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绝经激素治疗的获益与风险

谢梅青 谢小倩

谢梅青, 谢小倩. 绝经激素治疗的获益与风险[J]. 协和医学杂志, 2021, 12(2): 151-156. doi: 10.12290/xhyxzz.2021-0130
引用本文: 谢梅青, 谢小倩. 绝经激素治疗的获益与风险[J]. 协和医学杂志, 2021, 12(2): 151-156. doi: 10.12290/xhyxzz.2021-0130
XIE Mei-qing, XIE Xiao-qian. Benefits and Risks of Menopausal Hormone Therapy[J]. Medical Journal of Peking Union Medical College Hospital, 2021, 12(2): 151-156. doi: 10.12290/xhyxzz.2021-0130
Citation: XIE Mei-qing, XIE Xiao-qian. Benefits and Risks of Menopausal Hormone Therapy[J]. Medical Journal of Peking Union Medical College Hospital, 2021, 12(2): 151-156. doi: 10.12290/xhyxzz.2021-0130

绝经激素治疗的获益与风险

doi: 10.12290/xhyxzz.2021-0130
基金项目: 

中华预防医学会科研资金支持项目“中国妇女盆底功能障碍防治专项” 201819126

详细信息
    通讯作者:

    谢梅青  电话:020-81332131,E-mail:xiemq@mail.sysu.edu.cn

  • 中图分类号: R711.59

Benefits and Risks of Menopausal Hormone Therapy

Funds: 

Chinese Preventive Medicine Association Special Research Funding for Prevention and Treatment of Female Pelvic Floor Disorders 201819126

