Clinical Observation on Acupuncture Therapy for Depression at Perimenopause

Objective:To observe the effect of acupuncture therapy on depression at perimenopause.Methods:Sixty patients who had depression at perimenopause were divided into a treatment group and a control group,thirty patients in each group.Patients in the treatment group were treated with Bo’s abdominal acupuncture,while patients in the control group were treated with Prozac.Hamilton depression scale(HAMD)and Beck depression inventory(BDI)were observed before and after treatment to evaluate the clinical effect.Results:Depression levels decreased after treatments in both groups(P<0.05).There were no statistical differences between the two groups in the total effective rate and BDI.Conclusion:Abdominal acupuncture has similar effect in treating depression at perimenopause with Prozac..

上海市40~60岁社区妇女保健门诊患者骨质疏松症的认知状况及对预防服务需求的影响

目的了解上海市40~60岁社区妇女保健门诊患者骨质疏松症知识掌握情况、相关服务需求与利用状况,为进一步完善围绝经期妇女骨健康的预防策略提供依据。方法2022年10月—2023年4月,在上海市10家社区卫生服务中心妇女保健门诊就诊的40~60岁患者人群中开展骨质疏松症知识评价、服务需求与利用的问卷调查。结果1278名40~60岁社区妇女保健门诊患者骨质疏松症的知识问卷总知识得分的不及格率为73.00%。不同类别知识的不及格率从高到低排序,依次是危险因素(75.98%)、运动知识(71.83%)和钙知识(31.77%)。经卡方检验,三类知识的不及格率、及格率和良好率的差异有统计学意义(χ^(2)=655.83,P<0.001)。不同年龄组、文化程度、工作情况、月收入的妇女的骨质疏松症知识得分差异有统计学意义(P<0.05)。文化程度越低,月收入越低,知识得分越低;在岗妇女的知识得分更高,无业妇女的知识得分较低。排在前2位的骨质疏松症防治服务项目为“40岁以上妇女体检要增加骨密度检测项目”(81.14%)和“社区定期开展骨质疏松症的筛查”(77.70%)。logistic回归分析结果显示,与三类知识均及格的妇女相比至少一类(OR值为1.714,95%CI为1.068~2.751)或两类(OR值为1.603,95%CI为1.043~2.545)知识不及格的女性未做过骨密度检测的可能性更高。结论在上海市严峻的人口老龄化背景下,应关注骨健康知识薄弱环节,关注低学历、低收入、无职业的围绝经期妇女等重点人群,在围绝经期妇女保健服务中纳入骨质疏松症的健康教育、早期风险识别的预防措施,充分发挥基层妇女卫生保健服务的存量资源作用。

Association between depressive mood and body image and menopausal symptoms and sexual function in perimenopausal women

BACKGROUND Perimenopausal is the period when women's ovarian function begins to decline before and after menopause.During this period,women experience a series of mental state changes,such as decreased hormone levels,decreased libido,and even female sexual dysfunction(FSD)in severe cases,which reduces their quality of life.Factors affecting the occurrence of FSD include physiological and nonphysiological factors,among which physiological factors are uncontrollable.Therefore,it is particularly important to ascertain the related non-physiological factors that affect the occurrence of FSD for improving the quality of sexual life of perimenopausal women.AIM To investigate the mediating effect of depressive mood and body image on menopausal symptoms and sexual function in perimenopausal women.METHODS A total of 186 perimenopausal women were enrolled between January 2019 and January 2021 and divided into the FSD(134 cases)and control(52 cases)groups based on the presence and absence of FSD.Clinical data were compared between the two groups.FSD-related factors were analyzed using logistic regression analysis.Hamilton Depression Scale(HAMD),Body Image Scale(BIS),and Menopause Rating Scale(MRS)scores were compared among women with different FSD scores.The correlation of the MRS score with the BIS and HAMD scores and the mediating effect of the BIS and HAMD scores on the MRS score and female sexual function index(FSFI)were analyzed.RESULTS The HAMD and BIS scores were higher in the FSD group than in the control group,and the difference in monthly income between the two groups was statistically significant(all P<0.05).Monthly income of<2000 yuan[odds ratio(OR)=26.586,P=0.000],BIS score(OR=1.590,P=0.000),and HAMD score(OR=1.884,P=0.000)were independent risk factors for FSD.MRS scores were positively correlated with BIS and HAMD scores(r=0.358 and 0.244,P=0.000 and 0.001,respectively)and negatively correlated with FSFI scores(r=-0.433,P=0.000).Body image and depressive mood had partial mediating effects,accounting for 39.90%of the total effect.CONCLUSION Depression and body image play mediating roles between menopausal symptoms and sexual function in perimenopausal women.

