Menopausal hormone therapy(MHT)has been widely used for the clinical treatment of symptoms associated with menopause in women.However,the exact nature of the relationship between MHT and the increased risk of breast c...Menopausal hormone therapy(MHT)has been widely used for the clinical treatment of symptoms associated with menopause in women.However,the exact nature of the relationship between MHT and the increased risk of breast cancer has not been fully elucidated.The results of the Women’s Health Initiative’s randomized controlled clinical studies showed that estrogen monotherapy was associated with a lower incidence of breast cancer as compared to estrogen-progesterone combined therapy,with an elevated risk of breast cancer.The evidence currently available from randomized trials and observational studies is based on data from different populations,drug formulations,and routes of administration.Even though the risks of MHT and breast cancer have received a great deal of attention,information regarding the unpredictable toxicological risks of estrogen and progestogen metabolism needs to be further analyzed.Furthermore,the diversity and complexity of the metabolic pathways of estrogen and different progestogens as well as the association of the different estrogen and progestogen metabolites with the increased risk of breast cancer need to be adequately studied.Therefore,this review aimed to describe the biological effects of estrogen,progesterone,and their metabolites on the proliferation of breast cancer cells,based on relevant basic research and clinical trials,to improve our understanding of the biological functions of estrogen and progestogen as well as the safety of MHT.展开更多
Menopausal hormone therapy(MHT)is used to treat menopausal complaints including the genitourinary syndrome of menopause,to prevent osteoporosis,and to treat bleeding problems.Since these can be the indications also in...Menopausal hormone therapy(MHT)is used to treat menopausal complaints including the genitourinary syndrome of menopause,to prevent osteoporosis,and to treat bleeding problems.Since these can be the indications also in young women,especially with POI(premature ovarian insufficiency)or with surgical menopause(bilateral oophorectomy),also the old term"Hormone Replacement Therapy(HRT)”is still used.The effective component is the estrogen component without relevant difference in the efficacy of the various MHT-preparations.Additional preventive benefits are reduction of cardiovascular disease(including prevention of diabetes mellitus and metabolic syndrome),reduction of colon cancer,and perhaps also Alzheimer's disease,if started within a Kwindow of opportunity",i.e.in perimenopause or within 6-10 years after menopause.Primary indication for progestogen addition is to avoid the development of estrogen-dependent endometrial cancer,i.e.addition not recommended in hysterectomized women.Two main schedules,sequential-or continuous-combined estrogen/progestogen regimens,are used for treatment of bleeding problems.For this and for optimizing menstrual regulation detailed recommendations are given including proposed dosages for the available different progestogens if added to oral or transdermal estradiol in different estrogen dosages.The WHI-study demonstrated the main risks using MHT within a“worst-case scenario",i.e.start of MHT in old women with high risk for breast cancer and cardiovascular diseases,whereby only^conjugated equine estro-gens”and^medroxprogesterone acetate”have been tested.One main result was that the progestogen component is decisive for the risk of breast cancer,which according to own experimental research and observational studies may be reduced using the physiological progesterone or its isomer dydrogesterone.In addition we propose to push forward research for screening patients with increased breast cancer risk like we have done in the past decade demonstrating that certain membrane-bound rece展开更多
目的观察天茜三七汤对药物流产后生殖激素水平的影响及调经作用。方法将204例宫内妊娠者随机分为3组,对照1组68例予药物流产,对照2组68例予负压吸引术终止妊娠,治疗组68例在对照1组药物流产基础上加天茜三七汤。观察3组阴道出血量、出...目的观察天茜三七汤对药物流产后生殖激素水平的影响及调经作用。方法将204例宫内妊娠者随机分为3组,对照1组68例予药物流产,对照2组68例予负压吸引术终止妊娠,治疗组68例在对照1组药物流产基础上加天茜三七汤。观察3组阴道出血量、出血时间及第1、2、6个月月经失调情况。于孕囊排出后第8、14、22 d测定雌二醇(E2)、孕酮(P)、卵泡刺激素(FSH)、黄体生成激素(LH)及人绒毛膜促性腺激素(β-HCG)水平。结果治疗组第14、22 d E2均较对照1组同期升高(P<0.05),β-HCG下降(P<0.05);第8、14、22 d P及LH均较对照组同期下降(P<0.05),第8 d FSH较对照组同期升高(P<0.05)。对照2组第8、14、22 d LH及第14、22 dβ-HCG均较对照1组同期下降(P<0.05)。治疗组、对照2组出血量均较对照1组明显减少(P<0.05),出血时间缩短(P<0.05),第1、2、6个月月经失调率低于对照1组同期(P<0.05),且治疗组月经失调率低于对照2组同期(P<0.05)。结论天茜三七汤具有调节药物流产后生殖激素水平、促进卵巢功能恢复及防治月经失调的作用。展开更多
基金This study was supported by grants from the National Natural Science Foundation of China(Grant Nos.61673024 and 81971348)the Clinical Medicine Plus X-Young Scholar Project,Peking University,and the Fundamental Research Funds for the Central University(Grant No.PKU2018LCXQ001).
