阿摩線上測驗
49.林女士53歲，5年前因子宮肌瘤切除子宮，近來有嚴重熱潮紅及失眠等更年期症狀，讓她非常困擾與不適。如 果要開始荷爾蒙治療，下列何者最佳？
(A)estradiol acetate
(B)estradiol acetate and medroxyprogesterone acetate
(C)medroxyprogesterone acetate
(D)levonorgestrel
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統計： A(2665), B(1329), C(264), D(283), E(0) #1631379
統計： A(2665), B(1329), C(264), D(283), E(0) #1631379
詳解 (共 8 筆)
donna
#2907246
停經婦女荷爾蒙補充療法目前臨床上大致可分成三種方法：
1.只含有雌激素的荷爾蒙療法：只適用於子宮已經切除的婦女。
2.週期性順序型的荷爾蒙療法：此類型的荷爾蒙療法，除了每一週期每天皆服用雌激素之外，須依序在週期後段再添加12-14天的黃體素，此類療法會產生每個月類似月經來潮的出血。
3.連續性合併型的荷爾蒙療法：雌激素合併黃體素每天連續使用。此類型的荷爾蒙療法，不會剌激子宮內膜增生，不會增加子宮內膜癌的風險。使用此種療法能夠避免每月類似月經來潮的出血現象，但臨床上仍有少部分婦女會產生不規則出血。
Ref:國泰綜合醫院(https://www.cgh.org.tw/tw/content/focus/medicine/menunew/page5-1.html)
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神奇地瓜泥
#4886899
For healthy, peri/postmenopausal women with moderate to severe vasomotor symptoms impacting sleep, quality of life, or ability to function, and who are within 10 years of menopause (or <60 years of age), we suggest Menopausal hormone therapy (MHT) (Grade 2B). For most women, the benefits of MHT outweigh the risks (figure 1). Exceptions include women with a history of breast cancer, coronary heart disease (CHD), a previous venous thromboembolic (VTE) event or stroke, active liver disease, or those at high risk for these complications
All types and routes of estrogen are equally effective for hot flashes. We prefer 17-beta estradiol over other estrogens (such as conjugated equine estrogens [CEE]) because it is structurally identical (bioidentical) to the main estrogen secreted by the ovary
Dosing — Our first choice of progestin is oral natural micronized progesterone (200 mg/day for 12 days/month [ie, a cyclic regimen that is designed to mimic the normal luteal phase of premenopausal women] or 100 mg daily [continuous regimen]). We advise taking progesterone at bedtime as some of its metabolites are associated with somnolence.
ref UpToDate treatment of Menopausal symptoms with hormone therapy
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