绝经期激素治疗中降低孕激素剂量对子宫内膜作用的评价

Reduce the Dose of Progesterone for Endometrial Safety Assessment in Menopausal Hormone Therapy

目的研究绝经期激素治疗(menopause hormone therapy,MHT)中降低天然孕激素剂量对子宫内膜的安全性。方法采用随机、开放、平行对照的研究方法,将126例有绝经期妇女分为3组,给予雌二醇1mg,共25d,后10d A组加用天然黄体酮(MP)50mg,B组加用MP 100mg,C组作为加用醋酸甲羟孕酮(MPA)4mg,进行25天周期序贯治疗,连续服用12个周期,每3月随访1次。观察Kuppermen评分、阴道流血情况、阴道彩超检测子宫内膜厚度,内膜≥5mm者进行诊刮术。结果用药后3组K评分均显著改善,组间比较差异无统计学意义(P>0.05),用药期间无一例发生子宫内膜不典型增生和内膜癌,用药后子宫内膜厚度差异无统计学意义(P>0.05);A组阴道流血发生率低于其他两组,差异有统计学意义(P<0.05);A组不良反应发生率低于其他两组,差异无统计学意义(P>0.05)。结论绝经期雌孕激素治疗中,适当降低孕激素剂量对子宫内膜是安全的,副反应更低。

Objective Analying the safety of endorntried to reduce the dose of natural progesterone in menopausal hormone therapy（ menopause hormone therapy,MHT）. Methods A randomized,open,parallel-group study method were employel,the 126 cases have postmenopausaled women were divided into three groups,given estradiol 1mg,25 days. The last 10 days the A group with natural progesterone（ MP） 50 mg,group B plus MP 100 mg,group C as the plus medroxyprogesterone acetate（ MPA）4mg,performed 25 days cycle sequential therapy,for taking 12 cycles,Every three months had a follow-up visit,Observing Kuppermen score,vaginal bleeding,vaginal ultrasound to detect endometrial thickness,endometrial thickness≥5mm cases were curettaged.Results K scores after treatment were improved significantly in all gronps groups（ P〉0. 05）; no case of atypical endometrial hyperplasia and endometrial cancer during the treatment,No significant difference in endometrial thickness after treatment（ P〉0. 05）;Lowest incidence of vaginal bleeding and Lowest incidence of side effects in group A（ P〈0. 05）. Conclusion In postmenopausal estrogen and progesterone therapy,appropriate to reduce the dose of progesterone appropriately is safe for the endometrium and have loner side effet.