BACKGROUND Hormone replacement therapy is an effective treatment strategy for the management of symptoms in naturally menopausal women.However,some patients report experiencing adverse effects.AIM To analyze the effec...BACKGROUND Hormone replacement therapy is an effective treatment strategy for the management of symptoms in naturally menopausal women.However,some patients report experiencing adverse effects.AIM To analyze the effects of hormone replacement therapy in menopausal female patients.METHODS A total of 152 menopausal female patients admitted to the Gynecology Department of the Ganzhou Maternal and Child Health Hospital between January 2021 and December 2023 were divided into the observation group(n=76,conventional treatment+hormone replacement therapy)and the control group(n=76,conventional treatment only)via random casting.The improvement observed in the following items were compared between the groups:Kupperman menopausal index(KMI),emotional state[The Positive and Negative Affect Scale(PANAS)],sleep quality[Self-Rating Scale of Sleep(SRSS)],treatment effectiveness,and treatment safety.RESULTS The modified KMI and SRSS scores of the observation group were lower than those of the control group after three rounds of treatment.The improvement in the PANAS score observed in the observation group was greater than that observed in the control group(P<0.05).The total treatment effectivity rate in the observation group was higher than that in the control group(86.84%vs 96.05%,χ2=4.121,P=0.042).The incidence rate of adverse reactions in the two groups was comparable(6.58%vs 9.21%,χ2=0.361,P=0.547).CONCLUSION Hormone replacement therapy effectively improved the clinical symptoms,actively channeled negative emotions,and improved the quality of sleep in menopausal patients,indicating its effectiveness and safety.展开更多
Menopausal syndrome is a common disease of clinical women,which refers to a series of physical and mental symptoms caused by the fluctuation or reduction of sex hormones before and after menopause.Many of these patien...Menopausal syndrome is a common disease of clinical women,which refers to a series of physical and mental symptoms caused by the fluctuation or reduction of sex hormones before and after menopause.Many of these patients have sleep and mood abnormalities that affect their health and quality of life.At present,the understanding of it is gradually improving.This paper mainly analyzes its back-ground and current treatment.展开更多
Marked alterations in the normal female hormonal milieu in the perimenopausal period significantly affect women’s health,leading to decreased well-being,psychological distress,and impaired quality of life.Common meno...Marked alterations in the normal female hormonal milieu in the perimenopausal period significantly affect women’s health,leading to decreased well-being,psychological distress,and impaired quality of life.Common menopausal symp-toms include hot flashes,sleep and mood changes,fatigue,weight gain,and urogenital disturbances.Clinicians often neglect mood swings and disrupted sleep,although those can significantly limit the productivity of women and impair their cognitive function and mental health.Evidence-based management should include a personalized,holistic approach to alleviate symptoms and careful consideration of the risks vs benefits of hormone replacement therapy(HRT),with due consideration of personal preferences.A research paper in the recent issue of the World Journal of Psychiatry by Liu et al investigated the role of HRT in altering mood changes and impaired sleep quality in menopausal women,which helps us to understand the benefits of this treatment approach.展开更多
Menopausal hormone therapy(MHT)has been widely used for the clinical treatment of symptoms associated with menopause in women.However,the exact nature of the relationship between MHT and the increased risk of breast c...Menopausal hormone therapy(MHT)has been widely used for the clinical treatment of symptoms associated with menopause in women.However,the exact nature of the relationship between MHT and the increased risk of breast cancer has not been fully elucidated.The results of the Women’s Health Initiative’s randomized controlled clinical studies showed that estrogen monotherapy was associated with a lower incidence of breast cancer as compared to estrogen-progesterone combined therapy,with an elevated risk of breast cancer.The evidence currently available from randomized trials and observational studies is based on data from different populations,drug formulations,and routes of administration.Even though the risks of MHT and breast cancer have received a great deal of attention,information regarding the unpredictable toxicological risks of estrogen and progestogen metabolism needs to be further analyzed.Furthermore,the diversity and complexity of the metabolic pathways of estrogen and different progestogens as well as the association of the different estrogen and progestogen metabolites with the increased risk of breast cancer need to be adequately studied.Therefore,this review aimed to describe the biological effects of estrogen,progesterone,and their metabolites on the proliferation of breast cancer cells,based on relevant basic research and clinical trials,to improve our understanding of the biological functions of estrogen and progestogen as well as the safety of MHT.展开更多
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...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 receptors in breast cancer tissue or blood can increase this risk.To reduce the risk of venous thromboembolism and stroke,transdermal estradiol(gels,patches,)should be used,in free combination with progesterone or dydrogesterone as"golden standard"in patients with increased risk.To increase the compliance in our patients without special risks we mostly use the available fix-combinations of estradiol/dydrogesterone getting strong efficacy,good menstrual regulation or amenorrhea,respectively,but also other combinations may be indicated to take advantage of for example androgenic or antiandrogenic progestogens.展开更多
