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中华妇幼临床医学杂志(电子版)

Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition) ›› 2022, Vol. 18 ›› Issue (01): 94 -101. doi: 10.3877/cma.j.issn.1673-5250.2022.01.013

Original Article

Clinical study of improvement on menopausal symptoms in middle aged and elderly women by pelvic floor muscle training

Weimin Fan1,1, Xiaohui Mei2,2, Jina Chen2,2, Fuyun Dong2,2, Liwen Zhang2,2, Yaping Chen2,2, Jinhua Zhou1,1, Rujun Chen2,2,†()   

  • Received:2021-05-06 Revised:2022-01-08 Published:2022-02-01
  • Corresponding author: Rujun Chen
  • Supported by:
    Scientific Research Project of Health Commission of Minhang District, Shanghai(2019MW05)
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Objective

To evaluate effects of pelvic floor muscle training (PFMT) on menopausal symptoms (MS) in middle aged and elderly women.

Methods

From January 2020 to January 2021, a total of 165 middle aged and elderly women who were treated in menopause clinic or pelvic floor center of Shanghai Fifth People′s Hospital, Fudan University due to MS were selected as research subjects. According to stages of reproductive aging workshop + 10 (STRAW+ 10), they were divided into premenopausal group (n=45, with -3b to -2 stage of STRAW+ 10), early menopausal group (n=62, with -1 to + 1b stage of STRAW+ 10) and late menopausal group (n=58, with + 1C to + 2 stage of STRAW+ 10). Using prospective research methods, PFMT intervention measure was performed on subjects in each group for 12 weeks. The intervention effects of PFMT was comprehensively evaluated by Kupperman Index (KI) Scale, Menopause Rating Scale (MRS), Genitourinary Syndrome of Menopause (GSM) Symptom Score Scale and International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF) (hereinafter referred to as four scales). Mann-Whitney U test was used to statistically compare scores of various scales between before and after PFMT intervention. This study was approved by the Ethics Committee of Shanghai Fifth People′s Hospital, Fudan University [Approval No. (2019) lunshen (149)]. All subjects signed the clinical study informed consent forms.

Results

① Scores of four scales after PFMT intervention in premenopausal group were all lower than those before intervention, and the differences were statistically significant (P<0.05). Scores of somatosensory and urogenital tract in MRS, and scores of impact on daily life in ICIQ-UI SF after PFMT intervention, were all lower than those before intervention, and the differences were statistically significant (P<0.05). ② Scores of KI Scale, GSM Symptom Score Scale and ICIQ-UI SF after PFMT intervention in early menopausal group were all lower than those before intervention, and the differences were statistically significant (P<0.05). Scores of psychological sensation in MRS, scores of vaginal dryness and vaginal tingling in GSM Symptom Score Scale, scores of the frequency of urinary incontinence and its impact on daily life in ICIQ-UI SF after PFMT intervention, were all lower than those before intervention, and the differences were statistically significant (P<0.05); While the urogenital symptom score in MRS after PFMT intervention was 3 scores (0-3 scores), which was higher than that of 3 scores (0-3 scores) before intervention, and the difference was statistically significant (Z=-2.710, P=0.007). ③ Scores of four scales after PFMT intervention in late menopausal group were all lower than those before intervention, and the differences were statistically significant (P<0.05). Scores of somatic sensation, psychological sensation and urogenital tract in MRS, scores of vaginal dryness and dyspareunia in GSM Symptom Score Scale, scores of amount of urine leakage and impact on daily life in ICIQ-UI SF after PFMT intervention, were all lower than those before intervention, and the differences were statistically significant (P<0.05).

Conclusion

From premenopausal to late menopause, PFMT can improve MS in middle aged and elderly women.

