人工绝经的激素替代治疗.ppt
Sarrel PM and Nachtigall LF.Individualizing Hormone Therapy for the Surgically Menopausal Women,Oct 20 2004人工绝经与激素替代人工绝经与激素替代 方案选择方案选择 子宫有无子宫有无 添加雄激素？添加雄激素？lSome hormone therapy includes testosterone but they are too strong!Use care if prescribing.Estratest has 4 to 8 times more testosterone than a women should haveEstratest HS still too muchResearch has shown that the testosterone patch can help with sexual function,but much more research is needed.(Proctor&Gambles Intrinsa is in Phase III of testing)Estrogen+TestosteroneAn algorithm for the administration of HRTNo HRTYesUnopposed oestrogen therapyPrevious hysterecomyCyclical/sequential HRTIntact uterus+amenorrhoea 2 yrsCommence HRTBaseline investigations completedNoAbsolute contra-indication?Decision made to user HRTLancet 1997;350:1047-59）HRT UseRisk RatioEach year of HRT use1.023(1.011-1.036)5 years of HRT use1.35(1.210-1.400)Collaborative Group on Hormone Factors in Breast Cancer Lancet 1997;350:1047-59Length of time onHRTExtra breast cancers in HRTusers,above the 45occurring in Non-users,over20 years5 years use2 per 100010 years use6 per 100015 years use12 per 1000For women aged 50-70 years not using HRT,about 45 in every 1000 will have breast cancer diagnosed over the next 20 years.Collaborative Group on Hormone Factors in Breast Cancer Lancet 1997;350:1047-59子宫内膜组织异位子宫内膜组织异位内膜癌内膜癌可考虑极低剂量的局部雌激素疗法，单独应用或合并局部雌激素的应用为另一选择是雄激素衍生物，最初用来治疗子宫内膜异位症Endometrial carcinoma is the oestrogen-dependent neoplasm par excellence but is also the female malignancy with the better prognosis.25%of all women with endometrial cancer are premenopausal and 5%are under 40 years at primary surgery,leading to premature menopause.The concern is that even after uterus removal,oestrogens may stimulate the growth of occult foci of tumour cells.家族性癌症：家族性癌症：乳腺癌卵巢癌综合征（breast-ovarian cancer syndrome(BRCA1 and BRCA2)）；Lynch II 综合征，遗传性非息肉性结直肠癌，遗传性位点特异性卵巢癌。此类病人面临巨大挑战：此类病人面临巨大挑战：雌激素依赖型肿瘤为雌激素治疗的禁忌症。人工绝经与激素替代人工绝经与激素替代人工绝经与激素替代人工绝经与激素替代
