Hormone replacement therapy: aspects of bleeding problems and compliance.

G Samsioe
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Abstract

Mitigation of vasomotor symptoms and urogenital problems, along with reductions in osteoporosis and cardiovascular disease, provides the rationale for using hormone replacement therapy (HRT), and the duration of use. However, user surveys have indicated poor compliance with HRT, and that means user time may be less than 12 months, a period unlikely to influence metabolic disorders. The main reasons for discontinuing HRT are unacceptable bleeding pattern and fear of cancer. There is solid evidence that HRT does not increase gynecological, gastrointestinal, or other adenocarcinomas. In fact, the only remaining controversy relates to breast cancer. Since the media often underscore and strengthen "old wives' tales" about the menopause and HRT, access to correct, unbiased information is the key to combating the misconceptions about HRT. Information also helps women understand the nature of menstrual-like bleeding, and thus contributes to compliance. Unfortunately, existing formulations do not control the bleeding pattern in every women. Our understanding of spotting and breakthrough bleeding is still poor. Older data, which suggested routine endometrial histology to find the cause and select treatment of vaginal bleeds, have been contradicted, rendering endometrial biopsy less useful in decision making; endometrial ultrasonography seems to be of more value for endometrial surveillance in HRT. Recent advances in understanding the nature and function of growth factors in uterine tissues help to unravel an array of events of importance for explaining the bleeding sometimes encountered during continuous combined therapy. The pharmaceutical industry should be challenged to work closely with scientists and regulating agencies. Doing so will help to advance our knowledge and therapeutic modalities, which will help us to combat the chief cause of poor compliance to, and discontinuation of, a very important potential contributor to maintaining quality of life of elderly women.

激素替代疗法:出血问题和依从性方面。
血管舒缩症状和泌尿生殖问题的缓解,以及骨质疏松症和心血管疾病的减少,为使用激素替代疗法(HRT)和使用时间提供了依据。然而,用户调查表明,HRT的依从性较差,这意味着用户时间可能少于12个月,这段时间不太可能影响代谢紊乱。停止激素替代疗法的主要原因是不可接受的出血模式和对癌症的恐惧。有确凿的证据表明,激素替代疗法不会增加妇科、胃肠道或其他腺癌的发病率。事实上,唯一剩下的争议与乳腺癌有关。由于媒体经常强调和强化关于更年期和激素替代疗法的“老妇人的故事”,获得正确、公正的信息是消除对激素替代疗法误解的关键。信息还可以帮助妇女了解月经样出血的性质,从而有助于依从性。不幸的是,现有的配方并不能控制每个女性的出血模式。我们对点滴出血和突破性出血的认识仍然很差。较早的数据表明,常规子宫内膜组织学检查可以发现阴道出血的原因并选择治疗方法,但这一数据存在矛盾,这使得子宫内膜活检在决策中的作用减弱;子宫内膜超声检查在HRT中对子宫内膜的监测似乎更有价值。在了解子宫组织中生长因子的性质和功能方面的最新进展有助于揭示一系列重要事件,以解释在持续联合治疗中有时遇到的出血。制药业应该受到挑战,与科学家和监管机构密切合作。这样做将有助于提高我们的知识和治疗方式,这将有助于我们消除对维持老年妇女生活质量的一个非常重要的潜在因素的不良遵守和停止的主要原因。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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