妇产科学课件：更年期综合征（英文版)

1、单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,Menopause Syndrome,born,menopause,death,Premenopause(1850),Perimenopause(4651),postmenopause,menopausal transition,Definition,Menopause syndrome:a syndrome of serial body and psychic symptom caused by fluctuation or decrease of sexual hormone around cessation of menses,Natural menopause,The menopause occurs due to ovarian failure.,Artificial menopause,The menopause is induced by the ovaries which are,surgically removed or destroyed by radiation.,Endocr

2、ine changes,Estrogen,The estrogen is reduced for the ovarian failure.But its level is variational in different phase.,Early stage:FSHE,2,Late stage:lower E,2,Progesterone:,The progesterone is decreased in the,menopausal transition,and there no progesterone synthesize after menopause.,Androgens:,5-androstenedione(,雄烯二酮,),，,testosterone,（睾酮）,Gonadotropin hormone(GH):,perimenopause:FSH,，,LH is normal,Menopause:FSH and LH,FSH/LH1,Gonadotropin releasing hormone(GnRH):,it increases as the luteinizing

3、hormone.,Inhibin:,more early than E2,sensitive index of ovary degeneration,GnRH:gonadotropin releasing hormone,PIF:prolactin inhibitory factor,PRL:prolactin,LH:luteinizing hormone,E2:estradiol,P:progesterone,Symptoms,Menstrual turbulence:,It is the first symptom of the climacteric.,The usual monthly cycle may become irregular,the amount of menstruation may increase and the duration of menstruation may last longer.,Dysfunctional uterine bleeding may be happen.,It is the cessation of monthly perio

4、ds that characterize the coming menopause.,In this period,we should pay more attention to the pathological changes.E.g.carcinoma of endometrium,polypus,myoma of uterus.,Symptoms,Vasomotor symptoms:,Hot flushes,（,link,）,Nocturnal sweats,Insomnia(,失眠,),palpitations,Symptoms,Psychological symptoms:,Anxiety,irritability,nervousness,Poor concentration,Lack of confidence,Depression,These are more likely to result from concerns regarding loss of fertility and femininity rather than as a direct conseque

5、nce of estrogen lack.,Symptoms,The urinary and genital tract:,(atrophy),vulva,vagina,cervix,uterus,oviduct,ovary,the supporting structure,Dryness,difficult of intercourse,recurrent genital infection,frequent micturition,dysuria and urgent micturition,recurrent urinary infection,Symptoms,Osteoporosis:,For women,the existence of estrogen in normal level can help the absorbing and the transforming of,vitamin D and calcium,.,After menopause,the low estrogen levels will accelerate the loss of calcium

6、 from the skeleton,which can lead to osteoporosis and the,risk of fracture,increase.The commonest site is vertebral body.,Happen during 510 years after menopause,Osteoporosis,Symptoms,Cardiovascular disease:,Hypertension,Coronary artery disease,Atherosclerosis,Diagnosis,History and symptoms:,A history of absent menstruation combined with hot flushes,Nocturnal sweats,vaginal dryness is characteristic.In practice,symptoms often precede the hormone changes.,Hormone test:,FSH10U/L indicate decrease

7、of ovary function;FSH40U/L and E,2,10U/L,Treatment,Objective:release symptom,prevent osteoprosis and Atherosclerosis,General therapy:,General therapy is especially useful when HRT is contraindicated.,psychological treatment can help to remission the psychological symptoms.,vaginal lubricants can help to relieve dyspareunia.,Estazolam,（艾司唑仑,),，,Oryzanol,（谷维素）,Treatment of menopause,Hormonal replacement therapy,(HRT),Treatment,Aims:,to relieve the discomfort which caused by estrogen deficiency,and

8、 to reduce the risk of both osteoporotic fractures and cardiovascular disease.,Concerns:,a small increase risk of breast cancer associated with long-term use and an increased risk of endometrial cancer if unopposed estrogen is given.,Treatment,Indications,Menopause syndrome:vasomotor symptom,psychological symptoms,Urinary and genital tract atrophy,Osteoporosis,Contraindications:,unexplained vaginal bleeding,active liver disease or chronically impaired liver function,carcinoma of the breast,endom

9、etrial carcinoma,recent vascular thrombosis,past history of thromboembolic disease with previous HRT,Treatment,Relative contraindications:,hypertension,uterine leiomyomas,migraine headaches(,偏头痛,),familial hyperlipidemia,collagen disease,fibrocystic disease of the breast,gallbladder disease,diabetes mellitus,close family history of venous thromboembolism,et al,Treatment,Treatment,Types of hormones used in HRT:,Estrogen-hysterectomy,progesterone-perimenopause DUB,Natural,estrogens,are preferred t

10、o synthetic ones,as the latter have less favourable metabolic effects,such as estradiol(,雌二醇,),estrone,（雌酮）,estriol,（雌三醇）,and conjugated equine estrogen.,Oestrogen must always be given in combination with a progestogen in women with a uterus.,Tibolone,（替勃龙）,is a synthetic steroid having weak estrogenic,progestogenic and androgenic properties,and is used as HRT in post-menopausal women.,Progesterone:MPA,micronized progesterone,Testosterone is only occasionally used in HRT,to increase libido,（性欲）,

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