2. 中・高年女性のさらなるQOL向上を目指して : HRT,心身医学の活用による全人的医療(特別講演,第60回学術講演会要旨)

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Once, HERS and WHI study denied usefulness of hormone replacement therapy(HRT). But, International Menopause Society has asked us to agree and sign for a declaration that 1. HRT(HT) remains the most effective treatment for vasomotor symptoms and estrogen deficient urogenital symptoms. … 6. Estrogen has favorable metabolic and cardioprotective effects, at least until age 60. et. al., in the last August (2007). Prof W.H. Utian, the founder of North American Menopause Society, said "If only WHI had kept to its premise-but now it's time for their Mea Culpa" on the page of the editor of Menopause Management, Sept. Oct. 2007. On the other hand, psychosomatic medicine has been widely and deeply developped including psychoanalysis and The Morita Therapy, et al. Recently, it has been proved on the evidence based medicine that more usefulness of Cognitive Behavioral Psychotherapy for recurrence of panic disorder in comparison with drug therapy. Thus we should re-evaluate HRT and use more psychosomatic medicine to make menopausal and elderly women more healthy and brilliant. The life span of Japanese female is 85.81 y.o.(2007) and it has been the longest in the World for 22 years. But, the climacteric and elderly female has troubles in their Quality of Life, for example more longer period to be sick and lying in bed in comparison with male. Mean level of estradio1-17β (E_2) in peripheral blood is 5.9pg/ml in female after menopause, and it is lower than E_2(mean 19.3pg/ml) of same aged male. The acute estrogen decrease induces climacteric syndrome induces climacteric syndrome (hot flash, sweating et al.) and very low level of estrogens for long years after that induces many problems in elderly female, for example, cardio-vascular disease, osteoporosis, colpitis senilis, Alzheimer disease et al. The Lower serum level of allopregnanolone (3α-hydroxy-5α-pregnane-20-one, one of metabolites of progesterone) was reported in premenstrual syndrome and/or premenstrual dysphoric disorder. Selective serotonin reuptake inhibitor(SSRI) increase 3α-hydroxysteroid dehydrogenase and elevate allopregnanolone level in the brain, which gives anti-anxietic effect via GABA A receptor. The climacteric depression may have same mechanism. Actually SSRI is very useful for it. The psychotherapy is also very useful for the depression. New synthetic progestogens drospirenone and dienogest show anti depressive effects. In resent our study, odds ratio of breast cancer according to HRT is 0.432, namely breast cancer decrease with HRT in Japanese. Nurses Health Study" and other recent reports have eported that HRT has cardio protective effect during perimenopausal period(under 60 y.o.) HRT during 50〜63 y.o. reduces future Alzheimer disease (odds raio 0.35). E_2 and non-feminizing estrogen (J 861) accellate acetylcholine reactive neuron in Substantia Innominata of fore brain in our study. Conclusively we would like to recommend to use steroids selectively and timely (reducing amounts in elderly women), and psychosomatic medicine to make climacteric and elderly women more healthy and brilliant.
社団法人日本産科婦人科学会の論文
2008-08-01

2. 中・高年女性のさらなるQOL向上を目指して : HRT,心身医学の活用による全人的医療(特別講演,第60回学術講演会要旨)

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