Acupuncture Treatment of Menopausal Syndrome

Case HistoryMs. Li, aged 51 years, a staff member from a certain university in Beijing, paid her first visit on Feb. 17,2003, with the chief complaint of irregular menstrual cycle for more than 2 years. The patient complained that in the recent two years, she had shortened menstrual cycle, sometimes only with a 10-day interval between each two cycles, and each menstrual period lasting 3-10 days. The menstrual blood was profuse and fresh-red in color, accompanied with such symptoms as feverish sensation in the face,uncontrollable irritability and peevishness, poor sleep,excitation, difficulty in falling asleep. She also sometimes had vexation, palpitation, dizziness,forgetfulness, lumbar soreness, dry throat and thirst,dry stool, and yellow urine. She had been diagnosed by western medicine to have menopausal syndrome,and treated with western medicine accordingly with little effect.

CLINICAL ANALYSIS TO 74 CASES OF MENOPAUSAL SYNDROME TREATED WITH SIMPLE FIRE NEEDLE

In this paper,simple fire needle pricking the points of Du（Governor）and Ren（Conception）meridians was employed to treat 74 cases of menopausal syndrome.The result showedthat 41 cases were clinically cured,17 markedly improved,15 improved and 1 ineffective,with thetotal effective rate 87％.With the advantages of extensive materials used,simple manipulation andlarge variety of indications,this method is worthy to be popularized.

Effect of self prescription for nourishing liver and kidney combined with tibolone on hormone levels, lipid metabolism and immune response in women with menopausal syndrome

Objective:To study the effect of self prescription for nourishing liver and kidney combined with tibolone on hormone levels, lipid metabolism and immune response in women with menopausal syndrome.Methods: Patients with menopausal syndrome who were admitted in Hebei Weichang County Hospital between April 2014 and March 2017 were selected as the research subjects and randomly divided into to the combined group who accepted self prescription for nourishing liver and kidney combined with tibolone therapy and the control group who accepted tibolone monotherapy. The serum levels of sex hormones, lipid metabolism and immune cytokines were detected before treatment and3 months after treatment.Results: 3 months after treatment, serum E2, HDL-C, Omentin-1, VaspinC, IL-4 and IL-10 levels of both groups of patients were significantly higher than those before treatment while LH, FSH, TC, TG, LDL-C, Rsistin, IFN-γ and IL-2 levels were significantly lower than those before treatment, E2, LH and FSH levels were not significantly different between the two groups, serum TC, TG, LDL-C, Rsistin, IFN-γ and IL-2 levels of combined group were significantly lower than those of control group while HDL-C, Omentin-1, VaspinC, IL-4 and IL-10 levels were significantly higher than those of control group.Conclusion: Self prescription for nourishing liver and kidney combined with tibolone is equivalent to tibolone monotherapy in regulating the sex hormones, and more significant than tibolone monotherapy in improving the lipid metabolism and immune response in patients with menopausal syndrome.

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.

300 CASES OF MENOPAUSAL SYNDROME TREATED BY ACUPUNCTURE

Caused by hypo-ovarianism, menopausal syndrome usually occurs in women aged from 45-55 years. With high incidence and various symptoms, the disease often severely jeopardize the health of the women. The authors had treated 300 cases of menopausal syndrome by acupuncture and obtained a good result.

Management of genitourinary syndrome of menopause in breast cancer survivors:An update

There is increasing attention about managing the adverse effects of adjuvant therapy(Chemotherapy and anti-estrogen treatment)for breast cancer survivors(BCSs).Vulvovaginal atrophy(VVA),caused by decreased levels of circulating estrogen to urogenital receptors,is commonly experienced by this patients.Women receiving antiestrogen therapy,specifically aromatase inhibitors,often suffer from vaginal dryness,itching,irritation,dyspareunia,and dysuria,collectively known as genitourinary syndrome of menopause(GSM),that it can in turn lead to pain,discomfort,impairment of sexual function and negatively impact on multiple domains of quality of life(QoL).The worsening of QoL in these patients due to GSM symptoms can lead to discontinuation of hormone adjuvant therapies and therefore must be addressed properly.The diagnosis of VVA is confirmed through patient-reported symptoms and gynecological examination of external structures,introitus,and vaginal mucosa.Systemic estrogen treatment is contraindicated in BCSs.In these patients,GSM may be prevented,reduced and managed in most cases but this requires early recognition and appropriate treatment,but it is normally undertreated by oncologists because of fear of cancer recurrence,specifically when considering treatment with vaginal estrogen therapy(VET)because of unknown levels of systemic absorption of estradiol.Lifestyle modifications and nonhormonal treatments(vaginal moisturizers,lubricants,and gels)are the first-line treatment for GSM both in healthy women as BCSs,but when these are not effective for symptom relief,other options can be considered,such as VET,ospemifene,local androgens,intravaginal dehydroepiandrosterone(prasterone),or laser therapy(erbium or CO2 Laser).The present data suggest that these therapies are effective for VVA in BCSs;however,safety remains controversial and a there is a major concern with all of these treatments.We review current evidence for various nonpharmacologic and pharmacologic therapeutic modalities for GSM in BCSs and highlight the substantial gaps in the evidence for safe and effective therapies and the need for future research.We include recommendations for an approach to the management of GSM in women at high risk for breast cancer,women with estrogen-receptor positive breast cancers,women with triplenegative breast cancers,and women with metastatic disease.

