Данный блог содержит резюме и ссылки на полные тексты зарубежных и российских клинических рекомендаций по самым широким областям внутренней медицины. Сайт предназначен для российских врачей, которые хотят лечить своих пациентов качественно и грамотно, согласно последним достижениям современной доказательной медицины.
Вся представленная здесь информация предназначена для ознакомления и некоммерческого использования.

суббота, 6 сентября 2008 г.

Ведение женщин в постменопаузе

"In the United States, the median age at which menopause occurs is 52 years, but it can vary between 40 and 58 years of age," write Shobha S. Rao, MD, from the University of Texas Southwestern Medical Center in Dallas, and colleagues. "The World Health Organization (WHO) and the Stages of Reproductive Aging Workshop have defined menopausal transition as the time of an increase in follicle-stimulating hormone and either increased variability in menstrual cycle length, two skipped menstrual cycles with 60 days or more of amenorrhea, or both. It concludes with the final menstrual period, [and] postmenopause begins at that time, although it is not recognized until after 12 months of amenorrhea."
These recommendations, and their accompanying level of evidence rating, are as follows:

* In women who are aware of the risks and benefits and who are under medical supervision, extended use of hormone therapy is acceptable for those who believe that the benefits of menopausal symptom relief outweigh the risks, for those with moderate to severe menopausal symptoms and who are at high risk for osteoporotic fractures, and for those with decreased bone mass who wish to prevent additional bone loss when alternate therapies are contraindicated or otherwise inappropriate (level of evidence, C).
* To maintain bone health, all postmenopausal women should consume adequate amounts of calcium (1000 - 1500 mg of elemental calcium per day) and vitamin D (800 - 1000 IU per day) (level of evidence, C).
* For women at high risk for coronary heart disease, aspirin chemoprophylaxis is recommended (level of evidence, A).
* Beginning at age 40 years, women should be screened for breast cancer every 1 to 2 years (level of evidence, B).
* Women who are or who have been sexually active and who have a cervix should be routinely screened for cervical cancer (level of evidence, A).
* Beginning at age 50 years, women should be screened for colorectal cancer (level of evidence, A).
Источник - Am Fam Physician. 2008;78:583-591 Полный текст.