More Information
  • 摘要: 绝经激素治疗(menopausal hormone therapy,MHT)是对卵巢功能衰退的女性进行外源性雌激素补充以解决与雌激素不足相关的健康问题,MHT对于缓解绝经症状、防治泌尿生殖道萎缩相关疾病和预防骨质疏松的获益是毋庸置疑的。近80年来,医学界对MHT获益与风险的认识经历了跌宕起伏、崎岖发展的过程。特别是21世纪初美国大型前瞻性随机对照研究“妇女健康倡议(Women's Health Initiative,WHI) ”中期研究报告的发布,对全球MHT的应用产生了巨大震动,该项研究报告了老年女性使用MHT过程中心脑血管疾病事件及乳腺癌的发生风险升高,在2002年之后的18年里,医学界对MHT获益与风险的再评估从未停止过。目前,较为统一的认识是MHT的获益与风险与多种因素相关,包括启用MHT的年龄,绝经年限,性激素的种类、剂量、使用途径、用药时长,女性的基础健康状况,MHT管理是否规范等。本文参考过去10年内全球颁布的各项MHT指南、共识和发表的重要文献,对MHT的获益与风险进行论述。
    作者贡献:谢梅青负责选题设计、论文审核;谢小倩负责查阅文献、撰写和修订论文。
    利益冲突:  无
  • [1] Stute P, Wildt L, Neulen J. The impact of micronized progesterone on breast cancer risk: a systematic review[J]. Climacteric, 2018, 21: 111-122. doi:  10.1080/13697137.2017.1421925
    [2] Boardman HMP, Hartley L, Eisinga A, et al. Hormone therapy for preventing cardiovascular disease in post-menopausal women[J]. Cochrane Database Syst Rev, 2015, (3): CD002229. doi:  10.1002/14651858.CD002229.pub3/pdf/standard
    [3] 陈蓉, 郁琦, 徐克惠, 等. 中国14家医院妇科门诊40~60岁患者绝经相关特征的调查[J]. 中华妇产科杂志, 2013, 48: 723-727. doi:  10.3760/cma.j.issn.0529-567x.2013.10.002
    [4] Cintron D, Lipford M, Larrea-Mantilla L, et al. Efficacy of menopausal hormone therapy on sleep quality: systematic review and meta-analysis[J]. Endocrine, 2017, 55: 702-711. doi:  10.1007/s12020-016-1072-9
    [5] Sarri G, Pedder H, Dias S, et al. Vasomotor symptoms resulting from natural menopause: a systematic review and network meta-analysis of treatment effects from the National Institute for Health and Care Excellence guideline on menopause[J]. BJOG, 2017, 124: 1514-1523. doi:  10.1111/1471-0528.14619
    [6] Geiger PJ, Eisenlohr-Moul T, Gordon JL, et al. Effects of perimenopausal transdermal estradiol on self-reported sleep, independent of its effect on vasomotor symptom bother and depressive symptoms[J]. Menopause, 2019, 26: 1318-1323. doi:  10.1097/GME.0000000000001398
    [7] Zhang L, Ruan X, Cui Y, et al. Menopausal Symptoms and Associated Social and Environmental Factors in Midlife Chinese Women[J]. Clin Interv Aging, 2020, 15: 2195-2208. doi:  10.2147/CIA.S278976
    [8] Biehl C, Plotsker O, Mirkin S. A systematic review of the efficacy and safety of vaginal estrogen products for the treatment of genitourinary syndrome of menopause[J]. Menopause, 2019, 26: 431-453. doi:  10.1097/GME.0000000000001221
    [9] Lethaby A, Ayeleke RO, Roberts H. Local oestrogen for vaginal atrophy in postmenopausal women[J]. Cochrane Database Syst Rev, 2016, (8): CD001500. http://www.ncbi.nlm.nih.gov/pubmed/14583935
    [10] Gandhi J, Chen A, Dagur G, et al. Genitourinary syndrome of menopause: an overview of clinical manifestations, pathophysiology, etiology, evaluation, and management[J]. Am J Obstet Gynecol, 2016, 215: 704-711. doi:  10.1016/j.ajog.2016.07.045
    [11] Wells G, Tugwell P, Shea B, et al. Meta-analyses of therapies for postmenopausal osteoporosis. V. Meta-analysis of the efficacy of hormone replacement therapy in treating and preventing osteoporosis in postmenopausal women[J]. Endocrine reviews, 2002, 23: 529-539. doi:  10.1210/er.2001-5002
    [12] Cauley JA, Robbins J, Chen Z, et al. Effects of estrogen plus progestin on risk of fracture and bone mineral density: the Women's Health Initiative randomized trial[J]. JAMA, 2003, 290: 1729-1738. doi:  10.1001/jama.290.13.1729
    [13] Ran SY, Yu Q, Chen Y, et al. Prevention of postmeno-pausal osteoporosis in Chinese women: a 5-year, double-blind, randomized, parallel placebo-controlled study[J]. Climacteric, 2017, 20: 391-396. doi:  10.1080/13697137.2017.1325459
    [14] Marjoribanks J, Farquhar C, Roberts H, et al. Long-term hormone therapy for perimenopausal and postmenopausal women[J]. Cochrane Database Syst Rev, 2017, 1: CD004143.
    [15] Botteri E, Støer NC, Sakshaug S, et al. Menopausal hormone therapy and colorectal cancer: a linkage between nationwide registries in Norway[J]. BMJ Open, 2017, 7: e17639. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5695317/
    [16] Labadie JD, Harrison TA, Banbury B, et al. Postmeno-pausal Hormone Therapy and Colorectal Cancer Risk by Molecularly Defined Subtypes and Tumor Location[J]. JNCI Cancer Spectr, 2020, 4: a42. http://www.researchgate.net/publication/344253462_Postmenopausal_Hormone_Therapy_and_Colorectal_Cancer_Risk_by_Molecularly_Defined_Subtypes_and_Tumor_Location
