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OBJECTIVE To evalu ate the effects of perimenopausal one-day outpatient multidisciplinary model on the cognition of women to menopause hormone therapy （MHT）. METHODS The perimenopausal one-day outpatient service opened by the Third Affiliated Hospital of Chongqing Medical University in 2017 was introduced ，which was participated by doctors ，pharmacists， nutritionists，music psychotherapists ，nurses and other multidisciplinary members to provide systematic ，all-round，humanistic and face-to-face group science popularization and education ，practical experience and Q&A for women in perimenopause or about to enter perimenopause （called“students”）. The students who participated in one-day outpatient service in 2020 were selected as the survey object ， and the questionnaire was CMEI2020KPYJ（ZAMM）00206] designed to analyze the understanding of perimenopausal syndrome，awareness rate of MHT ，willingness to use and concerns. RESULTS A total of 295 students completed the questionnaire. Compared with before participation ， after participated in one-day outpatient service ，the cognition level of the students were all improved significantly ，including perimenopausal age （96.61％ vs. 99.32％，P＝0.037），the importance of perimenopausal health care knowledge （91.19％ vs. 96.95％，P＜0.001），whether the perimenopausal syndrome needs treatment （88.47％ vs. 99.32％，P＜0.001），willingness to use MHT （70.59％ vs. 94.48％ ，P＜0.001），MHT treatment timing （60.50％ vs. 95.17％ ，P＜0.001），reducing the risk of cardiovascular disease （51.68％ vs. 96.55％ ，P＜0.001），delaying aging （69.75％ vs. 97.59％ ，P＜0.001），preventing osteoporosis（65.13％ vs. 97.59％），P＜0.001）；the medical staff were higher than the non-medical staff （P＜0.05）. Totally 90％ of the students said they had gained knowledge about the prevention and treatment of common diseases ，nutrition and guidance， psychological regulation guidance hormone therapy related knowledges and exercise methods ；the proportion of the students who were willing to use MHT for 1 to 5 years（31.09％ vs. 47.93％）increased significantly. The proportion of the students who concerned about the risk of thrombosis （60.24％ vs. 36.81％），weight gain （59.64％ vs. 14.84％）and life-long dependence （52.41％ vs. 18.13％）was significantly reduced ，but that of the students who concerned about cancer risk was not diminished. From 2017 to 2020，the utilization rate of MHT was increased from 2.22％ to 62.16％ in non-medical staff among the students. CONCLUSIONS The multidisciplinary model of perimenopausal one-day outpatient service can improve the awareness of MHT among perimenopausal women ，eliminate misunderstandings ，and increase the utilization rate of MHT.
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This article gives a review on domestic and foreign researches on the non-drug intervention for patients with perimenopausal depression published from 2012 to 2022， so as to provide a reference for clinical treatment and nursing. Currently， pharmacotherapy is the mainstay of treatment for perimenopausal depression， while many existing problems remain to be solved such as the variation in treatment effect and the difficulty in maintaining emotional stability. however，high safety and relatively low cost are the characteristics of non-drug intervention， so this article expounds on the non-drug intervention measures for perimenopausal depression， such as music therapy， dietary therapy， exercise therapy， acupuncture therapy and repetitive transcranial magnetic stimulation （rTMS）.
