Clinical effect of intrinsic-nourishing exercise and oral Chinese medicine combined with conventional western medicine therapy in the treatment of perimenopause with insomnia / 国际中医中药杂志

Objective:To explore the clinical effect and safety of intrinsic-nourishing exercise and oral Chinese medicine combined with conventional western medicine therapy in the treatment of perimenopause with insomnia.Methods:Prospective cohort study. A total of 60 perimenopause with insomnia visiting the Hebei Medical Qigong Hospital were enrolled as the research objects between June 2019 and June 2021. According to random number table method, they were divided into the control group and the observation group, 30 in each group. The control group was treated with oral estazolam tablets, while the observation group was treated with intrinsic-nourishing exercise combined with oral Chinese medicine on basis of the control group. All the patients were treated for 4 weeks as a course, and totally 2 courses. The levels of serum estradiol (E 2), FSH, and LH were detected by automatic chemiluminescence immunoassay analyzer. Pittsburgh sleep quality Index (PSQI) was used to evaluate sleep quality, and the quality of life was evaluated by the MOS 36-item Short Form Health Survey (SF-36). And the responsive rates, sleep quality, scores of TCM symptoms, and adverse reactions were compared before and after treatment. Results:The total response rate of observation group was significantly higher than that of the control group (90.0% vs. 66.7%; χ2=4.81, P<0.05). After treatment, PSQI scores of sleep quality, time to fall asleep, sleep duration, sleep efficiency, sleep disturbance, use of hypnotics, and daytime function in the observation group were significantly lower than those in the control group ( t=14.11, 12.49, 9.88, 13.54, 9.47, 14.11, 17.91, P<0.01). After treatment, the TCM symptom scores of insomnia with more dreams, waist and knee soreness, five upsets, fatigue and forgetfulness in the observation group were significantly lower than those in the control group ( t=9.51, 13.08, 16.17, 12.81, P<0.01). After treatment, the E 2 [(35.16±3.61) mmol/L vs. (31.06±3.12) mmol/L, t=4.71] in the observation group was significantly higher than that of the control group ( P<0.01), while the FSH [(69.61±6.04) U/L vs. (73.26±7.41) U/L, t=2.09], and LH [(32.21±3.35) U/L vs. (36.04±3.49) U/L, t=4.34] in the observation group were significantly lower than those in the control group ( P<0.05 or P<0.01). At 4 and 8 week after treatment, the SF-36 scores in the observation group were significantly higher than those in the control group ( t=6.30, 4.36, P<0.01). During treatment, 16.7% (5/30) adverse reaction happened in the observation group, while 10.0% (3/30) in the control group, but there was no statistical significant difference between two groups ( χ2=0.56， P=0.448). Conclusion:The intrinsic-nourishing exercise and oral Chinese medicine combined with conventional western medicine therapy can significantly improve clinical curative effect, improve sleep quality and TCM symptoms, regulate hormones and quality of life in perimenopause with insomnia.

Correlation between metabolic syndrome and hyperuricemia in perimenopausal women / 中华内分泌代谢杂志

Objective:To assess the prevalence of metabolic syndrome(MS) and its relationship with hyperuricemia(HUA) in perimenopausal women in Anning city, Yunnan province.Methods:This is a cross-sectional survey. In May 2021, a multi-stage stratified sampling method was used to collect demographics and clinical data [ethnicity, living community, height, weight, waist circumference, blood pressure, fasting plasma glucose, triglycerides(TG), serum uric acid, high density lipoprotein-cholesterol(HDL-C), alanine transaminase(ALT), etc] in a total of 6 721 perimenopausal women aged 45-60 years.Results:A total of 6 721 perimenopausal women were included in this study. The prevalences of MS and HUA were 14.05%(95% CI 13.22%-14.88%) and 6.46%(95% CI 5.88%-7.07%), respectively. The average age, HDL-C, urea, direct bilirubin, and albumin levels in the perimenstrual HUA population were lower than those in the non-HUA population while the levels of TG, ALT, heart rate, body mass index(BMI), and creatinine were higher(all P<0.05). The prevalence of HUA in perimenopausal women with ethnic minorities and family history of chronic diseases was higher than that in Han nationality and without family history of chronic diseases. The prevalence of MS in perimenopausal women was increased with the increase of serum uric acid( Z=-15.313 8, P<0.001). Multivariate logistic regression model showed that HUA was positively correlated with MS( OR=1.526, 95% CI 1.192-1.954) after adjusting for covariates such as BMI and ethnicity, and the incidence of MS in perimenopausal women in HUA group was 1.526 folds higher than that in non-hyperuricemia group. Conclusion:HUA is highly positively correlated with MS in perimenopausal women. The management of uric acid level in perimenopausal women should be strengthened.

Psychological disorders in perimenopausal women / 中华老年医学杂志

Perimenopausal period includes the whole process from the beginning of the decline of gonadal function to the complete loss, which lasts for 1 to 10 years.It is a fragile'window period'with the high incidence of mental illness for women.During this period, the mental health status of women is closely related to their mental health status at older age.Emotional disorders, sleep disorders, and cognitive impairment are common in perimenopausal and postmenopausal women, but currently receive insufficient attention.Therefore, the present review discusses the current state of research on the prevalence, pathogenesis, intervention, and management of the above-mentioned disorders, and thus to provide a basis for prevention and intervention programs among perimenopausal women.

