Hormone therapy of premature ovarian failure: the case for "natural" estrogen.
Hormone therapy of premature ovarian failure: the case for "natural" estrogen.
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卵巢早衰的激素治疗：“天然”雌激素的案例。
DOI：
10.1161/hypertensionaha.108.128025
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发表时间：
2009
期刊：
影响因子：
--
通讯作者：
Oparil,Suzanne
中科院分区：
文献类型：
--
作者：
Oparil,Suzanne
卵巢激素在妇女的健康中起着重要作用，它提供了最可靠和最方便的避孕手段，并缓解更年期症状。1，2激素治疗还有其他益处，例如，调节月经不规律和缓解绝经期妇女的痛经，预防绝经后妇女的外阴阴道萎缩和骨质疏松/骨折。此外，天然雌激素（主要是17-雌二醇）和天然孕酮（但不是合成孕激素）具有保护血管免受氧化和炎症损伤并预防心血管疾病的生物学作用。[3]这些功能被一些人引用来解释与男性相比，女性临床心血管疾病和事件的出现延迟10- 15年。与内源性卵巢激素毫无疑问的益处相反，卵巢衰竭女性的激素治疗，无论是自然发生的还是手术诱导的，仍然是科学和流行文献中积极辩论的主题。尽管观察性研究显示（冠心病减少50%）绝经期激素治疗的益处（也称为“更年期激素替代疗法”或“激素替代疗法”）的妇女谁选择采取他们（通常在围绝经期或绝经后早期开始治疗），随机化，对照试验尚未证实其对心脏的保护作用，甚至有证据表明其有害。因此，目前的指南不建议使用绝经期激素治疗来预防或治疗女性心血管疾病。现有的随机对照试验的重要局限性在于，这些试验通常招募60岁的女性，因此，绝经后10年，并且通常使用非生理性激素制剂，例如，结合马雌激素和合成的孕激素醋酸甲羟孕酮。重要的是，这些试验没有回答关于绝经期激素治疗对年轻女性（即卵巢早衰患者）的影响的问题。虽然在美国没有关于40岁以下卵巢功能衰竭患者激素管理的具体指南，但实践标准是常规的绝经期激素治疗或口服避孕药，有时添加睾酮，直到通常的绝经年龄（51岁）。在本期《高血压》杂志上，Langrish等人4比较了生理刺激对心血管的影响（经皮雌二醇和阴道孕酮）与标准合成（口服炔雌醇和炔诺酮）在一小群年轻女性中的绝经激素治疗（19至39岁），具有多种病因的卵巢早衰。他们的主要发现非常显著：在治疗12个月时，雌二醇/孕酮方案通过动态血压监测使平均24小时血压降低7.3/7.4 mmHg，并伴有血浆血管紧张素II和血清肌酐水平降低。这些发现与以前的观察结果一致，即内源性雌二醇和雌二醇治疗都倾向于降低血压。3对月经周期血压的观察性研究表明，当雌二醇水平在黄体期达到峰值时，血压低于卵泡期的最低值。女性晚年血压的升高与更年期本身有关，除了衰老之外，还归因于...
Ovarian hormones play an important role in women’s health, providing the most reliable and convenient means of contraception and of relieving menopausal symptoms. 1, 2 Hormone therapy also has other benefits, eg, regulation of menstrual irregularities and relief of dysmenorrhea in menstruating women and prevention of vulvovaginal atrophy and osteoporosis/fractures in postmenopausal women. In addition, natural estrogens, principally 17-estradiol, and natural progesterone (but not synthetic progestins) have biological effects that protect the vasculature from oxidative and inflammatory injury and prevent cardiovascular disease. 3 These functions have been adduced by some to account for the 10-to 15-year delay in presentation of clinical cardiovascular disease and events in women compared with men. In contrast to the unquestioned benefits of endogenous ovarian hormones, hormone therapy of women with ovarian failure, whether naturally occurring or surgically induced, continues to be a topic of active debate in the scientific and popular literature. Although observational studies have shown substantial (50% reduction in coronary heart disease) benefit of menopausal hormone therapy (also referred to as “menopausal hormone replacement therapy” or “hormone replacement therapy”) in women who choose to take them (usually beginning treatment in the perimenopausal or early postmenopausal period), randomized, controlled trials have not confirmed a cardioprotective effect and have even shown evidence of harm. Accordingly, current guidelines do not recommend use of menopausal hormone therapy for the prevention or treatment of cardiovascular disease in women. Important limitations of the available randomized, controlled trials are that they typically enrolled women who were 60 years of age and, thus, were 10 years postmenopause and that they typically used nonphysiological hormone preparations, eg, conjugated equine estrogen and the synthetic progestin medroxyprogesterone acetate. Importantly, these trials do not answer questions about the effects of menopausal hormone therapy in young women, ie, those with premature ovarian failure. Although specific guidelines for hormone management of patients under age 40 years with ovarian failure are not available in the United States, the standard of practice is that conventional menopausal hormone therapies or oral contraceptives, sometimes with testosterone added, are administered until the usual age of menopause (51 years).In the current issue of Hypertension, Langrish et al4 compared the cardiovascular effects of physiological (transdermal estradiol and vaginal progesterone) with standard synthetic (oral ethinylestradiol and norethisterone) menopausal hormone therapy in a small group of young women (19 to 39 years of age) with premature ovarian failure of diverse etiologies. Their major findings were highly significant: 7.3/7.4 mmHg reductions in mean 24-hour blood pressure by ambulatory blood pressure monitoring accompanied by reduced plasma angiotensin II and serum creatinine levels with the estradiol/progesterone regimen at 12 months of treatment. These findings are consistent with previous observations that both endogenous estradiol and estradiol therapy tend to lower blood pressure. 3 Observational studies of blood pressure through the menstrual cycle have demonstrated that blood pressure is lower when estradiol levels peak during the luteal phase than when they are at their nadir during the follicular phase. The rise in blood pressure seen later in life in women has been related to menopause, per se, in addition to aging, and has been attributed to …
激素治疗对血压正常和高血压绝经后妇女血压的影响。
影响因子：
4.9
作者：
A. Mueck;H. Seeger
通讯作者：
H. Seeger
6 个月激素替代疗法与安慰剂的心血管影响：与绝经后年数相关的差异。
DOI：
10.1016/j.ajog.2003.09.045
发表时间：
2004
期刊：
American journal of obstetrics and gynecology.
影响因子：
--
作者：
Brownley,KimberlyA;Hinderliter,AlanL;West,SheilaG;Grewen,KarenM;Steege,JohnF;Girdler,SusanS;Light,KathleenC
通讯作者：
Light,KathleenC
第 70 章 — 口服避孕药、激素替代疗法和高血压
DOI：
10.1016/b978-0-323-03961-1.50073-8
发表时间：
2007
期刊：
JAMA
影响因子：
--
作者：
T. Rosenthal;S. Oparil
通讯作者：
S. Oparil