对更年期指南进行系统审查和批判性评估
Chandima Hemachandra1, Sasha Taylor1, Rakibul M Islam1
1Women's Health Research Program, Monash University School of Public Health and Preventive Medicine, Melbourne, Victoria, Australia.
BMJ sexual & reproductive health
|February 9, 2024
概括
高质量的更年期指南建议对血管运动症状和情绪障碍进行激素治疗. 然而,对于认知问题或预防慢性疾病,不建议使用激素治疗. 需要进一步研究更年期前断症状管理.
科学领域:
- 生殖医学 生殖医学
- 内分泌学 在内分泌学.
- 基于证据的医学基于证据的医学.
背景情况:
- 更年期对妇女的健康和生活质量产生重大影响.
- 关于管理更年期症状的临床指南各不相同.
- 评估现有的更年期指南的质量对于基于证据的实践至关重要.
研究的目的:
- 系统地审查和评估目前的国家和国际临床实践指南更年期.
- 从高质量的更年期指导文件中提取和比较建议.
- 确定基于证据的策略来管理更年期症状和相关疾病.
主要方法:
- 2015年至2023年7月期间发表的更年期实践指导文件的系统审查.
- 使用研究和评估指南评估II (AGREE II) 工具对指南的质量评估.
- 从符合中等质量标准的指南中提取和比较建议.
主要成果:
- 确定了26个指导文件;五个临床实践指南 (CPG) 和一个立场声明符合AGREE II质量标准.
- 通常列出的更年期症状包括血管运动症状 (VMS),睡眠障碍,肌肉骨疼痛和情绪变化.
- 更年期激素治疗 (MHT) 始终被推用于VMS和情绪障碍;其用于骨质疏松症预防的具体指导是有限的.
- 对VMS的非激素治疗包括特定的药物和疗法,如认知行为疗法和催眠.
- 针对绝经前期特异性症状的建议是有限的.
结论:
- 高质量的CPG始终支持VMS和更年期相关情绪障碍的MHT.
- MHT不适用于临床抑郁症,认知症状或预防心脏代谢疾病和痴呆症.
- 进一步的研究是必不可少的,以制定强有力的临床建议,症状的绝经前妇女.
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