Barrett-Connor E, Espeland M A, Greendale G A, Trabal J, Johnson S, Legault C, Kritz-Silverstein D, Einhorn P
Department of Family and Preventive Medicine, University of California at San Diego, 92093-0607, USA.
J Womens Health Gend Based Med. 2000 Jul-Aug;9(6):633-43. doi: 10.1089/15246090050118161.
Postmenopausal women often discontinue estrogen therapy within the first year. No studies have examined reasons why women continue or discontinue hormone replacement therapy (HRT) after several years of use, when hormone side effects have subsided. We wanted to identify determinants of estrogen use after participation in a 3-year randomized placebo-controlled trial. The Postmenopausal Estrogen/Progestin Intervention (PEPI) study compared the effects of estrogen alone or in combination with one of three progestogens with placebo. Post-PEPI use of hormone therapy was ascertained 1-4 years after the trial in 775 (90%) of the originally enrolled women. Potential correlates of treatment decisions were identified from sociodemographic characteristics, medical histories, and clinical measures ascertained at baseline and during and after the trial. Among women who had been assigned to placebo during PEPI, post-PEPI hormone use was significantly less common in women who were adherent to placebo during PEPI, older, or of non-Caucasian ethnicity. Hormone use was positively associated with hysterectomy. Among women assigned to an active regimen during PEPI, post-PEPI hormone use was significantly more common in women who used hormones before PEPI and in women who were adherent to hormones during PEPI. Older age, less education, and being non-Caucasian predicted less hormone use. Post-PEPI hormone use was highest in San Diego and lowest in Iowa City. Women on placebo who lost more bone mineral density (BMD) were more likely to begin hormones than women with less bone loss. Lipids, blood pressure, and other cardiovascular risk factors had relatively little influence on hormone use. The main predictors of post-PEPI hormone use were those associated with use in the general population (education, ethnicity, geographical region, hysterectomy, and prior use/adherence).
绝经后女性常常在第一年就停止雌激素治疗。尚无研究探讨女性在使用激素数年且激素副作用消退后继续或停止激素替代疗法（HRT）的原因。我们希望确定参与一项为期3年的随机安慰剂对照试验后雌激素使用的决定因素。绝经后雌激素/孕激素干预（PEPI）研究比较了单独使用雌激素或与三种孕激素之一联合使用与安慰剂的效果。在试验结束后1至4年，对最初入组的775名（90%）女性进行了PEPI后激素治疗情况的确定。从社会人口学特征、病史以及在基线、试验期间和试验后确定的临床指标中找出治疗决策的潜在相关因素。在PEPI期间被分配到安慰剂组的女性中，PEPI期间坚持使用安慰剂、年龄较大或非白种人的女性在PEPI后使用激素的情况明显较少。激素使用与子宫切除术呈正相关。在PEPI期间被分配到活性治疗方案组的女性中，PEPI前使用过激素以及PEPI期间坚持使用激素的女性在PEPI后使用激素的情况明显更常见。年龄较大、受教育程度较低和非白种人预示着激素使用较少。PEPI后激素使用在圣地亚哥最高，在爱荷华市最低。与骨量丢失较少的女性相比，安慰剂组中骨矿物质密度（BMD）丢失较多的女性更有可能开始使用激素。血脂、血压和其他心血管危险因素对激素使用的影响相对较小。PEPI后激素使用的主要预测因素是那些与一般人群使用情况相关的因素（教育程度、种族、地理区域、子宫切除术以及既往使用/依从性）。
