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摘要: 《中国绝经管理与绝经激素治疗指南(2018)》由中华医学会妇产科学分会绝经学组的全体专家在2012版指南基础上修订, 并采纳了国内相关学术领域专家的修改意见, 旨在指导医疗保健专业人士优化绝经过渡期及绝经后妇女的健康管理。本指南综合了本领域近年来的研究进展, 也借鉴了近几年全球各大绝经学会相应指南中的重要信息, 并纳入了证据水平和建议等级; 保留了2012版指南中的规范绝经激素治疗(menopause hormone therapy, MHT)诊疗流程, 并有所改进; 增加了绝经的分期系统——生殖衰老研讨会分期+10, 便于理解生殖衰老过程的临床、生物学、内分泌变化; 肯定了MHT的最佳适应证是治疗血管舒缩症状(vasomotor symptoms, VMS)、生殖泌尿道萎缩相关问题和预防绝经相关的低骨量及骨质疏松症。MHT的风险取决于药物类型、剂量、使用时间、管理方式、启动时间以及是否使用孕激素。MHT应依据现有最好的证据个体化进行, 定期重新评估是否继续或停止MHT, 以获得最大收益及最小风险。对年龄小于60岁或绝经10年内无MHT禁忌证的妇女, 针对VMS、骨量丢失和骨折, 启动MHT治疗的收益风险比最高。只要无禁忌证, 早发性卵巢功能不全患者应给予激素补充治疗至普通女性自然绝经的平均年龄, 之后按照绝经后MHT原则进行。Abstract: This guideline has been announced by experts of Menopause Group, Obstetrics and Gynecology Branch, Chinese Medical Association on menopause management and menopause hormone therapy (MHT) to help healthcare professionals in optimizing their management of transitionally menopausal and postmenopausal women. New results on MHT and menopause management after 2012 as well as all of the important information from main international guidelines were reviewed. Levels of evidence and grades of recommendations were also included. The standardized MHT flowcharts of diagnosis and treatment were retained and improved from the last version. The menopause staging system, Stages of Reproductive Aging Workshop +10 (STRAW+10), was added to facilitate the understanding on clinical, biological, and endocrine changes in the reproductive aging process for doctors in this field. Vasomotor symptoms (VMS), genitourinary syndrome of menopause, and prevention ofmenopause-related low bone mass and osteoporosis were reconfirmed as the indications for MHT. The risks of MHT depend on types, dosages, time of use, management, start-up time, and whether progesterone is used. To maximize the benefits and minimize the risks, MHT should be individualized based on the updated evidence, and the benefit-risk ratio should be reassessed annually. For women within 10 years after menopause, or younger than 60 years old with no contraindications, MHT for the treatment of VMS and prevention of bone loss and fractures has the most favorable benefit-risk ratio. Premature ovarian insufficiency patients should be treated with hormone replacement therapy till the average age of natural menopause and followed by the postmenopausal MHT.
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