From the Department of Obstetrics and Gynecology and Department of Statistics, University of California, Davis, Davis, California; Department of Statistics, University of California, Irvine, Irvine, California; Department of Medicine, Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California; School of Nursing, University of Michigan, Ann Arbor, Ann Arbor, Michigan; Kaiser Permanente Department of Research, Oakland, California; Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Ann Arbor, Michigan; and Division of Epidemiology, Department of Public Health Sciences, University of California, Davis, David, California.
Obstet Gynecol. 2009 Nov;114(5):989-998. doi: 10.1097/AOG.0b013e3181bb531a.
To estimate whether menopause transition stage is independently associated with the development of incontinence symptoms.
We conducted a longitudinal analysis, using discrete proportional hazards models, of women who were continent at baseline in the Study of Women's Health Across the Nation (SWAN), a multicenter, multiracial, multiethnic prospective cohort study of community-dwelling midlife women transitioning through menopause. At baseline and each of the six annual visits, SWAN elicited frequency and type of incontinence in a self- administered questionnaire and classified menopausal stage from menstrual bleeding patterns.
Compared with premenopause, being in the early perimenopause (incidence 17.8 per 100 woman years) made it 1.34 times and in the late perimenopause (incidence 14.5 per 100 woman years) made it 1.52 times more likely for women to develop monthly or more frequent incontinence. In contrast, women in postmenopause (incidence 8.2 per 100 woman years) were approximately one half as likely to develop this degree of incontinence. This pattern of association across the menopausal transition was similar for stress and urge incontinence. However, menopausal stage was not associated with developing more frequent incontinence (leaking several times per week or more). Worsening anxiety symptoms, a high baseline body mass index, weight gain, and new onset diabetes were associated with developing more frequent incontinence.
Menopausal transition stage was associated with developing monthly or more frequent but not weekly or more frequent incontinence, suggesting that only infrequent incontinence symptoms were attributable to the perimenopause. Because modifiable factors such as anxiety, weight gain, and diabetes were associated with developing more frequent incontinence, determining whether healthy life changes and treating medical problems can prevent incontinence is a priority.
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评估绝经过渡期与尿失禁症状发展是否独立相关。
我们采用离散比例风险模型对基线时无尿失禁的妇女进行了纵向分析，这些妇女来自全国妇女健康研究（SWAN），这是一项多中心、多种族、多民族的社区居住中年女性绝经过渡的前瞻性队列研究。在基线和每年的六次访视中，SWAN 通过自我管理问卷收集了尿失禁的频率和类型，并根据月经出血模式对绝经阶段进行了分类。
与绝经前相比，早绝经（发生率为 17.8/100 名女性年）使女性每月或更频繁发生尿失禁的可能性增加 1.34 倍，晚绝经（发生率为 14.5/100 名女性年）使女性每月或更频繁发生尿失禁的可能性增加 1.52 倍。相比之下，处于绝经后（发生率为 8.2/100 名女性年）的女性发生这种程度的尿失禁的可能性约为一半。这种跨绝经过渡期的关联模式对于压力性和急迫性尿失禁是相似的。然而，绝经阶段与更频繁发生尿失禁（每周漏尿几次或更多）无关。焦虑症状恶化、基线时的身体质量指数较高、体重增加和新发糖尿病与更频繁发生尿失禁有关。
绝经过渡期与每月或更频繁发生但不与每周或更频繁发生的尿失禁相关，这表明只有不频繁的尿失禁症状与围绝经期有关。由于焦虑、体重增加和糖尿病等可改变的因素与更频繁发生的尿失禁有关，因此确定健康生活方式的改变和治疗医疗问题是否可以预防尿失禁是当务之急。
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