Sowers M R, La Pietra M T
Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor 48109-2029, USA.
Epidemiol Rev. 1995;17(2):287-302. doi: 10.1093/oxfordjournals.epirev.a036194.
While there are weak indications that the decline in estradiol levels with menopause has ramifications for the expression of overt disease in women, the associations are not clearly characterized with the exception of osteoporosis. The lack of well-characterized associations is undoubtedly due to the same limitations previously described: difficulty in defining the menopausal stages and difficulty in doing serum hormone sampling. Added to these limitations are other impediments. Chronic diseases will not be expressed within a few short months of the menopause, so the temporal sequence of hormone change with clinical disease expression is difficult to establish. Furthermore, it is likely that menopause is an "enabling" state that allows for the subsequent disease in women with other risk factors. Until sufficient data are available to explore the menopause as both an effect modifier and confounder, inconclusive results are likely to be reported. Future studies of the association between chronic diseases and the menopause need to consider issues similar to those that have arisen relative to studies in symptomatology. There needs to be a more concise definition of menopausal status. Potential confounders, including race/ethnicity, body size, and socioeconomic status, must be considered in both design and analysis. Studies need to be designed to separate the effects of age from those of menopause. Finally, women with medically induced menopause should be evaluated separately from those with natural menopause.
虽然有微弱迹象表明绝经后雌二醇水平下降对女性显性疾病的表达有影响，但除骨质疏松症外，这些关联并未得到明确界定。缺乏明确界定的关联无疑是由于之前所述的相同局限性：难以定义绝经阶段以及难以进行血清激素采样。除了这些局限性之外，还有其他障碍。慢性疾病不会在绝经后的短短几个月内表现出来，因此激素变化与临床疾病表现的时间顺序难以确定。此外，绝经很可能是一种“促成”状态，会使有其他风险因素的女性随后患上疾病。在有足够数据可用于探究绝经作为效应修饰因素和混杂因素之前，可能会报告不确定的结果。未来关于慢性疾病与绝经之间关联的研究需要考虑与症状学研究中出现的类似问题。需要对绝经状态进行更精确的定义。在设计和分析中都必须考虑潜在的混杂因素，包括种族/民族、体型和社会经济地位。研究设计应将年龄的影响与绝经的影响区分开来。最后，医源性绝经的女性应与自然绝经的女性分开评估。
