婦產(chǎn)科學(xué)課件：更年期綜合征英文版

MenopauseSyndromebornmenopausedeathPremenopause(18~50)Perimenopause(46~51)postmenopausemenopausaltransitionDefinitionMenopausesyndrome:asyndromeofserialbodyandpsychicsymptomcausedbyfluctuationordecreaseofsexualhormonearoundcessationofmensesNaturalmenopause

Themenopauseoccursduetoovarianfailure.ArtificialmenopauseThemenopauseisinducedbytheovarieswhicharesurgicallyremovedordestroyedbyradiation.

EndocrinechangesEstrogenTheestrogenisreducedfortheovarianfailure.Butitslevelisvariationalindifferentphase.Earlystage:FSH↑→E2↑Latestage:lowerE2Progesterone:

Theprogesteroneisdecreasedinthemenopausaltransitionandtherenoprogesteronesynthesizeaftermenopause.Androgens:5-androstenedione(雄烯二酮)↓，testosterone（睪酮）↑Gonadotropinhormone(GH):

perimenopause:FSH↑，LHisnormalMenopause:FSHandLH↑,FSH/LH>1Gonadotropinreleasinghormone(GnRH):

itincreasesastheluteinizinghormone.Inhibin:↓moreearlythanE2,sensitiveindexofovarydegenerationGnRH:gonadotropinreleasinghormonePIF:prolactininhibitoryfactorPRL:prolactinLH:luteinizinghormoneE2:estradiolP:progesteroneSymptomsMenstrualturbulence:Itisthefirstsymptomoftheclimacteric.Theusualmonthlycyclemaybecomeirregular,theamountofmenstruationmayincreaseandthedurationofmenstruationmaylastlonger.Dysfunctionaluterinebleedingmaybehappen.Itisthecessationofmonthlyperiodsthatcharacterizethecomingmenopause.Inthisperiod,weshouldpaymoreattentiontothepathologicalchanges.E.g.carcinomaofendometrium,polypus,myomaofuterus.SymptomsVasomotorsymptoms:Hotflushes（link）NocturnalsweatsInsomnia(失眠)palpitationsSymptomsPsychologicalsymptoms:Anxiety,irritability,nervousnessPoorconcentrationLackofconfidenceDepressionThesearemorelikelytoresultfromconcernsregardinglossoffertilityandfemininityratherthanasadirectconsequenceofestrogenlack.SymptomsTheurinaryandgenitaltract:

(atrophy)vulvavaginacervixuterusoviductovarythesupportingstructureDryness,difficultofintercourse,recurrentgenitalinfection,frequentmicturition,dysuriaandurgentmicturition,recurrenturinaryinfectionSymptomsOsteoporosis:Forwomen,theexistenceofestrogeninnormallevelcanhelptheabsorbingandthetransformingofvitaminDandcalcium.Aftermenopause,thelowestrogenlevelswillacceleratethelossofcalciumfromtheskeleton,whichcanleadtoosteoporosisandtheriskoffractureincrease.Thecommonestsiteisvertebralbody.Happenduring5~10yearsaftermenopause

OsteoporosisSymptomsCardiovasculardisease:HypertensionCoronaryarterydiseaseAtherosclerosisDiagnosisHistoryandsymptoms:

Ahistoryofabsentmenstruationcombinedwithhotflushes,Nocturnalsweats,vaginaldrynessischaracteristic.Inpractice,symptomsoftenprecedethehormonechanges.Hormonetest:

FSH>10U/Lindicatedecreaseofovaryfunction;FSH>40U/LandE2<10-20pg/mlindicatemenopauseUltrasound:Thicknessofendometrium,massofuterusorovaryD&CandendometrialhistologyClomipheneexcitingtestCC50mgfor5days,FSH>10U/LTreatmentObjective:releasesymptom,preventosteoprosisandAtherosclerosisGeneraltherapy:GeneraltherapyisespeciallyusefulwhenHRTiscontraindicated.

psychologicaltreatmentcanhelptoremissionthepsychologicalsymptoms.vaginallubricantscanhelptorelievedyspareunia.Estazolam（艾司唑侖)，Oryzanol（谷維素）

TreatmentofmenopauseHormonalreplacementtherapy(HRT)

TreatmentAims:torelievethediscomfortwhichcausedbyestrogendeficiency,andtoreducetheriskofbothosteoporoticfracturesandcardiovasculardisease.Concerns:

asmallincreaseriskofbreastcancerassociatedwithlong-termuseandanincreasedriskofendometrialcancerifunopposedestrogenisgiven.

