Department of Obstetrics and Gynecology, George Washington University School of Medicine and Health Sciences, George Washington University, and IntimMedicine Specialists, Washington, DC; and the Department of Obstetrics, Gynecology and Reproductive Sciences, UCSD School of Medicine, San Diego, California.
Obstet Gynecol. 2024 Jul 1;144(1):12-23. doi: 10.1097/AOG.0000000000005553. Epub 2024 Mar 14.
Enthusiasm for the use of hormones to ameliorate symptoms of perimenopause and menopause has waxed and waned over the years. Both treatment for symptoms and training of women's health care practitioners in the management of menopause have sharply declined since publication of the Women's Health Initiative initial results in 2002. Findings from that trial, which treated a population of older, asymptomatic patients, have been extrapolated over the past 21 years to all estrogen products, all menopausal women, and all delivery mechanisms. Our patients deserve a more nuanced, individualized approach. Conjugated equine estrogens and medroxyprogesterone acetate are no longer the predominant medications or medications of choice available for management of menopausal symptoms. All hormones are not equivalent any more than all antiseizure medications or all antihypertensives are equivalent; they have different pharmacodynamics, duration of action, and affinity for receptors, among other things, all of which translate to different risks and benefits. Consideration of treatment with the right formulation, at the right dose and time, and for the right patient will allow us to recommend safe, effective, and appropriate treatment for people with menopausal symptoms.
多年来，人们对使用激素来改善围绝经期和绝经期症状的热情时高时低。自 2002 年妇女健康倡议最初结果公布以来，治疗症状的方法和对妇女保健医生进行绝经管理的培训都急剧下降。该试验针对的是年龄较大、无症状的患者人群，过去 21 年来，这些发现被推断应用于所有雌激素产品、所有绝经后妇女和所有给药机制。我们的患者需要更细致、更个体化的治疗方法。结合马雌激素和醋酸甲羟孕酮不再是治疗绝经症状的主要药物或首选药物。所有的激素不再是等效的，就像所有的抗癫痫药物或所有的降压药物都不是等效的一样；它们具有不同的药效学、作用持续时间和受体亲和力等，所有这些都转化为不同的风险和益处。考虑使用正确的配方、正确的剂量和时间、并针对正确的患者进行治疗，将使我们能够为有绝经症状的患者推荐安全、有效和适当的治疗方法。
