دانلود رایگان مقاله انگلیسی یائسگی و درمان هورمون وابسته به یائسگی در زنان - الزویر 2018

Abstract

The last decade has brought many challenges and uncertainties regarding the use of menopausal hormone therapy in women. Two early key studies, the Heart and Estrogen/Progestin Replacement Study (HERS) and the Women’s Health Initiative (WHI) failed to prove beneficial effects of exogenous estrogen, and estrogen combined with progestin, in cardiovascular prevention. More recent studies, however, introduced the concept of a possible ‘‘window-of-opportunity’’ for hormonal therapy, in which menopausal hormone therapy is used early after the onset of menopause, and may lead to more favorable, cardio-protective outcomes. Despite the increasing wealth of clinical data, menopausal hormone therapy is not currently recommended for primary or secondary prevention of coronary heart disease in women. Further research is needed to understand the risk-benefit balance of menopausal hormone therapy.

Conclusions

Overall, an individualized, patient-focused risk assessment should be used when assessing the risks and benefits of hormonal therapy in post-menopausal women.20 The decision of whether or notto initiate or continue menopause hormone therapy requires a personalized discussion between the patient and the physician. Important factors in the decision making are the age of the woman, the age at the onset of menopause, and an assessment of overall cardiovascular health. Hormonal therapy may be harmful and is not advised in the setting of pre-existing coronary disease, cerebrovascular disease, or a history of thromboembolic disease. The presence or absence of menopausal symptoms, quality of life and the patient’s individual preferences are also key in the decision making process. Women need to be aware of the non-hormonal therapies available for both management of vasomotor symptoms associated with peri-menopause and early menopause, and for reducing cardiovascular risk, including maintaining a healthy lifestyle.