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VTEリスクに対するE投与経路の影響を示す主な報告

VTEリスクは経口MHTで上昇するが経皮MHTでは上昇しない。
 
参考文献:
  1. Scarabin PY, et al.:Differential association of oral and transdermal oestrogen-replacement therapy with venous thromboembolism risk. Lancet. 2003 Aug 9;362(9382):428-32. PMID:12927428
  1. Canonico M, et al.:Hormone therapy and venous thromboembolism among postmenopausal women: impact of the route of estrogen administration and progestogens: the ESTHER study. Circulation 2007;115;840-845. PMID:17309934
  1. Canonico M, et al.:Hormone replacement therapy and risk of venous thromboembolism in postmenopausal women: systematic review and meta-analysis. BMJ 2008;336;1227-1231. PMID:18495631
  1. Canonico M, et al.:Postmenopausal hormone therapy and risk of idiopathic venous thromboembolism: results from the E3N cohort study. Arterioscler Thromb Vasc Biol. 2010;30:340-345. PMID:19834106
  1. Renoux C, et al.:Hormone replacement therapy and the risk of venous thromboembolism: a population-based study. J Thromb Haemost. 2010 May;8(5):979-86. PMID:20230416
  1. Laliberte F, et al. Does the route of administration for estrogen hormone therapy impact the risk of venous thromboembolism? Estradiol transdermal system versus oral estrogen-only hormone therapy. Menopause. 2011 Oct;18(10):1052-9. PMID:21775912
出典
img
1: 著者提供

更年期QOL質問票の例(東京医科歯科大学)

東京医科歯科大学では1994年以来本票を使用しているが、この他にも「日本人女性の更年期症状評価表」(日本産科婦人科学会)など様々な症状質問票が存在する。
合計点が低いほどQOLが低く、重症である。
出典
imgimg
1: Associations between anxiety, depression and insomnia in peri- and post-menopausal women.
著者: Masakazu Terauchi, Shiro Hiramitsu, Mihoko Akiyoshi, Yoko Owa, Kiyoko Kato, Satoshi Obayashi, Eisuke Matsushima, Toshiro Kubota
雑誌名: Maturitas. 2012 May;72(1):61-5. doi: 10.1016/j.maturitas.2012.01.014. Epub 2012 Feb 11.
Abstract/Text: OBJECTIVES: To determine the correlation between somatic and psychological symptoms and insomnia and the contribution of depression and anxiety to insomnia in a sample of peri- and post-menopausal women in a clinical setting.
STUDY DESIGN: The responses of 237 peri- and post-menopausal women enrolled in the Systematic Health and Nutrition Education Program (SHNEP) at the Menopause Clinic of the Tokyo Medical and Dental University Hospital between November 2007 and December 2010 to the Menopausal Health-Related Quality of Life (MHR-QOL) and Hospital Anxiety and Depression Scale (HADS) questionnaires were subjected to Spearman's rank correlation and logistic regression analyses.
RESULTS: The analysis revealed that (1) insomnia is highly prevalent, (2) the symptoms of difficulty in initiating sleep (DIS) and experiencing non-restorative sleep (NRS) are more strongly correlated with psychological than somatic symptoms, and (3) DIS is strongly associated with anxiety while NRS is strongly associated with depression in the population studied.
CONCLUSIONS: Insomnia is highly prevalent among peri- and post-menopausal female patients in a clinical setting and more closely associated with psychological than somatic symptoms. DIS is strongly correlated with anxiety while NRS is strongly correlated with depression.

Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.
Maturitas. 2012 May;72(1):61-5. doi: 10.1016/j.maturitas.2012.01.014. ...