A new mutation (1062 del 16) of iduronate-2-sulfatase gene from a Chinese patient with Hunter syndrome

Objective: To identify the mutations of iduronate-2-sulfatase (IDS) gene, to reveal its mutation features, and to establish a basis for genetic counseling and prenatal gene diagnosis of Hunter syndrome. Methods: Urine glycosaminoglycans (GAGs) assay, PCR and DNA sequencing were performed to detect mutation of IDS gene of the patient and his parents. Results: The result showed that the patient was: DS(++), HS(++), KS(-), CS(-), and that both of his parents were negative. A frame-shift deletion mutation (1062 del 16) was identified in exon 7 of the patient's IDS gene. His parents' genotypes were normal. Conclusion:The patient's mutation was not inherited by his parents but a novel one. The mutation probably altered the primary structure and tertiary structure of IDS enzyme protein remarkably and lowered the activity of IDS enzyme greatly. Therefore it is supposed to be the direct cause of the disorder.

磐安县部分女性MPS症状评分及影响因素分析

目的探讨围绝经期综合征(MPS)女性更年期症状评分及危险因素。方法选择2011年1月至2013年12期间在金华市磐安县妇幼保健院妇产科就诊的78例MPS患者为研究对象,选择同期在我院健康体检的72例健康女性为对照组使用女性版围绝经期Greene量表评估更年期症状。对更年期症状相关危险因素进行单因素及多因素Logistic回归分析。结果两组学历、与子女关系、性格方面比较,差异有统计学意义(x^2值分别为5.838、6.086、5.788,均P<0.05),观察组Greene评分显著高于对照组(t=9.962,P<0.05)。78例MPS患者中,轻度围绝经期症状27例(34.62%),中度围绝经期症状48例(61.54%),重度围绝经期症状3例(3.85%)。观察组症候群1~3评分显著高于对照组(t值分别为3.168、4.913、2.963,均P<0.05),观察组症候群4评分显著低于对照组(t=2.082,P<0.05)。低文化程度症候群1~3评分显著高于高文化程度(t值分别为2.019、1.990、2.287,均P<0.05);性格内向的女性症候群1~3评分显著高于性格外向组(t值分别为3.000、1.022、1.077,均P<0.05),子女关系较差的组别症候群2~3评分显著高于与子女关系好组(t值分别为3.190、3.265,均P<0.05)。结论 :MPS女性更年期症状和与子女关系、学历、性格密切相关。文化程度、与子女关系、性格、症候群1、症候群2、症候群3为MPS更年期症状的主要影响因素。

加巴喷丁对绝经后MPS的临床疗效观察

目的探讨加巴喷丁片对绝经后妇女更年期综合征(MPS)的临床效果。方法根据随机数字表法将122例患有绝经后MPS的患者分为观察组和实验组,每组各61例,观察组给予口服利维爱片,实验组给予口服加巴喷丁片,分别于给药前和给药后30、60、90 d时,比较两组的Kupperman得分、焦虑、抑郁、睡眠情况和不良反应。结果实验组的Kupperman评分在各时间点均低于观察组,治疗90 d后,实验组的评分降至(9.3±1.5)分,观察组评分降至(16.1±3.3)分,组间比较差异均有统计学意义(P<0.05);实验组的焦虑、抑郁及睡眠质量评分均较对照组降低明显(P<0.05);两组的不良反应发生率分别是24.2%、9.1%,对照组明显高于实验组(P<0.05)。结论口服加巴喷丁片对绝经期妇女MPS有明显的改善作用,不良反应发生率较低,且不会提高药物治疗费用,值得在临床推广应用。

Sleep Disorders in Menopause: Review of the Literature and Occurrence through Menopausal Stages

