Thông tin sản phẩm
Femoston conti ch\u1ee9a 1mg 17β-estradiol (hemihydrat) và 5mg dydrogesterone.
", "index": 1}, {"title": "C\u00f4ng d\u1ee5ng", "content": "", "index": 2}, {"title": "T\u00e1c d\u1ee5ng ph\u1ee5", "content": "Thông báo cho bác s\u1ef9 các tác d\u1ee5ng không mong mu\u1ed1n g\u1eb7p ph\u1ea3i khi s\u1eed d\u1ee5ng thu\u1ed1c
\nCác ph\u1ea3n \u1ee9ng b\u1ea5t l\u1ee3i c\u1ee7a thu\u1ed1c \u0111\u01b0\u1ee3c báo cáo ph\u1ed5 bi\u1ebfn nh\u1ea5t khi \u0111i\u1ec1u tr\u1ecb v\u1edbi estradiol/dydrogesterone trong các th\u1eed nghi\u1ec7m lâm sàng là \u0111au \u0111\u1ea7u, \u0111au b\u1ee5ng, \u0111au vú và \u0111au l\u01b0ng.
\nCác tác d\u1ee5ng không mong mu\u1ed1n \u0111\u01b0\u1ee3c báo cáo trong các th\u1eed nghi\u1ec7m lâm sàng nh\u01b0 sau (n=4929):
\nCác t\u1ea7n su\u1ea5t c\u1ee7a nghiên c\u1ee9u liên quan \u0111\u1ebfn các tác d\u1ee5ng ph\u1ee5 \u0111\u01b0\u1ee3c s\u1eafp x\u1ebfp theo sau: r\u1ea5t th\u01b0\u1eddng g\u1eb7p (hi\u1ec1u h\u01a1n 1 tr\u01b0\u1eddng h\u1ee3p trong 10 b\u1ec7nh nhân \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb); th\u01b0\u1eddng g\u1eb7p (t\u1eeb 1 \u0111\u1ebfn 10 tr\u01b0\u1eddng h\u1ee3p trong 100 b\u1ec7nh nhân \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb); ít g\u1eb7p (t\u1eeb 1 \u0111\u1ebfn 10 tr\u01b0\u1eddng h\u1ee3p trong 1000 b\u1ec7nh nhân \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb); hi\u1ebfm g\u1eb7p (t\u1eeb 1 \u0111\u1ebfn 10 tr\u01b0\u1eddng h\u1ee3p trong 10000 b\u1ec7nh nhân \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb).
\nNhi\u1ec5m khu\u1ea9n và nhi\u1ec5m ký sinh trùng
\nTh\u01b0\u1eddng g\u1eb7p: n\u1ea5m candida âm \u0111\u1ea1o
\nKh\u1ed1i u lành tính, ác tính và không xác \u0111\u1ecbnh
\nÍt g\u1eb7p: t\u0103ng kích th\u01b0\u1edbc u m\u1ec1m c\u01a1 tr\u01a1n
\nR\u1ed1i lo\u1ea1n h\u1ec7 mi\u1ec5n d\u1ecbch
\nÍt g\u1eb7p: các ph\u1ea3n \u1ee9ng d\u1ecb \u1ee9ng (quá m\u1eabn c\u1ea3m)
\nR\u1ed1i lo\u1ea1n tâm th\u1ea7n
\nTh\u01b0\u1eddng g\u1eb7p: tr\u1ea7m c\u1ea3m, c\u0103ng th\u1eb3ng
\nÍt g\u1eb7p: \u1ea3nh h\u01b0\u1edfng d\u1ee5c n\u0103ng
\nR\u1ed1i lo\u1ea1n h\u1ec7 th\u1ea7n kinh
\nR\u1ea5t th\u01b0\u1eddng g\u1eb7p: \u0111au \u0111\u1ea7u
\nTh\u01b0\u1eddng g\u1eb7p: migraine, chóng m\u1eb7t
\nR\u1ed1i lo\u1ea1n tim
\nHi\u1ebfm g\u1eb7p: nh\u1ed3i máu c\u01a1 tim
\nR\u1ed1i lo\u1ea1n m\u1ea1ch
\nÍt g\u1eb7p: huy\u1ebft kh\u1ed1i t\u0129nh m\u1ea1ch (xem bên d\u01b0\u1edbi \u0111\u1ec3 bi\u1ebft thêm thông tin)
\nR\u1ed1i lo\u1ea1n tiêu hóa
\nR\u1ea5t th\u01b0\u1eddng g\u1eb7p: \u0111au b\u1ee5ng
\nTh\u01b0\u1eddng g\u1eb7p: bu\u1ed3n nôn, nôn, \u0111\u1ea7y h\u01a1i
\nR\u1ed1i lo\u1ea1n gan
\nÍt g\u1eb7p: b\u1ea5t th\u01b0\u1eddng ch\u1ee9c n\u0103ng gan, thi tho\u1ea3ng kèm vàng da ho\u1eb7c suy nh\u01b0\u1ee3c, và \u0111au b\u1ee5ng, r\u1ed1i lo\u1ea1n túi m\u1eadt.
\nR\u1ed1i lo\u1ea1n da và mô d\u01b0\u1edbi da
\nTh\u01b0\u1eddng g\u1eb7p: ph\u1ea3n \u1ee9ng d\u1ecb \u1ee9ng da (ví d\u1ee5: phát ban, ng\u1ee9a ngáy)
\nHi\u1ebfm g\u1eb7p: phù m\u1ea1ch, ban xu\u1ea5t huy\u1ebft m\u1ea1ch máu
\nR\u1ed1i lo\u1ea1n c\u01a1 x\u01b0\u01a1ng và mô liên k\u1ebft
\nR\u1ea5t th\u01b0\u1eddng g\u1eb7p: \u0111au l\u01b0ng
\nR\u1ed1i lo\u1ea1n h\u1ec7 sinh s\u1ea3n và vú
\nR\u1ea5t th\u01b0\u1eddng g\u1eb7p: \u0111au/c\u0103ng vú
\nTh\u01b0\u1eddng g\u1eb7p: R\u1ed1i lo\u1ea1n kinh nguy\u1ec7t (v\u1ebft máu sau mãn kinh, ch\u1ea3y máu t\u1eed cung, rong kinh, vô kinh, kinh nguy\u1ec7t b\u1ea5t th\u01b0\u1eddng, \u0111au b\u1ee5ng kinh), \u0111au khung ch\u1eadu, \u0103n mòn c\u1ed5 t\u1eed cung.
