Sarrel P M
Departments of Obstetrics and Gynecology, and Psychiatry, Yale University School of Medicine, New Haven, CT 06520, USA.
Am J Obstet Gynecol. 1999 Mar;180(3 Pt 2):S319-24. doi: 10.1016/s0002-9378(99)70727-1.
Ovarian hormones-estrogens, androgens, and progesterone-produce a myriad of effects in the nervous system. The effects of androgens in the brain are mediated through androgen-specific receptors and by the aromatization of testosterone to estradiol. Alterations in the circulating levels of androgens play an important role in psychologic and sexual changes that occur after menopause. The effects of short-term estrogen therapy in improving psychologic symptoms, maintaining vaginal lubrication, decreasing vaginal atrophy, and increasing pelvic blood flow in postmenopausal women are well documented. However, some patients require more than estrogen alone to improve psychologic dysfunction, decreased sexual desire, or other sexual problems associated with menopause. Results from clinical studies show that hormone replacement therapy with estrogen plus androgens provides greater improvement in psychologic (eg, lack of concentration, depression, and fatigue) and sexual (eg, decreased libido and inability to have an orgasm) symptoms than does estrogen alone in naturally and surgically menopausal women.
卵巢激素——雌激素、雄激素和孕酮——在神经系统中产生众多影响。雄激素在大脑中的作用是通过雄激素特异性受体以及睾酮向雌二醇的芳香化作用介导的。雄激素循环水平的改变在绝经后发生的心理和性变化中起重要作用。短期雌激素治疗在改善绝经后妇女的心理症状、维持阴道润滑、减少阴道萎缩以及增加盆腔血流量方面的效果已有充分记录。然而，一些患者仅靠雌激素不足以改善心理功能障碍、性欲减退或与绝经相关的其他性问题。临床研究结果表明，对于自然绝经和手术绝经的女性，雌激素加雄激素的激素替代疗法在改善心理症状（如注意力不集中、抑郁和疲劳）和性症状（如性欲减退和无法达到性高潮）方面比单独使用雌激素有更大改善。
