目的：
本研究以女性月經異常患者之醫療照護情形為研究重點，探討月經異常對女性患者醫療資源利用情形之影響。
方法：
本研究使用國家衛生研究院所提供之全民健康保險研究資料庫，為次級資料分析之回溯性研究，根據ICD-9-CM診斷碼篩選月經異常患者，並排除研究期間有懷孕紀錄者作為研究個案組，對照組則採用傾向分數配對法，控制年齡與共病症權重指數以1:3的比例產生之無月經異常患者。研究期間為2010年至2012年，觀察起始日為於2010年初次因月經異常或初次因任何原因門診就醫，共追蹤兩年。以描述性統計、卡方檢定、t檢定、線性複迴歸與邏輯斯迴歸等統計方法進行分析，探討兩組別於醫療資源利用情形間之差異。
結果：
研究結果顯示，月經異常的分布以18-29歲佔多數。經線性複迴歸分析，有月經異常之女性患者在門診、急診與住院的次數皆高於無月經異常之女性患者，門急診總費用也以有月經異常之女性為多，且皆達到統計上的顯著差異(p<0.05)；邏輯斯迴歸分析結果為有月經異常之女性患者急診風險值為1.32 (95%CI 1.26-1.39)；住院的風險值為1.68 (95%CI 1.55-1.82)，皆顯著高於對照組(p<0.01)。
結論：
本研究結果顯示，有月經異常的女性患者確實有較高的醫療資源使用，其發生急診與住院的風險也較高。因此，政府與國民皆應重視月經異常所造成的負面影響，以促進女性健康福祉的提升，並達到降低資源浪費與提升照護品質之目的。

Objective:
The main objective of this study was focusing on female patients with menstrual disorders, and assessed the effect on medical care resource utilizations.
Method:
This research adopted a retrospective cohort study. Subjects were identified using National Health Insurance Research Database in Taiwan. We formed a new cohort of female patients with menstrual disorders and excluded the subjects with pregnancy as the case group. The female patients without menstrual disorders and pregnancy were the control group. Propensity Score Matching (PSM) was used to control the age and Charlson Comorbidity Index (CCI) for reducing sample selection bias. The following period was 2010 through 2012. The starting date was the first outpatient visit for menstrual disorder or any other reason in 2010, and following 2 years. Furthermore, t-test, chi-square test and regression analysis were used to assess medical care resource utilizations between the two groups.
Results:
The results showed that characteristic of patients with menstrual disorders were younger. The utilization of outpatient, emergency and hospitalization on patients with menstrual disorders were significantly higher (p<0.05). Furthermore, the risk of emergency visit in the case group was significantly higher than the control group (OR 1.32; 95%CI 1.26 to 1.39). The risk of hospitalization event was also higher in the case group (OR 1.68; 95%CI 1.55 to 1.82).
Conclusion:
The results of the study demonstrate that patients suffering from menstrual disorders significantly increased the utilization of health care resources, and the risk of emergency visit and hospitalization were higher in the patients with menstrual disorders.

