Women's health in midlife: the influence of the menopause, social factors and health in earlier life
Women's health in midlife: the influence of the menopause, social factors and health in earlier life
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DOI：
10.1111/j.1471-0528.1997.tb14352.x
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发表时间：
1997-08-01
期刊：
影响因子：
--
通讯作者：
Hardy, R
中科院分区：
文献类型：
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作者：
Kuh, DL;Wadsworth, M;Hardy, R
目的描述一个大的代表性样本的英国妇女在47岁的健康症状，并检查更年期的影响，允许社会因素和健康在早期的成年life.Design一个国家的前瞻性出生队列研究。通过邮寄问卷收集了47岁时的健康问题、月经周期、激素替代疗法的使用和生活压力等信息。在以前的家庭访问中收集了有关健康、吸烟行为和早年教育程度的信息。设置英格兰、苏格兰和威尔士。84%的人发送了一份问卷。主要结果测量二十自我-结果自然绝经早期的妇女发生血管痉挛的风险明显增加，症状（潮热或盗汗），性困难（阴道干燥或性交困难）和睡眠困难。然而，很少或没有其他身体或心理症状的过度风险。相比之下，所有类型的症状在子宫切除术或激素替代疗法的女性中更常见。与其他女性相比，36岁时受教育程度最低、生活压力大或既往生理和心理健康状况较差的女性在47岁时也报告了更多的症状，但在logistic回归模型中对这些因素进行调整并不影响症状与当前绝经状态之间的关系。与绝经前妇女相比，绝经后妇女血管痉挛症状的校正比值比为4.7（95%CI 2.6-8.5），围绝经期妇女血管痉挛症状的校正比值比为2.6（95%CI 1.9-3.5）。性生活困难的校正比值比分别为3.9（95%CI 2.1-7.1）和2.2（95%CI 1.4-3.2），睡眠障碍的校正比值比分别为3.4（95%CI 1.9-6.2）和1.5（95%CI 1.1-2.0）。中年妇女普遍存在更普遍的健康问题，特别是那些生活压力大的妇女，或者那些在绝经前做过子宫切除术或开始接受激素替代疗法的妇女。适当的咨询和支持需要易于获得。
Objective To describe the health symptoms of a large representative sample of British women at age 47 years, and to examine the influence of the menopause allowing for social factors and health in earlier adult life.Design A national prospective birth cohort study. Information on health problems, menstrual cycle, use of hormone replacement therapy and life stress at 47 years was collected using a postal questionnaire. Information on health, smoking behaviour and educational attainment earlier in life had been collected at previous home visits.Setting England, Scotland and Wales.Population A general population sample of 1498 women, 84% of those sent a questionnaire.Main outcome measure Twenty self-reported health symptoms over the previous 12 months.Results Women who had experienced an early natural menopause had a strongly raised risk of vasomotor symptoms (hot flushes or night sweats), sexual difficulties (vaginal dryness or difficulties with intercourse) and trouble sleeping. However, there was little or no excess risk of other somatic or psychological symptoms. In contrast, all types of symptoms were more common among women who had had a hysterectomy or were users of hormone replacement therapy. Women with the least education, stressful lives, or a previous history of poor physical and psychological health at age 36 also reported more symptoms at 47 years compared with other women, but adjustment for these factors in a logistic regression model did not affect the relations between symptoms and current menopausal status. For vasomotor symptoms, postmenopausal women had an adjusted odds ratio of 4.7 (95% CI 2.6-8.5) and perimenopausal women had an adjusted odds ratio of 2.6 (95% CI 1.9-3.5) compared with premenopausal women. Corresponding adjusted odds ratios for sexual difficulties were 3.9 (95% CI 2.1-7.1) and 2.2 (95% CI 1.4-3.2), and for trouble sleeping were 3.4 (95% CI 1.9-6.2) and 1.5 (95% CI 1.1-2.0).Conclusions Specific symptoms were clearly associated with the natural menopause. More general health concerns were common among women in middle life, particularly among those with stressful lives, or those who had had a hysterectomy or started taking hormone replacement therapy before they were postmenopausal. Appropriate advice and support needs to be easily accessible.