激素替代治疗更年期妇女80例分析

目的探讨小剂量激素治疗对绝经期症状的改善。方法将80例绝经期妇女（无激素替代治疗禁忌症）作为研究对象，其中40例作为治疗组，40例作为对照组，5年后比较治疗组和对照组产生的并发症及医疗开支。结果使用激素替代治疗组妇女出现骨质疏松、冠心病、老年性阴道炎、老年痴呆明显减小。结论小剂量激素替代治疗是更年期症状改善最佳方法，关键是掌握正确使用激素的要点，减少因激素使用不当产生的并发症。     

影响更年期激素替代疗法使用的多因素分析

目的通过调查妇女对更年期的体验、相关知识、态度、价值观、认知以及所受到的社会影响进行调查和研究，探讨这些因素对更年期激素替代疗法(HRT)使用的影响。方法入户调查278名40～60岁妇女(155名从未使用过HRT者，108名正在使用者和15名曾经使用者)，资料采用SPPS10．0软件包并应用Logistic多元回归分析。结果经Logistic多元回归分析发现社会影响、对HRT利大于弊的认知、可觉察到的治疗的需要以及HRT知识程度等四个因素(p=2．7749，p=1．9356，p=1．7115，p=1．5567)对使用HRT有正向作用；相反，对老年的价值观和对替代途径的有效性的认知两个变量起反向作用。结论医疗保健服务提供者应为更年期妇女提供充分的信息，在尊重本人观念、想法和价值观的前提下为她们提供一个综合性的保健方案。     

影响更年期激素替代疗法使用的多因素分析

目的 通过调查妇女对更年期的体验、相关知识、态度、价值观、认知以及所受到的社会影响进行调查和研究,探讨这些因素对更年期激素替代疗法(HRT)使用的影响.方法 入户调查278名40～60岁妇女(155名从未使用过HRT者,108名正在使用者和15名曾经使用者),资料采用SPPS10.0软件包并应用Logistic多元回归分析.结果 经Logistic多元回归分析发现社会影响、对HRT利大于弊的认知、可觉察到的治疗的需要以及HRT知识程度等四个因素(β=2.7 749,β=1.9 356,β=1.7 115,β=1.5 567)对使用HRT有正向作用;相反,对老年的价值观和对替代途径的有效性的认知两个变量起反向作用.结论 医疗保健服务提供者应为更年期妇女提供充分的信息,在尊重本人观念、想法和价值观的前提下为她们提供一个综合性的保健方案.     

绝经后长期小剂量激素替代疗法对子宫的影响

目的：探讨小剂量激素替代疗法对绝经后子宫体积和内膜厚度的影响。方法：利维爱组：54例患者口服利维爱1.25 mg,1次/d,用药12-24个月。对照组：同期健康女性。应用阴道彩超测量子宫体积和内膜厚度,并对两组进行比较。结果：利维爱组与对照组的子宫体积分别为（24.56±7.64）、（21.02±11.08） cm^3,无显著性差异（P〉0.05）。两组子宫内膜厚度分别为（0.36±0.10）、（0.29±0.12） cm,比较有显著性差异（P＜0.05）。结论：长期小剂量应用激素（利维爱）对子宫体积无显著影响,对子宫内膜厚度影响相对较大,故应定期监测,避免不良反应。     

绝经期激素替代疗法

SUMMARY Hormone replacement therapy (HRT) was initiated almost half a century ago to treat menopausal symptoms. Initially, its use remained limited even among symptomatic women and the move toward postmenopausal hormone use for disease prevention came later. Improved treatment schedules and delivery systems expanded the use of HRT worldwide. However, large trials of postmenopausal hormones with disease outcomes were even later in coming and today HRT has become a specialized, multidisciplinary area of research. As the population continues to grow older, there has been an increased focus on the effects of ageing. HRT may affect length and quality of life through disease prevention. It may have possible beneficial effects on cognition, on the incidence of hip fracture, myocardial infarction and stroke, and adverse effects on the incidence of breast cancer, endometrial cancer, and venous thromboembolism.Today's attitudes about the hormonal treatments for the menopausal transition have moved from expansive optimism to contracting disappointment amidst safety concerns and equivocal results and faces greater skepticism and scrutiny. The health and well being of large numbers of women are at stake, and researchers, clinicians and the general public are watching and weighing the options.     

