Leaders
来源于《社论》版块
Menopause
更年期
Second spring
第二春
Hormone-replacement therapy is safer than people think. More women should take it
激素替代疗法比人们认为的更安全。更多的女性应该接受它
It is known colloquially as “the change”. The end of a woman’s natural child-bearing years is a moment of transformation that is welcome to some and miserable for others. But for too many, menopause is also a painful process that can damage their bones, heart and brain. As societies age, the question of how best to preserve women’s health during menopause is becoming more urgent. In 1990 nearly half a billion women were 50 or older (the age when menopause typically begins). Today there are almost twice as many.
它俗称为“变化”。女性自然生育年龄的结束是一个转变的时刻，对此，一些人乐于接受，而另一些人则怅然若失。但对很多人来说，更年期也是一个痛苦的过程，会损害骨骼、心脏和大脑。随着社会老龄化，如何最好地保护更年期女性的健康问题变得越来越紧迫。1990年，50岁以上（更年期通常开始的年龄）的女性人数将近5亿。如今，这个数字几乎是以前的两倍。
About 47m women around the world reach the age of menopause each year. In Western countries, where most research has been conducted, up to 80% will experience symptoms such as hot flushes, night sweats, depression, insomnia, anxiety and memory loss. Symptoms can last up to 12 years. Around a quarter of women going through menopause feel so wretched that their quality of life is dimmed, according to studies in rich countries. Almost half of British women experiencing it say that their work suffers as a result.
全球每年约有4700万女性达到更年期年龄。在大多数研究已经开始进行的西方国家，高达80%的人会出现潮热、盗汗、抑郁、失眠、焦虑和失忆等症状。症状可持续长达12年。根据发达国家的研究，大约有四分之一的女性在经历更年期时感到非常痛苦，以至于生活质量变差了。在英国，几乎一半的女性表示，工作因此受到影响。
Twenty years ago, doctors would routinely have prescribed hormone-replacement therapy ( HRT) to women entering menopause. But in 2002 the results of a huge randomised trial were published, showing that the treatment brought health risks, including a slightly raised chance of breast cancer after five years. Women and doctors were alarmed. Around the world they abandoned hormonal therapy in droves. Before the study, 22% of menopausal women in America took HRT. Six years later that figure had fallen below 5%. In Australia, around 15% of menopausal women with moderate or severe symptoms receive the treatment. Take-up of HRT is now low in most countries. Women are scared and doctors wary.
20年前，医生通常会给进入更年期的女性进行激素替代疗法(HRT)。但在2002年，一项大型随机试验的结果发表了，结果显示，激素替代疗法带来了健康风险，包括5年后患乳腺癌的几率略有增加。妇女和医生对此感到震惊。在世界各地，激素替代疗法陆陆续续被放弃。在这项研究之前，22%的美国更年期妇女接受了激素替代疗法。六年后，这一数字降至5%以下。在澳大利亚，有中度或重度症状的更年期妇女中约有15%接受这种治疗。目前，激素替代疗法在大多数国家的使用率很低。女性很害怕，医生也很警惕。

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。

来源：经济学人