早发性卵巢功能不全激素补充治疗利弊评价

早发性卵巢功能不全（POI）指女性在40岁之前卵巢活动衰退的临床综合征,以月经紊乱伴高促性腺激素及低雌激素为特征。POI患者可出现潮热、出汗等绝经期症状,远期可发生骨质疏松、心血管疾病等问题。激素补充治疗（HRT）是POI患者的有效治疗方法。文章对POI患者应用HRT的获益及可能存在的风险进行综合分析与评价。     

早发性卵巢功能不全激素补充治疗利弊评价

早发性卵巢功能不全（POI）指女性在40岁之前卵巢活动衰退的临床综合征，以月经紊乱伴高促性腺激素及低雌激素为特征。POI患者可出现潮热、出汗等绝经期症状，远期可发生骨质疏松、心血管疾病等问题。激素补充治疗（HRT）是POI患者的有效治疗方法。文章对POI患者应用HRT的获益及可能存在的风险进行综合分析与评价。     

卵巢癌患者激素替代治疗研究近况

激素替代治疗（HRT）与卵巢癌的关系尚不确定。研究结果提示应用HRT息卵巢癌的风险小于雌激素替代治疗（ERT）；卵巢癌治疗后患者应用HRT未发现复发或恶化，可改善患者生活质量，但经验不足，应权衡利弊。实验研究中雌激素对卵巢癌细胞的影响不同，可能与其自身激素受体状态相关；Fibulin-1、组织蛋白酶D和人类激肽释放酶与雌激素在卵巢癌侵袭及转移中的相互作用正逐步被认识。     

卵巢癌患者激素替代治疗研究近况

激素替代治疗(HRT)与卵巢癌的关系尚不确定.研究结果提示应用HRT患卵巢癌的风险小于雌激素替代治疗(ERT);卵巢癌治疗后患者应用HRT未发现复发或恶化,可改善患者生活质量,但经验不足,应权衡利弊.实验研究中雌激素对卵巢癌细胞的影响不同,可能与其自身激素受体状态相关;Fibulin-1、组织蛋白酶D和人类激肽释放酶与雌激素在卵巢癌侵袭及转移中的相互作用正逐步被认识.     

激素补充治疗的安全性研究进展

检索激素补充治疗(HRT)安全性相关的系统评价、随机对照试验及国内外指南,评价HRT的安全性。HRT可能有增加乳腺癌、宫颈腺癌、卵巢癌的风险;HRT可能降低结肠癌的风险;HRT对心血管的影响存在争议,早期使用可能有益处;HRT有增加血栓栓塞的风险,但经皮应用雌激素风险小于口服雌激素;对认知功能的影响不明确;雌孕激素联合治疗不增加子宫内膜癌的风险。临床在使用HRT时,应权衡其利弊,考虑其风险,决定是否使用。     

绝经后妇女激素替代治疗中孕激素剂量与子宫内膜癌的发生危险

绝经后妇女无孕激素拮抗地应用雌激素会造成子宫内膜癌的发生危险增高，若结合应用孕激素可明显降低这种风险。许多研究提示子宫膜癌的发生危险随每月应用孕激素的时间而变化．但是很少有研究关注孕激素的剂量在激素替代治疗（HRT）中与子宫内膜癌发生的关系，对此进行临床研究。     

卵巢功能不全患者供卵治疗的临床分析

卵巢早衰（premature ovarian failure,POF）是指女性在40岁前出现的卵巢功能衰竭状态,表现为原发性或继发性闭经（至少6个月）同时伴有促性腺激素水平升高（FSH>40 U/L）和雌激素水平下降;在育龄期妇女中的发病率为1%~3%,且有升高趋势[1]。由于POF是卵巢功能衰退的终结状态,给患者及家庭带来了沉重的精神负担和心理压力。近年来逐渐用卵巢功能不全(primary ovarian insufficient, POI)替代POF这个名称[2]。如何解决POI患者的生育问题一直是临床治疗的重点,供卵联合辅助生殖技术是其中1种重要的治疗手段。1984年,Lutjen等[3]首次报道了POF患者采用激素补充治疗（HRT）联合供卵治疗成功获得正常新生儿;1994年1月,在中山大学附属第一医院诞生了国内首例POF患者通过HRT联合供卵治疗获得的新生儿[4]。供卵已成为POI患者获得妊娠的首选方案。不同于国外有大样本量的关于供卵妇女辅助生殖技术治疗结局的报道[5],目前在国内仅见样本量较小的研究报道。安徽医科大学第一附属医院自2000年即开始进行供卵治疗,本研究对本院近年来接受供卵治疗的POI患者的临床结果进行分析,以探究可能影响其妊娠结局的因素。     

