怎样做到正确应用绝经后激素治疗

针对绝经相关的临床问题,给予绝经后妇女以单一雌激素或与孕激素联合的治疗方法在既往的英文文献中常统称之为HRT(hormone replacement therapy),国内的中译名有激素替代治疗和激素补充治疗。自2002年7月以后,特别是随着美国WHI临床试验结果的陆续发表,不少国家或     

Effects of hormone replacement therapy on endocrine and spirometric parameters in asthmatic postmenopausal women

The aim of the study was to see if there are any correlations between changes in the endocrine system and clinical condition of asthmatic patients ,in particular their lung function ,caused by hormone replacement therapy (HRT). Fifty-five asthmatic and 20 healthy postmenopausal women (aged 48–60) were studied before HRT and after 6 months of cyclical transdermal 17β-estradiol and medroxyprogesterone acetate treatment. Serum estradiol ,cortisol and dehydroepiandrosterone sulfate (DHEAS) concentrations were assessed with the use of RIA ,and spirometry parameters were measured. Statistically significant diminution of asthma exacerbations ,reduced consumption of inhaled glucocorticosteroids and improvement in all investigated spirometry parameters was shown in patients treated with glucocorticosteroids during HRT. A reduction in mean 24-hour serum estradiol levels in asthmatic women was noted ,whereas cortisol and DHEAS serum concentrations were decreased in asthmatic patients treated with glucocorticosteroids compared with the control group ,before HRT. HRT produced increases in the concentrations of estradiol ,cortisol and DHEAS in serum. Significant positive correlations were noted between estradiol concentrations and small and medium bronchi tests. In conclusion ,HRT in postmenopausal asthmatic women has a favorable influence on the course of asthma ,reduces daily use of glucocorticosteroids and frequency of asthma exacerbations and normalizes serum concentrations of estradiol ,cortisol and DHEAS ,which were decreased before HRT.     

Compliance with hormone replacement therapy in postmenopausal Sicilian women

OBJECTIVE: To verify the compliance with hormone replacement therapy (HRT) over 2 years in a population of postmenopausal women in East Sicily. STUDY DESIGN: Patients starting hormonal therapy for the first time were enrolled in this study. A telephone survey was then conducted after 3, 6, 12 and 24 months and the reasons for any discontinuation were recorded. RESULTS: Of a total of 138 women who agreed to be enrolled in this prospective longitudinal study 72 were still taking the treatment after 1 year and only 56 at the end of the study, although only three patients reported that they had experienced no benefit. CONCLUSIONS: Type of work, surgical menopause and previous use of oral contraceptives were significantly statistically associated with better HRT compliance. Side effects and fear of breast cancer, which we maintain is exaggerated by the women and their family doctors, were the commonest reasons for early discontinuation of the hormonal treatment.     

Uterine effects of raloxifene in comparison with continuous-combined hormone replacement therapy in postmenopausal women

OBJECTIVE: We sought to compare the uterine effects of raloxifene with those of continuous-combined hormone replacement therapy. STUDY DESIGN: This randomized, double-blind 24-month study involved 136 postmenopausal women who received raloxifene 150 mg/d or conjugated equine estrogens 0.625 mg/d with medroxyprogesterone acetate 2.5 mg/d. After baseline evaluations, endometrial biopsy specimens were obtained, and endometrial thickness was measured annually by means of transvaginal ultrasonography. Statistical analyses were performed with an intention-to-treat approach. RESULTS: In the raloxifene group at the end point of the study 94.4% of biopsy specimens showed normal benign postmenopausal endometrium and 5.6% were classified as benign stimulatory endometrium. In the continuous-combined hormone replacement therapy group at the end point of the study 78.7% of biopsy specimens showed normal benign postmenopausal endometrium, 19. 1% were classified as benign stimulatory endometrium, and 2.1% showed benign abnormal postmenopausal endometrium. Mean endometrial thickness was unchanged from baseline with raloxifene and was increased significantly by 0.5 mm at 12 months with continuous-combined hormone replacement therapy. CONCLUSION: Raloxifene 150 mg/d did not increase endometrial thickness or cause endometrial proliferation in healthy postmenopausal women.     

Effects of hormone replacement therapy on endocrine and spirometric parameters in asthmatic postmenopausal women.