Effects of E-Coaching self-management model on health behavior change in perimenopausal women / 中华健康管理学杂志

Objective:To analyze the influence of E-Coaching self-management model on health behavior change in perimenopausal women.Methods:In this randomized controlled trial, 230 perimenopausal women who participated in health management prograam in the Health Management Center of Hangzhou Wuyunshan Hospital from January 2020 to October 2021 were selected as study objects by convenience sampling method. The subjects were divided into the experimental group and the control group with random number table (115 cases in each group). The experimental group was managed by health coaches with E-Coaching self-management model, and the control group was routinely managed by health managers. The intervention lasted for 6 months. Finally, 29 cases were lost to follow-up due to the failure of the subjects to comply with protocol requirements or voluntary withdrawal. So, a total of 201 subjects were included in the analysis (107 cases in the experimental group and 94 cases in the control group). χ2 test and t test were used to analyze the differences in modified Kupperman symptom score, perimenopausal knowledge and belief, regular exercise and dietary healthy behavior stage between the two groups. And the influence of E-Coaching self-management model on health behavior change in perimenopausal women was analyzed too. Results:After the intervention, the total score of modified Kupperman scale and the scores of insomnia, anxiety and fatigue in the experimental group were all lower than those in the control group [(7.36±2.91) vs (10.01±2.78) points, (0.49±1.13) vs (1.27±1.20) points, (0.80±0.99) vs (1.68±1.39) points, (0.67±0.55) vs (0.93±0.64) points]( t=6.553, 4.785, 5.219, 3.013, all P<0.05); and the total score of knowledge and belief questionnaire and the score of knowledge or belief dimension in the experimental group were significantly higher than those in control group [(25.15±1.55) vs (21.05±1.64) points, (9.61±0.56) vs (9.03±0.68) points, (15.54±1.53) vs (12.02±1.28) points] ( t=-18.238, -6.570, -17.801, all P<0.05). After the intervention, the proportions of the experimental group in the precontemplation and contemplation stage of exercise and diet were both significantly lower than those before intervention ( χ2=116.616, 139.964, both P<0.001), and were lower than those in the control group (the proportion of precontemplation stage of exercise was 7.5% vs 38.3%, and the contemplation stage of exercise was 26.2% vs 34.0%, χ2=38.330; the proportion of precontemplation stage of diet was 3.7% vs 23.4%, and the contemplation stage of diet was 18.7% vs 29.8%, χ2=25.399; all P<0.001). After the intervention, the proportion of the subjects in the preparation stage and action stage the experimental group were significantly higher than those before intervention ( χ2=116.616, 139.964, both P<0.001), and were higher than those in the control group (the proportion in preparation stage of exercise 18.7% vs 8.5%, and the action stage of exercise 47.7% vs 19.1%, χ2=38.330; the proportion in preparation stage of diet 20.6% vs 14.9%, and the action stage of diet 57.0% vs 31.9%, χ2=25.399; all P<0.001). Conclusion:E-Coaching self-management model can improve women′s perimenopausal symptoms in certain degrees, it improves their understanding of perimenopausal knowledge, enhances self-management beliefs and promotes healthy behavior changes.

Relationship between job burnout, job stress and depression in perimenopausal women / 中国基层医药

Objective:To investigate the relationship between job burnout, job stress, and depression in perimenopausal women.Methods:A total of 1 208 postmenopausal women from Wenzhou were randomly selected from August 2020 to August 2022 as research subjects for this study. Job burnout, job stress, social support, and depression were measured using the personal general condition questionnaire, the Chinese community nurse stress scale, Maslach Burnout Inventory-General Survey, Center for Epidemiologic Studies Depression Scale. The Pearson correlation coefficient was used to analyze the correlation between job burnout, job stress, and depression.Results:The scores of the Chinese community nurse stress scale and Maslach Burnout Inventory-General Survey in married people were (47.54 ± 4.54) points and (34.69 ± 4.12) points, respectively, which were significantly lower than those in unmarried, divorced, separated, and widowed people ( F = 9.49, 51.86, all P < 0.001). The Social Support Questionnaire score in married people was (33.28 ± 8.94) points, which was significantly higher than that in unmarried, divorced, separated, or widowed people ( F = 17.55, P < 0.001). There was no significant difference in the Center for Epidemiologic Studies Depression Scale score among married, unmarried, divorced,separated, or widowed people (all P > 0.05). The scores for the Chinese community nurse stress scale, Maslach Burnout Inventory-General Survey, Center for Epidemiologic Studies Depression Scale, and Social Support Questionnaire in people who received middle school-level education were (55.41 ± 6.15) points, (44.31 ± 6.13) points, (21.24 ± 4.11) points, and (40.76 ± 10.44) points, respectively, which were significantly higher than those in people who received education of primary school and below, college and above ( F = 147.29, 106.46, 70.14, 13.08, all P < 0.001). The scores of stressors for individuals engaged in other non-service professions, the score of the Maslach Burnout Inventory-General Survey, and the score of the Center for Epidemiologic Studies Depression Scale were (44.21 ± 3.84) points, (37.78 ± 5.24) points, (17.53 ± 3.42) points, and (34.27 ± 6.97) points, respectively, which were significantly lower than that of stressors for individuals engaged in nursing, teaching, and other service professions ( F = 207.75, 102.47, 37.24, 137.35, all P < 0.001). The results of correlation analysis showed that the score of the stressor scale was positively correlated with the scores of the Maslach Burnout Inventory-General Survey, Center for Epidemiologic Studies Depression Scale, and Social Support Questionnaire ( r = 0.58, 0.62, 0.52, all P < 0.05). The score of the Maslach Burnout Inventory-General Survey was positively correlated with the scores of the Center for Epidemiologic Studies Depression Scale and Social Support Questionnaire ( r = 0.59, 0.68, both P < 0.05). The score of the depression scale was positively correlated with the score of the Social Support Questionnaire ( r = 0.65, P < 0.05). Conclusion:Job burnout and job stress are positively correlated with depression and related to perimenopausal women's marital status, social support, occupation, and education level.

