[围绝经期和绝经后有什么新变化?]

Deutsche medizinische Wochenschrift (1946) Pub Date : 2024-11-01 Epub Date: 2024-10-22 DOI:10.1055/a-2165-5935
Katharina Tropschuh, Vanadin Seifert-Klauss
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引用次数: 0

摘要

更年期是近年来讨论得越来越多的一个话题。更年期泌尿生殖系统综合征(GSM)包括阴道和泌尿系统症状,如粘膜干燥、瘙痒和烧灼感、排尿困难或出血以及性交疼痛。更年期综合症会严重影响生活质量,如果雌激素缺乏持续了 3 个月,更年期综合症就会很常见,并且可以用非常小剂量的弱雌激素雌三醇进行局部治疗。"感觉不再像我自己了"--症状性围绝经期可能表现为睡眠障碍、乳腺增生、情绪波动、心悸、恐慌发作,也可能伴有关节疼痛、眩晕、头痛和脑雾--甚至在绝经前数年,雌激素水平仍然充足的情况下也会出现这些症状。在一项在线研究中,20% 处于更年期过渡期的妇女报告了她们无法解释的症状,这些症状可能会引起对严重疾病的恐惧。如果不考虑围绝经期的可能性,这可能会导致大量的医疗检查:全美妇女健康研究(SWAN)报告称,在围绝经期早期已经受到影响的妇女,血管运动症状持续时间较长(中位数:11.8 年),而绝经后才开始出现血管运动症状的妇女,症状持续时间较短(中位数:3.4 年)。对于血管运动症状的治疗,德国和国际指南都列出了药物和非药物或非处方药的治疗方案,但没有明确的疗效数据。Fezolinetant 是一种神经激肽-3 受体拮抗剂,目前已在德国上市,用于治疗有类固醇激素禁忌症或厌恶类固醇激素的绝经后妇女的血管运动症状。它通过阻断 KNDy 神经元来调节下丘脑的体温调节中枢。关于该类药物的另一个代表药物 Elinzanetant 的研究仍在进行中。
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[What is new on peri- and postmenopause?]

Menopause is an increasingly discussed topic in recent years. More women are demanding consultancy and help from their doctors via different channels, be it online or in menopause centers.The term genitourinary syndrome of menopause (GSM) comprises vaginal and urological symptoms such as mucosal dryness, itching and burning, dysuria or bleeding and pain during sexual intercourse. GSM can strongly affect quality of life, is common if estrogen deficiency has lasted for 3 months and can be treated locally with very low doses of the weak estrogen estriol."Not feeling like myself anymore" - symptomatic perimenopause may present with sleep disturbances, mastalgia, mood swings, palpitations, panic attacks, but also entail joint pain, vertigo, headache, and brain fog - even years before menopause and in the presence of still adequate estrogen levels. In an online study, 20% of women in the menopausal transition reported symptoms which they could not explain, and which may cause fears of serious illness. This can lead to extensive medical work-ups if the possibility of perimenopause as the cause is disregarded.(Peri-)menopausal complaints last much longer than previously thought: The Study of women's health across the nation (SWAN) reported longer duration of vasomotor symptoms (median: 11,8 years) in women who were already affected in early perimenopause, while those in whom VMS started only after menopause experienced a shorter duration of symptoms (median: 3,4 years).Female hormones protect women from fatty streaks and hypertension, but menopausal hormone therapy (MHT) has positive effects only if started in the first decade after menopause. The interaction with stress, aging and lifestyle factors is complex.For the treatment of VMS, German and international guidelines list both drug and non-drug or non-prescription options, although there is no clear data on their effectiveness.Fezolinetant, a Neurokinin-3 receptor antagonist, is now available in Germany for the treatment of vasomotor symptoms in postmenopausal women with contraindications or aversion against steroid hormones. It modulates the thermoregulation center in the hypothalamus by blocking the KNDy-neurons. Studies on Elinzanetant, another representative of this class of drugs, are still ongoing.

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