The aim of the study was to see if there are any correlations between changes in the endocrine system and clinical condition of asthmatic patients, in particular their lung function, caused by hormone replacement therapy (HRT). Fifty-five asthmatic and 20 healthy postmenopausal women (aged 48-60) were studied before HRT and after 6 months of cyclical transdermal 17 beta-estradiol and medroxyprogesterone acetate treatment. Serum estradiol, cortisol and dehydroepiandrosterone sulfate (DHEAS) concentrations were assessed with the use of RIA, and spirometry parameters were measured. Statistically significant diminution of asthma exacerbations, reduced consumption of inhaled glucocorticosteroids and improvement in all investigated spirometry parameters was shown in patients treated with glucocorticosteroids during HRT. A reduction in mean 24-hour serum estradiol levels in asthmatic women was noted, whereas cortisol and DHEAS serum concentrations were decreased in asthmatic patients treated with glucocorticosteroids compared with the control group, before HRT. HRT produced increases in the concentrations of estradiol, cortisol and DHEAS in serum. Significant positive correlations were noted between estradiol concentrations and small and medium bronchi tests. In conclusion, HRT in postmenopausal asthmatic women has a favorable influence on the course of asthma, reduces daily use of glucocorticosteroids and frequency of asthma exacerbations and normalizes serum concentrations of estradiol, cortisol and DHEAS, which were decreased before HRT.     

The metabolic consequences of treating postmenopausal women with non-oral hormone replacement therapy

Objective To define the metabolic profile of postmenopausal hormone replacement therapies when delivered through gels, patches, implants or other non-oral routes. Such information may be useful in the absence of reliable clinical data on the effects of these therapies on the risk of cardiovascular disease.
Design and methods Selective literature review.
Patients Postmenopausal women.
Results Non-oral oestrogen therapies fail to invoke the hepatic response associated with oral therapy. Changes in hepatic protein synthesis are minimal and so plasma levels of binding globulins and other proteins tend to be normal. Many of the perturbations of the haemostatic system seen with oral therapy are avoided. In the absence of hepatic over-synthesis of apolipoproteins, plasma lipoprotein levels are unchanged or reduced. The direct effects of oestrogen on vascular function are apparent when the hormone is administered non-orally.
Conclusions The net effect of non-oral oestrogen therapies on the risk of cardiovascular disease is difficult to predict on the basis of current data. Some changes in plasma lipoprotein levels, such as the reduced fasting levels of triglycerides, would be considered desirable, but the cardioprotective increase in levels of high-density lipoproteins is absent. The differential effect on haemostasis markers is promising, but preliminary data relating to transdermal patches fail to support the idea that non-oral therapies will avoid the increased risk of venous thromboembolism associated with oral therapy. The ability of non-oral therapies to improve vascular function implies that they will offer postmenopausal women at least some of the cardiovascular protection seen with oral therapy.     

Transdermal hormone replacement therapy in postmenopausal women with uterine leiomyomas.

OBJECTIVE: To evaluate the effects of transdermal hormone replacement therapy (HRT) on uterine and leiomyoma size and on uterine bleeding patterns in postmenopausal women with uterine leiomyomas. METHODS: The required sample size was calculated to be 30 subjects per group to detect an effect on the size of one standard deviation (SD) with an alpha value of 0.05 (two-sided) and a power 1 - delta = 0.8. At the end of the study, the power analysis showed a value of beta = 0.826. Seventy postmenopausal women with uterine leiomyomas were enrolled and treated for 12 cycles of 28 days each with transdermal 17 beta-estradiol (E(2)) patches plus oral medroxyprogesterone acetate continuously added (group A) or with calcium carbonate (group B). At entry and every three cycles, uterine and leiomyoma dimensions were measured by transvaginal ultrasonography. To evaluate the effect of transdermal HRT on the characteristics of uterine bleeding, 35 healthy postmenopausal women without uterine leiomyomas (group C) were enrolled and treated with the same regimen as group A. A daily diary was used to record the abnormal uterine bleeding episodes, and a rank scale was used to assess the severity of bleeding. RESULTS: There were no significant changes in mean uterine or leiomyoma size between groups A and B, or in each group compared with basal values. No significant difference was detected between groups A and C in uterine bleeding patterns. CONCLUSION: Transdermal HRT did not increase the size of uterine leiomyomas or affect uterine bleeding patterns in postmenopausal women.     

