Reproductive and Appetite Hormones and Bulimic Symptoms during Midlife

Eating disorders and related symptoms occur during midlife; however, little is known about their aetiology. It has been hypothesised that perimenopause represents a window of vulnerability for the development or exacerbation of eating disorder symptomatology because, like puberty, perimenopause is a period of reproductive hormone change. We compared symptoms of bulimia nervosa (bulimic symptomatology) assessed via mean scores on a self‐report questionnaire in premenopausal and perimenopausal women. We also examined the association between hormone concentrations (reproductive/appetite) and bulimic symptomatology. No mean differences in bulimic symptomatology were observed between premenopause and perimenopause. However, there was a significant positive association between leptin and binge eating. Although no significant associations between reproductive hormones and bulimic symptomatology were observed, additional research is needed to provide definitive information. It is essential to learn more about the aetiology of eating disorders and related symptomatology across the lifespan in order to develop age‐relevant treatment and prevention programs. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association.     

The management of perimenopausal abnormal uterine bleeding

Abnormal uterine bleeding in the perimenopause is a common gynaecological disorder and may affect 20–50 % of all women. It may be the first sign of premalignant or malignant disease. All women require assessment by means of pelvic ultrasound and an endometrial biopsy to exclude sinister pathology, identify other causes, and plan appropriate treatment. Pharmacological treatment includes antifibrinolytics, non-steroidal anti-inflammatories, combined hormonal contraception, cyclical progestogens and the levonorgestrel intrauterine system (LNG – IUS). Second line treatments may include endometrial ablation, uterine artery embolization, myomectomy or hysterectomy depending on the nature of the pathology. Minimal access techniques though the hysteroscopic, laparoscopic/robotic or vaginal route are increasingly used as the preferred surgical options. Novel treatments, either pharmacological or in the outpatient setting are likely to have a significant contribution in the future.     

玫瑰红芪当归水煎剂对围绝经期大鼠IL-2含量及Sparc表达的影响

目的观察玫瑰红芪当归水煎剂对围绝经期大鼠IL-2含量及Sparc表达变化的影响。方法通过手术切除Wistar♀大鼠双侧卵巢复制围绝经期综合征模型。造模后第7天用ELISA法检测血清雌二醇(estradiol,E2)含量确定造模是否成功,于造模成功后第2周将切除卵巢的大鼠随机分为模型组,玫瑰红芪当归水煎剂低、中、高剂量组(1.4,2.8,5.6 g·kg^-1)和戊酸雌二醇片组(0.09 mg·kg^-1),每组10只。另设10只Wistar♀大鼠作为正常组。末次给药24 h后,腹主动脉采血处死大鼠后,称取各组大鼠体质量,并计算其子宫指数及胸脾指数,HE染色法观察各组大鼠子宫组织形态学变化,ELISA法测定各组大鼠血清E2和白细胞介素-2(interleukin-2,IL-2)的含量,实时荧光定量PCR法检测各组大鼠富含半胱氨酸的酸性分泌蛋白(secreted protein acidic and rich in cysteine,Sparc)的基因表达,免疫组化法观察各组大鼠雌激素受体α(estradiol receptorα,ERα)的蛋白表达。结果与模型组相比,玫瑰红芪当归水煎剂中、高剂量组和戊酸雌二醇片组能明显降低大鼠的体质量,明显升高大鼠的子宫指数、胸腺指数、脾脏指数、Sparc的基因表达和ERα的蛋白表达(P<0.05);玫瑰红芪当归水煎剂各治疗组和戊酸雌二醇片组能明显升高模型组大鼠E2含量和IL-2的含量(P<0.05)。HE染色发现,玫瑰红芪当归水煎剂高剂量组和戊酸雌二醇片组子宫黏膜层出现腺体,单层柱状上皮细胞排列整齐。结论玫瑰红芪当归水煎剂治疗围绝经期综合征与调节机体内分泌-免疫系统有关,为临床应用和新药开发提供实验依据。     

Assessment of menopausal symptoms in different transition phases using the Greene Climacteric Scale among rural women of North India

Background: Menopause is the universal physiological process of women’s midlife and exhibits a wide variety of symptoms. However, there is little data on the menopausal symptoms and factors associated with their severity among rural Indian women.

Aim: To evaluate the prevalence of menopausal symptoms during the different transition phases of menopause among rural women of North India.

Subjects and methods: This cross-sectional study consisted of 351 women aged 35–55?years (mean age 44.6?years) residing in rural areas of North India. A structured questionnaire was used to collect data regarding menopausal status, demographic profile and reproductive history of the participants. Frequency and severity of menopausal symptoms were evaluated using the Greene Climacteric Scale in different stages of menopause. All statistical procedures were accomplished using SPSS version 19.0.

