The Impact of Breastfeeding Pattern on the Duration of Lactational Amenorrhoea in Chengdu, China

Objective To determine the relation between infant feeding practices (and other factors) and the duration of postpartum amenorrhoea in a sample of Chinese women Subjects &. Methods Infant feeding and the return of menses were measured longitudinally in 541 mothers and their infants in Pengxian County, Sichuan Province. The durations of breastfeeding and of lactational amenorrhoea were estimated through survival analysis. Cox's non-parametric hazards regression analysis was performed to determine the variables associated with the duration of lactational amenorrhoea. Results Mothers breastfed frequently per day, the mean frequency ranging from 6. 4 per day at 3 weeks postpartum to 5. 4 per day at 6 months. They breastfed for over 18. 3 months on average. The median duration of lactational amenorrhoea was 9. 5 months. The period from birth until the first breastfeed was a significant determinant of the duration of lactational amenorrhoea, P = 0. 038. Compared with women who ended full breastfeeding earlier, those who ceased full breastfeeding at 120 to 24C days returned to menses significantly sooner (risk ratio = 1. 34; 95% CI = 1. 06-1. 69). This finding is probably spurious since no relationship between full breastfeeding duration and the return of menses was found among women -who ended full breastfeeding after 240 days. Conclusion The most important determinant of the return of menses was the delay in the first breastfeed after birth, suggesting that the Ten Steps to Successful Breastfeeding should be more precisely implemented.

浅从“女子不月”论治青春期女童月经迟潮

基于《黄帝内经》中“女子不月”的相关论述,浅析青春期女童月经迟潮的中医病因病机及治疗。青春期女童的月经迟潮,病因上多以肾虚为本,兼有脾虚而气血生化乏源,在标与肝郁气滞密切相关,因此治疗上以调补脾肾为主,兼以疏肝解郁,行气活血。并附验案1则以兹探讨。

高泌乳素血症与不孕症关系的探讨

目的 :探讨高泌乳素 (PRL)血症对女性不孕症的影响及治疗结局。方法 :对 182 0例不孕症进行血清内分泌放射免疫测定后 ,分析其中 30 8例高 PRL 血症不孕症患者的 PRL 值与月经异常症状及雌激素 (E2 )水平的关系 ;观察接受溴隐亭药物治疗后的妊娠情况。结果 :由高 PRL 血症所致的不孕症占 16 .9% ,其在原发性不孕症所占的比率明显高于继发性不孕症 (χ2 =5 6 .4 88,P <0 .0 1) ;随着 PRL 值升高 ,闭经的概率增加 (χ2 =12 4 .32 8,P <0 .0 1) ;PRL 值与 E2 水平呈负相关 (r=- 0 .72 4 ,P <0 .0 1) ;接受治疗的 2 16例中 ,妊娠率为 84 .7% ,流产率为 2 3.5 %。结论 :高 PRL 血症是不孕症、尤其是原发性不孕症的重要原因 ,PRL 值的高低与闭经症状及 E2 水平关系密切。这些患者经过溴隐亭治疗后 ,其妊娠率高。

补肾调肝、祛湿活血周期用药法治疗多囊卵巢综合征——不孕疗效研究

目的:探讨调补肝肾、祛湿活血周期用药法治疗多囊卵巢综合征(PCOS)—不孕的机理和临床疗效。方法:选择2015年至2017年间肾虚湿阻血瘀型PCOS-不孕37例患者作为观察对象,对其采用调补肝肾,祛湿活血周期用药法治疗,给于自拟"补肾调肝祛湿活血方",以其自身治疗前后为对照,以月经周期为疗程,连续服药治疗6个疗程后,观察患者各项生化指标的变化和临床疗效。结果:用药治疗后患者月经周期规律,超声"多滤泡样改变"均有明显改善,受孕率达到81.08%。结论:补肾调肝祛湿活血周期用药法对PCOS-不孕(证属肾虚湿阻血瘀型)患者有良好的治疗作用。可能与调节肌体代谢和内分泌状态,降低促黄体生成素(LH)、睾酮(T)水平,提高促卵泡激素(FSH)水平,调节LH/FSH比值,改善生殖生育机能等有关。

