围绝经期妇女激素补充疗法的临床分析

通过对围绝经期妇女具有激素补充疗法 (HRT)适应症、本人同意并坚持随访的 112例妇女进行激素补充治疗 ,并根据绝经期综合征的不同表现采取不同的药物、不同的剂型、不同的剂量和不同的用药途径 ,收到了良好的效果。其中用药超过 3个月的症状改善率为 10 0 .0 0 % ,与对照组有明显差别。提示 :HRT对改善绝经期综合征、预防老年性疾病的发生、提高妇女的生活质量起着重要的作用。     

更年期综合征的激素补充

更年期是妇女必经的生理过程,部分妇女在更年期由于不能适应雌激素水平的下降,出现了以植物神经功能紊乱为主的症候群,这种症候群称为更年期综合征。国外用激素治疗更年期综合征已有60多年的历史,但国内更年期综合征的激素治疗还未被广泛接受。以下我们探讨更年期激素补充的方法。     

激素补充治疗的个性化治疗

激素补充治疗是医学治疗,要有明确的治疗适应证和禁忌证,要根据患者的需求和存在的主要问题选择治疗方案和使用期限,根据患者合并的其他并发症调整治疗方案,应定期随诊并根据患者的反应及时调整治疗方案。     

心血管疾病与激素补充疗法

绝经后妇女体内雌激素水平下降对高血压、高血脂、肥胖的发生有负面影响,而这些都是心血管疾病(Cardiovascular diseases,CVD)发生的风险因素。雌激素通过改善血管功能、胆固醇水平、血糖代谢、血压以及保护心肌的作用,具有潜在改善CVD风险的作用。激素补充疗法(Hormone replacement therapy,HRT)能有效治疗绝经相关症状,绝经后妇女HRT不适于作为CVD的一级和二级预防。但是,如果在围绝经期和绝经后早期对有绝经症状的中年妇女使用HRT,会形成一个对心血管有保护作用的"时间窗"。     

绝经期妇女激素补充治疗的新进展

女性一生中约有1/3,甚至更长的时间是在围绝经期与绝经期度过的。由于卵巢功能的逐渐衰退,造成雌激素不足,绝经后的妇女会出现一系列的身心症状,影响个人的生活质量,给家庭和社会带来巨大的压力和负担。激素补充治疗对缓解更年期综合征,减少骨质疏松和骨折,改善妇女的生活质量,减少社会和家庭的压力与负担起了很重要的作用。该文肯定了激素补充治疗(HRT)对绝经期妇女的益处多于不良作用,强调每年评估利与弊,不断总结应用HRT的特点,扬长避短,为绝经期保健提供科学的依据。     

乳腺增生症与精神压力月经现状激素补充的相关研究

乳腺增生症(HMG)是一种与内分泌紊乱密切相关的疾病.WHO命名为良性乳腺结构不良,发病率为7%[1,2],并呈世界性逐年上升趋势.近年该病在我国育龄妇女的检出率为15%～22.41%[3-9].据报道HMG已占专科门诊的50%～70%[3].同时因为乳腺增生多伴有疼痛,影响工作、生活.约有10%患者需要治疗.随着医学模式的转变,其病因的研究已突破了"内分泌障碍所致乳腺实质增生"纯生物学的定论,更注意其社会、心理的致病性.新近研究表明,该病的发生和发展与情绪不稳、家庭生活事件、性生活满意度和饮食习惯有关[5,6,8].鉴于该病患者发生乳癌的危险是正常人的2～4倍[2,9]及其对妇女生殖健康的危害性和防治的紧迫性,我们就乳腺增生症与精神压力、月经现状及激素补充关系作对照研究,以期为HMG的防治提供依据.     