Assessment of Cardiovascular Disease Risk among Perimenopausal Women :A Cross-sectional Study in a Rural Area of West Bengal

Introduction :Cardiovascular disease (CVD) has become the leading cause of mortality in the world, more so in the perimenopausal age group due to decreased levels of estrogen and diminished ovarian function because of ageing. To find out the magnitude of CVD risk among perimenopausalObjective: women residing in rural Bengal and its associated determinants. A cross-sectional study wasMethod: conducted in a rural area of Barasat block I during April-July 2021 on 150 peri-menopausal women selected by cluster sampling. A pre-designed pretested questionnaire was used for data collection and a 10-year probability of CVD risk was assessed using Framingham Risk Score. Logistic regression analysis was done to find out the associated factors. Intermediate & high CVD risk was present in 28 (18.7%) and 63Results: (42%) participants respectively. Among 150 participants, 62% were hypertensive, 44.7% were diabetic,, 51.3% with borderline high total cholesterol and 76% had low HDL cholesterol. Factors significantly associated with intermediate to high CVD risk were high mental stress [AOR=6.96, 95%CI=2.17-22.31], family history of chronic illness [AOR=14.46, 95% CI=4.26-49.06] and presence of chronic morbidities [AOR=6.84, 95%CI=1.93-24.22]. A significant proportion of perimenopausal women were atConclusion: risk of developing CVD. Thus, awareness campaigns in the community would help in empowering women in maintaining their health through regular screening and timely intervention when deemed necessary

Síntomas climatéricos y calidad de vida mediante índice de Kupperman-Blatt y escala de Cervantes / Climacteric Symptoms and Quality of Life according to the Kupperman-Blatt Index and the Cervantes Scale

Introducción: Durante el climaterio o perimenopausia se reflejan una serie de síntomas asociados a la disminución progresiva de las secreciones hormonales de estrógeno y progesterona, estas deficiencias provocan diversos síntomas de orden somático, vasomotor, sexual y psicológico que perjudican la calidad de vida en general de las mujeres, además de las alteraciones en el ciclo menstrual. Objetivo: Determinar la severidad de los síntomas climatéricos en mujeres perimenopáusicas mediante el índice de Kupperman-Blatt y la Escala de Cervantes. Métodos: Se trató de un estudio de corte cuantitativo, tipo descriptivo, observacional, y correlacional, en pacientes que asistían al Centro de Salud Las Moras, en el Departamento de Huánuco, Distrito Huánuco Perú. La muestra estuvo conformada por 60 mujeres que cumplieron con los criterios de inclusión. Se aplicaron el Índice Menopáusico de Kupperman-Blatt y la Escala de calidad de vida de Cervantes. Resultados: La evaluación global del Índice Menopáusico de Kupperman-Blatt clasificó a 55 por ciento de las pacientes con intensidad de síntomas leve, seguido de 35 por ciento en pacientes que declararon no tener síntomas. Esto se correspondió en la Escala de calidad de vida de Cervantes con 45 por ciento en pacientes clasificadas con compromiso leve de su calidad de vida, seguido de 40 por ciento con mediano compromiso de calidad de vida. Conclusiones: Con un nivel de significancia de p < 0,05, se demostró que durante la etapa climatérica ambos test presentan una correlación positiva, entre la intensidad de la sintomatología medida con el Índice Menopáusico de Kupperman-Blatt y la calidad de vida valorada con la Escala de Cervantes(AU)

Introduction: During climacteric or perimenopause, a series of symptoms are reflected in association with a progressive decrease in estrogen and progesterone hormone secretion. These deficiencies cause diverse somatic, vasomotor, sexual and psychological symptoms that impair the general quality of life of women, in addition to alterations in their menstrual cycle. Objective: To determine the severity of climacteric symptoms in perimenopausal women, using the Kupperman-Blatt index and the Cervantes scale. Methods: This was a quantitative, descriptive, observational and correlational study with patients attending Las Moras health center, Huanuco Department, Huanuco District, Peru. The sample consisted of 60 women who met the inclusion criteria. The Kupperman-Blatt Menopausal Index and the Cervantes Quality of Life Scale were applied. Results: According to the global assessment using the Kupperman-Blatt Menopausal Index, 55 percent of the patients were classified as presenting mild symptom intensity, followed by 35 percent of patients who reported no symptoms. This values were consistent with the Cervantes Quality of Life scale, with 45 percent of patients classified as presenting mild compromise of their quality of life, followed by 40 percent with medium compromise of quality of life. Conclusions: With a significance level of P<0.05, it was demonstrated that, during the climacteric stage, both tests present a positive correlation, regarding the intensity of the symptoms measured with the Kupperman-Blatt Menopausal Index and the quality of life assessed with the Cervantes scale(AU)

