自2014年以来，美国产科与妇科医师学会首次更新了其关于治疗与更年期常见相关症状的指南。
For the first time since 2014, the American College of Obstetricians and Gynecologists has updated its guidelines for the treatment of symptoms commonly associated with menopause.
BSIP/Universal Images Group/Getty Images 自2014年以来，美国产科与妇科医师学会首次更新了其关于治疗与更年期常见相关症状的指南。该医生组织，即ACOG，建议激素替代疗法与某些抗抑郁药、非激素药物及其他治疗方法并用，以应对潮热、失眠和情绪波动等症状。
BSIP/Universal Images Group/Getty Images For the first time since 2014, the American College of Obstetricians and Gynecologists has updated its guidelines for the treatment of symptoms commonly associated with menopause. The doctor's group, known as ACOG, recommends hormone replacement therapy alongside certain antidepressants, nonhormonal medicines, and other treatments to address symptoms like hot flashes, insomnia and mood swings.
“我们现在拥有的选择范围正在发生变化……而这带来的好处是，我们能够更好地为患者提供个性化的治疗方案，”产科/妇科医生、ACOG临床实践指南委员会主席、新指南共同作者凯瑟琳·坎西诺（Catherine Cansino）医学博士、公共卫生硕士表示。
"What's changing is the breadth of options that we now have … And the benefit of that is that we are better equipped to be able to take an individualized approach for patients," said Catherine Cansino, MD, MPH, an obstetrician/gynecologist, chair of ACOG's Committee on Clinical Practice Guidelines and co-author of the new guidance.
该指南于周四发布，聚焦于特定的更年期症状，并强调激素替代疗法的安全性如今已“得到充分确立”，坎西诺说。
The guidance, released Thursday, focuses on specific menopausal symptoms and underscores that the safety of hormone replacement therapy is now "well-established," Cansino said.
2002年，妇女健康倡议（Women's Health Initiative）曾指出，激素替代疗法会增加心脏病、乳腺癌、中风和肺栓塞的风险。
In 2002, the Women's Health Initiative suggested that hormone replacement therapy increased the risk of heart disease, breast cancer, stroke and pulmonary embolism.
然而，研究人员多年后重新审视这些数据时，发现其中存在某些局限性（包括大多数参与者年龄在60岁或以上），这使得将研究结果推广到正在经历更年期或围绝经期的年轻女性变得困难。
However, as researchers revisited that data years later, they noticed certain limitations, (including that a majority of participants were 60 years or older) making it difficult to generalize the findings to younger women experiencing menopause or perimenopause.
随着更多且质量更高的研究出现，医生能够审视证据并作出更明智的建议，坎西诺说。
With more and better quality studies, physicians are able to review the evidence and make better-informed recommendations, Cansino said.
“激素疗法可能是最终月经期后10年内或60岁之前出现症状的新进入更年期女性的最佳选择，”指南共同作者、罗伯特·考夫曼（Robert Kauffman）医学博士、运动与体育医学硕士在周四的新闻发布会上表示。
"Hormone therapy is probably the best option for symptomatic, newly menopausal women within 10 years of the final menstrual period or before the age of 60," said Robert Kauffman, MD, MSCP, a co-author of the guidelines, during a press briefing on Thursday.
除了激素替代疗法，指南还强调了治疗更年期症状的新型非激素选项，包括药物费佐林坦，商品名Veozah，该药于2023年获美国食品药品监督管理局批准用于治疗潮热，以及依林扎坦，商品名Lynkuet，该药于2025年获批。
In addition to hormone replacement therapy, the guidelines highlight new nonhormonal options for treating menopausal symptoms, including the drug fezolinetant, brand name Veozah, which the Food and Drug Administration approved to treat hot flashes in 2023 and elinzanetant, brand name Lynkuet, which was approved in 2025.
Cansino表示：“这些治疗选择之所以令人兴奋，是因为它们是基于我们对体温调节和睡眠生理学的理解而专门进行研究的。”
"What's so exciting about these treatment options is they were specifically studied based on the understanding that we have of the physiology of thermoregulation and sleep," Cansino said.
根据指南，这些药物通过阻断大脑中调节体温和管理睡眠/觉醒周期部分的某些化学信使来发挥作用。
The medications work by blocking certain chemical messengers in the part of the brain that regulates body temperature and manages sleep/wake cycles, according to the guidance.
每年约有200万女性进入更年期。根据指南，经历更年期的女性平均年龄为49.9岁。然而，更年期症状可能在女性最后一次月经之前数年就开始出现。
About 2 million women begin menopause each year. The average age of a woman experiencing menopause is 49.9 years, according to the guidelines. However, symptoms of menopause can begin years before a woman's final menstrual period.
新建议支持在有子宫且无激素禁忌症的女性中使用系统性激素替代疗法（HRT），即雌激素和孕激素的联合使用。
The new recommendations support the use of systemic hormone replacement therapy, or HRT, with a combination of estrogen and progestogen in women with a uterus who have no contraindications to hormones.
避免激素治疗的原因包括未诊断的异常生殖道出血，以及目前或过去患有某些妇科癌症、血栓、中风、心脏病发作、肝病，或已知或疑似怀孕的病史。
Reasons to avoid hormone therapy include undiagnosed abnormal genital bleeding, and current or past histories of certain gynecologic cancers, blood clots, stroke, heart attack, liver disease or a known or suspected pregnancy.