Objective To observe the effects of hormone replacement therapy (HRT) on endothelial function in menopausal women. Methods A total of 30 menopausal women were treated with 2.5 mg of Tibolone (Livial) daily. At the sam...Objective To observe the effects of hormone replacement therapy (HRT) on endothelial function in menopausal women. Methods A total of 30 menopausal women were treated with 2.5 mg of Tibolone (Livial) daily. At the same time,30 women with natural menopause without any treatment served as the control group. Endothelium-dependent (EDD),endothelium-independent (NID) vasodilatation function,and estradiol (E2) were examined by the non-invasive high-resolution ultrasonography before the treatment and at 12th,24th,36th and 48th week of treatment,respectively. Results After hormone treatment,E2 increased significantly and EDD was improved significantly (P<0.05),and E2 was positively related with EDD (r=0.8092,P<0.001). No change of EDD was observed in the control group whereas a significant increase was observed in the treatment group. Conclusion Endothelium-dependent vasodilatation dysfunction is prominent in menopausal women. Tibolone can help improve the condition.展开更多
Objective:To investigate the cognition,application and commendation of menopausal hormone therapy(MHT)among medical institution staff with different professional background.Methods:Female staff aged 40-60 years in 4 t...Objective:To investigate the cognition,application and commendation of menopausal hormone therapy(MHT)among medical institution staff with different professional background.Methods:Female staff aged 40-60 years in 4 tertiary hospitals were randomly selected.The participants'characteristics and the information of cognition,application and recommendation of MHT were collected by questionnaire.Results:A total of 341 people participated in this study,the cognition rate of MHT was 37%and the recommendation rate was 44%.For people with indications of MHT,the utilization rate is 15%,and 84.6%of them have used MHT for less than 3 years.84.6%of those who did not use MHT considered menopause is not a disease and there was no need to use medication.Compared with nurses,doctors know more about MHT(P<0.01),and MHT recommendation rate of doctors was higher than that of nurses(P<0.01).The cognition of MHT were analyzed in menopause group,irregular menstruation group and regular menstruation group,there was no difference was found among these three groups(P>0.05).Conclusion:Strengthening the training of MHT related knowledge in medical institutions,will be helpful to improve the cognition and utilization rate of medical institutions and promote the whole society to study and use MHT.展开更多
Background:Reducing disease risk for women after menopause is global health issue.A major portion of the Women’s Health Initiative(WHI)consisted of two clinical trials involving 161,809 post-menopausal women aged 50...Background:Reducing disease risk for women after menopause is global health issue.A major portion of the Women’s Health Initiative(WHI)consisted of two clinical trials involving 161,809 post-menopausal women aged 50–79 that tested the effect of hormone replacement therapy(HRT)on reducing cardiovascular disease and other secondary outcomes.Previous analyses of the data reveal that HRT should not be recommended for postmenopausal women,but show potential benefits for younger women.Thus,there may be a critical period just prior to or during the early stages of menopause where HRT could be both safe and beneficial.Main body:Menopause marks the beginning of a process of non-reversible reduction in estrogen by which estrogen levels decline progressively,followed by a reduction in estrogen receptors.This results in periods of hormone-receptor imbalances,exacerbating the effects of lower serum estrogen and is considered the primarily endocrinal source of menopause symptoms.Eventually a hormone-receptor balance is achieved at a lower level.Here,we purport that the negative outcomes from WHI trials were primarily due to the fact preventive HRT was initiated in women who had already achieved hormone-receptor equilibrium at lower hormonal levels.Conclusion:We argue for further HRT clinical trials in women at varying stages of menopause,including premenopause and early menopause,and in women from different countries.Variation across countries and subgroups in how women experience menopause and perceive menopause symptoms suggest that biocultural differences should be considered in both study design and measurement approaches to test the effectiveness of HRT.Particularly,we recommend longitudinal studies to assess changes in hormonal level over time,and to detect the“most effective period”for HRT to reduce health risk for women going through the whole menopause period.展开更多
Every year in the world a large number of women receive a diagnosis of gynecological cancer and undergo a therapy such as surgery, chemotherapy and radiotherapy to the pelvic region. A large portion of these patients ...Every year in the world a large number of women receive a diagnosis of gynecological cancer and undergo a therapy such as surgery, chemotherapy and radiotherapy to the pelvic region. A large portion of these patients are already in menopause, but for younger patients therapies are responsible of early menopause. The physical and psychological symptoms due to iatrogenic menopause significantly reduce the quality of life; however hormone replacement therapy(HRT) has a high efficacy in reducing menopausal symptoms. The prescription of HRT in patients with story of gynecological cancer is debated because its safety has not been completely proven. The main criticism is based on the theory that the hormone replacement could stimulate growth of residual cancer cells increasing the risk of recurrence.展开更多