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Objective:To observe the clinical efficacy of the modified Buzhong Yiqitang combined with Erxian decoction in treating stress urinary incontinence （SUI） of perimenopausal women due to spleen and kidney Qi deficiency. Method:One hundred and six patients were randomly divided into a control group （52 cases） and an observation group（54 cases）. Patients in both groups received lifestyle intervention and pelvic floor muscle training （PFMT）. On this basis， patients in the observation group were further treated with the modified Buzhong Yiqitang combined with Erxian decoction， 1 bag/day， while those in the control group were provided with Suoquan pills， 6 g/time， 2 times/day， for eight weeks. Following the international consultation on incontinence questionnaire-short form （ICIQ-SF） scoring before and after treatment， the urodynamic parameters such as maximum urinary flow rate （Q<sub>max</sub>）， maximum urethral closure pressure （MUCP）， residual urine volume （RUV）， abdominal pressure leakage point pressure （ALPP）， and bladder capacity （BC） were measured. The number of incontinence episodes per 24 h， the degree of urinary incontinence， the amount of 1 h urine leakage， and the spleen and kidney Qi deficiency syndrome score were recorded before and after treatment. The levels of estradiol （E<sub>2</sub>）， follicle stimulating hormone （FSH）， pituitary adenylate cyclase activating peptide （PACAP）， and vasoactive intestinal peptide （VIP） were measured before and after treatment. Result:The ICIQ-SF sub-scores of the urinary incontinence frequency， severity， and impact on quality of life as well as the total score in the observation group were all lower than those in the control group （<italic>P</italic><0.01）. Q<sub>max</sub>， MUCP， ALPP and BC in the observation group were elevated in contrast to those in control group （<italic>P</italic><0.01）， while the RUV declined （<italic>P</italic><0.01）. Compared with the control group， the observation group exhibited a decreased number of incontinence episodes per 24 h， milder degree of urinary incontinence， reduced amount of 1 h urine leakage， and lower spleen and kidney Qi deficiency syndrome score （<italic>P</italic><0.01）. The E<sub>2</sub>， PACAP， and VIP in the observation group were up-regulated as compared with those in the control group （<italic>P</italic><0.01）， whereas the FSH was down-regulated （<italic>P</italic><0.01）. The cure and effective rates of the observation group were （29/50） 58.00% and （47/50）94.00%， respectively， significantly better than （18/48）37.50% and （38/48）79.17% of the control group （<italic>χ</italic><sup>2</sup>=4.124， <italic>χ</italic><sup>2</sup>=4.683， <italic>P</italic><0.05）. Conclusion:On the basis of the lifestyle intervention and PFMT， the modified Buzhong Yiqitang combined with Erxian decoction obviously alleviates urinary incontinence， adjusts sex hormones， PACAP and VIP， ameliorates urodynamic parameters， and enhances the quality of life of patients with SUI due to spleen and kidney Qi deficiency. The resulting cure and effective rates are superior to those of the positive control.
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OBJECTIVE@#To compare the therapeutic effect of acupuncture combined with wheat-grain moxibustion and oral fluoxetine hydrochloride capsule on perimenopausal depression with kidney deficiency and liver depression.@*METHODS@#A total of 60 patients of perimenopausal depression with kidney deficiency and liver depression were randomized into an observation group and a control group, 30 cases in each one. Acupuncture combined with wheat-grain moxibustion were adopted in the observation group. Acupuncture was applied at Baihui (GV 20), Yintang (GV 29), Fengchi (GB 20), etc. for 30 min. Wheat-grain moxibustion was applied at Ganshu (BL 18), Shenshu (BL 23), Mingmen (GV 4) and Yongquan (KI 1), 3 moxa-cones for each acupoint. The treatment in the observation group was given once every 2 days, 3 times a week. Fluoxetine hydrochloride capsule was given orally in the control group, 20 mg each time, once a day. Treatment for 8 weeks was required in the both groups. The scores of Hamilton depression scale (HAMD) and modified Kupperman scale were observed in the both groups before and after treatment, and at 1, 3, 6-month follow-up. The therapeutic efficacy was evaluated after treatment.@*RESULTS@#Compared before treatment, the scores of HAMD and modified Kupperman scale after treatment and at each time point of follow-up were decreased in the both groups (@*CONCLUSION@#Acupuncture combined with wheat-grain moxibustion can effectively treat perimenopausal depression with kidney deficiency and liver depression, and have more stable and sustained therapeutic effect compared with oral fluoxetine hydrochloride capsule.
