熱潮紅持續的比預期更久


  【24drs.com】根據發表於婦產科(Obstetrics & Gynecology)期刊的研究結果,熱潮紅可能持續的比臨床實務認知的更久。
  
  賓州大學醫學院婦女健康與生殖研究中心、臨床流行病學與生物統計學中心婦產部Ellen W. Freeman博士等人寫道,停經後1年左右是發生熱潮紅的高峰期,但是熱潮紅的整體期間有多久則還不清楚。臨床指引指出,多數婦女的熱潮紅期間大約是6個月至2年。更多有關熱潮紅期間的資訊對於停經症候群的臨床處置相當重要。
  
  研究目標是估計中度到嚴重停經熱潮紅的發生期間,辨識熱潮紅期間的潛在風險因素,研究對象是「Penn Ovarian Aging Study」監測13年的婦女們。以9-12個月的間隔進行個人訪談,以評估熱潮紅情況。主要研究終點是對259名婦女的存活分析、估計中度到嚴重熱潮紅的期間,次級分析的對象是349名有任何熱潮紅的婦女。研究者評估了停經階段、年紀、種族、生殖荷爾蒙值、身體質量指數(BMI)、目前是否抽菸等與熱潮紅有關的潛在風險因素。
  
  中度到嚴重熱潮紅期間的中位數是10.2年,與開始停經階段有強烈關聯,剛邁入停經過度期間就開始熱潮紅者的期間中位數超過11.57年,早期過度階段時開始者則是7.35年(95%信心區間[CI]為4.94 - 8.89;P < .001),後期過度期到停經階段時開始者是3.84年(95% CI,1.77 -5.52;P < .001)。
  
  最常發生中度到嚴重熱潮紅的年紀是45-49歲,期間中位數為8.1年(95% CI,5.12 - 9.28)。根據校正分析結果,相較於白人婦女,非裔婦女的熱潮紅期間較長。
  
  研究作者寫道,熱潮紅的期間中位數超過一般臨床實務的認知。檢視的風險因素中,特別是停經階段、種族、BMI,對於考慮個人或治療與評估荷爾蒙治療或其他療法的風險與利益都很重要。
  
  研究限制包括,因為使用存活分析,可能高估了熱潮紅期間;某些熱潮紅的原因可能不是停經;未納入使用荷爾蒙治療的婦女;無法一般化到其他族群。
  
  研究作者結論表示,血管收縮症狀治療或許應針對比較年輕、月經不規則婦女,傳統荷爾蒙治療則不是此類族群的理想選項,例如,突破性出血和需要避孕等問題。需要評估其他的熱潮紅療法,特別是尚未停經的婦女。種族和身體質量指數也會顯著影響熱潮紅期間,對於個人化療法的考量也很重要,特別是預期的熱潮紅期間比目前建議的荷爾蒙治療期間更久時。
  
  資料來源:http://www.24drs.com/professional/list/content.asp?x_idno=6509&x_classno=0&x_chkdelpoint=Y
  

Hot Flushes Last Much Longer Than Expected in Practice

By Laurie Barclay, MD
Medscape Medical News

April 26, 2011 — Hot flushes may last longer than generally accepted in clinical practice, according to the results of a study reported in the May issue of Obstetrics & Gynecology.

"The peak prevalence of hot flushes occurs approximately 1 year after menopause, but the overall duration of hot flushes is unclear," write Ellen W. Freeman, PhD, from the Department of Obstetrics/Gynecology, the Center for Clinical Epidemiology and Biostatistics, and the Center for Research in Reproduction and Women's Health at the School of Medicine, University of Pennsylvania in Philadelphia, and colleagues. "Clinical guidelines indicate that the duration of hot flushes for most women is approximately 6 months to 2 years....Increased information about the duration of hot flushes is important for the clinical management of menopausal symptoms."

The goal of the study was to estimate the duration of moderate to severe menopausal hot flushes and to identify potential risk factors for hot flush duration among women monitored for 13 years in the Penn Ovarian Aging Study. In-person interviews at 9- to 12-month intervals allowed assessment of hot flushes. Duration of moderate to severe hot flushes, as estimated by survival analysis in 259 women, was the main study endpoint, and a secondary analysis was performed in 349 women who reported any hot flushes. The investigators evaluated menopausal stage, age, race, reproductive hormone levels, body mass index (BMI), and current smoking as potential risk factors associated with hot flushes.

The median duration of moderate to severe hot flushes was 10.2 years. Duration was strongly associated with menopausal stage at onset, with median duration of more than 11.57 years for hot flushes starting near entry into the menopause transition, 7.35 years (95% confidence interval [CI], 4.94 - 8.89; P < .001) for those beginning in the early transition stage, and 3.84 years (95% CI, 1.77 - 5.52; P < .001) for those beginning in the late transition to postmenopausal stages.

The most common ages at onset of moderate to severe hot flushes were 45 to 49 years, with median duration of 8.1 years (95% CI, 5.12 - 9.28). Compared with white women, African American women had a longer duration of hot flushes, according to results of an adjusted analysis.

"The median duration of hot flushes considerably exceeded the timeframe that is generally accepted in clinical practice," the study authors write. "The identified risk factors, particularly menopausal stage, race, and BMI, are important to consider in individualizing treatment and evaluating the risk-to-benefit ratio of hormones and other therapies."

Limitations of this study include possible overestimation of hot flush duration because of use of survival analysis, possible causation of some hot flushes by conditions other than menopause, exclusion of women using hormone therapy, and lack of generalizability to other populations.

"Perhaps treatments for vasomotor symptoms should be targeted more commonly to younger, irregularly menstruating women, although it must be recognized that traditional hormone therapy may not be the ideal choice for this population given, for example, the problems of breakthrough bleeding and the need for contraception," the study authors conclude. "Other treatments for hot flushes need to be evaluated, particularly for women who have not reached menopause. Race and body mass index also significantly influenced the duration of hot flushes and are important considerations in individualizing treatment, particularly when the predicted duration of hot flushes is substantially longer than the length of hormone therapy that is currently recommended."

The National Institutes of Health supported this study. Dr. Freeman has received research support from Forest Laboratories, Inc, Wyeth, Pfizer, and Xanodyne Pharmaceuticals. She has also received honoraria for consulting and presentations from Wyeth, Forest Laboratories, Inc, Pherin Pharmaceuticals, and Bayer HealthCare. The other study authors have disclosed no relevant financial relationships.

Obstet Gynecol. 2011;117:1095-1104.

    
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