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绝经激素治疗(menopausal hormone therapy, MHT)是否会增加乳腺癌的发病风险一直存在争议。2019年9月,Lancet发表了一篇荟萃分析,汇集了世界范围内关于MHT与乳腺癌发病风险的证据。此研究结果表明,除阴道应用雌激素外,所有方式应用MHT均增加乳腺癌发病风险,且该风险随MHT应用时间的延长逐渐升高。其中雌激素、孕激素联合治疗风险更高,停药后额外风险可持续10年以上。小剂量应用MHT或选择天然孕激素等并不能回避乳腺癌发病风险的增加。本文对该荟萃分析进行解读,强调应用MHT需考虑乳腺癌风险,全面评估患者风险与获益。 相似文献
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绝经激素治疗(menopausal hormone therapy,MHT)是对卵巢功能衰退的女性进行外源性雌激素补充以解决与雌激素不足相关的健康问题,MHT对于缓解绝经症状、防治泌尿生殖道萎缩相关疾病和预防骨质疏松的获益是毋庸置疑的.近80年来,医学界对MHT获益与风险的认识经历了跌宕起伏、崎岖发展的过程.特别是21... 相似文献
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绝经后妇女由于生殖内分泌激素的变化 ,尤其是卵巢分泌雌激素水平显著降低 ,机体发生许多生理病理改变 ,导致妇女身心功能失调 ,表现为潮热、烦躁、头痛、心悸等症状 ,不仅影响他们的生活质量和身体健康 ,还促使骨质疏松和心血管疾病的形成和发展。为了缓解症状 ,提高生活质量 ,促进健康 ,激素补充治疗 (hormonereplacementtherapy,HRT)是绝经后妇女保健不可缺少的措施。但目前自愿接受HRT的绝经后妇女仍占少数 ,其主要原因是对HRT副反应及潜在风险的顾虑。而HRT副反应中最主要的为子宫出血。本文主要介绍了对不同类型的激素补充疗法中… 相似文献
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绝经激素治疗(MHT)是改善女性更年期症状的重要治疗手段,对于健康的绝经后女性而言,MHT可以使其长期获益。但是不同人群应用MHT的安全性与获益性不尽相同,对于合并2型糖尿病(T2DM)的绝经后女性是否可以进行MHT仍存在争议。因此,确定MHT对T2DM患者的有益或不利影响十分必要。本文将对MHT对T2DM患者的影响作... 相似文献
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绝经后高血压是指女性在生理性绝经1年以后出现的血压升高,由于激素水平等其他方面的影响,常伴有肥胖、血脂异常、糖代谢异常和胰岛素水平增高,以及交感神经兴奋性增高等。由于其已成为冠心病(CHD)的危险因素之一,因此愈来愈受到人们的关注。绝经后女性血压升高的机制复杂且是多因素的,包括雌激素减少、垂体激素过多、体重增加,以及综合因素和其他未知神经体液因素的影响。鉴于绝经后女性症状的多样性,治疗高血压时,在降压药物的选用上需考虑患者的具体病症,因人而异。关于应用激素替代疗法(HRT)的机制已有多项实验研究证实,但对于患有高血压的绝经后妇女的疗效证据尚不确切。目前能确定的是,高血压不是应用HRT的禁忌证。而是否一些患有CHD的妇女可从HRT治疗中获益,仍需等待更前沿的随机临床实验结果。 相似文献
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目的 了解恩施市基层医务人员对绝经及其治疗的认知现况。方法 采用分层整群抽样方法抽取恩施市4家基层医疗单位的医务人员进行问卷调查。结果 有效调查医务人员219名,对围绝经期症状认知及绝经远期危害知识知晓率占67.12%、59.91%;当女性出现绝经症状时认为需要治疗占73.51%,会向患者推荐使用绝经激素治疗(MHT)占52.51%。不会推荐MHT的理由:不了解相关知识占43.27%,担心性激素治疗的副作用占39.42%,没有必要占17.31%。接受过绝经相关知识培训的医务人员占11.87%。结论 恩施市基层医务人员对绝经知识的知晓程度一般,对MHT的认知存在误区,培训率低。应普及恩施地区基层医务人员对绝经及其治疗知识。 相似文献
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张凌燕阮祥燕崔亚美谷牧青 《中国临床医生杂志》2020,(11):1349-1353
目的研究影响绝经后女性失眠的相关因素。方法选取2018年1月至2020年5月首都医科大学附属北京妇产医院2188例40~83岁的绝经后女性为研究对象,其中787例应用绝经激素治疗(menopausal hormone therapy,MHT),972例未应用MHT,429例受试者未回答是否应用MHT。应用改良Kupperman评分对失眠情况进行调查,应用简单和非条件logistic回归方法分析失眠的影响因素。结果绝经后女性失眠的患病率为66.72%,其中轻度35.38%,中度21.83%,重度9.51%。失眠发生率随着受教育程度降低而升高(OR=1.502~1.618,P<0.05);失眠发生率随着食用豆制品次数增多而降低,但仅当次数≥7次/周时,差异有显著性(OR=0.366,95%CI 0.221~0.607,P<0.05);失眠发生率随着每日运动强度降低而增加(OR=1.775~2.141,P<0.05)。与规律应用MHT相比,不用MHT会增加失眠发生率(OR=1.602,95%CI 1.105~2.321,P<0.05),而每日运动量、抽烟、饮酒、月经初潮年龄、孕次、产次及分娩方式与失眠均无关。结论规律应用MHT有助于改善失眠,部分社会环境因素与绝经后女性失眠相关,应给予足够重视。 相似文献
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目的探讨绝经后激素补充治疗(MHT)对绝经女性阴道微生态的影响。方法选择妇科门诊就诊的绝经女性322例,按绝经时间分为≤5年组、5年且11年组和≥11年组;按照MHT使用与否分为使用MHT组(n=104)与未使用MHT组(n=218);取阴道分泌物进行微生态检测,比较各组阴道微生态的数据。结果细菌性阴道病在不同绝经时间组中的发病率最高,在≤5年组为21.1%、5年且11年组为19.3%、≥11年组为16.0%;使用MHT组菌群/功能异常的阳性率明显低于未使用MHT组(P0.05);使用MHT组菌群正常率显著高于未使用MHT组(P0.01)。结论细菌性阴道病是绝经女性常见的阴道感染性疾病之一。MHT有助于阴道微生态的改善。 相似文献
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Mizunuma H 《Nihon rinsho. Japanese journal of clinical medicine》2003,61(2):268-273
Postmenopausal bone loss is accelerated since women experience menstrual irregularity. Postmenopausal women lose their bone mineral density by 20 to 25% during 10 years after menopause, therefore early detection of risks for postmenopausal osteoporosis is mandatory for prevention of the disease. Because estrogen deficiency is the primary cause of postmenopausal bone loss, hormone replacement therapy can be a reasonable choice for the first treatment of osteoporosis. However, to those who have contraindications against estrogen or who complain severe estrogen-related symptoms, other medication using SERM and bisphosphonate should be considered. 相似文献
