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中国绝经管理与绝经激素治疗指南(2018)

中华医学会妇产科学分会绝经学组 郁琦

中华医学会妇产科学分会绝经学组, 郁琦. 中国绝经管理与绝经激素治疗指南(2018)[J]. 协和医学杂志, 2018, 9(6): 512-525. doi: 10.3969/j.issn.1674-9081.2018.06.007
引用本文: 中华医学会妇产科学分会绝经学组, 郁琦. 中国绝经管理与绝经激素治疗指南(2018)[J]. 协和医学杂志, 2018, 9(6): 512-525. doi: 10.3969/j.issn.1674-9081.2018.06.007
Qi YU. 2018 Chinese Guideline on Menopause Management and Menopause Hormone Therapy[J]. Medical Journal of Peking Union Medical College Hospital, 2018, 9(6): 512-525. doi: 10.3969/j.issn.1674-9081.2018.06.007
Citation: Qi YU. 2018 Chinese Guideline on Menopause Management and Menopause Hormone Therapy[J]. Medical Journal of Peking Union Medical College Hospital, 2018, 9(6): 512-525. doi: 10.3969/j.issn.1674-9081.2018.06.007

中国绝经管理与绝经激素治疗指南(2018)

doi: 10.3969/j.issn.1674-9081.2018.06.007
基金项目: 

中国医学科学院医学与健康科技创新工程 2017-12M-1-002

国家重点研究发展计划(973计划) 2018YFC1002105

详细信息
    通讯作者:

    郁琦   电话:010-69155012, E-mail: wanggw@sj-hospital.org

  • 中图分类号: R711

2018 Chinese Guideline on Menopause Management and Menopause Hormone Therapy

More Information
  • 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。
  • 图  1  生殖衰老研讨会分期+10系统

    FSH:卵泡刺激素;AMH:抗缪勒氏管激素;*在周期第2~5天取血; * *依据目前采用的国际垂体激素标准的大致预期水平

    图  2  MHT临床规范诊疗流程

    MHT:绝经激素治疗

    图  3  更年期门诊初次接诊流程

    MHT:同图 2

    图  4  绝经激素治疗方案选择策略

    FSH:同图 1;MHT:同图 2;TSH:促甲状腺激素

    图  5  绝经激素治疗复诊与随访

    MHT:同图 2

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