Levonorgestrel intrauterine system (LNG-IUS) with conjugated oral equine estrogen: a successful regimen for HRT in perimenopausal women

BACKGROUND: This study was designed to assess the long-term efficacy (5 years) of the levonorgestrel-releasing intrauterine system (LNG-IUS) in protecting the endometrium from hyperplasia during estrogen replacement therapy in perimenopausal women. METHODS: Prospective, open, outpatient clinical trial in London and Oxford. Eighty-two women received oral conjugated equine estrogen 1.25 mg daily and LNG-IUS releasing 20 mug levonorgestrel per 24 h. Endometrial biopsy and histological assessment were performed annually. Endometrial thickness was measured by vaginal ultrasonography. RESULTS: Non-proliferative endometrium was present at the end of cycles 12, 24, 36, 48 and 60 in 98.6, 98.6, 95.5, 96.8 and 95.2% of the participants respectively. No endometrial hyperplasias were confirmed throughout a period of 60 cycles. The proportion of amenorrhoeic women increased from 54.4% at 12 cycles to 92.7% at the end of the study. The continuation rate per 100 women at 60 cycles was 79.84 (95% CI 71.0-88.6). CONCLUSIONS: The LNG-IUS with estrogen supplementation in perimenopausal women suppresses endometrial proliferation resulting in amenorrhoea and relieves vasomotor symptoms. The treatment regimen is well tolerated and provides an alternative strategy for perimenopausal women with the likelihood of increasing compliance.     

自凝刀子宫内膜射频消融术与宫腔镜子宫内膜电切术治疗围绝经期功血的临床疗效比较

目的:比较自凝刀子宫内膜射频消融术（BBT）与宫腔镜子宫内膜电切术（TCRE）治疗围绝经期功血的临床效果。方法:选取2015年5月-2016年12月在河南省许昌市建安区人民医院妇产科接受治疗围绝经期功血的患者96例,采用随机数字法分为对照组和观察组,每组患者各48例。对照组患者运用宫腔镜子宫内膜电切术治疗,观察组患者运用自凝刀子宫内膜射频消融术治疗。比较两组患者的临床疗效、治疗前后性激素水平、子宫内膜厚度、治疗前后血红蛋白水平、术中情况、住院时间及并发症情况。结果:观察组患者的总有效率为98%,对照组患者总有效率为94%,两组患者总有效率比较,差异无统计学意义（P>0.05）。两组患者性激素包括促卵泡激素（FSH）、促黄体素（LH）、睾酮（T）、催乳素（PRL）、孕酮（P）及雌二醇（E2）水平在治疗前、治疗后均无统计学差异（P>0.05）。 观察组患者术中出血量、手术时间及住院天数分别为（10.36±6.03）mL、（12.64±2.64）min、（2.15±1.29）d优于对照组（26.26±8.16）mL、（22.61±3.61）min、（3.64±1.74）d,差异有统计学意义（P<0.05）。观察组患者术后出血、发热等并发症发生率为2.08%低于对照组14.58%,差异有统计学意义（P<0.05）。两组患者治疗前子宫内膜厚度和血红蛋白水平比较无统计学差异（P>0.05）。观察组患者治疗后子宫内膜厚度[（3.49±0.97）mm]薄于对照组[（5.21±1.24）mm],患者治疗后,血红蛋白[（121.37±8.04）g/L]高于对照组[（101.51±10.28）g/L]（P<0.05）。结论:自凝刀子宫内膜射频消融术对围绝经期功能失调性出血疗效显著,恢复快、安全性高,对患者的内分泌激素水平无明显影响,值得临床推广应用。     

围绝经期女性胃食管反流病的临床特征分析

目的 分析围绝经期女性胃食管反流病(GERD)的临床特点,提高对该期女性GERD的认识.方法 对该院2014年1月至2015年12月门诊及住院确诊GERD的246例患者的临床资料、胃镜检查及24 h食管阻抗-pH监测结果进行回顾性分析;按性别将患者分为女性组和男性组,根据月经情况又将女性组分为围绝经期组和非围绝经组2个亚组,对比分析各组患者的临床特点.结果 女性组NERD所占比例较男性组高,以非典型症状为主诉的发生率也高于男性组,差异均有统计学意义(P＜0.05);女性组中围绝经期组、非围绝经组反酸发生率均低于男性组(P＜0.05);围绝经期组弱酸反流次数与非围绝经组和男性组比较差异均有统计学意义(P＜0.05).结论 围绝经期女性GERD多以非典型症状为主要表现,内镜、24 h食管阻抗-pH联合监测是诊断围绝经期女性GERD的选择.     

