绝经过渡期妇女性激素变化的特点及月经模式的改变

Endocrine characteristics and menstrual patterns of women during menopausal transition

目的探讨绝经过渡期妇女卵巢功能衰退对月经模式的影响。方法 2008年6月至2010年12月在首都医科大学附属复兴医院选择177例就诊的妇女作为研究对象。根据近1年月经周期变化分为3组:生育期组:39例,年龄(37.2±6.4)岁,月经周期规则。绝经过渡组:该组根据月经周期的特点又分为:绝经过渡期早期组(MT早期组):55例,年龄(44.5±3.1)岁,月经周期变异>7d,但停经<60d;绝经过渡期晚期组(MT晚期组):59例,年龄(48.4±3.5)岁,停经≥60d或月经越过≥2个周期,但停经<12个月。绝经组:24例,年龄(54.2±4.7)岁,停经≥12个月。研究对象抽静脉血测定:卵泡刺激素(FSH),黄体生成素(LH),雌激素(E2),抑制素B(InhB),抗苗勒管激素(AMH)。结果生育期组、MT早期组,MT晚期组、绝经组4组AMH、InhB、FSH值比较,差异有统计学意义(P<0.01);生育期组与MT晚期组及绝经组间LH比较差异有统计学意义(P<0.05);绝经组与各组间E2比较,差异有统计学意义(P<0.01)。将177例入组对象按年龄分组后,结果显示在40岁以前,入组女性月经周期保持规律;40～44岁女性,约35%出现月经周期变化;在45～49岁组,52%月经不规则,17.4%进入绝经期。当年龄超过50岁后,仅4.7%的女性有规律月经,31%的女性出现月经不规则,63%女性进入绝经期。各组月经模式变化比较差异有统计学意义(P=0.0012)。结论绝经过渡期妇女性激素、AMH、InhB值变化是卵巢功能减退的敏感指标;月经模式出现变异、增龄也可作为卵巢功能衰竭的参考依据。

Objective To investigate the effect on the menstrual pattern of decline of ovarian function in women during menopausal transition. Methods 177 cases of women in our hospital were analyzed in this study. The subjects were divided into three groups according to the change of the menstrual cycle in a year. Reproductive period group ： 39 cases, age 37.2 ±6. 4 years, woman＇s menstrual cycles remain regular,the menopausal transition group： according to the characteristics of the menstrual cycle was divided into： early menopausal, transition group （EMT group） ： 55 cases, age 44. 5 ±3. 1 years, the cycle length changed by seven days or more （ variable cycle length more than 7 days hut amenorrhea less than 60 days） ;late menopausal transition group （LMT group） ： 59 cases, age 48.4 ±3.5 years, was characterized by two or more skipped menstrual cycles and at least one intermenstrual interval of 60 days or more . Postmenopausal group ： 24 cases, age 54. 2 ± 4. 7 years. Menopause was the anchor point that defined after 12 months of amcnorrhea following the final menstrual period. Serum was assayed in all cases including follicle-stimulating hormone （ FSH ） , luteinizing hormone （LH）, estrogen （E2 ）, inhibin B （InhB）, anti-Mullcrian hormone （AMH）. Results Value of AMH, InhB, FSH among four groups were the difference ,P 〈 0. 01. There was statistical significance of LH value among reproductive group , LMT group and postmenopausal group,P 〈0. 05. Postnlenopausal group compared with other groups,E2 value was significant lower,P 〈 0. 01. 177 cases were divided into 4 groups according to age. The results showed that the menstrual cycle to keep regular before the age of 40; 35% women age between 40-44 years whose menstrual cycle changed ; 52% women age between 45 -49 ,the menstrual become irregular, otherwise 17.4% get into menopause period. When over 50 years of age, only 4. 7% of women with regular menstrual cycle, 31% of the women appeared irregular menstruation, 63% women enter menopause. By chi-square test, comparison of the percentage change in menstrual pattern is very significant,P =0. 0012. Conclusion Change of AMH, lnhB, FSH value was a sensitive indicator of ovarian function decline; menstrual pattern variation as well as aging can also be cline; menstrual pattern variation as well as aging can also be used as the reference for ovarian failure.