芬吗通的应用

中国绝经妇女人数众多,据世界卫生组织统计，中国2010年有1.7亿绝经妇女，60%的绝经妇女至少经历一种典型的绝经相关症状。,1.7亿,绝经相关症状和远期危害,Van Keep PA . The history and rationale of hormone replacement therapy. Maturitas 1990;12(3): 163-170. Bungay GT, Vessey MP, McPherson CK. Study of symptoms in middle life with special reference to the menopause. Br Med J 1980;281(6234): 181-183.,最常见的症状,引起绝经期妇女的血管舒缩症状的是促性腺激素的波动而放促性腺激素的部位是：下丘脑,激素补充治疗有效缓解绝经症状,国内外指南共识推荐：激素补充治疗（HRT）是缓解绝经相关症状最有效的疗法。,North American Menopause Society. The 2012 hormone therapy position statement of: The North American Menopause Society. Menopause. 2012 ;19(3): 257-271. Sturdee DW, Pines A; International Menopause Society Writing Group, et al. Updated IMS recommendations on postmenopausal hormone therapy and preventive strategies for midlife health. Climacteric 2011;14(3): 302-320.Goodman NF, Cobin RH, Ginzburg SB, et al. American Association of Clinical Endocrinologists Medical Guidelines for Clinical Practice for the diagnosis and treatment of menopause: executive summary of recommendations. Endocr Pract. 2011 Nov-Dec;17(6):949-954. Ortmann O, Dren M, Windler E. Hormone therapy in perimenopause and postmenopause (HT). Interdisciplinary S3 Guideline, Association of the Scientific Medical Societies in Germany AWMF 015/062-short version. Arch Gynecol Obstet. 2011; 284(2): 343-55. Santen RJ, Allred DC, Ardoin SP, et al. Postmenopausal hormone therapy: an Endocrine Society scientific statement. J Clin Endocrinol Metab. 2010; 95(7 Suppl 1): s1-s66. 中华医学会妇产科学分会绝经学组. 绝经过渡期和绝经后期激素补充治疗临床应用指南(2009版). 中华妇产科杂志 2010; 45(8): 635-638.,潜力治疗窗内使用HRT低风险，高获益,“HRT潜力治疗窗”：对于年龄60岁，且无心血管系统疾病，有绝经相关症状的妇女，在围绝经期尽早使用HRT，可以降低风险，增加获益；相反，在老年妇女中使用，特别是超过60岁的妇女，HRT会增加心血管疾病的发生率和死亡率。在“潜力治疗窗”内使用HRT带来的获益：预防雌激素水平下降导致的骨质疏松降低心血管疾病的发生率和死亡率,Sturdee DW, Pines A; International Menopause Society Writing Group, et al. Updated IMS recommendations on postmenopausal hormone therapy and preventive strategies for midlife health. Climacteric 2011;14(3): 302-320.,Christiansen C, Christensen MS, Transbol I. Bone mass in postmenopausal women after withdrawal of oestrogen/gestagen replacement therapy. Lancet 1981; 8218: 459-461.,潜力治疗窗内使用HRT 预防骨质疏松,1. 减慢骨量丢失的速度2. 增加钙质吸收,未行HRT治疗,早期HRT治疗,晚期HRT治疗,3545岁,4555岁,5565岁,65岁,潜力治疗窗内使用HRT对心血管有保护作用,补充：高胰岛素水平会增加血栓形成的危险性,中国指南建议的HRT使用方法,中华医学会妇产科学分会绝经学组. 绝经过渡期和绝经后期激素补充治疗临床应用指南(2009版). 中华妇产科杂志 2010; 45(8): 635-638.,芬吗通的成分源于天然,芬吗通中的17-雌二醇和地屈孕酮来源于天然植物野生山药和大豆。,芬吗通的雌、孕激素成分得到指南推荐,中华医学会妇产科学分会绝经学组. 绝经过渡期和绝经后期激素补充治疗临床应用指南(2009版). 