Cansino解释说，建议有子宫的女性使用孕激素的原因是，雌激素可以刺激子宫内膜的生长并增加子宫内膜癌的风险。孕激素疗法有助于降低这种风险。
The reason progestogen is recommended in women with a uterus is because estrogen can stimulate growth of the uterine lining and increase the risk of endometrial cancer. Progestogen therapy helps mitigate that risk, Cansino explained.
每年约有50万女性接受子宫切除手术，对于没有子宫的女性，美国妇产科医师学会（ACOG）建议仅使用雌激素。作为雌激素-孕激素疗法的替代方案，ACOG还推荐一种名为Duavee的药片，该药片结合了雌激素和一种称为巴泽度昔的药物。巴泽度昔是一种“选择性雌激素受体调节剂”，它能够阻断雌激素在身体某些部位的作用，例如乳腺组织，同时模拟雌激素对骨密度的有益影响。
Around half a million women have hysterectomies each year, and for women without a uterus, ACOG recommends estrogen alone As an alternative to estrogen-progestogen therapy, ACOG also recommends a pill, sold under the brand name Duavee, that combines estrogen and a drug called bazedoxifene. Bazedoxifene is a "selective estrogen receptor modulator," which blocks the estrogen from working in certain areas of the body, such as breast tissue, while mimicking estrogen's benefit for bone density, for instance. Another drug recommended in the new guideline is gabapentin, an anticonvulsant typically used to treat seizures.
新指南中还推荐了另一种药物——加巴喷丁，这是一种通常用于治疗癫痫发作的抗惊厥药。它也可以帮助无法耐受激素或其他新药物的人管理更年期症状。
It can also manage menopause symptoms for people who can't tolerate hormones or the other new medicines. Cognitive behavioral therapy, mindfulness-based interventions, exercise, clinical hypnosis, and acupuncture can all improve some symptoms, ACOG says, however the guidelines also note that the evidence for these interventions is weaker than the evidence for HRT.
美国妇产科医师学会（ACOG）表示，认知行为疗法、基于正念的干预、运动、临床催眠和针灸都能改善某些症状，但该指南同时指出，这些干预措施的证据力度不如激素替代疗法（HRT）的证据。尽管如此，患者可能有自己的偏好和目标，坎西诺说道。
Still, patients may have their own preferences and goals, Cansino said. "I live in California, and I have a practice where many patients don't necessarily want pharmacologic therapy," Cansino said.
“我住在加利福尼亚州，我的诊所里有很多患者不一定想要药物治疗，”坎西诺说。因此，她倾向于与患者进行大量关于非药物治疗选择的对话。
So, she tends to have a lot of conversations about non-pharmacologic treatment options with her patients. "A healthy diet and regular physical exercise is going to go a long way.
“健康饮食和规律的体育锻炼将起到很大作用。所以我们可以从这里开始，”然后讨论可以向治疗方案中添加的其他干预措施，她说。
So let's start with that," and then discuss what other interventions to add to the regimen, she said.
在一封跟进邮件中，有人询问坎西诺是否推荐某种药物或工具优于其他选择，她警告不要“基于层级过度简化治疗方案”。
Asked, in a follow-up email, whether Cansino recommended one medication or tool over another, she warned against "over-simplifying treatment based on tiers."
就像避孕一样，她指出，患者可能会选择某种方法，尽管知道其效果较低。“只要他们了解其中的利弊，这样的决定完全可以接受。”
Just like with contraception, she noted that patients may choose a certain method, knowing that it's less effective. "As long as they understand the pros and cons, such a decision is perfectly OK."
与此同时，激素替代疗法（HRT）的需求已经在上升。去年，美国食品药品监督管理局（FDA）取消了某些雌激素疗法标签上的“黑框警告”。近几个月，经皮贴剂等雌激素产品在药店难以保持库存。
Meanwhile, demand for HRT is already rising. Last year, the FDA scrapped the " black-box warning " on labels for certain estrogen therapies. In recent months, estrogen products like transdermal patches have been hard for pharmacies to keep in stock.
“我认为经皮雌激素疗法的短缺凸显了这样一个事实：我们对激素疗法关注度很高，但未必对其他治疗选择关注得足够，”坎西诺对NPR表示。
"I think the shortage of transdermal estrogen therapy highlights the fact that we have all of this attention about hormone therapy, and not necessarily enough about other treatment options," Cansino told NPR.
她还强调，患者需要与值得信赖的临床医生讨论治疗方案的利弊，避免对单一选择产生“狭隘视野”。
She also stressed the need for patients to talk to trusted clinicians about the pros and cons of treatments and to avoid having "tunnel vision" about a single option.
坎西诺表示，妇产科医生帮助个体患者找到合适治疗方案所提供的护理水平，是新指南中最重要的方面之一。
The level of care that OB/GYNs provide by helping individual patients find the right treatment is one of the most important aspects of the new guidance, Cansino said.
“外界存在大量错误信息和关于激素疗法的夸大宣传，因此有些人最终在不该冒险时承担了风险，”她补充道。更年期 女性健康
"There's a lot of misinformation out there and exaggerated claims about hormone therapy, and so some people end up taking risks when they shouldn't," she added. menopause Women's Health