Rees Margaret
Women's Centre, John Radcliffe Hospital, Oxford OX3 9DU, UK.
Best Pract Res Clin Obstet Gynaecol. 2009 Feb;23(1):151-61. doi: 10.1016/j.bpobgyn.2008.10.006. Epub 2008 Nov 17.
Concerns about the safety of oestrogen-based hormone replacement therapy after publication of the Women's Health Initiative study and Million Women Study has led to women turning to alternative therapies, erroneously believing that they are safer and 'more natural'. Evidence from randomized trials that alternative and complementary therapies improve menopausal symptoms or have the same benefits as conventional pharmacopoeia is poor. There are no recognized international criteria for the design of clinical trials of alternative therapies as there are for standard medicines and medical devices for endpoints of treatment and safety evaluations. Studies may have limitations such as design, sample size and duration. There is a wide range of different preparations, making comparison difficult. The evidence regarding botanicals, homeopathy, steroids, vitamin supplements, dietary changes and functional foods, and physical interventions are discussed in this chapter. Standard pharmacopoeia such as clonidine, selective serotonin re-uptake inhibitors and progestogens are also examined.
在《妇女健康倡议》研究和《百万女性研究》发表后，对基于雌激素的激素替代疗法安全性的担忧，导致女性转向替代疗法，错误地认为这些疗法更安全且“更天然”。随机试验表明，替代疗法和补充疗法改善更年期症状或具有与传统药典相同益处的证据不足。与标准药品和医疗设备在治疗终点及安全性评估方面不同，替代疗法的临床试验设计尚无公认的国际标准。研究可能存在设计、样本量和持续时间等方面的局限性。替代疗法有各种各样不同的制剂，这使得比较变得困难。本章将讨论有关植物药、顺势疗法、类固醇、维生素补充剂、饮食变化和功能性食品以及物理干预的证据。同时也会审视可乐定、选择性5-羟色胺再摄取抑制剂和孕激素等标准药典药物。
