HOMONEREPLACEMENTTHERAPYHRT激素替代疗法HRT

《HOMONEREPLACEMENTTHERAPYHRT激素替代疗法HRT》由会员分享，可在线阅读，更多相关《HOMONEREPLACEMENTTHERAPYHRT激素替代疗法HRT（54页珍藏版）》请在装配图网上搜索。

1、HOMONEREPLACEMEHOMONEREPLACEMENTTHERAPYHRTNTTHERAPYHRT激素激素替代疗法替代疗法HRTHRTWHAT?n nMenopauseisadeviationoftheancientGreekwordsmenos(month)andpauses(ending).n nThemenopauseissometimesknownasthechangeoflifeandismarkedbytheendingofmenstruation.WHAT?n nItbedefinedwithcertaintyaftertwelvemonthsspontaneousam

2、enorrhoea.n nEndofreproductivelife.Age(years)Age(years)Pre-menopausePre-menopausePost-menopausePost-menopauseMENOPAUSEMENOPAUSE1YEAR1YEARPeri-menopause“Climacteric”Peri-menopause“Climacteric”RELATED TERMINOLOGYWHEN?n nMenopausalage:45-55years(mean:50.7years)n nIfthemenopauseoccursinawomanwhoisunder4

3、5yearsofage,itisknownasprematuremenopause.n nLatemenopause:55yearsoldWHEN?n nOtherfactorsthatcanaffecttheageatwhichwomenhavetheirfinalperiodincludeageatmenarche,parity,previousoralcontraceptivehistoryethnicityandfamilyhistory.WHY?RELATIVEACTIVITYOFESTROGENRELATIVEACTIVITYOFESTROGENWHY?n nThemenopaus

4、eistheendofeggproduction(ovulation).Thisoccursasaresultoffallinglevelsofthefemalesexhormoneoestrogen,whichregulatesawomansperiods.WHY?n nThemenopauseresultsfromafallinthelevelofthefemalehormoneoestrogenintheblood.WHY?n nAtahormonallevel-asovarianfollicularactivitybeginstofail,oestrogenandprogesteron

5、elevelsfallandthereducednegativefeedbacktothepituitarycausesariseinluteinisinghormone(LH)andfolliclestimulatinghormone(FSH).HOW?n nOestrogenreductioneventuallyresultsinmenstrualcycledisruptionandothermenopausalsymptoms.HOW?n nOestrogenreductioneventuallyresultsinmenstrualcycledisruptionandothermenop

6、ausalsymptoms.*FSHFSHhighhigh(30170mU/ml)(30170mU/ml)*LH*LHhighhigh(2080mU/ml)(2080mU/ml)*Estradiol*Estradiollowlow(110pmol/L)(110pmol/L)Vasomotor SymptomsVasomotor SymptomsSleep DisordersSleep DisordersMenstrual DisordersMenstrual DisordersMood ChangesMood ChangesVaginal AtrophyVaginal AtrophyDyspa

7、reuniaDyspareuniaSkin AtrophySkin AtrophyOsteoporosisOsteoporosisAtherosclerosisAtherosclerosisCoronary Heart DiseaseCoronary Heart DiseaseCerebrovascular DiseaseCerebrovascular Disease40 yrs40 yrs50 yrs50 yrsMenopauseMenopause60 yrs60 yrsSYMPTOMS!ONSETOFSYMPTOMSINRELATIONTOAGEOFMENOPAUSEONSETOFSYMP

8、TOMSINRELATIONTOAGEOFMENOPAUSESYMPTOMS!n nChangesinyourperiodtimebetweenperiodsorflowChangesinyourperiodtimebetweenperiodsorflowmaybedifferent.maybedifferent.n nHotflashes(“hotflushes”)gettingwarmintheface,Hotflashes(“hotflushes”)gettingwarmintheface,neckandchest.neckandchest.n nNightsweatsandsleepi

9、ngproblemsthatmayleadtoNightsweatsandsleepingproblemsthatmayleadtofeelingtired,stressedortense.feelingtired,stressedortense.n nVaginalchangesthevaginamaybecomedryandVaginalchangesthevaginamaybecomedryandthin,andsexmaybepainful.thin,andsexmaybepainful.n nThinningofyourbones,whichmayleadtolossofThinni

10、ngofyourbones,whichmayleadtolossofheightandbonebreaks(osteoporosis).heightandbonebreaks(osteoporosis).SYMPTOMS!n nItisestimatedthat8outof10womenintheUKexperiencesymptomsleadinguptothemenopause.n nOfthese,45%findtheirsymptomsdifficulttodealwith.SYMPTOMS!n nWithouttreatment,mostmenopausalsymptomsgradu

