治疗绝经后妇女泌尿生殖器萎缩的一种新方法

治疗绝经后妇女泌尿生殖器萎缩的一种新方法中国医学科学院协医院妇产科（１００７３０）朱兰摘译香港中文大学妇产科学系王益夫审校在美国的人口结构中，以老年人的增长速度为最快，以人均寿命７６岁计算，大多数妇女的一生中有三分之一的时间生活在绝经后。目前，大约有...     

绝经后妇女泌尿生殖道症状流行病学及治疗现状

由于年龄的增长和雌激素的缺乏,泌尿生殖道症状在绝经后妇女中很普遍,尤以反复尿路感染、尿失禁、阴道干涩及性交痛最为明显,严重影响老年妇女生活质量.其主要生理改变为生殖道和泌尿道粘膜萎缩所致.近年来研究表明,性激素补充治疗可以有效地减轻妇女泌尿生殖道症状,治疗效果与雌激素类型、用药剂量及给药途径均有关,对于绝经后以泌尿生殖道症状为主的患者,强调经阴道给药优于全身给药.     

绝经后反复泌尿生殖道感染

绝经后反复泌尿生殖道感染是老年人常见多发病，北京大学第一医院妇产科联合临床药理研究所就以下三个病例进行了临床讨论，现报告如下。     

利维爱治疗绝经后妇女复发性泌尿生殖道感染30例

我科采用利维爱治疗绝经后妇女复发性泌尿生殖道感染30例,疗效甚好,总结如下。1 资料与方法1.1 一般资料1.1.1 研究对象 选择我科2000年1-6月门诊患者30例,自然或手术停经12个月以上,年龄最大78岁,最小45     

雌三醇栓治疗绝经后妇女萎缩性阴道炎的临床研究

目的 :在有对照组的条件下观察雌三醇栓治疗绝经后妇女萎缩性阴道炎的疗效及安全性。方法 :采用随机对照分组 ,按病例接纳顺序随机表分治疗组 (雌三醇栓组 ) 2 0例、对照组 (倍美力阴道用软膏组 ) 2 0例 ,观察时间 5 6天。结果 :雌三醇栓对绝经后妇女萎缩性阴道炎有明显治疗效果。结论 :雌三醇栓可以作为绝经后妇女萎缩性阴道炎的局部替代治疗药物 ,且安全、有效、经济、使用方便     

雌三醇软膏治疗绝经妇女复发性泌尿生殖道感染临床观察

目的探讨雌三醇软膏治疗绝经妇女复发性泌尿生殖道感染的效果。方法2003m3—2005-02在首都医科大学附属复兴医院确诊复发性泌尿道感染的绝经妇女52例为A组，其中用雌三醇软膏者为A1组（27例），服用抗生素者为A2组（25例）；复发性老年性阴道炎的绝经妇女56例为B组：B1组（30例）给予阴道雌三醇软膏治疗，B2组（26例）予莪术油栓治疗。所有患者用药共计12周。A组用药前后进行尿常规检查，评估泌尿系感染症状，进行阴道健康评分。B组用药前后进行阴道健康评分及阴道炎症状评分及阴道pH值测定。结果A1组、A2组用药后尿常规化验转为正常，泌尿系症状好转，两组间疗效比较差异无显著性（P〉0．05）。两组阴道健康评分用药前后比较，A1组评分增加（P〈0．01），A2组无变化（P〉0．05）；B1、B2组治疗前后阴道健康评分增加、阴道炎症状评分减少，pH值降低（P〈0．01，P〈0．05）。结论阴道局部应用雌三醇软膏能够有效治疗绝经妇女复发性泌尿道、阴道感染，副反应较小，值得临床推广应用。     