阿尔兹海默病与激素补充治疗

阿尔兹海默病(Alzheimer’s disease,AD)是一类最常见的老年痴呆症,其主要表现为进行性记忆和语言能力障碍,最终丧失自主生活能力。其主要病理特征为大脑中非正常蛋白质沉积。研究发现围绝经期女性或绝经早期女性应用激素补充治疗(hormone replacement therapy,HRT)可能会降低AD的发生率,绝经晚期应用HRT可能对AD的发生无明显作用,甚至有不利影响。     

激素补充治疗与代谢综合征

众所周知激素补充治疗(hormone replacement therapy,HRT)能够有效改善妇女的绝经相关症状。绝经早期开始HRT,对妇女的心血管疾病、骨质疏松及老年痴呆有预防作用。妇女绝经后代谢综合征(metabolic syndrome,MS)的发生风险增加。HRT对MS中的肥胖、血糖、血脂和血压有何影响,将在本文中综述。     

68例甲状腺功能减退症患者的激素补充替代治疗情况调查分析

目的:调查甲状腺功能减退症患者的激素补充替代治疗情况,为治疗保健工作提供依据。方法:对68例已诊断为甲状腺功能减退症的患者的治疗情况,从甲状腺功能化验(T3、T4、TSH值)和以问卷的形式,从是否有记忆力智力的下降,是否意识到需要长期的服药治疗,是否选择最佳药物,是否自行停药及原因,是否有医务人员的明确指导等情况进行了调查。结果:34%的被调查人甲状腺功能(T3、T4、TSH)未能在理想的数值。90%的被调查人在甲减治疗之前有记忆力智力的下降。46%的被调查人未意识到需要长期的服药治疗,47%的被调查人未能选择最佳药物。35%的被调查人自行停药。31%的被调查人未能得到医务人员的明确指导。结论:通过甲状腺功能减退症患者的激素补充替代治疗情况调查证明该病患者的激素补充替代治疗情况不够理想。有近1/2的被调查人对甲低的终生治疗不明确,有近1/2的被调查人不能选择最佳药物,有近1/3的被调查人自行停药。其原因与患者有记忆力智力的下降和未能得到医务人员的明确指导有关。有关的医疗保健人员有必要提高相关知识,加强耐心,除患者外对其亲友也有必要进行相关知识的交代,进一步提高此类疾病患者的治疗水平。     

Benefits and risks of sex hormone replacement in postmenopausal women

Because cardiovascular disease (CVD), which is far less common in young women than in men, but increases in prevalence in the postmenopausal years to that of men, estrogen repletion therapy (ERT) or combined hormone replacement therapy (HRT), has been widely used to protect against development of both CVD and osteoporosis, and possibly to delay or prevent cognitive loss or Alzheimer's disease (AD). To test the validity of favorable findings in many small-scale studies, and in clinical practice, a large-scale trial: the Women's Health Initiative (WHI) was undertaken by the National Institutes of Health (NIH), a trial that was prematurely ended because of increased CVD complications, despite some lessening of hip fractures. This paper suggests that the customary high intake of calcium (Ca)-advised to protect against osteoporosis, and the marginal magnesium (Mg) intake in the USA, might well be contributory to the adverse CV effects, that were all thromboembolic in nature. The procoagulant effect of estrogen is intensified by Ca; Mg-which counteracts many steps in the coagulation cascade and inhibits platelet aggregation and adhesion-is commonly consumed in sub-optimal amounts. The high American dietary Ca/Mg ratio might also be contributory to the WHI failure to confirm ERT's favorable mental effects. Discussed are mechanisms by which Mg enhances estrogen's central nervous system protective effects. Mg's improvement of cerebral blood flow, which improves brain metabolism, can also enhance removal of the beta amyloid peptide, accumulation of which is implicated in AD.     

Weighing the cons and pros: women's reasons for discontinuing hormone replacement therapy

As a greater proportion of U.S. women move into midlife, there has been increased interest in meeting their preventive health needs. Although hormone replacement therapy (HRT) may not be an option for all postmenopausal women, it has been documented as prolonging life expectancy and protecting against osteoporosis. Despite its advantages for many women, often those who initiate HRT discontinue its use within a short time. The purpose of this qualitative study is to gain insights into women's reasons for discontinuing HRT. We collected data by semistructured interview from three diverse samples: 10 women who had been on HRT for two years or less, 11 health care providers of women, and 34 women who had gone off HRT. Reasons for discontinuing fell into seven broad categories: general Gestalt, somatic complaints, mind (knowledge, emotion), not being heard, hassles, indecisive medical community, and cons outweighed pros. Results indicate that women who discontinue HRT do so for a variety of reasons, many of which are connected to the health care system and its providers. Outcomes also suggest that sharing in decision making along with increased education, support, and individualized care are necessary to better address the preventive health care needs of postmenopausal women.     

