Thomas A M, Hickey M, Fraser I S
Department of Obstetrics and Gynaecology, University of Sydney, NSW, Australia.
Hum Reprod. 2000 Aug;15 Suppl 3:7-17. doi: 10.1093/humrep/15.suppl_3.7.
Breakthrough bleeding is a common problem in postmenopausal women taking hormone replacement therapy (HRT) and is often the single most important factor deterring women from continuing to use HRT, or from starting it in the first place. The mechanisms which underlie this unscheduled bleeding are poorly understood. The benefits of HRT in terms of longevity and quality of life are becoming increasingly apparent, and a greater understanding of why this bleeding occurs and how we can prevent or treat it, will undoubtedly enable more women to reap the potential considerable benefits of long-term oestrogen and progestogen replacement. What sets postmenopausal women apart from their counterparts in the mid-reproductive years is the increased likelihood of endometrial adenocarcinoma in which unscheduled bleeding is the presenting symptom. Therefore, spontaneous postmenopausal bleeding must always be appropriately evaluated. Hence, the occurrence of unscheduled bleeding with HRT may provide a dilemma with diagnosis as well as a challenge to acceptability. Combined HRT regimens tend to be predominantly progestogenic, and there is increasing evidence to suggest that some of the vascular changes seen in women taking long-term, low-dose progestogen-only contraceptives may also occur in women taking HRT.
突破性出血是接受激素替代疗法（HRT）的绝经后女性常见的问题，而且往往是阻碍女性继续使用HRT或一开始就不启动HRT的唯一最重要因素。导致这种不规则出血的机制尚不清楚。HRT在延长寿命和提高生活质量方面的益处越来越明显，更深入了解这种出血为何发生以及如何预防或治疗，无疑将使更多女性能够从长期雌激素和孕激素替代疗法中获得潜在的巨大益处。绝经后女性与生殖期中期女性的不同之处在于，她们患子宫内膜腺癌的可能性增加，而不规则出血是其主要症状。因此，绝经后自发性出血必须始终进行适当评估。因此，HRT导致的不规则出血可能在诊断方面带来两难局面，并且对可接受性构成挑战。联合HRT方案往往以孕激素为主，而且越来越多的证据表明，长期服用低剂量单纯孕激素避孕药的女性出现的一些血管变化，也可能出现在服用HRT的女性身上。