11、allystopnaturally.Thisusuallyhappenstwotofiveyearsafterthesymptomsstart.n nAlthoughsomewomenexperiencesymptomsformanymoreyears.SYMPTOMS!SYMPTOMS!NORMALTRABECULARBONENORMALTRABECULARBONEOSTEROPEROTICBONEOSTEROPEROTICBONETREATMENTn nOnly1in10womenseekmedicaladvicewhentheygothroughthemenopauseandmanydo

12、notneedanytreatment.n nIfmenopausalsymptomsaresevereenoughtointerferewithdailylife,therearetreatmentsthatcanhelp.TREATMENTn nThekindoftreatmentyoucantakedependsontheseverityofthesymptoms,medicalhistoryandpatientsownpreferences.TREATMENTn nHRTn nNON-HRTHOMONE REPLACEMENT THERAPY(HRT)n nAsthenamesugge

13、sts,HRTworksbyreplacingoestrogen.n nHormonereplacementtherapy(HRT)canbeaneffectivetreatmentforthetypicalmenopause-relatedsymptoms.HOMONE REPLACEMENT THERAPY(HRT)n nHRTmayalsohaveaninfluenceonthelongtermhealthproblems(osteoporosis,cardiovascular diseaseandstroke),thoughitshouldbenotedthatitdoesnotnec

14、essarilyreducetheirriskforallwomen.HOMONE REPLACEMENT THERAPY(HRT)BENEFITSBENEFITSRISKSRISKSHOMONE REPLACEMENT THERAPY(HRT)n nForthetreatmentofmenopausalsymptomswheretherisk-benefitratio*isfavorable,infullyinformedwomen,inthelowestpossibledosetocontrolsymptomsandfortheshortestdurationpossible.HOMONE

15、 REPLACEMENT THERAPY(HRT)n nBENEFITSRelievemenopausalsymptomsMaintenanceofqualityoflifePreventionofosteoporosisNote:HRTshouldnotbeusedasafirst-linetreatmentinosteoparosisNote:HRTshouldnotbeusedasafirst-linetreatmentinosteoparosisexceptinwomenwhohaveexceptinwomenwhohavepremature menopausepremature me

16、nopause HOMONE REPLACEMENT THERAPY(HRT)n nRISKS OF VTEHRT(combinedoroestrogen-alone)increasestheriskofHRT(combinedoroestrogen-alone)increasestheriskofadeepveinthrombosisorpulmonaryembolism,adeepveinthrombosisorpulmonaryembolism,especiallyinthefirstyearoftreatment.Theriskismoreespeciallyinthefirstyea

17、roftreatment.Theriskismorepronouncedinwomenwithpre-existingriskfactors.pronouncedinwomenwithpre-existingriskfactors.Arecentmeta-analysissuggeststhattransdermalArecentmeta-analysissuggeststhattransdermaloestrogensmaybeasaferoptionthanoraloestrogensforoestrogensmaybeasaferoptionthanoraloestrogensforHR

18、THRT.HOMONE REPLACEMENT THERAPY(HRT)n nRISKS OF BREAST CANCERn nTheThe increasedincreased breastbreast cancercancer riskrisk isis proportionalproportional toto thethedurationdurationofofHRT.HRT.HRTHRTincreasesincreasesthisthisriskriskbybyaboutabout1.6times1.6timesafterafter55yearsyears ofofuseuseand

19、and2.3times2.3timesafterafter10years10years ofofuse.use.RiskdecreaseswithinafewyearsofstoppingHRT.RiskdecreaseswithinafewyearsofstoppingHRT.n nWomenWomen consideringconsidering HRTHRT shouldshould bebe counselledcounselled thatthat thetheabsoluteabsoluteriskriskforforbreastbreastcancercancerforforan

20、yanyindividualindividualremains remains relatively low*relatively low*HeractualriskincreasesHeractualriskincreases0.08%0.08%(ACOG)(ACOG)HOMONE REPLACEMENT THERAPY(HRT)n nRISKS OF ENDOMETRIAL CANCEREndometrialcancer:increasedriskonlywithunopposedEndometrialcancer:increasedriskonlywithunopposedoestrog

21、en.Thereisnoincreasedriskwithcombinedoestrogen.Thereisnoincreasedriskwithcombined(oestrogenandprogestogen)HRT.(oestrogenandprogestogen)HRT.RISKS OF OVARIAN CANCERlong-termuseofoestrogen-onlyHRTandcombinedHRTlong-termuseofoestrogen-onlyHRTandcombinedHRTmayslightlyincreasetherisk.Riskdecreasesaftermay

