台灣停經婦女經期狀態和更年期症狀與自主神經活動之關係

女性雌激素（estrogen）下降會出現情緒不穩、睡眠障礙、血管舒縮（熱潮紅和夜間盜汗）等更年期症狀，使用賀爾蒙替代療法（Estrogen Replacement Therapy, ERT）能改善情緒及血管舒縮等症狀，並會弱化交感神經、活化副交感神經反應，促進自主神經系統（Autonomic Nervous System, ANS）的平衡。經期狀態、更年期症狀和自主神經的關係研究不多見其結果也分歧，因此本文欲探討停經和更年期症狀與自主神經的關係。本研究將61位健康參與者分為停經前、中、後期三組。參與者填寫更年期症狀量表（GCS）、七日運動回顧問卷、匹茲堡睡眠品質量表（PSQI）等自陳式問卷與完成非侵入性心電圖（EKG）的心跳速率（HR）測量。結果為經期狀態和自主神經無顯著相關，不過停經中期和停經兩年內婦女中有心跳加快和煩躁不安的更年期症狀者，有副交感神經活化反應，表示自主神經系統仍維持動態平衡，可能與參與者均為正常組和症狀介於無到輕微之間有關。停經中期和兩年內婦女常見的症狀得分由高依序是感覺疲倦、不易入睡、肌肉關節疼痛、失去興趣和注意力無法集中。婦女的症狀越多，睡眠品質越差；心理和身體症狀越多，主觀睡眠品質越差、睡眠干擾越多；血管舒縮因子越多，睡眠總時數越少。本研究顯示更年期症狀和睡眠品質呈負相關，不同症狀影響不同的睡眠品質因子，而更年期的心理症狀和自主神經系統有關，可做為未來更年期症狀相關治療的評估依據和研究基礎。

關鍵字

雌激素；更年期症狀；自主神經系統

並列摘要

Estrogen decrement leads to climacteric symptoms including mood swings; sleep disorders, and vasomotor symptoms （hot flush and night sweats）. Estrogen Replacement Therapy（ERT）not only can be used to improve mood swings and vasomotor symptoms, but also weakening sympathetic nerve and strengthening parasympathetic nerve to maintain the balance of autonomic nervous system（ANS）. So far, only few studies reach the correlation between menstrual status, climacteric symptoms, and ANS. So the purpose of this thesis is to figure out the relationship between menopause, climacteric symptoms and ANS. Sixty-one healthy subjects were assigned into three groups – pre-menopause, peri-menopause, and post-menopause. All subjects were asked to fill out self-report questionnaires including GCS, PSQI, ISI. Their heart rate（HR）were measured with EKG. The result shows that status of menstrual period is not significantly related to ANS. Women in peri-menopause or the first two years of menopause which has climacteric symptoms including rapid HR and dysphoria shows strengthening parasympathetic response. Which indicates that ANS still remained dynamic balance. Subjects were normal or with symptoms between none and mild level might be a possible reason. Scoring the symptoms of women in peri-menopause or the first two years of menopause in descending sequence are tired feeling, difficulty of falling asleep, muscle and joint pain, interest lost, and inability to concentrate. The more symptoms expressed, the worse quality of sleeping; The more physical and psychological symptoms, the worse subjective quality of sleeping and more interrupt of sleeping; the more vasomotor factors, the less hours of sleeping. This research depicts that climacteric symptoms are negatively related to sleeping quality. Different symptoms affect different factors of sleeping quality. Despite the above, psychological symptoms of women in menopause is related with ANS, which can be an assessment and research basis for menopause-related therapy in the future.