A comparison of circulating hormone levels in postmenopausal women receiving hormone replacement therapy.

Seventeen postmenopausal subjects were randomized into this comparative study of esterified estrogen 0.625 mg (Estratab), esterified estrogen 0.625 mg plus 1.25 mg methyltestosterone (Estratest H.S.), or conjugated estrogen 0.625 mg (Premarin). Sixteen subjects completed the study in which plasma hormone concentrations of estrone and estradiol were assessed at various time points. There were no significant differences among the treatment groups.     

绝经后妇女激素补充治疗后同型半胱氨酸及超声心动图改变的初步观察

目的　观察绝经后妇女激素补充治疗 (HRT)后血浆总同型半胱氨酸 [H(e) ]及超声心动图的改变。方法　将受试者分为 4组。Ⅰ组、Ⅱ组为自然绝经妇女 ,各 30例 ,其中Ⅰ组给予HRT(结合雌激素 0 6 2 5mg d ,安宫黄体酮 2mg d ,或者每月后 14d加安宫黄体酮 4mg d) 3个月 ;Ⅱ组不给予HRT ,为对照 ;Ⅲ组 2 0例 ,为已接受HRT1 5年的绝经后妇女 ;Ⅳ组 2 0例 ,为从未应用HRT的绝经后妇女。Ⅰ组、Ⅱ组受试者于接受HRT前及接受HRT 3个月后测定H(e) ;Ⅲ组、Ⅳ组受试者测定H(e) ,并行超声心动图检查。结果　Ⅰ组、Ⅱ组接受HRT 3个月前后H(e)无明显变化 ,Ⅰ组接受HRT前为(9 3± 2 5 ) μmol L ,Ⅱ组为 (9 4± 2 9) μmol L ;Ⅰ组接受HRT后H(e)为 (9 1± 2 8) μmol L ,Ⅱ组为(9 8± 3 6 ) μmol L。两组比较 ,差异无显著性 (P >0 0 5 )。Ⅲ组H(e)明显低于Ⅳ组 ,分别为 (8 0±1 3) μmol L及 (10 3± 3 2 ) μmol L。两组比较 ,差异有显著性 (P <0 0 5 )。Ⅲ组、Ⅳ组的超声心动图检查结果无明显改变。结论　短期应用HRT对H(e)无明显改善 ,长期应用HRT可降低H(e)水平。绝经后妇女应用HRT 1 5年 ,未见超声心动图有明显变化。     

Effect of hormone replacement therapy on glucose tolerance in postmenopausal women.

Oral glucose tolerance tests were performed on 50 symptomatic postmenopausal women before and after three months of hormone replacement therapy. All patients were randomly allocated to one of five groups treated with various synthetic or so-called naturally occurring oestrogens. Therapy produced a significant deterioration of carbohydrate tolerance with sequential preparations containing 100 microgram of ethinyl oestradiol or graduated doses of mestranol up to 50 microgram. The conjugated equine oestrogen (1.25 mg daily) and oestrogen valerate (2 mg daily) treated groups did not show abnormal glucose tolerance. The decreased glucose tolerance may be due as much to dosage levels as to any metabolic characteristics of the various oestrogens prescribed.     

绝经后激素治疗适应证

伴随绝经过程及绝经后内分泌事件对妇女健康产生的不良影响,出现了一些临床问题需要激素治疗来纠正。激素治疗纠正这些健康问题是效价比最佳的措施。目前激素治疗主要有三大适应证:缓解绝经相关症状、治疗泌尿生殖道萎缩相关疾病、预防和治疗骨质疏松症。     

Estradiol/progesterone-releasing vaginal rings for hormone replacement therapy in postmenopausal women

