Abstract

Hormone therapy (HT) is an effective treatment for menopausal symptoms, including vasomotor symptoms and genitourinary syndrome of menopause. Randomized trials also demonstrate positive effects on bone health, and age-stratified analyses indicate more favorable effects on coronary heart disease and all-cause mortality in younger women (close proximity to menopause) than in women more than a decade past menopause. In the absence of contraindications or other major comorbidities, recently menopausal women with moderate or severe symptoms are appropriate candidates for HT. The Women’s Health Initiative (WHI) hormone therapy trials—estrogen and progestin trial and the estrogen-alone trial—clarified the benefits and risks of HT, including how the results differed by age. A key lesson from the WHI trials, which was unfortunately lost in the posttrial cacophony, was that the risk:benefit ratio and safety profile of HT differed markedly by clinical characteristics of the participants, especially age, time since menopause, and comorbidity status. In the present review of the WHI and other recent HT trials, we aim to provide readers with an improved understanding of the importance of the timing of HT initiation, type and route of administration, and of patient-specific considerations that should be weighed when prescribing HT.

中文翻译：

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更年期激素治疗：概念、争议和治疗方法

摘要

激素疗法（HT）是治疗更年期症状的有效方法，包括血管舒缩症状和更年期泌尿生殖系统综合征。随机试验也证明了对骨骼健康的积极影响，年龄分层分析表明，年轻女性（接近绝经期）对冠心病和全因死亡率的影响比绝经十多年后的女性更有利。在没有禁忌症或其他主要合并症的情况下，近期有中度或重度症状的绝经妇女是 HT 的合适人选。女性健康倡议 (WHI) 激素治疗试验——雌激素和孕激素试验以及雌激素单独试验——阐明了 HT 的益处和风险，包括结果如何因年龄而异。WHI 试验的一个重要教训，不幸的是，在审判后的嘈杂声中丢失的是，HT 的风险：收益比和安全性因参与者的临床特征而显着不同，尤其是年龄、绝经后的时间和合并症状态。在目前对 WHI 和其他近期 HT 试验的回顾中，我们旨在让读者更好地理解 HT 开始时间、给药类型和途径的重要性，以及在开具处方时应权衡的患者特定考虑因素H T。