| 摘要: | 背景和目的
停經是女人卵巢自然的老化，在這過程中會出現一些不適的更年期症狀，各國間會因種族、生活習慣、教育程度而有所差異，當這些症狀影響生活品質時，民眾會開始尋求方法解決。隨著歐美補充替代療法的盛行後，又因擔心賀爾蒙藥物帶來副作用，因此，在台灣也越來越多人開始自行尋找藥物以外的方式來改善更年症狀。近年來，許多的研究報導關於補充替代療法能改善更年期症狀和更年期婦女的生活品質。在台灣目前還沒有相關研究分析探討台灣更年期婦女如何去改善更年期症狀。因此，我們採用問卷調查的方式了解台灣更年期婦女面臨各種更年期症狀時，如何選擇賀爾蒙或替代療法來改善更年期症狀，及其對生活品質的影響。藉由這次的調查，我們更能了解民眾的想法，適時的介入衛教，給予專業的建議，提供有效且安全的選擇
研究方法：
本研究為匿名問卷，我們透過台北市及桃園市的各社區藥局發放問卷。問卷對象的選擇，會由我們委託的專業社區藥局藥師，針對40-65 歲婦女發放。研究的族群為40-65歲更年期婦女，排除對象為40-65歲月經週期正常的婦女。研究探討使用輔助與另類療法對改善更年期症狀婦女生活品質的影響。統計大部分使用次數分配表及卡方交叉表來呈現，生活品質改善差異是使用成對樣本t檢定。問卷設計是經由專家學者做效度方面的評估設計且通過信度測驗分析，最後送至台北醫學大學人體研究倫理委員會審查通過。
研究結果:
調查結果有效問卷為367份，自然停經平均年齡為50.9歲，沒有更年期症狀共50人(13.6%)，在更年期症狀最常發生為記憶力差(52.32%)，其次為難以入眠(47.68%)，第三為肌肉關節疼痛和熱潮紅並列(42.78%)；對生活品質影響最大為難以入眠，其次為記憶力差，第三為熱潮紅；在317位有更年期症狀中，有197位(62.74%)婦女會因更年期症狀而尋找治療，在熱潮紅、盜汗、焦慮緊張、漏尿、陰道乾燥、性慾低下，最常使用大豆異黃酮(各別比例47.73%、46.05%、29.82%、40%、33.33%、48.57%)，在記憶力差方面，最常使用銀杏(33.33%)，在肌肉關節疼痛方面，最常使用葡萄糖胺(42.39%)，在難以入眠方面，最常以運動(26.37%)來改善，在皮膚乾燥方面，最常使用乳液(40%)，在憂鬱方面，最常以運動(34.78%)來改善；分析以輔助及替代療法介入後，使用前後分數的差異有達到統計上的意義能證明此方法可改善更年期婦女生活品質；在治療焦慮緊張症狀以使用按摩、月見草、運動、大豆異黃酮、口服賀爾蒙藥物效果最好，在治療熱潮紅和盜汗以使用口服賀爾蒙藥物、大豆異黃酮、月見草效果最好，對陰道乾燥症狀則以使用大豆異黃酮、外用賀爾蒙藥物、口服賀爾蒙藥物效果最好，在難以入眠方面使用中藥、口服賀爾蒙藥物效果最好。
結論:
在對有更年期症狀群婦女中，有超過一半的人會因更年期症狀去尋求治療且在療效上能獲得實質的幫助及改善生活品質。但大部份更年期婦女對於症狀緩解的治療是不了解的，可能因為很多都是透過報章雜誌、廣告、親朋好友推薦而未受到專業人員的解釋評估。除了賀爾蒙藥物，因擔心可能帶來副作用及致癌的風險，民眾對於保健食品、中藥、精油、運動都是抱持著正面的態度。透過這次的研究，我們更了解更年期婦女可能會面臨的問題，而藥師該如何給予正確觀念且提供適當的解決方法，成為更年期婦女最重要的照顧者，這是未來社區藥局藥師可以努力的方向。
Background and objective:
Menopause is considered to be the natural ageing of ovaries. In the process, some uncomfortable menopausal symptoms will occur. Differences among countries in menopausal symptom prevalence are influenced by race, lifestyle and education. When these symptoms bother the quality of life, people will begin to seek solutions.
After the high prevalence of complementary and alternative therapies in Europe and America, more and more people in Taiwan use alternative therapies to improve the menopausal symptoms because of concerns about the side effects of hormone therapies. In recent years, many studies have reported that complementary and alternative medicine therapy can improve menopausal symptoms and the quality of life. In Taiwan, there is no relevant research to explore how Taiwanese menopausal women can improve menopausal symptoms. Therefore, we use a questionnaire survey to understand menopausal women how to deal with various menopausal symptoms and how to choose hormones or alternative therapies and that impact on quality of life. With this survey, we can know more about people's opinions, properly intervene in the education, give professional advice, and provide effective and safe choices.
Methods:
This study was an anonymous questionnaire administered by community pharmacy in Taipei and Taoyuan and conducted by community pharmacists among women aged 40-65 years old. The study population was 40-65 years old menopausal women and the exclusion criteria was women who were 40-65 years old with normal menstrual cycle. The study explored the impact of the use of complementary and alternative therapies on improving the quality of life of women with menopausal symptoms. The data was presented in the number allocation table and the chi-square cross table and the paired sample t tests were used to analyze the change in quality of life score. The validity of the questionnaire was designed by the experts and scholars, and passed the reliability test analysis. Finally, it was reviewed and approved by Taipei Medical University Join Institutional Review board.
Results:
367 questionnaires were considered valid. The mean age at natural menopause was 50.9 years old and 13.6% (50 cases) of menopausal women were asymptom. In menopausal symptoms, the most common symptoms were poor memory (52.32%), followed by insomnia (47.68%) , the third was muscle joint pain and hot flash (42.78%); the greatest impact on quality of life was insomnia, followed by poor memory, the third was hot flash; in 317 menopausal women with symptoms, 197 (62.74%) women will seek treatment for menopausal symptoms. Soy isoflavones are most commonly used in hot flash, night sweat, anxiety, leaking urine, vaginal dryness, and low libido, and the percent were 47.73%, 46.05%, 29.82%, 40%, 33.33%, 48.57%, respectively. Ginkgo was the most commonly used in the memory (33.33%).Glucosamine was the most commonly used in the muscle and joint pain (42.39%). Exercise was most often done to improve insomnia (26.37%). Emulsion was the most commonly used in dry skin (40%). Exercise was most often done to improve depression (34.78%). After the intervention of complementary and alternative therapies, the difference in the scores before and after use has statistical significance to improve the quality of life of menopausal women.
Conclusion:
More than half of women with menopausal symptoms will seek treatment and be able to get substantial help and improve their quality of life. However, most menopausal women do not understand the treatment of symptom relief, because many of them receive information from newspapers, magazines, advertisements, relatives and friends, and have not been evaluated by professionals. Except to hormone drugs, people are positive attitude toward natural products, Chinese medicine, essential oils, and exercise, because they worry about possible side effects and cancer risk of hormone drugs. Through this survey, we understand more about the problems of menopausal women, and how pharmacists should give correct concepts and provide appropriate solutions to become the most important caregivers. In the future, this is the direction that community pharmacists can work hard. |