Comparing the effectiveness of pattern differentiation treatment and fixed formula treatment for perimenopausal syndrome with Chinese herbal medicine:A study protocol

Objective:To further understand and compare the effectiveness of pattern differentiation treatment and fixed prescription treatment in perimenopausal syndrome.Methods:The study will be conducted in the Hong Kong Federation of Trade Unions Workers'Medical Clinics,Hong Kong Baptist University Chinese Medicine Clinic cum Training and Research Centre(Hong Kong,China).One hundred Chinese women,aged 45-55 years,will be recruited.The participants will be randomized into 2 groups.The intervention group will be administered medication,based on pattern differentiation,by qualified traditional Chinese medicine(TCM)practitioners.After each evaluation,TCM practitioners will evaluate and revise the prescription,based on the participants'patterns.The control group will be given the standard formula,i.e.,the Erxian decoction,which contains 6 herbs.The treatment period and the follow-up period will be 8 weeks each.The primary assessment outcome measure will be the Kupperman Index,and the secondary outcome measure will be the Menopause-specific Quality of Life Questionnaire score.Conclusion:Pattern-differentiated treatment is the basic principle of TCM to understand and treat diseases.The study will show the pattern-differentiated treatment is effectiveness than the fixed prescription.

Study on the Molecular Mechanism of Danggui Buxue Decoction in Intervention of Perimenopausal Syndrome Based on Network Pharmacology and Molecular Docking

[Objectives]This study was conducted to explore the intervention mechanism of Danggui Buxue Decoction in perimenopausal syndrome based on network pharmacology and molecular docking.[Methods]The chemical components and targets of Danggui Buxue Decoction were acquired through the TCMSP database,and the main targets of perimenopausal syndrome were obtained through the GeneCards database.The component targets and disease targets were intersected,and combining with active components and Chinese herbs in the decoction,a traditional Chinese medicine-component-target network was constructed using Cytoscape 3.7.1 software.The STRING platform was employed for protein-protein interaction analysis.The DAVID analysis platform was used to conduct target GO and KEGG enrichment analysis,so as to predict the action mechanism Danggui Buxue Decoction.Finally,an active component-disease target-signal pathway network diagram was constructed.[Results]Twenty two components in Danggui Buxue Decoction related to perimenopausal syndrome and 120 corresponding targets were obtained,including active components such as 1,7-dihydroxy-3,9-dimquercetin and kaempferol,and key targets such as TNF,ESR1 and PPARG.The results of GO analysis and KEEG analysis indicated that Danggui Buxue Decoction might regulate the transcription of RNA polymerase II promoter,DNA templating,gene expression,signal transduction,hypoxia response and other biological processes by regulating multiple signal pathways such as chemical carcinogenesis-receptor activation,cancer pathways,lipid and atherosclerosis,tryptophan metabolism,malaria,steroid hormone biosynthesis and chemical carcinogenesis-DNA adduct.[Conclusions]Danggui Buxue Decoction intervenes in perimenopausal syndrome through multiple components,targets and pathways,providing a basis for elucidating the intervention mechanism of Danggui Buxue Decoction and expanding its clinical application.

抗抑郁药物治疗围绝经期女性良性阵发性位置性眩晕复位后残余症状的疗效分析

良性阵发性位置性眩晕（BPPV）是指头部运动到某一特定位置时所诱发的短暂性眩晕[1]。以特定头位引起发作性短暂性眩晕及眼球震颤为典型表现,占所有眩晕20%～30%[2]。研究表明BPPV发病率随年龄增长呈上升趋势,发病高峰年龄40～60岁[3],女性较男性更易发作,男女比例为1∶1.5～1∶2.0[4],围绝经期女性好发是否与女性激素水平有关,有待深入研究[5]。

围绝经期综合症

一、概述 绝经:指妇女一生中的最后一次月经.绝经是卵巢功能的真正衰竭,以至月经最终停止.绝经年龄一般在40～54岁,平均45～51岁(WHO),中国妇女平均为50岁左右.