\nÍt g\u1eb7p: ng\u1ef1c to, h\u1ed9i ch\u1ee9ng ti\u1ec1n kinh nguy\u1ec7t
\nR\u1ed1i lo\u1ea1n chung và ph\u1ea3n \u1ee9ng t\u1ea1i n\u01a1i dùng thu\u1ed1c
\nTh\u01b0\u1eddng g\u1eb7p: Các tr\u1ea1ng thái suy nh\u01b0\u1ee3c (suy ng\u01b0\u1ee3c, m\u1ec7t m\u1ecfi, b\u1ea5t \u1ed5n), phù ngo\u1ea1i biên
\nKhám/xét nghi\u1ec7m:
\nTh\u01b0\u1eddng g\u1eb7p: T\u0103ng cân
\nÍt g\u1eb7p: gi\u1ea3m cân.
\nNguy c\u01a1 ung th\u01b0 vú
\n\u0110ã có báo cáo cho th\u1ea5y nguy c\u01a1 ung th\u01b0 vú t\u0103ng g\u1ea5p \u0111ôi \u1edf ph\u1ee5 n\u1eef dùng ph\u1ed1i h\u1ee3p oestrogen và progestogen trên 5 n\u0103m.
\nM\u1ee9c \u0111\u1ed9 t\u0103ng nguy c\u01a1 ung th\u01b0 vú \u1edf ng\u01b0\u1eddi s\u1eed d\u1ee5ng riêng oestrogen th\u1ea5p h\u01a1n rõ r\u1ec7t so v\u1edbi \u1edf ng\u01b0\u1eddi s\u1eed d\u1ee5ng ph\u1ed1i h\u1ee3p oestrogen và progestogen.
\nM\u1ee9c \u0111\u1ed9 nguy c\u01a1 ph\u1ee5 thu\u1ed9c vào th\u1eddi gian s\u1eed d\u1ee5ng (xem m\u1ee5c C\u1ea3nh báo và th\u1eadn tr\u1ecdng \u0111\u1eb7c bi\u1ec7t khi dùng thu\u1ed1c)
\nK\u1ebft qu\u1ea3 c\u1ee7a nghiên c\u1ee9u l\u1edbn nh\u1ea5t, ng\u1eabu nhiên có so sánh v\u1edbi placebo (nghiên c\u1ee9u c\u1ee7a WHI) và nghiên c\u1ee9u d\u1ecbch t\u1ec5 h\u1ecdc l\u1edbn nh\u1ea5t (MWS) \u0111\u01b0\u1ee3c \u0111\u01b0a ra d\u01b0\u1edbi \u0111ây.
\n| MWS-\u01af\u1edbc l\u01b0\u1ee3ng nguy c\u01a1 m\u1eafc thêm ung th\u01b0 vú sau 5 n\u0103m s\u1eed d\u1ee5ng | \n|||
| \u0110\u1ed9 tu\u1ed5i | \nS\u1ed1 tr\u01b0\u1eddng h\u1ee3p m\u1eafc b\u1ec7nh thêm/1000 tr\u01b0\u1eddng h\u1ee3p ch\u01b0a bao gi\u1edd dùng HRT trong 5 n\u0103m1 | \nT\u1ec9 l\u1ec7 nguy c\u01a1 và CI 96%# | \nS\u1ed1 tr\u01b0\u1eddng h\u1ee3p m\u1eafc b\u1ec7nh thêm/1000 tr\u01b0\u1eddng h\u1ee3p dùng HRT trong 5 n\u0103m (95% CI) | \n
| HRT v\u1edbi reieng oestrogen | \n|||
| 50-65 | \n9-12 | \n1,2 | \n1-2 (0-3) | \n
| Ph\u1ed1i h\u1ee3p oestrogen và progestogen | \n|||
| 50-65 | \n9-12 | \n1,7 | \n6 (5-7) | \n
| \n # Ti l\u1ec7 nguy c\u01a1 t\u1ed5ng th\u1ec3. T\u1ec9 l\u1ec7 nguy c\u01a1 không c\u1ed1 \u0111\u1ecbnh mà t\u0103ng theo th\u1eddi gian s\u1eed d\u1ee5ng \nChú ý: vì r\u1eb1ng ch\u1ec9 s\u1ed1 n\u1ec1n v\u1ec1 ung th\u01b0 vú là khác nhau \u1edf các n\u01b0\u1edbc châu Âu nên s\u1ed1 l\u01b0\u1ee3ng các tr\u01b0\u1eddng h\u1ee3p m\u1eafc ung th\u01b0 vú t\u0103ng thêm c\u0169ng thay \u0111\u1ed5i t\u01b0\u01a1ng \u1ee9ng. \n | \n|||
| Nghiên c\u1ee9u c\u1ee7a US WHI-Nguy c\u01a1 m\u1eafc thêm ung th\u01b0 vú sau 5 n\u0103m s\u1eed d\u1ee5ng | \n|||
| \u0110\u1ed9 tu\u1ed5i (n\u0103m) | \nCh\u1ec9 s\u1ed1 trên 1000 ph\u1ee5 n\u1eef dùng gi\u1ea3 d\u01b0\u1ee3c trong 5 n\u0103m | \nT\u1ec9 l\u1ec7 nguy c\u01a1 và CI 95% | \nS\u1ed1 tr\u01b0\u1ee3ng h\u1ee3p m\u1eafc b\u1ec7nh thêm/1000 tr\u01b0\u1eddng h\u1ee3p dùng HRT trên 5 n\u0103m (95%CI) | \n
| CEE v\u1edbi riêng oestrogen | \n|||
