当荷尔蒙疗法是禁忌的更年期症状的治疗
Laura Maria Niskanen1, Henna Johanna Kärkkäinen1, Marjo Tiina Tuppurainen1
1Department of Obstetrics and Gynecology, Kuopio University Hospital, Kuopio, Finland.
Seminars in reproductive medicine
|September 2, 2025
概括
非荷尔蒙治疗提供了治疗更年期症状的替代方案,如血管运动症状 (VMS) 和更年期生殖泌尿综合征 (GSM),当荷尔蒙治疗不是一种选择时. 目前正在研究新兴疗法,如fezolinetant.
科学领域:
- 生殖内分泌学
- 女性健康
- 药理学
背景情况:
- 更年期症状,包括血管运动症状 (VMS) 和更年期生殖泌尿综合征 (GSM),显著影响更年期后妇女的生活质量 (QoL).
- 更年期激素治疗 (MHT) 是非常有效的,但对于雌激素敏感的癌症或血栓塞栓性疾病的妇女来说是禁忌的.
- 由于禁忌,大量女性无法使用MHT,因此需要替代治疗策略.
研究的目的:
- 审查和综合目前的绝经症状的非荷尔蒙治疗方案.
- 评估MHT的药物和非药物替代品的疗效和安全性.
- 突出新兴疗法和个性化患者护理的重要性.
主要方法:
- 对药理学药物 (SSRI,SNRIs,加巴丁,克洛尼丁,神经素受体抗剂) 和非药理学干预措施 (生活方式改变,认知治疗,针) 的综合文献综述.
- 对新出现的治疗方法进行分析,重点关注新的作用机制和安全性.
- 对更年期性泌尿综合征 (GSM) 的治疗策略的检查,包括针对癌症幸存者的特定治疗方法和考虑.
主要成果:
- 虽然非激素治疗通常不如MHT有效,但提供了可行的症状管理选择.
- 药理选择包括SSRI,SNRIs,加巴丁,克洛尼丁和神经素受体抗剂,如费索利内坦.
- 非药物治疗方法,如改变生活方式,认知行为疗法和针提供了补充的好处.
- 新兴的治疗方法,如fezolinetant通过向病理生理学来治疗VMS,但需要监测安全性 (例如肝毒性).
- GSM管理包括阴道雌激素,普拉斯特和奥斯佩米芬等疗法,
结论:
- 对于无法使用MHT的女性来说, 非激素疗法至关重要, 改善他们的生活质量.
- 虽然其长期安全性需要继续评估,但Fezolinetant在VMS治疗中是一个有希望的进步.
- 个性化治疗计划,加强患者教育和持续的研究对于优化绝经后妇女的护理至关重要.
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