替勃龙对女性绝经期综合征的影响

目的探讨替勃龙治疗妇女绝经期综合征的疗效及副反应情况。方法将61例自然绝经的绝经综合征妇女随机分成两组,治疗组(替勃龙组)33例,对照组(钙尔奇-D组)28例。治疗组予以替勃龙2.5mg/d联合钙尔奇-D 600 mg/d;对照组仅予以钙尔-奇D 600 mg/d,疗程3月。观察治疗前后妇女更年期症状的变化(Kupperman评分),促卵泡生成素(FSH)、黄体生成素(LH)、雌二醇(E2)水平的变化,以及治疗前后体重指数(BMI)、肝功能(ALT、AST)、阴道出血、乳房胀痛变化的情况。结果治疗组应用替勃龙治疗3月后,更年期症状明显缓解,部分患者潮热、多汗消失,Kupperman评分显著降低;血FSH及LH水平下降,E2水平上升,与对照组治疗后相比差异具有显著性,对照组治疗前后无变化。治疗组与对照组治疗前后体重指数无明显变化,肝功能无明显异常,两组间比较无差异。治疗组患者治疗期间,1例在治疗2月后出现阴道流血,点滴状;2例在治疗1月后出现乳房胀痛,继续服药后症状消失;治疗组妇女治疗结束后妇科B超示子宫内膜厚度小于5mm。结论替勃龙能有效改善绝经后妇女更年期症状,且副反应少,患者耐受性良好。     

溴化钠苯甲酸钠咖啡因合剂治疗更年期抑郁临床观察

目的 观察溴化钠苯甲酸钠咖啡因合剂联合帕罗西汀治疗更年期抑郁症患者的疗效及不良反应.方法 90例更年期抑郁症的患者随机分为治疗组和对照组各45例,2组患者均给予口服帕罗西汀20 mg,1次/d,治疗组在对照组的基础上加服溴化钠苯甲酸钠咖啡因合剂,每次10 ml,3次/d,疗程1个月.结果 治疗组症状改善及抑郁自评量表减分率较对照组下降明显(P<0.05或P<0.01).结论 溴化钠苯甲酸钠咖啡因合剂能有效改善更年期抑郁症患者的抑郁症状.     

不同剂量结合雌激素联合天然孕激素对围绝经期综合征患者性激素水平及骨密度的影响

[目的]探讨不同剂量结合雌激素联合天然孕激素对围绝经期综合征患者性激素水平及骨密度的影响.[方法]选取2018年10月至2019年10月在本院诊治的82例围绝经期综合征患者,按照随机数表法分为低剂量组和标准剂量组,每组41例.低剂量组采用0.3 mg结合雌激素+天然孕激素治疗,标准剂量组采用0.625 mg结合雌激素+天然孕激素治疗,两组均治疗12个周期(每个周期28 d).比较两组患者女性绝经期自测表(KI)评分、临床疗效、性激素水平、骨密度及不良反应发生率.[结果]与治疗前相比,治疗后两组患者KI评分均降低(P<0.05),但两组间KI评分比较,差异无统计学意义(P>0.05).低剂量组总有效率为87.80％(36/41),与标准剂量组的95.12％(39/41)比较,差异无统计学意义(P>0.05).与治疗前相比,治疗后两组血清卵泡刺激素(FSH)、黄体生成素(LH)水平均降低(P<0.05),两组间血清FSH、LH水平比较,差异无统计学意义(P>0.05);与治疗前相比,治疗后两组血清雌二醇(E2)水平均升高(P<0.05),但低剂量组血清E2水平低于标准剂量组(P<0.05).与治疗前相比,治疗后两组腰椎2～4、股骨颈骨密度均升高(P<0.05),但两组间腰椎2～4、股骨颈骨密度比较,差异无统计学意义(P>0.05).低剂量组不良反应发生率低于标准剂量组(P<0.05).[结论]低剂量与标准剂量结合雌激素联合天然孕激素用于围绝经期综合征患者均可改善临床症状,调节性激素水平,防止骨丢失,但低剂量安全性更好.     

