2016年，国际绝经学会在《临床绝经》发表推荐意见，对绝经期激素疗法的安全性证据进行了更新。
根据推荐意见，绝经期激素疗法主要包括替勃龙以及共轭雌激素和巴多昔芬复合剂（CE/BZA）。在任何年龄段的女性，绝经期激素疗法都是治疗绝经期血管舒缩障碍最有效的方法。若在女性60岁前或绝经后10年内开始绝经期激素疗法，则其获益将大于风险。
绝经期激素疗法是唯一经随机对照研究证实可有效降低绝经后女性骨折风险的治疗方法，可显著降低绝经后女性发生股骨骨折、脊椎骨折和其他与骨质疏松相关骨折的风险。
随机对照研究、观察性资料和荟萃分析研究证实，对于年龄小于60岁或绝经后10年内的女性，只使用标准剂量雌激素的绝经期激素疗法可能会降低冠心病和全因死亡率。
对于接受绝经期激素疗法且年龄大于50岁的女性，有关其乳腺癌发生风险的问题较为复杂。有随机对照研究显示子宫切除术后女性单独使用雌激素治疗，其乳腺癌发生风险降低；而对于子宫未切除的女性，雌激素联合孕激素治疗可增加乳腺癌发生风险。
推荐意见指出，目前的安全数据并不支持乳腺癌生存者系统性使用绝经期激素疗法。虽然非激素治疗或替代治疗被证实不成功，但部分女性患者和肿瘤医师仍可能各执一词，就此事争论不休。
Climacteric. 2016;19(2):109-50.
2016 IMS Recommendations on women's midlife health and menopause hormone therapy.
Baber RJ, Panay N, Fenton A, Cardozo L, Castelo-Branco C, Davis SR, de Villiers TJ, Goldstein SR, Gompel A, Henderson VW, Hodis HN, Langer RD, Lobo RA, Maki PM, Mueck AO, Nappi RE, Pines A, Plu-Bureau G, Robinson D, Simoncini T, Vujovic SZ.
IMS Writing Group.
The International Menopause Society (IMS) has produced these new 2016 recommendations on women's midlife health and menopause hormone therapy (MHT) to help guide health-care professionals in optimizing their management of women in the menopause transition and beyond. The term MHT has been used to cover therapies including estrogens, progestogens and combined regimens. For the first time, the 2016 IMS recommendations now include grades of recommendations, levels of evidence and 'good practice points', in addition to section-specific references. Where possible, the recommendations are based on and linked to the evidence that supports them, unless good-quality evidence is absent. Particular attention has been paid to published evidence from 2013 onwards, the last time the IMS recommendations were updated. Databases have been extensively searched for relevant publications using key terms specific to each specialist area within menopause physiology and medicine. Information has also been drawn from international consensus statements published by bodies such as the IMS, the European Menopause and Andropause Society and the North American Menopause Society. The recommendations have been produced by experts derived mainly from the IMS, with the assistance of key collaborators where deemed advantageous. In preparing these international recommendations, experts have taken into account geographical variations in medical care, prevalence of diseases, and country-specific attitudes of the public, medical community and health authorities towards menopause management. The variation in availability and licensing of MHT and other products has also been considered.
KEYWORDS: HRT; IMS; Menopause hormone therapy; Recommendations; hormone replacement therapy; midlife health
PMID: 26872610
DOI: 10.3109/13697137.2015.1129166
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