Objective: To investigate the effect of perimenopausal hormone replacement therapy(HRT) on cytokine patterns in a perimenopausal mouse model established by ovarian castration. Methods: The mice were divided into natur...Objective: To investigate the effect of perimenopausal hormone replacement therapy(HRT) on cytokine patterns in a perimenopausal mouse model established by ovarian castration. Methods: The mice were divided into natural menopause group,ovariectomy group and HRT group, with 15 mice in each group, and the estrous cycle, estrous frequency and menopausal time of the mice were determined by vaginal cytology,and the estrous cycle, estrous frequency and menopausal time were compared among the three groups. The serum levels of estradiol(E2) and progesterone(P4) in each group were detected by double-antibody sandwich ELISA, and the levels of interferon gamma(IFN-γ), interleukin-2(IL-2), IL-4 and IL-10 in the spleen γ tissues of mice were detected by ELISA. Results: The time of menopause(53.07±3.99) d in the HRT group was between that of the natural menopause group(80.80±3.26) d and that of the ovariectomy group(16.27±4.35) d, with a statistically significant difference in the two-by-two comparison of the three groups(P<0.05). The levels of serum E2(694.4±128.3) ng/L and P4(14.2 ±6.0) ng/L in the HRT therapy group are between those of the ovariectomy group and the natural menopause group, with statistically significant differences between the groups(P<0.05). The levels of IL-2(30.9±5.3) pg/ml, IL-4(9.4±1.6) pg/ml, IL-10(19.7±3.1) pg/ml, IFN-γ(22.0±3.7) pg/ml in the HRT group were all between those of natural menopause group and ovariectomy group. The Th1/Th2 ratio in the ovariectomy group was 7.55±1.57, higher than that in the natural menopause group(1.53±0.48) and HRT group(2.38 ±0.44), with statistically significant differences(P<0.05). Conclusion:Menopausal HRT can partially correct the imbalance of Th1/Th2 cytokines, which is able to provide an experimental basis for the regulation of menopause-related immune imbalance by HRT.展开更多
Objective： To evaluate the efficacy and safety of Heyan Kuntai Capsule（和颜坤泰胶囊, HYKT） and hormone therapy（HT） on perimenopausal syndromes（PMSs）. Methods： From 2005 to 2008, 390 women with PMSs were recrui...Objective： To evaluate the efficacy and safety of Heyan Kuntai Capsule（和颜坤泰胶囊, HYKT） and hormone therapy（HT） on perimenopausal syndromes（PMSs）. Methods： From 2005 to 2008, 390 women with PMSs were recruited from 4 clinic centers. The inclusion criteria included ages 40 to 60 years, estradiol（E2） below 30 ng/L, and follicle stimulating hormone（FSH） above 40 IU/L, etc. The patients were randomly assigned to HYKT group or HT group by random number table method, administrated HYKT or conjugated estrogen with/without medroxyprogesterone acetate tablets for 12 months. During treatment, the patients were interviewed quarterly, Kupperman Menopausal Index（KMI） scores, hot flush scores, insomnia scores, Menopause-Specific Quality of Life（MENQOL） scores and adverse effects were used for evaluating drug efficacy and safety respectively. The last interview was made at the end of 12-month treatment. Results： After treatment, KMI scores of HYKT group and HT group were both significantly decreased compared with baseline（P〈0.01） and there was no significant difference between groups（P〉0.05）, except that KMI of HYKT group was higher after 3-month treatment（P〈0.05）. After treatment, hot flush and insomnia scores were both improved significantly in two groups（P〈0.01）; and HT had a better performance than HYKT in improving hot flush（P〈0.05）. MENQOL were significantly improved in both groups after treatment（P〈0.01）; but there was no significant difference between two groups（P〉0.05）. The incidence of adverse event in the HYKT group was much lower than that in the HT group（P〈0.01）. Conclusions： HYKT could effectively relieve PMSs and improve patient quality of life without severe adverse reactions. Although HYKT exerted curative effects more slowly than hormone, it possessed better safety profile than hormone.展开更多
Background: The Women’s Health Initiative (WHI) published findings in 2002 that changed the perception of the use of hormone replacement therapy (HRT) for the reduction of cardiovascular risks. Menopausal women using...Background: The Women’s Health Initiative (WHI) published findings in 2002 that changed the perception of the use of hormone replacement therapy (HRT) for the reduction of cardiovascular risks. Menopausal women using HRT for the relief of vasomotor symptoms were advised to use the lowest possible dose of HRT over the shortest possible duration. Objective: This study sought to examine patterns of HRT use for the treatment of menopausal symptoms before and after the WHI among women at least 40 years of age. Methods: A retrospective analysis was performed on a total of 1367 women in the pre-WHI group and 6467 women in the post-WHI group using the U.S. General Electric (GE) Centricity electronic medical record database. Menopause diagnosis was assessed using ICD-9 codes. Clinical characteristics and medication use were assessed for women with at least 3 years of enrollment (1 year baseline, 2 years follow-up). Results: The proportion of women in the post-WHI group that initiated HRT was significantly less than that of women in the pre-WHI group (31.3% vs. 56.9%, respectively;p < 0.001). Combination HRT use declined significantly (21.9% pre-WHI cohort vs. 7.2% post- WHI cohort, p < 0.001) among increases in non-HRT use, namely SSRIs (15.2% pre-WHI cohort v. 22.3% post-WHI cohort, p < 0.001) and tranquilizers (9.5% pre-WHI cohort v. 15.8% post-WHI cohort, p < 0.001). Conclusion: The results of the WHI 2002 publication made an impression on the perception of HRT’s role in the relief of menopausal symptoms. Decision-making on the part of women seeking treatment for vasomotor symptoms and women’s health professionals demonstrates that despite HRT precautions, women continue to exhibit a need for HRT use. This study’s findings suggest that women seeking treatment for menopausal symptom relief and women’s health professionals continue to work together to find the appropriate balance between therapy use and adherence to therapy use guidelines.展开更多
