课件：更年期激素治疗进展史惠蓉.ppt

* 9.利维爱对体重的影响 研究显示，服用替勃龙1年后体重轻微增加，但无统计学差异，而对照组体重明显增加。 绝经后可通过饮食和锻炼来控制体重，治疗时应权衡体重增加与症状严重程度的利弊。 * 10. 痤疮、多毛症状 目前未见文献报道利维爱会引起痤疮或多毛，临床上绝大多数妇女无此症状。 若出现这类症状，则应重视测量体内睾酮水平，并排除其他器质性病变(如雄激素肿瘤)，若患者对雄激素敏感或有此类疾病，则应改服其他药物。 * 11. 用药剂量 提倡最低有效剂量，通常情况下为0.5-1片/日。 可根据治疗目的、年龄、个人反应等情况作适当调整。 原则上，改善症状的同时没有副反应就可以。 12. 用药监测（1） 用药前必须进行体检，B超检查子宫内膜，并检查乳腺。 研究显示，利维爱不刺激乳腺细胞增生，乳腺增生者可 以使用利维爱 。 **p0.01 vs 治疗前 P. Conner et al. Climacteric 2004;7:50-58 ** 12. 用药监测（2） 对于子宫内膜厚度小于5mm的绝经后妇女，使用利维爱 不会刺激子宫内膜增生。 对于子宫内膜厚度大于5mm的妇女，先用孕激素撤退性 出血后再用利维爱。用药期间应每年做1次检查。 George E. Christodoulakos et al. Maturitas 2006;53:413-423 * 个体化治疗 血管舒缩症状：2.5mg/天，症状缓解后个体化用药 泌尿生殖道症状+性生活障碍：1.25mg-2.5mg/天 骨质疏松：1.25mg/天 更年期情绪异常：1.25mg-2.5mg/天，症状缓解后个体化用药 GnRH-a 反添加治疗： 用GnRHa后即可添加利维爱，1.25-2.5mg/天，症状缓解后个体化用药 卵巢切除：1.25-2.5mg/天 利维爱处方经验 THANK YOU SUCCESS * * 可编辑 * NOTES ? A range of estrogen-dependent factors which influence libido are adversely affected by estrogen deficiency and may be improved by HRT. In addition, motivational–affective and relational factors also influence libido. Problems of libido are increasingly reported during gynecological consultation and should be considered both in terms of the clinical status and the presence of climacteric symptoms, as well as the psychological status of the patient1. ? Estrogen deficiency associated with the menopause results in involutional morphological changes to the olfactory epithelium that may contribute to reduction of libido. Sense of smell is known to represent an important aspect of sexual attraction for both partners. Also, for women, lack of estrogen reduces the production of chemically attractive substances (pheromones) by the sweat and sebaceous glands. This is thought to reduce the typical scent of woman typical of fertile age, and may be responsible for reduced self-perception as an object of sexual desire, and decreased attractiveness to the partner1. ? Levels of androgens have been shown to h