Effects of low dose hormone replacement therapy on bone mineral density and estrogen level in the treatment of perimenopausal women with osteoporosis / 中国医师进修杂志

Objective:To study the effect of low dose hormone replacement therapy (HRT) on bone mineral density and estrogen level in perimenopausal women with osteoporosis (OP).Methods:A total of 105 perimenopausal OP patients diagnosed and treated in Guangrao County People′s Hospital from March 2019 to May 2020 were selected and divided into the conventional group (51 cases) and the hormone group (54 cases) according to the non-randomized clinical concurrent control study and the principle of patient voluntary. The former group was given conventional drug therapy, while the latter group was given low-dose HRT. Bone mineral density (BMD), bone metabolic markers, endometrial thickness, and hormone levels were compared between the two groups before and after the treatment, and the safety was assessed.Results:After the treatment, bone mineral density values of lumbar L 2 - L 4 and greater trochanter in the hormone group were higher than those in the conventional group: (1.23 ± 0.25) g/cm 2 vs. (1.12 ± 0.27) g/cm 2, (0.62 ± 0.16) g/cm 2 vs. (0.55 ± 0.17) g/cm 2, the differences were statistically significant ( P<0.05). After treatment, the level of bone alkaline phosphatase (BAP) in the hormone group was higher than that in the conventional group: (6.71 ± 1.20) μg/L vs.(5.82 ± 1.04) μg/L; the levels of tartrate resistant acid phosphatase-5b (TRACP-5b), osteocalcin (BGP) in the hormone group were lower than those in the conventional group: (501.42 ± 36.66) pg/L vs. (536.63 ± 38.58) pg/L, (75.86 ± 6.39) U/L vs. (79.32 ± 7.13) U/L, the differences were statistically significant ( P<0.05). After treatment, the levels of luteinizing hormone (LH) and follicle-stimulating hormone (FSH) in the hormone group were lower than those in the conventional group: (11.23 ± 2.21) U/L vs. (13.31 ± 1.98) U/L, (13.64 ± 3.68) U/L vs. (16.47 ± 4.04) U/L; the level of estradiol (E 2) in the hormone group was higher than that in the conventional group: (98.46 ± 18.34) nmol/L vs. (91.38 ± 17.59) nmol/L, the differences were statistically significant ( P<0.05). There was no significant difference in endometrial thickness between the two groups before and after the treatment ( P>0.05). There were no statistically significant differences in the incidence of adverse reaction and adverse event ( P>0.05). Conclusions:The application of low-dose HRT in the treatment of perimenopausal OP patients can effectively increase the body mineral density value, improve the level of sex hormone and bone metabolism markers, and do not increase the endometrial thickness, with a higher safety.

Clinical Efficacy of Zishui Bugan Decoction on Perimenopausal Insomnia Patients with Liver-kidney Deficiency / 中国实验方剂学杂志

ObjectiveTo evaluate the efficacy of Zishui Bugan decoction on perimenopausal insomnia of liver-kidney deficiency type and the safety. MethodA randomized， double-blind， placebo-controlled trial was designed. To be specific， 72 patients of perimenopausal insomnia with Liver-kidney deficiency were randomized into the treatment group and the control group at the ratio of 1∶1 and they were respectively treated with Zishui Bugan decoction and placebo for 3 weeks. The Pittsburgh sleep quality index （PSQI）， modified Kupperman index， traditional Chinese medicine （TCM） syndrome score， self-rating anxiety scale （SAS） score， and self-rating depression scale （SDS） score， were compared before and after treatment to determine the clinical efficacy， with adverse effects recorded. ResultThe total effective rate for insomnia was 85.3%（29/34） in treatment group and 17.6%（6/34） in control group（Z=-5.582，P<0.01）. After treatment， PSQI score， modified Kupperman index， TCM syndrome score， and SAS score were improved in both groups （P<0.05， P<0.01）， particularly the treatment group which showed significant difference from the control group （P<0.05，P<0.01）. The safety indicators were insignificantly different between two groups before and after treatment. No related adverse effects were reported in both groups during the treatment. ConclusionZishui Bugan decoction can improve the sleep quality and alleviate the menopausal symptoms， such as depression and anxiety， which shows ideal efficacy and safety for the perimenopausal insomnia with liver-kidney deficiency type.

Negative affect symptoms, anxiety sensitivity, and vasomotor symptoms during perimenopause

Objective: Vasomotor symptoms affect 60-80% of women during the menopausal transition. Anxiety, depression, and anxiety sensitivity can have an important role in the distressful experience of vasomotor symptoms. Our aim was to evaluate the prevalence and association of vasomotor and negative affect symptoms. Methods: A cross-sectional study was conducted with 89 perimenopausal women aged 45-55 years. Broad psychiatric and clinical evaluations were carried out. The primary outcome was the vasomotor symptom problem rating and the main study factor was anxiety sensitivity. Linear regression analyses were conducted to examine the associations between the study factors and the primary outcome, and a multiple regression model was created to assess which variables were independently associated with vasomotor symptom problem rating. Results: The prevalence of anxiety, depression, and vasomotor symptoms were 58, 62, and 73%, respectively. Negative affect symptoms were positively associated with vasomotor symptom problem rating. The association of anxiety sensitivity and vasomotor symptom problem rating remained significant after controlling for perimenopausal stage, thyrotropin, follicle-stimulating hormone levels, and psychotropic medication use (β = 0.314, p = 0.002). Conclusion: A better understanding of the experience of vasomotor symptoms is needed, especially the role of negative affect symptoms and anxiety sensitivity. New strategies focusing on related thoughts and behaviors could improve the quality of life of perimenopausal women.