Results: In the present study the mean ages of attainment of menarche and menopause were 14.3?years and 47.2?years, respectively. Mean score of total Greene Climacteric Scale was highest among perimenopausal women (16.12?±?8.1) over post-menopausal (14.78?±?7.3) and pre-menopausal women (11.08?±?6.1). Logistic regression analysis revealed that advancing age, low educational attainment, low socioeconomic status, menopausal status, later age at menarche and higher BMI were all associated with more severe menopausal symptoms.

Conclusion: The climacteric symptoms were more prevalent among women who were perimenopausal followed by post-menopausal women and were the lowest in pre-menopausal women. Age, menopausal status, socio-economic status, and reproductive factors significantly influenced the severity of menopausal symptoms.     

米非司酮治疗围绝经期功能失调性子宫出血57例临床分析

目的:探讨米非司酮治疗围绝经期功能失调性子宫出血临床效果。方法:选择2003年9月~2006年1月在东莞市人民医院确诊为围绝经期功血的患者57例,每晚睡前空腹口服米非司酮12.5 mg,每天一次,连续6个月,于治疗前及治疗3个月、6个月分别检测性激素6项、肝肾功能及血常规,观察月经情况,B超监测子宫内膜厚度。结果:治疗期间所有患者均闭经,血促卵泡生成素(FSH)、促黄体生成素(LH)、泌乳素(PRL)、睾酮(T)变化不明显,血孕酮(P)和雌二醇(E2)水平明显(P<0.01);子宫内膜变薄,由用药前(1.0±0.3)cm至用药后(0.4±0.2)cm(P<0.05);血红蛋白均有不同程度的提高,贫血得到改善。结论:米非司酮治疗围绝经期功能失调性子宫出血是一种安全有效的治疗方法,值得临床推广。     

围绝经期非器质性失眠妇女肝郁与PI3K/Akt信号通路的相关性研究

[目的]探讨肝郁影响围绝经期非器质性失眠的可能免疫学机制。[方法]收集围绝经期非器质性失眠妇女150例,通过四诊信息的采集获得患者的肝郁证素积分、肝郁分级及匹兹堡睡眠质量指数(PSQI),运用蛋白免疫印迹法(Western Blot)检测外周血单个核细胞(PBMC)中磷脂酰肌醇3激酶(PI3K)、蛋白激酶B(Akt)和磷酸化蛋白激酶B(pAkt)的蛋白表达量,实时荧光定量PCR法(RT-QPCR)检测PBMC中PI3K、Akt的mRNA含量,酶联免疫吸附法(ELISA)检测白介素1-β(IL-1β)、肿瘤坏死因子-α(TNF-α)水平。观察围绝经期非器质性失眠妇女的肝郁分级、PI3K/Akt信号通路各指标(PI3K、Akt、pAkt的蛋白表达量,PI3K mRNA、Akt mRNA含量;IL-1β、TNF-α水平)和PSQI之间的相互关系。[结果] 1)围绝经期非器质性失眠妇女中,肝郁分级与PSQI、PI3K/Akt信号通路各指标均呈正相关(P0.01);IL-1β、TNF-α均与PSQI呈正相关(P0.01);PI3K、Akt与其相应的基因水平分别呈正相关(P0.01)。2)PSQI、PI3K/Akt信号通路各指标在不同肝郁分级间的差异均具有统计学意义(P0.01),且肝郁分级越高,PSQI和PI3K/Akt信号通路各指标含量越高。[结论]肝郁是诱发或加重围绝经期非器质性失眠的病因之一。是通过影响PI3K/Akt信号通路,促使PBMC中PI3K mRNA和Akt mRNA含量增加,经基因表达后使PI3K、Akt和pAkt蛋白含量上升,经一系列级联反应后,进一步提高血清中IL-1β与TNF-α的含量,最终影响围绝经期妇女非器质性失眠。故今后研究可考虑通过阻断PI3K/Akt信号通路以改善围绝经期妇女非器质性失眠。     

围绝经期高血压研究进展

围绝经期妇女合并高血压严重影响患者生活质量,其特点是血压波动较大,且伴有一系列植物神经功能紊乱症状。现代医学研究认为与围绝经期雌激素水平下降及胰岛素抵抗等机制相关,治疗上以控制血压为主,性激素替代疗法目前仍存有争议;中医认为其病机以肝肾阴虚为主,辨证施治以滋肾平肝为主。     

宫腔镜在绝经过渡期和绝经后子宫出血的应用价值

目的 探讨宫腔镜检查在诊治绝经过渡期和绝经后异常子宫出血的价值.方法 应用宫腔镜检查116例绝经过渡期和绝经后异常子宫出血患者,结合病理学作出病因诊断,同时进行相应治疗.结果 异常子宫出血的原因主要是子宫黏膜下肌瘤、内膜息肉、内膜增生和宫内节育器(IUD)伴子宫出血.宫腔镜诊断与病理诊断的符合率95.7%,B超诊断与病理诊断的符合率68.1%;宫腔镜诊断子宫内膜异常的灵敏度96.4%,特异性93.9%,阳性预测值96.3%.结论 宫腔镜检查在绝经过渡期和绝经后异常子宫出血的诊治中有重要价值.