Menopausal symptoms in older women and the effects of treatment with hormone therapy
Menopausal symptoms in older women and the effects of treatment with hormone therapy
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DOI：
10.1016/s0029-7844(02)02369-4
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发表时间：
2002-12-01
影响因子：
7.2
通讯作者：
Pickar, JH
中科院分区：
文献类型：
--
作者：
Barnabei, VM;Grady, D;Pickar, JH
目的：在一些女性中，潮热和其他可归因于更年期的症状在月经停止后持续多年。这些症状的频率和严重程度以及对激素治疗的反应在老年女性中还没有很好的文献记录。方法：我们使用了心脏和雌激素/孕激素替代研究的数据，这是一项对2763名有记录的冠心病和子宫患者进行的盲法临床试验，这些妇女被随机分为两组，一组服用结合雌激素0.625 mg，另一组服用醋酸甲羟孕酮2.5 mg。参与者在基线和每年都被问及更年期症状。乳腺症状是自我报告的，子宫出血被记录在每天的日记中。结果：与绝经相关的症状在心脏和雌激素/孕激素替代研究参与者中相对常见，他们的平均年龄为67岁，自绝经以来平均为18年。在基线水平，16%的女性报告频繁潮热，26%的女性阴道干燥，10%的女性生殖器刺激，55%的女性睡眠困难，53%的女性早醒。与接受安慰剂治疗的女性相比，接受激素治疗的女性报告较少出现潮热、阴道干燥和睡眠困难，但更频繁地出现阴道分泌物、生殖器刺激、子宫出血和乳房症状。荷尔蒙组妇女的乳房症状报告从一年时的40%下降到第四年的13%。在治疗的第一年，激素组有31%的妇女报告了子宫出血，另外还有33%的妇女发现了子宫出血；到了第四年，这一比例分别下降到了11%和20%。结论：典型的更年期症状在老年妇女中很常见。绝经后激素治疗可以减少潮热、睡眠困难和阴道干燥，但在标准剂量下，老年妇女会出现阴道分泌物、生殖器刺激、子宫出血和乳房症状。(C)2002年，由美国妇产科医师学会提供。
OBJECTIVE: In some women, hot flashes and other symptoms attributed to menopause persist for many years after the cessation of menses. The frequency and severity of such symptoms and response to hormone therapy in older women have not been well documented.METHODS: We used data from the Heart and Estrogen/Progestin Replacement Study, a blinded, clinical trial among 2763 women with documented coronary disease and a uterus who were randomized to receive either conjugated estrogens 0.625 mg plus medroxyprogesterone acetate 2.5 mg in one tablet or placebo. Participants were queried at baseline and annually regarding menopausal symptoms. Breast symptoms were self-reported, and uterine bleeding was recorded on a daily diary.RESULTS: Symptoms associated with menopause were relatively common among Heart and Estrogen/Progestin Replacement Study participants, whose average age was 67 years and who averaged 18 years since menopause. At baseline, 16% of women reported frequent hot flashes, 26% vaginal dryness, 10% genital irritation, 55% trouble sleeping, and 53% early awakening. Women assigned to hormone therapy reported less frequent hot flashes, vaginal dryness, and trouble sleeping compared with women assigned to Placebo, but more frequent vaginal discharge, genital irritation, uterine bleeding, and breast symptoms. The reporting of breast symptoms among women in the hormone group decreased from 40% at 1 year to 13% by the 4th year. Uterine bleeding was reported by 31% and spotting by an additional 33% of women in the hormone group during the lst year of treatment; by the 4th year, these proportions had fallen to 11% and 20%, respectively.CONCLUSION: Symptoms typically attributed to menopause are common in elderly women. Postmenopausal hormone therapy reduces hot flashes, trouble sleeping, and vaginal dryness, but at standard doses in elderly women is associated with vaginal discharge, genital irritation, uterine bleeding, and breast symptoms. (C) 2002 by The American College of Obstetricians and Gynecologists.