低剂量帕罗西汀治疗围绝经期女性血管舒缩症状的临床疗效观察

目的探讨低剂量帕罗西汀治疗围绝经期女性血管舒缩症状的临床疗效与安全性。方法 2018年1月至2019年12月四川省人民医院门诊就诊的79例围绝经期女性,改良Kupperman评分为中到重度,分为盐酸帕罗西汀治疗组39例(10 mg/d,1日1次),激素治疗组40例(雌孕激素序贯治疗方案:17-雌二醇1 mg14片+17-雌二醇1 mg地屈孕酮10mg14片,1片/天)。两组均连用12周。比较治疗后2、4、8、12周两组患者的Kupperman评分和血管舒缩症状,12周后用药的不良反应。结果治疗第2、4、8、12周时,两组患者潮热出汗的频率差异均无统计学意义(P 0. 05),治疗第12周两组潮热出汗频率较治疗前均有明显改善(P0. 05);两组患者Kupperman评分均低于同组治疗前,激素治疗组评分低于盐酸帕罗西汀治疗组(P0. 05)。两组患者不良反应总发生率比较差异无统计学意义(P0. 05)。结论低剂量(10 mg)盐酸帕罗西汀在治疗围绝经期女性血管舒缩症状的频率方面与激素治疗具有相似的效果,对改善其他围绝经期症状及血管舒缩症状程度方面稍差于激素替代治疗,其耐受性好,安全有效,是围绝经期女性改善症状较好的非激素治疗方法。     

不同剂量孕激素治疗无排卵型月经失调的临床效果对比

对比观察不同剂量孕激素治疗无排卵型月经失调的临床效果。选取100例无排卵型月经失调的患者,随机分为试验组和对照组,试验组患者给予黄体酮300mg/d,对照组患者给予黄体酮100mg/d,经过治疗后,对比观察两组患者阴道出血量评分、出血时间、出血率及子宫内膜厚度。经过治疗后,试验组患者阴道出血量评分明显高于对照组,阴道出血概率(96.00%)明显高于对照组(70.00%),子宫内膜厚度明显比对照组更接近于正常值,具有统计学意义(P0.05)。治疗无排卵型月经失调,黄体酮剂量为300mg/d时效果最显著,能够增加阴道出血的概率,不改变子宫内膜厚度,可在临床上应用。     

酸枣仁汤合甘麦大枣汤治疗更年期失眠伴焦躁患者效果观察

目的:观察酸枣仁汤联合甘麦大枣汤治疗更年期失眠伴焦躁的临床效果。方法:选取自愿参加本研究的90例更年期失眠症焦躁患者为研究对象,按照随机对照方法分为中医治疗组和常规治疗组,每组45例。中医治疗组给予酸枣仁汤联合甘麦大枣汤治疗,常规治疗组给予常规西药治疗。比较两组治疗后睡眠质量、焦躁情绪及相关症状改善程度,激素水平差异。结果:两组治疗前的睡眠质量评分、焦虑评分、Kupperman评分及雌二醇、黄体生成素、卵泡生成素等指标比较无显著性差异(P0.05);治疗后,两组睡眠质量评分、焦虑评分、Kupperman评分较治疗前显著降低,且中医治疗组低于常规治疗组,差异有统计学意义(P0.05)。治疗后,两组雌二醇值较治疗前明显升高,黄体生成素、卵泡生成素值较治疗前明显降低,且中医治疗组雌二醇值高于常规治疗组,黄体生成素、卵泡生成素值低于常规治疗组,差异有统计学意义(P0.05)。结论:采用酸枣仁汤联合甘麦大枣汤治疗更年期失眠伴焦躁患者可明显改善患者睡眠质量,缓解患者焦躁等临床症状,调节患者激素水平,疗效显著。     

中西医结合治疗药物流产后阴道出血的临床效果观察

目的:观察中西医结合治疗方法对药物流产后阴道出血的疗效。方法:将51例药物流产后阴道持续出血者随机分为2组,观察组30例治疗:(1)雌-孕激素序贯疗法(苯甲酸雌二醇2mg,Bid×3d,肌注;第4天黄体酮20mg,qd×3d,肌注);(2)雌-孕激素停药后立即服用生化汤,每天1剂,连用5～7剂。对照组21例,服用安宫黄体酮10mg,qd×7d。结果:观察组有27例(90.00%)宫内残留物完全排出,阴道出血在残留物排出后1周内停止,B超复查示宫腔内清晰,无组织物残留,与对照组比较差异有显著意义。结论:中西医结合治疗药物流产后阴道顽固性出血效果满意。     

