Ernster V L, Bush T L, Huggins G R, Hulka B S, Kelsey J L, Schottenfeld D
Department of Epidemiology and International Health, School of Medicine, University of California, San Francisco 94143.
Prev Med. 1988 Mar;17(2):201-23. doi: 10.1016/0091-7435(88)90064-3.
Current evidence is reviewed here on risks and benefits of estrogen and progestin use by peri- and postmenopausal women in relation to the following conditions: endometrial cancer, breast cancer, osteoporosis, and coronary artery disease (CAD). On balance, estrogen therapy appears to be beneficial for menopausal women, as it probably reduces the risks of CAD and osteoporosis, two of the major causes of mortality and morbidity. Although unopposed estrogen therapy increases the risk of endometrial cancer, that cancer is relatively rare and is not fatal in the vast majority of cases associated with estrogen use. Definitive conclusions about the relation of menopausal estrogens to breast cancer cannot be drawn due to inconsistent evidence to date. Although evidence from randomized controlled trials is lacking, biochemical and clinical evidence suggest that progestin supplementation is associated with a reduction in endometrial cancer risk in women taking menopausal estrogens. Progestin supplementation also may augment the beneficial effects of estrogens in providing protection against osteoporosis, although this effect is not yet well established. There is little direct evidence bearing on the relation of menopausal progestins to breast cancer. Although studies of CAD per se are lacking at present, progestins probably unfavorably alter lipoprotein profiles, thereby increasing a user's risk of CAD. Given the relatively high incidence and mortality of CAD in postmenopausal women, any negative effects on CAD risk could potentially counterbalance beneficial effects on other causes. We conclude that estrogen replacement therapy is of potential benefit to postmenopausal women, but that the question of progestin supplementation requires further study, particularly for CAD risk.
子宫内膜癌、乳腺癌、骨质疏松症和冠状动脉疾病（CAD）。总体而言，雌激素治疗似乎对绝经后妇女有益，因为它可能降低CAD和骨质疏松症的风险，而这两种疾病是导致死亡和发病的主要原因。尽管单纯雌激素治疗会增加子宫内膜癌的风险，但这种癌症相对罕见，并且在绝大多数与雌激素使用相关的病例中并非致命。由于目前证据不一致，关于绝经雌激素与乳腺癌之间关系的明确结论尚无法得出。尽管缺乏随机对照试验的证据，但生化和临床证据表明，补充孕激素与服用绝经雌激素的女性子宫内膜癌风险降低有关。补充孕激素也可能增强雌激素在预防骨质疏松症方面的有益作用，尽管这种作用尚未得到充分证实。关于绝经孕激素与乳腺癌之间的关系，几乎没有直接证据。尽管目前缺乏关于CAD本身的研究，但孕激素可能会不利地改变脂蛋白谱，从而增加使用者患CAD的风险。鉴于绝经后女性CAD的发病率和死亡率相对较高，对CAD风险的任何负面影响都可能抵消对其他病因的有益影响。我们得出结论，雌激素替代疗法对绝经后女性有潜在益处，但补充孕激素的问题需要进一步研究，特别是对于CAD风险。
