Woods Nancy F, Carr Molly C, Tao Eunice Y, Taylor Heather J, Mitchell Ellen S
Department of Family and Child Nursing, University of Washington, Seattle, WA 98195-7260, USA.
Menopause. 2006 Mar-Apr;13(2):212-21. doi: 10.1097/01.gme.0000198490.57242.2e.
To determine whether cortisol levels change prospectively during the menopausal transition (MT); whether these changes are associated with changes in the hypothalamic-pituitary-ovarian axis (follicle-stimulating hormone [FSH] and estrone glucuronide [E1G]), stressors, or menopause symptoms; and whether women who experienced a rise in cortisol levels during the transition had behavioral practices, stressors, vasomotor symptoms, or mood or sleep disturbances that affected hypothalamic-pituitary-adrenal axis function.
One hundred sixty-nine women in the middle or late MT or early postmenopause stages provided monthly urine specimens for cortisol, FSH, and E1G, and rated symptoms and stress levels as part of a longitudinal study of the MT. Of these women, 91 completed a transition to the next MT stage: from early to middle (n = 30), middle to late (n = 39), or late to postmenopause (n = 22) and were eligible for inclusion in the analyses.
Cortisol increased from 7 to 12 months before the late MT stage to 7 to 12 months after onset of the late MT stage. There were no differences before and after the middle MT stage or the final menstrual period. Women with increased cortisol (>10 ng/mg creatinine) during the late MT stage had more severe vasomotor symptoms than those without changes, but did not differ in terms of age, body mass index, levels of FSH or E1G, health practices, exercise, mood, sleep, cognition, or stress levels.
Cortisol levels rise with age, but have not been linked to stages of the MT. Increased cortisol levels during the late MT stage, when menstrual irregularities are greatest, suggests increases in adrenal androgens and intraabdominal fat with menopause, and may influence risk of cardiovascular disease, vasomotor symptoms, mood, cognition, and bone loss.
确定皮质醇水平在绝经过渡期间（MT）是否会前瞻性变化；这些变化是否与下丘脑-垂体-卵巢轴（促卵泡激素[FSH]和雌酮葡萄糖醛酸苷[E1G]）、应激源或绝经症状的变化相关；以及在过渡期间皮质醇水平升高的女性是否具有影响下丘脑-垂体-肾上腺轴功能的行为习惯、应激源、血管舒缩症状或情绪或睡眠障碍。
169名处于MT中期或后期或绝经后早期阶段的女性每月提供尿样以检测皮质醇、FSH和E1G，并对症状和应激水平进行评分，作为MT纵向研究的一部分。在这些女性中，91人完成了向下一个MT阶段的过渡：从早期到中期（n = 30）、中期到后期（n = 39）或后期到绝经后（n = 22），并符合纳入分析的条件。
皮质醇在MT后期阶段前7至12个月到MT后期阶段开始后7至12个月期间升高。MT中期阶段或最后月经周期前后没有差异。在MT后期阶段皮质醇升高（>10 ng/mg肌酐）的女性比未发生变化的女性有更严重的血管舒缩症状，但在年龄、体重指数、FSH或E1G水平、健康习惯、运动、情绪、睡眠、认知或应激水平方面没有差异。
皮质醇水平随年龄增长而升高，但与MT阶段无关。在MT后期阶段，当月经不规律最为明显时，皮质醇水平升高表明绝经后肾上腺雄激素和腹部脂肪增加，可能会影响心血管疾病、血管舒缩症状、情绪、认知和骨质流失的风险。