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J B Collins 《Primary care》1988,15(3):593-606
The body of evidence now swings the scale toward the benefit of HRT for women beginning at the menopause. Based on newer studies, the risks for osteoporosis, cardiovascular morbidity, breast carcinoma, symptomatic vasomotor and anatomic changes occurring postmenopausally outweigh the risks of hormone replacement therapy in the end of the 20th century. Women should be instructed in adequate calcium intake, 1000 mg per day premenopausally and 1500 mg per day postmenopausally. Osteoporotic, breast carcinoma, and cardiovascular risks should be investigated at age 35 with appropriate lab screening, including lipoprotein analysis. Screening mammography should begin at age 40, continuing every 5 years until age 50, and yearly between ages 50 and 65. A diet high in calcium, low in cholesterol and fat, and a weight reduction program should be made available as early as possible and continued indefinitely. HRT should be made available beginning at menopause and continued to age 70. Moderate exercise should be encouraged at all ages. The next 5 to 10 years will answer some of the questions about the benefits of long-term HRT postmenopausally, especially with respect to its influence on cardiovascular risk. New progestational agents will probably be developed that will have fewer adverse effects on lipid profiles, while maintaining the protective effect on the endometrium and breast and further influencing the benefits of HRT postmenopausally. Modern medicine certainly cannot ensure living forever. The body of knowledge now available can modify the major causes for morbidity and mortality as the baby boom population reaches their middle age and golden years. 相似文献
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Hormone therapy in perimenopausal and postmenopausal women: examining the evidence on cardiovascular disease risks 总被引:1,自引:0,他引:1
Women may live for 30 years or longer after menopause with cardiovascular disease as their highest mortality risk. Menopause may correspond to health alterations for women, yet the use of estrogen during and after this transition has been controversial for the past four decades. The evidence from recent scientific studies does not support the use of hormone therapy for the prevention or treatment of cardiovascular disease, which has resulted in its removal from national guideline recommendations. However, because of concerns related to specific aspects of the research, there are gaps in the evidence. Studies are under way to evaluate alternate methods for hormone delivery, low-dose hormone therapy, and selective estrogen receptor modulators (SERMs) in reducing cardiovascular risks in perimenopausal and postmenopausal women. Implications for clinical nursing practice include education as well as assessment and counseling related to individual risk factors. 相似文献
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《The Journal for Nurse Practitioners》2017,13(8):562-569
Menopausal hormone therapy (MHT) is the most effective treatment for vasomotor symptoms; however, many women receive inadequate treatment because of a misunderstanding of important MHT research. Reanalysis of findings from the Women’s Health Initiative, in conjunction with recent findings from the Study of Women Across the Nation and the Kronos Early Estrogen Prevention Study, support the use of MHT in women who are < 10 years from the onset of menopause and are free of contraindications. Primary care providers are in the ideal position to provide evidence-based counseling to patients and help women make an individualized decision to use MHT safely. 相似文献
