绝经后激素治疗与认知及记忆功能

雌激素改善脑认知功能的作用早在20世纪70年代开始被人们认识,实验室和动物研究发现雌激素有神经保护功能且其机制复杂,许多研究显示绝经后激素治疗可降低与老年性痴呆有关的痴呆危险性并改善部分认知功能。近期研究发现激素治疗可通过增加脑萎缩这一机制增加大于65岁以上老年绝经后妇女认知障碍,激素治疗不能用于老年绝经后妇女认知功能的一级预防。     

绝经激素治疗与认知

阿尔茨海默病的发病存在性别差异,其机制复杂。绝经激素治疗对认知的影响尚不确定。从整体健康效益而言,绝经女性窗口期应用激素治疗的受益远大于风险,没有理由仅因未确定的风险而否定绝经激素治疗。     

绝经激素治疗与认知

阿尔茨海默病的发病存在性别差异,其机制复杂。绝经激素治疗对认知的影响尚不确定。从整体健康效益而言,绝经女性窗口期应用激素治疗的受益远大于风险,没有理由仅因未确定的风险而否定绝经激素治疗。     

绝经后激素治疗与骨健康

雌激素有促进肠钙吸收,抑制破骨细胞活性的功能。绝经后由于雌激素骤然缺乏使破骨细胞活跃,骨吸收增加,骨转换加快,导致骨量迅速丢失。因此,绝经后妇女是骨质疏松的高危人群。激素治疗是60岁以下绝经妇女防治骨质疏松的一线选择。     

绝经后激素治疗与乳腺相关问题

探讨绝经后妇女乳腺生理特点、性激素对乳腺的作用以及激素治疗(HT)对乳腺的影响和与乳腺癌的关系,同时指出应在HT前及治疗中进行乳腺的定期检查,以期能安全长期进行HT,以获得HT带来的最大益处。     

绝经激素治疗与绝经相关症状

绝经期是女性生命必经的过程,绝经后由于卵巢功能减退而引起的雌激素缺乏将导致女性出现血管舒缩症状、神经精神症状、泌尿生殖道萎缩等症状以及绝经晚期发生骨质疏松、心血管疾病和老年痴呆等疾病。这些症状和绝经相关的疾病严重影响绝经后女性的生活质量和身心健康,而绝经激素治疗（MHT）是治疗绝经相关症状及预防相关疾病最有效的方法。文章对绝经相关症状作一阐述,并进一步探讨MHT的价值。     

绝经激素治疗与绝经相关症状

绝经期是女性生命必经的过程,绝经后由于卵巢功能减退而引起的雌激素缺乏将导致女性出现血管舒缩症状、神经精神症状、泌尿生殖道萎缩等症状以及绝经晚期发生骨质疏松、心血管疾病和老年痴呆等疾病。这些症状和绝经相关的疾病严重影响绝经后女性的生活质量和身心健康,而绝经激素治疗（MHT）是治疗绝经相关症状及预防相关疾病最有效的方法。文章对绝经相关症状作一阐述,并进一步探讨MHT的价值。     

绝经后妇女激素替代治疗

女性绝经前后，因卵巢功能减退，体内激素水平失调，有些人对此变化一时不能适应，出现症状不一、轻重不等、时间长短各异的全身或局部表现，如潮热、心慌、性情急躁、失眠、多梦、多疑、抑郁等症状，严重者影响正常生活，应用适当的激素治疗(HRT)，可改善上述症状，提高生活质量。     

绝经后激素治疗禁忌证

为减少激素治疗(HT)的风险,使用HT需严格排除禁忌证,包括妊娠、原因不明的阴道出血、乳腺癌、性激素相关的恶性肿瘤、活动性静脉或动脉血栓栓塞性疾病、严重肝肾功能障碍和一些与性激素相关的少见疾病。     

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。     

绝经后激素治疗与卵巢癌

激素治疗(HT)可有效缓解绝经相关症状、防止绝经后骨质疏松,可显著提高女性与绝经相关的生活质量。但是,HT是否增加卵巢癌的发生风险?卵巢癌患者术后HT是否会增加复发危险?该文将结合文献报道对这两个问题进行讨论。     

绝经后激素治疗与抑郁障碍

围绝经妇女是抑郁障碍的高发人群,可能和这一时期特有的激素波动有关。妇产科医生在诊断绝经期综合征的同时要高度警惕抑郁障碍的存在。抗抑郁药物和激素治疗同时应用治疗围绝经期和绝经后抑郁症效果较好。     

Postmenopausal hormone therapy and quality of life.

