Lobo R A
Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, New York, NY 10032, USA.
Am J Obstet Gynecol. 1995 Sep;173(3 Pt 2):982-9. doi: 10.1016/0002-9378(95)90247-3.
Estrogen replacement therapy (ERT) has been shown to reduce the risk of cardiovascular disease (CVD) and osteoporosis in postmenopausal women. Studies also indicate a reduced risk of stroke and its consequent mortality among estrogen users, and ERT may also have a role in reducing the risk of Alzheimer's disease and increasing a woman's overall quality of life. On the negative side, some studies show a small duration-related risk of breast cancer with estrogen use and a significant increase in endometrial cancer; the latter is virtually eliminated with the addition of a progestin to the regimen. Although the definitive answer is not yet available, recent epidemiologic data suggest no reduction in protection against CVD and bone fracture with the addition of progestin, which is referred to as hormone replacement therapy, as opposed to using estrogen alone. A woman's potential risks associated with ERT or hormone replacement therapy must be weighed against her lifetime risks of developing CVD, stroke, and bone fracture. The reduction in mortality and morbidity rates with hormone use is generally viewed to be substantial and cost-effective. Health care professionals have an important role in shaping their patients' attitudes. Patients need more information from their physicians about the risks and benefits of estrogen therapy.
雌激素替代疗法（ERT）已被证明可降低绝经后女性患心血管疾病（CVD）和骨质疏松症的风险。研究还表明，雌激素使用者中风风险及其后续死亡率降低，ERT在降低阿尔茨海默病风险和提高女性总体生活质量方面可能也有作用。不利的一面是，一些研究显示使用雌激素存在与使用时长相关的小幅度乳腺癌风险，子宫内膜癌风险显著增加；在治疗方案中添加孕激素后，后者风险基本消除。尽管尚无定论，但近期流行病学数据表明，添加孕激素（即激素替代疗法，与单独使用雌激素相对）后，对CVD和骨折的预防作用并未降低。必须将女性与ERT或激素替代疗法相关的潜在风险与其一生中患CVD、中风和骨折的风险进行权衡。使用激素降低死亡率和发病率的效果通常被认为显著且具有成本效益。医疗保健专业人员在塑造患者态度方面发挥着重要作用。患者需要从医生那里获得更多关于雌激素疗法风险和益处的信息。