绝经后妇女雌激素替代治疗：雌三醇的疗效及血浆促性腺激素水平变化的研究

为确定绝经后妇女应用雌三醇(E_3)作雌激素替代治疗(ERT)的效果及治疗期间血浆促性腺激素(FSH、LH)的改变进行下述研究。观察对象为245例无明确症状的绝经后妇女。分为治疗组168例和安慰剂组77例。已停经12月者为自然绝经,通过检测绝经后FSH、LH、E_2水平确定绝经,FSH≥30 IU/L,LH≥15 IU/L,E_2<92 pmol/L。既往无用激素替代疗法(HRT)史,放免法检测激素水平。E_3治疗2 mg/d或安慰剂8周。治疗开始时及治疗后2、4及8周进行临床评估。     

绝经后妇女泌尿生殖病症流行病学及治疗现状

由于年龄的增长和雌激素的缺乏,泌尿生殖道病状在绝经后妇女中很普遍,尤有反复尿路感染、尿失禁、阴道干涩及性交痛最为明显,严重影响老年妇女生活质量。其主要生理改变为生殖道和泌尿道粘膜萎缩所致。近年来研究表明,性激素补充治疗可以有效地减轻妇女泌尿生殖道症状,治疗效果与雌激素类型、用药剂量及给药途径均有关,对于绝经后以泌尿生殖道症状为主的患者,强调经阴道给药优于全身给药。     

阴道局部应用雌激素治疗绝经后阴道萎缩的作用——2007年北美绝经学会立场声明(一)

前言 北美绝经学会(The North American Menopause Society,NAMS)征集一批公认为泌尿生殖疾病领域专家的临床医师和研究者,共同回顾、综合和解释阴道局部应用雌激素疗法(estrogen therapy,ET)治疗绝经后阴道萎缩的现有证据,得出结论,提供建议.     

A comparative study of safety and efficacy of continuous low dose oestradiol released from a vaginal ring compared with conjugated equine oestrogen vaginal cream in the treatment of postmenopausal urogenital atrophy

Objective To compare the safety, efficacy and acceptability of a continuous low dose oestradiol releasing vaginal ring with conjugated equine oestrogen vaginal cream in the treatment of postmenopausal urogenital atrophy.
Design An open, parallel, comparative multicentre trial.
Setting Sydney and Melbourne, Australia.
Participants and Interventions One hundred and ninety-four postmenopausal women with symptoms and signs of urogenital atrophy were randomised on a 2:1 basis to 12 weeks of treatment with an oestrogen vaginal ring versus an oestrogen cream.
Main outcome measures and results Equivalence (95% CI) was demonstrated between the two treatments for relief of vaginal dryness and dyspareunia, resolution of atrophic signs, improvement in vaginal mucosal maturation indices and reduction in vaginal pH. No significant difference was demonstrated in endometrial response to a progestogen challenge test and equivalence was demonstrated in the incidence of intercurrent bleeding episodes. The vaginal ring was significantly more acceptable than the cream (   P < 0.0001  ), and was preferred to the cream (   P < 0.001  ).
Conclusion With equivalent efficacy and safety and superior acceptability to vaginal cream, the low dose oestradiol vaginal ring is an advance in vaginal delivery systems for the treatment of urogenital atrophy.     

Randomized, double-blind, placebo-controlled study of the effects of raloxifene and conjugated equine estrogen on plasma homocysteine levels in healthy postmenopausal women

Objective: To investigate the long-term effects of raloxifene on fasting plasma homocysteine levels in postmenopausal women compared with conjugated equine estrogen (CEE).

Design: Randomized, double-blind, placebo-controlled study.

Setting: Outpatient department of a university hospital.

Patient(s): Fifty-two hysterectomized, healthy postmenopausal women.

Intervention(s): Oral raloxifene in two dosages (60 mg/d [n = 13] and 150 mg/d [n = 13]), oral CEE (0.625 mg/d [n = 13], and placebo (n = 13) were given for 24 months.

Main Outcome Measure(s): Fasting plasma homocysteine concentrations.

