Factors that influence entry into stages of the menopausal transition.
Factors that influence entry into stages of the menopausal transition.
复制标题
影响进入更年期过渡阶段的因素。
DOI：
10.1097/gme.0b013e3181a8f62b
复制
发表时间：
2009
期刊：
影响因子：
--
通讯作者：
Guo,Wensheng
中科院分区：
文献类型：
--
作者：
Sammel,MaryD;Freeman,EllenW;Liu,Ziyue;Lin,Hui;Guo,Wensheng
目的：本研究的目的是估计进入更年期过渡和进入每个后续过渡阶段的概率和确定危险因素。方法：在以人口为基础的中年妇女队列中，对进入每个绝经过渡阶段的概率和与每个过渡阶段相关的预测因子进行了估计。结果：在调整后的多变量模型中，卵泡刺激素（FSH）每增加一个单位（P< 0.001），抑制素B每减少一个单位（P< 0.001），进入更年期过渡和进入后续各阶段的可能性就会增加。观察到的平均FSH水平变化最大的是晚期（第4阶段）妇女的平均FSH水平为24.78 mIU/mL，而早期（第3阶段）妇女的平均FSH水平为10.38 mIU/mL。经历这种FSH变化的女性从3期过渡到4期的几率为1.90 （95% CI, 1.86-1.95）。抑制素B降低导致的比值比与FSH变化的幅度相似。目前吸烟使进入每个阶段的几率增加了约30%（优势比1.30;95% CI, 1.28-1.32）。平均雌二醇水平在不同阶段之间没有显著变化。然而，较高的雌二醇水平显著增加了进入过渡期的几率（P= 0.013）。年龄和种族可以预测过渡到某些阶段，但不是所有阶段。在调整了其他研究变量后，体重指数、饮酒和初潮年龄不能预测进入绝经过渡的任何阶段。结论：这些结果表明，FSH升高、抑制素B降低和吸烟强烈地预示着绝经早期的过渡阶段，即出血模式的改变。非裔美国人比白人妇女更早进入过渡阶段，但种族并不能预测进入过渡后期。较高的雌二醇水平预示着进入最早的过渡阶段，而不是随后的阶段。
Objective:The aim of this study was to estimate the probabilities and identify risk factors for entering the menopausal transition and moving into each subsequent transition stage.Methods:Estimations of probabilities of entry into each menopausal transition stage and predictors associated with each transition stage were conducted in a population-based cohort of midlife women.Results:The likelihood of entering the menopausal transition and moving into each subsequent stage was increased for each unit increase in follicle-stimulating hormone (FSH)(P< 0.001) and with each unit decrease in inhibin B (P< 0.001) in the adjusted multivariable model. The largest observed change in average FSH levels was the comparison of women in the late transition (stage 4), with an average of 24.78 mIU/mL, to those in the early transition (stage 3), with 10.38 mIU/mL. Women experiencing this amount of change in FSH had an odds of transitioning from stages 3 to 4 of 1.90 (95% CI, 1.86-1.95). Decreases in inhibin B resulted in odds ratios similar to the magnitude of changes in FSH. Current smoking increased the odds of transition into each stage by approximately 30%(odds ratio, 1.30; 95% CI, 1.28-1.32). Average estradiol levels did not change dramatically between stages. However, higher estradiol significantly increased the odds of entering the transition (P= 0.013). Age and race predicted transitions into some but not all stages. Body mass index, alcohol use, and age at menarche did not predict entrance into any stage of the menopausal transition after adjusting for other study variables.Conclusions:These results show that increased FSH, decreased inhibin B, and smoking strongly predict entry into the earliest stages of the menopausal transition as defined by changes in bleeding patterns. African Americans entered the transition before white women, but race did not predict entry into late transition stages. Higher estradiol levels predict entry into the earliest transition stage but not subsequent stages.