Wasenda Erika J, Kamisan Atan Ixora, Subramaniam Nishamini, Dietz Hans Peter
1Department of Reproductive Medicine, Division of Female Pelvic Medicine and Reconstructive Surgery, UC San Diego Health System, San Diego, CA 2Sydney Medical School Nepean, University of Sydney, Sydney, Australia 3Universiti Kebangsaan, Malaysia Medical Centre, Kuala Lumpur, Malaysia.
Menopause. 2017 Oct;24(10):1185-1189. doi: 10.1097/GME.0000000000000898.
To determine the effect of hormone therapy (HT) use on pelvic organ support.
A retrospective observational study involving postmenopausal women with pelvic floor dysfunction attending a tertiary urogynecology center between January 2012 and March 2015. All underwent a clinical examination including International Continence Society Pelvic Organ Prolapse Quantification and 4D translabial ultrasound imaging. Information on current or former use of systemic HT and current local estrogen use was collected. Main outcome measure was pelvic organ support.
One thousand four hundred forty-three women were seen during the study period. On univariate analysis, current HT was significantly associated with sonographically determined descent of the rectal ampulla (β [95% confidence interval] 3.4 mm [0.4-6.5], P = 0.03) and Gh + Pb (-0.45 mm [-0.8 to -0.1], P = 0.005). Past HT use, duration of HT use, or current vaginal estrogen use was not associated with pelvic organ support. On multivariate analysis controlling for age, parity, body mass index, history of forceps delivery, and avulsion, the association between current HT on the one hand and Gh + Pb as well as increased descent of the rectal ampulla on ultrasound, remained significant (P = 0.008 and P = 0.012, respectively).
HT may have a minor negative effect on pelvic organ support; however, the effect is likely too small to be clinically relevant.
确定激素疗法（HT）的使用对盆腔器官支撑功能的影响。
一项回顾性观察性研究，研究对象为2012年1月至2015年3月期间在一家三级泌尿妇科中心就诊的盆底功能障碍绝经后女性。所有患者均接受了包括国际尿失禁协会盆腔器官脱垂定量检查和经阴唇4D超声成像在内的临床检查。收集了关于当前或既往全身HT使用情况以及当前局部雌激素使用情况的信息。主要结局指标为盆腔器官支撑功能。
在研究期间共诊治了1443名女性。单因素分析显示，当前使用HT与超声检查确定的直肠壶腹下移显著相关（β[95%置信区间]3.4 mm[0.4 - 6.5]，P = 0.03）以及Gh + Pb（-0.45 mm[-0.8至-0.1]，P = 0.005）。既往HT使用情况、HT使用时长或当前阴道雌激素使用情况与盆腔器官支撑功能无关。在对年龄、产次、体重指数、产钳分娩史和会阴撕裂进行多因素分析时，当前HT一方面与Gh + Pb以及超声检查显示的直肠壶腹下移增加之间的关联仍然显著（分别为P = 0.008和P = 0.012）。
HT可能对盆腔器官支撑功能有轻微负面影响；然而，这种影响可能太小，在临床上不具有相关性。
