Hardy Rebecca, Kuh Diana
Department of Epidemiology and Public Health, Royal Free and University College Medical School, Medical Research Council-National Survey of Health and Development, Gower Street Campus, 1-19 Torrington Place, London WC1E 6BT, UK.
Soc Sci Med. 2002 Dec;55(11):1975-88. doi: 10.1016/s0277-9536(01)00326-4.
There remains uncertainty regarding what health symptoms can be directly attributed to the menopause. The association between changes in menopausal status and changes in vasomotor symptom and psychological symptom reporting was investigated and the effects of changing menopausal status were compared with those related to life events and difficulties. Reports of common health symptoms, menopausal status and life events and difficulties have been collected prospectively from 1572 British women followed up since their birth in 1946, every year between 47 and 52 years. Regression models for repeated measures were fitted with the change in symptom scores between consecutive years as the outcome. Estimates from these models were obtained using generalised estimating equations, thus allowing appropriately for the correlation between repeated measures on the same woman. Vasomotor symptoms were found to be strongly related to changes in menopausal status with increases being observed as women move through the menopause. Psychological symptoms were more strongly associated with current life events and difficulties, particularly those experienced in family life, than with menopausal status. An increase in symptoms was, however, observed in premenopausal and perimenopausal women starting hormone replacement therapy. These effects were not confounded or modified by previous psychological morbidity, social or behavioural factors. The findings suggest that vasomotor symptoms are dependent on changing hormone levels associated with the menopause, while psychological symptoms are not. The possibility that there is a small subgroup of women who experience increased psychological problems at the time of the menopause, and who in this cohort are identified by their use of HRT, is suggested. The mechanism behind this rise remains unclear. Factors other than the menopause should be considered, such as concurrent life events and past experiences and behaviours, when considering the treatment of psychological symptoms in women during middle life.
关于哪些健康症状可直接归因于更年期，目前仍存在不确定性。研究了更年期状态变化与血管舒缩症状及心理症状报告变化之间的关联，并将更年期状态变化的影响与生活事件及困难相关的影响进行了比较。自1946年出生起对1572名英国女性进行了前瞻性随访，在她们47至52岁期间每年收集常见健康症状、更年期状态以及生活事件和困难的报告。以连续年份之间症状评分的变化为结果，拟合了重复测量的回归模型。这些模型的估计值通过广义估计方程获得，从而适当考虑了同一女性重复测量之间的相关性。发现血管舒缩症状与更年期状态变化密切相关，随着女性经历更年期，症状会增加。心理症状与当前生活事件及困难，尤其是家庭生活中经历的事件及困难，比与更年期状态的关联更强。然而，开始激素替代疗法的绝经前和围绝经期女性症状有所增加。这些影响不受先前心理疾病、社会或行为因素的混淆或改变。研究结果表明，血管舒缩症状取决于与更年期相关的激素水平变化，而心理症状则不然。有迹象表明，可能有一小部分女性在更年期时会出现心理问题增加，在这个队列中，她们是通过使用激素替代疗法被识别出来的。这种增加背后的机制尚不清楚。在考虑中年女性心理症状的治疗时，应考虑更年期以外的因素，如并发的生活事件以及过去的经历和行为。