22、slightlyincreasetherisk.RiskdecreasesafterstoppingHRT.stoppingHRT.HOMONE REPLACEMENT THERAPY(HRT)n nRISKS OF CARDIOVASCULAR DISEASEThereisnotthesameevidenceofThereisnotthesameevidenceofcardioprotectionfromHRTaswasoriginallycardioprotectionfromHRTaswasoriginallythought.thought.AssessallwomensriskofCH

23、DpriortostartingAssessallwomensriskofCHDpriortostartingHRT.HRT.HOMONE REPLACEMENT THERAPY(HRT)HOMONE REPLACEMENT THERAPY(HRT)s sSequentially Sequentially combined HRTcombined HRT E(continuouslyE(continuouslyD1-D21)D1-D21)P(sequentiallyP(sequentiallyD11-D21)D11-D21)Continuous Continuous combined HRTc

24、ombined HRT E&PE&P(continuous:D1-(continuous:D1-D28)D28)HOMONE REPLACEMENT THERAPY(HRT)n nWomen with an intact uterusWomen with an intact uterusVasomotorsymptomsVasomotorsymptomsn nPerimenopausal:systemiccyclicalcombinedHRT.Perimenopausal:systemiccyclicalcombinedHRT.n nPostmenopausal:systemiccontinu

25、ouscombinedPostmenopausal:systemiccontinuouscombinedHRTortibolone.HRTortibolone.UrogenitalsymptomsUrogenitalsymptomsn nPerimenopausal:low-dosevaginaloestrogenorPerimenopausal:low-dosevaginaloestrogenorsystemiccyclicalcombinedHRT.systemiccyclicalcombinedHRT.n nPostmenopausal:low-dosevaginaloestrogeno

26、rPostmenopausal:low-dosevaginaloestrogenorsystemiccontinuouscombinedHRT.systemiccontinuouscombinedHRT.HOMONE REPLACEMENT THERAPY(HRT)n nWomen who have had a hysterectomyWomen who have had a hysterectomyVasomotorsymptoms:systemicoestrogen-onlyHRT.Vasomotorsymptoms:systemicoestrogen-onlyHRT.Urogenital

27、symptoms:low-dosevaginaloestrogenorUrogenitalsymptoms:low-dosevaginaloestrogenorsystemicoestrogen-onlyHRT.systemicoestrogen-onlyHRT.HOMONE REPLACEMENT THERAPY(HRT)HOMONE REPLACEMENT THERAPY(HRT)CONTRAINDICATIONS OF HRT!n nPregnancy and breast-feedingPregnancy and breast-feedingn nUndiagnosed abnorma

28、l vaginal bleedingUndiagnosed abnormal vaginal bleedingn nVenous thromboembolic diseaseVenous thromboembolic diseasen nActive or recent Active or recent anginaangina or or myocardial infarctionmyocardial infarctionn nSuspected,current or past breast cancerSuspected,current or past breast cancern nEn

29、dometrial cancer or other oestrogen-dependent cancerEndometrial cancer or other oestrogen-dependent cancern nActive liver disease with abnormal Active liver disease with abnormal liver function testsliver function testsSTART-UP SYMPTOMS OF HRT!n nBreast tendernessBreast tendernessn nNipple sensitivi

30、tyNipple sensitivityn nBloatingBloatingn nNausea,headachesNausea,headachesn nAppetite Appetite n nWeight gainWeight gainn nLeg crampsLeg crampsINVESTIGATIONS BEFORE HRT!Investigations are not usually necessary before Investigations are not usually necessary before starting HRT unless there is:starti

31、ng HRT unless there is:n nsudden change in menstrual pattern(IMB/PCB)sudden change in menstrual pattern(IMB/PCB)n nHigh risk of breast cancerHigh risk of breast cancern nPersonal/family history of VTEPersonal/family history of VTEn nWoman has arterial risk factorsWoman has arterial risk factorsALTER

32、NATIVE TO HRT!“Tibolone”is a synthetic hormone that acts in the “Tibolone”is a synthetic hormone that acts in the same way as HRT same way as HRT(SERM)(SERM)n nUsefulforpost-menopausalwomenwhowanttoendUsefulforpost-menopausalwomenwhowanttoendtheirperiods.theirperiods.n nWhichhasoestrogenic,progestog

33、enicandandrogenicWhichhasoestrogenic,progestogenicandandrogenicpropertiesproperties.(.(estrogenicactivityinestrogenicactivityinbonebone,CNSvasomotor,CNSvasomotorsuppressionofsuppressionofhotflusheshotflushesandandhelpfulinimprovingsexualfunction.helpfulinimprovingsexualfunction.STARTING HRT!“A full

34、physical examination is mandatory”A full physical examination is mandatory”n nFull blood countFull blood countn nRenal ProfileRenal Profile-Baseline-Baselinen nLiver Function TestLiver Function Testn nLipid profileLipid profileFOLLOW UP OF TAKING HRT!n nReviewthewoman3monthsafterstartingHRTReviewthe

