Grady D, Rubin S M, Petitti D B, Fox C S, Black D, Ettinger B, Ernster V L, Cummings S R
University of California, Prevention Sciences Group, San Francisco 94105.
Ann Intern Med. 1992 Dec 15;117(12):1016-37. doi: 10.7326/0003-4819-117-12-1016.
To critically review the risks and benefits of hormone therapy for asymptomatic postmenopausal women who are considering long-term hormone therapy to prevent disease or to prolong life.
Review of the English-language literature since 1970 on the effect of estrogen therapy and estrogen plus progestin therapy on endometrial cancer, breast cancer, coronary heart disease, osteoporosis, and stroke. We used standard meta-analytic statistical methods to pool estimates from studies to determine summary relative risks for these diseases in hormone users and modified lifetable methods to estimate changes in lifetime probability and life expectancy due to use of hormone regimens.
There is evidence that estrogen therapy decreases risk for coronary heart disease and for hip fracture, but long-term estrogen therapy increases risk for endometrial cancer and may be associated with a small increase in risk for breast cancer. The increase in endometrial cancer risk can probably be avoided by adding a progestin to the estrogen regimen for women who have a uterus, but the effects of combination hormones on risk for other diseases has not been adequately studied. We present estimates for changes in lifetime probabilities of disease and life expectancy due to hormone therapy in women who have had a hysterectomy; with coronary heart disease; and at increased risk for coronary heart disease, hip fracture, and breast cancer.
Hormone therapy should probably be recommended for women who have had a hysterectomy and for those with coronary heart disease or at high risk for coronary heart disease. For other women, the best course of action is unclear.
对考虑长期使用激素疗法预防疾病或延长寿命的无症状绝经后女性，严格审查激素疗法的风险和益处。
回顾1970年以来的英文文献，内容涉及雌激素疗法以及雌激素加孕激素疗法对子宫内膜癌、乳腺癌、冠心病、骨质疏松症和中风的影响。我们使用标准的荟萃分析统计方法汇总各项研究的估计值，以确定激素使用者患这些疾病的汇总相对风险，并使用改良的生命表方法估计因使用激素方案导致的终生患病概率和预期寿命的变化。
有证据表明，雌激素疗法可降低冠心病和髋部骨折的风险，但长期使用雌激素疗法会增加子宫内膜癌的风险，并且可能与乳腺癌风险的小幅增加有关。对于有子宫的女性，在雌激素方案中添加孕激素可能可以避免子宫内膜癌风险的增加，但联合激素对其他疾病风险的影响尚未得到充分研究。我们给出了因激素疗法导致子宫切除的女性、患有冠心病的女性以及冠心病、髋部骨折和乳腺癌风险增加的女性的终生患病概率和预期寿命变化的估计值。
对于已进行子宫切除的女性以及患有冠心病或冠心病高危的女性，可能应推荐使用激素疗法。对于其他女性，最佳行动方案尚不清楚。