葛根素联合雌二醇对去卵巢大鼠骨质疏松症的治疗作用

背景:雌激素治疗绝经后骨质疏松症产生的不良反应较大.目的:观察小剂量葛根素联合雌二醇对去卵巢大鼠骨组织的影响.方法:120 只健康雌性大白鼠等分成只切除卵巢旁的一小块脂肪垫的假手术组和切除双侧卵巢的去卵巢模型组、葛根素组、雌二醇组及葛根素+雌二醇组.1 周后葛根素组、雌二醇组和雌二醇+葛根素组分别皮下注射葛根素(50 mg/kg,1 次/d)、雌二醇(200 μg/kg,2 次/周)和雌二醇(100 μg/kg,2 次/周)+葛根素(25 mg/kg,1 次/d).结果与结论:去卵巢模型组大鼠骨组织稀疏,骨钙、磷水平和骨密度明显低于假手术组(P < 0.01),而经雌二醇和/或葛根素治疗后大鼠骨组织形态明显改善、骨钙、磷水平和骨密度明显升高.其中小剂量的葛根素联合雌二醇治疗与较大剂量的葛根素或雌二醇治疗效果接近.提示较小剂量的雌二醇与葛根素联合治疗也可对去卵巢大鼠骨质疏松症产生良好的治疗效果.     

宁神合剂对实验性更年期雌性大鼠性激素的影响

背景单纯的雌激素替代疗法治疗更年期综合征有许多的药物禁忌证的限制,并存在子宫内膜癌与乳房癌的潜在危险.中药防治更年期综合征具有疗效好,副作用小的优点.目的探讨复方宁神合剂对实验性更年期雌性大鼠生殖内分泌系统的影响.设计完全随机分组设计,空白对照实验.单位上海中医药大学医学中心实验室材料实验于2003-01/2003-05在上海中医药大学实验动物中心完成.选用清洁级雌性大鼠60只.随机分为6组,每组10只,分别为空白对照组、模型组、更年安组、宁神合剂大、中、小三组.方法①随机选取50只大鼠麻醉后行卵巢切除术.术后10 d左右,进行阴道涂片观察4 d,如阴道涂片显示性周期紊乱即造模成功.另取10只大鼠(空白对照组)采用假手术法,即切开腹腔即缝合.②宁神合剂中剂量组及更年安组给药剂量参照如下标准计算出人和大白鼠间按体表面积折算的等效剂量比率为10.018.大剂量组按中剂量的2倍,小剂量组按中剂量的1/2倍算出.空白对照组与模型对照组每次均予蒸馏水灌胃;更年安组每次灌含更年安生药1.25 mg/kg;宁神合剂组大、中、小剂量组分别灌以含生药1 00,0.50,0.25 mg/kg;空白对照组,模型对照组,更年安组,宁神合剂大、中、小剂量组均以等体积给药,共持续31 d后,剖腹从主动脉取血后2 h内分离血清.检测大鼠血清促卵泡激素、促黄体生成激素、雌二醇水平.主要观察指标各组大鼠血清雌二醇、促卵泡激素、促黄体生成激素水平比较.结果实验过程中宁神合剂大剂量组1只大鼠因灌药窒息死亡,最终进入结果分析空白对照组、模型组、更年安组、宁神合剂中小剂量组各10只,宁神合剂大剂量组9只.①促卵泡激素水平模型组、更年安组、宁神合剂大中小剂量组明显高于空白对照组(P＜0.05).②促黄体生成激素水平宁神合剂大中剂量组明显高于宁神合剂小剂量组(P＜0.05).③雌二醇水平模型组、更年安组、宁神合剂大中小剂量组明显高于空白对照组(P＜0.05),更年安组、宁神合剂大中小剂量组明显高于模型组(P＜0.05),宁神合剂小剂量组明显高于宁神合剂大中剂量组(P＜0.05).④促卵泡激素、促黄体生成激素、雌二醇水平更年安组与宁神合剂各剂量组相当(P＞0.05).结论①宁神合剂能显著提高实验性更年期大鼠模型雌二醇水平,而对降低促卵泡激素、促黄体生成激素的作用较弱.②宁神合剂以小剂量组提高雌二醇水平最为明显.③宁神合剂组对实验性更年期综合征大鼠的作用与更年安相似.     

