Wilbush J
University of Alberta, Edmonton, Canada.
Maturitas. 1988 Jul;10(2):83-108. doi: 10.1016/0378-5122(88)90154-5.
Like a parallel article [1] this one also attempts to answer the question why complaints of excessive premenopausal bleeding have now virtually disappeared. Unlike the first, a review, this is a discussion paper. It explores widely, investigating the question from all aspects, even utilizing, if with caution, such unconventional sources as still unproven hypotheses or marginal theories. Presentational attitudes to, and handling of, climacteric complaints appear partially to obscure some symptoms associated with excessive menses. More importantly, however, the examination of the historical records in the light of present knowledge greatly increases our understanding of past socio-clinical events. It is then that attention is concentrated on a significant omission in these data: the fall in numbers of births per woman, first among the French and European aristocracy, then the population of France and finally that of the rest of Europe. This parallels the spread of the menopausal syndrome and complaints of excessive menstrual loss. It is suggested that limitation of the family, by design or secondarily to lifestyle, has created a unique bio-endocrinology in the West. In the past this produced a number of complications, including climacteric menorrhagia. Never redressed by preventative measures--for these had repeatedly been rejected as militating against the lifestyle chosen by Western women--they were only solved with the advent of abdominal hysterectomy. Steroidal oral contraception and hormonal treatment have, however, made this operation often unnecessary.
与一篇平行文章[1]一样，本文也试图回答为何绝经前出血过多的抱怨如今几乎已消失这一问题。与第一篇综述文章不同，这是一篇讨论论文。它进行了广泛探讨，从各个方面研究该问题，甚至谨慎地利用了一些非常规来源，如未经证实的假设或边缘理论。对更年期症状的呈现态度和处理方式似乎部分掩盖了一些与月经过多相关的症状。然而，更重要的是，根据现有知识审视历史记录极大地增进了我们对过去社会临床事件的理解。就在此时，人们将注意力集中在这些数据中的一个重大遗漏上：每位女性生育数量的下降，首先在法国和欧洲贵族中出现，接着是法国人口，最后是欧洲其他地区的人口。这与更年期综合征和月经过多的抱怨的传播情况相平行。有人认为，有意或因生活方式导致的家庭规模限制在西方创造了一种独特的生物内分泌学。过去，这引发了一些并发症，包括更年期月经过多。由于预防措施一再被拒绝，因为它们被认为不利于西方女性选择的生活方式，这些问题一直没有得到解决，直到腹部子宫切除术出现才得以解决。然而，甾体类口服避孕药和激素治疗使这种手术常常不再必要。
