Al Kadri Hanan, Hassan Samar, Al-Fozan Haya M, Hajeer Ali
Obstetrics & Gynaecology, KFNGH, PO Box 57374, Riyadh, Saudi Arabia, 11574.
Cochrane Database Syst Rev. 2009 Jan 21(1):CD005997. doi: 10.1002/14651858.CD005997.pub2.
Endometriosis is characterized by the presence of ectopic endometrial tissue that might lead to many distressing and debilitating symptoms. Despite available studies supporting standard hormone therapy for women with endometriosis and post-surgical menopause, there is still a concern that estrogens may induce a recurrence of the disease and its symptoms.
This review aimed to look at pain and disease recurrence in women with endometriosis who used hormone therapy for post-surgical menopause.
We searched the Cochrane Menstrual Disorders and Subfertility Group Specialized Register (March 2008), Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2008, Issue 3), MEDLINE (1966 to March 2008), EMBASE (1980 to March 2008), and references lists of articles. Relevant journals and conference proceedings were handsearched.
Randomized controlled trials studying hormone therapy for women with endometriosis in post-surgical menopause.
Review authors assessed the eligibility of trials and their quality.
Two studies fulfilled our inclusion criteria. One trial compared the nonstop transdermal application of 17beta-estradiol (0.05 mg/day) combined with cyclic medroxy progesterone acetate (10 mg per day) for 12 days per month in women with a conserved uterus with nonstop tibolone (2.5 mg/day). The second trial used sequential administration of estrogens and progesterone with two 22 cm(2) patches applied weekly to produce a controlled release of 0.05 mg/day. Micronized progesterone was administered orally (200 mg/day) for 14 days with a 16-day interval free of treatment. Pain and dyspareunia The first trial reported recurrence of pain in the estrogen and progesterone arm in 4/10 of women compared with 1/11 in the tibilone arm. In the latter, 4/115 women reported recurrence of pain in the treatment group compared with 0/57 patients in the no-treatment arm. Neither finding was statistically different.Confirmed recurrence or exacerbation of endometriosis This outcome was not reported in the first trial. The second found that 2/115 of the treatment group developed recurrence of endometriosis with no recurrence reported in the no-treatment group. This was not statistically significant. No woman was re-operated on in the no-treatment group compared with 2/115 in the treatment group.
AUTHORS' CONCLUSIONS: Hormone replacement therapy for women with endometriosis in post-surgical menopause could result in pain and disease recurrence. However, the evidence in the literature is not strong enough to suggest depriving severely symptomatic patients from this treatment. There is a need for more randomised controlled studies.
子宫内膜异位症的特征是存在异位子宫内膜组织，这可能导致许多令人痛苦和使人虚弱的症状。尽管现有研究支持对患有子宫内膜异位症的女性及术后绝经女性采用标准激素疗法，但人们仍担心雌激素可能会诱发该病及其症状的复发。
本综述旨在研究接受激素疗法进行术后绝经的子宫内膜异位症女性的疼痛和疾病复发情况。
我们检索了Cochrane月经失调与生育力低下问题组专业注册库（2008年3月）、Cochrane对照试验中心注册库（CENTRAL）（《Cochrane图书馆》2008年第3期）、MEDLINE（1966年至2008年3月）、EMBASE（1980年至2008年3月）以及文章的参考文献列表。对手检了相关期刊和会议论文集。
研究激素疗法用于术后绝经的子宫内膜异位症女性的随机对照试验。
综述作者评估了试验的合格性及其质量。
两项研究符合我们的纳入标准。一项试验比较了在保留子宫的女性中，每月持续12天不间断经皮应用17β-雌二醇（0.05毫克/天）联合周期性醋酸甲羟孕酮（10毫克/天）与不间断应用替勃龙（2.5毫克/天）的效果。第二项试验采用雌激素和孕激素序贯给药，每周贴两片22平方厘米的贴片，以实现0.05毫克/天的控释。口服微粒化孕酮（200毫克/天）14天，间隔16天不进行治疗。疼痛和性交困难：第一项试验报告，雌激素和孕激素组10名女性中有4名出现疼痛复发，而替勃龙组11名女性中有1名出现疼痛复发。在后者中，治疗组115名女性中有4名报告疼痛复发，而未治疗组57名患者中无1名报告疼痛复发。两项结果均无统计学差异。子宫内膜异位症的确诊复发或加重：第一项试验未报告这一结果。第二项试验发现，治疗组115名女性中有2名出现子宫内膜异位症复发，未治疗组未报告复发情况。这无统计学意义。未治疗组无女性接受再次手术，而治疗组115名女性中有2名接受再次手术。作者结论：对术后绝经的子宫内膜异位症女性进行激素替代疗法可能会导致疼痛和疾病复发。然而，文献中的证据不足以表明应剥夺症状严重的患者接受这种治疗的机会。需要更多的随机对照研究。
