症的病理生理机制联系密切,与围绝经期抑郁症的症状也有联系.     

The pathophysiology of menopausal symptoms

Increasing life expectancy means that most Western women will experience the menopausal transition. This phase of reproductive life involves a biopsychosocial process where the majority of women experience physiological changes, influenced by a wide range of ethnic, psychological, social and cultural factors. With relatively similar endocrine changes, symptom reporting should be correspondingly similar, yet more women in Western cultures report vasomotor symptoms (hot flushes and night sweats) compared to women in Asian cultures. Different approaches to menopause based on biological, medical, psychological or psychosocial premises result in different treatments for women who have troublesome symptoms.Hormone Replacement Therapy (HRT) is widely used in the management of symptoms associated with oestrogen withdrawal such as hot flushes, night sweats, sleep disturbance, vaginal dryness and dyspareunia, but has no proven role in the treatment of midlife depression or arthritis. HRT prevents menopausal bone loss and osteoporotic fracture, though long-term use remains controversial because of the increased risk of breast cancer, myocardial infarction and stroke, as reported by the Women's Health Initiative. An understanding of the pathophysiology of menopausal symptoms and the risks and benefits of both hormonal and non-hormonal treatments assists in the individual management of patients.     

围绝经期和绝经后女性骨密度的变化及其相关危险因素分析

目的观察40岁以上围绝经期和绝经后女性骨密度(bone mineral density,BMD)的变化并分析其相关危险因素。方法选取2017年8月至2018年3月在我院门诊进行体检的40岁以上女性,详细记录其病史、身高、体重,进行生化和内分泌测试,然后进行双能X射线吸收测定扫描。结果研究人群的平均年龄为46.65岁,平均体质量指数为26.23 kg/m~2。研究中骨量减少的患病率为38%,骨质疏松症的患病率为4%,低骨密度的患病率为42%。随着年龄的增加和绝经状态的增加,低骨密度妇女的比例也随之增加。在内分泌评估中,60%的人群出现维生素D摄入不足的情况,56.67%的人群患有甲状旁腺功能亢进,100%的人群出现甲状腺功能减退,75%的人群伴随着甲状腺功能亢进,同时骨密度较低。在慢性疾病中,发现83.33%的女性患有糖尿病,50%的女性患有高血压,50%的女性具有肝肾功能异常,50%的女性患有关节炎等风湿性疾病,同时骨密度较低。每天接受阳光照射时间少于1 h的女性中,48.65%的人骨密度较低。由于日常体力劳动的减少,BMD正常的女性比例从72.72%下降到46.15%。在多因素Logistic回归分析中,发现血清维生素D缺乏,体力劳动和阳光照射不足与低BMD显著相关。结论低BMD不是仅限于绝经后妇女的疾病,它在40岁以上的女性中普遍存在。     

Time to the final menstrual period

OBJECTIVE: To determine, for a woman aged >45 years, whether selected hormonal, health status, and demographic measures are related to the time to final menstrual period (FMP) from a point where 6 weeks separate the shortest and longest cycles experienced to date. DESIGN: Cohort study. SETTING: Volunteers in an academic research environment. PATIENT(S): Ninety-nine menstruating women aged 46 years to 55 years on entry completed menstrual diaries, gave annual blood samples, and were interviewed annually. They were observed for a mean period of 1.5 years. Seventy-seven reached FMP during observation. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Time to reach FMP from the date of a marker event-the difference between the longest and shortest of recent cycles reaching 6 weeks. RESULT(S): Women self-rating as in the transition have a greater "hazard" or probability of FMP at any time after the marker event. Allowing for this and other covariates, the hazard is estimated to increase by 30% (confidence interval [CI]: 10%, 60%) for each year of age and 50% (CI: 7%, 118%) for each unit increase in log FSH, measured at the time of the marker event. CONCLUSION(S): For women aged >45 years, the time remaining in the menopausal transition from the day on which >or=6 weeks separate the longest and shortest recent cycles is related to self-rating of menopausal status and to serum FSH level. The median number of months remaining ranges from 11 for those with FSH of >20 IU/L and who see themselves as in transition to 21 months for those with lower FSH and who notice little evidence of being in transition.     

治疗围绝经期综合征中药小复方的筛选步骤与方法

目的：本文以治疗围绝经期综合征中药小复方为例，进行Ⅱ期临床前中药小复方最佳配伍及最佳剂量配比的比较研究，借以建立中药小复方精选的技术平台。方法：运用拆方研究方法，以比较特异的药效学指标为评价指标，对3种制备工艺进行最佳制备工艺的筛选，以均匀设计法进行处方最佳配伍和最佳剂量配比的比较研究。结果：3种工艺中以根据药物理化性质选择的现代药学提取法为最好，以均匀设计法得出了处方最佳配伍及最佳剂量配比的实验值和理论值。结论：本研究方法在理论和实践中具有实际可行性。     

中药益坤宁对围绝经期大鼠卵巢雌激素受体表达的影响

目的观察中药益坤宁对围绝经期大鼠卵巢雌激素受体(estrogen receptor,ER)α、ERβmRNA和蛋白表达的影响。方法12月龄雌性Wistar大鼠随机分为老年模型组、西药利维爱组、中药益坤宁组,连续灌胃给药4周;以5月龄大鼠作为青年对照组。采用RT-PCR和免疫组织化学检测大鼠卵巢中ERα、ERβmRNA和蛋白的表达。结果RT-PCR和免疫组织化学结果都显示:老年模型组大鼠卵巢ERα、ERβmRNA和蛋白表达明显低于青年组(P<0.05),中药益坤宁组和西药利维爱组ERα、ERβmRNA和蛋白表达明显升高,与老年模型组相比有显著性差异(P<0.05或P<0.01)。结论中药益坤宁上调大鼠卵巢ERα、ERβ的表达,可能是治疗围绝经期综合征的作用机制之一。