論文審定書 i
謝辭 ii
摘要 iii
Abstract iv
目錄 v
圖次 vii
表次 vii
第一章 緒論 1
第一節 研究背景與動機 1
第二節 研究目的 3
第二章 文獻探討 4
第一節 月經異常之介紹 4
第二節 月經異常之負面影響 7
第三節 月經異常於醫療照護之影響 8
第三章 研究方法 10
第一節 研究設計與架構 10
第二節 研究問題與研究假設 12
第三節 研究樣本與資料來源 13
第四節 研究變項之操作型定義 16
第五節 研究分析工具及方法 18
第四章 研究結果與分析 19
第一節 研究樣本人口學特質資料與就醫之醫療機構特性分布 19
第二節 人口學特質於研究組別之醫療資源利用情形 25
第三節 醫療機構特性於兩組研究樣本間對醫療資源利用情形之檢定分析 27
第四節 各變項對醫療資源利用所產生的影響之檢定分析 31
第五章 討論 43
第一節 月經異常的分布情形 43
第二節 月經異常的醫療資源利用情形 44
第三節 月經異常的急診與住院風險 45
第四節 研究假設驗證 46
第六章 結論與建議 47
第一節 結論 47
第二節 研究限制 48
第三節 研究建議 49
第四節 研究貢獻 50
參考文獻 51

一、中文文獻
王馨世 (1999)。女性生殖生理與內分泌學。台北：合記。
內政部戶政司 (2016)。人口資料庫。上網日期：2016年9月12日。網址：http://www.ris.gov.tw/zh_TW/346
邱敏惠、王秀紅 (2004)。護校女生經痛與月經態度關係之探討。護理雜誌，51(4)，45-52。
周先樂 (2001) 。人體生理學。台北：藝軒。
洪敏元、楊堉麟、劉良慧、林育娟、何明聰、賴明華 (2005)。當代生理學。台北：華杏。
陳旺全 (2006)。子宮異常出血之中醫藥治療。中醫藥研究論叢，9(1)，1-23。
劉介宇、洪永泰、莊義利、陳怡如、翁文舜、劉季鑫、梁賡義 (2006)。台灣地區鄉鎮市區發展類型應用於大型健康調查抽樣設計之研究。健康管理學刊。 4(1)，1-22.

二、英文文獻
Benjamins, L. J. (2009). Practice guideline: evaluation and management of abnormal vaginal bleeding in adolescents. Journal of Pediatric Health Care, 23(3), 189-193.
Chen, H. Y., Huang, B. S., Lin, Y. H., Su, I. H., Yang, S. H., Chen, J. L., ... & Chen, Y. C. (2014). Identifying Chinese herbal medicine for premenstrual syndrome: implications from a nationwide database. BMC complementary and alternative medicine, 14, 206-214.
Comenitz, L. (1983). The psychological effects of secondary amenorrhea in women runners. Clinical Social Work Journal, 11(1), 87-96.
Côté, I., Jacobs, P., & Cumming, D. (2002). Work loss associated with increased menstrual loss in the United States. Obstetrics & Gynecology, 100(4), 683-687.
Côté, I., Jacobs, P., & Cumming, D. C. (2003). Use of health services associated with increased menstrual loss in the United States. American journal of obstetrics and gynecology, 188(2), 343-348.
Deyo, R. A., Cherkin, D. C., & Ciol, M. A. (1992). Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases. Journal of Clinical Epidemiology, 45(6), 613-619.
Fraser, I. S., Langham, S., & Uhl-Hochgraeber, K. (2009). Health-related quality of life and economic burden of abnormal uterine bleeding. Expert Review of Obstetrics & Gynecology, 4(2), 179-189.
Garry, R., Fountain, J., Brown, J., Manca, A., Mason, S., Sculpher, M., ... & Lilford, R. (2004). EVALUATE hysterectomy trial: a multicentre randomised trial comparing abdominal, vaginal and laparoscopic methods of hysterectomy. Health Technology Assessment, 8(26), 1-154.
Harlow, S. D., & Ephross, S. A. (1995). Epidemiology of menstruation and its relevance to womens health. Epidemiologic Reviews, 17(2), 265-286.
Hidlebaugh, D. A. (2000). Cost and quality-of-life issues associated with different surgical therapies for the treatment of abnormal uterine bleeding. Obstetrics and gynecology clinics of North America, 27(2), 451-465.
Hurskainen, R., & Paavonen, J. (2004). Levonorgestrel-releasing intrauterine system in the treatment of heavy menstrual bleeding. Current Opinion in Obstetrics and Gynecology, 16(6), 487-490.
Jones, G. L., Kennedy, S. H., & Jenkinson, C. (2002). Health-related quality of life measurement in women with common benign gynecologic conditions: a systematic review. American journal of obstetrics and gynecology, 187(2), 501-511.
Koo, M., Chen, C. H., Tsai, K. W., Lu, M. C., & Lin, S. C. (2015). Ambulatory medical services utilization for menstrual disorders among female personnel of different medical professions in Taiwan: a nationwide retrospective cohort study. BMC women's health, 15(1), 1.