更年期外来受診者の症状別頻度

2006年から2010年までの間に東京医科歯科大学医学部附属病院更年期外来を受診した345名の女性について、初診時の症状別頻度を算出した。
出典
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1: Effects of the kampo formula tokishakuyakusan on headaches and concomitant depression in middle-aged women.
著者: Masakazu Terauchi, Shiro Hiramitsu, Mihoko Akiyoshi, Yoko Owa, Kiyoko Kato, Satoshi Obayashi, Eisuke Matsushima, Toshiro Kubota
雑誌名: Evid Based Complement Alternat Med. 2014;2014:593560. doi: 10.1155/2014/593560. Epub 2014 Feb 4.
Abstract/Text: Objectives. To identify the correlates of headaches in middle-aged women and investigate the effects of Tokishakuyakusan (TJ-23), a formula of traditional Japanese herbal therapy Kampo, on headache and concomitant depression. Methods. We examined cross-sectionally the baseline records of 345 women aged 40-59 years who visited our menopause clinic. Among them, 37 women with headaches were treated with either hormone therapy (HT) or TJ-23; the data of these women were retrospectively analyzed to compare the effects of the treatment. Results. The women were classified into 4 groups on the basis of their headache frequency, and no significant intergroup differences were noted in the physical or lifestyle factors, except age. Multiple logistic regression analysis revealed that the significant contributors to the women's headaches were their age (adjusted OR 0.92 (95% CI 0.88-0.97)) and their depressive symptoms (adjusted OR 1.73 (95% CI 1.39-2.16)). Compared to women treated with HT, women treated with TJ-23 reported relief from headaches (65% versus 29%) and concomitant depression (60% versus 24%) more frequently. Improvement in the scores of headaches and depression correlated significantly with TJ-23 treatment. Conclusions. Headache in middle-aged women is significantly associated with depression; TJ-23 could be effective for treating both of these symptoms.
Evid Based Complement Alternat Med. 2014;2014:593560. doi: 10.1155/201...

更年期症状の主成分分析

2005年から2012年までの間に東京医科歯科大学医学部附属病院更年期外来を受診した491名の女性について、初診時の症状についての主成分分析を行った。
出典
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1: Subgrouping of Japanese middle-aged women attending a menopause clinic using physical and psychological symptom profiles: a cross-sectional study.
著者: Masakazu Terauchi, Asuka Hirose, Mihoko Akiyoshi, Yoko Owa, Kiyoko Kato, Toshiro Kubota
雑誌名: BMC Womens Health. 2014 Nov 25;14:148. doi: 10.1186/s12905-014-0148-z. Epub 2014 Nov 25.
Abstract/Text: BACKGROUND: Women in the menopausal transition and the postmenopausal period are affected with vasomotor symptoms, urogenital atrophy, sexual dysfunction, somatic symptoms, cognitive difficulty, sleep disturbance, and psychological problems. It is important to gain a better understanding of the complexity and diversity of climacteric disturbance in order to optimize treatments for individual patients. The aim of this study was to identify subgroups of Japanese perimenopausal and postmenopausal women attending a menopause clinic based on their physical and psychological symptom profiles.
METHODS: We administered the Menopausal Health-Related Quality of Life questionnaire to 491 Japanese women aged 40-64 years who had enrolled in the Systematic Health and Nutrition Education Program at the Menopause Clinic of the Tokyo Medical and Dental University Hospital between 2005 and 2012. We performed a principal component analysis followed by a hierarchical cluster analysis of the responses to 9 physical and 12 psychological items on the questionnaire.
RESULTS: The first analysis extracted 3 principal components that defined the variance of physical and psychological symptom profiles: depression, somatic, and vasomotor/sleep. A subsequent cluster analysis was performed based on the 3 principal components to generate 4 clusters, CL8 (N = 162; 33.0%), CL6 (N = 111; 22.6%), CL5 (N = 102; 20.8%), and CL4 (N = 116; 23.6%). CL8 included women who only had mild-to-moderate musculoskeletal pains and tiredness. All women in CL6, CL5, and CL4 described their musculoskeletal pains and tiredness as moderate to severe. The women in CL5 also had moderate-to-severe vasomotor symptoms, while the women in CL4 also suffered from moderate-to-severe psychological symptoms, such as depression, anxiety, and insomnia.
CONCLUSIONS: Distinct subgroups of Japanese perimenopausal and postmenopausal women were identified based on their symptom profiles. Menopausal symptoms were shown to accumulate in this population in the order of musculoskeletal pains and tiredness, vasomotor symptoms, and psychological symptoms.
BMC Womens Health. 2014 Nov 25;14:148. doi: 10.1186/s12905-014-0148-z....

閉経への移行と血清エストロゲン濃度の推移

血清エストロゲン濃度は閉経前後の数年間に大きくゆらぎつつ低下する。
出典
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1: Adapted from: Cedars MI, Evans M. Menopause. In: Scott JR, Gibbs RS, Karlan BY, Haney AF, eds. Danforth‘s Obstetrics and Gynecology. Philadelphia, PA: Lippincott Williams & Wilkins; 2003:721-737.

