HOMONEREPLACEMENTTHERAPY(HRT)：激素替代疗法(HRT).ppt

MENOPAUSE WHAT?Menopause is a deviation of the ancient Greek words menos(month)and pauses (ending).The menopause is sometimes known as the change of life and is marked by the ending of menstruation.WHAT?It be defined with certainty after twelve months spontaneous amenorrhoea.End of reproductive life.Age(years)Pre-menopause Post-menopause MENOPAUSE 1 YEAR Peri-menopause Climacteric RELATED TERMINOLOGY WHEN?Menopausal age:45-55 years (mean:50.7 years)If the menopause occurs in a woman who is under 45 years of age,it is known as premature menopause.Late menopause:55 years old WHEN?Other factors that can affect the age at which women have their final period include age at menarche,parity,previous oral contraceptive history ethnicity and family history.WHY?RELATIVE ACTIVITY OF ESTROGEN WHY?The menopause is the end of egg production(ovulation).This occurs as a result of falling levels of the female sex hormone oestrogen,which regulates a womans periods.WHY?The menopause results from a fall in the level of the female hormone oestrogen in the blood.WHY?At a hormonal level-as ovarian follicular activity begins to fail,oestrogen and progesterone levels fall and the reduced negative feedback to the pituitary causes a rise in luteinising hormone(LH)and follicle stimulating hormone(FSH).HOW?Oestrogen reduction eventually results in menstrual cycle disruption and other menopausal symptoms.HOW?Oestrogen reduction eventually results in menstrual cycle disruption and other menopausal symptoms.*FSH high(30 170 mU/ml)*LH high(20 80 mU/ml)*Estradiol low(110 pmol/L)Vasomotor Symptoms Sleep Disorders Menstrual Disorders Mood Changes Vaginal Atrophy Dyspareunia Skin Atrophy Osteoporosis Atherosclerosis Coronary Heart Disease Cerebrovascular Disease 40 yrs 50 yrs Menopause 60 yrs SYMPTOMS!ONSET OF SYMPTOMS IN RELATION TO AGE OF MENOPAUSE SYMPTOMS!Changes in your periodtime between periods or flow may be different.Hot flashes(hot flushes)getting warm in the face,neck and chest.Night sweats and sleeping problems that may lead to feeling tired,stressed or tense.Vaginal changesthe vagina may become dry and thin,and sex may be painful.Thinning of your bones,which may lead to loss of height and bone breaks(osteoporosis).SYMPTOMS!It is estimated that 8 out of 10 women in the UK experience symptoms leading up to the menopause.Of these,45%find their symptoms difficult to deal with.SYMPTOMS!Without treatment,most menopausal symptoms gradually stop naturally.This usually happens two to five years after the symptoms start.Although some women experience symptoms for many more years.SYMPTOMS!SYMPTOMS!NORMAL TRABECULAR BONE OSTEROPEROTIC BONE TREATMENT Only 1 in 10 women seek medical advice when they go through the menopause and many do not need any treatment.If menopausal symptoms are severe enough to interfere with daily life,there are treatments that can help.TREATMENT The kind of treatment you can take depends on the severity of the symptoms,medical history and patients own preferences.TREATMENT HRT NON-HRT HOMONE REPLACEMENT THERAPY(HRT)As the name suggests,HRT works by replacing oestrogen.Hormone replacement therapy(HRT)can be an effective treatment for the typical menopause-related symptoms.HOMONE REPLACEMENT THERAPY(HRT)HRT may also have an influence on the long term health problems(osteoporosis,cardiovascular disease and stroke),though it should be noted that it does not necessarily reduce their risk for all women.HOMONE REPLACEMENT THERAPY(HRT)BENEFITS RISKS HOMONE REPLACEMENT THERAPY(HRT)For the treatment of menopausal symptoms where the risk-benefit ratio*is favorable,in fully informed women,in the lowest possible dose to control symptoms and for the shortest duration possible.HOMONE REPLACEMENT THERAPY(HRT)BENEFITS Relieve menopausal symptoms Maintenance of quality of life Prevention of osteoporosis Note:HRT should not be used as a first-line treatment in osteoparosis except in women who have premature menopause HOMONE REPLACEMENT THERAPY(HRT)RISKS OF VTE HRT(combined or oestrogen-alone)increases the risk of a deep vein thrombosis or pulmonary embolism,especially in the first year of treatment.The risk is more pronounced in women with pre-existing risk factors.A recent meta-analysis suggests that transdermal oestrogens may be a safer option than oral oestrogens for HRT.HOMONE REPLACEMENT THERAPY(HRT)RISKS OF BREAST CANCER The increased breast cancer risk is proportional to the duration of HRT.HRT increases this risk by about 1.6 times after 5 years of use and 2.3 times after 10 years of use.Risk decreases within a few years of stopping HRT.Women considering HRT should be counselled that the absolute risk for breast cancer for any individual remains relatively low*Her actual risk increases 0.08%(ACOG)HOMONE REPLACEMENT THERAPY(HRT)RISKS OF ENDOMETRIAL CANCER Endometrial cancer:increased risk only with unopposed oestrogen.There is no increased risk with combined(oestrogen and progestogen)HRT.RISKS OF OVARIAN CANCER long-term use of o