Result(s): Plasma homocysteine levels were not altered in the placebo group. After 12 months, a significant reduction versus baseline in the mean plasma homocysteine level (−16%) was found only in the raloxifene 150-mg group. The mean change in plasma homocysteine levels within this group also was significantly different from the changes versus baseline found in the placebo group (+2%) and the raloxifene 60-mg group (−2%), but not different from those found in the CEE group (−8%). After 24 months, plasma homocysteine levels were decreased significantly in the raloxifene 150-mg and CEE groups compared with both baseline (−13% and −10%, respectively) and placebo values (−15% and −11%, respectively). No significant change in plasma homocysteine levels was observed in the raloxifene 60-mg group.

Conclusion(s): Raloxifene has a favorable, dose-related effect on plasma homocysteine levels in postmenopausal women.     

Low-dose vaginal estrogens or vaginal moisturizer in breast cancer survivors with urogenital atrophy: a preliminary study

The study aim is to evaluate the efficacy and safety of two low-dose vaginal estrogen treatments (ETs) and of a non-hormonal vaginal moisturizer in postmenopausal breast cancer survivors with urogenital atrophy. Eighteen patients receiving estriol cream 0.25?mg (n?=?10) or estradiol tablets 12.5?μg (n?=?8) twice/week for 12 weeks were evaluated and compared with eight patients treated with polycarbophil-based moisturizer 2.5?g twice/week. Severity of vaginal atrophy was assessed using subjective [Vaginal Symptoms Score (VSS), Profile of Female Sexual Function (PFSF)] and objective [Vaginal Health Index (VHI), Karyopycnotic Index (KI)] evaluations, while safety by measuring endometrial thickness and serum sex hormones levels. After 4 weeks, VSS and VHI were significantly improved by both vaginal ETs, with further improvement after 12 weeks. PFSF improved significantly only in estriol group (p?=?0.02). Safety measurements did not significantly change. Vaginal moisturizer improved VSS at week 4 (p?=?0.01), but score returned to pre-treatment values at week 12; no significant modification of VHI, KI, PFSF was recorded. Both low-dose vaginal ET are effective for relieving urogenital atrophy, while non-hormonal moisturizer only provides transient benefit. The increase of serum estrogens levels during treatment with vaginal estrogen at these dosages is minimal.     

Effect of raloxifene on the response to conjugated estrogen vaginal cream or nonhormonal moisturizers in postmenopausal vaginal atrophy

OBJECTIVE: To study the effect of raloxifene on the response to conjugated estrogen cream or nonhormonal moisturizer in postmenopausal women with preexisting signs of vaginal atrophy. METHODS: Postmenopausal women with preexisting and untreated vaginal atrophy were enrolled in this parallel, placebo-controlled, randomized study. A total of 187 women were randomized to four treatment groups: daily oral raloxifene (60 mg per day) or a placebo in a double-blind manner plus one application of conjugated estrogen cream (0.5 g) or one applicator full of nonhormonal moisturizer, open label. The conjugated estrogen cream or nonhormonal moisturizer was applied daily for the first 2 weeks, and then twice weekly thereafter for 3 months. Efficacy of treatment regimens on signs and symptoms of vaginal atrophy was evaluated by monitoring objective and subjective parameters. RESULTS: Signs and symptoms of vaginal atrophy improved in all four treatment groups. Raloxifene did not diminish the magnitude of improvement when administered with either vaginal preparation. Conjugated estrogen cream produced a statistically greater improvement in signs (P <.05) but not in individual symptoms or overall satisfaction relative to nonhormonal moisturizer. CONCLUSION: Postmenopausal women with evidence of preexisting vaginal atrophy may use either low-dose conjugated estrogen cream or nonhormonal moisturizer to treat the atrophy concurrently with raloxifene (60 mg per day).     

Relief of vasomotor symptoms and vaginal atrophy with lower doses of conjugated equine estrogens and medroxyprogesterone acetate

Objective: To evaluate the efficacy of lower doses of conjugated equine estrogens (CEE) plus medroxyprogesterone acetate (MPA) for relieving vasomotor symptoms and vaginal atrophy.