滋肾活血方治疗多囊卵巢综合征临床观察

目的观察滋肾活血方治疗多囊卵巢综合征的临床疗效。方法将60例多囊卵巢综合征患者随机分为治疗组和对照组各30例。治疗组予滋肾活血方,对照组予达英-35,均治疗6个月。观察各组治疗前、治疗6个月后及停药3个月经周期血清黄体生成素(LH)、卵泡刺激素(FSH)、睾酮(T)水平及卵巢B超的变化情况,并评价临床疗效。结果停药3个月经周期后,治疗组、对照组临床总有效率分别为96.7%7、0.0%;组间临床疗效比较,差异有统计学意义(P<0.05)。治疗组、对照组妊娠例数分别为4例(13.3%)0、例(0.0%),组间差异有统计学意义(P<0.01)。组内比较,治疗组治疗前后FSH、LH、T水平差异有统计学意义(P<0.05,P<0.01),停药3个月经周期较治疗后的各项指标差异无统计学意义(P>0.05);对照组治疗前后LH、T水平差异有统计学意义(P<0.05,P<0.01),停药3个月经周期较治疗后T水平差异有统计学意义(P<0.05)。组间同期比较,治疗后及停药3个月经周期各项指标差异均有统计学意义(P<0.05,P<0.01)。治疗组治疗前后卵泡数大于10个的病例数分别为15例、1例,对照组为14例、5例;治疗后组间差异有统计学意义(P<0.05)。结论滋肾活血方治疗PCOS,近期、远期疗效良好。

从《黄帝内经》阳气理论探析妇人月事

[目的]从《黄帝内经》阳气理论出发,分析女子月经的生理过程及月经病的病因病机,探讨其临床辨证论治特色。[方法]以阳气理论为纲,结合各家对其女子月经相关经文的注解,阐述《黄帝内经》对妇人月事正常生理之内涵,及其对月经后期、月经量少、闭经、崩漏、痛经等病理过程的辨证论治。[结果]阳气理论是《黄帝内经》的重要学术思想之一,在论述阴阳二者相反相成、互根互用时,以阳为主导,强调阳固阴秘、阳主阴从。在对女子月经初潮的发生及相应的生理变化、月经错后之经闭不月、非时而下之崩漏、阳被阴乘之痛经的病理变化的论述中,处处体现了“阳气为本”的阳气理论。因此,在月经病的辨证论治中,提倡无问其病在阴在阳,皆需时时固护阳气。[结论]《黄帝内经》以阳气为女子月事发生、化生之根源,辨治时主张先谨察阴阳之所在,强调阳密固阴,阳生化长,从而调周整期,经汛如常。

四川彭县山区妇女母乳喂养及哺乳期闭经情况调查

作者于１９９２年３月对四川彭县山区１０４０名妇女产后哺乳期闭经、母乳喂养持续时间以及使用避孕措施的情况进行了调查和分析。结果产后１、６、１２个月的哺乳妇女分别为１００％、９５％、８２％。产后！、３、６、１２个月闭经妇女分别为９０％、７４％、６２％、３６％。产后２、６、１２个月避孕的妇女分别为１９％、４８％、９１％。认为妇女产后３个月采用避孕措施是适当的，并建议哺乳妇女首选不含激素宫内节育器。

从萧埙《女科经纶》看闭经的因机证治理论框架

《女科经纶》系统收集整理了清代前期及之前中医妇科经、带、胎、产的证治理论,具有重要的理论价值。该文以原作者的论述思路为主线,分析归纳文中所载闭经的病因病机和治法治则,提炼出《女科经纶》闭经的因机证治理论框架。

内科杂病验案选释(十)

陈某某，男，27岁，已婚，2012年3月5日初诊。牙齿松动5年，有时耳鸣，畏冷，口干口苦，无汗，劳累时腰痛，饮食二便尚可，舌苔薄白，脉沉细。工作性质需要经常熬夜。自述婚前有手淫史。

Ovarian Thecoma Fibroma Causing Menstrual Disorder &Infertility: Dramatic Resolution with Surgery

