Kaunitz Andrew M, Manson JoAnn E
Department of Obstetrics & Gynecology, University of Florida College of Medicine-Jacksonville, Jacksonville, Florida; and the Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
Obstet Gynecol. 2015 Oct;126(4):859-876. doi: 10.1097/AOG.0000000000001058.
Most menopausal women experience vasomotor symptoms with bothersome symptoms often lasting longer than one decade. Hormone therapy (HT) represents the most effective treatment for these symptoms with oral and transdermal estrogen formulations having comparable efficacy. Findings from the Women's Health Initiative and other recent randomized clinical trials have helped to clarify the benefits and risks of combination estrogen-progestin and estrogen-alone therapy. Absolute risks observed with HT tended to be small, especially in younger women. Neither regimen increased all-cause mortality rates. Given the lower rates of adverse events on HT among women close to menopause onset and at lower baseline risk of cardiovascular disease, risk stratification and personalized risk assessment appear to represent a sound strategy for optimizing the benefit-risk profile and safety of HT. Systemic HT should not be arbitrarily stopped at age 65 years; instead treatment duration should be individualized based on patients' risk profiles and personal preferences. Genitourinary syndrome of menopause represents a common condition that adversely affects the quality of life of many menopausal women. Without treatment, symptoms worsen over time. Low-dose vaginal estrogen represents highly effective treatment for this condition. Because custom-compounded hormones have not been tested for efficacy or safety, U.S. Food and Drug Administration (FDA)-approved HT is preferred. A low-dose formulation of paroxetine mesylate currently represents the only nonhormonal medication FDA-approved to treat vasomotor symptoms. Gynecologists and other clinicians who remain abreast of data addressing the benefit-risk profile of hormonal and nonhormonal treatments can help menopausal women make sound choices regarding management of menopausal symptoms.
大多数绝经后女性会出现血管舒缩症状，令人烦恼的症状往往会持续超过十年。激素疗法（HT）是治疗这些症状最有效的方法，口服和经皮雌激素制剂疗效相当。妇女健康倡议及其他近期随机临床试验的结果有助于阐明联合雌激素 - 孕激素疗法和单纯雌激素疗法的益处与风险。HT观察到的绝对风险往往较小，尤其是在年轻女性中。两种治疗方案均未增加全因死亡率。鉴于接近绝经起始且心血管疾病基线风险较低的女性接受HT出现不良事件的发生率较低，风险分层和个性化风险评估似乎是优化HT获益 - 风险状况及安全性的合理策略。全身HT不应在65岁时随意停用；相反，治疗持续时间应根据患者的风险状况和个人偏好进行个体化调整。绝经后泌尿生殖综合征是一种常见病症，会对许多绝经后女性的生活质量产生不利影响。若不治疗，症状会随时间恶化。低剂量阴道雌激素是治疗这种病症的高效方法。由于定制复合激素尚未经过疗效或安全性测试，因此首选美国食品药品监督管理局（FDA）批准的HT。目前，低剂量甲磺酸帕罗西汀制剂是FDA批准的唯一一种用于治疗血管舒缩症状的非激素药物。紧跟有关激素和非激素治疗获益 - 风险状况数据的妇科医生及其他临床医生，能够帮助绝经后女性就绝经症状的管理做出明智选择。
