Williams D B, Moley K H
Department of Obstetrics and Gynecology, Washington University School of Medicine, St Louis, Missouri.
Curr Opin Obstet Gynecol. 1994 Jun;6(3):284-92.
The benefits of estrogen replacement therapy (ERT) in the menopause have been well demonstrated and are of significant importance, particularly with regard to prevention of osteoporosis and reduction in cardiovascular morbidity and mortality. The addition of a progestin to ERT is advocated in patients with a uterus to minimize the risk of endometrial hyperplasia and cancer. Although progestins can have adverse effects on serum lipids, it is unclear whether or not these effects negate the cardioprotective effects of estrogen. Progestins are an important part of hormone replacement therapy (HRT) regimen in patients with an intact uterus. The minimum dose and duration should be given to offset potential adverse effects on serum lipids while affording adequate protection of the endometrium. Both continuous and sequential progestin regimens appear to be efficacious. The newer progestins may offer increased flexibility in minimizing progestin side-effects while protecting the endometrium. Other regimens, such as less than monthly progestin administration, may offer another alternative to achieve these goals. Future studies in these areas are warranted.
雌激素替代疗法（ERT）在绝经治疗中的益处已得到充分证实且具有重要意义，特别是在预防骨质疏松以及降低心血管疾病发病率和死亡率方面。对于有子宫的患者，主张在ERT中添加孕激素以将子宫内膜增生和癌症风险降至最低。尽管孕激素可能对血脂有不良影响，但这些影响是否会抵消雌激素的心脏保护作用尚不清楚。孕激素是有完整子宫患者激素替代疗法（HRT）方案的重要组成部分。应给予最小剂量和最短疗程，以抵消对血脂的潜在不良影响，同时为子宫内膜提供充分保护。连续和序贯孕激素方案似乎都有效。新型孕激素在最小化孕激素副作用的同时保护子宫内膜方面可能具有更大的灵活性。其他方案，如每月少于一次的孕激素给药，可能为实现这些目标提供另一种选择。有必要在这些领域开展进一步研究。
