Aidelsburger Pamela, Schauer Svenja, Grabein Kristin, Wasem Jürgen
CAREM GmbH, Sauerlach, Germany.
GMS Health Technol Assess. 2012;8:Doc03. doi: 10.3205/hta000101. Epub 2012 May 7.
Menopause is described as the transition from the reproductive phase of a women to the non reproductive. Changes in hormone levels might lead to complaints and health consequences especially during peri- and postmenopause. Hormone therapy has a potential damaging health risk profile and is recommended for temporal limited therapy for acute vasomotor symptoms only.
The present HTA-report aims to assess the effectiveness and the cost-effectiveness of alternative treatment methods for women with postmenopausal symptoms in Germany regarding patient relevant endpoints (reduction of symptoms and frequency of adverse events and improvement of quality of life).
A systematic literature search was carried out in 33 relevant databases in September 2010. Citations were selected according to pre-defined criteria and were extracted and evaluated.
In the systematic research 22 studies are identified for the effectiveness evaluation, 22 primary studies and one review. High doses of isolated genistein reduce the frequency/intensity of hot flashes while low doses of genistein show no significant effect. Intake of isoflavone extract such as genistein, daidzein, glycitein in various combinations does not have an effect on improvement of cognitive function or vaginal dryness. The effect of black cohosh and hop extract for menopausal complaints cannot be determined since results are heterogenous. The combination of isoflavone, black cohosh, monk's pepper, valerian and vitamin E has a positive effect on menopause symptoms. Ginkgo biloba shows no significant effect on menopause symptoms and cognitive improvement beside mental flexibility. Acupuncture has a significant influence on hot flashes especially in severe cases.
DISCUSSION/CONCLUSION: No final statement can be drawn regarding the effectiveness of alternative treatment methods due to qualitative shortcomings of included studies and a general limited availability of studies in this field. Furthermore, the generalization of the present HTA is limited due to the inclusion of only postmenopausal women.
绝经被描述为女性从生殖期向非生殖期的转变。激素水平的变化可能导致不适和健康问题，尤其是在围绝经期和绝经后。激素疗法存在潜在的健康风险，仅推荐用于急性血管舒缩症状的短期治疗。
本卫生技术评估报告旨在评估德国针对有绝经后症状女性的替代治疗方法在患者相关终点（症状减轻、不良事件频率降低及生活质量改善）方面的有效性和成本效益。
2010年9月在33个相关数据库中进行了系统的文献检索。根据预定义标准选择引文，并进行提取和评估。
在系统研究中，确定了22项用于有效性评估的研究、22项主要研究和1篇综述。高剂量的分离型染料木黄酮可降低潮热的频率/强度，而低剂量的染料木黄酮则无显著效果。摄入染料木黄酮、大豆苷元、黄豆黄素等不同组合的异黄酮提取物对改善认知功能或阴道干燥无作用。由于结果存在异质性，无法确定黑升麻和啤酒花提取物对绝经相关不适的影响。异黄酮、黑升麻、刺蒺藜、缬草和维生素E的组合对绝经症状有积极作用。除了心理灵活性外，银杏叶对绝经症状和认知改善无显著作用。针灸对潮热有显著影响，尤其是在严重病例中。
讨论/结论：由于纳入研究的质量缺陷以及该领域研究普遍有限，无法就替代治疗方法的有效性得出最终结论。此外，由于仅纳入了绝经后女性，本卫生技术评估的普遍性受到限制。
