Cheang A, Sitruk-Ware R, Utian W H
Medical Department, Ciba-Geigy Ltd, Basle, Switzerland.
Drug Saf. 1993 Nov;9(5):365-79. doi: 10.2165/00002018-199309050-00005.
Estrogen replacement therapy (ERT) is very effective in relieving many menopausal symptoms such as hot flushes, night sweats, urogenital atrophy and psychological disturbances. Moreover, it is effective in the prevention of postmenopausal osteoporosis and has a favourable effect on some risk factors for cardiovascular disease in the long term, via several mechanisms including mediating effects on the lipid profile. Most of these beneficial effects are maintained with transdermal estradiol therapy, involving the use of a cutaneous delivery system attached to the skin which delivers a controlled rate of estradiol over a period of up to 4 days. However, the clear demonstration of a favourable effect on some risk factors for cardiovascular disease remains to be established. Transdermal administration of estradiol appears to be at least as effective as oral conjugated estrogen therapy on most of the end-points which have been evaluated, but allows a lower dose to be used, avoiding some of the metabolic adverse effects experienced with oral treatment. Endocrinological adverse effects, such as breast tenderness, breakthrough bleeding and fluid retention, are similar in both treatments, and can be minimised by dose adjustments in most cases. The most common adverse effects related to transdermal therapy are local skin reactions at the site of application. These are usually mild and transient in nature, and can be overcome by changing the site of application. Serious risks of transdermal therapy appear to be the same as those for other forms of ERT, namely an increased risk of endometrial hyperplasia and cancer with estrogen therapy alone. However, combination therapy involving the sequential administration of a progestogen has been shown to substantially reduce the risk of endometrial proliferation. The potential increased risk of breast cancer has been controversial and appears to be minimal with ERT. The role of progestogens on breast cancer risk remains controversial, but the data to date do not indicate any significant change in risk when progestogens are added to ERT.
雌激素替代疗法（ERT）在缓解许多更年期症状方面非常有效，如潮热、盗汗、泌尿生殖系统萎缩和心理障碍。此外，它在预防绝经后骨质疏松症方面有效，并且从长期来看，通过多种机制，包括对血脂谱的调节作用，对心血管疾病的一些危险因素有有利影响。这些有益作用大多通过经皮雌二醇疗法得以维持，该疗法使用附着于皮肤的皮肤给药系统，在长达4天的时间内以可控速率释放雌二醇。然而，对心血管疾病一些危险因素的有利影响仍有待明确证实。在大多数已评估的终点方面，经皮给予雌二醇似乎至少与口服结合雌激素疗法一样有效，但允许使用较低剂量，避免了口服治疗所经历的一些代谢不良反应。两种治疗中内分泌方面的不良反应，如乳房压痛、突破性出血和液体潴留相似，在大多数情况下可通过调整剂量将其降至最低。与经皮疗法相关的最常见不良反应是用药部位的局部皮肤反应。这些反应通常性质轻微且短暂，可通过改变用药部位来克服。经皮疗法的严重风险似乎与其他形式的ERT相同，即单独使用雌激素疗法会增加子宫内膜增生和癌症的风险。然而，已证明序贯给予孕激素的联合疗法可大幅降低子宫内膜增生的风险。乳腺癌潜在增加的风险一直存在争议，ERT似乎风险极小。孕激素对乳腺癌风险的作用仍存在争议，但迄今为止的数据并未表明在ERT中添加孕激素时风险有任何显著变化。