更年期障害の成因

更年期障害は、内分泌変動や加齢という身体的因子に加え、成育歴や性格などの心理的因子、家庭や職場における対人関係などの社会的因子が複合的に関与して、発症に至るBio-Psycho-Socialな疾患である。
出典
img
1: 著者提供

MHTと死亡率との関係(WHI研究)

50~59歳でHTを開始した女性の死亡ハザード比は、介入期間中で0.69 [0.51-0.94]、経過観察中で 0.89 [0.79-1.01]と低かった。
 
参考文献:
Manson JE, et al.:Menopausal Hormone Therapy and Long-term All-Cause and Cause-Specific Mortality: The Women''s Health Initiative Randomized Trials. JAMA. 2017 Sep 12;318(10):927-938. PMID:28898378
出典
img
1: 著者提供

VTEリスクに対するE投与経路の影響を示す主な報告

VTEリスクは経口MHTで上昇するが経皮MHTでは上昇しない。
 
参考文献:
  1. Scarabin PY, et al.:Differential association of oral and transdermal oestrogen-replacement therapy with venous thromboembolism risk. Lancet. 2003 Aug 9;362(9382):428-32. PMID:12927428
  1. Canonico M, et al.:Hormone therapy and venous thromboembolism among postmenopausal women: impact of the route of estrogen administration and progestogens: the ESTHER study. Circulation 2007;115;840-845. PMID:17309934
  1. Canonico M, et al.:Hormone replacement therapy and risk of venous thromboembolism in postmenopausal women: systematic review and meta-analysis. BMJ 2008;336;1227-1231. PMID:18495631
  1. Canonico M, et al.:Postmenopausal hormone therapy and risk of idiopathic venous thromboembolism: results from the E3N cohort study. Arterioscler Thromb Vasc Biol. 2010;30:340-345. PMID:19834106
  1. Renoux C, et al.:Hormone replacement therapy and the risk of venous thromboembolism: a population-based study. J Thromb Haemost. 2010 May;8(5):979-86. PMID:20230416
  1. Laliberte F, et al. Does the route of administration for estrogen hormone therapy impact the risk of venous thromboembolism? Estradiol transdermal system versus oral estrogen-only hormone therapy. Menopause. 2011 Oct;18(10):1052-9. PMID:21775912
出典
img
1: 著者提供

更年期QOL質問票の例(東京医科歯科大学)

東京医科歯科大学では1994年以来本票を使用しているが、この他にも「日本人女性の更年期症状評価表」(日本産科婦人科学会)など様々な症状質問票が存在する。
合計点が低いほどQOLが低く、重症である。
出典
imgimg
1: Associations between anxiety, depression and insomnia in peri- and post-menopausal women.
著者: Masakazu Terauchi, Shiro Hiramitsu, Mihoko Akiyoshi, Yoko Owa, Kiyoko Kato, Satoshi Obayashi, Eisuke Matsushima, Toshiro Kubota
雑誌名: Maturitas. 2012 May;72(1):61-5. doi: 10.1016/j.maturitas.2012.01.014. Epub 2012 Feb 11.
Abstract/Text: OBJECTIVES: To determine the correlation between somatic and psychological symptoms and insomnia and the contribution of depression and anxiety to insomnia in a sample of peri- and post-menopausal women in a clinical setting.
STUDY DESIGN: The responses of 237 peri- and post-menopausal women enrolled in the Systematic Health and Nutrition Education Program (SHNEP) at the Menopause Clinic of the Tokyo Medical and Dental University Hospital between November 2007 and December 2010 to the Menopausal Health-Related Quality of Life (MHR-QOL) and Hospital Anxiety and Depression Scale (HADS) questionnaires were subjected to Spearman's rank correlation and logistic regression analyses.
RESULTS: The analysis revealed that (1) insomnia is highly prevalent, (2) the symptoms of difficulty in initiating sleep (DIS) and experiencing non-restorative sleep (NRS) are more strongly correlated with psychological than somatic symptoms, and (3) DIS is strongly associated with anxiety while NRS is strongly associated with depression in the population studied.
CONCLUSIONS: Insomnia is highly prevalent among peri- and post-menopausal female patients in a clinical setting and more closely associated with psychological than somatic symptoms. DIS is strongly correlated with anxiety while NRS is strongly correlated with depression.

Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.
Maturitas. 2012 May;72(1):61-5. doi: 10.1016/j.maturitas.2012.01.014. ...