Skouby Sven O, Jespersen Joergen
Department of Obstetrics and Gynecology, Herlev University Hospital, Faculty of Health Sciences, 63 C7F Herlev Ringvej, Herlev, Denmark.
Maturitas. 2009 Apr 20;62(4):371-5. doi: 10.1016/j.maturitas.2008.12.019. Epub 2009 Feb 8.
While the benefits of progestins in hormonal replacement therapy are well recognized as far as endometrial protection is concerned the data on breast tissue and the cardiovascular system are contentious. Following the Women's Health Initiative study, the Million Women Study and The Women's International Study of Long-duration (O)estrogen after Menopause the question can be raised: When dealing with optimal hormonal therapy after the menopause, is the progestin component accepted here on sufferance or is it desired? The answer is partly made up by the fact that the recent epidemiological data may have been not only wrongly translated in relation to the clinical settings, but also to the whole class of therapies. The various progestins available for hormonal therapy exert different partial effects at cellular level according to the biochemical composition. Due to the structural differences the progestins result in a variety of tissue transforming changes as well as metabolic and hemostatic changes. Since no single test or algorithm presently serves as golden standard for all desired hormonal effects the least changes or no changes from the premenopausal physiology may often be advantageous. In our opinion targeting this goal includes a sustained desire for an estrogen/progestin combination as optimal future hormone therapy. Moreover the strategy not only includes evaluation of the specific steroidal formula, but also a titration of the dose and choosing the optimal route of administration. With special reference to cardiovascular disease this review therefore makes a plea for differentiating between the array of chemically and functionally distinct progestins used therapeutically after the menopause in combination therapy.
就子宫内膜保护而言，孕激素在激素替代疗法中的益处已得到广泛认可，但关于乳腺组织和心血管系统的数据仍存在争议。继妇女健康倡议研究、百万妇女研究以及绝经后雌激素长期国际妇女研究之后，人们不禁要问：在处理绝经后的最佳激素疗法时，这里的孕激素成分是勉强被接受还是备受期待呢？部分答案在于，近期的流行病学数据可能不仅在临床背景方面被错误解读，而且在整个治疗类别方面也是如此。用于激素疗法的各种孕激素根据其生化组成在细胞水平上发挥不同的部分作用。由于结构差异，孕激素会导致多种组织转化变化以及代谢和止血变化。由于目前尚无单一测试或算法可作为所有期望激素效应的金标准，因此与绝经前生理状态相比变化最小或无变化往往具有优势。我们认为，实现这一目标需要持续追求雌激素/孕激素联合用药，将其作为未来最佳的激素疗法。此外，该策略不仅包括评估特定的甾体配方，还包括调整剂量和选择最佳给药途径。因此，特别是针对心血管疾病，本综述呼吁在绝经后联合治疗中使用的一系列化学和功能不同的孕激素之间进行区分。
