Stachowiak Grzegorz, Pertyński Tomasz, Pertyńska-Marczewska Magdalena
Department of Gynecology and Gynecological Oncology, Polish Mother's Memorial Hospital-Research Institute, Lodz, Poland.
M. Kopernik County Specialist Hospital, Lodz, Poland.
Prz Menopauzalny. 2015 Mar;14(1):59-64. doi: 10.5114/pm.2015.50000. Epub 2015 Mar 25.
Metabolic disorders occurring in menopause, including dyslipidemia, disorders of carbohydrate metabolism (impaired glucose tolerance - IGT, type 2 diabetes mellitus - T2DM) or components of metabolic syndrome, constitute risk factors for cardiovascular disease in women. A key role could be played here by hyperinsulinemia, insulin resistance and visceral obesity, all contributing to dyslipidemia, oxidative stress, inflammation, alter coagulation and atherosclerosis observed during the menopausal period. Undiagnosed and untreated, metabolic disorders may adversely affect the length and quality of women's life. Prevention and treatment preceded by early diagnosis should be the main goal for the physicians involved in menopausal care. This article represents a short review of the current knowledge concerning metabolic disorders (e.g. obesity, polycystic ovary syndrome or thyroid diseases) in menopause, including the role of a tailored menopausal hormone therapy (HT). According to current data, HT is not recommend as a preventive strategy for metabolic disorders in menopause. Nevertheless, as part of a comprehensive strategy to prevent chronic diseases after menopause, menopausal hormone therapy, particularly estrogen therapy may be considered (after balancing benefits/risks and excluding women with absolute contraindications to this therapy). Life-style modifications, with moderate physical activity and healthy diet at the forefront, should be still the first choice recommendation for all patients with menopausal metabolic abnormalities.
绝经期间出现的代谢紊乱,包括血脂异常、碳水化合物代谢紊乱(糖耐量受损——IGT、2型糖尿病——T2DM)或代谢综合征的组成部分,是女性心血管疾病的危险因素。高胰岛素血症、胰岛素抵抗和内脏肥胖在这里可能起关键作用,所有这些都会导致绝经期间出现的血脂异常、氧化应激、炎症、凝血改变和动脉粥样硬化。如果未被诊断和治疗,代谢紊乱可能会对女性的寿命和生活质量产生不利影响。早期诊断后的预防和治疗应该是参与绝经护理的医生的主要目标。本文简要回顾了有关绝经期间代谢紊乱(如肥胖、多囊卵巢综合征或甲状腺疾病)的现有知识,包括定制的绝经激素治疗(HT)的作用。根据目前的数据,不建议将HT作为绝经期间代谢紊乱的预防策略。然而,作为绝经后预防慢性病综合策略的一部分,可以考虑采用绝经激素治疗,尤其是雌激素治疗(在权衡利弊并排除对此疗法有绝对禁忌症的女性之后)。对于所有绝经后代谢异常的患者,以适度体育活动和健康饮食为首的生活方式改变仍应是首选建议。