McKinlay J B, McKinlay S M, Brambilla D J
Am J Epidemiol. 1987 Jan;125(1):110-21. doi: 10.1093/oxfordjournals.aje.a114492.
Since menopause is increasingly implicated in the etiology of some major age-related diseases in women, such as cancer, cardiovascular disease, osteoporosis, and depression, there is a need to understand the epidemiology of this physiologic event which is universal for women. To date, knowledge of menopause is based on a small proportion of self-selecting, predominantly ill women. A stereotype has emerged of the "typical" menopausal woman, who presents a broad range of diffuse symptoms and is a higher utilizer of health care. This prevailing view is contradicted by prospective data gathered over 27 months on a cohort of approximately 2,500 women who are representative of women aged 45-55 years in Massachusetts. It is demonstrated that menopause itself does not cause poorer health status (either physical or psychologic); menopause itself does not cause an increase in utilization behavior; occurrence of a surgical menopause is the primary menopause-related change associated with subsequent perceived health status and utilization behavior, and then only minimally; and almost all the explained variability in health status and utilization behavior outcomes is attributable to the prior health status of the respondents and, to a lesser extent, to utilization behavior. These findings underscore the importance of two methodological requirements for future work: representative samples of apparently healthy women; and prospective data which elucidate cause-effect relations.
由于绝经越来越多地与女性一些主要的年龄相关疾病的病因有关，如癌症、心血管疾病、骨质疏松症和抑郁症，因此有必要了解这一女性普遍存在的生理事件的流行病学情况。迄今为止，关于绝经的知识是基于一小部分自我选择的、主要是患病女性的数据。一种“典型”绝经女性的刻板印象已经形成，这类女性表现出广泛的弥漫性症状，且更多地利用医疗保健服务。在马萨诸塞州，对大约2500名年龄在45至55岁之间具有代表性的女性队列进行了超过27个月的前瞻性数据收集，这些数据与这种普遍观点相矛盾。研究表明，绝经本身并不会导致健康状况变差（无论是身体上还是心理上）；绝经本身并不会导致医疗利用行为增加；手术绝经的发生是与随后感知到的健康状况和医疗利用行为相关的主要绝经相关变化，而且影响极小；几乎所有健康状况和医疗利用行为结果中可解释的变异性都归因于受访者先前的健康状况，在较小程度上也归因于医疗利用行为。这些发现强调了未来研究在方法上的两个要求的重要性：明显健康女性的代表性样本；以及阐明因果关系的前瞻性数据。
