围绝经期血管舒缩症状治疗方法的研究进展

潘琦; 任菁菁

doi:10.16766/j.cnki.issn.1674-4152.003172

围绝经期血管舒缩症状治疗方法的研究进展

doi: 10.16766/j.cnki.issn.1674-4152.003172

潘琦,
任菁菁^,

浙江大学医学院附属第一医院全科医学科，浙江杭州 310003

基金项目:

国家自然科学基金项目 72274169

详细信息

通讯作者:
任菁菁，E-mail: 3204092@zju.edu.cn

中图分类号: R173.4
计量
- 文章访问数: 154
- HTML全文浏览量: 82
- PDF下载量: 11
- 被引次数: 0
出版历程
- 收稿日期: 2023-04-03
- 网络出版日期: 2023-10-19

Research progress in treatment of perimenopausal vasomotor symptoms

PAN Qi,
REN Jingjing^,

Department of General Practice, the First Affiliated Hospital, Zhejiang University, Hangzhou, Zhejiang 310003, China

摘要

摘要: 围绝经期是指女性绝经前后的一段时期，也是卵巢功能逐渐衰退的时期。此阶段因雌激素水平降低，可出现一系列绝经相关症状，短则持续1~2年，长则持续10~20年。其中潮热盗汗是血管舒缩症状的突出表现，也是围绝经期女性前来就诊的主要原因，严重影响女性的睡眠、工作及生活。因此，如何缓解围绝经期血管舒缩症状已成为医学研究人员关注的热点。目前绝经激素替代疗法仍是公认中重度潮热女性的首要治疗措施。激素替代治疗具有严格的适应证和禁忌证，长期使用需要定期全面体检，评估受益/风险比，以保证用药安全性。但因其在心血管疾病、静脉血栓及子宫内膜癌、乳腺癌等激素依赖肿瘤方面仍存在一定的风险，激素替代治疗的接受程度并不高。近年来，关于血管舒缩症状治疗的研究越来越多，一些非激素药物如选择性5-羟色胺再摄取抑制剂(SSRI)/选择性5-羟色胺和去甲肾上腺素双重再摄取抑制剂(SNRI)、黑升麻提取物、坤泰胶囊等，非药物治疗手段如身心疗法、针灸疗法等，也为深受血管舒缩症状困扰的女性提供更多治疗选择。本文通过查阅近年文献围绕围绝经期血管舒缩症状治疗措施包括激素药物治疗、非激素药物治疗及非药物治疗手段等方面进行归纳总结，为制定个体化临床治疗方案提供参考，以提高围绝经期女性的生活质量。
- 围绝经期 /
- 血管舒缩症状 /
- 药物治疗 /
- 非药物治疗
Abstract: Perimenopausal period refers to a period before and after menopause in women, and it's also a period of gradual decline of ovarian function. This stage due to estrogen levels decreased, may appear a series of menopausal symptoms, short lasting 1-2 years, long lasting 10-20 years. Among them, hot flashes and sweating are the prominent manifestation of vasomotor symptoms and the main reason for perimenopausal women to come to see a doctor, which seriously affects women's sleep, work and life. Therefore, how to alleviate perimenopausal vasomotor symptoms has become a hot topic for medical researchers. At present, postmenopausal hormone replacement therapy is still recognized as the primary treatment for women with moderate to severe tidal fever. Hormone replacement therapy has strict indications and contraindications. Long-term use requires regular and comprehensive physical examination to assess the benefit/risk ratio to ensure medication safety. But there are still some risks in cardiovascular disease, venous thrombosis, endometrial cancer, breast cancer and other hormone-dependent tumors, the acceptance of hormone replacement therapy is not high. In recent years, more and more research has been conducted on the treatment of vasodilatory symptoms. Non-hormonal medications such as selective 5-hydroxytryptamine reuptake inhibitors (SSRI)/selective 5-hydroxytryptamine and norepinephrine dual reuptake inhibitors (SNRI), black cohosh extract, and kuntai capsules, as well as non-pharmacological treatments such as mind-body therapies, and acupuncture treatments, have also provided more treatment choices for women who are deeply afflicted by vasodilatory symptoms. This paper summarizes the treatment measures of vasomotor symptoms in perimenopausal women, including hormone drug therapy, non-hormone drug therapy and non-drug therapy, and provides theoretical guidance for formulating individualized clinical treatment programs to improve the quality of life of perimenopausal women.
- Perimenopause /
- Vasomotor symptoms /
- Drug treatment /
- Non-drug treatment

