被采访嘉宾：ALFRED O. MUECK教授 德国图宾根大学妇产科医院内分泌学和绝经期研究中心主任 德国巴登符腾堡州（Baden-Wuerttemberg）妇女健康研究中心主任
采访内容：
Q: Ok. Good Evening! Nice to meet you! Welcome to China, professor Mueck.
Q:晚上好，Mueck教授，很高兴见到你，欢迎来到中国！
A: I’m happy to meet you, professor Tong.
A：很高兴见到你，童教授。
Q: So, I want to know how many times have you been in China?
Q：好，我想知道你这是第几次来中国？
A: I’m, eh, only second times in China. I was here in January and now in July. But I have an opportunity to give lectures in eight different Chinese cities. I was in January in Beijing, Shanghai and Guangzhou. And now this time I was in Jinan, Fuzhou, Hanzhou and Nanjing. I was very happy to be here with Chinese colleagues working in our field of gynecology and endocrinology.
A：呃，这只是我第二次来中国。上次来是在一月份，这次是七月份。我受邀请在中国的八个城市巡回演讲。一月份的时候我去了北京、上海以及广州，这次去的地方有济南、福州、杭州和南京。能有机会结交妇产科学和内分泌学的中国同僚，我喜不自胜。
Q: So, what’s your impression about the changes of China and impression about Chinese ob/gyn?
Q：那您如何看待中国的变化以及对中国妇产科医生的印象如何呢？
A: First of all, I am really impressed about the knowledge in the field of gynecological endocrinology. Because in Europe, especially in Germany, it’s only in certain centers like in the center of Hannover, and our center is in the southern part of Germany。It’s university of Tuebingen where I came from. But here in China, I feel that the knowledge especially in gynecological endocrinology is very broad. I felt it in the lectures because they have very good questions in the lectures, very bitter questions about the use of hormones, especially how about possibilities to reduce the risks. And I think my impression is really, that is, eh, very large , the knowledge in the broad field of gynecology. And now I feel a little bit of change compared to January because in January we had an impression about the study in hormone replacement therapy. As you know, the WHI (Women Health Initiative) study and we in Europe had a very negative influence on HRT. And this was the same in China here in January. And now in July, it’s like in Europe that all my colleagues GYN look much differently in detail to this study. They know they should share all results of the WHI to all preparations. And this is a little bit change which we have in Europe and which we see now also in China. And I think it’s important to see this because hormone replacement therapy------ the topic of my lecture is an important issue in our both common field in gynecology and endocrinology.
A：首先我要说的是我对中国妇科内分泌学医生的专业知识掌握程度感到惊讶。在欧洲，特别是在德国，妇科内分泌学研究集中于某些中心例如汉诺威大学，以及我们图宾根大学（地处德国南部）。而在中国，妇科内分泌学知识极为渊博，在我做讲座的时候，他们（中国同行们）针对激素的使用（特别是如何合理使用以降低风险）提出了极好的问题，有些还着实难以招架，故而让我印象深刻。相比一月的中国之行，此次访华，我还感受到了一点小小的变化。一月的时候，WHI（妇女健康启动项目）的初步结果和我们在欧洲（的同行）对HRT（激素替代治疗）的评价一度多带负面性质，在中国当时也是如此。时隔半年，我的欧洲妇科学同行们逐渐转变了对WHI研究的看法，他们意识到大家应该共享研究成果，在中国我们也看到了这一转变。我认为这一转变是很有意义的，因为激素替代治疗（我的演讲主题）是一个妇产科学和内分泌学方面的重要问题。
Q: So nowadays a lot of exchange and cooperation between China and Germany in many different fields like education, business and medicine. So is there any, eh, intensive or cooperation between your university and China.