In the present study, we aimed to retrospectively analyze the medication prescriptions of menopausal women diagnosed with menopausal syndrome in our hospital from 2015 to 2018, and compare the retention rate of estrog...In the present study, we aimed to retrospectively analyze the medication prescriptions of menopausal women diagnosed with menopausal syndrome in our hospital from 2015 to 2018, and compare the retention rate of estrogen and progesterone sequential therapy and hormone continuous therapy in menopausal women. The rational drug management system of Ningbo Women and Children’s hospital was used to screen the prescriptions of menopausal syndrome in 4 years. After the age, year included in the study, and prescription cost were adjusted, Kaplan-Meier regression analysis was performed to compare the prescription retention rates of the two drug regimens. The distribution of the two HRT regimens in the 4 years showed an increasing trend year by year, and the age groups of the two HRT regimens were mainly distributed between 41 and 60 years old, accounting for 97.1% and 87.06%, respectively. The cost distribution for the other two HRT regimens was approximately the same. Compared with the two HRT regimens, the drug retention rate of hormone continuous regimens was higher than that of hormone sequential regimens within 4 years. Kaplan-Meier regression analysis showed that the trend was significant(Tarone-Ware, Chi-square value = 3.857, P = 0.050). This study found that the median retention time of HRT therapy in menopausal women in our hospital was about half a year, which was significantly lower than that reported in previous studies of 1 year or longer. In addition, the present study found that compared with Femoston, the tibolone regimen significantly increased retention time in the treatment of menopausal syndrome.展开更多
Background Studies showed that arterial elasticity changes appear earlier than any structural changes, therefore, its accurate evaluation could be applied at early stage to prevent disease. Echo-tracking（E-tracking）...Background Studies showed that arterial elasticity changes appear earlier than any structural changes, therefore, its accurate evaluation could be applied at early stage to prevent disease. Echo-tracking（E-tracking） technique can track the wall motion trajectory in real-time, calculate the change in vascular diameter automatically, and assessment of vascular stiffness and flexibility directly. This article aims to assess the change of elasticity of carotid artery after hormone therapy （HT） using Echo-tracking technology. Methods Echotracking was used to evaluate the carotid elastic moduli, such as the pressure-strain elastic modulus （Ep）, stiffness parameter （β）, arterial compliance （AC）, pulse wave conducting velocity （PWVβ） and augmentation index （AI） by Aloka α10 color Doppler ultrasound diagnosis system. Results Ep,β and PWVβ in HT group were significantly lower than those in the control group （P 〈 0.01）, while AC was obviously higher than the control group （P 〈 0.01）. E2 was negatively related to β, Ep and PWVβ （r = -0.607, r = -0.573, r = -0.574, P 〈 0.001）, while positively related to AC （r = 0.574, P 〈 0.001）; endothelial-dependent dilatation （EDD） was negatively related to β, Ep and PWVβ （r = -0.521, r = -0.411, r = -0.456, P 〈 0.001）, while positively related to AC （r = 0.443, P 〈 0.001）; But IMT was positively related to β, Ep and PWVβ（r = 0.553, r = 0.444, r = 0.529, P 〈 0.001）, while negatively related to AC （r = -0.400, P 〈 0.001）. Conclusions Arterial stiffness increases and compliance decreases in menopausal women. As EDD decreases arterial elasticity recedes, and HT can improve arterial elasticity. E-tracking technology can discover the early changes in arterial stiffness effectively and it is more sensitive in finding out the changes of stiffness in early atherosclerosis than IMT of carotid artery.展开更多
Objective To assess the effects of hormone replacement therapy (HRT) on platelet activation in postmenopausal women compared with premenopausal women. Methods The expressions of CD41 and CD62P in fifteen postmenopau...Objective To assess the effects of hormone replacement therapy (HRT) on platelet activation in postmenopausal women compared with premenopausal women. Methods The expressions of CD41 and CD62P in fifteen postmenopausal women before and after HRT were detected using flow cytometry (FCM),with fifteen premenopausal women with a mean age of 47 years as controls.Results The expressions of CD41 and CD62P in postmenopausal women were higher than those in the control group. CD62P(%),CD62P(I) and CD41 were reduced from 36.40±5.9,37.75±5.8,and 470.11±74.0 to 27.97±5.6,26.64±4.9,and 303.23±72.8 after six months of HRT ( P <0.05). Conclusions Platelet activation in postmenopausal women was higher than in premenopausal women and was reduced significantly after six months of HRT. HRT may have a favorable effect on reduction of platelet activity.展开更多
Objective: The influence of hormone replacement therapy (HRT) on hemostasis processes depends on the type of hormone,the combination of doses,the time of taking HRT,and the route of administration (oral,transdermal,im...Objective: The influence of hormone replacement therapy (HRT) on hemostasis processes depends on the type of hormone,the combination of doses,the time of taking HRT,and the route of administration (oral,transdermal,implanted).The aim of the current study was to assess some parameters of coagulation,especially tissue factor pathway inhibitor (TFPI) and tissue factor (TF) in postmenopausal women using oral or transdermal HRT.Methods: The study was conducted on 76 healthy women,including 46 women aged 44–58 years who were taking oral (26) or transdermal (20) HRT,and 30 women aged 44–54 years who did not take HRT as the control group.Plasma concentrations of TF,TFPI,thrombin-antithrombin complex (TAT),and D-dimer were performed by enzyme-linked immunosorbent assay (ELISA).Moreover,the concentration of fibrinogen and activity of protein C were measured by chromogenic and chronometric methods.Results: We observed a significantly higher concentration of TF and a significantly lower concentration of TFPI in women taking oral and transdermal HRT in comparison with the control group.We also found a significantly lower concentration of fibrinogen in women taking oral HRT vs.the control group.Moreover,no statistically significant changes in concentrations of TAT and D-dimer,or activity of protein C were noted.Conclusions: In this study,the occurrence of an increased TF concentration simultaneously with a decreased concentration of TFPI in women taking HRT indicates hypercoagulability.No significant modification of TAT or D-dimer occurred,and thus there may not be increased risk of thrombosis.展开更多