Efeitos de três diferentes métodos de treinamento físico sobre os biomarcadores do estresse oxidativo e qualidade óssea de ratas no período da periestropausa / Effect of three different methods of physical training on oxidative stress biomarkers and bone quality of female rats during the periestropause period

O sedentarismo associado à diminuição da concentração plasmática de estrogênio aumenta o estresse oxidativo e promove alterações na homeostase óssea, culminando na osteopenia, que pode evoluir para osteoporose, aumentar a fragilidade óssea e o risco de fraturas. Assim, o presente estudo teve como objetivo avaliar a qualidade óssea de ratas Wistar naturalmente envelhecidas, no período da periestropausa submetidas a prática de três diferentes métodos de treinamento físico. Quarenta e oito ratas multíparas da linhagem Wistar com idade inicial de 18 meses foram submetidas três vezes por semana durante 120 dias a treinamento aeróbio (TA; corrida em esteira), treinamento resistido (TR; subir escadas), treinamento concorrente (TC; subir escadas + corrida em esteira) ou permanecer sedentário. Após o período experimental, aos 21 meses, foi realizado a coleta do material biológico para análises. Os diferentes métodos de treinamento propiciaram redução de estresse oxidativo, aumento no desempenho físico, densidade mineral óssea, melhor microarquitetura óssea, resistência mecânica, locomoção e deambulação de ratas envelhecidas naturalmente durante o período da periestropausa. Além de confirmar que o TR é boa estratégia de intervenção, verificamos também que a realização de TA e TC desencadeou benefícios importantes para a estrutura óssea e qualidade da marcha, sendo alternativas de baixo custo financeiro e de fácil acesso à comunidade, que pode ser adotada como estratégia de prevenção de fraturas osteoporóticas(AU)

A sedentary lifestyle associated with a decrease in the plasma concentration of estrogen increases oxidative stress and promotes changes in bone homeostasis, culminating in osteopenia, which can progress to osteoporosis, increase bone fragility and the risk of fractures. Thus, the present study aimed to evaluate the bone quality of naturally aged Wistar female rats, in the period of peristropause, submitted to the practice of three different methods of physical training. Forty-eight multiparous Wistar rats with an initial age of 18 months were submitted three times a week for 120 days to aerobic training (AT; treadmill running), resistance training (RT; stair climbing), concurrent training (CT; stair climbing + treadmill running) or remain sedentary. After the experimental period, at 21 months, the collection of biological material for analysis was performed. The different training methods provided reduced oxidative stress, increased physical performance, bone mineral density, better bone microarchitecture, mechanical strength, locomotion and walking of naturally aged rats during the period of periestropause. In addition to confirming that the RT is a good intervention strategy, we also verified that the performance of AT and CT triggered important benefits for bone structure and gait quality, being alternatives of low financial cost and easy access to the community, which can be adopted as a prevention strategy for osteoporotic fractures(AU)

Development and the reliability and validity test of Cognitive and Behavioral Questionnaire for Perimenopausal Period / 中国实用护理杂志

Objective:To develop a questionnaire on perimenopausal cognition and behavior and verify its reliability and validity, in order to provide an effective tool for evaluating perimenopausal women's cognition, doctor-seeking and doctor-following behaviors.Methods:Baseline survey, literature analysis and brainstorming were formed in the initial items, and group discussion and expert interview were performed to identify items of the form. By convenience sampling method, A survey was conducted on perimenopausal women in the communities around Chongqing Health Center for Women and Children from July to August 2019. Project analysis, exploratory factor analysis, confirmatory factor analysis, Pearson correlation analysis and reliability test were used to evaluate the questionnaire.Results:Two rounds of questionnaires were distributed in this study. In the first round, 260 questionnaires were distributed, 249 valid questionnaires were recovered, and the effective recovery rate was 95.8% (249/260). In the second round, 249 questionnaires were distributed, and the effective recovery rate was 96.4% (240/249). The questionnaire on perimenopausal cognition and behavior included 4 dimensions and 24 items. The cumulative contribution of variance was 66.330%, the Cronbach α coefficient was 0.893 and the spearman-brown half-fold coefficient was 0.773. Regarding to the construct validity, the correlation coefficient between factors and total score of the questionnaire was 0.567-0.860 ( P < 0.01). Confirmatory factor analysis showed that the approximate error root mean square was 0.055, the normal fitting index was 0.801, and the goodness of fit index was 0.828. Conclusions:The questionnaire has been proved to be reliable and valid. It can be used to evaluate perimenopausal women′s cognition, doctor-seeking and doctor-following behaviors.

