11 October 2017：

北美更年期学会（NAMS）年会

Presentation on approaches for evaluating diagnostic and treatment options

If you're postmenopausal, you shouldn't be bleeding. The very definition of menopause is having gone more than 12 months without a period. So if you're still bleeding, something is wrong. Determining the seriousness of the problem and treating it, is not always evident.

许多情况可能导致绝经后出血。其中一些疾病几乎没有健康后果，而另一些则可能导致某种癌症。子宫内膜癌是美国最常见的妇科癌。2017年，将发生60,000多例这种癌症，估计造成10,470例死亡。阴道出血是超过90％的绝经后妇女患有子宫内膜癌的主要症状，尽管大多数绝经后妇女出血的原因会更加良性，例如阴道壁或子宫内衬变薄，导致激素波动的结果水平。根据危险因素，绝经后出血的女性中有1-14％的女性将患有子宫内膜癌。

With such high stakes, there is a need to establish a standard of care that strives for 100% accuracy in correctly diagnosing the cause of the bleeding. In the past 25 years, the standard has changed substantially as new diagnostic techniques have been introduced, although no single method has proven appropriate for all patients.

11 October 2017：

北美更年期学会（NAMS）年会

Confusion about long-term treatment of osteoporosis clarified

骨质疏松症是绝经后妇女的一种常见疾病，导致骨折风险增加。虽然几种疗法可以改善骨骼强度并降低脊柱和髋部骨折的风险，但无法治愈骨质疏松症，需要长期治疗。计划于10月11日至14日在费城举行的北美更年期学会（NAMS）年度会议上举行的演讲，以提供有关双膦酸盐和denosumab治疗的长期有效性和安全性的新证据。

磷酸盐和denosumab最commonly prescribed treatments for osteoporosis. Protection from fractures occurs within the first few months of treatment and persists as long as treatment is continued. Upon stopping bisphosphonate therapy, protection from fractures is gradually lost over three to five years. Treatment for more than three years has been associated with an increasing risk of unusual or "atypical" fractures of the femur (thigh bone). After five years of treatment, the risk of these atypical fractures is about 20 per 100,000 patients and increases to about 1/1,000 patients after eight to ten years of treatment.

非典型裂缝分析的风险增加的结合ture along with a relatively slow offset of the protection from fractures due to osteoporosis led to the confusing concept of a "bisphosphonate holiday." The American Society for Bone and Mineral Research has recently provided clear recommendations about "bisphosphonate holidays." After three to five years of bisphosphonate treatment, a patient's risk of fracture should be reevaluated. For patients remaining at high risk of fracture (those with previous hip, spine, or multiple other fractures or with bone density values remaining in the osteoporosis range), continuing treatment or changing to a different drug like denosumab is important. For patients whose risk of fracture is lower, stopping treatment for two to three years (the "holiday") can be considered but is not mandatory.

11 October 2017：

北美更年期学会（NAMS）年会

Postmenopausal women more likely to use alternatives other than hormone therapy

Women today have more options than ever before for treating their menopause symptoms, although hormone therapy still ranks as the most effective treatment for debilitating symptoms such as hot flashes. A new study demonstrates, however, that women remain sceptical regarding the safety of hormone therapy and prefer less proven options. The study results will be presented during The North American Menopause Society (NAMS) Annual Meeting in Philadelphia, October 11-14.

在美国所有女性中，最多75％至80％的女性中有75％至80％的潮热（包括夜汗），其中一些人被认为是虚弱的，并且在月经周期结束后持续了很多年。尽管事实证明，激素疗法已被证明是潮热和其他麻烦的更年期症状的最有效治疗方法，但妇女及其医疗保健提供者仍在质疑其安全性，这导致处方数量减少和激素使用。这是最早研究妇女对更年期的信念和态度的研究之一，专门研究激素治疗。

Among the many findings, the survey results showed that participants were significantly less willing to use hormones for hot flashes and instead used exercise, diet, herbal supplements, acupuncture, or meditation. This was despite the fact that participants strongly agreed that hormone therapy could effectively reduce hot flashes.

11 October 2017：

北美更年期学会（NAMS）年会

Women can breathe sigh of relief when using vaginal oestrogen to treat menopause symptoms

冲洗并不是更年期过渡的唯一令人毛骨悚然的症状。许多绝经后妇女还经历了不需要雌激素药丸的性功能障碍和尿液问题，但可以通过阴道治疗的雌激素来缓解。一项新的研究表明，尽管以前误解了这种治疗方案，但不仅有效，而且是安全的。

乳霜或栓剂形式的阴道雌激素在管理一系列的性和尿液问题方面非常有效，共同称为更年期的泌尿生殖综合症。尽管具有公认的有效性，但使用阴道雌激素的使用受到妇女及其医疗保健提供者对其与诸如冠心病，乳腺癌，中风等严重健康问题的潜在联系的关注的限制。对超过45,000名参与者的妇女健康计划（WHI）观察研究的数据检查表明，使用阴道雌激素并没有显着增加心脏病或癌症的风险，包括乳腺癌，结肠直肠癌和子宫内膜癌。它也与诸如中风，肺栓塞，髋部骨折或死亡等其他问题的风险升高有关。

