HOMONEREPLACEMENTTHERAPY(HRT:激素替代疗法(HRT.ppt
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1、 MENOPAUSE第一页,共五十四页。WHAT?nMenopauseisadeviationoftheancientGreekwordsmenos(month)andpauses(ending).nThemenopauseissometimesknownasthechangeoflifeandismarkedbytheendingofmenstruation.第二页,共五十四页。WHAT?n nItbedefinedwithcertaintyaftertwelvemonthsspontaneousamenorrhoea.n nEndofreproductivelife.第三页,共五十四页。A
2、ge(years)Pre-menopausePost-menopauseMENOPAUSE1YEARPeri-menopause“Climacteric”RELATED TERMINOLOGY第四页,共五十四页。WHEN?n nMenopausalage:45-55years(mean:50.7years)n nIfthemenopauseoccursinawomanwhoisunder45yearsofage,itisknownasprematuremenopause.n nLatemenopause:55yearsold第五页,共五十四页。WHEN?n nOtherfactorsthatc
3、anaffecttheageatwhichwomenhavetheirfinalperiodincludeageatmenarche,parity,previousoralcontraceptivehistoryethnicityandfamilyhistory.第六页,共五十四页。WHY?RELATIVEACTIVITYOFESTROGENRELATIVEACTIVITYOFESTROGEN第七页,共五十四页。WHY?n nThemenopauseistheendofeggproduction(ovulation).Thisoccursasaresultoffallinglevelsofth
4、efemalesexhormoneoestrogen,whichregulatesawomansperiods.第八页,共五十四页。WHY?n nThemenopauseresultsfromafallinthelevelofthefemalehormoneoestrogenintheblood.第九页,共五十四页。WHY?n nAtahormonallevel-asovarianfollicularactivitybeginstofail,oestrogenandprogesteronelevelsfallandthereducednegativefeedbacktothepituitary
5、causesariseinluteinisinghormone(LH)andfolliclestimulatinghormone(FSH).第十页,共五十四页。HOW?n nOestrogenreductioneventuallyresultsinmenstrualcycledisruptionandothermenopausalsymptoms.第十一页,共五十四页。HOW?n nOestrogenreductioneventuallyresultsinmenstrualcycledisruptionandothermenopausalsymptoms.*FSHhigh(30170mU/ml
6、)*LHhigh(2080mU/ml)*Estradiollow(110pmol/L)第十二页,共五十四页。Vasomotor SymptomsVasomotor SymptomsSleep DisordersSleep DisordersMenstrual DisordersMenstrual DisordersMood ChangesMood ChangesVaginal AtrophyVaginal AtrophyDyspareuniaDyspareuniaSkin AtrophySkin AtrophyOsteoporosisOsteoporosisAtherosclerosisAth
7、erosclerosisCoronary Heart DiseaseCoronary Heart DiseaseCerebrovascular DiseaseCerebrovascular Disease40 yrs40 yrs50 yrs50 yrsMenopauseMenopause60 yrs60 yrsSYMPTOMS!ONSETOFSYMPTOMSINRELATIONTOAGEOFMENOPAUSE第十三页,共五十四页。SYMPTOMS!n nChangesinyourperiodtimebetweenperiodsorflowmayChangesinyourperiodtimebe
8、tweenperiodsorflowmaybedifferent.bedifferent.n nHotflashes(“hotflushes”)gettingwarmintheface,neckHotflashes(“hotflushes”)gettingwarmintheface,neckandchest.andchest.n nNightsweatsandsleepingproblemsthatmayleadtofeelingNightsweatsandsleepingproblemsthatmayleadtofeelingtired,stressedortense.tired,stres
9、sedortense.n nVaginalchangesthevaginamaybecomedryandthin,andsexVaginalchangesthevaginamaybecomedryandthin,andsexmaybepainful.maybepainful.n nThinningofyourbones,whichmayleadtolossofheightandThinningofyourbones,whichmayleadtolossofheightandbonebreaks(osteoporosis).bonebreaks(osteoporosis).第十四页,共五十四页。
10、SYMPTOMS!n nItisestimatedthat8outof10womenintheUKexperiencesymptomsleadinguptothemenopause.n nOfthese,45%findtheirsymptomsdifficulttodealwith.第十五页,共五十四页。SYMPTOMS!n nWithouttreatment,mostmenopausalsymptomsgraduallystopnaturally.Thisusuallyhappenstwotofiveyearsafterthesymptomsstart.n nAlthoughsomewome
11、nexperiencesymptomsformanymoreyears.第十六页,共五十四页。SYMPTOMS!第十七页,共五十四页。SYMPTOMS!NORMALTRABECULARBONEOSTEROPEROTICBONE第十八页,共五十四页。TREATMENTn nOnly1in10womenseekmedicaladvicewhentheygothroughthemenopauseandmanydonotneedanytreatment.n nIfmenopausalsymptomsaresevereenoughtointerferewithdailylife,therearetrea
