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卵巢衰老过程中的月经改变

何仲,  林守清,  陈蓉,  陈瑛,  高洪莲,  乌正赉

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文章导航 > 协和医学杂志  > 2016 >  7(2): 81-87
何仲, 林守清, 陈蓉, 陈瑛, 高洪莲, 乌正赉. 卵巢衰老过程中的月经改变[J]. 协和医学杂志, 2016, 7(2): 81-87. doi: 10.3969/j.issn.1674-9081.2016.02.001
引用本文: 何仲, 林守清, 陈蓉, 陈瑛, 高洪莲, 乌正赉. 卵巢衰老过程中的月经改变[J]. 协和医学杂志, 2016, 7(2): 81-87. doi: 10.3969/j.issn.1674-9081.2016.02.001
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Zhong HE, Shou-qing LIN, Rong CHEN, Ying CHEN, Hong-lian GAO, Zheng-lai WU. Menstrual Cyclicity Change in Ovarian Aging[J]. Medical Journal of Peking Union Medical College Hospital, 2016, 7(2): 81-87. doi: 10.3969/j.issn.1674-9081.2016.02.001
Citation: Zhong HE, Shou-qing LIN, Rong CHEN, Ying CHEN, Hong-lian GAO, Zheng-lai WU. Menstrual Cyclicity Change in Ovarian Aging[J]. Medical Journal of Peking Union Medical College Hospital, 2016, 7(2): 81-87. doi: 10.3969/j.issn.1674-9081.2016.02.001
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卵巢衰老过程中的月经改变

doi: 10.3969/j.issn.1674-9081.2016.02.001
  • 1.

    中国医学科学院 北京协和医学院 继续教育学院, 北京 100730

  • 2.

    中国医学科学院 北京协和医学院 北京协和医院妇产科, 北京 100730

  • 3.

    首都医科大学附属北京友谊医院妇产科, 北京 100050

  • 4.

    滨州医学院附属医院临床医学实验中心, 山东滨州 256603

  • 5.

    中国医学科学院 北京协和医学院 基础医学研究所流行病及统计学系, 北京 100005

详细信息
    通讯作者:

    林守清 电话:010-69158948, E-mail:shouqing_lin2003@163.com

  • 中图分类号: R711.51

Menstrual Cyclicity Change in Ovarian Aging

  • 1.

    Continuing Education College, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China

  • 2.

    Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China

  • 3.

    Department of Obstetrics and Gynecology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China

  • 4.

    Central Laboratory of Clinical Medicine, Binzhou Medical College, Binzhou, Shandong 256603, China

  • 5.

    Department of Epidemiology & Biostatistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100005, China