Prevalence and Risk Factors of Stress Urinary Incontinence Among Perimenopausal Women and Its Influence on Daily Life in Women with Sexual Desire Problem

The prevalence of,and related factors to,stress urinary incontinence (SUI) among perimenopausal Chinese women and its impact on daily life among those women with sexual desire problem in Hubei province were investigated.In this study,1519 perimenopausal women aged 40 to 65 years were selected from three urban communities in the Wuhan area,and two impoverished,mountainous communities in Hubei province,and followed from April to October 2014.Detailed information about demographic characteristics,menstruation,pregnancy,sexual life and chronic diseases was collected.A cross-sectional survey was carried out following information collection by Chi-square test and multiple logistic regression analysis.Univariate and multivariate logistic regression analysis demonstrated that the potential factors associated with developing SUI were old age (OR=3.4,95% CI:1.92-6.04),vaginal delivery (OR=0.623,95% CI:0.45-0.87),low income (OR=0.063,95% CI:0.40-0.92),atrophic vaginitis (OR=1.4,95% CI:1.03-1.80),pelvic organ prolapse (OR=2.81,95% CI:1.36-5.80),chronic pelvic pain (OR=2.17,95% CI:1.90-4.03),constipation (OR=1.44,95% CI:1.07-1.93) and incontinence of feces (OR=3.32,95% CI:2.03-5.43).Moreover,the ratio of SUI (33.2%) was higher than the ratio of urgency urinary incontinence (24.1 %) or the ratio of mixed urinary incontinence (17.4%),and SUI had a greater impact on daily life among women with decreased sexual desire.In conclusion,SUI is a common disorder affecting over one third of the women surveyed,and has a severe impact on the daily life of perimenopausal women with declined sexual desire.Age,mode of delivery,and monthly income are major risk factors involved in the development of SUI.

Research progress in the treatment of perimenopausal abnormal uterine bleeding with traditional Chinese and western medicine

In order to fully understand the research progress of Chinese and Western medicine in the treatment of perimenopausal abnormal uterine bleeding,this paper reviews all kinds of research by referring to related literature reports at home and abroad.The results showed that western medicine mainly used hormone drugs,supplemented by surgery,but the clinical adverse reactions were more and the recurrence rate was higher;traditional Chinese medicine often obtained satisfactory results through the treatment of traditional Chinese medicine,syndrome differentiation,stage treatment,acupuncture and other treatment methods,with fewer adverse reactions and low recurrence rate,but the effect of sudden collapse and hemostasis was slower;the combination of Chinese and Western medicine can learn from each other and become The research focus in recent years is worthy of further discussion.

Talking about Hot Flashes (潮热)

Women worldwide are dealing with hot flashes (潮热), a perimenopausal feature that is often tiring,embarrassing, and energeticallydraining. Conventionally, Chinese medicine defines hot flashes as Kidney-yin deficiency and its clinical manifestations include red face,sweating, hot sensations in the palms and soles, mouth and nose dryness, constipation, insomnia, lumbar soreness, knee weakness, redtongue, etc. To obtain a broader perspective and understand the dynamics of hot flashes, we examined the mechanisms behind hot flashesbased on both the knowledge from ancient Chinese medicinal texts, as well as novel research findings of Chinese and Western medicine.This perspective was the foundation for the acupuncture study of our traditional Chinese medicine conducted in 2018-2019 in Shanghai.This study, designed as a pragmatic randomized control trial with two parallel groups, focused on regulating and unblocking conceptionand governor vessels. The results confirmed that our acupuncture method could effectively reduce both the frequency and severity of hotflashes and improve life quality of middle-aged women.

Age Dependence of the Menstrual Cycle Correlation Dimension

Time series analysis, based on the idea that female reproductive endocrine physiology can be construed as a nonlinear dynamical system in a chaotic trajectory, is performed to measure the correlation dimension of the menstrual cycle data from subjects in two different age cohorts. The dimension is computed using a method proposed by Judd (Physica D, vol. 56, 1992, pp. 216-228) that does not assume the correlation dimension to be necessarily constant for all appropriate time scales of the system’s strange attractor. Significant time scale differences are found in the behavior of the dimension between the two age cohorts, but at the shortest time scales the correlation dimension converges to the same value, approximately 5.5, in both cases.