| 50-79 | \n21 | \n0,8 (0,7-1,0) | \n\n -4 (-6-0)2 \n\n | \n
| CEE+MPA oestrogen và progestogen** | \n|||
| 50-79 | \n17 | \n1,2 (1,0-1,5) | \n+4 (0-9) | \n
| ** Khi phân tích gi\u1edbi h\u1ea1n \u1edf ph\u1ee5 n\u1eef không s\u1eed d\u1ee5ng HRT tr\u01b0\u1edbc nghiên c\u1ee9u, nguy c\u01a1 b\u1ecb ung th\u01b0 vú không t\u0103ng trong 5 n\u0103m \u0111\u1ea7u \u0111i\u1ec1u tr\u1ecb: sau 5 n\u0103m, nguy c\u01a1 cao h\u01a1n \u1edf nhóm không s\u1eed d\u1ee5ng. | \n
1 S\u1eed d\u1ee5ng ch\u1ec9 s\u1ed1 c\u01a1 b\u1ea3n \u1edf các n\u01b0\u1edbc \u0111ang phát tri\u1ec3n
\n2 Nghiên c\u1ee9u WHI trên ph\u1ee5 n\u1eef không có t\u1eed cung và không th\u1ea5y t\u0103ng nguy c\u01a1 ung th\u01b0 vú
\nNguy c\u01a1 ung th\u01b0 n\u1ed9i m\u1ea1c t\u1eed cung
\nPh\u1ee5 n\u1eef sau mãn kinh có t\u1eed cung
\nKho\u1ea3ng 5/1000 ph\u1ee5 n\u1eef có t\u1eed cung không dùng HRT có nguy c\u01a1 ung th\u01b0 n\u1ed9i m\u1ea1c t\u1eed cung.
\nV\u1edbi ph\u1ee5 n\u1eef có t\u1eed cung, không nên dùng HRT v\u1edbi riêng oestrogen vì làm t\u0103ng nguy c\u01a1 ung th\u01b0 n\u1ed9i m\u1ea1c t\u1eed cung (xem m\u1ee5c C\u1ea3nh báo và th\u1eadn tr\u1ecdng \u0111\u1eb7c bi\u1ec7t khi dùng thu\u1ed1c).
\nTu\u1ef3 thu\u1ed9c vào th\u1eddi gian \u0111i\u1ec1u tr\u1ecb b\u1eb1ng oestrogen riêng và li\u1ec1u oestrogen s\u1eed d\u1ee5ng, c\u1ee9 1000 ph\u1ee5 n\u1eef trong \u0111\u1ed9 tu\u1ed5i t\u1eeb 50 \u0111\u1ebfn 65 thì nguy c\u01a1 ung th\u01b0 n\u1ed9i m\u1ea1c t\u1eed cung t\u0103ng thêm t\u1eeb 5 \u0111\u1ebfn 55 tr\u01b0\u1eddng h\u1ee3p.
\nCó th\u1ec3 tránh kh\u1ecfi nguy c\u01a1 t\u0103ng thêm này b\u1eb1ng cách dùng thêm progestogen ít nh\u1ea5t 12 ngày m\u1ed7i chu k\u1ef3 trong li\u1ec7u pháp oestrogen \u0111\u01a1n. Trong nghiên c\u1ee9u c\u1ee7a MWS, s\u1eed d\u1ee5ng HRT ph\u1ed1i h\u1ee3p t\u1ecfng 5 n\u0103m (liên t\u1ee5c ho\u1eb7c \u0111\u1ee9t \u0111o\u1ea1n) không làm t\u0103ng nguy c\u01a1 ung th\u01b0 n\u1ed9i m\u1ea1c t\u1eed cung (T\u1ec9 l\u1ec7 nguy c\u01a1 b\u1eb1ng 1,0 (0,8-1,2)).
\nUng thu bu\u1ed3ng tr\u1ee9ng
\nNguy c\u01a1 ung th\u01b0 bu\u1ed3ng tr\u1ee9ng t\u0103ng nh\u1eb9 khi dùng lâu dài HRT v\u1edbi oestrogen riêng và ph\u1ed1i h\u1ee3p oestrogen v\u1edbi progestogen. Trong nghiên c\u1ee9u c\u1ee7a MWS, trong s\u1ed1 2500 ng\u01b0\u1eddi s\u1eed d\u1ee5ng HRT trong 5 n\u0103m thì có 1 tr\u01b0\u1eddng h\u1ee3p t\u0103ng thêm.
\nNguy c\u01a1 huy\u1ebft kh\u1ed1i t\u0129nh m\u1ea1ch
\nHRT làm t\u0103ng nguy c\u01a1 huy\u1ebft kh\u1ed1i t\u0129nh m\u1ea1ch ti\u1ebfn tri\u1ec3n (VTE) lên 1,3-3 l\u1ea7n, t\u1ee9c là huy\u1ebft kh\u1ed1i t\u0129nh m\u1ea1ch sâu hay thuyên t\u1eafc t\u0129nh m\u1ea1ch ph\u1ed5i. Hi\u1ec7n t\u01b0\u1ee3ng này th\u01b0\u1eddng x\u1ea3y ra h\u01a1n trong n\u0103m \u0111\u1ea7u tiên dùng HRT (xem m\u1ee5c C\u1ea3nh báo và th\u1eadn tr\u1ecdng \u0111\u1eb7c bi\u1ec7t khi dùng thu\u1ed1c).