Q：如今中德之间在许多领域，如教育、商务和医药等领域存在交流和合作。在此我想知道你们学校和中国之间有无合作或是合作意向？
A: To be honest, until I know, not. Although we are very old university of Tuebingen like the university of Hannover, but because we have not this relation until I know. I want to be in China. It’s the reason that I’m here and have contacts in 8 different cities with my colleagues in the field of gynecology and endocrinology. And I had an opportunity to meet really many German and German woman here and experts in the field only within 6 months, and have an opportunity to meet many colleagues, and the same colleagues and other colleagues I’ve also met in the last 6 months in Europe during our most important congresses in Europe, and the last was congress of menopause in Madrid. I was there together with these famous Chinese experts and also during the international congress of endocrinology which was in Italy. We were together and we have also the European Congress of contraception in Prague and had a really opportunity to meet many colleagues and we’re just starting working together in the field of hormone replacement therapy. And we started independently with clinical studies and also experimental studies, so I look forward to this cooperation and then I want to say even though not acquainted with some of the colleagues here. I look forward to this cooperation. I know, you already have good cooperation with the university of Hannover.
A：实不相瞒，据我所知，虽然我们的图宾根大学和汉诺威大学一样历史悠久，但目前我们和中国暂时没有交流合作。这也是我来中国并在八个城市结交妇产科学和内分泌学界同行的原因。在这短短的六个月中我还认识了许多德国同胞，以及在过去半年中几度邂逅于欧洲重量级会议（如最近一次在马德里召开的绝经协会会议，在意大利召开的国际内分泌协会会议，在布拉格召开的欧洲节育协会会议）的同行们，还有素未谋面的同行们开始了激素替代治疗领域的合作研究。我们之前进行的是独立的临床试验或者实验研究。虽然我还不是很熟悉这里的一些同行，但是我很希望能够和你们一起合作。我知道，你们和德国汉诺威大学有着很好的合作。
Q: Right, it’s correct.
Q：对的。
Q: Yes，We’re going to build a new German-Chinese friendship hospital in Shanghai together with German colleagues and German company. And we’ve sent 20 doctors and nurses to Germany to get some training and education, and another 20 is on the way.
Q：是的。我们计划与德国同行合作共建一座中德友好医院，为此我们已经先期派遣了20名医生和护士到德国接受训练和教育，另外还有20名也正整装待发。
A: It’s a wonderful thing.
A：太棒了。
Q: So do you have any plan to get involved into this project.
Q：那你们有没有什么计划参与到这个项目中来？
A: Of course. We can speak about our special issues. We’re very engaged in the field of oncology because in Germany the field of oncology is also in our department of gynecological endocrinology which depends on hormone. So we are not engaged in chemotherapy. And in this field maybe we can have cooperation. Because we have a very large research center, I would say we have one of the largest research center with very modern technique in our university. I look forward to have cooperation with you.
A：当然有，我们可以谈谈我们的学科专长。我们妇科内分泌学系也进行肿瘤相关研究，对于需要激素治疗的肿瘤，我们小有造诣，而对于需要化疗或其他方式治疗的肿瘤，我们涉猎不多。在这方面我们也许可以进行合作。我们有个非常大的研究中心，我可以毫不夸张地说，它是我们学校最大的现代化研究中心之一。我非常期待和你们进行合作。
Q: Okay, what’s the topic of your lecture today?
