Davey Dennis A
Department of Obstetrics & Gynecology, Faculty of Health Sciences, University of Cape Town, Observatory, Western Cape 7925, South Africa.
Womens Health (Lond). 2012 Mar;8(2):169-89. doi: 10.2217/whe.12.1.
Much new information on menopausal hormone therapy (MHT) has become available since the publication of the first report of the Women's Health Initiative in 2002 and a consensus is now emerging. The risk of breast cancer depends on type of MHT, duration of use, body mass, breast density and interval between menopause and starting MHT. The risk of breast cancer is generally increased by MHT, particularly in lean women with no previous MHT who start estrogen-progestin therapy near the menopause and continue for several years, but there is no increased risk 5 years after stopping MHT. The risks of venous thrombo-embolic disease (VTE), stroke and coronary heart disease (CHD) depend on age on starting MHT, dose, nature and route of administration of MHT. The risk of VTE is increased in women over 60 years of age and in women who are obese or have had a VTE but may not be increased by transdermal estrogens. The risk of stroke is very small in women under 60 years of age and may not be increased by low dose oral and low dose transdermal estrogen. MHT is of benefit in preventing atherosclerosis and CHD in healthy younger postmenopausal women (under the age of 60) but is not of benefit, and may be harmful, in older women with clinical or subclinical atherosclerosis. MHT prevents bone loss and osteoporosis but is not generally recommended in women over 60 because of the risks of VTE, stroke and CHD, and if stopped at 60 years does not prevent fractures in later life. MHT reduces the overall mortality in women under 60. MHT is by far the most effective treatment, and greatly improves the quality of life in women with menopausal symptoms. A simplified approach to MHT is suggested as a framework for the care of women at and after the menopause.
自2002年妇女健康倡议的首份报告发表以来，已出现了许多关于绝经激素治疗（MHT）的新信息，目前正在形成一种共识。乳腺癌风险取决于MHT的类型、使用时长、体重、乳腺密度以及绝经与开始MHT之间的间隔时间。MHT通常会增加患乳腺癌的风险，尤其是在绝经前后开始接受雌激素 - 孕激素治疗且持续数年的瘦女性中，但停止MHT 5年后风险不会增加。静脉血栓栓塞性疾病（VTE）、中风和冠心病（CHD）的风险取决于开始MHT时的年龄、MHT的剂量、性质和给药途径。60岁以上的女性以及肥胖或曾患VTE的女性发生VTE的风险会增加，但经皮雌激素可能不会增加这种风险。60岁以下女性中风风险非常小，低剂量口服和低剂量经皮雌激素可能不会增加中风风险。MHT对预防健康的年轻绝经后女性（60岁以下）的动脉粥样硬化和冠心病有益，但对患有临床或亚临床动脉粥样硬化的老年女性无益，甚至可能有害。MHT可预防骨质流失和骨质疏松，但由于存在VTE、中风和冠心病风险，一般不建议60岁以上女性使用，而且如果在60岁时停止使用，无法预防晚年骨折。MHT可降低60岁以下女性的总体死亡率。MHT是迄今为止最有效的治疗方法，可极大改善有绝经症状女性的生活质量。建议采用一种简化的MHT方法作为绝经及绝经后女性护理的框架。