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Humans , Acupuncture Points , Acupuncture Therapy , Depression/therapy , Kidney , Liver , Moxibustion , Perimenopause , Treatment Outcome , TriticumABSTRACT
Objective To study Curative efficacy of Oryzanol combine with Dingkundan in treatment of perimenopausal period and its effects on endocrine improvement.Methods 90 patients of perimenopausal period who received therapy from March 2014 to March 2015 in our hospital were selected as research objects.According to draw method divided into the experimental group(n=45)and the control group(n=45).Two groups of patients were psychological support.The control group was treated with Oryzanol, each 10 mg, 3 times a day.while the experimental group was on the control group, treated with Dingkundan, 1 pills each time, 2 times a day, in the morning and evening.Then Serum estradiol(E2), Follicle stimulating hormone(FSH), Luteinizing hormone(LH)level, upset hot sweating, insomnia, irritability, hung up improve time, Kupperman score, clinical efficacy of two groups were compared.Results The E2 level in experimental group was significantly higher than the control group[(72.51±5.30)pg/mL vs.(66.80±4.75)pg/mL](P<0.05), FSH、LH level was significantly lower than the control group[(21.36±1.05)mIU/ml vs.(26.09±1.89)mIU/mL,(24.34±1.01)mIU/mL vs.(20.61±1.50)mIU/mL](P<0.05);upset hot sweating, insomnia, irritability, hung up improve time was significantly lower than the control group[(11.21±2.35)d vs.(20.05±5.07)d,(12.78±2.09)d vs.(18.32±4.13)d,(11.30±2.10)d vs.(20.16±5.02)d,(10.20±2.76)d vs.(16.58±4.03)d](P<0.05);Kupperman score was significantly lower than the control group[(4.32±1.09)score vs.(12.76±3.16)score](P<0.05);total effective rate was significantly higher than the control group[93.33%(42/45)vs.75.67%(34/45)](P<0.05).Conclusion Oryzanol combine with Dingkundan is well for perimenopausal period,which can significantly improve endocrine disorders, promote its balance, improve estrogen.
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Objective:To compare the clinical effects and improvement of serum hormone levels of kidney tonifying and blood circulation recipe and mirena in the treatment of perimenopasual dysfunctional uterine bleeding.Methods:92 cases of perimenopausal patients with dysfunctional uterine bleeding in our hospital from July 2013 to November 2016 were selected and divided into group A and group B with 46 cases in each group.Group A was orally administered with kidney tonifying and blood circulation recipe,and group B was administered with mirena.Both groups were treated for 3 periods.The efficacy and incidences of adverse effect in two groups were observed.The levels of serum hormones and hemoglobin (Hb),and endometial thickness (ET) were detected in two groups.The indices of serum hormone included follicle-stimulating hormone (FSH),luteinizing hormone (LH),progestone (P) and estradiol (E2).Results:No significant difference was found in the total effective rate between two groups (P＞0.05).After treatment,the levels of serum FSH,LH,E2 and P as well as ET and Hb in both groups were all significantly lower than those before treatment (P＜0.01),and the levels of serum FSH,LH,E2 and P as well as ET of group B were significantly lower than those of group A (P＜0.01),no significant difference in the Hb level between two groups (P＞0.05).The incidence of adverse reactions of group B (15.22％) was significantly higher than that of group A(0％) (P＜0.01).Conclusions:The kidney tonifying and blood circulation recipe had similar effect as mirena in the treatment of perimenopasual dysfunctional uterine bleeding,while mirena had strong improving effect in serum hormone level and ET,kidney tonifying and blood circulation recipe had higher security.
