经济学人下载:更年期激素替代疗法的利与弊(2)

And yet the conclusions of the study in 2002 were rapidly debunked. A re-examination of its results showed that women aged between 50 and 59 who took HRT were 31% less likely to die of any cause during their five to seven years of treatment with the hormones than those who did not. For a woman who has had her uterus removed or who starts menopause before the age of 45, HRT greatly reduces the risk of heart disease, a life-saving effect. It can also prevent osteoporosis, a disease in which bones become brittle. One study of postmenopausal American women over a ten-year period found that, of those who had had hysterectomies, between 18,000 and 91,000 died prematurely because they had shunned hormone therapy. HRT also lowers women’s risk of uterine and colon cancers. Fears about the increased risks of breast cancer have been overplayed.
然而，2002年的研究结论很快就被揭穿了。一项对结果的重新检验表明，在接受激素替代疗法的5到7年里，年龄在50到59岁之间的妇女因任何原因死亡的可能性比未接受激素替代疗法的妇女低31%。对于子宫切除或45岁前更年期的妇女来说，激素替代疗法大大降低了患心脏病的风险，这是一种挽救生命的效果。它还可以预防骨质疏松症，一种骨质变脆的疾病。一项对更年期后的美国妇女长达10年的研究发现，在那些做过子宫切除手术的妇女中，有18000到91000人因为逃避激素治疗而过早死亡。激素替代疗法还能降低女性患子宫癌和结肠癌的风险。关于乳腺癌风险增加的担忧被夸大了。

Hormonal therapies are typically off-patent and inexpensive. In Britain the annual price tag is only £125 ($165); in the United States generic pills are similarly affordable. And the benefits vastly outweigh the costs. Nothing else controls the symptoms of menopause so well, and a heightened risk of any one disease must be weighed against the lowered risks of contracting several others. Hormonal therapies are not appropriate for all menopausal women. For some, the symptoms are insufficiently severe for it to be worthwhile. The treatment might not be suitable for those with liver disease, or a history of blood clots, or breast or ovarian cancer. But for serious symptoms, alternative treatments are worse than taking HRT. Herbal supplements, yoga and faddy diets— to which some turn in the absence of medical help—may alleviate the unpleasantness of menopause but do not offer the long-term health benefits of HRT. Moreover, the symptoms can portend serious health problems in the future. Doctors could usefully prescribe HRT far more widely than they do today.
激素疗法通常是非专利的，而且便宜。在英国，一年的标价只有125英镑（合165美元）；在美国，仿制药也同样便宜。而且收益远远大于成本。没有什么比这更好地控制更年期症状了，任何一种疾病的高风险都必须与其他几种疾病的低风险相权衡。激素疗法并不适用于所有更年期妇女。对一些人来说，这些症状还不够严重，值得一试。这种疗法可能不适用于患有肝病、有血栓病史、乳腺癌或卵巢癌的患者。但是对于严重的症状，其他疗法比激素替代疗法更糟糕。草药补品、瑜伽和流行饮食——有些在没有医疗帮助的情况下转而采用——可能会减轻更年期的不愉快，但不会提供激素替代疗法的长期健康益处。此外，这些症状可能预示着未来严重的健康问题。医生可以比现在更广泛地使用激素替代疗法。