Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, New Territories, Hong Kong.
Climacteric. 2010 Aug;13(4):328-39. doi: 10.3109/13697130903450154.
Hormone replacement therapy (HRT) remains the gold standard for the management of menopausal symptoms; however, HRT use has declined due to concerns over possible adverse side-effects. Approaches to menopause management are continually being revised and these extend beyond the control of recognized menopausal symptoms to encompass wider aspects of menopausal women's health. Hypertension and associated cardiovascular risk are particularly important unmet needs in postmenopausal women, especially in the Asia-Pacific region which has a rapidly aging population and bears around half of the global burden of cardiovascular disease, two-thirds of which has been attributed to elevated blood pressure. As first point of contact for women with menopausal symptoms, gynecologists play a gatekeeper role in assessing women's health, providing appropriate lifestyle counseling, and, where appropriate, implementing treatment or referral to relevant specialists. This paper, with contributions by gynecologists and cardiologists from Asia Pacific and beyond, summarizes available evidence and provides a treatment algorithm that employs a flexible blood pressure classification strategy to assist physicians in their decision-making for the individualized management of menopausal symptoms in women with low, moderate and high cardiovascular risk, and also for women with diabetes. Individualized HRT according to cardiovascular risk may yield improvements in cardiovascular health, as well as managing menopausal symptoms.
激素替代疗法（HRT）仍然是治疗更年期症状的金标准；然而，由于担心可能出现不良反应，HRT 的使用有所减少。更年期管理方法不断在修订，这些方法不仅限于控制公认的更年期症状，还涵盖了更年期妇女健康的更广泛方面。高血压和相关心血管风险是绝经后妇女特别重要的未满足需求，尤其是在亚太地区，该地区人口老龄化迅速，全球一半的心血管疾病负担都在亚太地区，其中三分之二归因于血压升高。作为有更年期症状的女性的第一接触点，妇科医生在评估女性健康、提供适当的生活方式咨询以及在适当情况下实施治疗或转介给相关专家方面发挥着把关作用。本文由来自亚太地区及其他地区的妇科医生和心脏病专家共同撰写，总结了现有证据，并提供了一个治疗算法，该算法采用灵活的血压分类策略，帮助医生为低、中、高心血管风险的女性以及患有糖尿病的女性个体化管理更年期症状做出决策。根据心血管风险个体化的 HRT 可能会改善心血管健康，并管理更年期症状。
