Palacios Santiago, Stevenson John C, Schaudig Katrin, Lukasiewicz Monika, Graziottin Alessandra
1 Palacios' Institute of Women's Health, Madrid, Spain.
2 National Heart and Lung Institute, Imperial College London, Royal Brompton Hospital, London, UK.
Womens Health (Lond). 2019 Jan-Dec;15:1745506519864009. doi: 10.1177/1745506519864009.
Hormone therapy use has undergone dramatic changes over the past 20 years. Widespread use of hormone therapy in the 1980s and 1990s came to an abrupt halt in the early 2000s after initial findings of the Women's Health Initiative trial were published and the study was terminated. Since then, much has been learned about the characteristics of women most likely to benefit from hormone therapy. There is general agreement that women younger than 60 years or who initiate hormone therapy within 10 years of menopause onset gain short-term benefit in terms of symptomatic relief and long-term benefit in terms of protection from chronic diseases that affect postmenopausal women. Despite accumulating evidence in support of hormone therapy for symptomatic menopausal women, the slow response by the medical community has led to a 'large and unnecessary burden of suffering' by women worldwide. Greater efforts are clearly needed to educate physicians and medical students about the pathophysiology of menopause and the role of hormone therapy in supporting women through the transition. This article provides a brief historical perspective of events that led to the backlash against hormone therapy, explores the current position of guideline groups, and provides practical recommendations to guide first-line management of symptomatic menopausal women.
在过去20年里，激素疗法的使用发生了巨大变化。20世纪80年代和90年代激素疗法被广泛使用，但在21世纪初，随着妇女健康倡议试验的初步结果公布且该研究终止，其使用戛然而止。从那时起，人们对最有可能从激素疗法中受益的女性特征有了更多了解。普遍认为，60岁以下或在绝经开始后10年内开始使用激素疗法的女性，在缓解症状方面有短期益处，在预防影响绝经后女性的慢性疾病方面有长期益处。尽管有越来越多的证据支持对有症状的绝经女性使用激素疗法，但医学界的反应迟缓导致全球女性承受了“巨大且不必要的痛苦负担”。显然需要做出更大努力，向医生和医学生传授绝经的病理生理学以及激素疗法在帮助女性度过这一转变期方面的作用。本文简要回顾了导致对激素疗法产生强烈反对的事件的历史背景，探讨了指南制定小组的当前立场，并提供了实用建议，以指导对有症状的绝经女性进行一线管理。