重新认识绝经妇女长期性激素补充治疗的利弊

绝经妇女应用性激素补充治疗 (HRT)已有半个世纪的历史了 ,它的发展及人们对其受益与风险的认识 ,经历了曲折的道路。早年应用雌激素 ,仅限于治疗绝经期综合征。 2 0世纪 70年代 ,开始应用单一雌激素治疗围绝经期症状 ,但因子宫内膜癌发病数的增加 ,而使雌激素的临床应用陷入低潮。 2 0世纪 80年代 ,有关研究规定 ,有完整子宫的妇女在应用单一雌激素时必须加用孕激素 ,以及雌、孕激素的剂量、日程 (每日方案 )及配伍方案 ,并规定了补充雌激素的目标浓度。随后的研究发现 ,雌激素的作用广泛 ,HRT还可预防老年退化性疾病 ,首先是保护骨骼系…     

早发性卵巢功能不全的长期健康管理

早发性卵巢功能不全（POI）是指女性在40岁之前出现的卵巢功能减退。过早的雌激素缺乏不仅对患者一般生活、心理、生殖健康有着严重不良影响，而且更与患者长期健康后果相关，包括骨骼、心血管系统、神经系统、泌尿生殖系统及性健康等。因此，对POI患者的长期健康管理尤为重要。     

生育力保护在防治早发性卵巢功能不全中的应用价值

不孕不育已成为一个全球性的重大卫生挑战，早发性卵巢功能不全（premature ovarian insufficiency,POI）患者生育力显著下降，且各种慢性病发生风险增加。POI病因复杂，异质性高。随着生育力保护在癌症患者中的应用及得到越来越多的关注，生育力保护适应证也扩大到了特纳综合征、半乳糖血症等POI高风险的遗传性疾病。文章主要针对存在医源性和遗传因素POI风险的患者在发生POI前的生育力保护及POI的防治进行阐述。     

Management der prämaturen Ovarialinsuffizienz

The term “premature ovarian insufficiency” (POI) describes the premature loss of ovarian function before the age of 40 years. With POI comes a combination of hypogonadotropic hypogonadism and primary/secondary amenorrhea. POI not only has an adverse impact on a woman’s quality of life, psychological well-being and fertility, but is also associated with negative long-term effects on bone health, cardiovascular system and cognitive function. To prevent estrogen deficiency-related long-term consequences hormone replacements therapy at least until the average natural menopause age is recommended. The benefit-risk profile of HRT in naturally postmenopausal women cannot be unrestrictedly extrapolated to the cohort of patients with POI. In patients with POI, the benefits of HRT far outweigh the potential risks.     

Bone marrow derived mesenchymal stem cells transplantation rescues premature ovarian insufficiency induced by chemotherapy

Premature ovarian insufficiency (POI) is an important cause of infertility and also cause menopausal symptoms, which greatly reduced the quality of life for women. Hormone replacement therapy (HRT), as an important strategy, improved the quality of life for patients, however, the role of HRT in promoting fertility remains controversial. Therefore, seeking an optimal regime for POI becomes more urgent. In this study, we established POI model induced by CTX and BUS and utilized bone marrow derived mesenchymal stem cells (BM-MSCs) transplantation to treat the POI. We found that the decrease of estrogen and the increase of FSH induced by administration of CTX and BUS were rescued by BM-MSC transplantation. H&E staining and TUNEL assay showed that there were more healthy ovarian follicles and less apoptosis of ovarian cells after treatment with BM-MSCs. Further studies showed that there was an obvious decrease of Bax, p53, and p21 after transplantation, however, CyclinD2 was increased. In conclusion, our results demonstrated that BM-MSCs could restore injured ovarian function. Inhibiting apoptosis and promoting residual ovarian cell proliferation may contribute to the process.     

早发性卵巢功能不全对神经功能影响

多数观察性研究表明,低雌激素状态对精神神经功能和认知功能有影响,在早发性卵巢功能不全(POI)患者表现更为明显,但直接的研究证据或高级别循证医学研究的评估资料有限。对POI患者尽早开始激素补充治疗有利于预防或减缓神经功能的退化或下降,但并不能完全纠正过早的卵巢功能衰退和绝经对神经功能的负面影响。重视POI发生和进展的各项影响因素,尽可能减缓病程进展,是防范POI患者神经功能损伤的首要措施。     

Turbulent times for hormone replacement therapy: is there a way out?

