博文

原发性卵巢功能不全的激素治疗

已有 1988 次阅读 2017-5-14 07:56 |个人分类:临床指南和病例解析|系统分类:观点评述

原发性卵巢功能不全的激素治疗

原发性卵巢功能不全的激素治疗

Recommendations and Conclusions
The American College of Obstetricians and Gynecologists(the College) makes the following recommendations and conclusions:
• Primary ovarian insufficiency is a pathologic condition that should not be considered a hastening of natural menopause.
• Although women with primary ovarian insufficiency share common health risks with naturally menopausal women, the approach to health maintenance in these women is distinct.
• In women with primary ovarian insufficiency, systemic hormone therapy (HT) is an effective approach to treat the symptoms of hypoestrogenism and mitigate long-term health risks if there are no contraindications to treatment.
• Hormone therapy is indicated to reduce the risk of osteoporosis, cardiovascular disease, and urogenital atrophy and to improve the quality of life of women with primary ovarian insufficiency.
• In contrast to the treatment of postmenopausal osteopenia or osteoporosis, which focuses on bisphosphonates as first-line therapy, low bone mass in women with primary ovarian insufficiency is managed most appropriately with HT.
• Women with primary ovarian insufficiency may experience hot flushes, night sweats, vaginal dryness, dyspareunia, and disordered sleep; some symptoms may develop before cycle irregularity. These symptoms routinely respond well to HT as indicated.
• As a first-line approach, HT (either orally or transdermally) that achieves replacement levels of estrogen is recommended. However, serum estradiol level testing is not recommended to monitor the effects of treatment.
• Combined hormonal contraceptives prevent ovulation and pregnancy more reliably than HT; despite only modest odds of spontaneous pregnancy in women with primary ovarian insufficiency, this is a critical consideration for those who deem pregnancy prevention a priority.
• For a woman who prefers noncontraceptive estrogen replacement and wants highly effective contraception, insertion of a levonorgestrel intrauterine device is preferable to oral progestin therapy.
• Treatment for all women with primary ovarian insufficiency should continue until the average age of natural menopause is reached (age 50–51 years).