DeGregorio M W, Taras T L
Department of Internal Medicine, University of California, Sacramento 95817, USA.
J Am Pharm Assoc (Wash). 1998 Nov-Dec;38(6):738-44; quiz 744-6. doi: 10.1016/s1086-5802(16)30395-3.
To assess current ideas about the benefits and risks of estrogen and hormone replacement therapy (ERT/HRT) in postmenopausal women.
MEDLINE searches, supplemented by various texts, of the literature on HRT, ERT, and selective estrogen receptor modulators (SERMs): tamoxifen, toremifene, and raloxifene.
HRT is primarily used for improving quality of life in women suffering from vasomotor symptoms associated with menopause. HRT is beneficial in postmenopausal women for preventing cardiovascular disease, osteoporosis, and Alzheimer's disease. Review of meta-analyses of clinical trials showed that ERT/HRT ever-users (patients who have ever used ERT/HRT) did not have an increased risk of breast cancer, but current users did have an increased risk, with some studies reporting increasing risk with duration of ERT. No relationship was found between dose or the addition of progestin to ERT and increased breast cancer risk. Overall breast cancer mortality rates associated with HRT were decreased in current users. In general, HRT does not increase the risk of breast cancer in women with a family history of the disease, compared with those without a family history. New HRT strategies that could potentially prevent breast cancer are now being developed. The SERMs tamoxifen and toremifene appear to have positive clinical effects on bone and serum lipids; they are currently being investigated for use as breast cancer chemopreventive agents. Raloxifene, a new SERM used for the prevention of osteoporosis, is an alternative for women who cannot tolerate HRT. Unfortunately, these SERMS have anti-estrogenic effects and thus cause vasomotor adverse effects such as hot flashes and vaginal dryness. In addition, SERMs do not protect against heart disease or prevent osteoporosis as well as does HRT.
Presently, SERMs will not become first-line HRT, as the positive effects of ERT/HRT may outweigh any potentially increased risk of breast cancer. The development of new agents with pharmacodynamic profiles similar to that of ERT/HRT but lacking its adverse effects would be greatly beneficial for postmenopausal women.
评估目前关于绝经后女性雌激素及激素替代疗法（ERT/HRT）的益处与风险的观点。
通过MEDLINE检索，并辅以各种文献资料，检索关于HRT、ERT及选择性雌激素受体调节剂（SERM）：他莫昔芬、托瑞米芬和雷洛昔芬的文献。
HRT主要用于改善患有与绝经相关的血管舒缩症状的女性的生活质量。HRT对绝经后女性预防心血管疾病、骨质疏松症和阿尔茨海默病有益。对临床试验的荟萃分析综述表明，ERT/HRT既往使用者（曾使用过ERT/HRT的患者）患乳腺癌的风险并未增加，但目前使用者确实有增加的风险，一些研究报告称ERT使用时间越长风险越高。未发现ERT的剂量或添加孕激素与乳腺癌风险增加之间存在关联。目前使用者中与HRT相关的总体乳腺癌死亡率有所下降。一般而言，与无家族病史的女性相比，有乳腺癌家族病史的女性使用HRT不会增加患癌风险。目前正在研发可能预防乳腺癌的新HRT策略。SERM他莫昔芬和托瑞米芬似乎对骨骼和血脂有积极的临床作用；目前正在研究将它们用作乳腺癌化学预防药物。雷洛昔芬是一种用于预防骨质疏松症的新型SERM，是不能耐受HRT的女性的一种替代选择。不幸的是，这些SERM具有抗雌激素作用，因此会引起血管舒缩不良反应，如潮热和阴道干燥。此外，SERM在预防心脏病或骨质疏松症方面不如HRT有效。
目前，SERM不会成为一线HRT，因为ERT/HRT的积极作用可能超过任何潜在增加的乳腺癌风险。研发具有与ERT/HRT相似的药效学特征但无其不良反应的新型药物将对绝经后女性大有裨益。