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参考文献(49)

[1]	韩茹雪, 杨欣. 围绝经期血管舒缩症状的非激素治疗[J]. 实用妇产科杂志, 2022, 38(1): 29-32. https://www.cnki.com.cn/Article/CJFDTOTAL-SFCZ202201010.htm HAN R X, YANG X. Non-hormone therapy for perimenopausal vasoconstriction symptoms[J]. Journal of Practical Obstetrics and Gynecology, 2022, 38(1): 29-32. https://www.cnki.com.cn/Article/CJFDTOTAL-SFCZ202201010.htm
[2]	NAPPI R E, KROLL R, SIDDIQUI E, et al. Global cross-sectional survey of women with vasomotor symptoms associated with menopause: prevalence and quality of life burden[J]. Menopause, 2021, 28(8): 875-882. doi: 10.1097/GME.0000000000001793
[3]	中华医学会妇产科学分会绝经学组. 中国绝经管理与绝经激素治疗指南2023版[J]. 中华妇产科杂志, 2023, 58(1): 4-21. Menopause Group of Obstetrics and Gynecology Branch of Chinese Medical Association Guidelines for menopausal management and hormone therapy in China, 2023[J]. Chinese Journal of Obstetrics and Gynecology, 2023, 58(1): 4-21.
[4]	LANGER R D, HODIS H N, LOBO R A, et al. Hormone replacement therapy-where are we now?[J]. Climacteric, 2021, 24(1): 3-10. doi: 10.1080/13697137.2020.1851183
[5]	陈蓉. 绝经激素治疗的临床应用[J]. 实用妇产科杂志, 2020, 36(9): 644-647. https://www.cnki.com.cn/Article/CJFDTOTAL-SFCZ202009002.htm CHEN R. Clinical application of menopausal hormone therapy[J]. Journal of Practical Obstetrics and Gynecology, 2020, 36(9): 644-647. https://www.cnki.com.cn/Article/CJFDTOTAL-SFCZ202009002.htm
[6]	WOODIS C B, GHASSEMI E, MCLENDON A N. Bioidentical Oral 17β-Estradiol and progesterone for the treatment of moderate to severe vasomotor symptoms of menopause[J]. Ann Pharmacother, 2021, 55(9): 1153-1158. doi: 10.1177/1060028020982611
[7]	黄沁, 詹继东. 替勃龙补充治疗对绝经期综合征妇女冠心病发病风险的影响[J]. 中国妇幼保健, 2020, 35(21): 4045-4049. doi: 10.19829/j.zgfybj.issn.1001-4411.2020.21.046 HUANG Q, ZHAN J D. The effect of tibolone supplementation therapy on the risk of coronary heart disease in women with menopausal syndrome[J]. China Maternal and Child Health, 2020, 35(21): 4045-4049. doi: 10.19829/j.zgfybj.issn.1001-4411.2020.21.046
[8]	KIM H K, JEON S H, RYU K J, et al. Comparison of the efficacy of tibolone and transdermal estrogen in treating menopausal symptoms in postmenopausal women[J]. J Menopausal Med, 2019, 25(3): 123-129. doi: 10.6118/jmm.19205
[9]	LV C Y, ZHANG W C, TAN X, et al. The effect of tibolone treatment on lipid profile in women: a systematic review and dose-response meta-analysis of randomized controlled trials[J]. Pharmacol Res, 2021, 169: 105612. DOI: 10.1016/j.phrs.2021.105612.
[10]	PINKERTON J V, CONNER E A. Beyond estroge: advances in tissue selective estrogen complexes and selective estrogen receptor modulators[J]. Climacteric, 2019, 22(2): 140-147. doi: 10.1080/13697137.2019.1568403
[11]	GUPTA A. Hormone therapy-related hot flashes and their management[J]. JAMA Oncol, 2018, 4(4): 595. doi: 10.1001/jamaoncol.2017.4439
[12]	金勤, 黄铖, 花琪, 等. 更年期门诊妇女绝经综合征与抑郁症状相关性的初步研究[J]. 中华生殖与避孕杂志, 2018, 38(6): 441-447. JIN Q, HUANG C, HUA Q, et al. Preliminary study on the correlation between menopausal syndrome and depressive symptoms in menopausal outpatient women[J]. Chinese Journal of Reproduction and Contraception, 2018, 38(6): 441-447.
[13]	LI T, YANG J, LV Y H, et al. Quantitative comparison of drug efficacy in treating hot flashes in patients with breast cancer[J]. Breast Cancer Res Treat, 2019, 173(3): 511-520. doi: 10.1007/s10549-018-5029-y
