폐경후 여성호르몬 보충요법

박형무,Park, Hyoung-Moo 한국정신신체의학회 1996 정신신체의학 Vol.4 No.1

Korean women are now living almost 1/3 of their life after menopause. Sex-steroid hormone deficiency adversely affect various fields of physical & mental activity and quality of life during this period. Therefore, replacement of deficient hormone is thought to be natural therapeutic modality. Postmenopausal syndrome is recently redefined as an endocrinopathy with both short-and long-term sequelae, as a result of cessation of ovarian function. Hormone replacement therapy taken at or near time of menopause alleviates shot-term acute menopausal symptoms such as vasomotor disturbances and psychological problems. HRT also beneficially affects some of intermediate symptoms such as urogenital atrophy and cutaneous problems. The major benefits of long-term use were reductions in risk of long-term sequelae, that is, total fracture by 50-60%, cardiovascular disease by 50% and cerebrovascular disease by 30-40%, respectively. In addition, HRT may also positively influence Alzheimer's disease, reduce the colorectal cancer risk and increase longevity of the life. In conclusion, all postmenopausal women should consider preventive HRT when there are no contraindications.

Women`s Health Initiative 연구발표 전후 국내 호르몬 약제의 사용 변화: 2000~2009

박형무 ( Hyoung Moo Park ),상재홍 ( Jae Hong Sang ),김정연 ( Jeong Heun Kim ) 대한산부인과학회 2010 Obstetrics & Gynecology Science Vol.53 No.12

목적: 본 연구의 목적은 Women`s Health Initiative Study (WHI) 발표 전후 2000년부터 2009년까지 10년 동안의 폐경 여성에서 호르몬 사용의 변화와 WHI의 결과가 우리나라의 호르몬 요법 사용에 어떠한 영향을 보였는지 알아보고 이를 통해 앞으로의 폐경 후 호르몬 요법의 전망을 알아보고자 한다. 연구 방법: 이 연구는 International Medical Service HEALTH 회사에서 발표된 약제 통계자료에 기초하였다. 우리나라에서 판매된 호르몬 제제들에 대한 통계자료들은 2000년부터의 자료를 이용하였다. 폐경여성들의 호르몬 제제들의 사용은 연간 호르몬 제제들의 판매액으로 표시하였으며 총 호르몬 제제는 에스트로겐, 에스트로겐/프로게스토겐, 티볼론 제제들의 합으로 표시하였다. 호르몬 제제의 사용 변화를 알기 위해 전년 대비 성장률과 2000년을 기준으로 한 축적성장률을 산출하였다. WHI발표 이후의 사용 변화를 알기 해서 2002년부터 2009년까지 2002년을 기준으로 한 변화를 확인하였다. 결과: 2002년 WHI 발표 이후 우리나라의 총 호르몬 요법 사용은 2002년도의 511억에 비해 2006년에 39%의 감소를 보여 314억까지 감소하였다. 이후 조금씩 상승하여 2009년에는 356억이었다. 반면 티볼론의 사용은 WHI 이후 2년간은 감소하여 2002년 134억에 비해 2004년에는 100억으로 25.4% 감소하였으나 이후 지속적으로 상승하여 2007년에는 134억으로 2002년의 사용량보다 증가하였고, 2009년에는 145억으로 2002년 대비 8.2% 증가하였다. 저용량 호르몬 제제 또한 WHI 이후 지속적으로 증가하여 2002년 8억 대비 2009년에는 71억으로 787.5% 증가하였다. 결론: WHI의 발표 후 폐경 여성들의 호르몬 사용은 2002년에 비해 2003년에 23.9% 감소하였고 저용량 호르몬과 티볼론 사용이 확연히 증가하였다. 앞으로 우리나라 폐경 여성에서 호르몬 사용은 저용량의 호르몬과 티볼론이 대세를 이룰 것으로 생각된다. 또한 호르몬 요법을 시작할 때 환자의 병력, 신체검사를 통한 이득과 위험을 판단한 후 각 개인에 맞는 호르몬 요법을 시행하여야 할 것이다. Objective: This study aims to survey the change of comsumption of hormone therapy (HT) before and after publication of Women`s Health Initiative Study(WHI) result in Korea from 2000 to 2009. Methods: Data from Intercontinental Marketing Services were used to analyze and ten years of hormone consumption from 2000 to 2009 was expressed in terms of hormone sales amount (Korean won, KRW, 1 dollar=1,100 won). Total hormone consisted of Estrogen (ET), Estrogen/Progestogen (EPT), and Tibolone. To identify changes in total hormone consumption, the cumulative growth rate was based on the sales in 2002. Results: After publication of WHI result in 2002, HT consumption had been continuously decreased by 39% from 51.1 billion (bn) KRW in 2002 to 31.4 bn KRW in 2006. From 2007 to 2009, HT consumption has been slightly increased to 3.56 bn KRW. The decreased consumption of HT is mainly due to decrease of ET/EPT comsumption by 49%. Tibolone consumption was decreased by 25% during next 2years after WHI publication, but thereafter gradually increased over pre-WHI publication level in 2009. The proportion of consumption of low dosage regimen was markedly increased from 3.5% in 2002 to 41.8% in 2009. Conclusion: The total hormone consumption was markedly decreased after WHI. Low dosage regimen consumption was increased, comprising 3.5~41.8% of total EPT consumption. Tibolone consumption was transiently decreased during 2 years after WHI publication, but thereafter increased gradually and reached over the level of pre-WHI publication in 2009. We expect that low-dosage regimen of HT and tibolone will be more widely used. An individual-based treatment approach is essential in assessing the appropriateness of initiating hormone replacement therapy.