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OBJECTIVE:To investigate the effect of Danggui shaoyao powder (DSS) on uterine structure and expressions of estrogen receptorα(ERα),estrogen receptorβ(ERβ)in uterine cavity epithelium and matrix in model rats in perimenopausal peri-od. METHODS:40 female SD rats were randomly divided into sham operation group (normal saline),model group (normal sa-line),DSS low-dose,medium-dose,high-dose groups(1.94,3.87,7.44 g/kg),8 in each group. Except that rats in sham opera-tion group received resection of fat nearby ovaries,rats in other groups received resection of bilateral ovaries to induce models in perimenopausal period. After modeling,rats were intragastrically administrated once a day,for 8 weeks. After administration,wet mass of uterine was weighted. Changes in uterine morphology and structure of rats were observed,expressions levels of ERα and ERβ in uterine cavity epithelium and matrix were determined. RESULTS:Compared with sham operation group,rats in model group showed low columnar in endometrial columnar epithelium,lamina propria layer,muscular layer and serous layer were signifi-cantly atrophied,stromal cells had obvious nuclear condensation. There was marked decrease in uterine wet mass,uterine cavity ar-ea and endometrial thickness as well as the number of uterine glands(P<0.01),and the expression levels of ERαand ERβin uter-ine cavity epithelium and matrix were significantly reduced(P<0.01). Compared with model group,the atrophy degree of endome-trium and lamina propria layer had no significant differences in DSS each dose groups. However,lamina propria layer was rich in glands,and there were significant differences in uterine wet mass,uterine cavity area,endometrial thickness,ERα expression level in uterine cavity epithelium and matrix (P>0.05). However, the number of uterine glands in DSS medium-dose,high-dose groups was significantly increased(P<0.01),and ERβexpres-sion level in uterine cavity epithelium and matrix in DSS high-dose group was significantly increased (P<0.05 or P<0.01). CONCLUSIONS:DSS has not obvious effect on im-proving the symptoms of uterine gland atrophy of model rats in perimenopausal period,but it can increase the number ofuterine glands,and the mechanism may be associated with improving the ERβ expression level in uterine cavity epithelium and ma-trix.
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Objective To investigate the effect of Simoyinzi Decoction on serum 5-HT and inflammatory factors in the treatment of perimenopausal women with early onset of severe depression.Methods 82 cases of perimenopausal women with primary severe depression were selected and randomly divided into 2 groups, 41 cases of each group.Control group received basic medicine treatment, the research group received Simoyinzi Decoction treatment,serum neurotransmitter, inflammatory factor and sex hormone levels were detected before and after the treatment, and clinical symptom score and clinical curative effect were compared after the treatment.Results Compared with before treatment, levels of noradrenaline norepinephrine(NE), 5 serotonin(5-HT), dopamine(DA), glutamate(Glu) and N-methyl-D-aspartate(Asp) increased in 2 groups after treatment, levels of gamma amino acid (GABA) and glycine(Gly) decreased, levels of follicle stimulating hormone(FSH) and luteinizing hormone(LH) decreased, levels of estradiol(E2) increased, levels of IL-1β, IL-6, TNF-αand CRP decreased, scores of HAMD and Kupperman decreased, the differences were statistically significant (P<0.05), compared with the control group, levels of NE, 5-HT, Glu and Asp in the research group after treatment were higher, levels of GABA and Gly were lower, levels of FSH and LH were lower, levels of E2 were higher, levels of IL-1β, IL-6, TNF-αand CRP were lower, and scores of HAMD and Kupperman were lower, the differences were statistically significant(P<0.05), and the effective rate in the control group(70.73%) was lower than the research group ( 90.24%) ( P <0.05 ) .Conclusion Simoyinzi Decoction in the treatment of perimenopausal women with early onset of severe depression was curative effective, and it can improve the 5-HT and reduce the levels of inflammatory factors.