We here review principal literature data about sleep disorders in menopause and we compared it with data obtained from a systematical screening of a sample of 161 menopausal women through questionnaires and clinical evaluation. Our data reveal high occurrence of sleep disorders in this group of women if compared to literature data about general population, in the absence of statistically significant differences among the three menopausal stages: we find only a trend toward a higher risk of OSAS (Obstructive Sleep Apnea Syndrome) in PM versus early PM and MT. However, none of women in our survey underwent PSG (polysomnography), essential to confirm the diagnosis of OSAS and none was diagnosed with RLS (Restless Legs Syndrome) (prior to our survey) by the Gynecologist or General Pratictioner: these data reveal the issue of too low attention towards sleep disorders in this contest. Generic “sleep complaints” are clearly associated with depressed mood and worse-quality life along the menopausal process. In our sample, a non-specific definition of insomnia shows a peculiar relationship with a mood disorder: it is only variable not associated with higher BDI and KI scores, in fact. This might suggest that the conditions linked to depression of these women could be more specific sleep disturbances, such as RLS and OSAS.

Body Composition and Metabolic Risk Factors in Postmenopausal Women: Effects of a Dietary Weight Loss Program

Epidemiological studies showed an association between menopause, weight gain and risk factors that identify the metabolic syndrome (MS). We evaluated body composition and metabolic risk factors in postmenopausal women addressed to a center for the assessment of nutritional status to lose weight by hypocaloric balanced diet. 161 postmenopausal women were enrolled. MS diagnosis was made applying IDF (International Diabetes Foundation) criteria. After the prescription of hypocaloric diet all subjects were controlled every 2 months. In patients suffering from MS (MS+) at the first visit, diagnosis of MS was reassessed when 10% weight loss was achieved. 70 women were MS+. Years since menopause, low instruction level, obesity and Visceral Adipose Tissue (VAT) were each associated with MS. Particularly, BMI ≥ 30 Kg/m2 (OR: 2.61;95% CI, 1.76 - 3.46) and VAT > 6.6 cm (OR: 3.49;95% CI, 2.52 - 4.46) resulted independent risk factors. The 30% of the whole sample dropped out, the reminders significantly reduced weight, waist circumference (Wc) and Fat Mass (p 0.01). The 35% of MS+ women achieved the 10% weight loss with significant reduction of VAT, Wc, fasting glucose, tryglicerides, blood pressure and resolution of MS in the 78% of them. The 43.5% of postmenopausal women addressed in one center for the assessment of nutritional status to follow a weight-loss nutritional program had the MS;visceral obesity was the strongest independent risk factor and hypocaloric balanced diet resulted a good strategy to lose weight and treat MS.

Solid State Vaginal Laser for the Treatment of Genitourinary Syndrome of Menopause: A Preliminary Report

Background: Genitourinary syndrome of menopause (GSM) is the new term for vulvovaginal atrophy (VVA). The condition is relevant in more than 50% of women, having an adverse impact on quality of life and sexual relationships. Objective: To assess the efficacy and safety of a new type of non-ablative laser, Solid State Vaginal Laser (SSVL), for vaginal tissue regeneration and rejuvenation. Method: Eighty participants with GSM symptoms were treated with a total of 4 treatments in about two months (every 15 - 20 days) of a non-ablative SSVL (LASEmaR 1500TM-EUFOTON). A cumulative intensity of GSM symptoms using a 10-cm VAS (dryness and/or burning and/or dyspareunia), the vaginal health index (VHI), the Female Sexual Function Index (FSFI) were evaluated. Urinary Incontinence Short Form (ICIQ-UI SF) and vaginal bioptic samples were also collected. Results: Improvement following the SSVL was observed on VHIS, VVA symptoms and sexual female function. This finding was also ratified by the improvement of vaginal histological features. After the SSVL treatment, almost all patients (91%) affected by urinary incontinence obtained the complete remission of symptoms. Conclusion: The objective evaluation of VHIS, FSFI and ICIQ-UI SF scores and the histological results indicates a real favorable effect of SSVL on GSM and on urinary incontinence.