More Information

    摘要
  • 摘要:   目的  研究卵巢衰老过程中的月经各要素改变。  方法  对北京市某社区323名30~54岁健康女性前瞻性观察1年, 记录月经日记并测量血促卵泡激素(follicle-stimulating hormone, FSH)水平。按年龄、FSH水平及生殖衰老分期分别分组, 分析月经周期长度、经期长度和经量的改变。  结果  年龄影响:平均月经周期长度在40岁后逐渐延长, 从48岁以后变化明显, 在≥ 52岁组达最长, 为(67.04±36.77)d; 平均经期长度随年龄增长变化不明显, 但平均经期长度的变异在44岁后逐渐变大, 50~51岁组最大; 经量在38~47岁间大致相似, 在48~49岁组最高, 达(45.06±93.54)分, ≥ 52岁组最低, 为(15.87±13.81)分。FSH水平影响:月经周期长度随FSH水平的升高而延长; 平均经期长度在FSH各水平组间差异无统计学意义, 但经期长度的变异在20 < FSH ≤ 40 U/L组最大; 平均经量在10 < FSH ≤ 15 U/L组最高, 为(30.69±31.84)分, 在FSH > 40 U/L组最低, 为(17.38±24.38)分。生殖衰老分期的影响:经期长度和经量在生殖衰老各期的组间差异无统计学意义(P > 0.05)。  结论  在卵巢衰老过程中, 月经周期长度变化明显, 适于用作生殖衰老分期的标准, 但经期长度和经量的改变也有其特征性, 从临床角度有提示价值, 应予重视。
    Abstract:   Objective  To observe the alterations of each menstrual factor in ovarian aging.  Methods  The data were obtained from one-year observation of a prospective cohort involving 323 healthy women in the age of 30-54 years in a community in Beijing. Menstrual diary was kept and serum level of follicle-stimulating hormone (FSH) was tested. The participants were divided into groups based on age, FSH level, and stages of reproductive aging. Alterations of length of menstrual cycle (LMC), length of menstrual period, and menstrual volume were analyzed in each group.  Results  Age:the mean LMC extended after the age of 40 years, obviously after 48, and peaked with (67.04±36.77) days in ≥ 52-year-old group. The mean length of menstrual period did not vary much with age. However, the variation of mean length of menstrual period gradually increased with age after 44 years old, peaked in 50- to 51-year-old group. The menstrual volume scores were approximately stable between 38 and 47 years of age, with a peak of(45.06±93.54) in 48- to 49-year-old group and a minimum of (15.87±13.81) in ≥ 52-year-old group. FSH level:LMC increased with elevation of FSH levels. There was no significant difference in the mean length of menstrual period among FSH level groups, but the variation of length of menstrual period was maximum in 20 < FSH ≤ 40 U/L group. The maximum mean menstrual volume score was (30.69±31.84), observed in 10 < FSH ≤ 15 U/L group, while the minimum was (17.38±24.38) in FSH > 40 U/L group. Stages of reproductive aging:the length of menstrual period and menstrual volume scores among each stage showed no statistically significant difference(P > 0.05).  Conclusions  The LMC altered significantly in ovarian aging, which could be used as staging criteria of reproductive aging. The length of menstrual period and menstrual volume are also showing some characteristic changes, possibly of some clinical values.
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  • 图  1  北京市某社区妇女调研月经日记卡

    在相关日期栏中打“√”表示月经，同时记录本月重要生活事件(可能影响身体和情绪的重要事件)

    下载: 全尺寸图片 幻灯片

    图  2  北京市某社区妇女按年龄分组的平均LMC和LMC平均标准差

    LMC：月经周期长度

    下载: 全尺寸图片 幻灯片

    图  3  北京市某社区妇女按年龄分组的平均经期长度和经期长度平均标准差

    下载: 全尺寸图片 幻灯片

    图  4  北京市某社区妇女按年龄分组的平均经量和经量平均标准差

    下载: 全尺寸图片 幻灯片

    表  1  北京市某社区妇女按FSH水平分组的LMC比较

    FSH分组(U/L) n 平均年龄
    (岁)    		 LMC* LMC平均标准差†
    x±s，d 95% CI x±s，d 95% CI
    ≤10 163 42.72±4.04 29.56±4.08 28.19~36.58 4.78±3.65 4.34~11.00
    10＜FSH≤15 41 45.20±3.92 35.00±19.66 23.69~39.14 13.60±17.36 6.62~19.41
    15＜FSH≤20 24 46.78±4.04 45.39±24.53 33.30~53.63 23.87±25.64 11.75~28.90
    20＜FSH≤40 54 47.48±3.72 47.87±43.02 37.97~51.85 24.74±29.19 16.12~27.56
    ＞40 41 50.04±3.55 64.78±44.12 51.34~68.35 40.15±35.60 27.80~41.82
    F值 16.093 27.730
    P值 ＜0.001 ＜0.001
    FSH：促卵泡激素；LMC：同图 2；*除FSH≤10 U/L组与10 U/L＜FSH≤15 U/L组和15 U/L＜FSH≤20 U/L组与20 U/L＜FSH≤40 U/L组外，其他组间两两比较，P均＜0.05；†组间两两比较，P均＜0.05
    下载: 导出CSV