Q：言归正传，你今天演讲的主题是啥呢？
A: The lecture today is estrogen and progestogen treatment in menopause and beyond. My special topic is that in this estrogen and progestogen treatment, there are risks. And the topic is how to reduce the risk using natural estrogen combined with dydrogestrone. And I have structured the lecture in the following way. First, I will give an overview about the WHI study. There’s increased risks of breast cancer, venous thrombosis, stroke. Then I will give an overview over all data not only the WHI study in breast cancer and stroke, and thrombosis. And I will show that using natural hormones like dydrogestrone combined with estrogen preparation Femonston that with special combination all three risks can be reduced. There’s a France study which clearly shows that in the same study using Femonston compare to synthetic progestogens, the breast cancer risk is not increased in contract to synthetic progestogen. We have a study regarding venous thrombosis that comparing directly synthetic progestogen with Femostone that the risk with Femonston is not increased. But risk in certain synthetic progestin is increased. And the third main risk in the WHI which is stroke. There we can say that the risk of stroke is dependent on blood pressure or hypertension because this is the main reason of stroke and there’s good data that with Femonston, there is no increased blood pressure. And from this we can also expect that the risk of stroke is not increased. And I think this is really important because if we think about our main concern in hormone replacement therapy. This is the topic of my lecture and it’s really always breast cancer, venous thrombosis and stroke. And I know no other preparation with estrogens and progestogens can reduce all three risks. There are good preparations to reduce the blood pressure and there are good preparations for patients who are at risk of venous thrombosis. But there is no preparation that can reduce all three risks. For this reason,I really think the recommendation to use natural estrogen combined with dydrogestrone is a good recommendation and lastly we have chatted last week together with china menopause society. I was hornored to be invited to China Menopause Society and to discuss with China Menopause Society the main points of the international menopause society. We are in workgroups in the same society. And in the International Menopause Society, there is official recommendation to reduce the risk of breast cancer. We can use estrogen plus dydrogestrone. Because this the only combination which has been shown to reduce these risks. This is the officially recommendation also of the International Menopause Society, which is implemented in 60 congresses. Also in Germany, of course, the Germany Menopause Society, we have implement this recommendation and we know it’s very difficult in HRT in certain risk patients, But in general we can say that, if you use the natural hormone, those main risks are reduced, I have to say, I am a little afraid, I have not an opportunity to speak on efficacy in general. I have to speak. This was my topic about risks. But of course we have many benefits on HRT. But the benefit in climacteric symptoms, or urogenital complaints, osteoporosis are with all preparations. There’s no advantage of Femonston and also no disadvantage in the benefit and in the efficacy of all preparations are equal. But in the risks, they are different. These are all sections of my lecture.
Q：我今天的演讲是关于雌激素和孕激素在围绝经期及绝经后治疗中的应用。诚然，雌激素和孕激素用于治疗存在着风险，而我将致力于探讨如何通过天然雌激素和地屈孕酮的联合使用来降低风险。整个演讲的框架是这样子的：首先我会对WHI研究进行概述。我会显示，合理联用天然激素如芬吗通（地屈孕酮和雌二醇的联合制剂）可以降低上述三风险。一个比较芬吗通（中的地屈孕酮）和合成孕激素治疗中乳腺癌发生风险的法国研究显示，芬吗通（中的地屈孕酮）不增加乳腺癌风险，而合成孕激素则增加了风险。还有个研究比较了合成孕激素和芬吗通（中的地屈孕酮）治疗静脉血栓的发生风险，使用芬吗通（中的地屈孕酮）血栓发生风险并未增加，而合成孕激素增加了风险。WHI研究的第三个主要风险是中风，我们知道，血压过高是中风的主要原因，而研究数据显示，芬吗通不导致血压增高，所以它不会增加中风的风险。考虑到这三个风险是我们在激素替代治疗主要关注的问题，芬吗通在这些方面的表现很有说服力。据我所知，目前还没有任何其他制剂能够同时降低三个风险。因此，我认为天然雌激素和地屈孕酮联用是个很好的方案。上周承中国妇产科学会绝经学组盛情相邀访华，与同行们交流了国际绝经协会对ＨＲＴ的一些最新观点。由于雌激素和地屈孕酮联用可以有效降低乳腺癌等风险，这一方案被国际绝经协会采纳为推荐方案，并被六十多个国家的区域性协会采用，这其中就包括了我们德国绝经协会。我们知道，给予某些病人激素替代治疗往往困难重重，但一般来说，如果你用的是天然激素，这些主要风险的发生概率还是很低的。我想我恐怕没法在芬吗通的疗效方面多做赘言。事实上芬吗通和其他合成激素在疗效（如改善更年期症状、泌尿生殖系统症状，预防骨质疏松）方面效果不相上下，但在安全性方面，前者表现更有优势。以上就是我演讲的组成部分。
Q: You’re talking about a very sophisticated topic. It’s complicated. So do you get a feeling that most doctors were listening to your lecture understand the key message of your lecture?