    [17] Mauvais-Jarvis F, Manson JE, Stevenson JC, et al. Menopausal Hormone Therapy and Type 2 Diabetes Prevention: Evidence, Mechanisms, and Clinical Implications[J]. Endocr Rev, 2017, 38: 173-188. doi:  10.1210/er.2016-1146
    [18] Javed AA, Mayhew AJ, Shea AK, et al. Association Between Hormone Therapy and Muscle Mass in Postmenopausal Women: A Systematic Review and Meta-analysis[J]. JAMA Netw Open, 2019, 2: e1910154. doi:  10.1001/jamanetworkopen.2019.10154
    [19] Venetkoski M, Savolainen-Peltonen H, Rahkola-Soisalo P, et al. Increased cardiac and stroke death risk in the first year after discontinuation of postmenopausal hormone therapy[J]. Menopause, 2018, 25: 375-379. doi:  10.1097/GME.0000000000001023
    [20] Kim JE, Chang JH, Jeong MJ, et al. A systematic review and meta-analysis of effects of menopausal hormone therapy on cardiovascular diseases[J]. Sci Rep, 2020, 10: 20631. doi:  10.1038/s41598-020-77534-9
    [21] Rovinski D, Ramos RB, Fighera TM, et al. Risk of venous thromboembolism events in postmenopausal women using oral versus non-oral hormone therapy: A systematic review and meta-analysis[J]. Thrombosis Res, 2018, 168: 83-95. doi:  10.1016/j.thromres.2018.06.014
    [22] Scarabin PY. Progestogens and venous thromboembolism in menopausal women: an updated oral versus transdermal estrogen meta-analysis[J]. Climacteric, 2018, 21: 341-345. doi:  10.1080/13697137.2018.1446931
    [23] Shao H, Breitner JC, Whitmer RA, et al. Hormone therapy and Alzheimer disease dementia: new findings from the Cache County Study[J]. Neurology, 2012, 79: 1846-1852. doi:  10.1212/WNL.0b013e318271f823
    [24] Rossouw JE, Anderson GL, Prentice RL, et al. Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results From the Women's Health Initiative randomized controlled trial[J]. JAMA, 2002, 288: 321-333. doi:  10.1001/jama.288.3.321
    [25] Anderson GL, Limacher M, Assaf AR, et al. Effects of conjugated equine estrogen in postmenopausal women with hysterectomy: the Women's Health Initiative randomized controlled trial[J]. JAMA, 2004, 291: 1701-1712. doi:  10.1001/jama.291.14.1701
    [26] Collaborative Group on Hormonal Factors in Breast Cancer. Type and timing of menopausal hormone therapy and breast cancer risk: individual participant meta-analysis of the worldwide epidemiological evidence[J]. Lancet, 2019, 394: 1159-1168. doi:  10.1016/S0140-6736(19)31709-X
    [27] Gompel A, Plu-Bureau G. Progesterone, progestins and the breast in menopause treatment[J]. Climacteric, 2018, 21: 326-332. doi:  10.1080/13697137.2018.1476483
    [28] Formoso G, Perrone E, Maltoni S, et al. Short-term and long-term effects of tibolone in postmenopausal women[J]. Cochrane Database Syst Rev, 2016, (10): CD008536. http://www.researchgate.net/publication/309120259_Short-term_and_long-term_effects_of_tibolone_in_postmenopausal_women
    [29] Stute P, Neulen J, Wildt L. The impact of micronized progesterone on the endometrium: a systematic review[J]. Climacteric, 2016, 19: 316-328. doi:  10.1080/13697137.2016.1187123
    [30] Gompel A. Progesterone, progestins and the endometrium in perimenopause and in menopausal hormone therapy[J]. Climacteric, 2018, 21: 321-325. doi:  10.1080/13697137.2018.1446932
    [31] Vargiu V, Amar ID, Rosati A, et al. Hormone replacement therapy and cervical cancer: a systematic review of the literature[J]. Climacteric, 2020: 1-8. doi:  10.1080/13697137.2020.1826426.
    [32] Beral V, Gaitskell K, Hermon C, et al. Menopausal hor-mone use and ovarian cancer risk: individual participant meta-analysis of 52 epidemiological studies[J]. Lancet, 2015, 385: 1835-1842. doi:  10.1016/S0140-6736(14)61687-1
    [33] Pergialiotis V, Pitsouni E, Prodromidou A, et al. Hormone therapy for ovarian cancer survivors: systematic review and meta-analysis[J]. Menopause, 2016, 23: 335-342. doi:  10.1097/GME.0000000000000508
    [34] Kilander C, Lagergren J, Konings P, et al. Menopausal hormone therapy and biliary tract cancer: a population-based matched cohort study in Sweden[J]. Acta Oncol, 2019, 58: 290-295. doi:  10.1080/0284186X.2018.1549367
    [35] Zhong G, Liu Y, Chen N, et al. Reproductive factors, menopausal hormone therapies and primary liver cancer risk: a systematic review and dose-response meta-analysis of observational studies[J]. Hum Reprod Update, 2016, 23: 126-138. doi:  10.1093/humupd/dmw037
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出版历程
  • 收稿日期:  2021-01-29
  • 录用日期:  2021-02-22
  • 刊出日期:  2021-05-30

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