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

2018 Chinese Guideline on Menopause Management and Menopause Hormone Therapy

doi: 10.3969/j.issn.1674-9081.2018.06.007
More Information
  • Corresponding author: YU Qi   Tel:010-69155012, E-mail: wanggw@sj-hospital.org
  • Received Date: 2018-08-07
  • Publish Date: 2018-11-30
  • 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.
  • loading
  • [1] de Villiers TJ, Hall JE, Pinkerton JV, et al. Revised Global Consensus Statement on Menopausal Hormone Therapy[J]. Climacteric, 2016, 19:313-315. doi:  10.1080/13697137.2016.1196047
    [2] Baber RJ, Panay N, Fenton A. 2016 IMS Recommendations on women's midlife health and menopause hormone therapy[J]. Climacteric, 2016, 19:109-150. doi:  10.3109/13697137.2015.1129166
    [3] 中华医学会妇产科学分会绝经学组.绝经期管理与激素补充治疗临床应用指南(2012版)[J].中华妇产科杂志, 2013, 48:795-799. doi:  10.3760/cma.j.issn.0529-567x.2013.10.018
    [4] Royal College of Obstetricians and Gynaecologists.Development of RCOG Greentop Guidelines (Clinical Governance Advice No. 1)[EB/OL]. http://www.rcog.org.uk/green-top-development.
    [5] Harlow SD, Gass M, Hall JE, et al. Executive summary of the Stages of Reproductive Aging Workshop +10:addressing the unfinished agenda of staging reproductive aging[J]. Climacteric, 2012, 15:105-114. doi:  10.3109/13697137.2011.650656
    [6] 中国营养学会.中国居民膳食指南(2016)[M].北京:人民卫生出版社, 2016:10-11.
    [7] The NAMS 2017 Hormone Therapy Position Statement Advisory Panel. The 2017 hormone therapy position statement of The North American Menopause Society[J]. Menopause, 2017, 24:728-753. doi:  10.1097/GME.0000000000000921
    [8] Committee on Gynecologic Practice. Committee Opinion No. 698:Hormone Therapy in Pri-mary Ovarian Insufficiency[J]. Obstet Gynecol, 2017, 129:e134-e141. doi:  10.1097/AOG.0000000000002044
    [9] Sarri G, Davies M, Lumsden MA, et al.Diagnosis and management of menopause:summary of NICE guidance[J].BMJ, 2015, 351:h5746. http://www.ncbi.nlm.nih.gov/pubmed/26563259
    [10] 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 random-ized controlled trial[J]. JAMA, 2002, 288:321-333. doi:  10.1001/jama.288.3.321
    [11] Moen MH, Rees M, Brincat M, et al. EMAS position statement:managing the menopause in women with a past history of endometriosis[J]. Maturitas, 2010, 67:94-97. doi:  10.1016/j.maturitas.2010.04.018
    [12] Gallos ID, Shehmar M, Thangaratinam S, et al. Oral progestogens vs levonorgestrel-releasing intrauterine system for endometrial hyperplasia:a systematic review and metaanalysis[J]. Am J Obstet Gynecol, 2010, 203:541-547. doi:  10.1016/j.ajog.2010.02.032
    [13] American College of Obstetricians and Gynecologists. ACOG committee opinion no. 556:Postmenopausal estrogen therapy:route of administration and risk of venous thromboembolism[J]. Obstet Gynecol, 2013, 121:887-890. doi:  10.1097/01.AOG.0000428645.90795.d9
    [14] Bergendal A, Kieler H, Sundstrom A, et al. Risk of venous thromboembolism associated with local and systemic use of hormone therapy in peri- and postmenopausal women and in relation to type and route of administration[J]. Menopause, 2016, 23:593-599. doi:  10.1097/GME.0000000000000611
    [15] Liu B, Beral V, Balkwill A, et al. Gallbladder disease and use of transdermal versus oral hormone replacement therapy in postmenopausal women:prospective cohort study[J]. BMJ, 2008, 337:a386. doi:  10.1136/bmj.a386
    [16] Canonico M. Hormone therapy and hemostasis among postmenopausal women:a review[J]. Menopause, 2014, 21:753-762. doi:  10.1097/GME.0000000000000296