New horizon of SERM and tissue specific effect

박형무 ( Hyoung Moo Park ) 대한내과학회 1999 대한내과학회 추계학술대회 Vol.57 No.-

한국 비고령 폐경 여성에서 비타민 D의 영양상태

박형무 ( Hyoung Moo Park ),박성대 ( Sung Dae Park ),박황신 ( Hwang Shin Park ),허민 ( Min Hur ) 대한폐경학회 2004 대한폐경학회지 Vol.10 No.1

한국 폐경여성에서 호르몬 대체요법시 WHI 연구결과에 의거한 암발생의 관점에서 본 손익에 대한 추정효과

박형무 ( Hyoung Moo Park ) 대한폐경학회 2004 대한폐경학회지 Vol.10 No.2

폐경 여성에서 골다공증 치료 시 비타민 D 사용에 대한 환자의 인식도 조사

박형무 ( Hyoung Moo Park ),김정연 ( Jeong Yuen Kim ),정여진 ( Ryoh Jin Chung ),김재준 ( Jae Joon Kim ) 대한산부인과학회 2007 Obstetrics & Gynecology Science Vol.50 No.7

목적: 골 건강에는 여러 요인들이 복합적으로 관여하며, 이들 중 영양적 요인으로 칼슘과 비타민 D를 들 수 있다. 골다공증 치료 시 비타민 D의 부가적 투여에 대한 환자의 인식도에 대한 기초 조사를 실시하였다. 연구 방법: 골다공증 제제를 복용하고 있는 50세 이상의 여성 400명을 대상으로 1) 비타민 D의 복용 여부, 2) 비타민 D에 대한 지식수준, 3) 비타민 D에 대한 상담, 4) 비타민 D 영양에 대한 홍보매체의 역할 등에 관한 항목들을 포함한 22개 문항의 설문지로 조사하였다. 결과: 골다공증 관리를 위해 보충제를 복용하는 환자는 62%였고, 이들 중 비타민 D 제제를 복용하는 환자는 28%로 칼슘 (57%)의 복용 빈도의 반 정도로 나타났다. 비타민 D 제제를 불규칙적으로 복용하는 환자의 78%가 비타민 D의 중요성을 이해하지 못하였으며 칼슘에 비해 비타민 D에 대한 지식은 상대적으로 부족한 것으로 나타났다. 환자들은 건강한 뼈를 형성하는데 있어서 칼슘과 운동에 이어 비타민 D를 세 번째로 중요하다고 생각하고 있었고 칼슘과 비타민 D의 상담 빈도를 비교하였을 때 의사, 환자 모두 칼슘에 비해 비타민 D의 상담 빈도가 현저히 낮았다. 비타민 D 영양에 대해 홍보매체를 통해 접해본 적이 있는 환자의 80% 이상에서 긍정적인 효과를 보였다. 22개 문항의 결과를 종합해 볼 때 비타민 D에 대한 환자들의 인식이나 관심이 낮으며 골다공증 치료 시 그 중요성이 낮게 평가되고 있는 것으로 나타났다. 결론: 골다공증 치료에 있어서 비타민 D에 대한 인지도가 낮기 때문에 비타민 D 제제의 복용률 또한 낮게 나타났으며 비타민 D에 대한 홍보와 교육을 통해 환자의 이해를 높임으로써 골다공증 치료에 기여할 것으로 예상된다. Objective: The purpose of this study was to evaluate the vitamin D perception level in the treatment of osteoporosis of Korean postmenopausal women. Methods: This study investigates the perception levels of 400 postmenopausal women aged 50 and over, vitamin D supplement administration, knowledge of vitamin D nutrition, consulting and information of vitamin D and the effect of media exposure during osteoporosis management. A descriptive survey design and a convenience sample of 400 female postmenopausal patients were used. Data were collected with a questionnaire and analysed. Results: Sixty-two% of the patients took supplementary drugs in addition to prescribed main anti-osteoporotic medications. As supplementary drugs, most of them took calcium (57%) and this was twice the number of people taking vitamin D. For those who failed to take the recommended vitamin D or calcium regularly, seventy-eight% of them did not understand that it is important to take regularly. And this survey showed that people do not have enough knowledge on vitamin D compared to calcium. Patients thought that vitamin D is the third most important factor, next to calcium and exercise, for managing healthy and strong bones. Findings indicated that the women displayed a low level of perception and interests in vitamin D and the importance of vitamin D in the management of osteoporosis was assessed at lower than the truth. Conclusion: These findings suggested that the rates of vitamin D administration of Korean postmenopausal women in the management of osteoporosis is a low level because of a low level of perception of the importance of vitamin D. Therefore the education and the informations about vitamin D are contributable to the treatment of osteoporosis.