The long-awaited results of the large Women's Health Initiative (WHI) trial on the effects of combined estrogen-progestin hormone replacement therapy (HRT) in postmenopausal women show that the overall benefits are smaller than the risks. Herein I argue that many of the findings could be predicted from earlier observational studies. Although the WHI trial will rightly reverse the soaring HRT use of the last decades, there is unquestionably a future for HRT. A consensus is growing that postmenopausal women may be treated with HRT only when seeking help for disturbing symptoms of the ovarian hormone insufficiency syndrome, rather than be treated for menopause per se. The ovarian hormone insufficiency syndrome comprises conditions of estrogen and/or androgen insufficiency; at this time, the diagnosis of these clinical entities is based largely on symptomatology. Future research should disclose why the deprivation of ovarian hormones has a variable impact on women's functioning, and further trials ought to reveal effective and safe treatments for women suffering from this syndrome.     

早发性卵巢功能不全诊断及遗传学进展

早发性卵巢功能不全（POI）是指女性在40岁之前出现卵巢功能衰退（不全）,发病率约为1%。POI患者过早的雌激素缺乏严重影响其生存质量,也是导致女性不孕的重要原因之一。随着对POI的进一步认识,其诊断标准也发生一些改变。POI病因复杂,包括遗传、自身免疫、医源性因素、感染、环境因素等。文章对POI最新诊断标准及其遗传学病因的进展进行阐述。     

„Premature ovarian insufficiency/failure syndrome“ (POI/POF)

The average age of women at menopause is 50-52 years. Approximately 1?% of women are affected by an earlier onset of ovarian insufficiency before the age of 40 years which is known as premature ovarian insufficiency/premature ovarian failure syndrome (POI/POF). Affected women suffer from estrogen deficiency syndromes identical to the symptoms of older menopausal women. There are multifactorial causes of POI/POF including various autoimmune, iatrogenic, genetic, infectious and idiopathic reasons. In cases of suspected POI/POF syndrome a systematic diagnostic procedure and counseling are required. Association with various autoimmune diseases is relevant and testing for Addison’s disease is required. A karyogram is useful to detect gonadal dysgenesis. For genetic reasons testing for a premutation of the FMR1- (fragile X mental retardation 1) gene is recommended. The probability of spontaneous conception of approximately 5?% is also important to make adjustments to the hormone therapy (HT). Such a HT is useful to improve symptoms of estrogen deficiency and is probably also osteoprotective and cardioprotective. An HT should be continued until the normal age of menopause. Chemotherapy and/or radiotherapy are iatrogenic reasons for POI/POF; therefore, women should be counseled about fertility preservation methods before starting adjuvant therapy for malignant diseases.     

Hormonersatztherapie nach Mamma- und Ovarialkarzinom

Breast cancer patients undergoing chemotherapy or anti-endocrine treatment suffer from a subsequent lack of estrogen. While these women would benefit substantially by estrogen replacement, the pertinent data are sparse and inconsistent. Observational studies have not shown an increased risk of recurrence under hormone replacement therapy (HRT); however, the studies are heterogeneous, retrospective and mostly underpowered. The few randomized prospective studies suggest an increased recurrence rate with HRT regimens. Since ovarian cancer is a hormone-related malignancy as well, HRT in perimenopausal and postmenopausal women may have an impact on ovarian cancer risk, especially after primary treatment, but data are scanty. Epidemiological studies have shown that long-term HRT might even increase the risk of ovarian cancer The data on HRT after ovarian cancer treatment are even scantier ; thus, there are no reliable recommendations. This paper reviews the current literature concerning the feasibility of HRT in order to develop new recommendations.     

Bone and heart health in menopause

Age at menopause has been shown to have an impact on bone and heart health, with younger menopause age consistently associated with a higher risk of cardiovascular disease, osteoporosis, and fracture. These risks are particularly high increased among women who encountering menopause at an early age, including women with premature ovarian insufficiency (POI) and early menopause, due to a prolonged period of oestrogen deprivation. Several interventions are suggested to optimise the bone and cardiovascular health of women with menopause including lifestyle modification, dietary supplements, hormonal, and non-hormonal therapies. Hormone therapy (HT) is indicated for women with POI. For women with early menopause, there is a paucity of evidence for the management of bone and cardiovascular health. For women beyond the average age of menopause, HT is not indicated solely for bone protection and cardiovascular health. In this group, screening for bone and heart disease, as well as primary and secondary prevention, should be undertaken in line with national and international guidelines.