文摘BACKGROUND Hormone replacement therapy is an effective treatment strategy for the management of symptoms in naturally menopausal women.However,some patients report experiencing adverse effects.AIM To analyze the effects of hormone replacement therapy in menopausal female patients.METHODS A total of 152 menopausal female patients admitted to the Gynecology Department of the Ganzhou Maternal and Child Health Hospital between January 2021 and December 2023 were divided into the observation group(n=76,conventional treatment+hormone replacement therapy)and the control group(n=76,conventional treatment only)via random casting.The improvement observed in the following items were compared between the groups:Kupperman menopausal index(KMI),emotional state[The Positive and Negative Affect Scale(PANAS)],sleep quality[Self-Rating Scale of Sleep(SRSS)],treatment effectiveness,and treatment safety.RESULTS The modified KMI and SRSS scores of the observation group were lower than those of the control group after three rounds of treatment.The improvement in the PANAS score observed in the observation group was greater than that observed in the control group(P<0.05).The total treatment effectivity rate in the observation group was higher than that in the control group(86.84%vs 96.05%,χ2=4.121,P=0.042).The incidence rate of adverse reactions in the two groups was comparable(6.58%vs 9.21%,χ2=0.361,P=0.547).CONCLUSION Hormone replacement therapy effectively improved the clinical symptoms,actively channeled negative emotions,and improved the quality of sleep in menopausal patients,indicating its effectiveness and safety.
基金Research Project of Nantong Health and Health Commission,No.MS2023041,No.MA2019003,and No.MA2021017Science and Technology Program of Nantong City,No.Key03,and No.JCZ2022040and Kangda College of Nanjing Medical University,No.KD2021JYYJYB025,No.KD2022KYJJZD019,and No.KD2022KYJJZD022.
文摘Menopausal syndrome is a common disease of clinical women,which refers to a series of physical and mental symptoms caused by the fluctuation or reduction of sex hormones before and after menopause.Many of these patients have sleep and mood abnormalities that affect their health and quality of life.At present,the understanding of it is gradually improving.This paper mainly analyzes its back-ground and current treatment.
文摘Marked alterations in the normal female hormonal milieu in the perimenopausal period significantly affect women’s health,leading to decreased well-being,psychological distress,and impaired quality of life.Common menopausal symp-toms include hot flashes,sleep and mood changes,fatigue,weight gain,and urogenital disturbances.Clinicians often neglect mood swings and disrupted sleep,although those can significantly limit the productivity of women and impair their cognitive function and mental health.Evidence-based management should include a personalized,holistic approach to alleviate symptoms and careful consideration of the risks vs benefits of hormone replacement therapy(HRT),with due consideration of personal preferences.A research paper in the recent issue of the World Journal of Psychiatry by Liu et al investigated the role of HRT in altering mood changes and impaired sleep quality in menopausal women,which helps us to understand the benefits of this treatment approach.
基金This study was supported by grants from the National Natural Science Foundation of China(Grant Nos.61673024 and 81971348)the Clinical Medicine Plus X-Young Scholar Project,Peking University,and the Fundamental Research Funds for the Central University(Grant No.PKU2018LCXQ001).
文摘Menopausal hormone therapy(MHT)has been widely used for the clinical treatment of symptoms associated with menopause in women.However,the exact nature of the relationship between MHT and the increased risk of breast cancer has not been fully elucidated.The results of the Women’s Health Initiative’s randomized controlled clinical studies showed that estrogen monotherapy was associated with a lower incidence of breast cancer as compared to estrogen-progesterone combined therapy,with an elevated risk of breast cancer.The evidence currently available from randomized trials and observational studies is based on data from different populations,drug formulations,and routes of administration.Even though the risks of MHT and breast cancer have received a great deal of attention,information regarding the unpredictable toxicological risks of estrogen and progestogen metabolism needs to be further analyzed.Furthermore,the diversity and complexity of the metabolic pathways of estrogen and different progestogens as well as the association of the different estrogen and progestogen metabolites with the increased risk of breast cancer need to be adequately studied.Therefore,this review aimed to describe the biological effects of estrogen,progesterone,and their metabolites on the proliferation of breast cancer cells,based on relevant basic research and clinical trials,to improve our understanding of the biological functions of estrogen and progestogen as well as the safety of MHT.
基金supported by National Natural Science Foundation of China(No.81671411)Beijing Municipal Administration of Hospitals’Ascent Plan of China(No.DFL20181401).