In order to investigate whether vaginal rings delivering estradiol and progesterone could prevent endometrial hyperplasia and relieve climacteric symptoms ,two variants of rings were used in 20 postmenopausal women with intact uteri for 4 months. One ring designated as PI-002 (n = 8) delivered in vitro estradiol 160 μg/day and progesterone 20 mg/day ,while the other (PI-003; n = 12) delivered the same dosage of estradiol but only half the progesterone (10 mg/day). Serum estrone ,estradiol and progesterone were measured at pretreatment ,weekly for 4 weeks ,and then monthly for 4 months. The incidence of hot flushes ,frequency of night sweats ,mood scores ,vaginal discharge and bleeding profiles were recorded. Endometrial thickness was monitored by ultrasonography. The mean estrone level was 50 pg/ml for 16 weeks. The mean serum estradiol level was 75 pg/ml for the first 4 weeks and gradually decreased to 50 pg/ml at 16 weeks. The mean progesterone level with the PI-002 ring was 5 ng/ml for the first 4 weeks and decreased to 3.5 ng/ml at 16 weeks. With the PI-003 ring ,the mean progesterone level was initially 3.5 ng/ml and then decreased to 2.5 ng/ml thereafter. Significant decreases in the incidence of hot flushes and night sweats as well as a striking improvement in mood scores were noted as early as 2 weeks after insertion. Three of the 20 women discontinued the treatment ,owing to ring expulsion. Increased vaginal discharge was observed with both rings in the first 6 weeks. Vaginal bleeding was more frequently apparent among users of the PI-002 ring ,although bleeding and spotting were confined to the first 6 weeks. Ultrasonographic monitoring of the endometrium constantly revealed a thickness of < 3 mm for both variants throughout use for 16 weeks. An estradiol/progesterone-releasing vaginal ring is a potential alternative to long-term hormone replacement therapy with minimum attention required. It provides effective protection against endometrial hyperplasia.     

Effects of hormone replacement therapy on glucose and lipid profiles and on cardiovascular risk parameters in postmenopausal women

Objectives  

The aim of this study was to evaluate the effects of hormone replacement therapy (HRT) on carbohydrate and lipid metabolisms and cardiovascular risk parameters in healthy postmenopausal women.     

Significance of "normal" endometrial cells in cervical cytology from asymptomatic postmenopausal women receiving hormone replacement therapy

OBJECTIVE: The aim of this study is to assess the significance of normal endometrial cells identified in screening Pap smears from asymptomatic postmenopausal women taking hormone replacement therapy (HRT). METHODS: Endometrial histology reported from 93 asymptomatic postmenopausal women receiving HRT noted to have normal endometrial cells on a screening Pap smear was reviewed. Information regarding HRT, endometrial sampling, and interval between the sentinel Pap and sampling was extracted from the record. RESULTS: Endometrial biopsies were obtained an average of 1.7 months after the Pap smears. Eighteen of the ninety-three histology specimens (19%, 95% CI: 12--27%) identified abnormalities, in four cases precancerous or cancerous lesions. These 18 abnormalities included 7 endometrial polyps; 7 cases of simple hyperplasia, 1 with atypia; 3 cases of complex hyperplasia, 1 with atypia; and 1 endometrial adenocarcinoma. CONCLUSION: Normal endometrial cells identified on a screening Pap smear in this population may be an indication of endometrial disease.     

The comparison of bleeding patterns with high-dose and low-dose hormone replacement therapy in postmenopausal women

Our objective was to compare vaginal bleeding patterns with lower doses of conjugated equine estrogen (CEE) and medroxyprogesterone acetate (MPA), in a randomized, double- blind, placebo-controlled trial. A total of 112 healthy, postmenopausal women were divided into three groups. Group A received CEE 0.625 mg/day plus MPA 2.5 mg/day; group B received CEE 0.3 mg/day, plus MPA 1.25 mg/day; and another group received placebo. All medications were continued for 13 months and bleeding data were analyzed in each group. The percentage of patients who experienced no bleeding in cycle one was 45.2% in group B. These values were significantly greater than the figure for group A (18.2%) and lower than in the placebo group (66.7%). A linear trend between time since menopause and cumulative amenorrhea was observed in cases in group B and the placebo group in all cycles (p <?0.05). This finding was significant in only cycle 13 in group A. In conclusion, a higher rate of amenorrhea was observed with a lower-dose regimen of CEE/MPA, which may be the appropriate regimen.     

Peripheral blood lymphocyte subpopulations of postmenopausal women with hormone replacement therapy]

The effect of hormone replacement therapy on cellular immunity of postmenopausal women was studied by flow cytometry (FACS). Lymphocyte subsets in peripheral blood before and after hormonal replacement therapy (HRT) were measured. After 6 months of HRT with the sequential combined drug Klimonorm(R) (2 mg estradiol valerate and 0,15 mg levonorgestrel) the cytotoxic T-cells (CD8) were reduced and the CD4/CD8 ratio was increased significantly (p < 0,05).