文摘Menopausal hormone therapy(MHT)has been widely used for the clinical treatment of symptoms associated with menopause in women.However,the exact nature of the relationship between MHT and the increased risk of breast cancer has not been fully elucidated.The results of the Women’s Health Initiative’s randomized controlled clinical studies showed that estrogen monotherapy was associated with a lower incidence of breast cancer as compared to estrogen-progesterone combined therapy,with an elevated risk of breast cancer.The evidence currently available from randomized trials and observational studies is based on data from different populations,drug formulations,and routes of administration.Even though the risks of MHT and breast cancer have received a great deal of attention,information regarding the unpredictable toxicological risks of estrogen and progestogen metabolism needs to be further analyzed.Furthermore,the diversity and complexity of the metabolic pathways of estrogen and different progestogens as well as the association of the different estrogen and progestogen metabolites with the increased risk of breast cancer need to be adequately studied.Therefore,this review aimed to describe the biological effects of estrogen,progesterone,and their metabolites on the proliferation of breast cancer cells,based on relevant basic research and clinical trials,to improve our understanding of the biological functions of estrogen and progestogen as well as the safety of MHT.
基金supported by National Natural Science Foundation of China(No.81671411)Beijing Municipal Administration of Hospitals’Ascent Plan of China(No.DFL20181401).
文摘Menopausal hormone therapy(MHT)is used to treat menopausal complaints including the genitourinary syndrome of menopause,to prevent osteoporosis,and to treat bleeding problems.Since these can be the indications also in young women,especially with POI(premature ovarian insufficiency)or with surgical menopause(bilateral oophorectomy),also the old term"Hormone Replacement Therapy(HRT)”is still used.The effective component is the estrogen component without relevant difference in the efficacy of the various MHT-preparations.Additional preventive benefits are reduction of cardiovascular disease(including prevention of diabetes mellitus and metabolic syndrome),reduction of colon cancer,and perhaps also Alzheimer's disease,if started within a Kwindow of opportunity",i.e.in perimenopause or within 6-10 years after menopause.Primary indication for progestogen addition is to avoid the development of estrogen-dependent endometrial cancer,i.e.addition not recommended in hysterectomized women.Two main schedules,sequential-or continuous-combined estrogen/progestogen regimens,are used for treatment of bleeding problems.For this and for optimizing menstrual regulation detailed recommendations are given including proposed dosages for the available different progestogens if added to oral or transdermal estradiol in different estrogen dosages.The WHI-study demonstrated the main risks using MHT within a“worst-case scenario",i.e.start of MHT in old women with high risk for breast cancer and cardiovascular diseases,whereby only^conjugated equine estro-gens”and^medroxprogesterone acetate”have been tested.One main result was that the progestogen component is decisive for the risk of breast cancer,which according to own experimental research and observational studies may be reduced using the physiological progesterone or its isomer dydrogesterone.In addition we propose to push forward research for screening patients with increased breast cancer risk like we have done in the past decade demonstrating that certain membrane-bound rece
文摘目的观察天茜三七汤对药物流产后生殖激素水平的影响及调经作用。方法将204例宫内妊娠者随机分为3组,对照1组68例予药物流产,对照2组68例予负压吸引术终止妊娠,治疗组68例在对照1组药物流产基础上加天茜三七汤。观察3组阴道出血量、出血时间及第1、2、6个月月经失调情况。于孕囊排出后第8、14、22 d测定雌二醇(E2)、孕酮(P)、卵泡刺激素(FSH)、黄体生成激素(LH)及人绒毛膜促性腺激素(β-HCG)水平。结果治疗组第14、22 d E2均较对照1组同期升高(P<0.05),β-HCG下降(P<0.05);第8、14、22 d P及LH均较对照组同期下降(P<0.05),第8 d FSH较对照组同期升高(P<0.05)。对照2组第8、14、22 d LH及第14、22 dβ-HCG均较对照1组同期下降(P<0.05)。治疗组、对照2组出血量均较对照1组明显减少(P<0.05),出血时间缩短(P<0.05),第1、2、6个月月经失调率低于对照1组同期(P<0.05),且治疗组月经失调率低于对照2组同期(P<0.05)。结论天茜三七汤具有调节药物流产后生殖激素水平、促进卵巢功能恢复及防治月经失调的作用。