文摘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 receptors in breast cancer tissue or blood can increase this risk.To reduce the risk of venous thromboembolism and stroke,transdermal estradiol(gels,patches,)should be used,in free combination with progesterone or dydrogesterone as"golden standard"in patients with increased risk.To increase the compliance in our patients without special risks we mostly use the available fix-combinations of estradiol/dydrogesterone getting strong efficacy,good menstrual regulation or amenorrhea,respectively,but also other combinations may be indicated to take advantage of for example androgenic or antiandrogenic progestogens.
文摘Objective To observe the effects of hormone replacement therapy (HRT) on endothelial function in menopausal women. Methods A total of 30 menopausal women were treated with 2.5 mg of Tibolone (Livial) daily. At the same time,30 women with natural menopause without any treatment served as the control group. Endothelium-dependent (EDD),endothelium-independent (NID) vasodilatation function,and estradiol (E2) were examined by the non-invasive high-resolution ultrasonography before the treatment and at 12th,24th,36th and 48th week of treatment,respectively. Results After hormone treatment,E2 increased significantly and EDD was improved significantly (P<0.05),and E2 was positively related with EDD (r=0.8092,P<0.001). No change of EDD was observed in the control group whereas a significant increase was observed in the treatment group. Conclusion Endothelium-dependent vasodilatation dysfunction is prominent in menopausal women. Tibolone can help improve the condition.
文摘Objective:To investigate the cognition,application and commendation of menopausal hormone therapy(MHT)among medical institution staff with different professional background.Methods:Female staff aged 40-60 years in 4 tertiary hospitals were randomly selected.The participants'characteristics and the information of cognition,application and recommendation of MHT were collected by questionnaire.Results:A total of 341 people participated in this study,the cognition rate of MHT was 37%and the recommendation rate was 44%.For people with indications of MHT,the utilization rate is 15%,and 84.6%of them have used MHT for less than 3 years.84.6%of those who did not use MHT considered menopause is not a disease and there was no need to use medication.Compared with nurses,doctors know more about MHT(P<0.01),and MHT recommendation rate of doctors was higher than that of nurses(P<0.01).The cognition of MHT were analyzed in menopause group,irregular menstruation group and regular menstruation group,there was no difference was found among these three groups(P>0.05).Conclusion:Strengthening the training of MHT related knowledge in medical institutions,will be helpful to improve the cognition and utilization rate of medical institutions and promote the whole society to study and use MHT.
文摘Background:Reducing disease risk for women after menopause is global health issue.A major portion of the Women’s Health Initiative(WHI)consisted of two clinical trials involving 161,809 post-menopausal women aged 50–79 that tested the effect of hormone replacement therapy(HRT)on reducing cardiovascular disease and other secondary outcomes.Previous analyses of the data reveal that HRT should not be recommended for postmenopausal women,but show potential benefits for younger women.Thus,there may be a critical period just prior to or during the early stages of menopause where HRT could be both safe and beneficial.Main body:Menopause marks the beginning of a process of non-reversible reduction in estrogen by which estrogen levels decline progressively,followed by a reduction in estrogen receptors.This results in periods of hormone-receptor imbalances,exacerbating the effects of lower serum estrogen and is considered the primarily endocrinal source of menopause symptoms.Eventually a hormone-receptor balance is achieved at a lower level.Here,we purport that the negative outcomes from WHI trials were primarily due to the fact preventive HRT was initiated in women who had already achieved hormone-receptor equilibrium at lower hormonal levels.Conclusion:We argue for further HRT clinical trials in women at varying stages of menopause,including premenopause and early menopause,and in women from different countries.Variation across countries and subgroups in how women experience menopause and perceive menopause symptoms suggest that biocultural differences should be considered in both study design and measurement approaches to test the effectiveness of HRT.Particularly,we recommend longitudinal studies to assess changes in hormonal level over time,and to detect the“most effective period”for HRT to reduce health risk for women going through the whole menopause period.
文摘Every year in the world a large number of women receive a diagnosis of gynecological cancer and undergo a therapy such as surgery, chemotherapy and radiotherapy to the pelvic region. A large portion of these patients are already in menopause, but for younger patients therapies are responsible of early menopause. The physical and psychological symptoms due to iatrogenic menopause significantly reduce the quality of life; however hormone replacement therapy(HRT) has a high efficacy in reducing menopausal symptoms. The prescription of HRT in patients with story of gynecological cancer is debated because its safety has not been completely proven. The main criticism is based on the theory that the hormone replacement could stimulate growth of residual cancer cells increasing the risk of recurrence.
