BACKGROUND Menopausal symptoms can be very distressing and considerably affect a woman’s personal and social life. It is becoming more and more evident that leaving bothersome symptoms untreated in midlife may lead to altered quality of life, reduced work productivity and, possibly, overall impaired health. Hormone therapy (HT) for the relief of menopausal symptoms has been the object of much controversy over the past two decades. At the beginning of the century, a shadow was cast on the use of HT owing to the concern for cardiovascular and cerebrovascular risks, and breast cancer, arising following publication of a large randomized placebo-controlled trial. Findings of a subanalysis of the trial data and extended follow-up studies, along with other more modern clinical trials and observational studies, have provided new evidence on the effects of HT. OBJECTIVE AND RATIONALE The goal of the following paper is to appraise the most significant clinical literature on the effects of hormones in postmenopausal women, and to report the benefits and risks of HT for the relief of menopausal symptoms. SEARCH METHODS A Pubmed search of clinical trials was performed using the following terms: estrogens, progestogens, bazedoxifene, tibolone, selective estrogen receptor modulators, tissue-selective estrogen complex, androgens, and menopause. OUTCOMES HT is an effective treatment for bothersome menopausal vasomotor symptoms, genitourinary syndrome, and prevention of osteoporotic fractures. Women should be made aware that there is a small increased risk of stroke that tends to persist over the years as well as breast cancer risk with long-term estrogen–progestin use. However, healthy women who begin HT soon after menopause will probably earn more benefit than harm from the treatment. HT can improve bothersome symptoms, all the while conferring offset benefits such as cardiovascular risk reduction, an increase in bone mineral density and a reduction in bone fracture risk. Moreover, a decrease in colorectal cancer risk is obtainable in women treated with estrogen–progestin therapy, and an overall but nonsignificant reduction in mortality has been observed in women treated with conjugated equine estrogens alone or combined with estrogen–progestin therapy. Where possible, transdermal routes of HT administration should be preferred as they have the least impact on coagulation. With combined treatment, natural progesterone should be favored as it is devoid of the antiapoptotic properties of other progestogens on breast cells. When beginning HT, low doses should be used and increased gradually until effective control of symptoms is achieved. Unless contraindications develop, patients may choose to continue HT as long as the benefits outweigh the risks. Regular reassessment of the woman’s health status is mandatory. Women with premature menopause who begin HT before 50 years of age seem to have the most significant advantage in terms of longevity. WIDER IMPLICATIONS In women with bothersome menopausal symptoms, HT should be considered one of the mainstays of treatment. Clinical practitioners should tailor HT based on patient history, physical characteristics, and current health status so that benefits outweigh the risks.

中文翻译：

---

绝经后激素治疗：考虑临床实践中的益处和风险

背景技术更年期症状可能非常令人痛苦，并且极大地影响了女性的个人和社会生活。越来越明显的是，在中年不治疗烦人的症状可能会导致生活质量改变、工作效率降低，甚至可能导致整体健康受损。在过去的二十年里，用于缓解更年期症状的激素疗法 (HT) 一直是备受争议的对象。在本世纪初，由于对心血管和脑血管风险以及乳腺癌的担忧，HT 的使用蒙上了一层阴影，这是在一项大型随机安慰剂对照试验发表后出现的。对试验数据和扩展后续研究的子分析结果，以及其他更现代的临床试验和观察性研究，为HT的影响提供了新的证据。目标和基本原理 本文的目的是评估关于激素对绝经后妇女影响的最重要的临床文献，并报告 HT 对缓解更年期症状的益处和风险。搜索方法 使用以下术语对临床试验进行 Pubmed 搜索：雌激素、孕激素、巴多昔芬、替勃龙、选择性雌激素受体调节剂、组织选择性雌激素复合物、雄激素和更年期。结果 HT 是治疗令人烦恼的更年期血管舒缩症状、泌尿生殖系统综合征和预防骨质疏松性骨折的有效方法。应该让女性意识到，中风的风险会持续多年，而长期使用雌孕激素会增加患乳腺癌的风险。然而，在绝经后不久开始 HT 的健康女性可能会从治疗中获得更多的益处而不是伤害。HT 可以改善令人烦恼的症状，同时带来抵消性益处，例如降低心血管风险、增加骨矿物质密度和降低骨折风险。此外，接受雌激素-孕激素治疗的女性可降低结直肠癌风险，单独使用结合马雌激素或联合雌激素-孕激素治疗的女性死亡率总体下降，但并不显着。在可能的情况，应首选 HT 的透皮给药途径，因为它们对凝血的影响最小。在联合治疗中，应优先使用天然黄体酮，因为它没有其他孕激素对乳腺细胞的抗凋亡特性。开始 HT 时，应使用小剂量并逐渐增加，直至症状得到有效控制。除非出现禁忌症，否则只要收益大于风险，患者可能会选择继续 HT。定期重新评估女性的健康状况是强制性的。在 50 岁之前开始 HT 的过早绝经的女性似乎在长寿方面具有最显着的优势。更广泛的意义 对于有令人烦恼的更年期症状的女性，HT 应被视为主要的治疗方法之一。