Design: A randomized, double-blind, placebo-controlled trial (the Women’s Health, Osteoporosis, Progestin, Estrogen study).

Setting: Study centers across the United States.

Patient(s): Two thousand, six hundred, seventy-three healthy, postmenopausal women with an intact uterus, including an efficacy-evaluable population (n = 241 at baseline).

Intervention(s): Patients received for 1 year (13 cycles; in milligrams per day) CEE, 0.625; CEE, 0.625 and MPA, 2.5; CEE, 0.45; CEE, 0.45 and MPA, 2.5; CEE, 0.45 and MPA, 1.5; CEE, 0.3; CEE, 0.3 and MPA, 1.5; or placebo.

Main Outcome Measure(s): Number and severity of hot flushes and Papanicolaou smear with vaginal maturation index (VMI) to assess vaginal atrophy.

Result(s): In the efficacy-evaluable population, reduction in vasomotor symptoms was similar with CEE of 0.625 mg/d and MPA of 2.5 mg/d (the most commonly prescribed doses) and all lower combination doses. CEE of 0.625 mg/d alleviated hot flushes more effectively than the lower doses of CEE alone. VMI improved in all active treatment groups.

Conclusion(s): Lower doses of CEE plus MPA relieve vasomotor symptoms and vaginal atrophy as effectively as commonly prescribed doses.     

The effect of estradiol vaginal tablet and conjugated estrogen cream on urogenital symptoms in postmenopausal women: a comparative study.

OBJECTIVES: To compare the effects of estradiol vaginal tablet with conjugated estrogen cream on urogenital symptoms, vaginal health index, vaginal cytology, endometrial thickness, and plasma estradiol level in postmenopausal women. METHODS: Fifty-three women with urogenital symptoms were randomized to local vaginal treatment of 25 microg estradiol tablet or 1 g of conjugated estrogen cream for 12 weeks. They were assessed for urogenital symptoms, vaginal health index, vaginal cytology, endometrial thickness and estradiol level. RESULTS: Forty-eight women completed the treatment. Both groups showed improvement of urogenital symptoms, vaginal health index, and vaginal cytology after the first 4 weeks of treatment. Conjugated estrogen cream showed superior efficacy in alleviating vaginal dryness and dyspareunia. Two cases of endometrial proliferation were noted. CONCLUSIONS: Estradiol vaginal tablet and conjugated estrogen cream were effective in treating urogenital symptoms, the restoration of normal vaginal epithelium and reduction of vaginal pH in postmenopausal women. However, 2 cases of endometrial proliferation were noted.     

High internal consistency and efficacy of intravaginal DHEA for vaginal atrophy

Following the compelling data obtained in a pivotal phase III clinical trial performed in 218 postmenopausal women suffering from vaginal atrophy who received daily intravaginal 0.25, 0.5 or 1.0% DHEA (dehydroepiandrosterone) ovules for 12 weeks, we have performed analysis of the four co-primary objectives at each site of that multicentre U.S. and Canadian trial. Comparison was made of the change in percentage of parabasal and superficial cells, vaginal pH and severity of the most bothersome symptom. The site-by-site (seven sites) analysis has shown that 10–13 women per group are generally sufficient to obtain a significant or highly statistically significant decrease in vaginal pH and percentage of parabasal cells and increased percentage of superficial cells at p values ranging from 0.02 to <0.0001. For vaginal pain as the most bothersome symptom, a statistically significant difference from baseline was found at six out of seven sites.

The exceptionally high consistency between all sites in this phase III study and high potency of the compound permit to obtain a clinically and statistically significant to highly significant effect of treatment on all parameters of vaginal atrophy with the 0.5% DHEA daily intravaginal dose which does not significantly affect the serum levels of oestrogens, thus avoiding systemic risks.