Division of Reproductive Endocrinology, Department of Obstetrics and Gynecology, Columbia University Medical Center, 622 West 168th Street, New York, New York 10032, USA.
J Clin Endocrinol Metab. 2013 May;98(5):1771-80. doi: 10.1210/jc.2012-4070. Epub 2013 Mar 14.
The media attention surrounding the publication of the initial results of WHI in 2002 led to fear and confusion regarding the use of hormonal therapy (HT) after menopause. This led to a dramatic reduction in prescriptions for HT in the United States and around the world. Although in 2002 it was stated that the results pertained to all women receiving HT, subsequent studies from the Women's Health Initiative (WHI) and others clearly showed that younger women and those close to menopause had a very beneficial risk-to-benefit ratio. Indeed, the results showed similar protective effects for coronary disease and a reduction in mortality that had been shown in earlier observational studies, which had also focused on younger symptomatic women. In younger women, the increased number of cases of venous thrombosis and ischemic stroke was low, rendering them "rare" events using World Health Organization nomenclature. Breast cancer rates were also low and were found to be decreased with estrogen alone. In women receiving estrogen and progestogen for the first time in the WHI, breast cancer rates did not increase significantly for 7 years. Other data suggest that other regimens and the use of other progestogens may also be safer. It has been argued that in the 10 years since WHI, many women have been denied HT, including those with severe symptoms, and that this has significantly disadvantaged a generation of women. Some reports have also suggested an increased rate of osteoporotic fractures since the WHI. Therefore, the question is posed as to whether we have now come full circle in our understanding of the use of HT in younger women. Although it is appropriate to treat women with symptoms at the onset of menopause, because there is no proven therapy for primary prevention, in some women the use of HT for this role may at least be entertained.
媒体对 WHI 初始结果 2002 年公布的关注导致了绝经后激素治疗（HT）的使用的恐惧和困惑。这导致美国和世界各地 HT 的处方数量急剧减少。尽管 2002 年有人声称结果与所有接受 HT 的女性有关，但随后的 WHI 和其他研究清楚地表明，年轻女性和接近绝经的女性具有非常有益的风险-效益比。事实上，结果显示出类似的对冠心病的保护作用，并降低了死亡率，这在早期的观察性研究中也得到了证实，这些研究也集中在年轻有症状的女性上。在年轻女性中，静脉血栓形成和缺血性中风的病例增加数量较少，按照世界卫生组织的命名法，这些病例属于“罕见”事件。乳腺癌的发病率也较低，且仅用雌激素治疗即可降低。在 WHI 中首次接受雌激素和孕激素治疗的女性中，乳腺癌的发病率在 7 年内没有显著增加。其他数据表明，其他方案和使用其他孕激素可能也更安全。有人认为，自 WHI 以来的 10 年中，许多女性（包括症状严重的女性）被拒绝使用 HT，这使一代女性受到了严重的不利影响。一些报告还表明，自 WHI 以来，骨质疏松性骨折的发生率有所增加。因此，问题是我们对年轻女性使用 HT 的理解是否已经完全改变。尽管在绝经开始时治疗有症状的女性是合适的，因为没有经过证实的用于一级预防的治疗方法，但在某些女性中，至少可以考虑将 HT 用于这一角色。