Effect of tibolone as well as Estradiol and Drospirenone replacement therapy on the neurohumoral indexes and immune function in perimenopausal women

Objective: To explore the effect of tibolone as well as Estradiol and Drospirenone replacement therapy on the neurohumoral indexes and immune function in perimenopausal women. Methods: A total of 180 perimenopausal women who were treated in our hospital between December 2014 and December 2016 were collected and divided into the tibolone group (n=90) as well as Estradiol and Drospirenone group (n=90) by random number table, they received tibolone as well as Estradiol and Drospirenone replacement therapy respectively, and both therapies lasted for 6 months. The differences in serum levels of neurohumoral indexes and immune function indexes were compared between the two groups. Results:Before treatment, differences in serum levels of neurohumoral indexes and immune function indexes were not statistically significant between the two groups. After 6 months of treatment, serum E2, IL-4 and IL-13 levels of both groups of patients were significantly higher than those before treatment while P, T, FSH, LH, PRL, IFN-γ and IL-2 levels were significantly lower than those before treatment, and serum E2, IL-4 and IL-13 levels of observation group were significantly higher than those of control group while P, T, FSH, LH, PRL, IFN-γ and IL-2 levels were significantly lower than those of control group. Conclusion: Both tibolone and Estradiol and Drospirenone can be used in the treatment of women with perimenopausal syndrome, but tibolone is more effective in optimizing hormone levels and equalizing immune function.

Menopausal Status and Metabolic Syndrome in Women in Climacteric Period Treated at a Clinic in Southern Brazil

Background: This study aims to understand the relationship between menopausal status and the presence of Metabolic Syndrome in women from 40 to 65 years, as well as to describe the distribution of each component of Metabolic Syn- drome according to sample characteristics. Methods: A cross-sectional study was conducted with 551 women treated at a clinic in southern Brazil. MetS and its components were defined according to NCEP-ATP III and menopausal status as pre, peri, and post-menopause. Prevalences of menopausal status and of MetS and its components were calculated. Estimates of prevalence ratios crude and adjusted with confidence intervals of 95% were calculated by Poisson Regression with robust variance. Demographic, socioeconomic, behavioral, and reproductive characteristics were considered as potential confounding factors in multivariable models based on a conceptual framework of MetS determination. Results: The prevalence of Metabolic Syndrome in the sample was 56.1% (CI95%: 51.9 to 60.2), being more common among older women (56 to 65 years), with low education, menarche 11 years old, with three or more pregnancies and in the post-menopausal period. In multivariate analysis, there was an increase of prevalence ratios when comparing perimenopause and post-menopause with pre-menopause;however, the confidence intervals include the unit. Regarding the analysis of isolated components in the sample, the most prevalent altered components were: hypertension (84.8%;CI95%: 81.7 to 87.8), waist circumference (66.4%;CI95%: 62.5 to 70.4) and HDL cholesterol (51.7%;CI95%: 47.5 to 55.9). There was a linear increase on mean blood glucose through menopausal status. Conclusions: Our study indicates variation on the distribution of MetS and each component according to menopausal status and other women characteristics. Future studies on MetS should also have foresight to use this type of approach to improve understanding and targeting of actions and programs focusing on women in this period of life.

The Efficacy and Safety of Modified Xiaoyao San for Perimenopausal Syndrome (PMS): A Systematic Review and Meta-Analysis

Objectives: To assess the efficacy and safety of modified Xiaoyao San (XYS) for treating Perimenopausal syndrome (PMS). Methods: Literature searches were carried out on PubMed, Cochrane Library, CNKI Database, Chinese Biomedical Literature Database, Wan Fang Database, and VIP Database up to December 2018. Hand search for further references was conducted. Study selection, data extraction, quality assessment, and data analyses were performed as request of the Cochrane standards. Results: Nine publications in total were suitable for inclusion. There was evidence that modified XYS was tested to be more effective in improving overall symptoms compared with HRT (odds ratio 3.50, 95% CI 2.56 to 4.78). Whereas HRT was more sensitive and direct in decreasing FSH (WMD 6.69, 95% CI 5.60 to 9.52) and LH (WMD 7.00, 95% CI, 5.75 to 8.25) in comparison with XYS group. It was also strongly supported that XYS had less adverse effect than HRT (odds ratio 0.07, 95% CI 0.05 to 0.10). Conclusion: Modified XYS might be more effective and safer in treatment of perimenopausal syndrome. However, due to poor methodological quality in the majority of included studies, the potential benefit and safety about XYS need to be confirmed in rigorously designed, multi-centre, and large-scale trials.