Purpose: To report the case of successfully managed oligo-amenorrhoea with infertility as a result of thecoma fibroma in a young Nigerian Igbo woman. Case Presentation: She was a 24-year-old, married, nulliparous woman who presented with 5 years history of oligomenorrhoea and 18 months history of infertility. Following her menarche at 14 years of age, she had a regular 30-day menstrual cycle with 4 - 6 days moderate flow. Symptoms of oligomenorrhoea worsened to amenorrhoea over time with menstrual flow occurring only when a progesterone agent was used. Clinical evaluation revealed no abnormalities in the systems apart from the presence of left adnexal mass on pelvic examination. Radiological test suggested benign left adnexal mass. Results: She had surgical removal of the mass after work up. Her normal menstrual flow resumed 48 hours following surgery and became regular thereafter. The histopathology report confirmed thecoma-fibroma. She commenced sexual intercourse 12 weeks after surgery. At 18 weeks post operative period, she presented with amenorrhoea and pregnancy symptoms. Intra-uterine pregnancy was confirmed with a pelvic ultrasound scan. She was managed in antenatal clinic till 38 weeks gestational age when she had spontaneous vaginal delivery of a live female neonate that weighed 3 kg with good APGAR scores. She is currently being followed up. Conclusion: Ovarian thecoma-fibroma is a rare cause of menstrual irregularities and infertility in young women. Surgical removal could result in a dramatic and favourable clinical response, as in the case presented.

Utilization of Postpartum Family Planning Services between Six and Twelve Months of Delivery at Ntchisi District Hospital, Malawi

This study examined factors that determine utilization of postpartum family planning services at Ntchisi District Hospital in Malawi. The study design was descriptive and utilized quantitative methods of data collection and analysis. A random sample of 383 postpartum women was interviewed using a structured questionnaire. Data were analysed using SPSS version 16.0. Chi-square tests were used to establish relationships between utilization of Post Partum Family Planning services and demographic variables. Knowledge about family planning services was almost universal at 94.3% among the women. About 75% of the women were using the contraceptives within the first year after delivery however they started taking the contraceptives after they had already resumed sex. There was a significant association (P < 0.05) between utilization of post partum family planning services and the following: clarity of family planning information given, level of education, period for resuming sex, husband’s approval of family planning method, counselling on fertility intention, duration of lactation amenorrhoea, maternal age and parity. There is therefore a need to promote these factors to increase uptake of postpartum services.

The Use of <i>Kigelia africana</i>in the Management of Polycystic Ovary Syndrome (PCOS)

This paper reports the beneficial effect of twice daily ingestion (a table spoonful) of dried Kigelia africana fruit powder in the management of Polycystic Ovary Syndrome (PCOS) in two patients. Both patients had the classical triad of Amenorrhoea, acne and hirsutism. The two were 25 years old and 22 years old spinsters respectively. The ultrasonography was suggestive only in the latter;unfortunately there were no facilities to do the confirmatory serum enzymes assay. The use of herbal preparation restored the menstrual flow in both of them as well as leading to significant reduction in the acne but there was no noticeable effect on the hirsutism. There was no observable side effect associated with the use of the powder. These preliminary data thus suggest that Kigelia africana fruit powder may be beneficial for cases of PCOS especially in the developing countries where the new generation oral contraceptives, presently being used for the condition, may not be readily available.

人工流产致子宫性闭经5例治疗报告

从1995年3月至2001年3月,湖北职院附属医院收治了5例人工流产致子宫性闭经的患者,通过宫腔粘连分离术,排出子宫内陈旧经血,宫腔内注入抗菌素、激素等药物,恢复了正常月经周期。

从瘀论治闭经与崩漏举隅

整理古文献中有关瘀血的条文,探析络脉独特的生理和病理特点,进而分析瘀血、络脉与妇科多发病闭经与崩漏的关系,提出在妇科月经病的防治过程中,应在辨证论治基础上尽早且适当配合使用活血化瘀法。

某师范大学女生多囊卵巢综合征就诊与治疗的依从性

目的探讨大学女生多囊卵巢综合征(polycystic ovarian syndrome,PCOS)患者就诊和治疗依从性,为女大学生防治PCOS提供依据。方法选择首都师范大学校医院妇科2015-06至2017-06就诊的疑似PCOS在校女生。通过分析转诊结果反馈表及确诊后每月的转诊记录,了解患者规定时间内到上级医院就诊情况,以及确诊后每月的转诊情况。结果疑似患者216例,规定时间内到上级医院就诊的有178例,占82.4%,最终确诊155例,确诊率87.1%;确诊后3、6个月,到校医院继续开转诊介绍单的依次为75、50例。确诊后6个月,转诊1次的143例(92.3%),2次的90例(58.1%),3次的88例(56.8%),4次的55例(35.5%),5次的30例(19.4%),6次的仅有16例(10.3%)。治疗6个月后,50例中,症状改善38例,占76.0%。结论该师范大学女生PCOS就诊和治疗的依从性差,大学女生PCOS患者身体健康状况堪忧。