    [17] 马薇, 金泉秀, 吴云飞, 等.乳腺增生症诊治专家共识[J].中国实用外科杂志, 2016, 36:759-762. http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=zgsywkzz201607013
    [18] Rebbeck TR, Friebel T, Wagner T, et al. Effect of short-term hormone replacement therapy on breast cancer risk reduction after bilateral prophylactic oophorectomy in BRCA1 and BRCA2 mutation carriers:the PROSE Study Group[J]. J Clin Oncol, 2005, 23:7804-7810. doi:  10.1200/JCO.2004.00.8151
    [19] Cummings SR, Ettinger B, Delmas PD, et al. The effects of tibolone in older postmenopausal women[J]. N Engl J Med, 2008, 359:697-708. doi:  10.1056/NEJMoa0800743
    [20] Somboonporn W, Panna S, Temtanakitpaisan T, et al. Effects of the levonorgestrel-releasing intrauterine system plus estrogen therapy in perimenopausal and postmenopausal women:systematic review and meta-analysis[J]. Menopause, 2011, 18:1060-1066. doi:  10.1097/gme.0b013e31821606c5
    [21] 中华医学会妇产科学分会绝经学组.绝经相关激素补充治疗的规范诊疗流程[J].中华妇产科杂志, 2013, 48:155-158. doi:  10.3760/cma.j.issn.0529-567x.2013.02.018
    [22] de Villiers TJ, Stevenson JC. The WHI:the effect of hormone replacement therapy on fracture prevention[J]. Climacteric, 2012, 15:263-266. doi:  10.3109/13697137.2012.659975
    [23] Hawkes N. HRT increases risk of blood clots and stroke, finds new analysis[J]. BMJ, 2015, 350:h1336. doi:  10.1136/bmj.h1336
    [24] L'Hermite M. HRT optimization, using transdermal estradiol plus micronized progesterone, a safer HRT[J]. Climacteric, 2013, 16:44-53. doi:  10.3109/13697137.2013.808563
    [25] Schierbeck LL, Rejnmark L, Tofteng CL, et al. Effect of hormone replacement therapy on cardiovascular events in recently postmenopausal women:randomised trial[J]. BMJ, 2012, 345:e6409. doi:  10.1136/bmj.e6409
    [26] Harman SM, Black DM, Naftolin F, et al. Arterial imaging outcomes and cardiovascular risk factors in recently meno-pausal women:a randomized trial[J]. Ann Intern Med, 2014, 161:249-260. doi:  10.7326/M14-0353
    [27] Hodis HN, Mack WJ, Henderson VW, et al. Vascular Effects of Early versus Late Postmeno-pausal Treatment with Estradiol[J]. N Engl J Med, 2016, 374:1221-1231. doi:  10.1056/NEJMoa1505241
    [28] Gleason CE, Dowling NM, Wharton W, et al. Effects of Hormone Therapy on Cognition and Mood in Recently Postmenopausal Women:Findings from the Randomized, Controlled KEEPS-Cognitive and Affective Study[J]. PLoS Med, 2015, 12:e1001833, e1001833. doi:  10.1371/journal.pmed.1001833
    [29] Bitoska I, Krstevska B, Milenkovic T, et al. Effects of Hormone Replacement Therapy on Insulin Resistance in Postmenopausal Diabetic Women[J]. Open Access Maced J Med Sci, 2016, 4:83-88. doi:  10.3889/oamjms.2016.024
    [30] Stuenkel CA. Menopause, hormone therapy and diabetes[J]. Climacteric, 2017, 20:11-21. doi:  10.1080/13697137.2016.1267723
    [31] Maggiolini M, Picard D. The unfolding stories of GPR30, a new membrane-bound estrogen receptor[J]. J Endocrinol, 2010, 204:105-114. http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=c8a0c7afca109e8f77e9bbc5568f013c
    [32] Greising SM, Baltgalvis KA, Lowe DA, et al. Hormone therapy and skeletal muscle strength:a meta-analysis[J]. J Gerontol A Biol Sci Med Sci, 2009, 64:1071-1081. http://biomedgerontology.oxfordjournals.org/content/64A/10/1071.full
    [33] Davey DA. Menopausal hormone therapy:a better and safer future[J]. Climacteric, 2018:1-8. doi: 10.1080/13697137.2018.1439915.[Epub ahead of print].