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Objective To investigate the effects of uterine benign disease in perimenopausal women underwent simultaneous hysterectomy and bilateral salpingectomy on pelvic pseudocyst,ovarian function and symptoms of peri-menopausal period.Methods Nine hundred and ninety-three patients with benign uterine disease underwent hysterectomy of total or subtotal uterus were selected as our subjects,who hospitalized from Jan 2005 to Dec 2009.All patients were followed up for 36 months,and 235 patients were lost.The rest 758 patients included 438 patients underwent simultaneous hysterectomy and bilateral salpingectomy,who were served as study group,and 320 patients underwent only hysterectomy were served as control group.The occurrence of pelvic pseudocyst,symptoms of peri-menopausal period and the changes of serum sexual hormone were observed.Results (1) The rate of pelvic pseudocyst was 1.6％ (7/438) in study group,which was significantly lower than that in control group (4.4％ (14/320),x2 =10.962,P =0.026).(2) Follicle-stimulating hormone (FSH) in study group at 6 months and 12 months after surgery were (17.7 ±2.3) U/L and (26.8±5.1) U/L,higher than that in control group((12.3 ±2.9) U/L,(22.4 ± 3.2) U/L,t =-1.020,-1.162,P ＜ 0.05);FSH in study group(34.0 ± 6.8) U/L was lower than that in control group (39.1 ± 4.9) U/L at 36 months after surgery,and the difference was statistically significant (t =-1.209,P ＜ 0.05).At 3 months and 12 months after surgery,luteinizing hormone (LH) in study group were (14.0 ± 2.3) U/L and (26.2 ± 3.1) U/L,higher than that in control group ((11.7 ± 2.6) U/L,(21.6 ± 1.9) U/L; t =-1.421,-0.962,P ＜ 0.05).Estradiol in study group was (90 ± 23) pmol/L,lower than that in control group((110 ± 18) pmol/L) at 24 months after surgery(t =-1.502,P ＜0.05).(3) At 6 months after surgery,the rate of perimenopausl systems was 21.7％ (95/438) in study group,higher than that in control group (14.1％ (45/320),x2 =9.102,P =0.027).However,at 24 months after surgery,the rate of perimenopausal symptoms in control group was 60.6％ (194/320),higher than that in study group (47.0％ (206/438),x2 =7.620,P =0.039).Conclusion Simultaneous hysterectomy and bilateral salpingectomy could decrease the occurrence of pelvic pseudocyst and peri-menopausal symptoms nearly equivalent to that of hysterectomy only in patients with benign uterine diseases.
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Objective To observe the effect of freeze-dried sea cucumber powder in the treatment of patients with kidney-yang deficiency of perimenopause syndrome ,and to observe its effect on the levels of gonadal hormone . Methods 30 patients with kidney-yang deficiency of perimenopause syndrome were selected ,the changes of the Kup-perman score,the clinical effect and the levels of serum E2,FSH and LH before and after treatment were observed. Results After treatment,the clinical symptoms were significantly improved and the total effective rate was 90%.The improvement of Kupperman scores had significant difference (P<0.01).The serum level of E2 was increased signifi-cantly after treatment (P<0.05),while the serum levels of FSH and LH were decreased significantly (P<0.05). Conclusion Freeze-dried sea cucumber powder in the treatment of patients with kidney-yang deficiency of perimeno-pause syndrome has preferable clinical effects and can modify gonadal hormone levels .
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Sleep disorders are main clinical symptoms in perimenopausal women. The symptoms are difficulty in initiating or maintaining sleep, early morning awakening and so on. These sleep problems had made serious im-pacts on the quality of women's life during menopausal periods. Menopausal sleep disorders can be caused by changes of serum estrogen levels, vasomotor symptoms, mood disorders and patient's state of disease. This paper presented an overview of inducing factors and current situation of menopausal disorder treatment.
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Objective To research the safety of intrauterine device retention during perimenopausal period. Methods The form of questionnaire was used to investigate women in perimenopausal period in this district. We selected 300 women using intrauterine device as observing group and 300 using other contraceptive methods. Not using intrauterine device ) as control group. The enrolled subjects were given consultation and health examination and the menstruation state waist and abdomen's pain and the occurrence of gynecological inflammation were compared between two groups. Results There was no statistically significant difference in the menstrual blood volume of women in perimenopausal period between two groups (P>0.05).There was statistically significant difference in the incidence of pain in waist or abdomen in women in perimenopausal period between two groups (P<0.05). The incidence of gynecological inflammation in women in perimenopausal period was 63.33%and 59.67%in the observing group and control group respectively and there was no statistically significant difference between two groups. Conclusion Intrauterine device retention during perimenopausal period has no impact on women' menstruation state and gynecological inflammation,but is relevant with waist and abdomen's pain.