文摘Objective: To investigate the effect of perimenopausal hormone replacement therapy(HRT) on cytokine patterns in a perimenopausal mouse model established by ovarian castration. Methods: The mice were divided into natural menopause group,ovariectomy group and HRT group, with 15 mice in each group, and the estrous cycle, estrous frequency and menopausal time of the mice were determined by vaginal cytology,and the estrous cycle, estrous frequency and menopausal time were compared among the three groups. The serum levels of estradiol(E2) and progesterone(P4) in each group were detected by double-antibody sandwich ELISA, and the levels of interferon gamma(IFN-γ), interleukin-2(IL-2), IL-4 and IL-10 in the spleen γ tissues of mice were detected by ELISA. Results: The time of menopause(53.07±3.99) d in the HRT group was between that of the natural menopause group(80.80±3.26) d and that of the ovariectomy group(16.27±4.35) d, with a statistically significant difference in the two-by-two comparison of the three groups(P<0.05). The levels of serum E2(694.4±128.3) ng/L and P4(14.2 ±6.0) ng/L in the HRT therapy group are between those of the ovariectomy group and the natural menopause group, with statistically significant differences between the groups(P<0.05). The levels of IL-2(30.9±5.3) pg/ml, IL-4(9.4±1.6) pg/ml, IL-10(19.7±3.1) pg/ml, IFN-γ(22.0±3.7) pg/ml in the HRT group were all between those of natural menopause group and ovariectomy group. The Th1/Th2 ratio in the ovariectomy group was 7.55±1.57, higher than that in the natural menopause group(1.53±0.48) and HRT group(2.38 ±0.44), with statistically significant differences(P<0.05). Conclusion:Menopausal HRT can partially correct the imbalance of Th1/Th2 cytokines, which is able to provide an experimental basis for the regulation of menopause-related immune imbalance by HRT.
基金Supported by the"Tenth-Five"National Medical Science and Technique Foundation,China(No.2004BA720A08)
文摘Objective： To evaluate the efficacy and safety of Heyan Kuntai Capsule（和颜坤泰胶囊, HYKT） and hormone therapy（HT） on perimenopausal syndromes（PMSs）. Methods： From 2005 to 2008, 390 women with PMSs were recruited from 4 clinic centers. The inclusion criteria included ages 40 to 60 years, estradiol（E2） below 30 ng/L, and follicle stimulating hormone（FSH） above 40 IU/L, etc. The patients were randomly assigned to HYKT group or HT group by random number table method, administrated HYKT or conjugated estrogen with/without medroxyprogesterone acetate tablets for 12 months. During treatment, the patients were interviewed quarterly, Kupperman Menopausal Index（KMI） scores, hot flush scores, insomnia scores, Menopause-Specific Quality of Life（MENQOL） scores and adverse effects were used for evaluating drug efficacy and safety respectively. The last interview was made at the end of 12-month treatment. Results： After treatment, KMI scores of HYKT group and HT group were both significantly decreased compared with baseline（P〈0.01） and there was no significant difference between groups（P〉0.05）, except that KMI of HYKT group was higher after 3-month treatment（P〈0.05）. After treatment, hot flush and insomnia scores were both improved significantly in two groups（P〈0.01）; and HT had a better performance than HYKT in improving hot flush（P〈0.05）. MENQOL were significantly improved in both groups after treatment（P〈0.01）; but there was no significant difference between two groups（P〉0.05）. The incidence of adverse event in the HYKT group was much lower than that in the HT group（P〈0.01）. Conclusions： HYKT could effectively relieve PMSs and improve patient quality of life without severe adverse reactions. Although HYKT exerted curative effects more slowly than hormone, it possessed better safety profile than hormone.
文摘Background: The Women’s Health Initiative (WHI) published findings in 2002 that changed the perception of the use of hormone replacement therapy (HRT) for the reduction of cardiovascular risks. Menopausal women using HRT for the relief of vasomotor symptoms were advised to use the lowest possible dose of HRT over the shortest possible duration. Objective: This study sought to examine patterns of HRT use for the treatment of menopausal symptoms before and after the WHI among women at least 40 years of age. Methods: A retrospective analysis was performed on a total of 1367 women in the pre-WHI group and 6467 women in the post-WHI group using the U.S. General Electric (GE) Centricity electronic medical record database. Menopause diagnosis was assessed using ICD-9 codes. Clinical characteristics and medication use were assessed for women with at least 3 years of enrollment (1 year baseline, 2 years follow-up). Results: The proportion of women in the post-WHI group that initiated HRT was significantly less than that of women in the pre-WHI group (31.3% vs. 56.9%, respectively;p < 0.001). Combination HRT use declined significantly (21.9% pre-WHI cohort vs. 7.2% post- WHI cohort, p < 0.001) among increases in non-HRT use, namely SSRIs (15.2% pre-WHI cohort v. 22.3% post-WHI cohort, p < 0.001) and tranquilizers (9.5% pre-WHI cohort v. 15.8% post-WHI cohort, p < 0.001). Conclusion: The results of the WHI 2002 publication made an impression on the perception of HRT’s role in the relief of menopausal symptoms. Decision-making on the part of women seeking treatment for vasomotor symptoms and women’s health professionals demonstrates that despite HRT precautions, women continue to exhibit a need for HRT use. This study’s findings suggest that women seeking treatment for menopausal symptom relief and women’s health professionals continue to work together to find the appropriate balance between therapy use and adherence to therapy use guidelines.