11 October 2017：

北美更年期学会（NAMS）年会

研究表明，在报告更加压力的生活事件的女性中，情绪的改善最大

您是否知道您在更年期过渡期间遭受抑郁症的可能性更大？一项新的研究表明，透皮雌二醇不仅是治疗现有的围绝经抑制的关键，而且还可能阻止它，并且可能会使您的情绪受益的机会更大，而您所承受的压力就越大。

抑郁症是更年期过渡的普遍报道的症状，这已不是什么秘密。先前几项小型试验表明，经雌二醇疗法（即雌激素斑）有效治疗围绝经抑制。但这是第一个研究其在防止以前不抑郁的妇女中绝经中抑郁症发作的有效性的研究。雌二醇是在女性生殖年代产生的主要雌激素（雌性性激素），从而影响繁殖和性功能。

由戴维·鲁比诺（David Rubinow）博士和苏珊·吉德勒（Susan Girdler）及其团队在北卡罗来纳大学教堂山（Chapel Hill）进行的为期12个月的干预措施表明，透皮雌二醇比安慰剂更有效地保持了更积极的情绪，并防止了临床上重要的抑郁症的出现在更年期早期过渡的妇女中（与上期过渡后期或绝经后时期的妇女相对）。在入学前六个月中，女性报告了更多压力事件的女性，治疗对情绪的有效性也更强。

11 October 2017：

北美更年期学会（NAMS）年会

研究表明，临床医生需要额外的教育

在妇女健康计划（WHI）临床试验中，关于激素治疗（HT）的误解十多年，仍然使许多妇女免除了更年期症状。弗吉尼亚大学卫生系统的一项新研究发现了治疗绝经后妇女的临床医生的知识差距，并确定了额外的教育需求。

Despite the fact that published evidence from the WHI suggests that HT is a relatively safe, viable solution for symptomatic menopausal women under age 60 or within 10 years postmenopause, the number of women being prescribed and using hormones continues to decline. To counteract ongoing skepticism amongst medical professionals regarding the safety of hormones, a new medical education program was shared with 1,087 physicians, nurse practitioners (NPs), and physician assistants (PAs).

Participants were asked a series of questions before and after reviewing the educational program to identify knowledge gaps relative to hormone safety and determine if additional education would help to overcome misperceptions. Among physicians, the average percentage of participants who correctly answered test questions related to outcomes of the WHI trials was 57% pre-activity and 70% post-activity; for NPs, the average percentage answering correctly was 49% pre-activity and 68% post-activity; and for PAs, 52% and 70% respectively.

11 October 2017：

北美更年期学会（NAMS）年会

研究提供了有关女性随着年龄的增强活跃的原因而提供的添加见解

As women age, sexual activity typically declines. But that doesn't necessarily mean they are no longer interested in sex. The problem for many is physical. A new study demonstrates the impact on sexual activity of postmenopausal women as a result of vulvovaginal atrophy and lower urinary tract problems.

近年来，医学界采用了术语“更年期的生殖综合症”（GSM），更准确地指的是在更年期期间影响许多女性的集体阴道和膀胱问题。简而言之，GSM包括阴道壁变薄，包括疼痛性症状，以及膀胱问题，可能导致性活动期间尿液泄漏，以及在其他无法预测的时期。作为这项新研究的一部分，研究人员评估了这些症状对女性具有性活跃和享受性经历的能力的影响。

More than 1,500 women completed a questionnaire regarding their sexual activity. While both vulvovaginal atrophy and bladder problems negatively impacted sexual enjoyment and frequency of activity, the fear of experiencing pain during sex was reported as a reason for avoiding or restricting activity more often (?20%) than bladder problems, such as fear of wetting the bed or having to interrupt activity to go to the bathroom (?9%).

11 October 2017：

北美更年期学会（NAMS）年会

Study demonstrates effectiveness of cognitive behavioural therapy for menopausal insomnia on depressive symptoms

对于努力入睡和战斗抑郁的成千上万个赛周痛和绝经后妇女，帮助不能很快就能出现。尽管更年期过渡期间的身体变化通常是这些问题的原因，但得克萨斯大学的一项新研究表明，认知行为疗法可能会提供这些妇女寻求的救济。

Insomnia is a frequently cited problem, affecting 30-60% of peri- and postmenopausal women. Depressive symptoms are nearly equally prevalent, affecting 25-40% of this female population. Over the years, medical professionals have proposed a number of treatment options to relieve one or both of these menopause symptoms. Cognitive behavioural therapy for insomnia is one alternative that has shown tremendous potential in treating menopausal insomnia. This new study, however, is the first to examine the effects of this same therapy on depressive symptoms. Cognitive behaviour therapy for insomnia is a type of psychotherapy which targets negative thoughts and behaviours contributing to insomnia.

11 October 2017：

北美更年期学会（NAMS）年会

Study reviews WHI data to demonstrate lack of association between migraines, cardiovascular disease and hormone therapy; opens door to increased use of hormones to treat migraines

偏头痛在女性中很常见，但由于各种健康风险，在老年人中治疗可能具有挑战性。尽管激素疗法可有效缓解许多更年期症状，但尚未确认其在偏头痛女性中的安全使用。一项基于妇女健康计划（WHI）数据的新研究证明了其对该人群的安全。