    表  2  北京市某社区妇女按FSH水平分组的经期长度比较

    FSH分组(U/L) n 经期长度 经期长度平均标准差
    x±s，d 95% CI x±s，d 95% CI
    ≤10 163 4.62±1.31 4.33~4.86 0.97±0.71* 0.87~1.30
    10＜FSH≤15 41 5.15±1.57 4.68~5.65 1.29±1.55 0.89~1.70
    15＜FSH≤20 24 4.81±1.72 4.20~5.48 1.45±1.49 0.84~1.90
    20＜FSH≤40 54 4.65±1.98 4.27~5.14 1.81±2.24* 1.34~2.06
    ＞40 41 4.67±1.85 4.22~5.30 1.49±1.24 0.80~1.69
    F值 0.760 21.830
    P值 0.601 ＜0.001
    FSH：同表 1；组间两两比较，*P＜0.05
    下载: 导出CSV

    表  3  北京市某社区妇女按FSH水平分组的月经前淋漓发生情况比较

    FSH分组(U/L) n 经前淋漓 经前淋漓平均标准差
    x±s，d 95% CI x±s，d 95% CI
    ≤10 163 1.32±0.09** 1.14~1.50 0.73±0.10* 0.54~0.92
    10＜FSH≤15 41 1.53±1.60 1.15~1.81 1.15±0.18* 0.79~1.51
    15＜FSH≤20 24 1.72±1.10 1.21~2.07 1.26±1.65 0.71~1.64
    20＜FSH≤40 54 1.81±0.93 1.37~1.96 1.30±1.23 0.86~1.50
    ＞40 41 1.90±0.19** 1.53~2.27 1.08±1.05 0.46~1.25
    F值 6.839 5.374
    P值 ＜0.001 ＜0.001
    FSH：同表 1；组间两两比较，*P＜0.05，* *P＜0.01
    下载: 导出CSV

    表  4  北京市某社区妇女按FSH水平分组的经量比较

    FSH分组(U/L) n 经量 经量平均标准差
    x±s，分 95% CI x±s，分 95% CI
    ≤10 163 29.21±26.15 24.19~32.90 27.32±41.69 18.98~35.10
    10＜FSH≤15 41 31.95±26.90 23.72~40.13 37.15±50.33 21.84~52.21
    15＜FSH≤20 24 30.69±31.84 20.07~41.28 35.24±83.33 15.77~55.05
    20＜FSH≤40 54 26.21±24.22 20.11~34.89 25.72±31.24 12.89~40.25
    ＞40 41 17.38±24.38 6.84~8.87 18.23±60.78 1.1385~37.37
    F值 1.478 5.957
    P值 0.190 ＜0.001
    FSH：同表 1
    下载: 导出CSV

