| 摘要: |
| ［摘要］ 随着恶性肿瘤早期诊断技术与综合治疗方案的不断革新，肿瘤患者规范治疗后，生存期显著延长，由医源性卵巢功能衰竭引发的绝经相关健康问题已成为影响肿瘤幸存者长期生活质量的核心议题。绝经激素治疗（MHT）曾因潜在的肿瘤复发风险，长期被列为女性肿瘤术后的绝对禁忌。然而，近年来基于大样本队列研究、meta分析及多中心随机对照试验的高质量循证证据不断涌现，国际绝经学会、北美绝经学会、中华医学会妇产科学分会等更新指南，推动MHT从“全面禁止”向“风险分层、个体化精准应用”的范式转变。该文系统梳理近年来国内外核心指南更新要点，重点解析乳腺癌、子宫内膜癌、卵巢癌、宫颈癌等女性常见恶性肿瘤术后MHT的适应证界定、禁忌证放宽依据、用药方案优化策略及安全性证据链，深入阐明MHT从禁忌到个体化应用的逻辑演进，同时补充临床实践中的细节操作与特殊人群管理，为临床规范化实施女性恶性肿瘤患者绝经健康管理提供兼具循证依据与实践价值的参考路径。 |
| 关键词: 肿瘤术后 绝经激素治疗 指南解读 个体化治疗 生活质量 |
| DOI：10.3969/j.issn.1674-3806.2026.06.02 |
| 分类号:R 73 |
| 基金项目:内蒙古医学科学院公立医院科研联合基金科技项目（编号：2024GLLH0371）；呼和浩特市“青城名医”工程医学创新人才项目（编号：呼青城名医-2025008） |
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| From contraindication to individualization: interpretation of new advances in domestic and international guidelines for menopausal hormone therapy in women after malignant tumor surgery |
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WANG Yu1, JU Rui1,2, ZHAO Rongwei1, ZHANG Jing1, LI Xia1
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1.Department of Gynecology, Hohhot Maternal and Child Health Care Hospital(Hohhot Women and Children′s Hospital), Hohhot 010021, China; 2.Drug Clinical Trial Institution Office, Beijing Obstetrics and Gynecology Hospital, Capital Medical University/Beijing Maternal and Child Health Care Hospital, Beijing 100026, China
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| Abstract: |
| ［Abstract］ With continuous innovations in early diagnosis techniques and comprehensive treatment protocols for malignant tumors, the survival period of cancer patients has been significantly prolonged after standardized treatment. The health problems related to menopause caused by iatrogenic ovarian failure have become the core issue affecting the long-term quality of life of the tumor survivors. Menopausal hormone therapy(MHT) has long been listed as an absolute contraindication for women after tumor surgery due to the potential risk of tumor recurrence. However, in recent years, high-quality evidence-based data from large-sample cohort studies, meta-analyses, and multicenter randomized controlled trials have been emerging continuously, and the International Menopause Society, the North American Menopause Society and the Obstetrics and Gynecology Branch of the Chinese Medical Association have updated their guidelines, driving a paradigm shift in MHT from “complete prohibition” to “risk stratification and individualized precise application”. This paper systematically reviews the key updates to domestic and international core guidelines in recent years. It focuses on analyzing the definition of indications, the rationale for decreasing contraindications, optimization strategies for medication regimens, and the safety evidence chain for MHT in common female malignancies including breast cancer, endometrial cancer, ovarian cancer and cervical cancer after malignant tumor surgery. Furthermore, it deeply elucidates the logical evolution of MHT from an absolute contraindication to individualized application, while supplementing the detailed operations and special population management in clinical practice, providing a reference path with both evidence-based basis and practical value for the standardized implementation of menopausal health management in female patients with malignant tumors. |
| Key words: Post-tumor surgery Menopausal hormone therapy(MHT) Guideline interpretation Individualized treatment Quality of life |
