Setty Prathima, Rekedal Laura, Warren Michelle P
1Healthworks of Northern Virginia, Leesburg, VA 2Department of Obstetrics and Gynecology, Columbia University Medical Center, New York, NY.
Menopause. 2016 Jan;23(1):7-10. doi: 10.1097/GME.0000000000000493.
In the years after the 2002 publication of results from the Women's Health Initiative study, there has been a reluctance to prescribe hormone therapy to symptomatic postmenopausal women and confusion over its duration and method of prescription. The main concerns are the risks of cardiovascular events and breast cancer. However, local vaginal estrogen (VE) may provide benefits without systemic effects.
This study investigates the use and effects of VE on quality of life and urogenital morbidity among women who stopped hormone therapy after the Women's Health Initiative and compares them with women who continued hormone therapy. Three groups were compared: group 1, women who have remained on HT/ET; group 2, women who have resumed HT/ET after stopping for at least 6 months, and group 3, women who have stopped HT/ET and have not resumed.
Overall, ever use and present use of VE were most prevalent in women who reported dyspareunia (ever, P = 0.003; present, P = 0.005) and vaginal dryness (ever, P = 0.001; present, P = 0.004). VE use was significantly more probable for women in group 3 than for women in the other groups (group 3 [3.5%] vs. group 1 [17.7%] and group 2 [16.7%]; P = 0.002). Women in group 3 who used VE reported significantly higher sexual quality of life (using the sexual domain of the Utian Quality of Life Scale) compared with women in group 3 who did not use VE (P = 0.007). There was no difference in the incidence of urinary tract infections between the three groups (group 1, 22.9%; group 2, 26.3%; group 3, 25.5%). The percentage of women who were either married or living in a marriage-like relationship did not differ between the three groups (group 1, 68.4%; group 2, 78.6%; group 3, 78.8%).
Women who report dyspareunia and vaginal dryness are more likely to use VE. Women who do not use systemic therapy but use VE score significantly higher on the sexual quality-of-life scale than women not using VE.
在2002年妇女健康倡议研究结果发表后的几年里，对于有症状的绝经后女性，医生不愿开具激素疗法，且在激素疗法的疗程和处方方法上存在困惑。主要担忧是心血管事件和乳腺癌的风险。然而，局部阴道雌激素（VE）可能带来益处且无全身效应。
本研究调查了在妇女健康倡议研究后停止激素疗法的女性中VE的使用情况及其对生活质量和泌尿生殖系统疾病的影响，并将她们与继续使用激素疗法的女性进行比较。比较了三组：第1组，继续接受激素替代疗法/雌激素疗法（HT/ET）的女性；第2组，停止使用至少6个月后恢复HT/ET的女性；第3组，停止HT/ET且未恢复使用的女性。
总体而言，报告性交困难（曾经有过，P = 0.003；目前有，P = 0.005）和阴道干燥（曾经有过，P = 0.001；目前有，P = 0.004）的女性中，VE的既往使用和目前使用最为普遍。第3组女性使用VE的可能性显著高于其他组女性（第3组[3.5%]对比第1组[17.7%]和第2组[16.7%]；P = 0.002）。与第3组中未使用VE的女性相比，第3组中使用VE的女性在性生活质量方面（使用乌田生活质量量表的性领域）得分显著更高（P = 0.007）。三组之间尿路感染的发生率没有差异（第1组，22.9%；第2组，26.3%；第3组，25.5%）。三组中已婚或处于类似婚姻关系的女性比例没有差异（第1组，68.4%；第2组，78.6%；第3组，78.8%）。
报告性交困难和阴道干燥的女性更有可能使用VE。不使用全身疗法但使用VE的女性在性生活质量量表上的得分显著高于未使用VE的女性。