Sociodemographic and Clinical Aspects of Climacteric Syndrome of Menopause in the City of Kati in Mali Involving 113 Women

Objective: This paper aims to study the sociodemographic and clinical aspects of menopausal climacteric syndrome in the city of Kati in Mali. Patients and Methods: This was a quantitative descriptive and cross-sectional study, conducted in the city of Kati from February 1 to July 31, 2021. We included 112 menopausal women. Women were selected from a household survey using the sampling step. We were interested in conjugal, family and professional life, self-esteem and the state of health of women in general. Results: More than half of the women in our study were already postmenopausal (52.2%);the mean age was 50.5 years with the extremes ranging from 41 to 62 years. The majority of them were married (69.9%), housewives (43.4%) and Bambara (53.1%). The most common climacteric syndromes were: joint pain (65.5%), hot flashes (62.8%) and night sweats (56.6%). Genital-urinary syndromes (42.5%) were dominated by decreased libido (41.7%), urinary disorder (23%) and vaginal dryness (14.6%). Genitalia-urinary syndromes increased the frequency of disagreements;Pearson’s Chi-square = 33.63;ddl = 1;P = 0.001. There was a statistically significant relationship between night sweat, genital-urinary syndromes, joint pain, and increased disease frequency with, respectively: Pearson’s chi-square = 4.660;ddl = 1;P = 0.031;Fisher’s exact test, P = 0.001, Pearson’s Chi-square = 8.434;ddl = 1;P = 0.004. There was no statistically significant relationship between climacteric syndrome and family life, work life and self-esteem. Changes in the professional relationship between women and their co-workers included, respectively: arguments (50%);disagreements (25%) and disobedience (25%). Conclusion: Menopause deteriorates the quality of life of women who suffer in silence, hence the need to pay special attention to them.

Discussion on the mechanism of TCM treatment of climacteric syndrome based on TCM inheritance assistance system and network pharmacology

Background:To explore the law of traditional Chinese medicine in the treatment of climacteric syndrome,and to study the potential mechanism of traditional Chinese medicine therapy.Methods:For the relevant prescriptions collected from Chinese Journal Full-text Database,Wanfang medical network,PubMed and EMBASE were transferred to the traditional Chinese medicine inheritance assistant system(TCMISSV2.5)to conduct the nucleocentric drug group analysis.In this study,we used BATMAN-TCM(http://bionet.ncpsb.org/batman-tcm/)online analysis tool to analyze Therapeutic Target Database disease enrichment and Kyoto Gene and Genome Encyclopedia(KEGG)pathway enrichment,and Cytoscape(3.7.1)software was used to construct disease-target and KEGG pathway-target networks for visualization.Results:Among the 103 prescriptions,3 pairs of core drug combinations and 9 new prescriptions were selected by data mining.In the KEGG pathway of Zhimu(Anemarrhenae rhizoma)and Huangbo(Phellodendri Chinensis cortex),the most potential targets were found in the neural active ligand receptor interaction pathway.Conclusion:The compatibility of Anemarrhenae rhizoma and Phellodendri Chinensis cortex may play a role in the treatment of nervous system symptoms in patients with climacteric syndrome by interfering the neuroactive ligand receptor interaction signaling pathway.

坤宝丸治疗更年期综合征临床疗效和安全性Meta分析

目的系统评价坤宝丸治疗更年期综合征的有效性和安全性。方法采用计算机检索PubMed,EMbase,The Cochrane Library,Web of Science及中国知网(CNKI)、万方(WanFang)、维普(VIP)数据库自建库起至2022年12月的相关文献。由2位评价员独立筛选文献、提取资料并评价纳入研究的偏倚风险,采用RevMan 5.3软件对纳入研究进行Meta分析。结果共纳入13项研究,涉及1590例更年期综合征患者,其中观察组803例,对照组787例。按对照组的用药种类进行亚组分析,坤宝丸单用组的临床疗效显著高于氟桂利嗪+谷维素+维生素B1组[RR=1.75,95%CI(1.38,2.22),P<0.00001],坤宝丸联用组临床疗效显著高于戊酸雌二醇+甲羟孕酮组[RR=1.18,95%CI(1.03,1.34),P=0.01]和刺五加组[RR=1.20,95%CI(1.08,1.33),P=0.0007];坤宝丸单用组对更年期临床症状调查表(Kupperman)评分显著低于替勃龙组[MD=-6.00,95%CI(-7.72,-4.28),P<0.00001];坤宝丸联用组卵泡刺激素(FSH)显著低于刺五加组[MD=-25.70,95%CI(-33.22,-18.18),P<0.00001];坤宝丸联用组促黄体素(LH)显著低于刺五加组[MD=-11.20,95%CI(-12.05,-10.35),P<0.00001];坤宝丸单用组雌二醇(E2)显著高于替勃龙组[MD=-7.00,95%CI(-11.44,-2.56),P=0.002]。药品不良反应主要为腹胀、便秘、头晕、阴道出血、体质量增加等,患者均能耐受。结论坤宝丸对更年期综合征患者的临床疗效、Kupperman评分、激素指标等的改善效果与激素类药物相当,甚至更优。但由于纳入研究的质量不高,尚需更严格、高质量的临床研究进一步证实。

