EA 7285 Research Unit 'Risk and Safety in Clinical Medicine for Women and Perinatal Health', Versailles-Saint-Quentin University (UVSQ), Montigny-le-Bretonneux, France.
Department of Reproductive Medicine and Fertility Preservation, Hôpital universitaire Antoine Béclère, Clamart, France.
Acta Obstet Gynecol Scand. 2021 May;100(5):850-859. doi: 10.1111/aogs.14014. Epub 2020 Oct 24.
High-dose progestins are used as an effective therapy for painful symptoms of endometriosis but their impact on sexual function has been poorly studied. The study aims to assess the impact of high-dose progestin on sexual function among women treated for endometriosis.
In this bicenter prospective observational study, women with endometriosis who received medical or surgical treatment for endometriosis and who were sexually active were included. They completed the Sexual Activity Questionnaire (SAQ, a validated tool) before (T0) and 12 months after (T1) endometriosis treatment. We classified patients into two groups according to whether they were using high-dose progestins at T1: a high-dose progestin group and a control group. The main outcome was sexual function measured by the SAQ score (from 0 to 30) at T1. The secondary outcomes were each individual SAQ item, the dyspareunia 100-mm visual analog scale (VAS) and the quality of life assessed with EuroQoL Group 5D Index (EQ-5D) at T1. We also assessed the change in dyspareunia VAS and quality of life between T0 and T1. The Ethics Committee of Ile-de-France (Act 2004-806, 9 August 2004) approved the study.
Among 214 women included, 25 (12%) were exposed to high-dose progestins at T1. The SAQ score of women exposed to high-dose progestins was significantly lower compared with the control group, with or without adjustment for covariates (15.5 ± 6.3 vs 18.3 ± 6.2, P = .03, adjusted effect size -0.44 [95% CI -0.86 to -0.02], P = .04). High-dose progestin intake at T1 was associated with a lower subscore on two SAQ items: pleasure (1.8 ± 0.8 vs 2.2 ± 0.9, P = .02), and satisfaction with frequency of intercourse (1.2 ± 1.2 vs 1.8 ± 1.1, P = .02). In the overall population, dyspareunia VAS and quality of life assessed by EQ-5D improved between T0 and T1 (45 ± 29 at T0 vs 28 ± 29 at T1, P < .001; 0.78 ± 0.14 at T0 vs 0.86 ± 0.14 at T1, P < .001, respectively). At T1, the groups did not differ significantly for dyspareunia VAS (effect size 0.36 [95% CI -0.06 to 0.78], P = .10) and quality of life (EQ-5D, effect size 0.02 [95% CI -0.40 to 0.44], P = .91).
In this observational study, high-dose progestins impair the sexual function of women treated for endometriosis even though they improved dyspareunia.
大剂量孕激素被用作治疗子宫内膜异位症疼痛症状的有效疗法，但它们对性功能的影响研究甚少。本研究旨在评估高剂量孕激素治疗子宫内膜异位症对女性性功能的影响。
在这项双中心前瞻性观察性研究中，纳入了接受医学或手术治疗子宫内膜异位症且有性生活的子宫内膜异位症患者。她们在子宫内膜异位症治疗前（T0）和治疗后 12 个月（T1）完成了性活动问卷（SAQ，一种经过验证的工具）。我们根据患者在 T1 是否使用大剂量孕激素将其分为两组：大剂量孕激素组和对照组。主要结局是 T1 时通过 SAQ 评分（0 至 30 分）测量的性功能。次要结局是 T1 时每个 SAQ 项目、性交痛 100 毫米视觉模拟量表（VAS）和使用欧洲五维健康量表（EQ-5D）评估的生活质量。我们还评估了 T0 和 T1 之间性交痛 VAS 和生活质量的变化。法兰西岛伦理委员会（法案 2004-806，2004 年 8 月 9 日）批准了该研究。
在纳入的 214 名女性中，有 25 名（12%）在 T1 时接受了大剂量孕激素治疗。与对照组相比，接受大剂量孕激素治疗的女性的 SAQ 评分明显较低，无论是否调整了协变量（15.5±6.3 与 18.3±6.2，P=.03，调整后的效应大小-0.44[95%CI-0.86 至-0.02]，P=.04）。T1 时大剂量孕激素的摄入与两个 SAQ 项目的较低子评分相关：愉悦（1.8±0.8 与 2.2±0.9，P=.02）和性交频率满意度（1.2±1.2 与 1.8±1.1，P=.02）。在总体人群中，性交痛 VAS 和使用 EQ-5D 评估的生活质量在 T0 和 T1 之间有所改善（T0 时为 45±29，T1 时为 28±29，P<0.001；T0 时为 0.78±0.14，T1 时为 0.86±0.14，P<0.001）。在 T1 时，两组之间的性交痛 VAS 差异无统计学意义（效应大小 0.36[95%CI-0.06 至 0.78]，P=.10）和生活质量（EQ-5D，效应大小 0.02[95%CI-0.40 至 0.44]，P=.91）。
在这项观察性研究中，大剂量孕激素尽管改善了性交痛，但仍会损害子宫内膜异位症治疗女性的性功能。