Q：你所谈论的话题非比寻常，它很是复杂。你觉得听你讲座的大部分医生理解到了你所讲内容的精髓了吗？
A: I’m really, eh ,this is now in a interview. I have to summarize very rapidly. But I have during the lecture more than one hour time for this. And I go slowly to the structure, data on the breast cancer, data on venous thrombosis, data on stroke, slowly explain that stroke, depends on blood pressure and if you increase blood pressure. Then you increase stroke, I have time in the lecture to explain that during the WHI, there was increased blood pressure and there was increased stroke and make this lecture in this form I really have the impression I’m convinced that with this message comes to the people that are listening. The main message is we have to see risks and the next message also comes that the risks can be reduced if we use the natural hormones and the other point would be if you start early ,this is also important.
A：由于现在是访谈，所以我只能快速总结。而在讲座中，我有一个小时以上的时间，以乳腺癌、静脉血栓和中风方面的研究数据逐步解释。例如我深入解释中风依赖于血压，一旦血压升高了，中风的风险就增加了。WHI的研究也显示了血压的升高导致了中风风险的增加。以这样的形式来演讲，我相信在场的听众能够明白我的思想：首先我们必须意识到风险的存在；其次，我们可以通过使用天然激素来降低风险；此外，尽早开始治疗也是相当重要的。
Q: So, as you know, there’re always increased concern about the risks of hormone replacement therapy. We all want to have a healthy and attractive woman along with us. But we have to do something to keep them young and beautiful. That’s why we use hormone preparations to make it happen. But there’re always one, two, three, four side effects. We can correctly use hormone. What do you want to say about the common risks like increasing incidence of breast cancer, heart attack and stroke, like this?
Q：如你所知，激素替代治疗的风险越来越受关注。我们都希望身边的女同胞又健康又迷人，但是我们要有所行动，以使她们青春常驻，风采不减。为此我们采用了激素制剂来达成目的。而副作用总是存在的，因此我们得正确使用激素。你对诸如乳腺癌、静脉血栓及中风此类的风险有何看法？
A: In common regarding hormone replacement therapy. I think the basic must be the results in the WHI study, and in WHI study there was an increase of breast cancer with combined HRT, not estrogen only. As you know the WHI study was with only one synthetic progestogen with MPA. And I think we have to expect that we each preparation for HRT might be a certain risk of breast cancer. If you have a long treatment period, this risk in absolute numbers is low. I always told my patients it’s about 1 case in a thousand patients per year, and this is really a low risk. But breast cancer is the next important risk for women and for us. I think we have to explain, it’s difficult, but we have to explain to patients if we have a long term therapy with estrogen plus progestogen. These risks may exist. It’s very low. But I think it’s now really that we can decrease the risk using natural hormones. It’s the first point. And the next point myocardial infarction. This is easy to answer, I think, because in WHI study, an increase of myocardial infarction only was seen, if you start for the first time with HRT in patients who had their menopause more than 20 years ago. That means on average in patients more than 70 years old . That means myocardial infarction is not the issue. If you start early, you can even reduced risk of myocardial infarction. The issue is breast cancer and the issue is thrombosis and thrombosis in the arteries mainly to stroke, and this is dependent on blood pressure. And as I told you, this can be avoided by preparations which do not increase blood pressure. And with Femonston. It has been shown it does not increase blood pressure. It even decreases the blood pressure. And the other thing is thrombosis can also be decreased. And you ask me about assessment in whole of HRT.I think these 3 risks always exist. We can even not exclude the risk of Femonstone. But we can say the risk is reduced according to the present evidence and the data.
