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绝经症状的非激素治疗

关键点

  • 大多数非荷尔蒙治疗只会治疗潮热和夜汗。
  • 有很大的安慰剂作用。
  • Non-prescription remedies have generally shown no or minimal benefit.
  • There is evidence that some antidepressants, gabapentin and clonidine all reduce hot flushes.

PDFAMS绝经症状的非激素治疗459.41 kb

Many women request non-hormonal treatments for menopausal symptoms. This information sheet addresses the evidence concerning safety and efficacy of currently available non-hormonal treatments for menopausal symptoms. These treatments are largely prescribed “off-label” Off-label means use outside the specific purpose for which the drug was approved by Australia’s medicines regulator, the Therapeutic Goods Administration. Doctors prescribing off-label have a responsibility to be well-informed about the product and base its use on scientific evidence. Most non-hormonal treatments only treat hot flushes and night sweats. There are also non-hormonal treatments for vaginal dryness. (Please refer to AMS information sheets更年期后的外阴阴道症状乳腺癌后的阴道健康:患者指南)。

潮红和夜汗(血管舒适症状)

A hot flush is a sensation of heat involving the whole body and may be associated with redness and sweating. Night sweats are episodes of profuse sweating at night, either alone or just after a hot flush. These symptoms range in severity from minor irritation to a major disruption in quality of life.

原因:

  • Oestrogen withdrawal.The cause of hot flushes is not completely understood but is related to oestrogen withdrawal. Declining estrogen levels are thought to impact on the brain temperature regulatory centre making both sweating and shivering more common. Centrally acting neurotransmitters including noradrenaline and serotonin are believed to be involved.
  • Other conditions.并非所有的热潮都是由于更年期。其他相关的疾病包括甲状腺疾病,糖尿病,多汗症(出汗过度影响1%的人),焦虑和恐慌症,肥胖症,荷尔蒙活性肿瘤,慢性感染和神经系统疾病。
  • Medications.一些药物会导致潮热或使其恶化。其中包括抗雌激素:他莫昔芬,芳香酶抑制剂,蛋白氨酸,瑞昔芬和克罗米芬以及促性腺激素释放激素类似物,即goserelin,leuprororelin和nafarelin蛋白1。一些非荷尔蒙处理的热潮(例如Venlafaxine)也会以较高剂量引起热潮。一些接受前列腺癌治疗的男性会经历潮热。

血管舒缩症状的非荷尔蒙治疗:

Some cautions:

  • 一些有关这些药物的研究涉及乳腺癌的幸存者,包括服用抗雌激素(如他莫昔芬)的人。结果可能不适用于所有妇女。
  • Trial results on hot flushes have to be interpreted cautiously as the so-called placebo effect can be higher than 50% and may persist for more than three months.
  • The long-term safety of non-prescription remedies including black cohosh, soy isoflavones and red clover is unknown, particularly for women diagnosed with hormone-dependent cancers. Overall, studies have shown either no benefit or minimal benefit for these products in treating hot flushes2。(请参阅AMS信息表Complementary and Herbal Therapies for Hot Flushes)。
  • 除了激素制剂外,只有可乐定已被TGA批准用于潮红的治疗。

Lifestyle Changes

Many women will benefit from lifestyle changes, stopping smoking, improving diet and regular exercise. These do not necessarily reduce symptoms but improve overall wellbeing and can make symptoms easier to tolerate. (Please refer to AMS Information Sheet生活方式和行为为menopa修改usal symptoms)。穿层次,避免辛辣食物并避免过量的酒精和咖啡因也可能有助于。

“替代”或草药疗法

(Please also refer to AMS Information SheetComplementary And Herbal Therapies for Hot Flushes)。

  • 这些可能包括草药或植物补充剂,并以护肤霜和食物为营销,关键成分是植物雌激素。
  • 几乎没有扎实的科学证据来支持对更年期健康的替代疗法的主张。
  • Black Cohosh has been shown in some trials to reduce hot flushes in peri-menopausal women3。但是,有报道称肝脏损害其使用可能是由于某些产品中的污染物。

维生素E。

维生素E是一种非处方脂溶性维生素。

  • 维生素E显示出非常边缘的功效减少潮热(平均每天减少一次热冲洗)4
  • 剂量/副作用:800to 1000 international units (IU) per day in divided doses, taken with food. Although safety has not been established there was no toxicity in one study of 120 people.