围绝经期非器质性失眠患者失眠严重程度与肝郁分级的相关性

目的 研究围绝经期妇女非器质性失眠严重程度(ISI)与肝郁的相互关系,为预防围绝经期非器质性失眠提供临床思路.方法 纳入围绝经期非器质性失眠妇女182例,根据朱文锋《证素辨证学》确定肝郁积分并分级,运用失眠严重程度指数量表进行失眠严重程度评估,统计分析ISI与肝郁积分的相互关系.结果 ISI在不同肝郁分级间的差异有统计学意义(F=3.209,P=0.024),且肝郁分级越高,ISI积分越高;样本总体的ISI评分与肝郁评分呈正相关(r=0.246,P=0.001);不同肝郁分级与不同失眠严重程度呈正相关(r=0.243,P=0.001).结论 围绝经期非器质性失眠妇女广泛存在不同程度的肝郁,且肝郁越严重,失眠程度越重.心理因素肝郁可诱发失眠,并且加重失眠的严重程度.     

针刺治疗阴虚型围绝经期综合征的临床观察

目的观察针刺治疗阴虚型围绝经期综合征的疗效。方法本研究采用随机对照的临床研究方法,观察针刺疗法治疗阴虚型围绝经期综合征的临床疗效。将阴虚型围绝经期综合征患者分为针刺组和更年安对照组,观察两组治疗前后的Kupperman指数,并进行疗效评价。结果针刺和更年安治疗均能改善阴虚型围绝经期综合征患者的临床症状,针刺组疗效优于更年安对照组。结论针刺治疗阴虚型围绝经期综合征疗效肯定。     

Lipid profile,inflammation, and oxidative status in peri- and postmenopausal women

Objective: To evaluate the effect of perimenopause and postmenopause on lipid profile, inflammation, and oxidative stress in women.

Methods: This cross-sectional study included 117 women (47?±?6 years) classified as perimenopausal (n?=?47), postmenopausal (n?=?40), or non-menopausal (n?=?30). In serum, we analyzed lipid profile, tumor necrosis factor-alpha (TNF-α), interleukin-1α (IL-1α), and C-reactive protein (CRP). Pro-oxidant status was assessed by thiobarbituric acid reactive substances (TBARS) and protein carbonyls. Antioxidant defense was performed by analysis of superoxide dismutase (SOD) and catalase activities.

Results: Compared to non-menopausal women, triacylglycerols (TG) were similar, total cholesterol and LDL-C were higher in perimenopausal and postmenopausal women, while HDL-C concentrations were decreased. TNF-α and IL-1α were higher in postmenopausal women, while CRP concentrations were elevated in both peri-and postmenopausal women (p?p?p?Conclusion: Menopausal transition and postmenopause were associated with dyslipidemia, inflammation, and unbalanced oxidative status exposing women to cardiovascular risk.     

长期木兰拳练习对围绝经期妇女腰椎和股骨近端骨密度及骨代谢相关激素水平的影响

采用双能Ｘ线吸收法（ＤＥＸＡ）、放免测定法对５５名围绝经期妇女进行测试,探讨围绝经期妇女长期进行木兰拳练习对骨密度及骨代谢激素的影响。结果表明,长期进行木兰拳练习的围绝经期妇女的骨密度与久坐工作者相比较;腰椎（Ｌ２－Ｌ４）、股骨颈（ＦＮ）、股骨近端（ＦＴＲＯ）和ＷＡＲＤＳ区（ＦＷＴ）的骨密度有显著性差异（Ｐ＜０．０５;骨代谢相关激素仅甲状旁腺素（ＰＴＨ）有显著性差异（Ｐ＜０．０５＝;同时发现,运动在围绝经期不同阶段的介入对骨密度亦有不同程度的影响。     

护理干预对围绝经期妇女心血管危险因素的影响

目的探讨护理干预措施对围绝经期妇女心血管功能的影响。方法将2012年1月-2013年1月来深圳妇幼保健院妇科门诊就诊,并诊断为围绝经期综合征200例患者随机分为常规口头宣教的对照组和进行围绝经健康教育、运动指导、饮食指导、心理护理等护理干预的实验组。干预前后测定两组患者的体质指数（BMI）、绝经症状评分、缺血性心血管疾病（ICVD）10年发病危险评估、踝肱指数（ABI）、总胆固醇、甘油三脂、血压的变化。结果实验组患者在护理干预治疗1年后绝经症状评分、ICVD评分、血压、总胆固醇等指标明显低于对照组及治疗前,差异均有统计学意义（P〈0．05）,其他指标没有明显改变。结论通过对围绝经期妇女采取护理干预措施,不仅能减轻患者的围绝经期症状,同时使ICVD评分、血压、总胆固醇均下降,从而降低围绝经妇女心血管疾病的发生率。     

围绝经期合并乳腺良性增生性疾病患者全程化药学服务模式构建与实践

目的:建立围绝经期合并乳腺良性增生性疾病患者的全程化药学服务模式,并评价激素补充治疗(hormone replace-ment therapy,HRT)用于这类特殊患者的有效性和安全性.方法:介绍某院更年期联合门诊服务于围绝经期合并乳腺良性增生性疾病患者的工作模式、团队构建和药师职责.统计分析142例乳腺良性增生性疾病...