The relationship of longitudinal change in reproductive hormones and vasomotor symptoms during the menopausal transition
The relationship of longitudinal change in reproductive hormones and vasomotor symptoms during the menopausal transition
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DOI：
10.1210/jc.2005-1374
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发表时间：
2005-11-01
影响因子：
5.8
通讯作者：
Matthews, KA
中科院分区：
文献类型：
--
作者：
Randolph, JF;Sowers, MF;Matthews, KA
内容：生殖激素与血管紧张症状（VMS）的关系尚未完全探讨，尽管中年时此类症状的增加和激素治疗的减少表明了强烈而直接的关系。65-76%经历绝经过渡期的妇女报告血管痉挛症状，这是在这个生命阶段进行医疗干预的主要原因。目的：本报告的目的是将生殖激素雌二醇（E2），FSH，睾酮（T），硫酸脱氢表雄酮（DHEAS），和SHBG和游离激素指数、游离E2指数（FEI）和游离T指数（FTI）与绝经过渡期妇女VMS的发生有关。基线时，招募了3302名属于五个种族/种族群体之一的女性，并进行了年度随访。在年度访谈中自我报告前2周症状（潮热、盗汗）的频率和其他协变量以及潜在混杂变量的测量值。每年采集一次血清，在自行车女性自发周期的第2-5天或非自行车女性基线研究访视周年纪念日的90天内，测定FSH、E2、T、SHBG和DHEAS。计算FTI和FEI。这项分析纳入了3293名妇女的纵向数据，不包括首次报告使用激素治疗或子宫切除术时或之后收集的信息。数据进行了分析，采用纵向边际logistic回归模型和偏比例优势model.Results：调整年龄，体重指数，和其他相关协变量后，VMS患病率增加较高的logFSH浓度，增加更大时，抽血超过5天后月经开始。FSH浓度与潮热或盗汗的频率呈正相关，较高的FSH浓度与报告更频繁症状的可能性更大相关。血管紧张症状患病率随着（log）E2、（sqrt）SHBG和logFEI的升高而降低，但仅当这些激素值独立于logFSH值建模且标本在第2-5天窗口外获得时。当同时用logFSH、（log）E2、（sqrt）SHBG和logFEI建模时，症状患病率不再显著相关。（立方）T根和（平方）DHEAS浓度和logFTI与VMS的患病率无关。当集体纵向建模时，年度血清FSH浓度与VMS的患病率和频率相关，但与E2、T、DHEAS、FTI或FEI无关。中年女性中VMS的患病率和频率。
Context: The relationship of reproductive hormones to vasomotor symptoms (VMS) has been incompletely explored, although an increase in such symptoms at midlife and their reduction with hormone therapy suggest a strong and direct relationship. Vasomotor symptoms are reported by 65-76% of women traversing the menopausal transition and are a primary reason for medical intervention during this life stage.Objective: The purpose of this report was to relate longitudinal serum concentrations of the reproductive hormones estradiol (E2), FSH, testosterone ( T), dehydroepiandrosterone sulfate (DHEAS), and SHBG and the free hormone indices free E2 index (FEI) and free T index (FTI) with the occurrence of VMS in women traversing the menopausal transition.Participants and Main Outcome Measures: At baseline, 3302 menstruating women who belonged to one of five ethnic/racial groups were recruited and followed up with annual visits. Frequencies of symptoms ( hot flashes, night sweats) for the prior 2 wk and measures of other covariates as well as potentially confounding variables were self-reported in the annual interview. Serum was obtained annually, on d 2-5 of a spontaneous cycle in cycling women or within 90 d of the anniversary of the baseline study visit in noncycling women and assayed for FSH, E2, T, SHBG, and DHEAS. FTI and FEI were calculated. This analysis incorporated available longitudinal data from 3293 women, excluding information collected at or after first report of hormone therapy use or hysterectomy. Data were analyzed using longitudinal marginal logistic regression models and a partial proportional odds model.Results: After adjusting for age, body mass index, and other related covariates, VMS prevalence increased with higher logFSH concentrations, and the increase was greater when blood was drawn more than 5 d after menses began. FSH concentrations were positively associated with the frequency of either hot flashes or night sweats, and higher FSH concentrations were associated with greater odds of reporting more frequent symptoms. Vasomotor symptom prevalence decreased with higher (log)E2, (sqrt)SHBG, and logFEI but only when these hormone values were modeled independently of logFSH values and the specimens were obtained outside the d 2-5 window. When modeled simultaneously with logFSH, (log)E2, (sqrt)SHBG, and logFEI were no longer significantly associated with symptom prevalence. (Cubic) T-root and (sqrt)DHEAS concentrations and logFTI were not associated with the prevalence of VMS.Annual serum FSH concentrations, but not E2, T, DHEAS, FTI, or FEI when collectively modeled longitudinally, are associated with both the prevalence and frequency of VMS in women at midlife.