한국 폐경여성의 호르몬 대체 요법에 대한 인지도와 수용성에 대한 연구 - 폐경과 호르몬 대체요법에 대한 한국 갤럽 역학연구 조사 결과

박형무(Hyoung Moo Park),최훈(Hoon Choi),이홍균(Hong Kyoon Lee) 대한폐경학회 2002 대한폐경학회지 Vol.8 No.1

N/A Objective: This epidemiologic study was designed to assess HRT awareness and acceptance in Korean postmenopausal women as a part of 3rd Korean Estrogen Deficiency Awareness (KEDA) anniversary program. Design: This study was conducted by Korea Gallup under the auspices of Korea Menopause Society and Korea Wyeth through the face to face interviews with 1201 women aged between 50 and 59 years, who were randomly recruited from all areas in Korea, by using questionnaire consisting of 53 items of question about menopause and HRT. Results: Of total cohort, slightly more than half reported they were aware of HRT. HRT awareness was strongly and significantly influenced by educational level, household income and living area. Among 938 women without menstruation, 228 women comprising 24.3% had ever used HRT, which was the total of 23.3% of natural menopausal women and 29.8% of hysterectomized women. Forty-four percents of ever-users of HRT, were currently using HRT and 56% were past-users. Nearly one-tenth of women with natural menopause were currently using HRT, while 19% of hysterectomized women were current-users. Ever and current use of HRT was more common after hysterectomy. Sixty-four percents of ever-users reported major motivation to take HRT was doctor's recommendation. Twenty-eight percents were recommended by relatives and friends while 8% were recommended by media such as radio, TV and press. Primary reason for never initiating therapy was no or mild menopausal symptom. Second most common reason was therapy seemed to be not natural and ignorance of HRT. Among past users of HRT, primary reason for stopping HRT was undesirable side effects from the medication. Next most common reason was medication seems to be troublesome and complicated, third most common reason was resolution of symptom. Near one-third of ever-users of HRT started medication soon after menopause and slightly more than half started within 1 year after menopause. Of ever-users of HRT, slightly more than half stopped within 1 year. Three-quarters consulted by gynecologist for prescription of HRT, 18% internist, 4% general practictioner. As basal lab test for HRT, 81% had pap smear, 76% had mammography and 48% had a bone density assessment. Eighty-six percents of ever-users reported HRT was effective for treatment of climacteric symptoms but 14% reported it was ineffective. Conclusion: Even slight more than half of women were aware of HRT, the rate of ever-use was 24.3% and that of current-use was only 10.8%. Therefore we should improve the prescription rate and compliance rate of HRT through continuous education for doctors and postmenopausal women.

한국 폐경 및 폐경 주변기 여성에서 골다공증 예측을 위한 자가 측정표 (Osteoporosis Self assessment Tool for Asian, OSTA)의 유용성

박형무 ( Hyoung Moo Park ),소재성 ( Jae Sung So ) 대한산부인과학회 2003 Obstetrics & Gynecology Science Vol.46 No.2

