雌孕激素连续联合替代疗法对绝经后妇女阴道流血及子宫内膜的影响

目的 :比较不同剂量倍美力与安宫黄体酮连续联合替代治疗对绝经后妇女子宫内膜的影响。方法 :绝经 1～ 4年的健康妇女 81名 ,年龄 43～ 59岁 ,随机入组 :I:倍美力 0 .62 5mg/ d、安宫黄体酮 2 mg/ d;II:倍美力 0 .3 mg/ d与安宫黄体酮 2 mg/ d(以上 2组均每日补充元素钙 60 0 mg) ;III:单纯补钙组。治疗时间为 2年 ,期间观察阴道出血、B超测量子宫内膜厚度并行子宫内膜病理检查。结果 :( 1 )治疗期间阴道无出血、少量出血、中等以上出血发生率 I组分别为 7%、1 9%、74% ,II组分别为 46%、3 6%、1 8,III组为85%、8%、8% ,差异显著 ( P<0 .0 0 1 ) ;3组出血月数分别为 7.5、1 .6及 0 .6月 ( P<0 .0 0 1 )。( 2 )各组治疗前后子宫内膜厚度无明显变化。 ( 3 )治疗 1年子宫内膜活检 ,I组增生、分泌、静止或萎缩内膜各 2例 ,2年后活检各为 1例 ,增生病例均为治疗前内膜厚度 >5mm、内膜活检为单纯增生者 ,无新的内膜增生病例发生 ;II及 III组内膜无增生。各组无复杂增生及不典型增生 ;阴道流血、子宫内膜厚度、子宫内膜病理之间无明确关系。结论 :倍美力 0 .62 5或 0 .3 mg/ d与安宫黄体酮 2 mg/ d连续联合治疗 2年对子宫内膜无明显致增生作用 ;倍美力 0 .62 5mg/ d与安宫黄体酮 2 mg/ d配伍不能完全逆转已增生

Effects of continuous combined estrogen-progestogen replacement therapy on uterine bleeding patterns and endometrial histology in postmenopausal women

Objective: To compare the endometrial response to continuous combined estrogen-progestogen replacement therapy of conjugated equine estrogen (Premarin) at dose of 0.625 mg/d or 0.3 mg/d with medroxyprogesterone acetate 2 mg/d in postmenopausal women. Methods: This is a 2-year prospective, randomized controlled study. 81 postmenopausal women were divided into 3 groups: group I. Premarin 0.625 mg combinedwith medroxyprogesterone 2 mg daily; group II. Premarin 0.3 mg with medroxyprogesterone 2 mg daily, women in either group received calcium concurrently (600 mg/d); group III. Calcium taken only. Uterine bleeding was recorded. Endometrial thickness was detemined by transvaginal sonography. Endometrial biopsy was taken at 1-year and 2-year after treatment. Before treatment, endometrial biopsy was also taken in women when endometrial thickness over 5 mm. Results: (1)The percentages of no bleeding, spotting and bleeding in group I were 7.4%, 18.5% and 74.1% respectively. There were 46%, 36% and 18% respectively in group II and 85%,8% and 8% in group III (P<0.001);(2)Before and after treatment, there was no significant change in endometrial thickness in 3 groups; (3) In group I, endometrial simple hyperplasia was found in 2 of 26 women after 1 year of treatment, and in 1 of 20 women after 2 years of treatment. The women showing hyperplasia after treatment also had thicker endometrium (>5 mm) and were diagnosed as hyperplasia before treatment. There was no new case of hyperplasia. No hyperplasia was found in group II and group III. Conclusion: Continuous combined regimen of Premarin 0.625 or 0.3 mg/d with medroxyprogesterone acetate 2 mg/d for 2 years were not associated with an increased risk of endometrial hyperplsia; however, the combination of Premarin 0.625 mg daily with medroxyprogesteron acetate 2 mg daily can't completely convert the existed hyperplasia to normal.