激素替代加抗抑郁剂对更年期综合征患者焦虑、抑郁症状的干预效应

背景运用雌激素治疗更年期综合征临床有很多不足之处,除了激素水平紊乱外,5-羟色胺、去甲肾上腺素也偏低,从而引起相应症状.盐酸氟西汀是选择性5-羟色胺再摄取抑制剂的代表药物,对焦虑近、抑郁件神经症等非常有效.目的评估抗抑郁药物合并雌激素对围绝经期更年期综合征治疗效果,并与单独使用雌激素进行开放性对照.设计随机分组设计,对比观察.单位重庆医科大学附属第一医院妇产科.对象选择2003-11/2004-01在重庆医科大学附属第一医院妇科门诊诊断为更年期综合征患者60例,年龄42～52岁,平均(46±3)岁,病程3～12个月.随机分为两组,联合用药组30例,激素替代组30例.方法联合用药组口服盐酸氟西汀胶囊,每天晨服1次,20 mg/次,连服2个月,同时口服雌二醇,每2周1片,连服2个月.激素替代组单服雌二醇,每2周1片,连服2个月.期间停用其他药物.治疗2个月后进行功能测评①女性更年期评分项目症状消失为完全缓解,明显改善为显效,症状减轻为有效,治疗前后无变化者为无效.总体疗效以50%临床症状改善为准.②汉密顿抑郁量表代表患者精力和内心动力的第一因子(睡眠因子和焦虑因子)评分.③绝经指数进行临床评估以及不良事件的描述性分析,评估盐酸氟西汀胶囊合用雌二醇治疗围绝经期更年期综合征的安全性.主要观察指标女性更年期评分;汉密顿抑郁量表评分;绝经指数评估.结果①联合用药组在女性更年期评分项目中完全缓解和显效评分明显优于激素替代组.②联合用药组汉密顿抑郁量表第一因子评分优于激素替代组(联合用药组治疗1～8周评分分别为25,18,15,10,8,5,5,4分,激素替代组治疗1～8周评分分别为25,17,15,14,13,12,13,13分).③联合用药组绝经指数总分评分优于激素替代组(联合用药组治疗1～8周绝经指数分别为32,22.5,15,15,14,15,15,14,激素替代组治疗1～8周绝经指数分别为33,21,16,14,13,12,13,13),且对睡眠障碍、抑郁、焦虑的缓解率大大提高,而不良事件的发生率与激素替代组差异无显著性.结论使用盐酸氟西汀联合雌激素治疗女性更年期综合征确实有比较明显的疗效,能缩短疗程,症状改善明显.     

理性看待绝经激素治疗与乳腺癌发病风险

随着当代女性对绝经认知的不断提高,越来越多的女性开始进行绝经激素治疗(menopausal hormone therapy,MHT),以缓解绝经相关症状,如月经紊乱、潮热、多汗、睡眠障碍、情绪波动、泌尿生殖道萎缩以及骨质疏松等,进而提高生活质量.但在应用MHT的过程中,乳腺癌的发病风险一直是困扰女性的重要问题之一,而M...     

Morning/evening menopausal formula relieves menopausal symptoms: a pilot study

OBJECTIVE: The purpose of the study was to determine the efficacy of a morning/evening menopause formula (morning capsule contains panax ginseng, black cohosh, soy, and green tea extracts; evening capsule contains black cohosh, soy, kava, hops, and valerian extracts) for relieving menopausal symptoms such as hot flashes and sleep disturbance. METHODS: Healthy postmenopausal women, between 45 and 65 years of age, were asked to take the menopause formula orally, one capsule of the morning formula every morning and one capsule of the evening formula every evening for 2 months. The Greene Climacteric Scale (GCS) and the Pittsburgh Sleep Quality Index (PSQI) were used to determine the efficacy. RESULTS: Morning/evening menopause formula significantly reduced the number of hot flashes. The reduction in the number of hot flashes was observed as early as at the end of the second week. At the end of the second week, the number of hot flashes was reduced by 47%. The morning/evening menopause formula also significantly reduced the GCS total and subscale scores. At the end of the eighth week, the vasomotor, anxiety, and depression scores of GCS were reduced by 50%, 56%, and 32%, respectively. Furthermore, the morning/evening menopause formula significantly reduced global PSQI score and scores in five components (sleep quality, sleep latency, sleep duration, sleep disturbance, and daytime dysfunction) by 18%-46%. CONCLUSIONS: This study suggests that the morning/evening menopausal formula is safe and effective for relieving menopausal symptoms including hot flashes and sleep disturbance.     