    [34] Kotsopoulos J, Gronwald J, Karlan BY, et al. Hormone Replacement Therapy After Oopho-rectomy and Breast Cancer Risk Among BRCA1 Mutation Carriers[J]. JAMA Oncol, 2018. doi: 10.1001/jamaoncol.2018.0211.[Epub ahead of print].
    [35] 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
    [36] Crandall CJ, Hovey KM, Andrews C, et al. Comparison of clinical outcomes among users of oral and transdermal estrogen therapy in the Women's Health Initiative Observational Study[J]. Menopause, 2017, 24:1145-1153. doi:  10.1097/GME.0000000000000899
    [37] Sjogren LL, Morch LS, Lokkegaard E. Hormone replacement therapy and the risk of endome-trial cancer:A systematic review[J]. Maturitas, 2016, 91:25-35. doi:  10.1016/j.maturitas.2016.05.013
    [38] Jaakkola S, Pukkala E, K Lyytinen H, et al. Postmenopausal estradiol-progestagen therapy and risk for uterine cervical cancer[J]. Int J Cancer, 2012, 131:E537-E543. doi:  10.1002/ijc.27321
    [39] Bassuk SS, Manson JE. Oral contraceptives and menopausal hormone therapy:relative and attributable risks of cardiovascular disease, cancer, and other health outcomes[J]. Ann Epidemiol, 2015, 25:193-200. doi:  10.1016/j.annepidem.2014.11.004
    [40] Beral V, Gaitskell K, Hermon C, et al. Menopausal hormone use and ovarian cancer risk:individual participant meta-ana-lysis of 52 epidemiological studies[J]. Lancet, 2015, 385:1835-1842. doi:  10.1016/S0140-6736(14)61687-1
    [41] Manson JE, Chlebowski RT, Stefanick ML, et al. Menopausal hormone therapy and health outcomes during the intervention and extended poststopping phases of the Women's Health Initiative randomized trials[J]. JAMA, 2013, 310:1353-1368. doi:  10.1001/jama.2013.278040
    [42] Schwartz AG, Ray RM, Cote ML, et al. Hormone Use, Reproductive History, and Risk of Lung Cancer:The Women's Health Initiative Studies[J]. J Thorac Oncol, 2015, 10:1004-1013. doi:  10.1097/JTO.0000000000000558
    [43] Grodstein F, Martinez ME, Platz EA, et al. Postmenopausal hormone use and risk for colorec-tal cancer and adenoma[J]. Ann Intern Med, 1998, 128:705-712. doi:  10.7326/0003-4819-128-9-199805010-00001
    [44] Grodstein F, Newcomb PA, Stampfer MJ. Postmenopausal hormone therapy and the risk of colorectal cancer:a review and meta-analysis[J]. Am J Med, 1999, 106:574-582. doi:  10.1016/S0002-9343(99)00063-7
    [45] Prentice RL, Pettinger M, Beresford SA, et al. Colorectal cancer in relation to postmenopau-sal estrogen and estrogen plus progestin in the Women's Health Initiative clinical trial and obser-vational study[J]. Cancer Epidemiol Biomarkers Prev, 2009, 18:1531-1537. doi:  10.1158/1055-9965.EPI-08-1209
