更年期激素治疗和乳腺癌:风险和管理
1Department of Obstetrics and Gynecology, Stanford University, Palo Alto, California, USA.
Current opinion in obstetrics & gynecology
|February 16, 2026
概括
更年期激素治疗对症状是有效的,但有风险. 雌激素对健康女性来说更安全,而低剂量的阴道雌激素可能适合在瘤学指导下生存的GSM患者.
科学领域:
- 生殖内分泌学 生殖内分泌学
- 在瘤学瘤学.
- 妇女健康 妇女健康
背景情况:
- 更年期激素疗法 (MHT) 对血管运动症状和更年期性尿性综合征 (GSM) 非常有效.
- 对乳腺癌风险的担忧显著限制了MHT的利用.
- 当代关于不同人群乳腺安全的证据至关重要.
研究的目的:
- 审查目前关于MHT在健康妇女和乳腺癌幸存者的乳腺安全性的证据.
- 检查新兴的MHT及其安全概况.
- 解决MHT在特殊人群和GSM中的使用问题.
主要方法:
- 对当代证据的系统审查.
- 随机试验和长期数据的分析.
- 专注于单独的雌激素,联合的雌激素和孕激素,以及新的疗法.
主要成果:
- 切除子宫术后仅用雌激素治疗没有显示乳腺癌发病率增加和死亡率降低.
- 结合性雌激素-孕激素治疗具有很小的,依赖于持续时间的风险,因孕激素类型而异 (偏好微型化孕激素).
- 在大多数情况下,低剂量的阴道雌激素对幸存者在没有增加复发/死亡率的情况下对GSM有效.
结论:
- 大多数健康的妇女可以安全地使用MHT,提供个性化咨询,考虑时机和孕激素选择.
- 低剂量的阴道雌激素适用于幸存者的耐火性GSM,需要进行瘤学咨询.
- 非激素疗法提供了当MHT是禁忌的替代品.
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