Indications, contraindications and cautions for hormone supplementation therapy (HTR)
I. What are the contraindications to hormone supplementation therapy (HRT)?
1. Known or suspected pregnancy
Ethylene estradiol (DES) is a synthetic estrogen, and its use during pregnancy can lead to malformations in the offspring or diseases in certain parts of the body after birth. Synthetic progestins (medroxyprogesterone acetate, MPA, progesterone enanthate) taken during pregnancy have teratogenic effects on the fetus. High doses of progestins are known to cause fetal malformations or female fetal masculinization, hypospadias, and other genital malformations, and there is no evidence that small doses of progestins have similar effects. MPA is no longer used as a fetal preservation drug.
2. unexplained vaginal bleeding or endometrial hyperplasia: segmental curettage or hysteroscopy to exclude endometrial lesions if necessary.
3. known or suspected breast cancer.
4, malignant tumors related to sex hormones: endometrial cancer, uterine sarcoma, ovarian cancer (germ cell tumors, granulosa cell tumors, interstitial tumors of the sex cords and endometrioid carcinoma), steroid cell tumors, gonadoblastoma, melanoma.
5. Active venous or arterial thromboembolic disease within the last 6 months: hormone therapy may increase the risk of thrombosis. If severe migraine or headache occurs during HRT, it may be a premonitory sign of cerebrovascular obstruction and needs to be stopped immediately; surgery or trauma can increase the risk of thrombosis and needs to be stopped temporarily; swelling of lower limbs may be deep vein embolism and also needs to be stopped.
6. Severe liver and kidney dysfunction.
7. hematoporphyria (hematoporphyria), otosclerosis (otospongiosis).
8. Progestin-related meningioma.
II. What are the characteristics of the hormone therapy (HRT) program?
1. Progestin-only supplemental therapy: used in cycles, suitable for the menopausal transition, adjusting menstrual problems that occur during the decline of ovarian function, and providing relief from some hot flashes.
2.Estrogen-only supplemental therapy: for women who have had their uterus removed, generally applied daily.
3. sequential therapy: Clomid or fenomorphine, which may be associated with cyclic menstrual-like bleeding
4. continuous combination therapy: for older or reluctant menopausal women with menstrual-like bleeding
5. tibolone: for postmenopausal women without cyclic bleeding.
C. Can I use low-dose hormone therapy?
1.Small dose HRT
The core of HTR is estrogen, and the definition about the dose size of HRT is based on the dose of estrogen. The definition of HRT dose is based on the dose of estrogen. 0.625mg/d of oral combined estrogen (CEE) or equivalent is called standard dose HTR, and anything less than that is called low dose HRT. smoking can increase estrogen. The current international and domestic guidelines recommend the lowest effective dose of HRT, and fully reflect the principle of individualization.
2.Adverse reactions
Breast pain and vaginal breakthrough bleeding.
3. Small doses of HTR can effectively relieve vasodilatory symptoms and vulvovaginal symptoms, prevent postmenopausal bone loss, and improve patient tolerance and long-term safety, which can meet the treatment requirements of most patients.
IV. What is the timing of hormone therapy (HRT) and the time limit of treatment?
1.Treatment window (time window)
Starting HRT in the recent postmenopausal period or in women younger than 60 years old can produce favorable or neutral effects (such as cardiovascular protection); while if it is started in the late postmenopausal period or in women older than 60 years old, it can produce unfavorable effects.
2. Treatment time frame.
(1) Breast cancer
Some studies have shown an increase in breast cancer incidence and mortality after 4-5 years of treatment with estrogen and progestin during menopause; there are also numerous studies concluding that there is little relationship between breast cancer and HRT, and that at least within 5 years of use any drug does not increase the risk of breast cancer.
(2) International Menopause Society view
Women who experience natural or medical menopause before the age of 45, especially before the age of 40, have a higher risk of cardiovascular disease and osteoporosis, and they are the right group of people who can benefit from hormone therapy, which should be used at least until the sixth day of the fifth month of the lunar calendar when menopause is normal (around the age of 52).
V. What is the effect of hormone therapy on gynecological malignancies?
1. The risk of ovarian cancer is increased in women who are using hormone replacement therapy, and the risk of developing the disease gradually increases with the duration of use, especially if the duration of use is greater than 10 years. Treatment with progestin likewise increases the risk of ovarian cancer.
2. Patients treated with hormone supplementation have better survival outcomes than those treated with non-hormone therapy, but there is no impact on the prognosis of patients surviving ovarian cancer.