不同生殖衰老分期及激素替代治疗的绝经期女性性功能障碍状况分析

目的 调查不同生殖衰老分期女性性功能障碍(female sexual dysfunction,FSD)以及应用激素替代治疗(hormone replace therapy,HRT)的绝经后女性FSD的现状。方法 本研究为多中心临床研究,纳入2019年6月至2020年8月在首都医科大学附属北京妇产医院及两家医联体医疗机构就诊且符合纳入和排除标准的女性902例。根据生殖衰老分期(Stages of Reproductive Aging Workshop, STRAW+10)及绝经后女性是否应用激素替代治疗(hormone replace therapy,HRT),将研究对象分为7组:生育期组(reproductive group, R)146例、绝经过渡期早期组(early menopausal transition group, ET)199例,绝经过渡期晚期组(late menopausal transition group, LT)87例,绝经后早期组(early postmenopause group, EP)183例,绝经后晚期组(late postmenopause group, LP)41例,绝经后早期应用HRT组(early postmenopausal women using HRT, EP-HRT)207例应用雌二醇片2 mg/雌二醇地屈孕酮片(2 mg:10 mg),绝经后晚期应用HRT组(late postmenopausal women using HRT, LP-HRT)39例应用雌二醇屈螺酮片(1 mg:2 mg)。女性性功能指数(Female Sexual Function Index, FSFI)量表评估FSD。结果 EP组和LP组的FSD、性欲障碍、阴道润滑障碍、性满意度障碍以及性交痛的比例均明显高于R组、ET组和LT组,LP组性唤起障碍和性高潮障碍的比例、EP组性唤起障碍的比例高于R组、ET组,LT组性欲障碍和性唤起障碍的比例、EP组性高潮障碍的比例高于R组,LP组的阴道润滑障碍和性交痛的比例均高于EP组(P＜0.05)。EP-HRT组的FSD、性欲障碍和性满意度障碍的比例明显低于EP组(P＜0.05)。LP-HRT组的阴道润滑障碍、性满意度障碍以及性交痛的比例明显低于LP组(P＜0.05)。结论 女性FSD的比例随生殖衰老分期的提高而显著升高,应用HRT可降低绝经后女性FSD的比例。

Study on the situation of female sexual dysfunction in different reproductive aging stages and postmenopausal women using hormone replacement therapy

Objective To investigate the situation of female sexual dysfunction (FSD) at different reproductive stages and the situation of FSD at postmenopausal women using hormone replacement therapy (HRT). Methods A multicenter clinical study was conducted among 902 women in the Department of Gynecological Endocrinology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University and other two medical alliance institutions from Jun. 2019 to Aug. 2020. According to the 2011 stages of the Reproductive Ageing Workshop (STRAW+10) and postmenopausal women using HRT or not, the subjects were divided into seven groups: 146 women in reproductive age (R), 199/87 women in early (ET)/late (LT) menopausal transition, 183/41 women in early (EP)/late (LP) postmenopause. Totally 207 women in early postmenopausal stage using estradiol sequentially combined with dydrogesterone (EP-HRT) and 39 women in late postmenopausal stage using estradiol combined with drospirenone administered continuously (LP-HRT). The Female Sexual Function Index (FSFI) was used to assess FSD. Results In group EP and LP, the proportion of FSD, sexual desire disorder, lubrication disorder, dissatisfaction and pain was significantly higher than those in R, ET and LT groups (P＜0.05). In group LP, the proportion of arousal disorder and orgasm disorder was significantly higher than those in R and ET groups (P＜0.05). The proportion of sexual desire disorder, orgasm disorder in LT group, the proportion of orgasm disorder in EP group, and the proportion of arousal disorder in LP group was significantly higher than those in R group. The proportion of lubrication disorder and pain in LP group was significantly higher than those in EP group (P＜0.05). Comparing EP group versus EP-HRT group, the proportion of FSD, sexual desire disorder and dissatisfaction was significantly lower in EP-HRT group (P＜0.05). Comparing LP group versus LP-HRT group, the proportion of FSD, lubrication disorder, dissatisfaction and pain was significantly lower in LP-HRT group (P＜0.05). Conclusion There was a clear association between deteriorating sexual function and increasing STRAW+10 classification, suggesting the consequence of decreasing ovarian function. HRT containing ‘natural hormones' imposed a beneficial effect on FSD.