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首页> 外文期刊>Taiwanese journal of obstetrics and gynecology >Standard and low-dose hormone therapy for postmenopausal women--focus on the breast.
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Standard and low-dose hormone therapy for postmenopausal women--focus on the breast.

机译：绝经后妇女的标准和低剂量激素疗法-以乳房为重点。

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Menopause occurs naturally when the ovary ceases folliculogenesis, or artificially by surgical and/or medical ablation of the ovarian function. Menopause is a hypoestrogenic state, which may adversely affect estrogen target tissues, such as the brain, skeleton and skin, as well as the cardiovascular and genitourinary systems, with resultant frequency and severity of climacteric symptoms. The climacteric symptoms, however, vary significantly among women. For decades, hormone therapy (HT) has been the mainstay and is considered the most effective for managing menopausal symptoms. The prolonged use of either single estrogen therapy or a combination therapy of estrogen and progestogen (EPT) might be associated with a slightly increased risk of breast cancer and many resultant adverse events, such as coronary heart disease, stroke and venous thromboembolism. Perhaps because the clear benefits are limited to these end points of HT in treating menopausal women, the relatively significant adverse event profiles of these women may not be enough to trigger primary care physicians to be more aggressive than they have been to date in treating climacteric symptoms of postmenopausal women. However, severe climacteric symptoms really disturb the woman's life. Some epidemiologic studies have shown that the increased risk for breast cancer after 5 years of combined EPT is similar in magnitude to other lifestyle variables, such as 10-year delayed menopause, fewer pregnancies and reduced breastfeeding, postmenopausal obesity, excessive alcohol or cigarette use, and lack of regular exercise. Furthermore, elevated serum concentrations of either endogenous or exogenous (replaced by HT) sex hormone in either pre- or postmenopausal women are associated with an increased risk of breast cancer. Finally, the increased breast cancer risk diminishes soon after discontinuing hormones, and largely disappears by 5 years after cessation. Taken together, low-dose conventional HT can be used with symptomatic menopausal women, but is worthy of further evaluation because we found the following potential benefits, including (i) low-dose oral EPT appears to be effective for the alleviation of climacteric symptoms; (ii) it has a good tolerability profile with a low incidence of the most common and problematic side effects, such as breast tenderness and an increased mammographic density. Altogether, when compared with the standard dose HT, physicians may prefer to use low-dose HT initially in managing the climacteric symptoms of postmenopausal women. Time will prove.
机译：当卵巢停止卵泡生成时，更年期自然发生，或者通过外科手术和/或医学上切除卵巢功能人工地绝经。更年期是一种低雌激素状态，可能会对雌激素目标组织（如大脑，骨骼和皮肤以及心血管和泌尿生殖系统）产生不利影响，从而导致更年期症状的发生频率和严重程度。然而，女性之间的更年期症状差异很大。数十年来，激素疗法（HT）一直是主流，被认为是治疗更年期症状最有效的方法。长期使用单一雌激素疗法或雌激素和孕激素（EPT）联合疗法可能会增加患乳腺癌的风险，并导致许多不良事件，例如冠心病，中风和静脉血栓栓塞。也许因为明显的益处仅限于治疗绝经妇女的HT终点，所以这些妇女相对重大的不良事件可能不足以促使初级保健医生变得比以往更积极地治疗更年期症状绝经后妇女但是，严重的更年期症状确实打扰了妇女的生活。一些流行病学研究表明，EPT联合使用5年后患乳腺癌的风险在很大程度上与其他生活方式变量类似，例如更年期推迟10年，怀孕和哺乳减少，绝经后肥胖，过量饮酒或吸烟，而且缺乏规律的运动。此外，绝经前或绝经后妇女内源性或外源性激素的血清浓度升高与患乳腺癌的风险增加有关。最后，停药后不久增加的乳腺癌风险会逐渐降低，在停止使用激素后的5年内会大大消失。总之，低剂量的常规HT可以用于有症状的更年期妇女，但值得进一步评估，因为我们发现了以下潜在益处，包括：（i）低剂量口服EPT似乎对缓解更年期症状有效; （ii）它具有良好的耐受性，最常见和最有问题的副作用（如乳房压痛和乳房X线照片密度增加）的发生率较低。总之，当与标准剂量HT相比时，医生可能更喜欢在治疗绝经后妇女的更年期症状时首先使用小剂量HT。时间会证明。

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