绝经后女性衰弱的机制与绝经激素治疗的作用
收稿日期: 2025-02-11
网络出版日期: 2026-01-30
版权
Mechanisms of frailty in postmenopausal women and the role of menopausal hormone therapy
Received date: 2025-02-11
Online published: 2026-01-30
Copyright
衰弱是一种与年龄增长相关的老年综合征，表现为多系统功能衰退，导致个体对外界应激的脆弱性增加，增高不良健康结局风险。流行病学研究表明，女性衰弱发生率高于男性，且受到绝经后雌激素水平急剧下降的影响显著，进而导致骨骼、肌肉、代谢和免疫功能的退化。绝经激素治疗（menopausal hormone therapy, MHT）作为绝经后管理的一种方式，其对衰弱风险的影响尚存争议。研究显示，MHT对衰弱相关生理指标具有明确的改善作用，但对衰弱的整体预防作用仍需更多高质量研究加以验证。本文就绝经与衰弱的相关证据进行综述，重点探讨MHT在其中的作用及局限性，未来研究应聚焦于个性化治疗策略、联合干预效果以及社会心理因素在衰弱管理中的作用。
牟睿 , 蒋婕 , 木卡大斯·热合曼 , 童建菁 . 绝经后女性衰弱的机制与绝经激素治疗的作用[J]. 内科理论与实践, 2026 , 20(06) : 505 -509 . DOI: 10.16138/j.1673-6087.2025.06.14
Frailty is an age-related geriatric syndrome characterized by multisystem functional decline, which increases vulnerability to external stressors and raises the risk of adverse health outcomes. Epidemiological studies indicate a higher prevalence of frailty in women than in men, significantly influenced by the abrupt decline in estrogen levels after menopause, leading to deterioration in skeletal, muscular, metabolic, and immune functions. As an approach to postmenopausal management, menopausal hormone therapy (MHT) remains to have a debated impact on frailty risk. Studies show that MHT has demonstrated clear benefits on frailty-related physiological indicators; however, its overall efficacy in frailty prevention requires further validation through high-quality studies. This review summarizes current evidence linking menopause and frailty, with a focus on the role and limitations of MHT. Future research should focus on personalized treatment strategies, effects of combined intervention, and the role of psychosocial factors in frailty management.
Key words： Frailty; Postmenopause; Menopausal hormone therapy
| [1] | Fried LP, Cohen AA, Xue QL, et al. The physical frailty syndrome as a transition from homeostatic symphony to cacophony[J]. Nat Aging, 2021, 1(1):36-46. |
| [2] | O'Caoimh R, Sezgin D, O'Donovan MR, et al. Prevalence of frailty in 62 countries across the world: a systematic review and meta-analysis of population-level studies[J]. Age Ageing, 2021, 50(1):96-104. |
| [3] | 田鹏, 杨宁, 郝秋奎, 等. 中国老年衰弱患病率的系统评价[J]. 中国循证医学杂志, 2019, 19(6):656-664. |
| Tian P, Yang N, Hao QK, et al. Epidemiological characteristics of frailty in Chinese elderly population: a systematic review[J]. Chinese Journal of Evidence-Based Medicine, 2019, 19(6):656-664. | |
| [4] | Lu L, Tian L. Postmenopausal osteoporosis coexisting with sarcopenia: the role and mechanisms of estrogen[J]. J Endocrinol, 2023, 259(1):e230116. |
| [5] | U?an Yama? S, Bakir N. Aging anxiety levels of women in menopause and associated factors[J]. Rev Assoc Med Bras (1992), 2025, 71(1):e20240573. |
| [6] | Whitesides L, Lynn J. The psychosocial effects of frailty on women[J]. Clin Geriatr Med, 2021, 37(4):543-552. |
| [7] | Verschoor CP, Tamim H. Frailty is inversely related to age at menopause and elevated in women who have had a hysterectomy: an analysis of the canadian longitudinal study on aging[J]. J Gerontol A Biol Sci Med Sci, 2019, 74(5):675-682. |
| [8] | Kojima G, Taniguchi Y, Aoyama R, et al. Earlier menopause is associated with higher risk of incident frailty in community-dwelling older women in England[J]. J Am Geriatr Soc, 2022, 70(9):2602-2609. |
| [9] | Kojima G, Taniguchi Y, Ogawa K, et al. Age at menopause is negatively associated with frailty: a systematic review and meta-analysis[J]. Maturitas, 2022, 165: 94-99. |
| [10] | Hao W, Wang Q, Yu R, et al. Reproductive factors and their association with physical and comprehensive frailty in middle-aged and older women: a large-scale population-based study[J]. Hum Reprod Open, 2024, 2024(3):hoae038. |
| [11] | Gomes CS, Pirkle CM, Barbosa JFS, et al. Age at first birth, parity and history of hysterectomy are associated to frailty status: cross-sectional analysis from the international mobility in aging study -Imias[J]. J Cross Cult Gerontol, 2018, 33(4):337-354. |
| [12] | Huang G, Coviello A, LaValley MP, et al. Surgical menopause and frailty risk in community-dwelling older women: study of osteoporotic fractures[J]. J Am Geriatr Soc, 2018, 66(11):2172-2177. |
| [13] | Fischer V, Haffner-Luntzer M. Interaction between bone and immune cells: implications for postmenopausal osteoporosis[J]. Semin Cell Dev Biol, 2022, 123: 14-21. |