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Objective:To investigate the clinical effects of levonorgestrel-releasing intrauterine device(LNG-IUD) in the treatment of adenomyosis in perimenopausal period. Methods: A total of 92 patients with adenomyosis in perim enopausal period were treated with LNG-IUD and followed up at the 3rd,6th, 12th,24th month. Change of menses, uterine volume,visual analogue scale (VAS) of dysmenorrhea,the serum CA_(125) level and degree of satisfaction with the treatment were observed. Results:The dysmenorrhea was alleviated along with the follow-up time in all of the pa tients after insertion of the LNG-IUD ( P<0.05). The menstrual volume, uterine volume and serum CA_(125) level were decreased significantly(P<0.05) .Conclusions:LNG-IUD is a safe, effective and simple treatment of adenomyosis in perimenopausal period.
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0.05). However, incidence of amenorrhea and degree of endometrium atrophy were higher in patients treated with mifepristone than in those with esogestrel-ethinylestradiol(P
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@#Objective To observe curative effect of mental therapy on women perimenopausal period syndrome.Methods 100 patients with perimenopausal period syndrome were randomly divided into the treatment group and control group with 50 cases in each group. Patients of the treatment group were treated by Cryzanolam, Surazepam, etc,and mental therapy was given simultaneously twice one week. Patients of the control group were treated only by drugs. The period of treatment was four weeks. The curative effect was assessed by SCL-90 symptom self evaluation scales.Results Several factors and total average points of two groups' SCL-90 all dropped, and there was significant difference between two groups after therapy (P<0.01). For patients of the treatment group, clinic symptoms were markedly abated after treatment (P<0.05), and average scores of several factors were not significantly different from normal adults (P>0.05). Conclusion The mental therapy can remit symptoms of women perimenopausal period syndrome effectively and improve their healthy.
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BACKGROUND: Although it is well known that bone mineral density (BMD) loss occurs after menopausal transition, there are only few previous studies that describe differences of BMD and biochemical bone markers in women of pre- and postmenopausal periods. The purpose of this study was to find factors that contribute to loss of BMD after menopause and to show changes of BMD and biochemical bone markers during pre- and postmenopausal periods by retrospective cohort study. METHODS: This retrospective cohort study was performed from Jan. 1995 to Jan. 2001 at a health promotion center. Twenty one healthy perimenopausal women were enrolled. BMD and biochemical bone markers were checked more than two times during the study period. Changes of BMD and biochemical bone markers between pre- and postmenopausal state were compared by paired t-test. Pearson correlation and multiple regression were performed to find the contributing factors to loss of BMD after menopause. RESULTS: Postmenopausal BMD (164.65 36.34 mg/cm3) was significantly decreased to 16.49 16.91 mg/cm3 (P<0.001) as compared with premenopausal BMD (181.14 40.81 mg/cm3). In biochemical bone markers only urine deoxypyridinoline had a significant difference (3.30 3.97 nMDP/mMcre, P<0.05) Only premenopausal BMD contributed to decreasing rate of BMD between the two states and the loss of BMD after menopause (P<0.05). CONCLUSION: In perimenopausal healthy women, postmenopausal BMD was significantly decreased as compared with premenopausal BMD. And only premenopausal BMD was shown to be a contributing factor to decreasing rate of BMD between the two states and the loss of BMD after menopause. It suggests that premenopausal BMD is important in predicting postmenopausal osteoporosis and efforts to prevent loss of BMD before menopause can prevent progress of postmenopausal osteoporosis.