\nK\u1ebft qu\u1ea3 nghiên c\u1ee9u c\u1ee7a WHI cho th\u1ea5y:
\n| Nghiên c\u1ee9u c\u1ee7a WHI - Nguy c\u01a1 m\u1eafc thêm VTE sau 5 n\u0103m s\u1eed d\u1ee5ng | \n|||
| \u0110\u1ed9 tu\u1ed5i (n\u0103m) | \nCh\u1ec9 s\u1ed1 trên 1000 ph\u1ee5 n\u1eef dùng gi\u1ea3 d\u01b0\u1ee3c trong 5 n\u0103m | \nT\u1ec9 l\u1ec7 nguy c\u01a1 và CI 95% | \nS\u1ed1 tr\u01b0\u1eddng h\u1ee3p m\u1eafc b\u1ec7nh thêm/1000 ng\u01b0\u1eddi dùng HRT | \n
| U\u1ed1ng riêng oestrogen3 | \n|||
| 50-59 | \n7 | \n1,2 (0,6-2,4) | \n1 (-3-10) | \n
| U\u1ed1ng oestrogen và progestogen ph\u1ed1i h\u1ee3p | \n|||
| 50-59 | \n4 | \n2,3 (1,2-4,3) | \n5 (1-13) | \n
3 Nghiên c\u1ee9u trên ph\u1ee5 n\u1eef không có t\u1eed cung
\nNguy c\u01a1 b\u1ec7nh \u0111\u1ed9ng m\u1ea1ch vành
\nNguy c\u01a1 b\u1ec7nh \u0111\u1ed9ng m\u1ea1ch vành t\u0103ng nh\u1eb9 \u1edf nh\u1eefng ng\u01b0\u1eddi dùng k\u1ebft h\u1ee3p oestrogen-progestogen \u1edf \u0111\u1ed9 tu\u1ed5i trên 60 (xem m\u1ee5c C\u1ea3nh báo và th\u1eadn tr\u1ecdng \u0111\u1eb7c bi\u1ec7t khi dùng thu\u1ed1c)
\nNguy c\u01a1 \u0111\u1ed9t qu\u1ef5
\nCh\u1ec9 dùng oestrogen và \u0111i\u1ec1u tr\u1ecb v\u1edbi oestrogen-progestogen có liên quan t\u1edbi vi\u1ec7c t\u0103ng 1,5 l\u1ea7n nguy c\u01a1 t\u01b0\u01a1ng \u0111\u1ed1i \u0111\u1ed9t qu\u1ef5. Nguy c\u01a1 \u0111\u1ed9t qu\u1ef5 não không t\u0103ng trong th\u1eddi gian dùng HRT.
\nNguy c\u01a1 t\u01b0\u01a1ng \u0111\u1ed1i không ph\u1ee5 thu\u1ed9c vào tu\u1ed5i tác hay kho\u1ea3ng th\u1eddi gian dùng thu\u1ed1c, nh\u01b0ng vì nguy c\u01a1 gi\u1edbi h\u1ea1n ph\u1ee5 thu\u1ed9c nhi\u1ec1u h\u01a1n vào tu\u1ed5i nên nguy c\u01a1 \u0111\u1ed9t qu\u1ef5 chung \u1edf ph\u1ee5 n\u1eef dùng HRT s\u1ebd không t\u0103ng theo tu\u1ed5i (xem m\u1ee5c C\u1ea3nh báo và th\u1eadn tr\u1ecdng \u0111\u1eb7c bi\u1ec7t khi dùng thu\u1ed1c)
\n| Nghiên c\u1ee9u c\u1ee7a WHI-Nguy c\u01a1 \u0111\u1ed9t qu\u1ef5 sau 5 n\u0103m s\u1eed d\u1ee5ng | \n|||
| \u0110\u1ed9 tu\u1ed5i (n\u0103m) | \nCh\u1ec9 s\u1ed1 trên 1000 ph\u1ee5 n\u1eef dùng gi\u1ea3 d\u01b0\u1ee3c trong 5 n\u0103m | \nT\u1ec9 l\u1ec7 nguy c\u01a1 và CI 95% | \nS\u1ed1 tr\u01b0\u1eddng h\u1ee3p m\u1eafc b\u1ec7nh thêm/1000 ng\u01b0\u1eddi dùng HRT | \n
| 50-59 | \n8 | \n1,3 (1,1-1,6) | \n3 (1-5) | \n
Các ph\u1ea3n \u1ee9ng b\u1ea5t l\u1ee3i \u0111ã \u0111\u01b0\u1ee3c báo cáo có liên h\u1ec7 t\u1edbi vi\u1ec7c \u0111i\u1ec1u tr\u1ecb oestrogen-progestogen (bao g\u1ed3m estradiol/dydrogesterone):
\nKh\u1ed1i u lành tính, ác tính và không xác \u0111\u1ecbnh
\nKh\u1ed1i u ph\u1ee5 thu\u1ed9c oestrogen c\u1ea3 kh\u1ed1i u lành tính và u ác tính, ví d\u1ee5 ung th\u01b0 n\u1ed9i m\u1ea1c t\u1eed cung, ung th\u01b0 bu\u1ed3ng tr\u1ee9ng. T\u0103ng kích th\u01b0\u1edbc kh\u1ed1i u ph\u1ee5 thu\u1ed9c progestogen (ví d\u1ee5 u màng não)
\nR\u1ed1i lo\u1ea1n h\u1ec7 máu và b\u1ea1ch huy\u1ebft: Thi\u1ebfu máu tan máu
\nR\u1ed1i lo\u1ea1n h\u1ec7 mi\u1ec5n d\u1ecbch: Lupus ban \u0111\u1ecf h\u1ec7 th\u1ed1ng
\nR\u1ed1i lo\u1ea1n chuy\u1ec3n hóa và dinh d\u01b0\u1ee1ng: T\u0103ng triglyceride máu
\nR\u1ed1i lo\u1ea1n h\u1ec7 th\u1ea7n kinh: Kh\u1ea3 n\u0103ng m\u1ea5t trí t\u0103ng, ch\u1ee9ng máu gi\u1eadt, làm n\u1eb7ng thêm các tri\u1ec7u ch\u1ee9ng \u0111\u1ed9ng kinh.