哺乳期妇女应用醋酸甲羟孕酮长效避孕针临床效果观察

目的:观察醋酸甲羟孕酮长效避孕针(DMPA)在哺乳期妇女的使用效果。方法:经知情选择,自愿采用DMPA避孕,无禁忌证的哺乳期妇女252例,深部肌肉注射DMPA 150mg,3个月1次,以90天为1个观察周期,统计其避孕效果、乳量改变情况、月经及副反应。结果:①经3228个妇女月的观察,无一例妊娠,有效率达100％;②前3个观察周期,乳量增多比例明显增加,分别为20.9％、57.7％、61.1％;③用药后普遍存在闭经、出血反应,以点滴出血为主,随观察周期的增加,出血反应减少。结论:哺乳期妇女使用DMPA即能及时,完全避孕,又能增加乳量,提高母乳喂养率,且副反应小。是值得推广的哺乳期避孕方法。

刘宇新教授治疗多囊卵巢性不孕经验总结

多囊卵巢是青春期少女和育龄期妇女最常见的妇科内分泌疾病之一,它主要表现为功能性高雄激素血症和不排卵,近年发现继发于胰岛素抵抗的高胰岛素血症也是它的特征性表现之一。中医认为多囊卵巢的发生多与肾虚、脾虚有关,属月经后期、闭经、不孕等范畴。根据女性生理特点及多囊卵巢的发病机制,刘宇新教授治疗以"补肾"为主,常用温阳补肾、化湿消囊法调整月经周期,促进排卵,从而达到治愈的效果。

甜梦口服液联合阿立哌唑治疗抗精神病药物所致脾肾两虚型女性闭经及高泌乳素症临床研究

目的探讨甜梦口服液联合阿立哌唑治疗抗精神病药物所致脾肾两虚型女性闭经及高泌乳素血症的临床效果。方法将88例抗精神病药物所致脾肾两虚型女性闭经及高泌乳素血症患者分为治疗组和对照组,各44例。在维持原抗精神病药物治疗的基础上,给予治疗组甜梦口服液联合阿立哌唑治疗,对照组阿立哌唑治疗。连续治疗8周后,比较两组月经、溢乳情况和阳性和阴性综合征量表(PANSS)评分及不良反应发生情况。结果治疗组月经、溢乳治疗总有效率高于对照组(P <0. 05);治疗后第4、8周末,两组患者PANSS评分均较治疗前降低(P <0. 05);治疗后第8周末,治疗组PANSS评分低于对照组(P <0. 05)。两组总不良反应发生率比较差异无统计学意义(P> 0. 05)。结论对抗精神病药物所致脾肾两虚型女性闭经及高泌乳素血症患者采用甜梦口服液、阿立哌唑联合治疗效果显著,能有效改善月经不调、溢乳情况以及精神分裂症的临床症状,无明显不良反应,有较高的安全性。

中药药对在闭经中的应用

闭经的治则不外乎"虚则补,实则泻",肝肾亏虚,精血不足型的常用药对为熟地黄-山茱萸、女贞子-续断;脾胃亏虚,气血不足型的常用药对为黄芪-白术、人参-熟地黄;肝气郁滞,血行不畅型的常用药对为香附-川芎、丹参-红花;阴虚血燥型的常用药对为生地黄-地骨皮、玄参-麦冬;寒凝血瘀型的常用药对为吴茱萸-桂枝、当归-附子;痰湿阻滞型的常用药对为白术-茯苓、苍术-香附。不同证型选用不同功效的药对,使用药对起到协同增效、制约毒性的作用。但目前,药对的现代药理研究尚不成熟,药对的潜在功能仍需进一步深入研究,以期为药对的临床应用提供理论依据。

穴位埋线疗法配合闭经汤治疗继发性闭经的临床疗效

目的深入探讨穴位埋线配合闭经汤治疗继发性闭经的临床效果。方法选取我院2014年9月-2015年10月收治的80例继发性闭经患者为研究对象,随机将80例患者分为观察组和对照组,每组各40例;对照组采用闭经汤治疗,观察组联合穴位埋线治疗。结果治疗有效率比较,观察组优于对照组（P〈0.05）,差异有统计学意义。结论在继发性闭经患者的治疗中,采用穴位埋线和闭经汤联合治疗整体效果较好。