激素替代治疗卵巢肿瘤的临床分析

目的观察激素替代治疗（HRT）对卵巢肿瘤的临床诊治及预后影响。方法将2003年1月～2005年12月我院收治的卵巢肿瘤患者术后或放疗后进行HRT，同时选择同期收治的年龄、临床期别和病理类型相同的77例卵巢癌患者，使用倍美力片或尼尔雌醇加安宫黄体酮作为HRT方法，采用卡方和t检验，对随访数据进行分析。结果HRT和非HRT两组在各临床病理因素间相比较，差异无显著性（P〉0．05）。HRT和非HRT两组的卵巢癌复发和转移间相比较，差异无显著性（P〉0．05）。HRT和非HRT两组的生存期比较差异无显著性（P〉0．05）。结论根据ERT对卵巢癌细胞的不同影响，可能与其自身激素受体、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有关，HRT对卵巢癌的预后无明显不良影响。     

小剂量激素替代治疗对绝经早期妇女生理、心理健康的影响

目的:探讨小剂量激素替代(HRT)治疗对绝经早期妇女生理、心理健康的影响。方法:选择绝经早期有明显症状和不同程度心理症状的病人40例。每天口服倍美力0.3mg及安宫黄体酮片2mg,同时口服钙剂6个月,于治疗前后分别填写临床症状调查表和心理症状自评量表(SCL-90),比较用药前后临床症状和SCL-90各项指标的变化,做相关性分析;通过B超监测其安全性。结果:小剂量HRT治疗前后比较临床症状和SCL-90各项指标均有显著差异(P<0.05,P<0.01)。临床症状与心理症状存在相关性(P<0.01)。在治疗过程中子宫内膜未见增生。结论:小剂量HRT能安全、有效改善绝经早期妇女生理、心理相关症状,明显提高生活质量。     

Evaluation of hormone replacement therapy

Hormone Replacement Therapy (HRT), once considered as the gold standard of treatment of menopausal symptoms and osteoporosis, introduced about seventy years ago still continuing with lot of controversies. Menopause, a transitional period of women's life, is not an illness when oestrogen level falls leading to its consequences. Results of earlier observational studies showed beneficial effects of HRT including cardiovascular protection. But all recent randomized controlled trials have failed to prove these positive effects, rather increases the cardiovascular risk and breast cancer. Women's Health Initiative(WHI), one of the recent randomized controlled trials was stopped prematurely in 2002 due to unfavorable risk-benefit ratio. HRT is not the only way of treating the menopausal symptoms and other consequences of estrogen deficiency. There are suitable alternatives without bearing the risk of HRT. Vasomotor symptoms with hot flushes and sweating experienced by about 75 percent of menopausal women can be treated with alternatives like phyto-estrogens, selective estrogen receptor modulators (SERMs), clonidine, selective serotonin reuptake inhibitors, acupuncture, exercise, behavioral therapy etc. HRT is no longer considered as the first line of treatment of postmenopausal osteoporosis. It can be treated with alternatives like regular weight bearing exercise, balanced calcium rich diet, maintaining weight, avoidance of bone robbers, (like excess alcohol, caffeine, smoking), use of SERMs etc. Use of HRT should be individualized and rationalized considering its risks and benefits.     

Menopausal depression:comparison of hormone replacement therapy and hormone replacement therapy plus fiuoxetine

Background To compare the efficacy and safety of hormone replacement therapy (HRT) combined with fluoxetine, with HRT alone, in post-menopausal women suffering from depression.Methods A randomized, open-label, parallel trial was applied. HRT was administered to all patients for 2 cycles, with ]4 days of estrogen therapy and 14 days of estrogen plus progesterone. Patients who were randomly assigned to the HRT plus fluoxetine group were given fluoxetine in combination with HRT. Hamilton Depression Rating Scale (HAMD), Kupperman Menopausal Index (KMI), and Clinical Global Impressions scale were used to measure the efficacy. Results One hundred and twenty-three post-menopausal patients with depression were enrolled in the study. Among them, 120 had at least one post-treatment visit and entered into the statistical analysis. The mean total HAMD scores were significantly lower, and the percentages of HAMD score reductions were higher in the HRT plus fluoxetine Group compared with the HRT Group, after at least 3 weeks of treatment, with an average difference of 5 points at the endpoint. The Clinical Global Impression-Severity and Clinical Global Impression-Improvement scores were significantly different in the 2 groups, in favor of the combination therapy. The mean total KMI was significantly lower in the Combination Group compared with the HRT Group, after at least 6 weeks of treatment, with an average 4. 5-point difference between the groups. No statistically significant differences were found in most of the adverse events reported in the Combination Group compared with the HRT group, with the exception of 3 symptoms, i. e., dry mouth, loss of appetite, and abdominal distention. They were mild to moderate in severity. Two patients in the HRT group, but none in the combination group, dropped out due to adverse events. Conclusion HRT plus fluoxetine therapy was effective in the treatment of menopausal depression with a satisfactory safety profile.     

