Turner Ralph J, Kerber Irwin J
1Department of Surgery, University of Texas Health Science Center at Tyler, Tyler, TX 2Department of Obstetrics and Gynecology, University of Texas Southwestern Medical School, Dallas, TX.
Menopause. 2017 Sep;24(9):1086-1097. doi: 10.1097/GME.0000000000000895.
The aim of the study was to propose a unifying theory for the role of estrogen in postmenopausal women through examples in basic science, randomized controlled trials, observational studies, and clinical practice.
Review and evaluation of the literature relating to estrogen.
The role of hormone therapy and ubiquitous estrogen receptors after reproductive senescence gains insight from basic science models. Observational studies and individualized patient care in clinical practice may show outcomes that are not reproduced in randomized clinical trials. The understanding gained from the timing hypothesis for atherosclerosis, the critical window theory in neurosciences, randomized controlled trials, and numerous genomic and nongenomic actions of estrogen discovered in basic science provides new explanations to clinical challenges that practitioners face. Consequences of a hypo-estrogenemic duration in women's lives are poorly understood. The Study of Women Across the Nation suggests its magnitude is greater than was previously acknowledged. We propose that the healthy user bias was the result of surgical treatment (hysterectomy with oophorectomy) for many gynecological maladies followed by pharmacological and physiological doses of estrogen to optimize patient quality of life. The past decade of research has begun to demonstrate the role of estrogen in homeostasis.
The theory of eu-estrogenemia provides a robust framework to unify the timing hypothesis, critical window theory, randomized controlled trials, the basic science of estrogen receptors, and clinical observations of patients over the past five decades.
本研究旨在通过基础科学、随机对照试验、观察性研究及临床实践中的实例，提出一种关于雌激素在绝经后女性中作用的统一理论。
对与雌激素相关的文献进行综述和评估。
生殖衰老后激素治疗及普遍存在的雌激素受体的作用可从基础科学模型中获得见解。观察性研究及临床实践中的个体化患者护理可能显示出随机临床试验中未再现的结果。从动脉粥样硬化的时机假说、神经科学中的关键窗口期理论、随机对照试验以及基础科学中发现的雌激素的众多基因组和非基因组作用中获得的认识，为从业者面临的临床挑战提供了新的解释。女性生命中雌激素缺乏期的后果尚不清楚。全国女性健康研究表明其影响程度比之前认为的更大。我们认为，健康使用者偏差是许多妇科疾病采用手术治疗（子宫切除术加卵巢切除术），随后使用药理和生理剂量的雌激素以优化患者生活质量的结果。过去十年的研究已开始证明雌激素在体内平衡中的作用。
雌激素正常血症理论提供了一个强有力的框架，以统一时机假说、关键窗口期理论、随机对照试验、雌激素受体的基础科学以及过去五十年来患者的临床观察结果。
