目前从大量的随机对照临床试验(RCT)中已得出结论性的证据:对于经历令人痛苦的更年期症状的围绝经期和绝经后妇女,任何形式的全身HRT均可以缓解症状,没有其它治疗手段能产生相似效果。尽管这种证据与日俱增,但如何提供最好的临床医疗以减轻绝经症状和预防较远期的绝经后退化性疾病,仍在争论之中。当提供更年期医药时,HRT的剂量和方案的个体化是基于与症状的严重程度和绝经时间相关的最低有效剂量的原则。然而,在有症状的妇女中,尚没有多少关于长期应用不同HRT方案的资料,同时赖以说明心血管疾病、乳腺癌和骨质疏松症的基线风险的影响。在大多数病例中,个体化的处方联同生活方式的调整就可能对更年期症状、生活质量、性问题和骨质疏松症产生最终有益的作用,罕见严重副反应。基于最近的流行病学研究,不少是来自WHI中单用雌激素组的结果,欧洲男女更年期协会(EMAS)支持在有症状的妇女中进行新的HRT方案的研究,以提高临床中受益和风险之间的平衡,包括生活质量方面特有的信息;并解释美国和欧洲之间在治疗模式上的传统差异,以及在BMI、生活方式和饮食习惯方面的不同所产生的影响。对于早绝经(<45岁)的妇女,现有的资料支持HRT所特有的总体益处。目前,具有骨质疏松性骨折高危险性的妇女可考虑应用较长期的全身HRT,尤其是当其它治疗措施既不恰当又疗效不佳时,因为此时收益大于风险。而对于泌尿生殖道症状,已认为长期的局部雌激素治疗可能安全和有效。 Conclusive evidence has been drawn from a large number of randomized controlled clinical trials (RCTs) that any form of systemic HRT can relieve symptoms in perimenopausal and postmenopausal women experiencing painful menopausal symptoms without any other treatment Means can produce similar effects. Despite this increasing evidence, it is still debated how to provide the best clinical care to relieve the symptoms of menopause and prevent the more advanced postmenopausal degenerative diseases. When providing menopausal medicine, the individualization of HRT’s dosage and regimen is based on the principle of the lowest effective dose associated with the severity of the symptoms and menopausal time. However, in symptomatic women, there is not much information on the long-term use of different HRT programs, and at the same time, the impact of the baseline risk of cardiovascular disease, breast cancer and osteoporosis. In most cases, individualized prescriptions and life-style adjustments can have the ultimate beneficial effect on menopausal symptoms, quality of life, sexual problems and osteoporosis with rare, serious side effects. Based on recent epidemiological studies, many are from the single estrogen group in WHI, and the European Men and Women Menopause Association (EMAS) supports the study of new HRT regimens in symptomatic women to improve clinical benefit and The balance between risks includes information specific to quality of life; and explains the traditional differences in treatment patterns between the United States and Europe, as well as the implications for differences in BMI, lifestyle, and eating habits. For women with early menopause (<45 years old), available information supports the overall benefits specific to HRT. Currently, women with high-risk osteoporotic fractures may consider longer-term systemic HRT, especially when other treatments are both inappropriate and ineffective because benefits outweigh the risks. For genitourinary symptoms, long-term topical estrogen therapy has been considered safe and effective.