A：我认为考虑激素替代治疗的时候，出发点应该是WHI研究的结果。WHI研究显示，单用雌激素者不增加乳腺癌风险，而使用联合激素替代治疗则增加了乳腺癌风险，在此研究中仅采用了一种合成孕酮（MPA）。因此我认为我们要意识到任一种制剂都有潜在的致乳腺癌风险。如果你接受的是长期治疗，发病风险是很低的。我总是告诉我的病人每年一千个病人中只有一个人发病，这样的发病率是相当低的。乳腺癌对于女性和我们两个来说都是最严重的风险，因此我们要向病人解释，虽然这会很困难，但我们要向她们解释，如果接受雌激素和孕激素的联合治疗，风险尽管存在，但是微乎其微。此外，用的如果是天然激素，风险可以更低。这是我要说明的第一点。接下来我要说的是关于心肌梗死，这还是比较好回答的，在WHI研究中，只有在绝经超过二十年，也就是平均年龄大于70岁的人群中，第一次用药后出现了发病率的上升。这说明心肌梗死不是问题，如果用药较早的话，还可以降低心肌梗死发病风险。问题在于乳腺癌、血栓和和动脉血栓导致的中风。其中中风发生与否取决于血压，采用不升高血压的制剂芬吗通可以避免中风。研究显示，芬吗通非但不升高血压，甚至还有降血压作用。如果要我说对整个激素替代治疗的评价的话，我想说这三个风险总是存在的，即便是用芬吗通，也不能避免风险，但是数据显示它可以使风险最小化。
Q: Good, as I said before, I am not an expert in endocrinology, but I’m a big fan. I am a little familiar with Femonton and dydrogestrone. So do you think dydrogestrone, or if you want to say something about, are these two dydrogestrone or femostone preparations superior to other hormone preparation or just the same?
Q:很好。我之前说过，我并非内分泌学专家，但是我是个超级粉丝。我对芬吗通和地屈孕酮略有所知。请问你认为地屈孕酮或芬吗通相比于其他激素制剂是有优势还是相差无几呢？
A: I am convinced that regarding the main risks, breast cancer, venous thrombosis and stroke. Femonston is the only product to date. We have data that those 3 risks can be decreased. They’re not increased, maybe even decreased. I know no other preparations those data exists for all three risks. I know that for venous thrombosis there are good data of preparations to reduce risk of venous thrombosis. But I know no data regarding breast cancer risk. I know there are new preparations to reduce blood pressure，very good new progestogen from the Bayer company to reduce blood pressure. But until I know, we have no data on breast cancers. For this reason, I really would say on the main risk, we both are concerned with our patients. Breast cancer, thrombosis, we have an advantage, compare femostone regarding the main indications, climacteric symptoms. We have no advantage we can use all preparations if we use it in a correct dosage. The same for urogenital complaints, and the same for osteoporosis fractures. I am honored to be invited here again in October to the Congress of osteoporosis and bone research which is in Beijing and I have a lecture, “meet the professors” and assess Hormone replacement therapy for prevention of osteoporosis. There I will strengthen the International Menopause Society recommends officially HRT for prevention of fracture in patients who are at high risk. But this we can do with all preparation not only Femonston and the advantage is not in the efficacy. The advantage is in tolerability and safety. And for this reason, this was my issue in these lectures.