Treatment of Perimenopausal Anovulatory Dysfunctional Uterine Bleeding Based on Thought of Liver Being Innate Basis of Women / 中国实验方剂学杂志

Perimenopausal anovulatory dysfunctional uterine bleeding （ADUB） is a severe acute disease that is difficult to be dealt with in gynecology， accounting for about 70% of abnormal uterine bleeding. The significant differences in bleeding patterns make it particularly challenging to treat. The main manifestations of perimenopausal ADUB are prolonged menstrual period， inexhaustible menstrual bleeding， or heavy inter-menstrual vaginal bleeding， which allow it to be classified into the category of metrorrhagia and metrostaxis in traditional Chinese medicine （TCM）. After conducting in-depth research on this disease， physicians of the past dynasties have figured out its etiology and pathogenesis and accumulated rich experience in its differentiation and treatment， thus forming a relatively systematic theoretical system. The existing literature mainly focuses on four types of its pathogenesis， namely blood heat， blood stasis， spleen deficiency， and kidney deficiency， and there are few discussions on liver. However， patients with metrorrhagia and metrostaxis due to liver dysfunction are commonly seen in clinical practice. The theory of liver being innate basis of women explores the special physiological and pathological characteristics of women and emphasizes the important role of liver in the treatment of this disease based on its characteristic functions and meridian circulation. Considering the close relationship of liver Qi and blood with spleen， kidney， and thoroughfare and conception vessels， this paper discussed the TCM treatment of perimenopausal ADUB from the following four aspects： soothing liver Qi and nourishing liver blood， liver and kidney sharing the same source， simultaneous regulation of liver and spleen， and liver meridian circulation， so as to broaden the clinical treatment options. Perimenopause is a unique physiological period when women tend to suffer from Qi stagnation and blood deficiency. Liver， characterized by Yin in property and Yang in function， governs the free flow of Qi， induces ovulation， stores blood， and regulates blood volume. Therefore， the liver should be emphasized in the treatment of perimenopausal ADUB， which contributes to correcting the hormone disorder caused by abnormal ovulation， stopping bleeding， and alleviating perimenopausal symptoms. This paper has provided a new direction for the clinical treatment of perimenopausal ADUB .

Prevalence of hot flashes in women of 40 to 65 years of age with metabolic syndrome

SUMMARY OBJECTIVE: Hot flashes have a negative impact on the quality of life of women during the menopausal transition and thereafter. The progressive reduction in gonadal estrogen levels associated with aging promotes an accumulation of abdominal fat, dyslipidemia, and arterial hypertension, all of which are components of metabolic syndrome (MetS). The objective of the present study was to estimate the prevalence of hot flashes and evaluate their relationship with MetS in women ≥ 40 years of age. METHODS: This was a cross-sectional study involving women aged between 40 and 65 years. We used the Kupperman index to quantify the climacteric symptoms and the National Cholesterol Education Program Adult Treatment Panel III criteria for the diagnosis of MetS. RESULTS: 1,435 women were initially selected, and we obtained information from 647. The mean age at menopause was 45.99 years (SD 6.61 years) and the prevalence of hot flashes and MetS were 55.83% (95% CI: 52.35-59.25%) and 46.29% (95% CI: 44.75-52.53%), respectively. We identified a positive association between MetS and hot flashes (OR 1.16; 95% CI: 1.01-1.33). CONCLUSIONS: In women ≥ 40 years of age, hot flashes are highly prevalent and appear to be associated with MetS.

RESUMO OBJETIVO: As ondas de calor têm um impacto negativo na qualidade de vida das mulheres no climatério. A redução progressiva dos níveis de estrogênio gonadal associada ao envelhecimento promovem o acúmulo de gordura abdominal, dislipidemia e hipertensão arterial, componentes da síndrome metabólica (SM). O objetivo do presente estudo foi estimar a prevalência de ondas de calor e avaliar sua relação com SM em mulheres com idade ≥40 anos. MÉTODOS: Estudo transversal envolvendo mulheres entre 40 e 65 anos de idade. Utilizamos o índice de Kupperman para quantificar os sintomas climatéricos e os critérios do National Cholesterol Education Program Adult Treatment Panel III para o diagnóstico de SM. RESULTADOS: Mil, quatrocentas e trinta e cinco mulheres foram selecionadas inicialmente e obtivemos informações de 647. A idade média da menopausa foi de 45,99 anos (DP 6,61 anos) e a prevalência de ondas de calor e SM foi de 55,83% (95% CI: 52,35-59,25%) e 46,29% (95% CI: 44,75-52,53%), respectivamente. Identificamos uma associação positiva entre SM e ondas de calor (OR 1,16; IC95%: 1,01-1,33). CONCLUSÕES: Em mulheres com idade ≥40 anos, as ondas de calor são altamente prevalentes e parecem estar associadas a SM.

Prevalence of thyroid dysfunction in women with abnormal uterine bleeding in reproductive age

Background: Abnormal uterine bleeding (AUB) is one of the commonest presentations encountered in gynecological outpatient department. Menstruation is also regulated by many mechanisms, including thyroid hormone. So, for definitive management of AUB, it becomes imperative to assess thyroid status in those with abnormal uterine bleeding.Methods: Cross sectional study was conducted on all woman attending to OPD at Sri Siddhartha Medical College, Tumukuru, with complaints of abnormal uterine bleeding (AUB). Thyroid test was done for those who were eligible under inclusion criteria. Incidence of thyroid disorders among AUB and type of abnormal menstrual pattern associated with specific type of thyroid dysfunction were noted in this study.Results: Total of 522 presented with AUB. AUB was most common among woman age >40 years at 49.23% (257 of total 522 cases). AUB was more common in Multipara at 61.49% (321 of 522 cases). Menorrhagia was commonest pattern in AUB accounting for 51.34% (268 of 522cases). Thyroid dysfunction was present in 12.27% (64 of 522) of cases with AUB. Among them hypothyroid was most common accounting for 8.81% (46 of 522 cases). Hyperthyroidism was present in 3.44% (18 of 522 cases). Menorrhagia was most common pattern in Hypothyroidism at 65.21% (30 of 46 cases, followed by polymenorrhea at 17.39% (8 of 46 cases). Oligomenorrhea was most common in hyperthyroid group at 55.54% (10 of 18 cases) closely followed by hypomenorrhea at 44.44% (8 of 18 cases).Conclusions: Abnormal uterine bleeding (AUB) is one of the commonest gynecological complaint at gynecological OPD.  Thyroid dysfunction is noted consistently in cases of AUB. So, evaluation of thyroid profile should be part of evaluation of AUB, especially during perimenopause.