Antidepressants

在短期研究中,已经注意到了几种类型的抗抑郁药(下面解释的SNRI和SSRIS),以减少潮热。缓解(如果有的话)是迅速的,与抑郁症不同,在抑郁症中通常不会在六到八周内观察到药物的作用。四个星期足以确定这些产品是否可以有效减少潮热。这些药物不应与任何其他抗抑郁药或任何含有圣约翰麦芽汁和停用的物质一起服用。

  • Venlafaxine和Desvenlafaxineare serotonin-noradrenaline reuptake inhibitors (SNRIs). Serotonin and noradrenaline, known to affect mood, may also impact thermoregulation
    • 最佳结果是Venlafaxine 75mg SR和Desvenlafaxine 100mg。
    • Side-effectsinclude dry mouth, nausea, sleep disturbances, loss of appetite and constipation. Venlafaxine should not be used in women with heart disease, electrolyte imbalance or uncontrolled high blood pressure. Blood pressure should be monitored while taking it and discontinuation should be tapered.
    • 75mg of SR venlafaxine is equivalent to ultra-low dose oestrogen (25 mcg) for the treatment of hot flushes5
  • SSRI(选择性5-羟色胺再摄取抑制剂)。这类抗抑郁药包括帕罗西汀,氟西汀,氟氟众,舍曲雷和西妥约优氨酸酯,依他普兰。关于不同的非荷尔蒙药物的相比,由于缺乏头部研究,有效果的互相比较的信息有限。在使用非荷尔蒙方法选择第一线治疗时,最近的系统评价报告说,Venlafaxine 75mg CR,Escitalopram 10-20mg和Gabapentin 900ng都已已经有效,并且在乳腺癌后有效。
    • 我们不知道的:很少有研究将抗抑郁药与其他疗法(例如平均剂量激素疗法)进行比较。这些药物对健康女性的长期影响尚不清楚。
    • 副作用:治疗热冲洗的剂量通常低于用于治疗抑郁症的剂量。在治疗开始时,非常低剂量可以最大程度地减少副作用。如果这不有效,则一周后可以增加剂量。经历嗜睡的妇女应该在晚上服用药物。口干是最常见的副作用。其他包括恶心,腹泻,头痛,失眠,抖动,疲劳和性困难。突然的戒断会引起头痛和焦虑,因此停止逐渐减少。
    • 使用他莫昔芬在乳腺癌女性中使用SSRI。There have been concerns that certain SSRIs (paroxetine and fluoxetine) may reduce the active metabolite of tamoxifen. However, it is uncertain whether this is of clinical relevance7

加巴喷丁

加巴喷丁is an anticonvulsant (an analogue of gamma-aminobutyric acid). It is approved to treat neurological disorders such as seizures and neuropathic pain.

  • 研究:一项系统评价证实,加巴喷丁每天900mg比安慰剂更有效地减少热潮6。加巴喷丁最常见的副作用是哀悼,女性可能更喜欢晚上服用。
  • A recent randomized-controlled trial of 12-weeks duration, compared a higher dose of gabapentin (2400mg daily) and oestrogen (Premarin 0.625mg daily) against a placebo. There was a significant placebo effect (54% reduction in severity and frequency of hot flushes) and gabapentin appeared to be as effective as oestrogen (71% and 72% respectively).
  • 我们不知道的:Higher doses may be more effective but may cause more side-effects. There have been no long-term studies. The interaction of gabapentin with breast cancer treatments such as tamoxifen has not been studied, but it is thought unlikely because gabapentin does not interfere with other anti-seizure medications.
  • Dosage:建议的治疗方法是从低剂量开始(每天100毫克三次,持续三天),然后每天服用300毫克平板电脑。妇女通常在几天内报告潮热减少。
  • Side-effects包括皮疹,头晕和过度的嗜睡,随着时间的流逝而倾向于改善。该药物还会导致下肢肿胀和体重增加。停用应该在一周内逐渐逐步。

Clonidine

Clonidine is a centrally-acting alpha adrenergic agonist which stimulates particular brain receptors and has been used for many years to lower blood pressure and prevent migraine as well as treat hot flushes.