基金Ningbo Public Welfare Science and Technology Plan(Grant No.2019C50089)。
文摘In the present study, we aimed to retrospectively analyze the medication prescriptions of menopausal women diagnosed with menopausal syndrome in our hospital from 2015 to 2018, and compare the retention rate of estrogen and progesterone sequential therapy and hormone continuous therapy in menopausal women. The rational drug management system of Ningbo Women and Children’s hospital was used to screen the prescriptions of menopausal syndrome in 4 years. After the age, year included in the study, and prescription cost were adjusted, Kaplan-Meier regression analysis was performed to compare the prescription retention rates of the two drug regimens. The distribution of the two HRT regimens in the 4 years showed an increasing trend year by year, and the age groups of the two HRT regimens were mainly distributed between 41 and 60 years old, accounting for 97.1% and 87.06%, respectively. The cost distribution for the other two HRT regimens was approximately the same. Compared with the two HRT regimens, the drug retention rate of hormone continuous regimens was higher than that of hormone sequential regimens within 4 years. Kaplan-Meier regression analysis showed that the trend was significant(Tarone-Ware, Chi-square value = 3.857, P = 0.050). This study found that the median retention time of HRT therapy in menopausal women in our hospital was about half a year, which was significantly lower than that reported in previous studies of 1 year or longer. In addition, the present study found that compared with Femoston, the tibolone regimen significantly increased retention time in the treatment of menopausal syndrome.
文摘Background Studies showed that arterial elasticity changes appear earlier than any structural changes, therefore, its accurate evaluation could be applied at early stage to prevent disease. Echo-tracking（E-tracking） technique can track the wall motion trajectory in real-time, calculate the change in vascular diameter automatically, and assessment of vascular stiffness and flexibility directly. This article aims to assess the change of elasticity of carotid artery after hormone therapy （HT） using Echo-tracking technology. Methods Echotracking was used to evaluate the carotid elastic moduli, such as the pressure-strain elastic modulus （Ep）, stiffness parameter （β）, arterial compliance （AC）, pulse wave conducting velocity （PWVβ） and augmentation index （AI） by Aloka α10 color Doppler ultrasound diagnosis system. Results Ep,β and PWVβ in HT group were significantly lower than those in the control group （P 〈 0.01）, while AC was obviously higher than the control group （P 〈 0.01）. E2 was negatively related to β, Ep and PWVβ （r = -0.607, r = -0.573, r = -0.574, P 〈 0.001）, while positively related to AC （r = 0.574, P 〈 0.001）; endothelial-dependent dilatation （EDD） was negatively related to β, Ep and PWVβ （r = -0.521, r = -0.411, r = -0.456, P 〈 0.001）, while positively related to AC （r = 0.443, P 〈 0.001）; But IMT was positively related to β, Ep and PWVβ（r = 0.553, r = 0.444, r = 0.529, P 〈 0.001）, while negatively related to AC （r = -0.400, P 〈 0.001）. Conclusions Arterial stiffness increases and compliance decreases in menopausal women. As EDD decreases arterial elasticity recedes, and HT can improve arterial elasticity. E-tracking technology can discover the early changes in arterial stiffness effectively and it is more sensitive in finding out the changes of stiffness in early atherosclerosis than IMT of carotid artery.
文摘Objective To assess the effects of hormone replacement therapy (HRT) on platelet activation in postmenopausal women compared with premenopausal women. Methods The expressions of CD41 and CD62P in fifteen postmenopausal women before and after HRT were detected using flow cytometry (FCM),with fifteen premenopausal women with a mean age of 47 years as controls.Results The expressions of CD41 and CD62P in postmenopausal women were higher than those in the control group. CD62P(%),CD62P(I) and CD41 were reduced from 36.40±5.9,37.75±5.8,and 470.11±74.0 to 27.97±5.6,26.64±4.9,and 303.23±72.8 after six months of HRT ( P <0.05). Conclusions Platelet activation in postmenopausal women was higher than in premenopausal women and was reduced significantly after six months of HRT. HRT may have a favorable effect on reduction of platelet activity.
基金Project (No.73/04) supported by the Collegium Medicum in Bydgoszcz,Nicolaus Copernicus University in Toruń,Poland
文摘Objective: The influence of hormone replacement therapy (HRT) on hemostasis processes depends on the type of hormone,the combination of doses,the time of taking HRT,and the route of administration (oral,transdermal,implanted).The aim of the current study was to assess some parameters of coagulation,especially tissue factor pathway inhibitor (TFPI) and tissue factor (TF) in postmenopausal women using oral or transdermal HRT.Methods: The study was conducted on 76 healthy women,including 46 women aged 44–58 years who were taking oral (26) or transdermal (20) HRT,and 30 women aged 44–54 years who did not take HRT as the control group.Plasma concentrations of TF,TFPI,thrombin-antithrombin complex (TAT),and D-dimer were performed by enzyme-linked immunosorbent assay (ELISA).Moreover,the concentration of fibrinogen and activity of protein C were measured by chromogenic and chronometric methods.Results: We observed a significantly higher concentration of TF and a significantly lower concentration of TFPI in women taking oral and transdermal HRT in comparison with the control group.We also found a significantly lower concentration of fibrinogen in women taking oral HRT vs.the control group.Moreover,no statistically significant changes in concentrations of TAT and D-dimer,or activity of protein C were noted.Conclusions: In this study,the occurrence of an increased TF concentration simultaneously with a decreased concentration of TFPI in women taking HRT indicates hypercoagulability.No significant modification of TAT or D-dimer occurred,and thus there may not be increased risk of thrombosis.