Calidad de vida y su relación con la percepción de estrés y el perfil antropométrico en mujeres adultas / Quality of life and its relationship to stress perception and anthropometric profile in adult women

La perimenopausia produce cambios hormonales y emocionales, que podrían influir en la calidad de vida como en la percepción de estrés de las mujeres. El objetivo de este estudio fue evaluar la calidad de vida y su relación con la percepción de estrés y el perfil antropométrico en mujeres adultas. Se efectuó un estudio transversal en mujeres adultas (40-65 años) que concurrieron a la Fundación Hemocentro Buenos Aires (FHBA). El estado nutricional se evaluó con el índice de masa corporal (IMC) y circunferencia de cintura (CC). La calidad de vida se valoró mediante el cuestionario de calidad de vida (CV) de la Organización Mundial de la Salud (WHOQoL-Bref). La percepción de estrés (PS) se valoró por escala de estrés percibido (PSS-10). Se incluyeron 128 mujeres (52,3% premenopáusicas y 47,7 % posmenopáusicas). El 56,3% refirió tener una CV entre bastante buena y muy buena. La prevalencia de sobrepeso y obesidad fue de 60,2% (IC 95%; 51,5 - 68,2%). La percepción de CV se asoció inversamente al IMC (p= 0,0031) al igual que los dominios físico (p= 0,016) y psicológico de CV (p= 0,001). Asimismo, la PS se asoció de manera inversa a la precepción de CV (p= 0,008) y los cuatro dominios de CV.

Perimenopause produces hormonal and emotional changes, which could influence quality of life as well as stress perception in women. The objective of this study was to evaluate quality of life and its relationship with stress perception and anthropometric profile in adult women. A cross-sectional study was carried out in adult women (40-65 years old) who attended the Fundación Hemocentro Buenos Aires. Nutritional status was evaluated with body mass index (BMI) and waist circumference (WC). Quality of life was assessed using the World Health Organization quality of life questionnaire. Perception of stress was assessed by the perceived stress scale (PSS-10). We included 128 women (52.3% premenopausal and 47.7% postmenopausal). Over half (56.3%) reported having a quality of life between fairly good and very good. The prevalence of overweight and obesity was 60.2% (95% CI, 51.5 - 68.2%). The perception of quality of life was inversely associated to the BMI (p= 0.0031) as well as the physical (p= 0.016) and psychological domains of quality of life (p= 0.001). Similarly, perceived stress was associated inversely with the quality of life perception (p= 0.008) and the four quality of life domains.

Etiological factors of abnormal uterine bleeding according to PALM- COEIN classification in perimenopausal women in a tertiary care centre

Background: Perimenopause is described as years prior to menopause that encompasses the change from normal ovulatory cycle to cessation of menses, ending 12 months after the last menses. International federation of gynaecology and obstetrics (FIGO) developed a new classification PALM-COEIN in order to standardize the factors associated with AUB. It classifies AUB as polyp, adenomyosis, leiomyoma, malignancy and hyperplasia (PALM) - structural abnormalities Coagulopathy, ovulatory dysfunction, endometrial, iatrogenic, not yet classified (COEIN) - unrelated to structural abnormalities. Objectives of this study were to categorise the causes of AUB in perimenopausal women in context to PALM COEIN classification system. Correlation of co-morbities (diabetes, hypertension and thyroid disorders) with AUB in perimenopausal age group.Methods: This is a retrospective study from the month of May 2019 to October 2019, considering 100 patients of perimenopausal age group (40 to 55 years of age group) in J. K. Hospital Bhopal, Madhya Pradesh with complaints of abnormal uterine bleeding, admitted in gynae ward.Results: Most of the patients in the current study were between 45-50 years of age i.e. 44%. Menorrhagia was the commonest menstrual disorder encountered in 52% of patients. As per FIGO; AUB-L constituted 42% AUB-O constituted 12%, AUB-P constituted 11%, AUB-A 10%, AUB-M constituted 8% AUB-E constituted 8%, not yet classified constituted 4% of total cases.Conclusions: AUB (PALM-COEIN) for causes of abnormal uterine bleeding classification was very useful in categorizing cases of AUB. It suggests that etiology of AUB and also gives place for presence of multiple factors as a cause of AUB in a particular case.

