长期激素替代疗法（HT）对绝经后妇女的安全性、后果和剂量仍不清楚。我们的目标是分析子宫切除术后接受20年HT治疗的妇女的效果，重点关注更年期症状、血压、血脂谱和骨密度。设计了一个前瞻性的观察性纵向研究。60岁时，初始经皮雌二醇剂量减半（0.025 mg/d）。使用双变量分析分析了包括人口统计学、心血管、骨密度和代谢变量以及生活质量特征在内的不同参数。使用R软件包geepack拟合了用于长期数据间时间差异和剂量（<60 vs ≥ 60 y）的多变量广义估计方程。经过20年的HT治疗，研究对象56名接受子宫切除术的妇女的平均年龄为67.1岁。Kupperman指数得分的均值从26.7降至12.0（P < 0.001）。随着时间推移，总胆固醇和低密度脂蛋白胆固醇的降低以及高密度脂蛋白胆固醇的增加呈现出趋势。HT后检测到甘油三酯的降低（P = 0.05）和T评分椎体密度测量的增加（P = 0.014）。使用减量HT治疗的60岁以上妇女的健康结果没有变化。0.02％妇女由于乳腺癌退出研究。子宫切除术后的HT治疗长达20年可能有益于骨骼和心血管健康以及整体生活质量。我们的数据表明，评估HT的剂量和时机的重要性。版权所有 © 2023 The Author(s)。由 Wolters Kluwer Health, Inc. 代表北美绝经期学会出版。

The safety, consequences, and dosage of long-term hormone therapy (HT) for postmenopausal women remain unclear. Our aim was to analyze the effects of HT after 20 years of therapy in women after hysterectomy, focusing on the symptoms of menopause, blood pressure, lipid profiles, and bone density.A prospective observational longitudinal study was designed. The initial transdermal estradiol dose was reduced in half (0.025 mg/d) at 60 years of age. Different parameters including demographic, cardiovascular, bone density, and metabolic variables, as well as quality of life characteristics, were analyzed using bivariate analyses. Multivariate generalized estimating equations for longitudinal data were fitted for differences over time and between doses (<60 vs ≥60 y) using the R package geepack.After 20 years of HT, the mean age of 56 studied hysterectomized women was 67.1 years. The mean Kupperman index score decreased from 26.7 to 12.0 (P < 0.001). A trend with total and low-density lipoprotein cholesterol reduction and high-density lipoprotein cholesterol increase was observed over time. A decrease in very-low-density lipoprotein cholesterol (P = 0.05) and an increase in T score vertebral densitometry (P = 0.014) were detected after HT. No changes in health outcome were detected in women older than 60 years with the reduced dose of HT. Breast cancer was the reason for dropouts in 0.02% women.HT for up to 20 years after hysterectomy may be beneficial for bone and cardiovascular health and for the overall quality of life. Our data suggest the importance of evaluating the dose and the timing of HT.Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of The North American Menopause Society.