Endometrial Evaluation by Transvaginal Ultrasonography Saline Infusion Sonohysterography, Hysteroscopy versus Endometrial Office Bipsy in Perimenopausal Bleeding: A Comparative Study

Postmenopausal bleeding is a very common and alarming symptom accounting for 5 percent of all gynecological outpatients’ clinic attendances. This cross-section study was conducted in the Department of Obstetrics and Gynecology at University Hospitals and included 176 patients with perimenopausal bleeding who attended a patient clinic during the period from January 2017 to May 2019. All patients were subjected to transvaginal ultrasound, saline sonohysterography and out-patient endometrial sampling using pipelle;all the results were compared to histopathology obtained by hysteroscopic guided biopsy and/or hysterectomy. Result: In comparing the validity of TVS and SHG we found highly significant decrease in malignancy assessment in the TVS method compared to hysteroscopic-guided biopsy. According to the validity of pipelle in detection of malignant lesion, it was found to detect 80 cases out of 88 cases of malignancy with sensitivity 90.9%, specificity 100% and 95.45% accuracy with respect to histopathology by hysteroscopy guided biopsy and/or hysterectomy. Combination tests were done between SHG and pipelle and we found that the validity of combination tests in detecting malignancy improves the sensitivity and specificity in detection of malignancy sensitivity = 100% and specificity = 100% and this was found to be as an effective method in detection of malignancy. Conclusion: When SHG combined to outpatient endometrial sampling “pipelle”, the results were the same as hysteroscopy.

Advances in the Pathogenesis of Perimenopausal Syndrome

Perimenopause syndrome refers to the syndrome of the disorders of multiple systems of women around menopause caused by the reduction in secreted estrogen and is also known as menopause syndrome.Its pathogenesis involves increasing age,the abatement of ovarian function,and psychological change caused by the increasing life pressure.The above factors lead to physical and mental changes in postmenopausal women.This paper summarizes the pathogenesis of perimenopause from the perspective of gene studies and existing experimental studies and provide some ideas for clinical treatment and research.

Research on the Effects of the Extract of Polygala fallax Hemsl on Sex Hormones andβ-EP in Perimenopausal Rat Models

Objective:To study the effects of the ethnic medicine Polygala fallax Hemsl with Guangxi characteristics on the sex hormones andβ-EP in research objective perimenopausal rat models.Methods:40 female SPF rats were randomly divided into 4 groups,including the normal,model,high-dose and lowdose groups.Rats of three groups except for the normal one were treated with perimenopausal modelling through the method of subcutaneous injection of compound 4-VCD for 15 consecutive days.Rats of the normal and model group were normally fed without any treatment.Rats of the high-dose and low-dose groups were administered by high-and low-dose intragastric administration of the extract of Polygala fallax Hemsl.According to the menstrual cycle of the vaginal smear of the rat,each menstrual cycle is a course of treatment and 6 consecutive courses of treatment would be given.The indexes of serum sex hormones(E2,FSH,LH)andβ-EP of rats in each group were observed after treatment.Results:After the treatment of 6 cycles,for the levels ofβ-EP and E2,the model group was lowest(P<0.05),the normal group was highest(P<0.05);and the high-dose group was higher than the low-dose group;For the levels of FSH and LH,the normal group was lowest(P<0.05),the model group was highest(P<0.05),and the high-dose group was lower than the low-dose group.Conclusion:Guangxi characteristic national medicine Polygala fallax Hemsl can effectively improve the levels of serum sex hormones andβ-EP in perimenopausal rat models and relieve the related symptoms with a certain dose-effect relationship.