목적 : 한국 폐경 및 폐경 주변기 여성에서 OSTA (Osteoporosis Self-assessment Tool for Asians)에 대한 검증을 위해 시행하였다. 연구 방법 : 중앙대학교 폐경기 클리닉을 방문한 45세 이상의 폐경 및 폐경 주변기 여성 1488명을 대상으로 하였다. 이들 대퇴골두 골밀도의 측정에는 이중 에너지 X-ray 흡수 계측법 (DEXA; Lunar DPXIQ #7055)를 이용하였다. 골밀도는 세계보건기구 (WHO)의 정 Objective : The purpose of this study was to evaluate the performance of OSTA (Osteoporosis Self assessment Tool for Asian) in Korean peri- and postmenopausal women. Design and Methods : Total 1488 peri- and postmenopausal women over 45 years were include

폐경후 호르몬 보충요법시 골밀도의 감소

박형무(Hyoung Moo Park),허민(M. Hur) 대한폐경학회 2000 대한폐경학회지 Vol.6 No.2

N/A Objective: Hormone replacement therapy(HRT) with estrogen, either alone or in cambination with progestogen has been well established for preservation of postmenopausal bone loss, However actual decrease in bone mineral density(BMD) is observed in some proportion of postmenopausal woman in practice, even though the use of bone-conserving doses of estrogen. The purpose of this study is to find out the incidence of the postmenopausal women with decreased BMD on HRT, the difference in incidence of the subjects with decreased BMD between natural and surgical menopause, and whether the factors such as duration of menopause, initial BMD and mode of HRT are influencing on the incidence of subjects with decreased BMD. Methods: One hundred-twenty one natural and thirty one surgical postmenopausal women on HRT were checked spine and femur BMD by dual energy X-ray absorptiometry at 1 year interval from Jan 1995 to May 1997. Results: The incidence of the subjects with decreased and significanly decreased spinc BMD in natural menopause was 24,8% and J7.5% respectively, At femur, the incidence of decrease and significant decrease in BMD was 33,0% and 22.9%, which was not statistically different from the incidence in spine BMD. In surgical menopause, the subjects with decreased and significantly decreased spine and femur BMD were markedly increased up to around 70% and over 50% respectively, which showed significant decrease compared with natural menopause. Duration of menopause, initial BMD and mode of HRT did not influence the incidence of significant decrease in BMD in natural menopause. Incidence of significant decrease in spine BMD was elevated within first 5 years of postmenopausal period in surgical menopause, but initial BMD did not influence this incidence. Conclusion: About 20% of natural and 50% of surgical postmenopausal women suffered from significant decrease in BMD even though conventional HRT. The incidence of decrease and significant decrease in femur BMD was not significantly different from incidence in spine BMD, and duration of menopause, initial BMD, and mode of HRT did not influence these incidence in menopause, except menopausal duration which was inversely associated with these incidence in surgical menopause.

생리적 농도의 난포호르몬이 인간자궁동맥 평활근 긴장도에 미치는 효과

박형무(Hyoung Moo Park),허민(M. Hur) 대한폐경학회 2000 대한폐경학회지 Vol.6 No.2

N/A Objective: The present study was performed to investigate whether estrogen of physiological concentration induces the change of vascular reactivity in endothelium-denuded human uterine artery by calcium modulation through receptor-and voltage-dependent calcium channels. Design: The human uterine arteries were obtained at the time of hysterectomy from 28 women followed by denudation of endothelium. After confirmation of functional integrity of endothelium-denuded uterine artery by using acetylcholine(10μM), sodium nitroprusside(10μM), tamsulosin(10μM), vascular reactivity induced by estrogen was measured by using isometric force transducer and recorded by physiograph. Contraction of uterine artery was induced by 10-14 and 10-6 M norepinephrine and 70mM and 35mM KCI solution which activated receptor-and voltage4ependent calcium channels respectively. Estradiol of 4 different concentrations including physiological concentrations, from 3 x 10-11M to 3 x 10-8M was administered, Result: 17β-estradiols from 3 X 10-11M to 3X10-8M showed no significant relaxation on contraction of endothelium-denuded uterine artery induced by 10-4 norepinephrine & extracellular potassium 70mM. But physiologic 17β-estradiol showed significant dose-dependent vascular relaxation, that is, 86.3±3.2% & 82.4±4.1% of contraetion induced by norepinephrine 10-6 & KC1 35mM at the 3X10-10M concentration of 17β-estradiol. 70.5±4.2% & 71.6±5.9% of contraction induced by norepinephrine 10-6 & KC1 35mM at the 3 x 10-9M concentration of 17β-estradiol. Conclusion; Estradiol at physiological concentration has endothelium-independent vasorelaxation effect in human uterine arteries. These vasorelaxant effects may be mediated through antagonistic action on receptor- and voltage-dependent calcium channels in vascular smooth muscle, This estrogenic mechanism may contribute to prevention and treatment for cardiovascular desease.