[14]	刘玉龙, 张明霞, 舒冰. 可乐定在围绝经期潮热治疗中的研究进展[J]. 现代医药卫生, 2018, 34(22): 3511-3513, 3558. doi: 10.3969/j.issn.1009-5519.2018.22.027 LIU Y L, ZHANG M X, SHU B. Research progress of clonidine in the treatment of perimenopausal hot flashes[J]. Journal of Modern Medicine & Health, 2018, 34(22): 3511-3513, 3558. doi: 10.3969/j.issn.1009-5519.2018.22.027
[15]	SHAN D, ZOU L, LIU X J, et al. Efficacy and safety of gabapentin and pregabalin in patients with vasomotor symptoms: a systematic review and meta-analysis[J]. Am J Obstet Gynecol, 2020, 222(6): 564-579. doi: 10.1016/j.ajog.2019.12.011
[16]	DEPYPERE H, LADEMACHER C, SIDDIQUI E, et al. Fezolinetant in the treatment of vasomotor symptoms associated with menopause[J]. Expert Opin Investig Drugs, 2021, 30(7): 681-694. doi: 10.1080/13543784.2021.1893305
[17]	SANTORO N, WALDBAUM A, LEDERMAN S, et al. Effect of the neurokinin 3 receptor antagonist fezolinetant on patient-reported outcomes in postmenopausal women with vasomotor symptoms: results of a randomized, placebo-controlled, double-blind, dose-ranging study (VESTA)[J]. Menopause, 2020, 27(12): 1350-1356. doi: 10.1097/GME.0000000000001621
[18]	MCGARRY K, GEARY M, GOPINATH V. Beyond estrogen: treatment options for hot flashes[J]. Clin Ther, 2018, 40(10): 1778-1786. doi: 10.1016/j.clinthera.2018.08.010
[19]	DAILY J W, KO B S, RYUK J, et al. Equol decreases hot flashes in postmenopausal women: a systematic review and meta-analysis of randomized clinical trials[J]. J Med Food, 2019, 22(2): 127-139. doi: 10.1089/jmf.2018.4265
[20]	李慧玲, 高红艳, 杭晨, 等. 黑升麻制剂治疗围绝经期综合征的初步探讨[J]. 中国计划生育和妇产科, 2019, 11(6): 45-49. https://www.cnki.com.cn/Article/CJFDTOTAL-JHFC201906013.htm LI H L, GAO H Y, HANG C, et al. Preliminary exploration of black cohosh preparation in the treatment of perimenopausal syndrome[J]. Chinese Journal of Family Planning and Gynecotokology, 2019, 11(6): 45-49. https://www.cnki.com.cn/Article/CJFDTOTAL-JHFC201906013.htm
[21]	MAHBOUBI M. Evening Primrose (Oenothera biennis) oil in management of female ailments[J]. J Menopausal Med, 2019, 25(2): 74-82. doi: 10.6118/jmm.18190
[22]	KAZEMI F, MASOUMI S Z, SHAYAN A, et al. The effect of evening primrose oil capsule on hot flashes and night sweats in postmenopausal women: a single-blind randomized controlled trial[J]. J Menopausal Med, 2021, 27(1): 8-14. doi: 10.6118/jmm.20033
[23]	COLLINS T, ALEXANDER D, BARKATALI B. Platelet-rich plasma: a narrative review[J]. EEFORT Open Rev, 2021, 6(4): 225-235. doi: 10.1302/2058-5241.6.200017
[24]	MERHI Z, SECKIN S, MOUANNESS M. Intraovarian PRP injection improved hot flashes in a woman with very low ovarian reserve[J]. Reprod Sci, 2022, 29(2): 614-619. doi: 10.1007/s43032-021-00655-7
[25]	张欣, 高珊, 王运贤, 等. 柴胡桂枝汤加减对围绝经期综合征血管舒缩功能失调血清FSH、LH、E2水平和子宫内膜厚度影响[J]. 中华中医药学刊, 2019, 37(12): 3010-3012. https://www.cnki.com.cn/Article/CJFDTOTAL-ZYHS201912047.htm ZHANG X, GAO S, WANG Y X, et al. The effect of modified Chaihu Guizhi Tang on serum FSH, LH, E2 levels and endometrial thickness in patients with vascular dysfunction in perimenopausal syndrome[J]. Chinese Archives Of Traditional Chinese Medicine, 2019, 37(12): 3010-3012. https://www.cnki.com.cn/Article/CJFDTOTAL-ZYHS201912047.htm