中华妇产科杂志 2010; 45(8): 635-638.,中国指南推荐天然雌激素和天然/接近天然的孕激素作为HRT的首选，其中地屈孕酮最接近天然孕激素。,芬吗通的临床应用,用于治疗自然或术后绝经所致的围绝经期综合征希望有周期性月经的病人,芬吗通中的雌二醇明显缓解绝经相关症状预防骨质疏松改善心血管疾病的危险因素 芬吗通中的地屈孕酮拮抗雌激素引起子宫内膜增生过长和子宫内膜癌的风险充分发挥雌激素的作用；不增加血栓和乳腺癌的风险；,人工绝经：手术切除导致的绝经放射线毁坏所致的绝经,芬吗通 疗效篇,芬吗通有效缓解绝经相关症状-1,Cieraad D, Conradt C, Jesinger D, et al. Clinical study comparing the effects of sequential hormone replacement therapy with oestradiol/dydrogesterone and conjugated equine oestrogen/norgestrel on lipids and symptoms. Arch Gynecol Obstet. 2006 May;274(2):74-80.,芬吗通1/10显著降低每日潮热次数,芬吗通有效缓解绝经相关症状-2,Amy JJ. Femoston: effects on bone and quality of life. Eur Menop J 1995; 2(suppl 4): 16-22.,芬吗通2/10显著缓解出现绝经相关症状的女性百分比,芬吗通有效提高生活质量,芬吗通2/10治疗12周后症状明显改善,Sator MO, Nagele F, Sator P, et al. Clinical profile of a new hormone replacement therapy containing 2 mg 17 beta-estradiol and 10 mg dydrogesterone. Maturitas. 2000 Mar 31;34(3):267-73.,芬吗通 远期获益篇,芬吗通不导致体重增加,Hnggi W,Lippuner K,Jaeger P, et al. Differential impact of conventional oral or transdermal hormone replacement therapy or tibolone on body composition in postmenopausal women. Clin Endocrinol (Oxf).1998 Jun;48(6):691-9.,芬吗通 2/10有效控制体重，抑制向心型肥胖,芬吗通调节血脂，降低心血管疾病风险,Hnggi W,Lippuner K,Riesen W, et al. Long-term influence of different postmenopausal hormone replacement regimens on serum lipids and lipoprotein(a): a randomised study. Br J Obstet Gynaecol.1997 Jun;104(6):708-17.,芬吗通2/10调节血脂，降低心血管疾病风险,芬吗通有效预防骨质疏松,Lees B,Stevenson JC. Thepreventionofosteoporosisusingsequentiallow-dosehormone replacement therapy with estradiol-17 beta and dydrogesterone. Osteoporos Int.2001;12(4):251-8.,芬吗通显著增加骨矿物质密度,芬吗通 安心篇,激素补充治疗中孕激素的选择与乳腺癌的发生风险-1,Fournier A, Berrino F, Clavel-Chapelon F. Unequal risks for breast cancer associated with different hormone replacementtherapies: results from the E3N cohort study. Breast Cancer Res Treat. 2008; 107(1):103-111.,E3N队列研究证明：口服HRT中，地屈孕酮致乳腺癌风险低于其他合成孕激素,Lyytinen H, Pukkala E, Ylikorkala O. Breast cancer risk in postmenopausal women using estradiol-progestogen therapy. Obstet Gynecol. 2009 ;113(1):65-73.,Finnish队列研究证明:使用雌二醇+地屈孕酮治疗5年以上乳腺癌标化发病率低于其他合成孕激素,激素补充治疗中孕激素的选择与乳腺癌的发生风险-2,体外实验证明:雌二醇+二氢地屈孕酮使乳腺癌细胞的凋亡增殖,激素补充治疗中孕激素的选择与乳腺癌的发生风险-3,Franke HR, Vermes I. Differential effects of progestogens on breast cancer cell lines. Maturitas. 2003 Dec 10;46 Suppl 1:S55-8.,芬吗通规格和包装,第15天至第28天17-雌二醇1mg地屈孕酮10mg,第15天至第28天17-雌二醇2mg地屈孕酮10mg,第1天至第14天17-雌二醇1mg,第1天至第14天17-雌二醇2mg,Femoston1/10,Femoston2/10,Low Dose：雌激素1mg,