Menopausal depression: comparison of hormone replacement therapy and hormone replacement therapy plus fluoxetine

Background To compare the efficacy and safety of hormone replacement therapy (HRT) combined with fluoxetine, with HRT alone, in post-menopausal women suffering from depression.Methods A randomized, open-label, parallel trial was applied. HRT was administered to all patients for 2 cycles, with 14 days of estrogen therapy and 14 days of estrogen plus progesterone. Patients who were randomly assigned to the HRT plus fluoxetine group were given fluoxetine in combinationwith HRT. Hamilton Depression Rating Scale (HAMD), Kupperman Menopausal Index (KMI), and Clinical Global Impressions scale were used to measure the efficacy.Results One hundred and twenty-three post-menopausal patients with depression were enrolled in the study. Among them, 120 had at least one post-treatment visit and entered into the statistical analysis. The mean total HAMD scores were significantly lower, and the percentages of HAMD score reductions were higher in the HRT plus fluoxetine Group compared with the HRT Group, after at least 3 weeks of treatment, with an average difference of 5 points at the endpoint. The Clinical Global Impression-Severity and Clinical Global Impression-Improvement scores were significantly different in the 2 groups, in favor of the combination therapy. The mean total KMI was significantly lower in the Combination Group compared with the HRT Group, after at least 6 weeks of treatment, with an average 4. 5-point difference between the groups. No statistically significant differences were found in most of the adverse events reported in the Combination Group compared with the HRT group, with the exception of 3 symptoms, i. e., dry mouth, loss of appetite, and abdominal distention. They were mild to moderate in severity. Two patients in the HRT group, but none in the combination group, dropped out due to adverse events.Conclusion HRT plus fluoxetine therapy was effectivewith a satisfactory safety profile.in the treatment of menopausal depression with a satisfactory safety profile.     

Current trends in hormone replacement therapy

As life span increases, more and more women live longer after the menopause, and see its long-term consequences. The menopause and climacteric have major consequences for the well being of most women, resulting in a variety of symptoms including vasomotor, psychological, sexual symptoms and increased risk of osteoporosis and atherosclerosis. Prevention of osteoporosis and reduction in cardiovascular risks are the long-term goals of post-menopausal hormone replacement therapy. Post-menopausal women who receive hormone replacement therapy have approximately half of the rate of coronary artery disease compared to those who do not take it. Similarly, estrogen replacement alone for 5 years results in 50% reduction in the risk of overall fracture and is a major factor in the prevention and management of osteoporosis. A wide range of estrogen preparations is available for administration by various routes. The choice depends on indications, side effects and convenience. Oral estrogen is the most commonly used preparation followed by transdermal preparation. Controversy still exists over the efficacy and safety of hormone replacement therapy among both the medical and lay authorities. There is overwhelming evidence that hormone replacement therapy improves the quality of life and reduces the morbidity and mortality by reversing the metabolic and pathological changes induced by the menopause. The benefits of hormone replacement therapy out weigh any increased risk of venous thromboembolism or breast, ovarian and endometrial cancers.     

Oestrogen and cyclical progestogen in postmenopausal hormone replacement therapy.

OBJECTIVE: To ascertain the effectiveness, safety and incidence of side effects of a postmenopausal hormone replacement regimen consisting of continuous conjugated equine oestrogens and cyclical medroxyprogesterone acetate given for the first 14 days of each calendar month. DESIGN: A six month, prospective, open label, two centre, outpatient study of continuous Premarin (0.625 mg; Wyeth-Ayerst) and cyclical Provera (10 mg; Upjohn). Dosage adjustment was allowed in one centre. STUDY POPULATION: Seventy-six postmenopausal women in Adelaide and Brisbane. MAIN OUTCOME MEASURES: Menopausal symptom score, serum lipid levels, routine biochemical and haematological indices, endometrial histology and clinical bleeding pattern, blood pressure, weight changes, side effects, withdrawal from the study, compliance and necessary dose adjustment. MAIN RESULTS: Eight women withdrew from the study and nearly 50% experienced some minor side effect. Where dosage adjustment was allowed, almost all side effects were eliminated. Most patients had acceptable regular withdrawal bleeds although some were deemed heavy. There was a statistically highly significant 54% reduction in the menopausal symptoms score at three months and a 62% reduction at six months. Endometrial biopsy at six months showed atrophic or secretory endometrium with no inappropriate proliferation or hyperplasia. Total cholesterol and low density lipoprotein (LDL) cholesterol levels were significantly decreased. The high density lipoprotein (HDL) cholesterol level remained unchanged and triglyceride levels were raised within the normal range. There were no other clinically relevant biochemical, haematological or clinical changes. CONCLUSION: Continuous conjugated equine oestrogens (0.625 mg) and cyclical medroxyprogesterone acetate (10 mg) for the first 14 days of each calendar month proved to be a safe and effective postmenopausal therapy regimen. Initial minor side effects were common but could be readily ameliorated with early follow-up and dose titration.