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.     

从三阴中风探讨围绝经期综合征的经方证治规律

[目的]探讨并总结经方治疗围绝经期综合征的思路和规律。[方法]基于女性更年期的生理特点,从六经体系及其疾病传变规律的角度,结合《伤寒论》《金匮要略》等经方典籍的理法方药,总结围绝经期综合征的经方治疗规律。[结果]围绝经期综合征的基础病机为血虚中风、虚寒水饮、火热内扰,在此基础上可分为太阴中风和厥阴中风两大类。太阴中风偏营伤失养者,以养营解表为治则,治疗以黄芪桂枝五物汤及黄芪竹叶汤为主;太阴中风偏虚热夹饮者,以清热除饮为治则,治疗以芪芍桂酒汤及黄芪汤为主。厥阴中风偏寒热夹杂者,以分调水火为治则,治疗以柴胡桂枝干姜汤及柴胡桂枝汤为主;厥阴中风偏于水热蕴结者,以荡涤水热为治则,治疗以柴胡加龙骨牡蛎汤及大柴胡汤为主。[结论]从三阴中风来探讨围绝经期综合征的经方证治规律,可以为本病的临床诊疗思路提供较为可靠的辨证基础。     

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。     

Hormones, heart disease, and health: individualized medicine versus throwing the baby out with the bathwater

It is increasingly axiomatic that depression has widespread adverse physiological effects and, conversely, that a variety of physiological systems impact the risk for developing depression. This convergence of depression and altered physiology is particularly dramatic during midlife--a time during which reproductive failure presages dramatic increases in prevalence of both heart disease and depression. The potentially meaningful and illuminating links between estrogen deficiency, cardiovascular disease (CVD), and depression have largely been obscured, first by assertions, subsequently repudiated, that the perimenopause was not a time of increased risk of depression, and more recently by the denegration of hormone replacement therapy by initial reports of the Women's Health Initiative. Increasingly, however, research has led to unavoidable conclusions that CVD and depression share common, mediating pathogenic processes and that these same processes are dramatically altered by the presence or absence of estrogen (E2). This review summarizes data supporting these contentions with the intent of placing depression and estrogen therapy in their proper physiologic context.     

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.     

围绝经期女性子宫肌瘤转归影响因素及生活质量分析

目的:回顾性研究影响围绝经期子宫肌瘤患者转归的因素,分析手术治疗组及非手术治疗组生存质量上的差异,为此类患者治疗方案的选择提供依据.方法:随机选取在2012年—2021年于上海市静安区中心医院及复旦大学附属妇产医院就诊的围绝经期最大肌瘤直径在2～5 cm的女性中符合标准的320例患者.患者均完成调查问卷,按最后一次随访...     

中药益坤宁对围绝经期大鼠卵巢血管内皮生长因子表达的影响

目的:观察中药益坤宁对围绝经期大鼠卵巢血管内皮生长因子(Vascular endothelial growth factor,VEGF)表达的影响。方法:采用自然老化法建立围绝经期大鼠模型。选择处于围绝经期的雌性Wistar大鼠(12~14月龄)30只,随机分为老年对照组、西药对照组和中药实验组,分别以生理盐水、利维爱和益坤宁灌胃4周;另取5月龄大鼠10只作为青年对照组,生理盐水灌胃4周。通过免疫组化观察大鼠卵巢VEGF蛋白质的表达确切部位;Western Blot定量检测大鼠卵巢VEGF蛋白质的表达;RT-PCR检测各组大鼠卵巢VEGF mRNA的表达。结果:VEGF蛋白主要表达于卵巢的黄体细胞中,老年对照组大鼠卵巢的VEGF表达明显高于青年组,中药实验组大鼠卵巢VEGF表达明显下降;青年对照组、中药实验组和西药对照组VEGF164和VEGF120的mRNA表达量均低于老年对照组(P<0.05),此结果与VEGF蛋白表达的结果相一致。结论:益坤宁能够下调围绝经期大鼠卵巢VEGF mRNA及蛋白的表达,这可能是其治疗围绝经期综合征的机制之一。     

围绝经期及绝经后阴道出血428例病因分析

目的：分析围绝经期及绝经后阴道出血的原因。方法：回顾性分析428例围绝经期及绝经后阴道出血患者资料。结果：围绝经期及绝经后阴道出血的主要原因为炎症性疾病,占45．3％。其次为功能失调性子宫出血和子宫肌瘤,约占38．6％。恶性肿瘤居第三位,约占14．0％。结论：围绝经期及绝经后阴道出血的原因主要为炎症性疾病和子宫良性疾病。恶性肿瘤虽少,但老年妇女发病率在增高,需引起重视。     

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。     

围绝经期大鼠动情周期变化的研究

目的：观察围绝经期大鼠动情周期的改变。方法连续15天对47只12月龄雌性Sprague-Dawley（ SD）大鼠进行阴道脱落细胞涂片,观察大鼠动情周期的变化。结果大部分大鼠动情周期变化不规则,其中以动情后期和动情期延长为主,发生例数分别占动物总数的76.6％和38.3％。结论12月龄大鼠已经进入围绝经期,并且动情周期发生紊乱,以动情后期和动情期延长为主要表现。