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Sjöberg L Kaaja R Tuomilehto J 《International journal of clinical practice. Supplement》2004,(139):4-12
Hypertension is more common in younger men than women but this trend is inverted at approximately 60 years of age--thereafter hypertension is more common in women. Menopause's contribution to this phenomenon is complex. Oestrogen deficiency after menopause precipitates a number of factors and these have established the 'menopausal metabolic syndrome' as a concept in postmenopausal women. However, studies have indicated that changes in the prevalence of hypertension, and overall cardiovascular risk profiles in postmenopausal women, might be due to ageing and not oestrogen deficiency. Undoubtedly, there is a strong multicolinearity between the two phenomena. Furthermore, hormone replacement therapy (HRT) may reduce age-induced blood pressure increases, thus decreasing cardiovascular risks. However, recent results have questioned HRT's role in cardiovascular disease (CVD) prevention in postmenopausal women and trials have unequivocally shown that CVD risk in postmenopausal women with hypertension can be effectively reduced by common antihypertensive drugs. 相似文献
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I Fogelman BSc MD FRCP P Ryan MA MRCP 《International journal of clinical practice》1991,45(3):189-196
SUMMARY The osteoporosis epidemic will continue unabated unless the issue of prevention of bone loss is seriously addressed. While a continuing programme of education for both the medical profession and the general public is necessary, positive action is required. Women lose bone at an accelerated rate following the menopause and this seems to be the optimal time for intervention. Those women who enter the menopause with the lowest bone density are at greatest risk of subsequent fracture. An individual's bone density can be accurately measured and those women who have the lowest bone density should have hormone replacement therapy (HRT) recommended, but it is important to discuss fully the possible benefits and risks. It is probable that non-hormonal agents for prevention of bone loss will be available in the near future, and cyclical diphosphonate therapy appears particularly promising. However, at the present time, long-term HRT is the mainstay for the prevention of bone loss. 相似文献
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The osteoporosis epidemic will continue unabated unless the issue of prevention of bone loss is seriously addressed. While a continuing programme of education for both the medical profession and the general public is necessary, positive action is required. Women lose bone at an accelerated rate following the menopause and this seems to be the optimal time for intervention. Those women who enter the menopause with the lowest bone density are at greatest risk of subsequent fracture. An individual's bone density can be accurately measured and those women who have the lowest bone density should have hormone replacement therapy (HRT) recommended, but it is important to discuss fully the possible benefits and risks. It is probable that non-hormonal agents for prevention of bone loss will be available in the near future, and cyclical diphosphonate therapy appears particularly promising. However, at the present time, long-term HRT is the mainstay for the prevention of bone loss. 相似文献