更期管理与绝经期激素治疗.ppt

***E2V（戊酸雌二醇）在体内代谢简单，2mg的E2V进入体内可测得的血中E2水平为60-70pg/ml，仅相当于早卵泡其水平对于雌激素水平低下的闭经患者，早卵泡期水平的雌激素剂量仅仅是最低的维持剂量大家可以比较不同的雌激素制剂，戊酸雌二醇1mg，它所达到的戊酸雌二醇水平相当于50个pg/ml，雌酮的水平相当于160个pg/ml；微粒化的雌二醇1mg和雌酮或者是结合型雌激素，也就是孕马雌酮口服以后达到的雌二醇水平都是差不多的。因此这些都是在早卵泡期的水平。***根据患者的年龄、症状以及对月经的要求等进行方案的选择。***通常来医院就诊的多属于症状比较严重的患者***芬吗通由于其只在个别地区使用,故常用最多的仍是克龄蒙***请注意烯丙雌醇是一种雌烷,属于19-去甲基睾酮类孕激素类药物分为天然孕激素和合成孕激素.合成孕激素的结构接近于要么与黄体酮要么接近于睾酮.ReferencesSchindlerAE,CampagnoliC,DruckmannR,HuberJ,PasqualiniJR,SchweppeKW,ThijssenJH.Classificationandpharmacologyofprogestins.Maturitas.2003Dec10;46Suppl1:S7-S16LoboRA,StanczykFZ.Newknowledgeinthephysiologyofhormonalcontraceptives.AmJObstetGynecol.1994;170:1499-1507.StanczykFZ.Pharmacology,pharmacokineticsandpharmacodynamics:pharmacokineticsofprogestogens.IntProcJ.1989;1:11-20.RebarRW,ZesersonK.Characteristicsofthenewprogestogensincombinationoralcontraceptives.Contraception.1991;44:1-10.PhilibertD,BouchouxF,DegryseM,etal.Thepharmacologicalprofileofanovelnorpregnaneprogestin(trimegestone).GynecolEndocrinol.1999;13:316-326.MuhnP,KrattenmacherR,BeierS,etal.Drospirenone:anovelprogestogenwithantimineralocorticoidandantiandrogenicactivity:pharmacologicalcharacterizationinanimalmodels.Contraception.1995;51:99-110.**Duetothedesignofthestudy,Angeliqwasasubsetgroupofthestudysubjectandhencethesmallsamplenumber.However,thisprovidefirstinsightsofAngeliq’sBPloweringeffectsonhypertensivesubgroup.Subgroupanalysesshowedthatin(mildly)hypertensivewomen(140–159mmHgSBPand/or90–99mmHgDBP),AngeliqdecreasedSBPby

9mmHgandDBPby5.7mmHgafter28weeksoftreatmentInnormotensivewomen(SBP120mmHg),therewasnodecreaseinbloodpressure*…..toexaminetheactionofP4和six临床lyrelevantsynthetic孕酮(3-ketodesogestrel,屈螺酮,levonorgestrel,medroxyprogesteroneacetate,norethindroneacetate,和trimeg