    表  5  北京市某社区妇女根据STRAW分期分组的经期长度及其标准差、经量及其标准差比较

    STRAW
    分期    		 n 经期长度 经期长度平均标准差 经量 经量平均标准差
    x±s，d 95% CI x±s，d 95% CI x±s，分 95% CI x±s，分 95% CI
    生育期 82 4.80±0.19 4.43~5.16 0.94±0.15 0.64~1.24 29.26±3.07 23.25~35.34 27.61±5.68 16.44~38.78
    MT早期 146 4.62±0.13 4.36~4.88 1.19±0.11 0.97~1.40 28.37±2.18 24.07~32.67 27.46±4.04 19.52~35.40
    MT晚期 95 4.79±0.18 4.43~5.14 1.63±0.15 1.34~1.92 25.06±2.98 19.18~30.93 26.94±1.48 17.41~39.12
    F值 0.415 4.642 0.453 0.011
    P值 0.660 0.100 0.604 0.990
    STRAW：生殖衰老分期系统；MT：绝经过渡期
    下载: 导出CSV
    • 参考文献(16)
  • [1] Harlow SD, Mitchell ES, Crawford S, et al.The ReSTAGE Collaboration:defining optimal bleeding criteria for onset of early menopausal transition[J]. Fertil Steril, 2008, 89:129-140. doi:  10.1016/j.fertnstert.2007.02.015
    [2] Harlow SD, Cain K, Crawford S, et al. Evaluation of four proposed bleeding criteria for the onset of late menopausal transition[J]. J Clin Endocrinol Metab, 2006, 91:3432-3438. doi:  10.1210/jc.2005-2810
    [3] Soules MR, Sherman S, Parrott E, et al. Executive summary:Stages of Reproductive Aging Workshop (STRAW)[J]. Fertil Steril, 2001, 76:874-878. doi:  10.1016/S0015-0282(01)02909-0
    [4] Harlow SD, Gass M, Hall JE, et al. Executive summary of the Stages of Reproductive Aging Workshop +10:addressing the unfinished agenda of staging reproductive aging[J]. J Clin Endocrinol Metab, 2012, 97:1159-1168. doi:  10.1210/jc.2011-3362
    [5] Paramsothy P, Harlow SD, Greendale GA, et al. Bleeding patterns during the menopausal transition in the multi-ethnic Study of Women's Health Across the Nation (SWAN):A prospective cohort study[J]. BJOG, 2014, 121:1564-1573. doi:  10.1111/1471-0528.12768
    [6] Mitchell ES, Woods NF, Mariella A.Three stages of the menopausal transition from the Seattle Midlife Women's Health Study:toward a more precise definition[J]. Menopause, 2000, 7:334-349. doi:  10.1097/00042192-200007050-00008
    [7] American College of Obstetricians and Gynecologists. Practice Bulletin Number 136, July 2013:Management of Abnormal Uterine Bleeding Associated with Ovulatory Dysfunction[J]. Obstet Gynecol, 2013, 1222:176-185. http://europepmc.org/abstract/med/23787936
    [8] Munro MG, Critchley HO, Fraser IS, et al. The FIGO classification of causes of abnormal uterine bleeding in the reproductive years[J]. Fertil Steril, 2011, 95:2204-2208. doi:  10.1016/j.fertnstert.2011.03.079
    [9] 中华医学会妇产科学分会妇科内分泌学组.异常子宫出血诊断与治疗指南[J].中国妇产科杂志, 2014, 49:801-806. http://d.wanfangdata.com.cn/Periodical/zhfck201411001
    [10] Higham JM, O'Brien PM, Shaw RW. Assessment of menstrual blood loss using a pictorial chart[J]. Br J Obstet Gynaecol, 1990, 97:734-739. doi:  10.1111/j.1471-0528.1990.tb16249.x
    [11] Treloar AE, Boynton RE, Behn BG, et al. Variation of the human menstrual cycle through reproductive life[J]. Int J Fertil, 1962, 12:77-126. http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=WK_LWW2017052520382999
    [12] Dudley EC, Hopper JL, Taffe J, et al. Using longitudinal data to define the perimenopause by menstrual cycle characteristics[J]. Climacteric, 1998, 1:18-25. doi:  10.3109/13697139809080677
    [13] Faddy MJ. Follicle dynamics during ovarian ageing[J]. Mol Cell Endocrinol, 2000, 163:43-48. doi:  10.1016/S0303-7207(99)00238-5
    [14] Hansen KR, Knowlton NS, Thyer AC, et al. A new model of reproductive aging:the decline in ovarian non-growing follicle number from birth to menopause[J].Hum Reprod, 2008, 23:699-708. doi:  10.1093/humrep/dem408
    [15] Klein NA, Illingworth PJ, Groome N, et al. Decreased inhibin B secretion is associated with the monotropic FSH rise in older, ovulatory women:a study of serum and follicular fluid levels of dimeric inhibin A and B in spontaneous menstrual cycles[J]. J Clin Endocrinol Metab, 1996, 81:2742-2745. http://www.ncbi.nlm.nih.gov/pubmed/8675606
    [16] Miro F, Parker SW, Aspinall LJ, et al. Sequential classification of endocrine stages during reproductive aging in women:the FREEDOM study[J]. Menopause, 2005, 12:281-290. doi:  10.1097/01.GME.0000147018.30796.25
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  • 收稿日期:  2016-02-01
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