中药复方治疗绝经前后诸证的疗效评价与Meta分析

目的系统评价中药复方治疗绝经前后诸证的临床疗效性。方法检索中国知网(CNKI)、重庆维普(VIP)、万方全文数据库,限定时间为1993年1月-2023年5月公开发表的与单纯中药复方治疗绝经前后诸证的疗效性相关的随机对照试验(Randomized controlled trial,RCT)。根据Cochrane手册评价文献质量,应用RevMan 5.4软件进行Meta分析。结果本研究共纳入131篇随机对照试验,Meta分析显示,与激素治疗相比,单纯中药复方治疗可提高临床有效率(OR=3.90,95%CI:3.50-4.34,P<0.00001)、降低Kupperman评分(MD=-3.69,95%CI:-4.79--2.58,P<0.00001)以及降低黄体生成素(LH)水平(MD=-2.79,95%CI:-4.65--0.92,P=0.003)。亚组分析结果表明,柴胡桂枝龙骨牡蛎汤、丹栀逍遥散、二仙汤、六味地黄丸(汤)、知柏地黄汤和滋水清肝饮这6类经方治疗绝经前后诸证患者的临床疗效优于激素治疗(OR=3.83,95%CI:3.13-4.68,P=0.002)。结论中药复方治疗能够显著提高临床有效率,同时缓解不适症状,降低Kupperman评分,改善LH水平。

妇女绝经期与下尿路症状中西医诊疗的研究进展

下尿路功能障碍(lower urinary tract dysfunctions,LUTD)是绝经期泌尿生殖系统综合征(genitourinary syndrome of menopause,GSM)症状中的关键问题,主要是由女性绝经后体内雌激素水平降低、泌尿生殖道结构改变、炎症反应、微生态菌群变化引起,严重影响女性生活质量。LUTD治疗涉及中西医防治及健康监测,其中阴道局部低雌激素用药是目前治疗的核心,任何单一药物不能替代。在诊疗过程中更要注重对GSM的综合、个体化、总体健康情况把控及长期管理。本文主要综述妇女绝经期与下尿路症状中西医诊疗的研究进展。

绝经泌尿生殖综合征的非激素治疗进展

绝经泌尿生殖综合征(GSM)是指围绝经期和绝经后女性雌激素水平显著下降,产生外阴阴道症状、泌尿系统症状以及性生活障碍等的一类慢性进展性疾病,随着年龄增加和绝经时间延长而加重,严重影响中老年女性的生活质量。目前,绝经激素治疗是最有效的疗法,但长期应用激素替代治疗并非适合所有女性。本文将对GSM的非激素治疗的进展进行综述,为临床医生提供治疗策略。

绝经综合征焦虑状态中西医治疗研究进展

绝经综合征焦虑状态是围绝经期妇女常见的症状之一,是指妇女在绝经前后出现除烘热汗出、倦怠乏力等生理症状以外的心理精神症状,表现为焦虑烦躁、抑郁寡欢、记忆力减退等,严重影响女性的身心健康。治疗上,目前对绝经综合征焦虑状态的西医治疗多为激素补充疗法和抗焦虑药物治疗,但激素类药物长期服用的不良作用争议大,存在发生乳腺癌、肝肾功能损伤、血栓的风险,抗焦虑药物会引起神情淡漠、神经麻痹等副作用。中医治疗方法多样,以整体观念及辨证论治等思想为准则,灵活运用中药及中医传统疗法治疗,安全且疗效稳定。

正念减压疗法对改善女性更年期综合征生活质量及负性情绪的效果

目的研究分析正念减压疗法对改善女性更年期综合征生活质量及负性情绪的效果。方法选择2020年1月—2022年6月在梅州市第三人民医院接受治疗的100例女性更年期综合征伴负性情绪患者为研究对象,并按照随机数字表法分为对照组(n=50)与观察组(n=50)。两组均接受抗抑郁药治疗,观察组在此基础上给予正念减压疗法。比较两组干预前后负性情绪、激素水平、女性绝经期自测量表评分及生活质量。结果干预后,观察组焦虑自评量表及汉密尔顿抑郁量表评分均低于对照组,组间差异有统计学意义(P<0.05);干预后,观察组5-羟色胺、雌二醇水平高于对照组,女性绝经期自测量表评分低于对照组,组间差异有统计学意义(P<0.05);观察组干预后生活质量评分高于对照组,组间差异有统计学意义(P<0.05)。结论正念减压疗法可改善女性更年期综合征负性情绪及激素水平,缓解患者临床症状,提高生活质量。