[26]	《中成药治疗优势病种临床应用指南》标准化项目组. 中成药治疗更年期综合征临床应用指南(2020年)[J]. 中国中西医结合杂志, 2021, 41(4): 418-426. https://www.cnki.com.cn/Article/CJFDTOTAL-ZZXJ202104004.htm Standardization project team of traditional Chinese patent medicines and simple preparations clinical application guide for treatment of dominant diseases. Clinical application guide of traditional Chinese patent medicines and simple preparations in the treatment of climacteric syndrome (2020)[J]. Chinese Journal of Integrated Traditional and Western Medicine, 2021, 41(4): 418-426. https://www.cnki.com.cn/Article/CJFDTOTAL-ZZXJ202104004.htm
[27]	郁琦. 坤泰胶囊临床应用指导建议[J]. 中国实用妇科与产科杂志, 2019, 35(10): 1120-1122. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGSF201910013.htm YU Q. Suggestion for clinical application guidance of Kuntai capsules[J]. Chinese Journal of Practical Gynecology and Obstetric, 2019, 35(10): 1120-1122. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGSF201910013.htm
[28]	门晓亮, 赵丽萍, 杨杰, 等. 坤泰胶囊治疗围绝经期综合征的系统评价再评价[J]. 中国中药杂志, 2021, 46(19): 5103-5109. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGZY202119028.htm MEN X L, ZHAO L P, YANG J, et al. A Systematic Review and Reevaluation of Kuntai Capsule in the Treatment of Perimenopausal Syndrome[J]. China Journal of Chinese Materia Medica, 2021, 46(19): 5103-5109. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGZY202119028.htm
[29]	The 2017 hormone therapy position statement of The North American Menopause Society[J]. Menopause, 2018, 25(11): 1362-1387.
[30]	李融融, 陈伟. 基于地中海饮食的围绝经期营养管理[J]. 协和医学杂志, 2021, 12(2): 167-171. https://www.cnki.com.cn/Article/CJFDTOTAL-XHYX202102005.htm LI R R, CHEN W. Perimenopausal nutrition management based on Mediterranean diet[J]. Medical Journal Of Peking Union Medical College Hospital, 2021, 12(2): 167-171. https://www.cnki.com.cn/Article/CJFDTOTAL-XHYX202102005.htm
[31]	BARREA L, PUGLIESE G, LAUDISIO D, et al. Mediterranean diet as medical prescription in menopausal women with obesity: a practical guide for nutritionists[J]. Crit Rev Food Sci Nutr, 2021, 61(7): 1201-1211.
[32]	KAHLEOVA H, ZNAYENKO-MILLER T, URIBARRI J, et al. Dietary advanced glycation end-products and postmenopausal hot flashes: a post-hoc analysis of a 12-week randomized clinical trial[J]. Maturitas, 2023, 172: 32-38.
[33]	NGUYEN T M, DO T T T, TRAN T N, et al. Exercise and quality of life in women with menopausal symptoms: a systematic review and meta-analysis of randomized controlled trials[J]. Int J Environ Res Public Health, 2020, 17(19): 7049.
[34]	SEALS D R, NAGY E E, MOREAUM K L. Aerobic exercise training and vascular function with ageing in healthy men and women[J]. J Physiol, 2019, 597(19): 4901-4914.
[35]	CARCELÉN-FRAILE M D C, AIBAR-ALMAZÁN A, MARTÍNEZ-AMAT A, et al. Effects of physical exercise on sexual function and quality of sexual life related to menopausal symptoms in peri-and postmenopausal women: a systematic review[J]. Int J Environ Res Public Health, 2020, 17(8): 2680.
[36]	俞小红, 王红亚, 傅华君. 基于渐进性抗阻训练的健康管理对绝经后骨质疏松女性跌倒风险的影响[J]. 中华全科医学, 2020, 18(8): 1337-1340. doi: 10.16766/j.cnki.issn.1674-4152.001501 YU X H, WANG H Y, FU H J. The impact of health management based on progressive resistance training on the risk of falls in postmenopausal women with osteoporosis[J]. Chinese Journal of General Practice, 2020, 18(8): 1337-1340. doi: 10.16766/j.cnki.issn.1674-4152.001501
