2022年医学专题—HOMONEREPLACEMENTTHERAPY(HRT)：激素替代疗法(HRT)(1).ppt

MENOPAUSE,第一页，共五十四页。,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.,第二页，共五十四页。,WHAT?,It be defined with certainty after twelve months spontaneous amenorrhoea.End of reproductive life.,第三页，共五十四页。,Age(years),Pre-menopause,Post-menopause,MENOPAUSE,1 YEAR,Peri-menopause“Climacteric”,RELATED TERMINOLOGY,第四页，共五十四页。,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,第五页，共五十四页。,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.,第六页，共五十四页。,WHY?,RELATIVE ACTIVITY OF ESTROGEN,第七页，共五十四页。,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.,第八页，共五十四页。,WHY?,The menopause results from a fall in the level of the female hormone oestrogen in the blood.,第九页，共五十四页。,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).,第十页，共五十四页。,HOW?,Oestrogen reduction eventually results in menstrual cycle disruption and other menopausal symptoms.,第十一页，共五十四页。,HOW?,Oestrogen reduction eventually results in menstrual cycle disruption and other menopausal symptoms.*FSHhigh(30 170 mU/ml)*LHhigh(20 80 mU/ml)*Estradiollow(110 pmol/L),第十二页，共五十四页。,Vasomotor SymptomsSleep DisordersMenstrual DisordersMood Changes,Vaginal AtrophyDyspareuniaSkin Atrophy,OsteoporosisAtherosclerosisCoronary Heart DiseaseCerebrovascular Disease,40 yrs,50 yrs,Menopause,60 yrs,SYMPTOMS!,ONSET OF SYMPTOMS IN RELATION TO AGE OF MENOPAUSE,第十三页，共五十四页。,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).,第十四页，共五十四页。,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.,第十五页，共五十四页。,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.,第十六页，共五十四页。,SYMPTOMS!,第十七页，共五十四页。,SYMPTOMS!,NORMAL TRABECULAR BONE,OSTEROPEROTIC BONE,第十八页，共五十四页。,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.,第十九页，共五十四页。,TREATMENT,The kind of treatment you can take depends on the severity of the symptoms,medical history and patients own preferences.,第二十页，共五十四页。,TREATMENT,HRTNON-HRT,第二十一页，共五十四页。,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.,第二十二页，共五十四页。,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.,第二十三页，共五十四页。,HOMONE REPLACEMENT THERAPY(HRT),BENEFITS,RISKS,第二十四页，共五十四页。,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.,第二十五页，共五十四页。,HOMONE REPLACEMENT THERAPY(HRT),BENEFITSRelieve menopausal symptomsMaintenance of quality of lifePrevention of osteoporosis Note:HRT should not be used as a first-line treatment in osteoparosis except in women who have premature menopause,第二十六页，共五十四页。,HOMONE REPLACEMENT THERAPY(HRT),RISKS OF VTEHRT(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.,第二十七页，共五十四页。,HOMONE REPLACEMENT THERAPY(HRT),RISKS OF BREAST CANCERThe increased breast cancer risk is proportional to the duration of HRT.HRT increases this risk by about 1.6times after 5 years of use and 2.3times after 10years of use.Risk decreases within a few years of stopping HRT.Women considering HRT should be counselled that the absol