12、tmentsthatcanhelp.第十九页,共五十四页。TREATMENTn nThekindoftreatmentyoucantakedependsontheseverityofthesymptoms,medicalhistoryandpatientsownpreferences.第二十页,共五十四页。TREATMENTn nHRTn nNON-HRT第二十一页,共五十四页。HOMONE REPLACEMENT THERAPY(HRT)n nAsthenamesuggests,HRTworksbyreplacingoestrogen.n nHormonereplacementtherapy
13、(HRT)canbeaneffectivetreatmentforthetypicalmenopause-relatedsymptoms.第二十二页,共五十四页。HOMONE REPLACEMENT THERAPY(HRT)n nHRTmayalsohaveaninfluenceonthelongtermhealthproblems(osteoporosis,cardiovascular diseaseandstroke),thoughitshouldbenotedthatitdoesnotnecessarilyreducetheirriskforallwomen.第二十三页,共五十四页。HO
14、MONE REPLACEMENT THERAPY(HRT)BENEFITSBENEFITSRISKSRISKS第二十四页,共五十四页。HOMONE REPLACEMENT THERAPY(HRT)n nForthetreatmentofmenopausalsymptomswheretherisk-benefitratio*isfavorable,infullyinformedwomen,inthelowestpossibledosetocontrolsymptomsandfortheshortestdurationpossible.第二十五页,共五十四页。HOMONE REPLACEMENT
15、THERAPY(HRT)n nBENEFITSRelievemenopausalsymptomsMaintenanceofqualityoflifePreventionofosteoporosisNote:HRTshouldnotbeusedasafirst-linetreatmentinosteoparosisexceptinNote:HRTshouldnotbeusedasafirst-linetreatmentinosteoparosisexceptinwomenwhohavewomenwhohavepremature menopausepremature menopause 第二十六页
16、,共五十四页。HOMONE REPLACEMENT THERAPY(HRT)n nRISKS OF VTEHRT(combinedoroestrogen-alone)increasestheriskofadeepveinHRT(combinedoroestrogen-alone)increasestheriskofadeepveinthrombosisorpulmonaryembolism,especiallyinthefirstyearofthrombosisorpulmonaryembolism,especiallyinthefirstyearoftreatment.Theriskismo
17、repronouncedinwomenwithpre-existingtreatment.Theriskismorepronouncedinwomenwithpre-existingriskfactors.riskfactors.Arecentmeta-analysissuggeststhattransdermaloestrogensmayArecentmeta-analysissuggeststhattransdermaloestrogensmaybeasaferoptionthanoraloestrogensforHRTbeasaferoptionthanoraloestrogensfor
18、HRT.第二十七页,共五十四页。HOMONE REPLACEMENT THERAPY(HRT)n nRISKS OF BREAST CANCERn nTheThe increasedincreased breastbreast cancercancer riskrisk isis proportionalproportional toto thethedurationdurationofofHRT.HRT.HRTHRTincreasesincreasesthisthisriskriskbybyaboutabout1.6times1.6timesafterafter55yearsyearsofo
19、fuseuseandand2.3times2.3timesafterafter10years10yearsofofuse.use.RiskRiskdecreasesdecreaseswithinwithinafewyearsofstoppingHRT.afewyearsofstoppingHRT.nWomen considering HRT should be counselled that theabsolute risk for breast cancer for any individualremains relatively low*HeractualriskincreasesHera
20、ctualriskincreases0.08%0.08%(ACOG)(ACOG)第二十八页,共五十四页。HOMONE REPLACEMENT THERAPY(HRT)n nRISKS OF ENDOMETRIAL CANCEREndometrialcancer:increasedriskonlywithunopposedEndometrialcancer:increasedriskonlywithunopposedoestrogen.Thereisnoincreasedriskwithcombinedoestrogen.Thereisnoincreasedriskwithcombined(oe
21、strogenandprogestogen)HRT.(oestrogenandprogestogen)HRT.RISKS OF OVARIAN CANCERlong-termuseofoestrogen-onlyHRTandcombinedHRTmaylong-termuseofoestrogen-onlyHRTandcombinedHRTmayslightlyincreasetherisk.RiskdecreasesafterstoppingHRT.slightlyincreasetherisk.RiskdecreasesafterstoppingHRT.第二十九页,共五十四页。HOMONE
22、 REPLACEMENT THERAPY(HRT)n nRISKS OF CARDIOVASCULAR DISEASEThereisnotthesameevidenceofcardioprotectionThereisnotthesameevidenceofcardioprotectionfromHRTaswasoriginallythought.fromHRTaswasoriginallythought.AssessallwomensriskofCHDpriortostartingAssessallwomensriskofCHDpriortostartingHRT.HRT.第三十页,共五十四
23、页。HRTE+PEHOMONE REPLACEMENT THERAPY(HRT)第三十一页,共五十四页。E+PEForForhysterectomizedhysterectomizedptsptsHOMONE REPLACEMENT THERAPY(HRT)sSequentially Sequentially combined HRTcombined HRT E(continuouslyE(continuouslyD1-D21)D1-D21)P(sequentiallyP(sequentiallyD11-D21)D11-D21)Continuous Continuous combined HR
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