[37]	SHAMS V, HOSEYN F, MOHAMMAD A A. Effect of eight weeks of low, moderate, and high-intensity TRX training on hot flashes, mood, fat percentage, and muscular endurance in postmenopausal women[J]. Apunts Sports Medicine, 2020, 55(207): 97-103.
[38]	CRAMER H, PENG W B, LAUCHE R. Yoga for menopausal symptoms: a systematic review and meta-analysis[J]. Maturitas, 2018, 109: 13-25.
[39]	KIM D H. A literature review of the Effects of pilates on menopause women[J]. Journal of the Korean society for Wellness, 2019, 14(2): 405-417.
[40]	李晶, 李建国, 谢兴文, 等. 传统健身功法防治绝经后骨质疏松症的临床研究进展[J]. 甘肃科技, 2020, 36(20): 135-138, 126. https://www.cnki.com.cn/Article/CJFDTOTAL-GSKJ202020045.htm LI J, LI J G, XIE X W, et al. Clinical research progress on traditional fitness techniques for preventing and treating postmenopausal osteoporosis[J]. Gansu Science and Technology, 2020, 36(20): 135-138, 126. https://www.cnki.com.cn/Article/CJFDTOTAL-GSKJ202020045.htm
[41]	HARDY C, GRIFFITHS A, NORTO S, et al. Self-help cognitive behavior therapy for working women with problematic hot flushes and night sweats (MENOS@Work): a multicenter randomized controlled trial[J]. Menopause, 2018, 25(5): 508-519.
[42]	SADEGHIJOOLA N, AFSHARI P, JOFREH M G, et al. Comparing the effects of face-to-face versus phone counseling based on cognitive-behavioral therapy for vasomotor symptoms in postmenopausal women: a randomized controlled trial[J]. Postep Psychiatr Neurol, 2022, 31(3): 114-120.
[43]	VAN DRIEL C M, STUURSMA A, SCHROEVERS M J, et al. Mindfulness, cognitive behavioural and behaviour-based therapy for natural and treatment-induced menopausal symptoms: a systematic review and meta-analysis[J]. BJOG, 2019, 126(3): 330-339.
[44]	罗筱凡, 罗业浩, 吕挺, 等. 针灸及其相关疗法治疗围绝经期综合征的研究进展[J]. 中国老年学杂志, 2023, 43(1): 227-232. https://www.cnki.com.cn/Article/CJFDTOTAL-ZLXZ202301054.htm LUO X W, LUO Y H, LV T, et al. Research progress of acupuncture and moxibustion and its related therapy for perimenopausal syndrome[J]. Chinese Journal of Gerontology, 2023, 43(1): 227-232. https://www.cnki.com.cn/Article/CJFDTOTAL-ZLXZ202301054.htm
[45]	LI T, ZHANG Y, CHENG Q Q, et al. Quantitative study on the efficacy of acupuncture in the treatment of menopausal hot flashes and its comparison with nonhormonal drugs[J]. Menopause, 2021, 28(5): 564-572.
[46]	庄楣, 来婷. 耳穴治疗在围绝经期综合征中的应用[J]. 中国当代医药, 2020, 27(12): 20-23. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGUD202012007.htm ZHUANG M, LAI T. Application of Ear Acupoint Therapy in Perimenopausal Syndrome[J]. China Modern Medicine, 2020, 27(12): 20-23. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGUD202012007.htm
[47]	RAHIMAZDEH P, IMANI F, NAFISSI N, et al. Comparison of the effects of stellate ganglion block and paroxetine on hot flashes and sleep disturbance in breast cancer survivors[J]. Cancer Manag Res, 2018, 10: 4831-4837.
[48]	PINKERTON J V, SANTEN R J. Managing vasomotor symptoms in women after cancer[J]. Climacteric, 2019, 22(6): 544-552.
[49]	WANG M, KARTSONAKI C, GUO Y, et al. Factors related to age at natural menopause in China: results from the China Kadoorie Biobank[J]. Menopause, 2021, 28(10): 1130-1142.