Department of Endocrinology and Menopause, Centre for Women's Health BW, University Women's Hospital, Calwer Strasse 7, D-72076 Tuebingen, Germany.
Endocr Relat Cancer. 2010 Sep 23;17(4):R263-71. doi: 10.1677/ERC-10-0076. Print 2010 Dec.
More than 15 case-control studies and at least four large cohort studies demonstrated a decrease in the risk of endometrial cancer of about 50% for ever use of combined oral contraceptives (COCs). In most of these studies, this protective effect persisted for more than 10-15-20 years after cessation of the COC. An increasing protective effect with longer duration of COC use has been found in most studies. The beneficial effect was independent of the composition of COC, i.e. dosage and type of progestogen, combined with ethinyl estradiol 30-50 μg/day. COCs with higher progestogen potency seem to be somewhat more effective. Nonhormonal uterine devices have also been found to be strongly protective; however, data on oral or injectable progestogen-only preparations (POPs) including the levonorgestrel-releasing intrauterine system (LNG-IUS) are still rare, but also suggest similar protective action. COCs, POPs, as well as LNG-IUS can effectively reduce endometrial hyperplasia but should only be used in exceptional cases in patients with or after endometrial cancer. In contrast to nonhormonal IUS, systemic side effects cannot be excluded with LNG-IUS, but they are certainly rare, as the main effect has decreased the endometrial estrogen response because of the high endometrial tissue levels of LNG.
超过 15 项病例对照研究和至少四项大型队列研究表明，长期使用复方口服避孕药（COC）可使子宫内膜癌的风险降低约 50%。在大多数研究中，这种保护作用在停止使用 COC 后持续 10-15-20 年以上。大多数研究发现，COC 使用时间越长，保护作用越强。这种有益的效果与 COC 的成分无关，即孕激素的剂量和类型，与炔雌醇 30-50μg/天联合使用。孕激素效力较高的 COC 似乎更有效。非激素宫内节育器也被发现具有很强的保护作用；然而，关于口服或注射用孕激素仅制剂（POPs）包括左炔诺孕酮释放宫内节育系统（LNG-IUS）的数据仍然很少，但也表明了类似的保护作用。COC、POPs 和 LNG-IUS 都可以有效地减少子宫内膜增生，但仅应在有或患有子宫内膜癌的患者的特殊情况下使用。与非激素 IUS 不同，LNG-IUS 不能排除全身副作用，但它们肯定很少见，因为主要作用是由于 LNG 在子宫内膜组织中的高浓度而降低了子宫内膜的雌激素反应。