Kuppermann, M., Varner, R. E., Summitt Jr, R. L., Learman, L. A., Ireland, C., Vittinghoff, E., ... & Hulley, S. B. (2004). Effect of hysterectomy vs medical treatment on health-related quality of life and sexual functioning: the medicine or surgery (Ms) randomized trial. JAMA, 291(12), 1447-1455.
Liu, Z., Doan, Q. V., Blumenthal, P., & Dubois, R. W. (2007). A Systematic Review Evaluating Health‐Related Quality of Life, Work Impairment, and Health‐Care Costs and Utilization in Abnormal Uterine Bleeding. Value in health, 10(3), 183-194.
Lynn, A. M., Lai, L. J., Lin, M. H., Chen, T. J., Hwang, S. J., & Wang, P. H. (2015). Pattern of ambulatory care visits to obstetrician-gynecologists in Taiwan: A nationwide analysis. International journal of environmental research and public health, 12(6), 6832-6841.
Matteson, K. A., Raker, C. A., Clark, M. A., & Frick, K. D. (2013). Abnormal uterine bleeding, health status, and usual source of medical care: analyses using the Medical Expenditures Panel Survey. Journal of Women's Health, 22(11), 959-965.
Protheroe, J. (2004). Modern management of menorrhagia. Journal of Family Planning and Reproductive Health Care, 30(2), 118-122.
Protheroe, J., Bower, P., Chew-Graham, C., Peters, T. J., & Fahey, T. (2007). Effectiveness of a computerized decision aid in primary care on decision making and quality of life in menorrhagia: results of the MENTIP randomized controlled trial. Medical Decision Making, 27(5), 575-584.
Santer, M., Wyke, S., & Warner, P. (2007). What aspects of periods are most bothersome for women reporting heavy menstrual bleeding? Community survey and qualitative study. BMC Women's Health, 7, 8-13.
Sardo, A. D. S., Spinelli, M., Zizolfi, B., & Nappi, C. (2016). Ambulatory management of heavy menstrual bleeding. Women's Health, 12(1), 35-43.
Shen, S. Y., Huang, S. Y., Hsieh, C. H., Hsu, M. I., Cheng, C. Y., & Hsu, C. S. (2014). Clinical and biochemical characteristics of women with menstrual disturbance. Taiwanese Journal of Obstetrics and Gynecology, 53(2), 178-182.
Smith, D. R. (2008). Menstrual disorders and their adverse symptoms at work: an emerging occupational health issue in the nursing profession. Nursing & health sciences, 10(3), 222-228.
Solomon, C. G., Hu, F. B., Dunaif, A., Rich-Edwards, J., Willett, W. C., Hunter, D. J., ... & Manson, J. E. (2001). Long or highly irregular menstrual cycles as a marker for risk of type 2 diabetes mellitus. JAMA, 286(19), 2421-2426.
Solomon, C. G., Hu, F. B., Dunaif, A., Rich-Edwards, J. E., Stampfer, M. J., Willett, W. C., ... & Manson, J. E. (2002). Menstrual cycle irregularity and risk for future cardiovascular disease. The Journal of Clinical Endocrinology & Metabolism, 87(5), 2013-2017.
Sowter, M. C. (2003). New surgical treatments for menorrhagia. The Lancet, 361(9367), 1456-1458.
Tanaka, E., Momoeda, M., Osuga, Y., Rossi, B., Nomoto, K., Hayakawa, M., ... & Wang, E. C. (2013). Burden of menstrual symptoms in Japanese women: results from a survey-based study. Journal of medical economics, 16(11), 1255-1266.
Weiss, D. J., Charles, M. A., Dunaif, A., Prior, D. E., Lillioja, S., Knowler, W. C., & Herman, W. H. (1994). Hyperinsulinemia is associated with menstrual irregularity and altered serum androgens in Pima Indian women. Metabolism, 43(7), 803-807.
Zia, A., & Rajpurkar, M. (2016). Challenges of diagnosing and managing the adolescent with heavy menstrual bleeding. Thrombosis research, 143, 91-100.