\nR\u1ed1i lo\u1ea1n m\u1eaft: ng\u1ea5m vào \u0111\u1ed9 cong c\u1ee7a giác m\u1ea1c, không dung n\u1ea1p v\u1edbi kính áp tròng
\nR\u1ed1i lo\u1ea1n m\u1ea1ch: các c\u1ee5c máu \u0111ông, \u1edf \u0111\u1ed9ng m\u1ea1ch (ch\u1ee9ng huy\u1ebft kh\u1ed1i \u0111\u1ed9ng m\u1ea1ch)
\nR\u1ed1i lo\u1ea1n tiêu hóa: Viêm tu\u1ef5 (\u1edf nh\u1eefng ph\u1ee5 n\u1eef \u0111ã b\u1ecb t\u0103ng triglyceride máu tr\u01b0\u1edbc \u0111ó)
\nR\u1ed1i lo\u1ea1n da và mô d\u01b0\u1edbi da: ban \u0111\u1ecf \u0111a d\u1ea1ng, ban \u0111\u1ecf nút, ch\u1ee9ng rám da/da \u0111\u1ed3i m\u1ed3i, chúng có th\u1ec3 v\u1eabn còn khi ng\u1eebng dung thu\u1ed1c.
\nR\u1ed1i lo\u1ea1n c\u01a1 x\u01b0\u01a1ng và mô liên k\u1ebft: chu\u1ed9t rút \u1edf chân
\nR\u1ed1i lo\u1ea1n th\u1eadn và ti\u1ebft ni\u1ec7u: m\u1ea5t ki\u1ec3m soát c\u1ee7a bàng quang (không ki\u1ec1m ch\u1ebf \u0111\u01b0\u1ee3 ti\u1ec3u ti\u1ec7n)
\nR\u1ed1i lo\u1ea1n h\u1ec7 sinh s\u1ea3n và vú: B\u1ec7nh \u1edf vú lành tính, \u0103n mòn c\u1ed5 t\u1eed cung.
\nR\u1ed1i lo\u1ea1n do b\u1ea9m sinh, y\u1ebfu t\u1ed1 gen/gia \u0111ình: Tr\u1ea7m tr\u1ecdng thêm b\u1ec7nh \u0111ái ra porphyria.
\nKhám/xét nghi\u1ec7m: T\u0103ng hormone tuy\u1ebfn giáp.
", "index": 3}, {"title": "Ch\u1ec9 \u0111\u1ecbnh", "content": "Li\u1ec7u pháp thay th\u1ebf hormone (HRT) \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb các tri\u1ec7u ch\u1ee9ng thi\u1ebfu h\u1ee5t estrogen \u1edf nh\u1eefng ph\u1ee5 n\u1eef \u0111ã qua k\u1ef3 kinh nguy\u1ec7t g\u1ea7n nh\u1ea5t ít nh\u1ea5t 12 tháng.
\nNg\u0103n ng\u1eeba loãng x\u01b0\u01a1ng \u1edf ph\u1ee5 n\u1eef sau mãn kinh mà có nguy c\u01a1 cao r\u1ea1n g\u1eaby x\u01b0\u01a1ng mà không dung n\u1ea1p, ho\u1eb7c ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh v\u1edbi các thu\u1ed1c khác dùng d\u1ef1 phòng loãng x\u01b0\u01a1ng.
\nNg\u01b0\u1eddi già:
\nKinh nghi\u1ec7m trong \u0111i\u1ec1u tr\u1ecb \u1edf ph\u1ee5 n\u1eef trên 65 tu\u1ed5i còn h\u1ea1n ch\u1ebf.
", "index": 4}, {"title": "Ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh", "content": "Ung th\u01b0 vú \u0111ã có ho\u1eb7c còn nghi ng\u1edd
\nCác u ác tính ph\u1ee5 thu\u1ed9c estrogen \u0111ã bi\u1ebft ho\u1eb7c còn nghi ng\u1edd (ví d\u1ee5: ung th\u01b0 màng trong t\u1eed cung).
\nCác u ph\u1ee5 thu\u1ed9c progestogen \u0111ã bi\u1ebft ho\u1eb7c còn nghi ng\u1edd (ví d\u1ee5: u màng não)
\nCh\u1ea3y máu b\u1ed9 ph\u1eadn sinh d\u1ee5c ch\u01b0a ch\u1ea9n \u0111oán \u0111\u01b0\u1ee3c
\nT\u0103ng s\u1ea3n n\u1ed9i m\u1ea1c t\u1eed cung mà ch\u01b0a \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb
\nHuy\u1ebft kh\u1ed1i t\u1eafc t\u0129nh m\u1ea1ch t\u1ef1 pháp tr\u01b0\u1edbc \u0111ây ho\u1eb7c \u0111ang g\u1eb7p (huy\u1ebft kh\u1ed1i t\u0129nh m\u1ea1ch sâu, t\u1eafc m\u1ea1ch ph\u1ed5i).
\nR\u1ed1i lo\u1ea1n ch\u1ea3y máu \u0111ã bi\u1ebft (ví d\u1ee5 protein C, protein S ho\u1eb7c thi\u1ebfu h\u1ee5t ch\u1ea5t ch\u1ed1ng \u0111ông máu (xem m\u1ee5c C\u1ea3nh báo và th\u1eadn tr\u1ecdng \u0111\u1eb7c bi\u1ec7t khi dùng thu\u1ed1c bên d\u01b0\u1edbi)
\nB\u1ec7nh huy\u1ebft kh\u1ed1i \u0111\u1ed9ng m\u1ea1ch c\u1ea5p tính ho\u1eb7c g\u1ea7n \u0111ây (ví d\u1ee5: \u0111au th\u1eaft ng\u1ef1c, nh\u1ed3i máu c\u01a1 tim)
\nB\u1ec7nh gan c\u1ea5p tính ho\u1eb7c ti\u1ec1n s\u1eed b\u1ec7nh gan, ch\u1eebng nào mà các test ch\u1ee9c n\u0103ng gan ch\u01b0a tr\u1edf l\u1ea1i bình th\u01b0\u1eddng.