| [14] | Rahimipour Anaraki S, Mohammadian A, Saghafian Larijani S, et al. Frailty syndrome in women with osteoporosis, should physicians consider screening?[J]. Bone Rep, 2023, 19: 101722. |
| [15] | Divaris E, Anagnostis P, Gkekas NK, et al. Early menopause and premature ovarian insufficiency may increase the risk of sarcopenia: a systematic review and meta-analysis[J]. Maturitas, 2023, 175: 107782. |
| [16] | Jia B, Wang Z, Zhang T, et al. Prevalence of social frailty and risk factors among community-dwelling older adults: a systematic review and meta-analysis[J]. Arch Gerontol Geriatr, 2024, 123: 105419. |
| [17] | Tang Y, Peng B, Liu J, et al. Systemic immune-inflammation index and bone mineral density in postmenopausal women: a cross-sectional study of the national health and nutrition examination survey (NHANES) 2007-2018[J]. Front Immunol, 2022, 13: 975400. |
| [18] | Meloni A, Cadeddu C, Cugusi L, et al. Gender differences and cardiometabolic risk: the importance of the risk factors[J]. Int J Mol Sci, 2023, 24(2):1588. |
| [19] | Xu H, Brown JL, Bhaskaran S, et al. Reactive oxygen species in the pathogenesis of sarcopenia[J]. Free Radic Biol Med, 2025, 227: 446-458. |
| [20] | Mishra M, Wu J, Kane AE, et al. The intersection of frailty and metabolism[J]. Cell Metab, 2024, 36(5):893-911. |
| [21] | Nishikawa H, Asai A, Fukunishi S, et al. Metabolic syndrome and sarcopenia[J]. Nutrients, 2021, 13(10):3519. |
| [22] | García-Vigara A, Fernandez-Garrido J, Chedraui P, et al. Association between anxiety and frailty in postmenopausal women[J]. Gynecol Endocrinol, 2024, 40(1):2329714. |
| [23] | Dou X, Yao L, Xu H, et al. Association between physical frailty and social support in community-dwelling older adults: a systematic review[J]. Arch Gerontol Geriatr, 2025, 133: 105826. |
| [24] | Ge L, Yap CW, Heng BH. Associations of social isolation, social participation, and loneliness with frailty in older adults in Singapore: a panel data analysis[J]. BMC Geriatr, 2022, 22(1):26. |
| [25] | Navab E, Legacy N, Haase KR, et al. Interventions to support caregivers of older adults undergoing surgery: a systematic review[J]. Am J Surg, 2025, 242: 116226. |
| [26] | Rossouw JE, Anderson GL, Prentice RL, et al. Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results from the Women's Health Initiative randomized controlled trial[J]. JAMA, 2002, 288(3):321-333. |
| [27] | Faubion SS, Crandall CJ, Davis L, et al. The 2022 hormone therapy position statement of the North American Menopause Society[J]. Menopause, 2022, 29(7):767-794. |
| [28] | Michael YL, Gold R, Manson JE, et al. Hormone therapy and physical function change among older women in the Women's Health Initiative: a randomized controlled trial[J]. Menopause, 2010, 17(2):295-302. |
| [29] | Kim H, Lee E. Association between menopausal hormone therapy and frailty: cross-sectional study using national survey data in Korea[J]. Healthcare (Basel), 2022, 10(11):2121. |
| [30] | Gosset A, Pouillès JM, Trémollieres F. Menopausal hormone therapy for the management of osteoporosis[J]. Best Pract Res Clin Endocrinol Metab, 2021, 35(6):101551. |
| [31] | Genazzani AR, Monteleone P, Giannini A, et al. Hormone therapy in the postmenopausal years: considering benefits and risks in clinical practice[J]. Hum Reprod Update, 2021, 27(6):1115-1150. |
| [32] | Gon?alves CR, Vasconcellos AS, Rodrigues TR, et al. Hormone therapy in women with premature ovarian insufficiency: a systematic review and meta-analysis[J]. Reprod Biomed Online, 2022, 44(6):1143-1157. |
| [33] | Kim SW, Kim R. The association between hormone therapy and sarcopenia in postmenopausal women: the Korea National Health and Nutrition Examination Survey, 2008-2011[J]. Menopause, 2020, 27(5):506-511. |
| [34] | Wullems JA, Degens H, Morse CI, et al. Evaluating the effects of hormone therapy termination on skeletal muscle and physical independence in postmenopausal women[J]. Menopause, 2024, 31(6):546-555. |
| [35] | Cheng YJ, Lin CH, Lane HY. From menopause to neurodegeneration-molecular basis and potential therapy[J]. Int J Mol Sci, 2021, 22(16):8654. |
| [36] | Sochocka M, Karska J, Pszczo?owska M, et al. Cognitive decline in early and premature menopause[J]. Int J Mol Sci, 2023, 24(7):6566. |
/
| 〈 |
|
〉 |
