Unit of Integrative Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts.
JAMA Netw Open. 2023 Sep 5;6(9):e2334545. doi: 10.1001/jamanetworkopen.2023.34545.
Although premenstrual disorders (PMDs) end at menopause, it is unclear whether they are associated with the timing and symptom severity of menopause.
To prospectively examine whether women with PMDs have increased risks of early menopause and menopause-related vasomotor symptoms (VMS).
DESIGN, SETTING, AND PARTICIPANTS: This population-based cohort study was nested in the Nurses' Health Study II (data collected from questionnaire sent between June 1991 and June 2017). Analysis of menopause timing included participants who did not have natural or surgical menopause before study entry, while the analysis of VMS was restricted to women who provided information on VMS. Data were analyzed from August 2022 to March 2023.
PMDs were identified by self-reported diagnosis and confirmed with symptom questionnaires from 1991 to 2005. Participants were age-matched to women without PMD diagnoses and confirmed absence of or minimal premenstrual symptoms.
During follow-up through 2017, timing of natural menopause was assessed biennially, and VMS were assessed in 2009, 2013, and 2017. The association of PMDs with early menopause was assessed by Cox proportional hazards models and with VMS by logistic regression models.
Of 1220 included women with PMDs, the median (IQR) age was 40.7 (37.3-43.8) years; of 2415 included women without PMDs, the median (IQR) age was 41.7 (38.3-44.8) years. The median (IQR) follow-up in this study was 20.3 (17.8-22-2) years. Early natural menopause (menopause before age 45 years) was reported by 17 women with PMDs (7.1 per 1000 person-years) and 12 women without PMDs (2.7 per 1000 person-years; adjusted hazard ratio, 2.67; 95% CI, 1.27-5.59). In addition, 795 women with PMDs (68.3%) and 1313 women without PMDs (55.3%) reported moderate or severe VMS (adjusted odds ratio, 1.68; 95% CI, 1.32-2.14). There was no observed association between PMDs and mild VMS (adjusted odds ratio, 0.99; 95% CI, 0.76-1.28).
In this cohort study of US women, PMDs were associated with increased risks of early menopause and moderate or severe VMS. PMDs may be indicative of underlying physiology linked to early menopause and VMS, suggesting a phenotype observable during the reproductive years that may allow clinicians to target women at risk of earlier menopause and subsequent health risks later in the life course.
尽管经前期障碍（PMD）在绝经后结束，但尚不清楚它们是否与绝经的时间和症状严重程度有关。
前瞻性研究患有 PMD 的女性是否有更早绝经和与绝经相关的血管舒缩症状（VMS）的风险增加。
设计、设置和参与者：这项基于人群的队列研究嵌套在护士健康研究 II 中（数据收集自 1991 年 6 月至 2017 年 6 月之间发送的问卷）。绝经时间的分析包括在研究入组前没有自然或手术绝经的参与者，而 VMS 的分析仅限于提供 VMS 信息的女性。数据分析于 2022 年 8 月至 2023 年 3 月进行。
PMD 通过自我报告的诊断确定，并通过 1991 年至 2005 年的症状问卷进行确认。参与者与没有 PMD 诊断的女性年龄匹配，并确认没有或轻微的经前症状。
在通过 2017 年的随访期间，每两年评估一次自然绝经的时间，并且在 2009 年、2013 年和 2017 年评估 VMS。通过 Cox 比例风险模型评估 PMD 与早绝经的关系，并通过逻辑回归模型评估 VMS。
在 1220 名患有 PMD 的女性中，中位数（IQR）年龄为 40.7（37.3-43.8）岁；在 2415 名没有 PMD 的女性中，中位数（IQR）年龄为 41.7（38.3-44.8）岁。本研究的中位（IQR）随访时间为 20.3（17.8-22.2）年。17 名患有 PMD 的女性（每 1000 人年 7.1 例）和 12 名没有 PMD 的女性（每 1000 人年 2.7 例）报告了早发性自然绝经（绝经前年龄<45 岁）；调整后的危险比为 2.67（95%CI，1.27-5.59）。此外，795 名患有 PMD 的女性（68.3%）和 1313 名没有 PMD 的女性（55.3%）报告了中度或重度 VMS（调整后的比值比，1.68；95%CI，1.32-2.14）。PMD 与轻度 VMS 之间未见关联（调整后的比值比，0.99；95%CI，0.76-1.28）。
在这项针对美国女性的队列研究中，PMD 与早绝经和中度或重度 VMS 的风险增加有关。PMD 可能与早绝经和 VMS 的潜在生理机制有关，这表明在生殖期可观察到一种表型，这可能使临床医生能够针对有更早绝经和随后生命过程中健康风险的女性。
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