Accuracy of transvaginal sonography in evaluation of abnormal uterine bleeding in perimenopausal women

Background: AUB is a commonly encountered complaint in peri- and postmenopausal women visiting OBG OPDs and accounts for about 70% of all gynaecological complaints. Key to management depends on the cause of AUB. Protocol has changed over the years from performing investigations randomly to a condition specific approach. This study aims to evaluate and compare the efficacy of transvaginal sonography and hysteroscopy in perimenopausal women with AUB and note its relation with histopathology.Methods: A prospective study was conducted on 103 women of 40-55 years presenting to the OBG OPD of Father Muller Medical College Hospital, Mangalore. All patients underwent a transvaginal scan to note the endometrial thickness followed by a hysteroscopy and biopsy. Endometrium was sent for histopathology. Findings of these modalities were correlated.Results: The diagnostic value of transvaginal sonography in relation to histopathology had a sensitivity and specificity of 33.33% and 95.95% for atrophic endometrium, 52.5% and 62.9% for proliferative, 29.41% and 79.41% for secretory, and 55.55% and 74.19% for hyperplastic. When compared to histopathology, hysteroscopy had a sensitivity and specificity of 100% and 92.3% for atrophic, 26.19% and 96.96% for proliferative, 27.07% and 98.59% for secretory, and 100% and 64.94% for hyperplastic endometrium. It had a sensitivity of 77.77% and a specificity of 92.92% for endometrial polyps. Agreement between TVS and histopathology based on kappa co-efficient was fair for atrophic endometrium but poor for proliferative, secretory and hyperplastic endometrium. Agreement between hysteroscopy and histopathology was moderate for atrophic endometrium and for endometrial polyps. It was fair for proliferative, secretory and hyperplastic endometrium.Conclusions: TVS seems to be a good initial method for evaluation of AUB. However, a subsequent hysteroscopy with biopsy is advisable to evaluate the cause of AUB.

Cambios en la glucemia en ayunas durante la transición a la menopausia / Fasting plasmatic glucose changes during the menopausal transition

Resumen OBJETIVO: Evaluar los cambios en la glucemia en ayunas en mujeres en transición a la menopausia. MATERIALES Y MÉTODOS: Estudio observacional, retrospectivo, de una cohorte de mujeres atendidas en el Hospital Quirón Salud de Madrid entre 2007 y 2018. Criterios de inclusión: diagnóstico del ginecólogo y al menos una medición en ayunas de la glucemia y perfil lipídico. Los reportes del laboratorio se clasificaron en perimenopáusicos o posmenopáusicos, según la fecha de la última menstruación. Para el análisis estadístico se utilizaron las siguientes pruebas: χ2, t de Student, U-Mann Whitney (dependiendo del comportamiento paramétrico) y ANOVA. RESULTADOS: Se incluyeron 1949 reportes de glucemia en ayunas: 459 (23.6%) en pacientes en la perimenopausia y 1490 (76.4%) en la posmenopausia (n = 275). La glucemia en ayunas fue significativamente mayor en las mujeres en la posmenopausia (p < 0.001). En el cambio de la glucemia en ayunas a lo largo del tiempo, según la fecha de la última menstruación, se observó un aumento continuo de la glucemia, sin diferencias significativas entre la peri y posmenopausia. La edad al momento de los estudios, la diabetes gestacional, los antecedentes familiares de diabetes y las concentraciones de triglicéridos se asociaron, de forma independiente, con la glucemia en ayunas (p < 0.001 en todos los casos). CONCLUSIONES: Las diferencias en la glucemia en ayunas entre los periodos de perimenopausia y posmenopausia son significativas; sin embargo, los datos del cambio de la glucemia ajustados por edad y tratamiento sugieren que el estado menopáusico no actúa de forma independiente en la glucemia en ayunas. Los que sí influyeron fueron: la edad al momento de las mediciones, la diabetes gestacional, los antecedentes familiares de diabetes y las concentraciones de triglicéridos.

Abstract OBJECTIVE: To evaluate the fasting plasmatic glucose changes during the menopausal transition. MATERIALS AND METHODS: This is a retrospective observational study of laboratory studies from women visited in hospital Quirón Salud de Madrid from 2007-2018 years. The inclusion criteria were one or more laboratory studies of fasting plasmatic glucose and lipid profile from women visited because of irregular menstruation, menopausal symptoms and/or amenorrhea. Laboratory studies values were classified as perimenopausal or posmenopausal based on their date of last menstruation. For quantitative variables, Student's T or Mann-Whitney U tests (depending on the normality distribution) were applied to analyze differences between perimenopausal and posmenopausal values. Chi-square or Fisher's exact test were used for qualitative variables. ANOVA test was performed to compare the glucose quartiles. RESULTS: 1949 laboratory reports of fasting glucose were included: 459 (23.6%) were perimenopausal and 1490 (76.4%) were posmenopausal, from 275 women with 7.3 laboratory report-women. Fasting plasmatic glucose was higher at the posmenopausal samples (p < 0.001). The evolution of the fasting plasmatic glucose showed a continuous increase that starts during perimenopause. There were no significant differences in the evolution trend between perimenopause and posmenopause. Age in the moment of the blood sample, gestational diabetes, family history of diabetes and triglycerides levels were independently associated with fasting plasmatic glucose (p < 0.001 in all cases). CONCLUSION: The differences in fasting blood glucose between periods of perimenopause and posmenopause are significant; however, data on age-adjusted blood glucose change and treatment suggest that menopausal status does not act independently on fasting blood glucose. Those that did influence were: age at the time of the measurements, gestational diabetes, family history of diabetes and triglyceride concentrations.