Department of Obstetrics and Gynecology, University of Southern California Keck School of Medicine, Los Angeles, CA 90033, USA; Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles, CA 90033, USA.
Department of Obstetrics and Gynecology, University of Toronto and The Keenan Research Center of Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ont., Canada M5B 1W8.
J Steroid Biochem Mol Biol. 2014 Jul;142:30-8. doi: 10.1016/j.jsbmb.2013.11.011. Epub 2013 Nov 26.
Medroxyprogesterone acetate (MPA) has been in clinical use for over 30 years, and was generally considered to be safe until the results of long-term studies of postmenopausal hormone therapy (HT) using treatment with conjugated equine estrogens (CEE) combined with MPA and CEE alone suggested that MPA, and perhaps other progestogens, may play a role in the increased risk of breast cancer and cardiovascular diseases. This review examines critically the safety of MPA in terms of breast cancer and cardiovascular disease risk, and its effects on brain function. Research into mechanisms by which MPA might cause adverse effects in these areas, combined with the available clinical evidence, suggests a small increase in relative risk for breast cancer and stroke, and a decline in cognitive function, in older women using MPA with an estrogen for postmenopausal HT. However, short-term (less than 5 years) use of MPA with an estrogen in the years immediately after the onset of menopause for the management of vasomotor symptoms does not appear to be associated with any increased risk of these disorders.
醋酸甲羟孕酮（MPA）已经在临床上使用了 30 多年，直到使用结合马雌激素（CEE）与 MPA 联合治疗和 CEE 单独治疗的绝经后激素治疗（HT）的长期研究结果表明，MPA，也许还有其他孕激素，可能在增加乳腺癌和心血管疾病的风险中发挥作用。本综述从乳腺癌和心血管疾病风险的角度，以及对大脑功能的影响，批判性地评估了 MPA 的安全性。对 MPA 可能在这些领域引起不良反应的机制的研究，结合现有的临床证据，表明在使用雌激素进行绝经后 HT 的老年妇女中，使用 MPA 会使乳腺癌和中风的相对风险略有增加，认知功能下降。然而，在绝经后早期（5 年内）使用雌激素与 MPA 联合治疗血管舒缩症状，似乎不会增加这些疾病的风险。
