Lindenfeld Etta A, Langer Robert D
Department of Psychiatry, University of California, San Diego, California 92037, USA.
Obstet Gynecol. 2002 Nov;100(5 Pt 1):853-63. doi: 10.1016/s0029-7844(02)02245-7.
To explore whether significant differences exist between bleeding patterns with common regimens of hormone replacement therapy using two different progestogens.
A total of 875 women in the Postmenopausal Estrogen and Progestin Interventions Trial took either placebo, conjugated equine estrogen 0.625 mg, conjugated equine estrogen 0.625 mg plus medroxyprogesterone acetate 2.5 mg in a continuous fashion, or conjugated equine estrogen 0.625 mg daily plus either cyclical medroxyprogesterone acetate 10 mg or cyclical micronized progesterone 200 mg/day for 12 days per month. Bleeding days, amounts, and episodes were recorded in diaries and aggregated by 6-month intervals for 3 years for the 596 participants with a uterus. Any bleeding for women on continuous regimens, or more than 6 episodes of bleeding per 6-month period for cyclical regimens, was considered excess.
Conjugated equine estrogen plus micronized progesterone cyclical was associated with fewer excess episodes of bleeding than conjugated equine estrogen plus medroxyprogesterone acetate continuous in the first 6 months. Quantities of bleeding for conjugated equine estrogen plus micronized progesterone cyclical were less than for conjugated equine estrogen plus medroxyprogesterone acetate cyclical through 30 months and for the number of bleeding days through study end. The 3-year cumulative quantities, days, and episodes of bleeding were significantly lower for conjugated equine estrogen plus micronized progesterone cyclical than for conjugated equine estrogen plus medroxyprogesterone acetate cyclical. Placebo treated women had scant bleeding and conjugated equine estrogen had modest amounts relative to the combination therapies.
The bleeding measures for conjugated equine estrogen plus micronized progesterone cyclical showed consistent advantages over those for cyclical conjugated equine estrogen plus medroxyprogesterone acetate in terms of quantity, length, and episodes of bleeding. In the first 6 months, conjugated equine estrogen plus micronized progesterone cyclical had fewer excess bleeding episodes than continuous conjugated equine estrogen plus medroxyprogesterone acetate.
探讨使用两种不同孕激素的常见激素替代疗法方案在出血模式上是否存在显著差异。
共有875名女性参与绝经后雌激素和孕激素干预试验，她们分别服用安慰剂、0.625毫克结合马雌激素、持续服用0.625毫克结合马雌激素加2.5毫克醋酸甲羟孕酮，或每日服用0.625毫克结合马雌激素加每月12天周期性服用10毫克醋酸甲羟孕酮或200毫克/天微粒化孕酮。有子宫的596名参与者在日记中记录出血天数、出血量和出血次数，并每6个月汇总一次，持续3年。持续疗法的女性出现的任何出血，或周期性疗法每6个月出血超过6次，均被视为出血过多。
在最初6个月，结合马雌激素加微粒化孕酮周期性疗法比结合马雌激素加醋酸甲羟孕酮持续疗法的出血过多次数更少。在30个月内，结合马雌激素加微粒化孕酮周期性疗法的出血量少于结合马雌激素加醋酸甲羟孕酮周期性疗法，且在研究结束时出血天数也更少。结合马雌激素加微粒化孕酮周期性疗法的3年累计出血量、天数和出血次数显著低于结合马雌激素加醋酸甲羟孕酮周期性疗法。接受安慰剂治疗的女性出血很少，与联合治疗相比，结合马雌激素的出血量适中。
在出血量、出血时长和出血次数方面，结合马雌激素加微粒化孕酮周期性疗法的出血指标始终优于周期性结合马雌激素加醋酸甲羟孕酮疗法。在最初6个月，结合马雌激素加微粒化孕酮周期性疗法的出血过多次数少于持续的结合马雌激素加醋酸甲羟孕酮疗法。