\nR\u1ed1i lo\u1ea1n s\u1eafc t\u1ed1 hi\u1ebfm g\u1eb7p \"porphyria\"
\nQuá m\u1eabn v\u1edbi ho\u1ea1t ch\u1ea5t hay b\u1ea5t k\u1ef3 tá d\u01b0\u1ee3c nào.
", "index": 5}, {"title": "Li\u1ec1u d\u00f9ng", "content": "Thu\u1ed1c dùng \u0111\u01b0\u1eddng u\u1ed1ng.
\nOestrogen và progestogen này \u0111\u01b0\u1ee3c dùng m\u1ed7i ngày không gián \u0111o\u1ea1n.
\nLi\u1ec1u dùng là m\u1ed9t viên m\u1ed7i ngày trong chu k\u1ef3 28 ngày. Dùng Femoston conti liên t\u1ee5c mà không gián \u0111o\u1ea1n gi\u1eefa các h\u1ed9p thu\u1ed1c.
\nB\u1ea5t k\u1ec3 là \u0111\u1ec3 kh\u1edfi \u0111\u1ea7u hay ti\u1ebfp t\u1ee5c \u0111i\u1ec1u tr\u1ecb các tri\u1ec7u ch\u1ee9ng sau mãn kinh, c\u1ea7n dùng li\u1ec1u th\u1ea5p nh\u1ea5t mà có hi\u1ec7u qu\u1ea3 và dùng trong th\u1eddi gian ng\u1eafn nh\u1ea5t (xem m\u1ee5c C\u1ea3nh báo và th\u1eadn tr\u1ecdng \u0111\u1eb7c bi\u1ec7t khi dùng thu\u1ed1c)
\n\u0110i\u1ec1u tr\u1ecb k\u1ebft h\u1ee3p liên t\u1ee5c có th\u1ec3 b\u1eaft \u0111\u1ea7u v\u1edbi Femoston conti ph\u1ee5 thu\u1ed9c vào th\u1eddi gian t\u1eeb lúc mãn kinh và m\u1ee9c \u0111\u1ed9 tr\u1ea7m tr\u1ecdng c\u1ee7a các tri\u1ec7u ch\u1ee9ng.
\nD\u1ef1a vào \u0111áp \u1ee9ng lâm sàng, li\u1ec1u dùng có th\u1ec3 \u0111\u01b0\u1ee3c \u0111i\u1ec1u ch\u1ec9nh sau \u0111ó.
\nB\u1ec7nh nhân chuy\u1ec3n t\u1eeb ch\u1ebf ph\u1ea9m dùng liên t\u1ee5c theo trình t\u1ef1 ho\u1eb7c chu k\u1ef3 nên hoàn thành chu k\u1ef3 28 ngày sau \u0111ó chuy\u1ec3n sang Femoston conti.
\nB\u1ec7nh nhân chuy\u1ec3n t\u1eeb ch\u1ebf ph\u1ea9m k\u1ebft h\u1ee3p \u0111\u01b0\u1ee3c dùng liên t\u1ee5c có th\u1ec3 b\u1eaft \u0111\u1ea7u \u0111i\u1ec1u tr\u1ecb \u1edf b\u1ea5t k\u1ef3 th\u1eddi \u0111i\u1ec3m nào.
\nN\u1ebfu quên dùng m\u1ed9t li\u1ec1u thu\u1ed1c, nên dùng càng s\u1edbm càng t\u1ed1t. N\u1ebfu h\u01a1n 12 gi\u1edd trôi qua, vi\u1ec7c \u0111i\u1ec1u tr\u1ecb nên \u0111\u01b0\u1ee3c ti\u1ebfp t\u1ee5c v\u1edbi viên nén ti\u1ebfp theo mà không dùng viên \u0111ã quên. Kh\u1ea3 n\u0103ng ch\u1ea3y máu b\u1ea5t th\u01b0\u1eddng ho\u1eb7c có v\u1ebft máu có th\u1ec3 t\u0103ng.
\nFemoston conti có th\u1ec3 dùng ho\u1eb7c không dùng cùng v\u1edbi th\u1ee9c \u0103n.
\nTr\u1ebb em
\nFemoston conti không \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh dùng cho tr\u1ebb em.
", "index": 6}, {"title": "\u0110\u00f3ng g\u00f3i", "content": "H\u1ed9p 1 v\u1ec9 x 28 viên
", "index": 7}, {"title": "H\u01b0\u1edbng d\u1eabn s\u1eed d\u1ee5ng", "content": "L\u01b0u ý khi s\u1eed d\u1ee5ng (C\u1ea3nh báo và th\u1eadn tr\u1ecdng)
\n\u0110\u1ed1i v\u1edbi vi\u1ec7c \u0111i\u1ec1u tr\u1ecb tri\u1ec7u ch\u1ee9ng sau mãn kinh, ch\u1ec9 nên b\u1eaft \u0111\u1ea7u dùng li\u1ec7u pháp dùng hormon thay th\u1ebf (HRT) khi các tri\u1ec7u ch\u1ee9ng \u1ea3nh h\u01b0\u1edfng x\u1ea5u t\u1edbi ch\u1ea5t l\u01b0\u1ee3ng cu\u1ed9c s\u1ed1ng. Trong m\u1ecdi tr\u01b0\u1eddng h\u1ee3p, c\u1ea7n \u0111ánh giá c\u1ea9n th\u1eadn \u0111\u1ecbnh k\u1ef3, ít nh\u1ea5t là hàng n\u0103m v\u1ec1 các l\u1ee3i ích và nguy c\u01a1. Ch\u1ec9 ti\u1ebfp t\u1ee5c dùng HRT khi l\u1ee3i ích là v\u01b0\u1ee3t tr\u1ed9i so v\u1edbi nguy c\u01a1.