Missed symptoms of menopause

OBJECTIVE: This review examines the available data on the efficacy of selective serotonin reuptake inhibitors (SSRIs) and serotonin-noradrenaline reuptake inhibitors (SNRIs) for treating the commonly missed climacteric symptoms of menopause. DISCUSSION: Although some women may pass through the menopausal transition phase with few or no symptoms, the majority experience one or more symptoms serious enough to be disruptive to their lives. The most common are vasomotor symptoms (VMS; hot flushes and night sweats), but they are not the only climacteric symptoms that can negatively affect quality of life. The 'missed symptoms' of menopause -- symptoms with high prevalence and an impact on quality of life that nonetheless receive less attention than do VMS -- include mood changes, sleep disturbances and somatic complaints. These symptoms are reported by approximately half of menopausal women, with numbers varying by region and ethnic background. As with VMS, the effects of declining oestrogen levels on serotonin/noradrenaline pathways could play a role in their development. CONCLUSIONS: Results from pilot studies of several SSRIs and SNRIs suggest that they may improve menopausal mood and sleep symptoms, but few studies have demonstrated significant improvement compared with placebo. One SNRI (venlafaxine) improved menopausal mood symptoms and two SSRIs (citalopram and paroxetine) improved sleep, each in a single placebo-controlled trial of women with VMS. Additional placebo-controlled trials are needed to determine whether SSRIs or SNRIs are effective treatment options for women who cannot or choose not to use hormone therapy.     

Mood scores in relation to hormone replacement therapies during menopause: a prospective randomized trial

There is lack of studies in literature about the long-term effects of hormone replacement therapies and cholesterol levels on mood scores in menopause. In the present study we have investigated whether serum lipid levels affect mood scores in menopause and evaluated the long-term effects of the combined hormone replacement regimens (HRT) on depressive symptoms in postmenopausal women. In this prospective-randomized, placebo-controlled, double-blind study, 286 women in menopause were divided into four groups according to therapeutic regimens they received; 1) Conjugated equine estrogen (CEE) of 0.625 mg plus medroxyprogesterone acetate (MPA) of 2.5 mg (n = 79), 2) CEE (0.625 mg) plus MPA of 5 mg (n = 77), 3) tibolone of 2.5 mg (a selective tissue estrogenic activity regulator) (n = 76), and 4) Calcium (Ca) of 1,000 mg (n = 54). Beck Depression Inventory (BDI), and serum levels of lipoprotein lipids were assessed before and after 12-months of treatment with oral continuous HRT and Ca supplementation. BDI scores in the study groups were not correlated with lipid profiles. We compared two subgroups of patients with initial BDI scores 0-14 (normal mood scores) in order to asses for the possible relation between the lipid profile and mood. Following treatment, first subgroup had increased scores to 15-30 (mildly depressed women, n = 27) and the second subgroup preserved BDI scores of 0-14 (normal mood scores, n = 23). Serum levels of total cholesterol, high-density lipoprotein, low-density lipoprotein and body mass index were found to be similar between these two groups. BDI scores decreased significantly in all HRT groups after 12 months of treatment, compared to Ca group (p < 0.05). We did not observe any correlation between BDI scores and lipid profiles before and following continuous HRT or Ca supplementation. Continuous combined hormone replacement regimens, CEE + MPA and tibolone, have superior long-term effects on mood scores in menopause and should be considered during the decision process for use of HRT due to menopausal symptoms.     

The evolving role of oral hormonal therapies and review of conjugated estrogens/bazedoxifene for the management of menopausal symptoms

This review describes the evolving role of oral hormone therapy (HT) for treating menopausal symptoms and preventing osteoporosis, focusing on conjugated estrogens/bazedoxifene (CE/BZA). Estrogens alleviate hot flushes and prevent bone loss associated with menopause. In nonhysterectomized women, a progestin should be added to estrogens to reduce the risk of endometrial cancer. Use of HT declined since the Women’s Health Initiative (WHI) studies showed that HT does not prevent coronary heart disease (CHD) and that conjugated estrogens/medroxyprogesterone acetate increased the risk of invasive breast cancer after nearly 5 years of use. However, re-analyses of the WHI data suggest that some risks (eg, CHD, all-cause mortality) may be reduced when HT is initiated in women <60 years of age and <10 years since menopause, compared with later. CE/BZA is the first menopausal HT without a progestogen for nonhysterectomized women. Instead, BZA, a selective estrogen receptor modulator, in combination with CE, protects against estrogenic effects on uterine and breast tissue. Data from 5 large, randomized clinical trials show that CE/BZA reduces hot flush frequency/severity, prevents bone loss, reduces bone turnover, improves the vaginal maturation index and ease of lubrication, and improves some measures of sleep and menopause-specific quality of life. In studies of up to 2 years, there was no increase in endometrial hyperplasia, vaginal bleeding, breast density, or breast pain/tenderness compared with placebo. Venous thromboembolism and stroke are risks of all estrogen-based therapies. The choice of HT should be individualized, with consideration of the risk/benefit profile and tolerability of therapy, as well as patient preferences.     

