激素治疗对绝经妇女子宫肌瘤的影响

Effects of Hormone Therapy on Postmenopausal Uterine Myoma

目的：观察个体化周期序贯激素治疗对绝经妇女子宫肌瘤发生及生长的影响。方法：选择因绝经相关症状且合并单发性子宫肌瘤（肌瘤最大径线〈5cm）的绝经妇女60例，给予雌孕激素周期序贯方案，起始剂量为口服戊酸雌二醇1．0mg，每日1次，连用21-25天，后10-14天加用甲羟孕酮每日4mg。随后，根据每人对药物的不同反应，调整口服戊酸雌二醇的每日用量为0．5—2．0mg，甲羟孕酮的每日用量相应为4—6mg。不能连续应用激素治疗或失访者被排除。分别于治疗前及治疗3、6、12、24、36个月时采用阴道超声测定肌瘤大小及子宫内膜厚度。结果：53例患者完成了3年的观察，平均年龄51．4（44—57）岁，绝经年限平均2．3（1—7）年。激素周期序贯治疗3、6、12、24、36个月，肌瘤大小均无明显改变（P〉0．05），没发现新生肌瘤（P〉0．05），子宫内膜厚度均无明显增厚（P〉0．05）。结论：根据个体对药物反应不同制定不同剂量的激素周期序贯方案，不促进绝经妇女子宫肌瘤的发生和生长。

Objectives： To evaluate the effects of individual cyclic sequential hormone therapy on the risk of utenne myoma onset and progression. Methods： In a prospective 3-year study from 1999 to 2001,60 patients with single asymptomatic uterine myoma （largest dimension 〈 5 cm） were recruited. Patients were voluntary and had no contraindications to HT. They received cyclic sequential oral estradiol valerate 1.0 mg/d for 21 - 25 days/cycle and medroxyprogesterone acetate 4 mg/d for 10 - 14 days/cycle,after that, according to Individual reaction to estradiol valerate,the doses of oral estradiol valerate were adjusted from 0.5 mg/d to 2.0 mg/d,and of medroxyprogesterone acetate from 4 mg/d to 6 mg/d for 3 years. The patients in hormone therapy group who discontinued the treatments or lost in follow-up were excluded from the study. Effects of the treatment on the progression （size） and onset of myorna uteri were evaluated by transvaginal sonography before treatment and at 3,6,12,24 and 36 months after onset of the treatment.Statistical analyses were performed by Student paired t-two tail tests. Results.The patients＇ mean age was 51.4 （ range 44 - 57） years, mean menopausal period 2.3 （ range 1 - 7） years. All the patients completed the study.The progression （size） and onset of myoma uteri and the thickness of endometrium have no statistically significant differences before and after hormone therapy at 3.6.12.24 and 36 months. Conclusions. Under suitable Individual cyclic sequential hormone therapy, there is no effect on the onset and progression of menopausal uterine myorna.