\nB\u1eb1ng ch\u1ee9ng v\u1ec1 các r\u1ee7i ro liên quan t\u1edbi HRT trong \u0111i\u1ec1u tr\u1ecb mãn kinh s\u1edbm khá h\u1ea1n ch\u1ebf. Tuy nhiên do m\u1ee9c \u0111\u1ed9 th\u1ea5p c\u1ee7a nguy c\u01a1 tuy\u1ec7t \u0111\u1ed1i \u1edf ph\u1ee5 n\u1eef tr\u1ebb, cân b\u1eb1ng gi\u1eefa l\u1ee3i ích và nguy c\u01a1 r\u1ee7i ro \u1edf nh\u1eefng ph\u1ee5 n\u1eef này có th\u1ec3 thu\u1eadn l\u1ee3i h\u01a1n \u1edf ph\u1ee5 n\u1eef l\u1edbn tu\u1ed5i.
\nKhám/theo dõi
\nTr\u01b0\u1edbc khi b\u1eaft \u0111\u1ea7u s\u1eed d\u1ee5ng ho\u1eb7c b\u1eaft \u0111\u1ea7u s\u1eed d\u1ee5ng l\u1ea1i HRT, c\u1ea7n tìm hi\u1ec3u \u0111\u1ea7y \u0111\u1ee7 ti\u1ec1n s\u1eed y khoa c\u1ee7a cá nhân và c\u1ee7a c\u1ea3 gia \u0111ình. D\u1ef1a vào ti\u1ec1n s\u1eed y khoa và các ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh, c\u1ea3nh báo khi dùng thu\u1ed1c, c\u1ea7n ph\u1ea3i khám th\u1ef1c th\u1ec3 (bao g\u1ed3m c\u1ea3 vùng x\u01b0\u01a1ng ch\u1eadu và vú). Trong khi \u0111i\u1ec1u tr\u1ecb, c\u1ea7n khám \u0111\u1ecbnh k\u1ef3 v\u1ec1 t\u1ea7n su\u1ea5t và tính ch\u1ea5t ph\u1ee5 h\u1ee3p v\u1edbi t\u1eebng ph\u1ee5 n\u1eef. C\u1ea7n yêu c\u1ea7u ng\u01b0\u1eddi ph\u1ee5 n\u1eef thông báo cho bác s\u0129 ho\u1eb7c \u0111i\u1ec1u d\u01b0\u1ee1ng b\u1ea5t c\u1ee9 thay \u0111\u1ed5i nào \u1edf vú (xem ''ung th\u01b0 vú\" d\u01b0\u1edbi \u0111ây). Ph\u1ea3i ki\u1ec3m tra, bao g\u1ed3m c\u1ea3 b\u1eb1ng các ph\u01b0\u01a1ng pháp hình \u1ea3nh thích h\u1ee3p nh\u01b0 là ch\u1ee5p nh\u0169 \u1ea3nh, phù h\u1ee3p v\u1edbi các h\u01b0\u1edbng d\u1eabn khám lâm sàng l\u1ecdc hi\u1ec7n có và \u0111\u01b0\u1ee3c thay \u0111\u1ed5i theo yêu c\u1ea7u lâm sàng c\u1ee7a t\u1eebng cá nhân.
\nNh\u1eefng tr\u01b0\u1eddng h\u1ee3p c\u1ea7n theo dõi
\nV\u1edbi b\u1ea5t c\u1ee9 tr\u01b0\u1eddng h\u1ee3p nào sau \u0111ây, \u0111ã t\u1eebng x\u1ea3y ra tr\u01b0\u1edbc \u0111ây, và/ho\u1eb7c tr\u1ea7m tr\u1ecdng h\u01a1n trong quá trình mang thai ho\u1eb7c tr\u01b0\u1edbc khi \u0111i\u1ec1u tr\u1ecb hormon, b\u1ec7nh nhân c\u1ea7n \u0111\u01b0\u1ee3c theo dõi ch\u1eb7t. C\u1ea7n tính \u0111\u1ebfn vi\u1ec7c nh\u1eefng tr\u01b0\u1eddng h\u1ee3p này có th\u1ec3 tái xu\u1ea5t hi\u1ec7n ho\u1eb7c n\u1eb7ng h\u01a1n trong quá trình \u0111i\u1ec1u tr\u1ecb b\u1eb1ng Femoston conti, \u0111\u1eb7c bi\u1ec7t là:
\nU c\u01a1 tr\u01a1n (u x\u01a1 t\u1eed cung) ho\u1eb7c l\u1ea1c n\u1ed9i m\u1ea1c t\u1eed cung
\nCác y\u1ebfu t\u1ed1 nguy c\u01a1 r\u1ed1i lo\u1ea1n huy\u1ebft kh\u1ed1i t\u1eafc m\u1ea1ch (xem bên d\u01b0\u1edbi)
\nCác yêu t\u1ed1 nguy c\u01a1 kh\u1ed1i u ph\u1ee5 thu\u1ed9c estrogen, ví d\u1ee5 nh\u01b0 s\u1ef1 di truy\u1ec1n m\u1ee9c \u0111\u1ed9 1 \u0111\u1ed1i v\u1edbi ung th\u01b0 vú
\nT\u0103ng huy\u1ebft áp
\nR\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng gan (ví d\u1ee5 nh\u01b0 u tuy\u1ebfn gan)
\n\u0110ái tháo \u0111\u01b0\u1eddng có ho\u1eb7c không có bi\u1ebfn ch\u1ee9ng m\u1ea1ch máu
\nS\u1ecfi m\u1eadt
\n\u0110au n\u1eeda \u0111\u1ea7u ho\u1eb7c \u0111au \u0111\u1ea7u (n\u1eb7ng)
\nLupus ban \u0111\u1ecf h\u1ec7 th\u1ed1ng
\nTi\u1ec1n s\u1eed t\u0103ng s\u1ea3n n\u1ed9i m\u1ea1c t\u1eed cung (xem bên d\u01b0\u1edbi)
\nB\u1ec7nh \u0111\u1ed9ng kinh
\nHen
\nX\u01a1 c\u1ee9ng tai
\nCác lý do c\u1ea7n ng\u01b0ng dùng Femoston conti ngay l\u1eadp t\u1ee9c:
\nC\u1ea7n d\u1eebng \u0111i\u1ec1u tr\u1ecb ngay l\u1eadp t\u1ee9c trong các tr\u01b0\u1eddng h\u1ee3p ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh và trong các tr\u01b0\u1eddng h\u1ee3p sau:
\nVàng da ho\u1eb7c suy gi\u1ea3m ch\u1ee9c n\u0103ng gan
\nT\u0103ng huy\u1ebft áp \u0111áng k\u1ec3
\nKh\u1edfi \u0111\u1ea7u m\u1edbi c\u1ee7a ch\u1ee9ng \u0111au \u0111\u1ea7u ki\u1ec3u migraine
\nMang thai
\nT\u0103ng s\u1ea3n n\u1ed9i m\u1ea1c t\u1eed cung và ung th\u01b0 bi\u1ec3u mô:
\n\u1ede ph\u1ee5 n\u1eef còn t\u1eed cung nguyên v\u1eb9n, nguy c\u01a1 t\u0103ng s\u1ea3n n\u1ed9i m\u1ea1c t\u1eed cung và ung th\u01b0 bi\u1ec3u mô t\u0103ng lên khi dùng oestrogen m\u1ed9t mình trong th\u1eddi gian dài. Các báo cáo cho th\u1ea5y nguy c\u01a1 ung th\u01b0 n\u1ed9i m\u1ea1c t\u1eed cung \u1edf nh\u1eefng ng\u01b0\u1eddi ch\u1ec9 dùng oestrogen t\u0103ng lên g\u1ea5p t\u1eeb 2 \u0111\u1ebfn 12 l\u1ea7n so v\u1edbi ng\u01b0\u1eddi không s\u1eed d\u1ee5ng, ph\u1ee5 thu\u1ed9c vào th\u1eddi gian \u0111i\u1ec1u tr\u1ecb và li\u1ec1u oestrogen s\u1eed d\u1ee5ng (xem m\u1ee5c Tác d\u1ee5ng không mong mu\u1ed1n). Nguy c\u01a1 ngày v\u1eabn còn cao trong ít nh\u1ea5t 10 n\u0103m sau khi ng\u1eebng \u0111i\u1ec1u tr\u1ecb.
\nDùng thêm progestogen theo chu k\u1ef3, ít nh\u1ea5t 12 ngày m\u1ed7i tháng/chu k\u1ef3 28 ngày, ho\u1eb7c dùng liên t\u1ee5c ph\u1ed1i h\u1ee3p oestrogen-progestogen cho ph\u1ee5 n\u1eef ch\u01b0a ph\u1eabu thu\u1eadt c\u1eaft b\u1ecf t\u1eed cung có th\u1ebb tránh \u0111\u01b0\u1ee3c s\u1ef1 t\u0103ng nguy c\u01a1 ung th\u01b0 do ch\u1ec9 dùng riêng oestrogen.
\nCh\u1ea3y máu b\u1ea5t th\u01b0\u1eddng ho\u1eb7c có v\u1ebft máu có th\u1ec3 x\u1ea3y ra trong tháng \u0111\u1ea7u \u0111i\u1ec1u tr\u1ecb. N\u1ebfu b\u1ea1n th\u1ea5y ch\u1ea3y máu b\u1ea5t th\u01b0\u1eddng ho\u1eb7c có v\u1ebft máu xu\u1ea5t hi\u1ec7n nhi\u1ec1u l\u1ea7n trong khi \u0111i\u1ec1u tr\u1ecb ho\u1eb7c v\u1eabn còn ti\u1ebfp t\u1ee5c sau khi \u0111ã ng\u1eebng \u0111i\u1ec1u tr\u1ecb, hãy thông báo ngay v\u1edbi bác s\u0129. Bác s\u0129 s\u1ebd \u0111i\u1ec1u tra xác \u0111\u1ecbnh nguyên nhân, ch\u1eb3ng h\u1ea1n sinh thi\u1ebft t\u1eed cung \u0111\u1ec3 lo\u1ea1i tr\u1eeb ung th\u01b0 t\u1eed cung.
\nUng th\u01b0 vú
\nD\u1eabn ch\u1ee9ng t\u1ed5ng quan cho th\u1ea5y t\u0103ng nguy c\u01a1 ti\u1ebfn tri\u1ec3n ung th\u01b0 vú \u1edf nh\u1eefng ph\u1ee5 n\u1eef dùng d\u1ea1ng k\u1ebft h\u1ee3p oestrogen-progestogen và c\u0169ng có th\u1ec3 ch\u1ec9 dùng oestrogen, \u0111i\u1ec1u \u0111ó ph\u1ee5 thu\u1ed9c vào th\u1eddi gian \u0111i\u1ec1u tr\u1ecb
\nLi\u1ec7u pháp oestrogen-progestogen k\u1ebft h\u1ee3p
\nNghiên c\u1ee9u ng\u1eabu nhiên có ki\u1ec3m soát gi\u1ea3 d\u01b0\u1ee3c, nghiên c\u1ee9u WHI (T\u1ed5 ch\u1ee9c Nghiên c\u1ee9u s\u1ee9c kh\u1ecfe ph\u1ee5 n\u1eef) và các nghiên c\u1ee9u d\u1ecbch t\u1ec5 \u0111ã tìm th\u1ea5y r\u1eb1ng nguy c\u01a1 ung th\u01b0 vú t\u0103ng lên \u1edf ph\u1ee5 n\u1eef dùng HRT ph\u1ed1i h\u1ee3p oestrogen-progestogen, th\u1ea5y rõ sau kho\u1ea3ng 3 n\u0103m (xem m\u1ee5c Tác d\u1ee5ng không mong mu\u1ed1n).
\nLi\u1ec7u pháp dùng riêng oestrogen
\nTh\u1eed nghi\u1ec7m c\u1ee7a WHI cho th\u1ea5y nguy c\u01a1 ung th\u01b0 vú không t\u0103ng \u1edf ph\u1ee5 n\u1eef \u0111ã