35、woman3monthsafterstartingHRTandonceeachyearthereafter.andonceeachyearthereafter.n nAt3-months:At3-months:Enquireaboutbleedingpatterns,checkbloodEnquireaboutbleedingpatterns,checkbloodpressure,andbodyweight.pressure,andbodyweight.AssesstheeffectivenessoftreatmentandAssesstheeffectivenessoftreatmentan

36、dadjusttoachievesymptomcontrol.adjusttoachievesymptomcontrol.EnquireaboutadverseeffectsandmanageEnquireaboutadverseeffectsandmanageappropriately.appropriately.FOLLOW UP OF TAKING HRT!n nOnceeachyear:Onceeachyear:Checkbloodpressure,effectivenessoftreatmentandCheckbloodpressure,effectivenessoftreatmen

37、tandadjusttoachievesymptomcontrol.adjusttoachievesymptomcontrol.EnquireaboutadverseeffectsandmanageEnquireaboutadverseeffectsandmanageappropriately.appropriately.ConsiderswitchingfromcyclicalHRTtoConsiderswitchingfromcyclicalHRTtocontinuouscombinedHRT,ifappropriate.continuouscombinedHRT,ifappropriat

38、e.FOLLOW UP OF TAKING HRT!DiscusstherisksandbenefitsofHRT.DiscusstherisksandbenefitsofHRT.PerformabreastexaminationifindicatedbypersonalPerformabreastexaminationifindicatedbypersonalorfamilyhistory.orfamilyhistory.EncouragebreastawarenessandparticipationintheEncouragebreastawarenessandparticipationi

39、nthenationalbreastscreeningprogrammeasappropriatenationalbreastscreeningprogrammeasappropriatefortheirage.fortheirage.PelvicexaminationisrequiredonlyifclinicallyPelvicexaminationisrequiredonlyifclinicallyindicatedindicatedNON-HRTLifestyle modificationLifestyle modificationStop smokingStop smokingHea

40、lthy dietHealthy dietWeight controlWeight controlRegular moderate-intensity exerciseRegular moderate-intensity exerciseControl blood pressure and cholesterolControl blood pressure and cholesterolNON-HRTn nFor vasomotor symptoms For vasomotor symptoms Atrial(2weeks)ofparoxetine,fluoxetineAtrial(2week

41、s)ofparoxetine,fluoxetinecitalopramorvenlafaxine(SSRI)citalopramorvenlafaxine(SSRI)Atrial(24weeks)ofclonidineAtrial(24weeks)ofclonidineAprogestogensuchasnorethisteroneorAprogestogensuchasnorethisteroneormegestrolmegestrolNON-HRTn nFor vaginal drynessFor vaginal drynessVaginallubricantormoisturizer,s

42、uchasReplensVaginallubricantormoisturizer,suchasReplens.NON-HRTn nFor osteoporosisAlendronate(Alendronate(FosamaxFosamax)RocaltriolRocaltriolAlpha-calcidolAlpha-calcidolRaloxifene(Raloxifene(EvistaEvista)NON-HRTn nFor psychological symptoms-Self-helpgroupsSelf-helpgroups-Psychotherapy-Psychotherapy-

43、Otherformsofcounselling-Otherformsofcounselling-Antidepressants.-Antidepressants.NON-HRTComplementary therapiesn nRemifemin(Cimicifugarhizomeextract)Remifemin(Cimicifugarhizomeextract)n nRedcloverplantRedcloverplant n nSoyproductsSoyproductsn nEveningprimroseEveningprimrosen nBlackcohoshBlackcohoshn

44、 nPhytoestrogensPhytoestrogensn nGinsengGinsengNON-HRTComplementary interventionsComplementary interventionsn nAcupunctureAcupuncturen nReflexologyReflexologyDiet and supplementsDiet and supplementsn nVitamins and mineralsVitamins and mineralsn nVitamin EVitamin EHomeopathyHomeopathyPremature menopa

45、use?n nMenopausalsymptomsinwomenwhoareyoungerthanMenopausalsymptomsinwomenwhoareyoungerthan40years(1%)40years(1%)n nOfferlifestyleadvice.Offerlifestyleadvice.n nOffersystemichormonereplacementtherapy(HRT)orOffersystemichormonereplacementtherapy(HRT)orthecombinedoralcontraceptivepill(COC)thecombinedoralcontraceptivepill(COC)n nDecreasedlibido:testosteroneimplantsandpatchesDecreasedlibido:testosteroneimplantsandpatchesmaybeconsideredmaybeconsideredTHANK YOU结束结束