HOMONEREPLACEMENTTHERAPY(HRT)：激素替代疗法(HRT)

MENOPAUSEWHAT?MenopauseisadeviationoftheancientGreekwordsmenos(month)andpauses(ending).Themenopauseissometimesknownasthe'changeoflife'andismarkedbytheendingofmenstruation.WHAT?Itbedefinedwithcertaintyaftertwelvemonths'spontaneousamenorrhoea.Endofreproductivelife.Age(years)Pre-menopausePost-menopauseMENOPAUSE1YEARPeri-menopause“Climacteric”RELATEDTERMINOLOGYWHEN?Menopausalage:45-55years(mean:50.7years)Ifthemenopauseoccursinawomanwhoisunder45yearsofage,itisknownasprematuremenopause.Latemenopause:55yearsoldWHEN?Otherfactorsthatcanaffecttheageatwhichwomenhavetheirfinalperiodincludeageatmenarche,parity,previousoralcontraceptivehistoryethnicityandfamilyhistory.WHY?RELATIVEACTIVITYOFESTROGENWHY?Themenopauseistheendofeggproduction(ovulation).Thisoccursasaresultoffallinglevelsofthefemalesexhormoneoestrogen,whichregulatesawoman'speriods.WHY?Themenopauseresultsfromafallinthelevelofthefemalehormoneoestrogenintheblood.WHY?Atahormonallevel-asovarianfollicularactivitybeginstofail,oestrogenandprogesteronelevelsfallandthereducednegativefeedbacktothepituitarycausesariseinluteinisinghormone(LH)andfolliclestimulatinghormone(FSH).HOW?Oestrogenreductioneventuallyresultsinmenstrualcycledisruptionandothermenopausalsymptoms.HOW?Oestrogenreductioneventuallyresultsinmenstrualcycledisruptionandothermenopausalsymptoms.*FSHhigh(30–170mU/ml)*LHhigh(20–80mU/ml)*Estradiollow(110pmol/L)VasomotorSymptomsSleepDisordersMenstrualDisordersMoodChangesVaginalAtrophyDyspareuniaSkinAtrophyOsteoporosisAtherosclerosisCoronaryHeartDiseaseCerebrovascularDisease40yrs50yrsMenopause60yrsSYMPTOMS!ONSETOFSYMPTOMSINRELATIONTOAGEOFMENOPAUSESYMPTOMS!Changesinyourperiod—timebetweenperiodsorflowmaybedifferent.Hotflashes(“hotflushes”)—gettingwarmintheface,neckandchest.Nightsweatsandsleepingproblemsthatmayleadtofeelingtired,stressedortense.Vaginalchanges—thevaginamaybecomedryandthin,andsexmaybepainful.Thinningofyourbones,whichmayleadtolossofheightandbonebreaks(osteoporosis).SYMPTOMS!Itisestimatedthat8outof10womenintheUKexperiencesymptomsleadinguptothemenopause.Ofthese,45%findtheirsymptomsdifficulttodealwith.SYMPTOMS!Withouttreatment,mostmenopausalsymptomsgraduallystopnaturally.Thisusuallyhappenstwotofiveyearsafterthesymptomsstart.Althoughsomewomenexperiencesymptomsformanymoreyears.SYMPTOMS!SYMPTOMS!NORMALTRABECULARBONEOSTEROPEROTICBONETREATMENTOnly1in10womenseekmedicaladvicewhentheygothroughthemenopauseandmanydonotneedanytreatment.Ifmenopausalsymptomsaresevereenoughtointerferewithdailylife,therearetreatmentsthatcanhelp.TREATMENTThekindoftreatmentyoucantakedependsontheseverityofthesymptoms,medicalhistoryandpatient’sownpreferences.TREATMENTHRTNON-HRTHOMONEREPLACEMENTTHERAPY(HRT)Asthenamesuggests,HRTworksbyreplacingoestrogen.Hormonereplacementtherapy(HRT)canbeaneffectivetreatmentforthetypicalmenopause-relatedsymptoms.HOMONEREPLACEMENTTHERAPY(HRT)HRTmayalsohaveaninfluenceonthelongtermhealthproblems(osteoporosis,cardiovasculardiseaseandstroke),thoughitshouldbenotedthatitdoesnotnecessarilyreducetheirriskforallwomen.HOMONEREPLACEMENTTHERAPY(HRT)BENEFITSRISKSHOMONEREPLACEMENTTHERAPY(HRT)Forthetreatmentofmenopausalsymptomswheretherisk-benefitratio*isfavorable,infullyinformedwomen,inthelowestpossibledosetocontrolsymptomsandfortheshortestdurationpossible.HOMONEREPLACEMENTTHERAPY(HRT)BENEFITSRelievemenopausalsymptomsMaintenanceofqualityoflifePreventionofosteoporosisNote:HRTshouldnotbeusedasafirst-linetreatmentinosteoparosisexceptinwomenwhohaveprematuremenopauseHOMONEREPLACEMENTTHERAPY(HRT)RISKSOFVTEHRT(combinedoroestrogen-alone)increasestheriskofadeepveinthrombosisorpulmonaryembolism,especiallyinthefirstyearoftreatment.Theriskismorepronouncedinwomenwithpre-existingriskfactors.Arecentmeta-analysissuggeststhattransdermaloestrogensmaybeasaferoptionthanoraloestrogensforHRT.HOMONEREPLACEMENTTHERAPY(HRT)RISKSOFBREASTCANCERTheincreasedbreastcancerriskisproportionaltothedurationofHRT.HRTincreasesthisriskbyabout1.6timesafter5yearsofuseand2.3timesafter10yearsofuse.RiskdecreaseswithinafewyearsofstoppingHRT.WomenconsideringHRTshouldbecounselledthattheabsoluteriskforbreastcancerforanyindividualremainsrelativelylow*Heractualriskincreases0.08%(ACOG)HOMONEREPLACEMENTTHERAPY(HRT)RISKSOFENDOMETRIALCANCEREndometrialcancer:increasedriskonlywithunopposedoestrogen.Thereisnoincreasedriskwithcombined(oestrogenandprogestogen)HRT.RISKSOFOVARIANCANCERlong-termuseofoestrogen-onlyHRTandcombinedHRTmayslightlyincreasetherisk.RiskdecreasesafterstoppingHRT.HOMONEREPLACEMENTTHERAPY(HRT)RISKSOFCARDIOVASCULARDISEASEThereisnotthesameevidenceofcardioprotectionfromHRTaswasoriginallythought.Assessallwomen'sriskofCHDpriortostartingHRT.HRTE+PEHOMONEREPLACEMENTTHERAPY(HRT)E+PEForhysterectomizedptsHOMONEREPLACEMENTTHERAPY(HRT)sSequentiallycombinedHRTE(continuouslyD1-D21)P(sequentiallyD11-D21)ContinuouscombinedHRTE&P(continuous:D1-D28)HOMONEREPLACEMENTTHERAPY(HRT)WomenwithanintactuterusVasomotorsymptomsPerimenopausal:systemiccyclicalcombinedHRT.Postmenopausal:systemiccontinuo