Key words: Perimenopause, Premenopause, Postmenopause, Pelvic floor, Urinary incontinence, Menopausal symptoms, Pelvic floor muscle training, Female
表1 3组受试者一般临床资料比较
组别 例数 年龄(岁，±s) BMI(kg/m2，±s) 文化程度[例数(%)]a 孕次(次，±s)
本科以下 本科
①绝经前期组 45 43.7±2.9 23.7±2.8 26(57.8) 19(42.2) 3.2±2.5
②绝经早期组 62 49.9±2.1 23.8±1.8 55(88.7) 7(11.3) 3.0±1.7
③绝经晚期组 58 58.0±2.9 23.9±2.8 51(87.9) 7(12.1) 2.1±1.2
总体比较(检验值/P值)   F＝393.600/<0.001 F＝0.045/0.956 χ2＝19.109/<0.001 F＝5.730/0.004
两两比较(检验值/P值)            
  ① vs ②   t＝-12.272/<0.001 — χ2＝11.933/<0.001 t＝0.544/0.588
  ① vs ③   t＝-25.039/<0.001 — χ2＝10.663/<0.001 t＝2.780/0.007
  ② vs ③   t＝-17.696/<0.001 — χ2<0.001/>0.999 t＝3.271/0.001
组别 例数 产次(次，±s) 血清FSH水平(IU/L，±s) 最大新生儿出生体重(g，±s)b 距末次分娩时间(年，±s)
绝经前期组 45 1.4±0.5 5.9±3.1 3 500±250 15.8±10.2
绝经早期组 62 2.0±1.1 26.9±1.7 3 381±439 22.8±7.6
绝经晚期组 58 1.6±0.8 38.0±6.7 3 392±457 31.7±8.4
总体比较(检验值/P值)   F＝5.782/0.004 F＝682.600/<0.001 F＝1.143/0.322 F＝41.290/<0.001
两两比较(检验值/P值)          
  ① vs ②   t＝-3.472/0.001 t＝-41.405/<0.001 — t＝-3.636/<0.001
  ① vs ③   t＝-1.142/0.256 t＝-32.473/<0.001 — t＝-8.105/<0.001
  ② vs ③   t＝2.236/0.027 t＝-12.258/<0.001 — t＝-5.945/<0.001
表2 绝经前期组受试者PFMT干预前、后KI量表和MRS评分结果比较[分，M(P25~P75)]
项目 例数 KI量表评分 MRS评分 躯体感觉评分 心理感觉评分 泌尿生殖道评分
干预前 45 2(2~9) 4(3~20) 0(0~4) 4(0~8) 3(0~9)
干预后 45 2(2~6) 4(3~12) 0(0~4) 3(0~4) 3(0~3)
Z值   2.020 3.310 2.560 1.800 2.450
P值   0.046 0.001 0.013 0.079 0.020
表3 绝经早期组受试者PFMT干预前、后KI量表和MRS评分结果比较[分，M(P25~P75)]
项目 例数 KI量表评分 MRS评分 躯体感觉评分 心理感觉评分 泌尿生殖道评分
干预前 62 6(2~12) 12(4~16) 8(0~8) 4(0~8) 3(0~3)
干预后 62 4(2~10) 12(4~15) 7(0~8) 4(0~4) 3(0~3)
Z值   4.620 1.580 1.840 2.650 -2.710
P值   <0.001 0.121 0.077 0.011 0.007
表4 绝经晚期组受试者PFMT干预前、后KI量表和MRS评分结果比较[分，M(P25~P75)]
项目 例数 KI量表评分 MRS评分 躯体感觉评分 心理感觉评分 泌尿生殖道评分
干预前 58 8(4~12) 19(12~26) 8(4~16) 8(4~8) 3(3~6)
干预后 58 6(4~7) 12(7~14) 4(4~8) 4(0~4) 2(0~3)
Z值   5.090 4.550 2.450 4.100 4.400
P值   <0.001 <0.001 0.020 <0.001 <0.001
表5 绝经前期组受试者PFMT干预前、后GSM症状评分量表结果比较[分，M(P25~P75)]
项目 例数 GSM症状评分量表评分 阴道干燥评分 阴道刺痛评分 排尿困难评分 性交困难评分
干预前 45 3(1~4) 1(0~2) 0(0~1) 0(0~1) 0(0~1)
干预后 45 2(1~4) 1(0~2) 0(0~0) 0(0~0) 0(0~1)
Z值   2.860 1.860 1.730 1.410 1.000
P值   0.005 0.095 0.149 0.203 0.424
表6 绝经早期组受试者PFMT干预前、后GSM症状评分量表结果比较[分，M(P25~P75)]
项目 例数 GSM症状评分量表评分 阴道干燥评分 阴道刺痛评分 排尿困难评分 性交困难评分
干预前 62 3(2~4) 1(0~2) 0(0~1) 0(0~1) 1(0~2)
干预后 62 3(1~3) 1(0~1) 0(0~1) 0(0~1) 1(0~1)
Z值   3.380 2.270 2.240 1.000 1.930
P值   <0.001 0.031 0.037 0.424 0.065
表7 绝经晚期组受试者PFMT干预前、后GSM症状评分量表结果比较[分，M(P25~P75)]
项目 例数 GSM症状评分量表评分 阴道干燥评分 阴道刺痛评分 排尿困难评分 性交困难评分
干预前 58 3(2~5) 1(1~2) 0(0~0) 0(0~1) 1(1~2)
干预后 58 3(2~4) 1(1~2) 0(0~0) 0(0~1) 1(0~2)
Z值   3.190 2.460 0.450 -1.410 2.330
P值   <0.001 0.018 0.766 0.182 0.026
表8 绝经前期组受试者PFMT干预前、后ICIQ-UI SF评分比较[分，M(P25~P75)]
项目 例数 ICIQ-UI SF评分 尿失禁频率评分 漏尿量评分 对日常生活影响评分
干预前 45 0(0~4) 0(0~1) 0(0~2) 0(0~1)
干预后 45 0(0~3) 0(0~1) 0(0~1) 0(0~1)
Z值   3.070 1.730 2.000 2.460
P值   0.003 0.149 0.072 0.018
表9 绝经早期组受试者PFMT干预前、后ICIQ-UI SF评分比较[分，M(P25~P75)]
项目 例数 ICIQ-UI SF评分 尿失禁频率评分 漏尿量评分 对日常生活影响评分
干预前 62 3(0~4) 1(0~1) 1(0~1) 1(0~2)
干预后 62 3(0~4) 1(0~1) 1(0~1) 1(0~1)
Z值   3.300 2.270 2.000 2.640
P值   0.001 0.031 0.072 0.010
表10 绝经晚期组受试者PFMT干预前、后ICIQ-UI SF评分比较[分，M(P25~P75)]
项目 例数 ICIQ-UI SF评分 尿失禁频率评分 漏尿量评分 对日常生活影响评分
干预前 58 0(0~4) 0(0~2) 0(0~1) 0(0~1)
干预后 58 0(0~3) 0(0~1) 0(0~1) 0(0~1)
Z值   3.070 2.070 2.740 2.390
P值   0.002 0.053 0.007 0.021
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