  • 研究:Several randomized controlled trials have shown that clonidine is more effective than placebo for hot flushes, but side effects may limit tolerability. Both tablets and transdermal (skin patches) have been tested. Several small studies showed reduced hot flushes at eight weeks (38% for clonidine versus 24% for placebo). Patches reduced flushes by 80% compared to 46% for oral clonidine, however the patches are not available in Australia. Two larger studies of breast cancer survivors taking tamoxifen showed reduced frequency of flushes with oral and transdermal clonidine compared to placebo.
  • 一项最近比较可乐定与文拉法辛在乳腺癌患者中的研究表现出相等的功效,但可乐定的耐受性更好8
  • Dosage:口服剂量开始低。每天两次25毫米图(MCG)每天两次,尽管有些女性每天可能需要150 MCG,但每天两次加油。
  • Side-effects包括口干,嗜睡,头晕,便秘和睡眠困难。建议是在四个星期后没有好处,请停止可乐定。高剂量应逐渐逐渐变细,以避免副作用,例如升高的血压。

Ongoing treatment and follow-up

任何治疗潮热需要评估d periodically. Before switching from one treatment to another there may need to be a gradual tapering of medication.

内容更新2016年8月

Additional reading – Position Statements.

//www.carrick-masonic.com/hp/position-statements/emas-position-statement-non-hormonal-management-of-menopausal-vasomotor-symptoms

//www.carrick-masonic.com/hp/position-statements/nonhormonal-management-of-menopause-associated-vasomotor-symptoms-2015

References

1。Hickey M, Saunders CM, Stuckey BG. Management of menopausal symptoms in patients with breast cancer: an evidence-based approach. Lancet Oncol 2005;6:687-95.

2。Franco OH, Chowdhury R, Troup J, et al. Use of Plant-Based Therapies and Menopausal Symptoms: A Systematic Review and Meta-analysis. Jama 2016;315:2554-63.

3. Laakmann E,Grajecki D,Doege K,Zu Eulenburg C,Buhling KJ。cimicifuga racemosa,perforatum perforatum和agnus Castus的功效在治疗最佳申诉方面:系统评价。Gynecol Endocrinol 2012; 28:703-9。

4. Rada G,Capurro,D.,Pantoja,T.,Corbalán,J.,Moreno,G.,Letelier,L.M.Cochrane数据库Syst Rev 2011; 9月8日:CD004923。

5. Joffe H,Guthrie,K.A.,Lacroix,A.Z.,Reed,S.D.,Ensrud,K.E.,Manson,J.E.,Newton,K.M.,Freeman,E.W.,Anderson,G.L.,Rexrode,K.M.,Caan,B.,Sternfeld,B.,Carpenter,.J.S,Cohen,Cohen,L。低剂量雌二醇和5-羟色胺 - 甲肾上腺素再蛋白肾上腺素抑制剂Venlafaxine用于血管运动症状:一项随机临床试验。JAMA Intern Med 2014; 174:1058-66。

6. Johns C,Seav SM,Dominick SA等。告知乳腺癌幸存者的热闪存治疗决策:比较主动干预措施的随机试验的系统评价。2016; 156:415-26。

7。Haque R, Shi J, Schottinger JE, et al. Tamoxifen and Antidepressant Drug Interaction in a Cohort of 16,887 Breast Cancer Survivors. J Natl Cancer Inst 2016;108.

8. Boekhout Ah,Vincent,A.D.,Dalesio,O.B.,Van den Bosch,J.,Foekema-Töns,J.H.,J.H.,Adriaansz,S.,Sprangers,S.,Nuijen,B.患有Venlafaxine和Clonidine患有乳腺癌的患者的热闪光治疗:一项随机,双盲,安慰剂对照试验。J Clin Oncol 2011; 29:3862-8。

AMS Empowering Menopausal Women

笔记:澳大利亚更年期社会提供和认可的医学和科学信息可能与特定人的情况无关,应始终与该人自己的医疗保健提供者讨论。beplay官网地址

该信息表可能包含版权或其他受保护的材料。可以允许澳大利亚更年期社会成员和其他卫生专业人员复制此信息表进行临床实践。beplay官网地址beplay手机登录网址任何其他使用此信息(硬拷贝和电子版本)必须得到澳大利亚更年期协会并批准。beplay官网地址

内容更新于2018年9月

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