Gosset A, Robin G, Letombe B, Pouillès J-M, Trémollieres F
Centre de ménopause et maladies osseuses métaboliques, hôpital Paule-de-Viguier, CHU de Toulouse, 330, avenue de Grande-Bretagne, TSA 70034, 31059 Toulouse cedex 9, France.
Service de gynécologie médicale, orthogénie et sexologie-UF de gynécologie endocrinienne, CHU Jeanne-de-Flandres, Lille, France.
Gynecol Obstet Fertil Senol. 2021 May;49(5):358-372. doi: 10.1016/j.gofs.2021.03.019. Epub 2021 Mar 21.
Menopause Hormonal Treatment (MHT) was initially developed to correct the climacteric symptoms induced by postmenopausal estrogen deficiency. In non-hysterectomized women, MHT combines estrogens and a progestogen, the latter opposing the negative impact of estrogen on endometrial proliferation. In France, and contrary to the USA and Northern European countries, MHT mainly combines 17β-estradiol, which is the physiological estrogen produced by the ovary, and progesterone or its derivative, dihydrogesterone. France has been a pioneer in the development of cutaneous administration routes (gel or transdermal patch) for estradiol, allowing better metabolic tolerance and a reduction of the risk of venous thromboembolism compared to the oral route. The choice of the doses as well as the treatment regimen is underpinned by tolerance as well as acceptance and compliance. The risk of breast cancer, which is one of the main risks of MHT, is higher with estro-progestogen combinations than with estrogens alone ; the preferential use of progesterone or dihydrogesterone being likely to limit the excess risk of breast cancer associated with MHT at least for duration of treatment of less than 5 to 7 years. The question of the optimal duration of MHT remains an issue and must take into account the initial indication of treatment as well as the benefit-risk balance, which is specific to each woman. Continuation of MHT is conditioned by the benefit-risk balance, which must be evaluated regularly, but also by the evolution of symptoms when MHT is stopped as well as menopause-related health risks or induced by MHT. After stopping MHT, it is necessary to maintain a medical follow-up to be adapted to the clinical situation of each woman and in particular, her cardiovascular and gynecological risk factors.
更年期激素治疗（MHT）最初是为纠正绝经后雌激素缺乏引起的更年期症状而研发的。对于未行子宫切除术的女性，MHT联合使用雌激素和孕激素，后者可对抗雌激素对子宫内膜增殖的负面影响。在法国，与美国和北欧国家不同，MHT主要联合使用17β-雌二醇（这是卵巢产生的生理性雌激素）以及孕激素或其衍生物双氢孕酮。法国在雌二醇经皮给药途径（凝胶或透皮贴剂）的研发方面处于领先地位，与口服途径相比，经皮给药途径具有更好的代谢耐受性，并能降低静脉血栓栓塞风险。剂量的选择以及治疗方案的确定以耐受性、接受度和依从性为依据。乳腺癌风险是MHT的主要风险之一，雌激素-孕激素联合用药的乳腺癌风险高于单纯使用雌激素；优先使用孕激素或双氢孕酮可能会至少在治疗时间少于5至7年时限制与MHT相关的额外乳腺癌风险。MHT的最佳持续时间问题仍然是一个议题，必须考虑治疗的初始指征以及每位女性特有的获益-风险平衡。MHT的持续使用取决于获益-风险平衡（必须定期评估），也取决于停用MHT时症状的演变以及与更年期相关的健康风险或MHT引起的健康风险。停用MHT后，有必要根据每位女性的临床情况，特别是其心血管和妇科风险因素进行医学随访。
