Lieberman Allan, Curtis Luke
Altern Ther Health Med. 2017 Nov;23(6):24-32.
Context • The medical literature on the use of progesterone in postmenopausal women is often confusing and contradictory. Some physicians implicate natural progesterone in an increase in the risk of breast cancer. The chemical structure of natural progesterone (P4) is quite different from chemically altered, synthetic chemicals called progestins, which results in different actions at the cell level. Objective • The research team intended to review the literature to examine the benefits and safety of natural progesterone and determine whether it can cause an increase or decrease in breast cancer risk. Design • A review of the medical literature to examine the benefits and safety of natural progesterone as compared with synthetic progestins. Intervention • Studies examined compared controls not receiving hormone therapy with women receiving estrogen alone and in combination with natural progesterone and with various synthetic progestins, such as medroxyprogesterone acetate-the most commonly used synthetic progestin. Outcome Measures • Outcome measures included factors such as progression and survival of breast and other cancers and other epidemiological and laboratory data. Results • A meta-analysis of 3 studies involving 86 881 postmenopausal women reported that the use of natural progesterone was associated with a significantly lower risk of breast cancer compared with synthetic progestins. Anovulation and low levels of serum progesterone have been associated with a significantly higher risk of breast cancer in premenopausal women. Use of progesterone has been linked to lower rates of uterine and colon cancers and may also be useful in treating other cancers such as ovarian, melanoma, mesothelioma, and prostate. Progesterone may also be helpful in preventing cardiovascular disease and preventing and treating neurodegenerative conditions such a stroke and traumatic brain injury. Conclusions • Physicians should have no hesitation prescribing natural progesterone. The evidence is clear that progesterone does not cause breast cancer. Indeed, progesterone is protective and preventative of breast cancer.
背景 • 关于绝经后女性使用孕酮的医学文献常常令人困惑且相互矛盾。一些医生认为天然孕酮会增加患乳腺癌的风险。天然孕酮（P4）的化学结构与化学结构改变的合成化学物质（称为孕激素）有很大不同，这导致它们在细胞水平上有不同的作用。
目的 • 研究团队旨在回顾文献，以研究天然孕酮的益处和安全性，并确定其是否会增加或降低患乳腺癌的风险。
设计 • 对医学文献进行回顾，以研究天然孕酮与合成孕激素相比的益处和安全性。
干预 • 所审查的研究将未接受激素治疗的对照组与单独接受雌激素以及与天然孕酮和各种合成孕激素联合使用的女性进行了比较，例如醋酸甲羟孕酮——最常用的合成孕激素。
结果指标 • 结果指标包括乳腺癌和其他癌症的进展与生存等因素以及其他流行病学和实验室数据。
结果 • 一项涉及86881名绝经后女性的3项研究的荟萃分析报告称，与合成孕激素相比，使用天然孕酮与患乳腺癌的风险显著降低有关。无排卵和血清孕酮水平低与绝经前女性患乳腺癌的风险显著升高有关。使用孕酮与子宫癌和结肠癌的发病率较低有关，也可能有助于治疗其他癌症，如卵巢癌、黑色素瘤、间皮瘤和前列腺癌。孕酮还可能有助于预防心血管疾病以及预防和治疗中风和创伤性脑损伤等神经退行性疾病。
结论 • 医生在开具天然孕酮处方时应毫不犹豫。有明确证据表明孕酮不会导致乳腺癌。事实上，孕酮对乳腺癌具有保护和预防作用。
