Paschou Stavroula A, Athanasiadou Kleoniki I, Papanas Nikolaos
Endocrine Unit and Diabetes Centre, Department of Clinical Therapeutics, School of Medicine, Alexandra Hospital, National and Kapodistrian University of Athens, Athens, Greece.
Diabetes Centre, Second Department of Internal Medicine, Medical School, University Hospital of Alexandroupolis, Democritus University of Thrace, G. Kondyli 22, 68132, Alexandroupolis, Greece.
Diabetes Ther. 2024 Apr;15(4):741-748. doi: 10.1007/s13300-024-01546-1. Epub 2024 Feb 16.
Menopause is accompanied by several metabolic adaptations, which are related to insulin resistance, increased total body fat mass, and central abdominal fat accumulation, predisposing women to type 2 diabetes mellitus (T2DM) development. Metabolic syndrome has a high prevalence in postmenopausal women, indicating the loss of estrogen protection on metabolic and cardiovascular health. Moreover, earlier age at menopause has been related to increased risk of T2DM. Menopausal hormone therapy (MHT) has favorable results in glucose metabolism. Indeed, it reduces the risk of T2DM in women without this condition and improves glycemic control in women with T2DM. Before MHT initiation in women with clinical indications, it is imperative to assess their cardiovascular disease (CVD) risk, using official electronic algorithms for score calculation. The latter will determine regimen, dose, and administration route of MHT. Oral estrogens are preferable in women with low CVD risk, while transdermal administration is indicated in those with moderate and high CVD risk, as the risk of stroke and venous thromboembolism (VTE) is increased with oral administration. Oral 17β-estradiol is usually preferred in women with T2DM, as this route has more beneficial effects on glucose metabolism. Oral estrogens are also suggested in perimenopausal or recently postmenopausal women with low CVD risk. Although oral estrogens have favorable effects when indicated, the risk of VTE or stroke should always be considered. Micronized progesterone, dydrogesterone, and transdermal norethisterone are the progestogens used in postmenopausal women with T2DM and intact uterus. MHT should not be initiated in women > 60 years or > 10 years in menopause, as there is an increased thromboembolic risk in women with established atherosclerosis and no additional cardiovascular benefit in women without atherosclerosis. In conclusion, MHT administration in postmenopausal women with T2DM can be safe and effective as long as the therapeutic regimen has been properly selected according to their cardiovascular, metabolic, and fracture risk.
绝经伴随着多种代谢适应性变化，这些变化与胰岛素抵抗、全身脂肪量增加以及腹部中央脂肪堆积有关，使女性易患2型糖尿病（T2DM）。代谢综合征在绝经后女性中患病率很高，表明雌激素对代谢和心血管健康的保护作用丧失。此外，绝经年龄较早与T2DM风险增加有关。绝经激素治疗（MHT）对葡萄糖代谢有良好效果。事实上，它可降低无T2DM女性患T2DM的风险，并改善T2DM女性的血糖控制。在有临床指征的女性开始MHT之前，必须使用官方电子算法评估其心血管疾病（CVD）风险以计算得分。后者将决定MHT的治疗方案、剂量和给药途径。CVD风险低的女性首选口服雌激素，而CVD风险中等和高的女性则建议采用经皮给药，因为口服给药会增加中风和静脉血栓栓塞（VTE）风险。T2DM女性通常首选口服17β-雌二醇，因为这种给药途径对葡萄糖代谢有更有益的影响。CVD风险低的围绝经期或近期绝经后女性也建议使用口服雌激素。尽管口服雌激素在有指征时具有良好效果，但应始终考虑VTE或中风风险。微粒化孕酮、地屈孕酮和经皮炔诺酮是用于有T2DM且子宫完整的绝经后女性的孕激素。60岁以上或绝经超过10年的女性不应开始MHT，因为已患动脉粥样硬化的女性血栓栓塞风险增加，而未患动脉粥样硬化的女性没有额外的心血管益处。总之，只要根据绝经后T2DM女性的心血管、代谢和骨折风险正确选择治疗方案，MHT给药可以是安全有效的。
