Optimizing menopausal hormone therapy:for treatment and prevention,menstrual regulation,and reduction of possible risks  

作　　者：Xiangyan Ruan Alfred O.Mueck 

机构地区：[1]Department of Gynecological Endocrinology,Beijing Obstetrics and Gynecology Hospital,Capital Medical University,Beijing Maternal and Child Health Care Hospital,Yaojiayuan Road 251,Beijing 100026,China [2]Department of Women's Health,University Hospital Tuebingen,Calwer Strasse 7,Tuebingen 72076,Germany

出　　处：《Global Health Journal》2022年第2期61-69,共9页全球健康杂志（英文）

基　　金：supported by National Natural Science Foundation of China(No.81671411);Beijing Municipal Administration of Hospitals’Ascent Plan of China(No.DFL20181401).

摘　　要：Menopausal hormone therapy(MHT)is used to treat menopausal complaints including the genitourinary syndrome of menopause,to prevent osteoporosis,and to treat bleeding problems.Since these can be the indications also in young women,especially with POI(premature ovarian insufficiency)or with surgical menopause(bilateral oophorectomy),also the old term"Hormone Replacement Therapy(HRT)”is still used.The effective component is the estrogen component without relevant difference in the efficacy of the various MHT-preparations.Additional preventive benefits are reduction of cardiovascular disease(including prevention of diabetes mellitus and metabolic syndrome),reduction of colon cancer,and perhaps also Alzheimer's disease,if started within a Kwindow of opportunity",i.e.in perimenopause or within 6-10 years after menopause.Primary indication for progestogen addition is to avoid the development of estrogen-dependent endometrial cancer,i.e.addition not recommended in hysterectomized women.Two main schedules,sequential-or continuous-combined estrogen/progestogen regimens,are used for treatment of bleeding problems.For this and for optimizing menstrual regulation detailed recommendations are given including proposed dosages for the available different progestogens if added to oral or transdermal estradiol in different estrogen dosages.The WHI-study demonstrated the main risks using MHT within a“worst-case scenario",i.e.start of MHT in old women with high risk for breast cancer and cardiovascular diseases,whereby only^conjugated equine estro-gens”and^medroxprogesterone acetate”have been tested.One main result was that the progestogen component is decisive for the risk of breast cancer,which according to own experimental research and observational studies may be reduced using the physiological progesterone or its isomer dydrogesterone.In addition we propose to push forward research for screening patients with increased breast cancer risk like we have done in the past decade demonstrating that certain membrane-bound rece

关 键 词：Menopausal hormone therapy(MHT) ESTROGENS PROGESTOGENS Women's Health Initiative(WHI)-trial MHT-regimens MHT-indications MHT-risks 

分 类 号：R73[医药卫生—肿瘤]