Effects of Soy Isoflavones on the Sex Hormone Level and Pathological Changes in the Perimenopausal Syndrome Animal Model

[Objectives] To observe the effect of soy isoflavones on the perimenopausal syndrome model of female rats,and to find its mechanism,in order to provide experimental evidence for the clinical treatment of menopausal syndrome. [Methods]50 female SD rats were randomly divided into five groups,with 10 rats in each group,respectively,for the normal control group,sham operation group,model group,diethylstilbestrol group,soy isoflavone treated group,except the normal control group and sham operation group,the other groups were ovariectomized rats,the formation model of perimenopausal rats treated with normal saline,diethylstilbestrol,soy isoflavone by gavage,normal control group and sham operation group were given the same dose of normal saline and soy isoflavone by gavage. After 6 weeks of continuous treatment,abdominal aorta was taken blood,the serum was isolated,and radioimmunoassay method to measure E_2( Eestradiol),P( Progesterone),T( Testosterone). And removal of the pituitary gland,uterine and adrenal prepared pathological section,experimental effect was observed by light microscopy,using immunohistochemical method to observe the brain pituitary FSH( Follicle-Stimulating Hormone) and LH( Luteinizing Hormone) levels. [Results] Radiation immune analysis results showed that soy isoflavone could significantly improve serum E_2 level in ovariectomized rats,compared with the model group,the statistical analysis showed significant difference( P < 0. 05),but the serum P and T level had little effect. The pathological results showed that( i) uterus: the uterine wall and endometrial thickness of soy isoflavone group was between that of model group and sham operation group,the surface epithelium was columnar,glands increased;( ii) pituitary gland: soy isoflavone ovariectomized group cells were between model group and normal group;( iii) adrenal gland: soy isoflavone group adrenal tissue did not change significantly. Immunohistochemical results showed that soy isoflavone group pituitary tissues of FSH and LH cells compared with the model group decreased significantly. [Conclusions] The soy isoflavones could make the uterus wall and endometria of perimenopausal syndrome animal model thicken,improve the serum level of E_2 in ovariectomized rats,and decrease the level of FSH and LH,but had little effect on the adrenal tissues,level of T and P.

Analysis of Famous TCM Doctor Zan Qiang's Experience in the Treatment of Perimenopausal Osteoporosis

The purpose of this study was to analyze the clinical experience of Zan Qiang,a famous doctor of Traditional Chinese Medicine in Shaanxi province,in the treatment of perimenopausal osteoporosis.Zan believed that the main etiology and pathogenesis of perimenopausal osteoporosis were "deficiency of kidney essence,decreased marrow and bone",deficiency of liver and kidney"and"stasis caused by deficiency".Although it is a chronic physiological disease,and the pathological process is irreversible,the treatment groups of"tonifying kidney and filling essence","tonifying liver and tonifying kidney"and "tonifying deficiency and promoting blood circulation" can significantly improve the symptoms of patients,slow down the progress of the disease and improve the quality of life of patients.

Meta-analysis of randomized controlled trials of acupuncture in the treatment of menopausal insomnia

Objective:We aimed to investigate the safety and efficacy of acupuncture in the treatment of climacteric insomnia compared with western medicine through a comprehensive metaanalysis.Methods:Literature retrieval,research selection and data extraction were done independently and in duplicate.Effect-size estimates are expressed as risk ratio(RR)and 95%confidence interval(CI).Results:Summary data from 27 articles,involving a total of 2349 menopausal women,were meta-analyzed.The overall analysis showed that the clinical cure rate(RR=1.85,95%CI:1.57~2.18,P<0.001)of acupuncture was 1.85 times higher than western medicine,and the markedly effective rate was 1.3 times higher than that of westernmedicine(RR=1.30,95%CI:1.09~1.54,P=0.003).In terms of Pittsburgh Sleep quality Index((PSQI)),simple acupuncture is superior to western medicine in sleep quality,falling asleep time,sleep time,sleep efficiency and daytime dysfunction.In the evaluation of adverse reactions,the incidence of adverse events in the acupuncture-related therapy group(3.5%)was lower than that in the western medicine group(12.5%).Conclusion:The results of metaanalysis show that the clinical efficacy of acupuncture in the treatment of climacteric insomnia is better than that of western medicine which has better efficacy and safety.The acupuncture therapy is suitable for clinical.