Chakravarti S, Collins W P, Thom M H, Studd J W
Br Med J. 1979 Apr 14;1(6169):983-5. doi: 10.1136/bmj.1.6169.983.
Out of a consecutive series of 300 patients seen at a menopause clinic, 82 complained of symptoms generally associated with the climacteric, although they were still menstruating. Vasomotor disturbances were absent in 42 of these patients (group 1) and present in 40 (group 2). Headaches, insomnia, and dyspareunia were the most common complaints among the women with vasomotor symptoms, whereas loss of libido and depression predominated in those without. Conjugated equine oestrogens (Premarin) 1.25 mg daily given for three weeks out of four relieved nearly all symptoms in group 2, but in group 1 the response was disappointing. The mean plasma oestradiol concentration in women with vasomotor symptoms was significantly lower than that observed during days 1-10 of the menstrual cycle, but plasma testosterone values were not significantly different from those observed in younger women. Plasma follicle-stimulating hormone (FSH) and luteinising hormone (LH) concentrations were similar to those seen after the menopause. Concentrations of these hormones in the women without vasomotor symptoms were similar to those in the younger, regularly menstruating women. After six months of oestrogen treatment patients in group 2 had a 2.1-fold increase in mean plasma oestradiol concentration, and plasma FSH and LH concentrations were reduced to 39% and 66% of their pretreatment values respectively; in group 1, however, no such pronounced changes occurred. High concentrations of FSH were present in patients with oestrogen-responsive symptoms, 15 U/1 being the diagnostic cut-off point. This measurement in the presence of characteristic symptoms therefore constitutes the best method of selecting patients for oestrogen-replacement therapy.
在一家更年期诊所连续就诊的300例患者中，82例虽仍有月经，但主诉有通常与更年期相关的症状。其中42例患者（第1组）无血管舒缩功能紊乱，40例（第2组）有血管舒缩功能紊乱。血管舒缩症状的女性中，头痛、失眠和性交困难是最常见的主诉，而无血管舒缩症状的女性中，性欲减退和抑郁更为突出。每天服用1.25mg结合马雌激素（倍美力），每四周服用三周，可缓解第2组几乎所有症状，但第1组的反应令人失望。有血管舒缩症状的女性血浆雌二醇平均浓度显著低于月经周期第1 - 10天观察到的浓度，但血浆睾酮值与年轻女性观察到的值无显著差异。血浆促卵泡激素（FSH）和促黄体生成素（LH）浓度与绝经后观察到的浓度相似。无血管舒缩症状的女性这些激素的浓度与年轻、月经规律的女性相似。雌激素治疗6个月后，第2组患者血浆雌二醇平均浓度增加2.1倍，血浆FSH和LH浓度分别降至治疗前值的39%和66%；然而，第1组未出现如此明显的变化。雌激素反应性症状患者存在高浓度FSH，诊断切点为15U/L。因此，在有特征性症状的情况下进行此项检测是选择雌激素替代治疗患者的最佳方法。