OBJECTIVE: To evaluate whether hormonal therapy (HT) had any significant effect on quality of life (QoL) in a selected group of postmenopausal women. METHODS: The study was conducted in a specialist private practice in Tygerberg, Cape Town, South Africa, over an 18-month period ending in July 2003. A questionnaire using the Utian Quality of Life (UQoL) scale was posted to all women with established postmenopausal status, seen over this period. 541 questionnaires were posted, 421 returned and 398 could be used. Women gave written informed consent. RESULTS: The average age of the women was 60 years. 313 women (78.6%) were using hormone therapy (HT) while 275 women (69.1%) reported concomitant medical problems. HT users had significantly higher scores in three of the four QoL domains, namely, occupational (p=0.046), emotional (p=0.03), and sexual (p=0.009). There was no significant difference in the health domain (p=0.2). CONCLUSION: This study found that post-menopausal South African women experienced that HT had a positive effect on global quality of life.     

Postmenopausal hormone therapy and cardiovascular disease in perspective

The totality of data indicate that the window of opportunity for reducing mortality and coronary heart disease is initiation of hormone therapy (HT) within 6 years of menopause and/or by 60 years of age and continued for 6 years or more. Additionally, the risks of HT are rare (<1/1000) especially in younger postmenopausal women and comparable with other primary prevention therapies. In fact, as randomized controlled trial results accumulate, the more they look like the consistent observational data. These studies showed that young postmenopausal women with menopausal symptoms who use HT for long periods of time have lower rates of mortality and coronary heart disease than comparable postmenopausal women who do not use HT.     

Postmenopausal hormone therapy and risk of developing urinary incontinence

OBJECTIVE: To better understand associations between post-menopausal hormone therapy and the development of urinary incontinence. METHODS: Postmenopausal hormone use was assessed via biennial mailed questionnaires beginning in 1976 among Nurses' Health Study participants. In 1996, 39,436 post-menopausal women aged 50-75 years reported no leaking of urine and were followed-up for 4 years to identify incident cases of incontinence. We used logistic regression to estimate multivariable-adjusted relative risks (RRs) and 95% confidence intervals (CIs) for the relation of postmenopausal hormone use from 1976 to 1996 to the development of incontinence from 1996 to 2000. RESULTS: We identified 5,060 incident cases of occasional (leaking urine 1-3 times/month) and 2,495 cases of frequent incontinence (leaking at least weekly) for average yearly incidence rates of 3.2% and 1.6%, respectively. The risk of incontinence was elevated among women taking postmenopausal hormones compared with women who had never taken hormones (oral estrogen: RR 1.54, 95% CI 1.44, 1.65; transdermal estrogen: RR 1.68, 95% CI 1.41, 2.00; oral estrogen with progestin: RR 1.34, 95% CI 1.24, 1.44; transdermal estrogen with progestin: RR 1.46, 95% CI 1.16, 1.84). There was little risk after the cessation of hormones (RR 1.14, 95% CI 1.06, 1.23) and a decreasing risk of incontinence with increasing time since last hormone use; 10 years after stopping hormones, the risk was identical in women who had and had never taken hormone therapy (RR 1.02, 95% CI 0.91, 1.14). CONCLUSION: Postmenopausal hormone therapy appears to increase risk of developing urinary incontinence. This risk does not vary by route of administration, type of hormones, or dose taken, but is diminished upon cessation of use. LEVEL OF EVIDENCE: II-2     

绝经后激素治疗与皮肤结缔组织变化

绝经和衰老导致皮肤的改变如干燥,皱纹增加,伤口不易愈合及松弛等。雌激素通过雌激素受体调节皮肤的表皮角质化细胞、真皮成纤维细胞、黑色素细胞和毛囊等对皮肤产生影响。激素治疗能增加皮肤水合作用、皮肤厚度、皮肤弹性,减少皱纹,而且增加皮肤胶原含量和质量等,延缓衰老导致的皮肤改变。