    [46] Manson JE, Chlebowski RT, Stefanick ML, et al. Meno-pausal hormone therapy and health outcomes during the intervention and extended poststopping phases of the Women's Health Initiative randomized trials[J]. JAMA, 2013, 310:1353-1368. doi:  10.1001/jama.2013.278040
    [47] Mcglynn KA, Sahasrabuddhe VV, Campbell PT, et al. Reproductive factors, exogenous hor-mone use and risk of hepatocellular carcinoma among US women:results from the Liver Cancer Pooling Project[J]. Br J Cancer, 2015, 112:1266-1272. doi:  10.1038/bjc.2015.58
    [48] Camargo MC, Goto Y, Zabaleta J, et al. Sex hormones, hormonal interventions, and gastric cancer risk:a meta-analysis[J]. Cancer Epidemiol Biomarkers Prev, 2012, 21:20-38. doi:  10.1158/1055-9965.EPI-11-0834
    [49] Brusselaers N, Maret-Ouda J, Konings P, et al. Menopausal hormone therapy and the risk of esophageal and gastric cancer[J]. Int J Cancer, 2017, 140:1693-1699. doi:  10.1002/ijc.30588
    [50] Maclennan AH, Broadbent JL, Lester S, et al. Oral oestrogen and combined oestrogen/progestogen therapy versus placebo for hot flushes[J]. Cochrane Database Syst Rev, 2004:D2978. http://europepmc.org/abstract/MED/15495039
    [51] Cintron D, Lahr BD, Bailey KR, et al. Effects of oral versus transdermal menopausal hormone treatments on self-reported sleep domains and their association with vasomotor symptoms in recently menopausal women enrolled in the Kronos Early Estrogen Prevention Study (KEEPS)[J]. Menopause, 2018, 25:145-153. doi:  10.1097/GME.0000000000000971
    [52] Loprinzi CL, Sloan J, Stearns V, et al. Newer antidepressants and gabapentin for hot flashes:an individual patient pooled analysis[J]. J Clin Oncol, 2009, 27:2831-2837. doi:  10.1200/JCO.2008.19.6253
    [53] Toulis KA, Tzellos T, Kouvelas D, et al. Gabapentin for the treatment of hot flashes in women with natural or tamoxifen-induced menopause:a systematic review and meta-analysis[J]. Clin Ther, 2009, 31:221-235. doi:  10.1016/j.clinthera.2009.02.006
    [54] 陈蓉, 郁琦.香芍颗粒临床应用指导建议[J].中国实用妇科与产科杂志, 2015, 31:419-420. http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=zgsyfkyckzz201505013
    [55] 李存存, 王晶晶, 陈潮, 等.坤泰胶囊与激素替代疗法治疗更年期综合征有效性和安全性比较的Meta分析[J].中国中西医结合杂志, 2013, 33:1183-1190. doi:  10.7661/CJIM.2013.09.1183
    [56] 中华医学会妇产科学分会绝经学组.莉芙敏临床应用指导建议[J].中国实用妇科与产科杂志, 2012, 28:556-557. http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=zgsyfkyckzz201207028
    [57] Gaudard AM, Silva DSS, Puga ME, et al. Bioidentical hormones for women with vasomotor symptoms[J]. Cochrane Database Syst Rev, 2016, (8):D10407. http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=a531fae25f3b99245656d5acc385c979
    [58] Lethaby A, Marjoribanks J, Kronenberg F, et al. Phytoestrogens for menopausal vasomotor symptoms[J]. Cochrane Database Syst Rev, 2013, (12):D1395.