Health, health risks and inequalities: an exploratory study of women's perceptions

Recent theoretical and empirical research has highlighted the importance of understanding the relationship between social structure and health beliefs. The empirical study described here explores the relationships between occupational social class and two dimensions of health beliefs which were concepts of health and perception of vulnerability to disease. Both the dimensions are claimed to be associated with decisions to carry out health behaviour and thus one of the aims was to shed some light on the social class gradient in patterns of preventive health behaviour and risk-taking behaviour. The findings showed a more marked social class differentiation in concepts of health when they were defined in the abstract compared with when they were defined in relation to personal health. The concept of personal vulnerability itself was shown to be problematic and theories about vulnerability were similar for both classes. Explanations for the findings are discussed.     

Sexual orientation and health: comparisons in the women's health initiative sample

CONTEXT: Little is known about older lesbian and bisexual women. Existing research rarely compares characteristics of these women with comparable heterosexual women. OBJECTIVE: To compare heterosexual and nonheterosexual women 50 to 79 years on specific demographic characteristics, psychosocial risk factors, screening practices, and other health-related behaviors associated with increased risk for developing particular diseases or disease outcomes. DESIGN: Analysis of data from 93,311 participants in the Women's Health Initiative (WHI) study of health in postmenopausal women, comparing characteristics of 5 groups: heterosexuals, bisexuals, lifetime lesbians, adult lesbians, and those who never had sex as an adult. SETTING: Subjects were recruited at 40 WHI study centers nationwide representing a range of geographic and ethnic diversity. PARTICIPANTS: Postmenopausal women aged 50 to 79 years who met WHI eligibility criteria, signed an informed consent to participate in the WHI clinical trial(s) or observational study, and responded to the baseline questions on sexual orientation. MAIN OUTCOME MEASURES: Demographic characteristics, psychosocial risk factors, recency of screening tests, and other health-related behaviors as assessed on the WHI baseline questionnaire. RESULTS: Although of higher socioeconomic status than the heterosexuals, the lesbian and bisexual women more often used alcohol and cigarettes, exhibited other risk factors for reproductive cancers and cardiovascular disease, and scored lower on measures of mental health and social support. Notable is the 35% of lesbians and 81% of bisexual women who have been pregnant. Women reporting that they never had sex as an adult had lower rates of Papanicolaou screening and hormone replacement therapy use than other groups. CONCLUSIONS: This sample of older lesbian and bisexual women from WHI shows many of the same health behaviors, demographic, and psychosocial risk factors reported in the literature for their younger counterparts, despite their higher socioeconomic status and access to health care. The lower rates of recommended screening services and higher prevalence of obesity, smoking, alcohol use, and lower intake of fruit and vegetables among these women compared with heterosexual women indicate unmet needs that require effective interactions between care providers and nonheterosexual women.     

Individualizing hormone therapy to minimize risk: accurate assessment of risks and benefits

Contrary to the exaggerated risks associated with HRT that developed after the initial press reports held by the Women's Health Initiative (WHI) writing group, the recent approach to hormone therapy is more balanced and evidence based. A review of over 40 years of scientific studies demonstrates that estrogen is a medication that can decrease mortality, cardiovascular disease, osteoporosis fracture, urogenital atrophy and dementia. When timing of administration, dose of therapy and route of administration are considered, estrogen is associated with low risks and substantial benefits. The decision of whether or not to take HRT for either short symptom relief or for long-term therapy, should be based on an accurate risk-benefit analysis. Adjusting the dose of therapy and considering a transdermal approach, particularly in high-risk patients, are important considerations.