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Other possible risk - with estrogen therapy increases gallbladder disease, bronchial spasms , ovarian cancer, systemic lupus erythematosus , Raynaud's phenomenon and the associated . These data are insufficient epilepsy. Incontinence - estrogen can relieve pain during intercourse , recurrent cystitis, women after vaginal / urethral atrophy and inflammation in postmenopausal women. However, both the Heart and Estrogen / progestin Replacement Study (HERS) and the Women's Health Initiative (WHI) trial showed that oral hormone therapy worsen incontinence. Therefore , oral estrogen or progestin should not be prescribed for this indication no . Notably , low -dose transdermal unopposed estrogens ( 0.014 mg / day ) does not seem to increase urinary incontinence [ 99 ] risk. ( See " treatment of female urinary incontinence and prevention " in the " other drugs " one ) . Use of topical vaginal estrogen therapy of urogenital atrophy symptoms are discussed separately . ( See " Treatment of vaginal atrophy ." ) Bronchospasm - Estrogen therapy may be associated with asthma related. In the Nurses' Health Study , for example , the relative risk of new-onset 36,094 postmenopausal women followed for 10 years with asthma remarkable women serving larger Estrogen compared with those who did not ( relative risk 1.5 ) [ 100 ] a . This increased risk is dose-related , it was statistically significant only in the dose , because of the small number of women , may be greater than 0.625 mg / day of conjugated estrogens study . Conflicting data after estrogen therapy in postmenopausal women will lead to deterioration of the asthmatic airway function . A study conducted in 15 postmenopausal women with mild to moderate asthma showed that estrogen therapy for women with subclinical deterioration of disease activity ( eg by peak expiratory flow and spirometry ) [ 101 ] . By contrast, a second study of women with asthma with measures of airway obstruction in 20 postmenopausal women , there was no difference stopping and restarting estrogen therapy [ 102 ] after . Thus, although estrogen in women is not taboo obstructive pulmonary disease , clinicians should be aware of the possibility of worsening of bronchial spasm . In addition , estrogen can be considered as etiological factors in women who suffer from asthma during treatment . Systemic lupus erythematosus - estrogen appears to increase developing systemic lupus erythematosus [ 103 ] risk. A report from the Nurses' Health Study found that the relative risk of 2.5 current estrogen therapy for the past 1.8 estrogen therapy had no significant risk and who had never received estrogen [ 104 ] compared to women . The duration of exposure is associated with estrogen therapy . ( See " Epidemiology and pathogenesis of systemic lupus erythematosus ." ) Use of estrogen in postmenopausal women may increase the risk of lupus flares established , but these flares tend to be mild to moderate , moderate and severe . This is discussed in detail elsewhere . ( See " menstrual function , menopausal hormonal contraceptives and women with systemic lupus erythematosus ," in " Menopause " section. ) Uterine fibroids - the use of postmenopausal hormone therapy after childbearing age may lead some women continue to have uterine fibroids after menopause symptoms. Symptoms may vary depending on the risk , in part, on the location of uterine fibroids (if higher mucosa [ 105 ] ) and type ( high estrogen transdermal estrogen preparations in some studies [ 106, 107 ] , but not others [ 108 ] ) . A systematic review of randomized controlled trials , including five found that postmenopausal hormone therapy -induced growth of uterine fibroids , but this usually occurs without clinical symptoms [ 109 ] . These findings confirmed in subsequent prospective study [ 110 ] . Therefore, there is a hormonal treatment of fibroids after menopause is not a contraindication , nor with new symptoms related to uterine fibroids most women . Epilepsy - 42 menopausal women with epilepsy report , hormone therapy (HT) and increase the frequency of seizures [ 111 ] related. Although these data are not sufficient to recommend that women disappear seizures serotonin can not provide indications of hormone replacement has shrunk dramatically since the publication of the WHI . Women who are treating epilepsy should be carefully monitored. Dry eye - a large observational study of postmenopausal dry eye syndrome confirmed in unopposed estrogen or estrogen for women - increases the risk of progestin therapy compared with non- users ( relative risk [RR] 1.69 , and 1.29 , 95% CI 1.49-1.91 and 1.13 - 1.48 , respectively ) [ 112 ] . This may reflect the effects of estrogen on the tear film . ( See "dry eye ." ) Kidney stones - menopause may increase urinary calcium excretion, an important risk factor for the development of calcium kidney stones [ 1 13 ] . However , the rate of increase is unclear . In contrast , exogenous estrogen therapy may reduce urinary calcium excretion. Although the risk that people might expect an increase in kidney stones and menopause and reduce the risks associated with estrogen therapy , data, to solve this problem is inconsistent : ● In the Nurses' Health Study , a prospective cohort study , the risk of natural menopause is not associated with an increased related kidney stones [ 114 ] . In addition , postmenopausal estrogen users, compared with nonusers , did not lower the risk of kidney stones. ● Data from the WHI , the only randomized trial to address this problem , we recommend that estrogen therapy may increase kidney stones [ 115 ] risk. In the post- analysis of two trials of hormone therapy , kidney stones by the patient self-report data is obtained . After adjusting for age, body mass index, hormone therapy before , with coffee or diuretics, have kidney stones small excess risk of hormone group compared with placebo ( 39 vs. 34 / 10,000 person-years ; ? ? Hazard ratio 1.21 ) . The reason , the results of these differences is unclear . However , the incidence of kidney stones in the WHI were compared Nurses' Health Study ( includes only symptomatic stone cases ) [ 114 ] at nearly three times higher . In addition, women taking estrogen are more likely to develop gallstones [ 61 ] , and imaging studies to assess the gallbladder will identify asymptomatic kidney stones. Given the present study the small absolute risk ( five cases per 10,000 person-years of additional lower ) , we do not think of kidney stones is an important factor to consider in deciding whether to take short-term hormone therapy for menopausal symptoms ( see " gallbladder disease ' above) the weight of other issues - although women are often concerned that, after taking postmenopausal hormone therapy will increase, weight gain occurs in middle age , a meta-analysis of 28 trials of 28,559 women found no evidence that the anti-estrogen effect, or physical the combination of estrogen and progesterone body weight or body mass index [ 116 ] . Women with primary ovarian insufficiency ( premature ovarian failure ) - data from the Women's Health Initiative (WHI) should not be generalized to women with primary ovarian insufficiency ( premature ovarian failure , menopause before age 40 years ) , after which postmenopausal hormone therapy generally start at a young age . In healthy women with primary ovarian insufficiency , we continue until their postmenopausal hormone therapy after menopause , with an average age of about 50 years old to 51 years old. At this point, the benefits of the potential risk of postmenopausal hormone therapy and how should the same discussion . Androgen therapy - after perimenopausal and postmenopausal women using exogenous androgen therapy is examined separately . ( See " androgen production and treatment of women " and " female sexual dysfunction : management," in part " androgens ." ) Expert group - the group most experts agree that hormone therapy is indicated for the management of menopausal symptoms , instead of cardiovascular disease or dementia [ 7,117-119 ] primary or secondary prevention. Some groups believe that hormone therapy may be reasonable for women with osteoporosis who can not take non- estrogen therapy [ 5,117 ] . Patient Information - current offers two types of patient education materials , " Basics" and " Beyond the Basics " on the basis of patient education pieces are in plain language , at the 5th to 6th grade reading level , and they answer the four or five patients may be the key issues for a given condition. These products are our people who want a general overview of the patient , who prefers short , easy-to -read materials. In addition to basic patient education sheet for longer , more complex and detailed. These articles are written in grades 10 to 12, and the most appropriate reading level who want in-depth information and customary use of some medical terminology patients. The following articles are related to this topic patient education. We encourage you to print or e-mail these topics to your patients. ( You can also locate a wide variety of topics in patient education articles by searching for " Patient Information" and interested keywords. ) _________________________________________ 再次不謝唷品質專業近乎苛求 google翻譯大神竭誠為您服務 -- ※ 發信站: 批踢踢實業坊(ptt.cc) ◆ From: 36.226.193.252