    [59] Carmody J, Crawford S, Churchill L. A pilot study of mindfulness-based stress reduction for hot flashes[J]. Menopause, 2006, 13:760-769. doi:  10.1097/01.gme.0000227402.98933.d0
    [60] Carmody JF, Crawford S, Salmoirago-Blotcher E, et al. Mindfulness training for coping with hot flashes:results of a randomized trial[J]. Menopause, 2011, 18:611-620. doi:  10.1097/gme.0b013e318204a05c
    [61] Stuenkel CA, Davis SR, Gompel A, et al. Treatment of Symptoms of the Menopause:An Endocrine Society Clinical Practice Guideline[J]. J Clin Endocrinol Metab, 2015, 100:3975-4011. doi:  10.1210/jc.2015-2236
    [62] Faubion SS, Larkin LC, Stuenkel CA, et al. Management of genitourinary syndrome of menopause in women with or at high risk for breast cancer:consensus recommendations from The North American Menopause Society and The International Society for the Study of Women's Sexual Health[J]. Menopause, 2018, 25:596-608. doi:  10.1097/GME.0000000000001121
    [63] 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
    [64] Caretto M, Giannini A, Russo E, et al. Preventing urinary tract infections after menopause without antibiotics[J]. Maturitas, 2017, 99:43-46. doi:  10.1016/j.maturitas.2017.02.004
    [65] Castro RA, Arruda RM, Bortolini MA. Female urinary incontinence:effective treatment strategies[J]. Climacteric, 2015, 18:135-141. doi:  10.3109/13697137.2014.947257
    [66] Chughtai B, Forde JC, Buck J, et al. The concomitant use of fesoterodine and topical vaginal estrogen in the management of overactive bladder and sexual dysfunction in postmenopausal women[J]. Post Reprod Health, 2016, 22:34-40. doi:  10.1177/2053369116633017
    [67] Appa AA, Creasman J, Brown JS, et al. The impact of multimorbidity on sexual function in middle-aged and older women:beyond the single disease perspective[J]. J Sex Med, 2014, 11:2744-2755. doi:  10.1111/jsm.12665
    [68] Iglesia CB. What's new in the world of postmenopausal sex?[J]. Curr Opin Obstet Gynecol, 2016, 28:449-454. doi:  10.1097/GCO.0000000000000311
    [69] Pines A, Sturdee DW, Maclennan AH. Quality of life and the role of menopausal hormone therapy[J]. Climacteric, 2012, 15:213-216. doi:  10.3109/13697137.2012.655923
    [70] Biglia N, Maffei S, Lello S, et al. Tibolone in post-menopausal women:a review based on recent randomised controlled clinical trials[J]. Gynecol Endocrinol, 2010, 26:804-814. doi:  10.3109/09513590.2010.495437
    [71] Wierman ME, Arlt W, Basson R, et al. Androgen therapy in women:a reappraisal:an Endocrine Society clinical practice guideline[J]. J Clin Endocrinol Metab, 2014, 99:3489-3510. doi:  10.1210/jc.2014-2260
    [72] Linton A, Golobof A, Shulman LP. Contraception for the perimenopausal woman[J]. Climacteric, 2016, 19:526-534. doi:  10.1080/13697137.2016.1225033
    [73] Webber L, Davies M, Anderson R, et al. ESHRE Guideline:management of women with premature ovarian insufficiency[J]. Hum Reprod, 2016, 31:926-937. doi:  10.1093/humrep/dew027
    [74] 中华医学会妇产科学分会绝经学组.早发性卵巢功能不全的激素补充治疗专家共识[J].中华妇产科杂志, 2016, 51:881-886. doi:  10.3760/cma.j.issn.0529-567x.2016.12.001
    [75] Sternfeld B, Wang H, Quesenberry CJ, et al. Physical activity and changes in weight and waist circumference in midlife women:findings from the Study of Women's Health Across the Nation[J]. Am J Epidemiol, 2004, 160:912-922. doi:  10.1093/aje/kwh299
    [76] Sullivan SD, Sarrel PM, Nelson LM. Hormone replacement therapy in young women with primary ovarian insufficiency and early menopause[J]. Fertil Steril, 2016, 106:1588-1599. doi:  10.1016/j.fertnstert.2016.09.046
    [77] Bidet M, Bachelot A, Bissauge E, et al. Resumption of ovarian function and pregnancies in 358 patients with premature ovarian failure[J]. J Clin Endocrinol Metab, 2011, 96:3864-3872. doi:  10.1210/jc.2011-1038
    [78] Cartwright B, Robinson J, Seed PT, et al. Hormone Replacement Therapy Versus the Combined Oral Contraceptive Pill in Premature Ovarian Failure:A Randomized Controlled Trial of the Effects on Bone Mineral Density[J]. J Clin Endocrinol Metab, 2016, 101:3497-3505. doi:  10.1210/jc.2015-4063
  • 加载中


    通讯作者: 陈斌, bchen63@163.com
    • 1. 

      沈阳化工大学材料科学与工程学院 沈阳 110142

    1. 本站搜索
    2. 百度学术搜索
    3. 万方数据库搜索
    4. CNKI搜索


    Article Metrics

    Article views (1800) PDF downloads(2550) Cited by()
    Proportional views


    DownLoad:  Full-Size Img  PowerPoint