TreatmentIndicationsMenopausesyndrome:vasomotorsymptom,psychologicalsymptomsUrinaryandgenitaltractatrophyOsteoporosisContraindications:

unexplainedvaginalbleedingactiveliverdiseaseorchronicallyimpairedliverfunctioncarcinomaofthebreastendometrialcarcinomarecentvascularthrombosispasthistoryofthromboembolicdiseasewithpreviousHRTTreatmentRelativecontraindications:hypertensionuterineleiomyomasmigraineheadaches(偏頭痛)familialhyperlipidemiacollagendiseasefibrocysticdiseaseofthebreastgallbladderdiseasediabetesmellitusclosefamilyhistoryofvenousthromboembolismetalTreatmentTreatmentTypesofhormonesusedinHRT:

Estrogen---hysterectomy,progesterone---perimenopauseDUBNaturalestrogensarepreferredtosyntheticones,asthelatterhavelessfavourablemetaboliceffects,suchasestradiol(雌二醇),estrone（雌酮）,estriol（雌三醇）andconjugatedequineestrogen.Oestrogenmustalwaysbegivenincombinationwithaprogestogeninwomenwithauterus.Tibolone（替勃龍）isasyntheticsteroidhavingweakestrogenic,progestogenicandandrogenicproperties,andisusedasHRTinpost-menopausalwomen.Progesterone:MPA,micronizedprogesteroneTestosteroneisonlyoccasionallyusedinHRT,toincreaselibido（性欲）.TreatmentRegimens:1.Combinedsequentialtherapy:Itisthemostpopularone.Oestrogenisgivencontinuouslyandaprogestogenisgivenfor12dayspermonth.Mostwomenwillhaveslightcyclicalwithdrawalbleeding.Treatment2.Continuouscombinedoestrogenandprogestogentherapy(CCT):thisisachievedbyinducingendometrialatrophy.itshouldbegivenonlytowomenwhoreport12monthsofamenhorroeaandwhoarethoughttobemenopause.theadvantagesofCCT:periodfree,easyadministration,bettercompliance.TreatmentRoutesofadministration:

1.oral:

thefirst-passlivermetabolism,sothedoseishigher.

2.transdermal:

asmalladhesivepatchesagelapplieddirectlyontotheskin3.implants:

smallpelletsinsertedsubcutaneouslyunderlocalanaesthetic.releaseacontinuoussmallamountofoestrogenovermanymonths.mostcommonlyusedafterhysterectomy.4.vaginal:creamsandgelatinTreatmentBenefitsofHRT:

1.Short-term:relievessymptomsofoestrogendeficiency.improve

generalisedatrophicchangesfeelingofimprovedenergy,confidenceandqualityoflife.2.Long-term:

loweredriskofosteoporosisandcardiovasculardiseaseTreatmentSide-effectsandriskofHRT:

irregularuterinebleedingsideeffectsofsexualhormone:Estrogen:breasttenderness,migraine(偏頭痛)，pigmentationProgesterone:abdominalbloating,edema,irritationAndrogen:hyperlipemia,venousthromboembolism,acne(痤瘡)endometrialcancerbreastcancerovarycancercardiovascularandembolismdiseasediabetesmillitusTreatmentStartingusageandmonitoringofHRT:

AthoroughandaccurateunderstandingtheindicationandcontraindicationGynaecologicalandmedicalhistoryPhysicalexamination,especiallypelvicandbreastexamination.