Quality of life and costs associated with micronized progesterone and medroxyprogesterone acetate in hormone replacement therapy for nonhysterectomized, postmenopausal women

BACKGROUND: Because natural progesterone is poorly absorbed and rapidly metabolized, synthetic derivatives of progesterone, such as medroxyprogesterone acetate (MPA), are used in combination with estrogen in hormone replacement therapy. A micronized form of natural progesterone is available that is readily absorbed and reaches peak serum concentrations from 1 to 4 hours after administration. OBJECTIVE: The purpose of this study was to compare the quality of life (QOL), menopausal symptoms, and costs associated with a natural micronized progesterone (MP) formulation versus MPA as add-on therapy to estrogen in hormone replacement for post-menopausal women. METHODS: This prospective, multicenter, randomized, fixed-dose, open-label, parallel-group study enrolled postmenopausal, otherwise healthy, nonhysterectomized women 45 to 65 years of age who had been amenorrheic for > or =6 months and exhibited symptoms of estrogen deficiency. All women received 0.625 mg conjugated equine estrogens on days 1 to 25 of a 30-day cycle; on days 12 to 25, women were randomized to receive either MP 200 mg or MPA 5 mg; patients were followed for 9 months. QOL, the primary end point, was measured at baseline and months 3, 6, and 9 using the 36-Item Short-Form Health Survey (SF-36), the Nottingham Health Profile (NHP), and the condition-specific Women's Health Questionnaire (WHQ). Bleeding pattern, compliance, menopausal symptoms, and cost were evaluated as secondary end points. Costs (in 1997 Canadian dollars) were assessed from the societal perspective and included costs of study medication, hormone therapy monitoring, concomitant medication, outpatient resources, out-of-pocket expenses, and patient and caregiver time loss. RESULTS: A total of 182 women were enrolled; 89 received MP and 93 received MPA. Improvements in climacteric symptoms were observed from baseline to month 9 for both treatments. Mean scores on all domains of the SF-36 at month 9 were greater than scores at baseline in both treatment groups but the increases were not statistically significant. All domains within the NHP and WHQ improved significantly over this period for both groups (P < or = 0.008). Only patients receiving MP showed specific improvements in the menstrual problems and cognitive domains of the WHQ. The difference in average 9-month cost per patient was not statistically significant, at Can 367 dollars +/- 120 dollars and Can 360 dollars +/- 369 dollars for patients receiving MP and MPA, respectively. CONCLUSIONS: MP is a clinically effective, well-tolerated, and cost-comparable alternative to MPA.     

中年女性围绝经期症状及影响因素的研究现状分析

围绝经期由于激素水平下降出现潮热、心悸、失眠、记忆力下降、性欲减退、烦躁、抑郁、阴道干涩及泌尿系统疾病等身体和心理的不适症状。不同种族、不同地域和个人经历的女性,在围绝经期的症状存在差异,不同程度地影响其健康。本文作者通过文献分析,探讨女性围绝经期症状及影响因素的研究趋向。发现围绝经期症状直接影响女性的身心健康状况、生活质量水平,我国大多数围绝经期女性的自我保护意识尚低。因此,明确围绝经期女性的症状特点和影响因素,有助于提供适宜有效的健康干预。     

Counseling patients about hormone therapy and alternatives for menopausal symptoms

The results of recent large clinical trials have led physicians and patients to question the safety of menopausal hormone therapy. In the past, physicians prescribed hormone therapy in an attempt to improve overall health and prevent cardiac disease. Hormone therapy appears to increase the risk of breast cancer when used for more than three to five years; therefore, regulatory agencies now advise that physicians prescribe it only to treat menopausal symptoms such as hot flashes and vaginal atrophy, with the smallest effective dosage and for the shortest possible duration. Although estrogen is the most effective treatment for hot flashes, alternatives such as venlafaxine and gabapentin are effective for some patients. Herbal formulations such as dong quai, ginseng, kava, and dietary soy, among others, do not appear to benefit patients more than placebo. In contrast to systemic estrogen therapy, topical estrogen therapy for vulvovaginal atrophy is more appealing for certain patients because it does not require the addition of a progestogen for endometrial protection. Some have advocated selective estrogen reuptake modulators as alternatives to hormone therapy for the prevention of menopausal osteoporosis. The decision to use either therapy depends on clinical presentation and a thorough evaluation of the risks and benefits, because both have potential detrimental health effects and both are linked to an increased risk of venous thromboembolism.