Bińkowska Małgorzata
First Department of Obstetrics and Gynecology, Centre of Postgraduate Medical Education, Warsaw, Poland.
Prz Menopauzalny. 2014 Oct;13(5):267-72. doi: 10.5114/pm.2014.46468. Epub 2014 Nov 2.
Menopausal hormone therapy (MHT) is the most effective method of treating vasomotor symptoms and other climacteric symptoms related to estrogen deficiency in peri- and postmenopausal period. In addition to estrogen replacement, women with preserved uterus require the addition of progestagen in order to ensure endometrial safety. One of rare but severe complications of MHT is venous thromboembolism (VTE). The incidence of VTE rises in parallel to women's age and body weight. The condition is also linked to hereditary and acquired risk factors. Oral estrogens increase the risk of venous thromboembolic complications to varying extents, probably depending on their type and dose used. Observational studies have not found an association between an increased risk of VTE and transdermal estrogen treatment regardless of women's age and body mass index (BMI). Micronized progesterone and pregnanes, including dydrogesterone, have no effect on the risk of VTE, whereas norpregnane progestagens cause an additional increase in risk. Among hormonal preparations which are commercially available in Poland, the combination of transdermal estradiol with oral dydrogesterone appears to be the optimum choice, as it does not elevate the risk of VTE (compared to patients not using MHT), and dydrogesterone seems to be the progestagen of choice.
绝经激素治疗（MHT）是治疗血管舒缩症状及绝经前后与雌激素缺乏相关的其他更年期症状最有效的方法。除雌激素替代治疗外，子宫保留的女性需要加用孕激素以确保子宫内膜安全。MHT一种罕见但严重的并发症是静脉血栓栓塞（VTE）。VTE的发生率随女性年龄和体重的增加而升高。该疾病还与遗传和获得性风险因素有关。口服雌激素会不同程度增加静脉血栓栓塞并发症的风险，这可能取决于其类型和使用剂量。观察性研究未发现无论女性年龄和体重指数（BMI）如何，VTE风险增加与经皮雌激素治疗之间存在关联。微粉化孕酮和孕烷类，包括地屈孕酮，对VTE风险无影响，而诺孕烷类孕激素会使风险进一步增加。在波兰市售的激素制剂中，经皮雌二醇与口服地屈孕酮的组合似乎是最佳选择，因为它不会增加VTE风险（与未使用MHT的患者相比），且地屈孕酮似乎是首选的孕激素。