A：我相信顾及到乳腺癌、静脉血栓和中风这三个主要风险，芬吗通是至今最为合适的产品。我这里有数据表现它可以降低这三个风险的发病率，而这是其他制剂做不到的。单纯治疗静脉血栓有很好的制剂来控制发病风险，拜耳先灵公司也研发出了新的孕激素制剂用于血压控制，但是据我所知，目前还没有乳腺癌方面的数据。在疗效方面，只要剂量掌握得当，我们用什么制剂都无伤大雅。但在预防乳腺癌和血栓、泌尿生殖系统症状、骨质疏松性骨折等风险方面，芬吗通有其独特优势。我有幸受邀十月时再次访华参加国际骨质疏松与骨研究大会，在会议的“Meet the professors”部分，我将发表演讲，评估激素替代治疗对预防骨质疏松的作用。届时我会强调国际绝经协会官方向高风险患者们推荐的激素替代治疗方案。实际上这些疗效其他制剂也能做到，芬吗通的优势不在于疗效，而是体现在其无可比拟的耐受性和安全性方面。这是我在所有的演讲中主要阐述的问题。
Q: Great! I know you have achieved a lot of academic achievements and gain very highly respect from many colleagues. If you want to say one sentence to Chinese doctor about the suggestion of hormone replacement therapy, what do you want to say?
Q：真棒！你已经取得了这么高的学术成就，得到了众多同行的高度评价。在此你可否用一句话向中国同行们建议激素替代治疗时考虑的要点？
A: You want a Short or long sentence? I would say there are three rules. The first is start early if indicated, the second is use low dosages, the third is individualized therapy, and think of options to reduce the risks like the combined use of estrogen and dydrogestrone. This was one sentence.
A：你是要长的还是短的一句话？呵呵。我想说的是，（在激素替代治疗时）我们应该遵循三个原则：首先，如有适应症，尽早开始用药；其次，剂量要低；最后，考虑选择可以降低风险的个体化方案，例如联用雌激素和地屈孕酮。这就是我想说的。
Q: That’s a little bit long. And if you want to say two sentences, what’s the second sentence?
Q：貌似长了点。如果可以说两句话，你的第二句话会是什么呢？
A: The second sentence would be: There’re 3 points which we should consider in HRT in general in addition to those recommendations. The first is that I think that with the loss of estrogen during menopause and beyond. There are really very severe symptoms in some patients, climacteric symptoms, urogenital complaints. We should not leave those patients alone. We should give them help and should treat the symptoms. The second point is that we should counsel for patients that we give them the benefits and risks and should say to them how this is balanced in a special case. This is the individualized therapy. This is the second point. The third point is in general we should not treat all patients with HRT. There’re patients who has no symptoms. And in those patients we should consider we again and again speak to them if there are symptoms. And if not we need no treatment.
A：第二句话是：应用激素替代治疗时除了上面三条原则外，我们还应考虑三点：第一点是围绝经期及绝经后由于雌激素的缺失，有些病人的症状相当严重，她们会出线更年期症状及泌尿生殖系统症状，我们不应抛开她们不管而应给予她们帮助和治疗以改善症状；第二点是，我们应当用心和病人沟通，让她们充分了解用药的好处和风险，对每个病人，在好处和风险之间找到平衡点加以治疗，也就是我们要推行个体化治疗；第三点是，HRT不是适用于所有病人的，比如有些病人没有症状，这种情况下我们应该考虑和她们再谈一次，确定有无症状，如果的确没有，是不需要用药的。
Q: In China, if a very important person wants to say something, he would say,” I have three sentences to say.” So you have said 2 sentences, the last sentence you want to say to Chinese doctors, what do you want to say?
Q：在中国，大人物出来说话往往会说，“诸位，我有三句话要说。”你现在已经说了两句话了，最后一句你想说的是什么呢？
A: I would say that in China the knowledge of gynecology and endocrinology is so good that I am honored to be invited here. But I’m convinced most of the Chinese doctors already know it.
A：我想说，中国的妇产科学和内分泌学知识已经这么好了，我能被邀请来到这里，是莫大的荣幸。我相信，即便我不说，多数中国医生也应当已经知道这些知识了。
Q: So welcome to China again. Thank you very much!
Q：再次欢迎你来到中国，谢谢你接受采访！
A: Thank you for this interview. Thank you!
A：谢谢你的采访，谢谢！
