Weinstein L
Obstet Gynecol. 1987 Jun;69(6):929-32.
The major concern with the use of unopposed estrogen is its neoplastic effect on the endometrium. Progestins used to oppose the estrogen may be associated with vaginal bleeding and reversal of estrogen's protective changes in serum lipoprotein concentrations. A study was performed in which all postmenopausal women received conjugated equine estrogen for days 1-28; with group I receiving 2.5 mg medroxyprogesterone acetate for days 1-28, group II receiving 5 mg medroxyprogesterone acetate for days 1-28, and group III receiving 5 mg medroxyprogesterone acetate for days 17-28. Pre- and postdrug evaluations of the endometrium revealed atrophic changes after therapy with continuous combined estrogen-progestin. Pre- and poststudy evaluation of serum lipoprotein concentrations demonstrated significant declines in cholesterol and low-density lipoprotein cholesterol within groups I and III, and no change in group II. All patients kept a weekly diary recording any vaginal bleeding or change in vasomotor symptoms. The results suggest that a continuous regimen of 0.625 mg conjugated equine estrogen with 2.5 mg medroxyprogesterone acetate is beneficial as a primary hormonal replacement therapy for the postmenopausal patient.
使用无对抗雌激素的主要担忧在于其对子宫内膜的肿瘤形成作用。用于对抗雌激素的孕激素可能与阴道出血以及雌激素对血清脂蛋白浓度的保护性改变的逆转有关。进行了一项研究，所有绝经后女性在第1 - 28天接受结合马雌激素；第一组在第1 - 28天接受2.5毫克醋酸甲羟孕酮，第二组在第1 - 28天接受5毫克醋酸甲羟孕酮，第三组在第17 - 28天接受5毫克醋酸甲羟孕酮。对子宫内膜的用药前和用药后评估显示，连续联合雌激素 - 孕激素治疗后出现萎缩性变化。对血清脂蛋白浓度的研究前和研究后评估表明，第一组和第三组的胆固醇和低密度脂蛋白胆固醇显著下降，第二组无变化。所有患者每周记录任何阴道出血或血管舒缩症状的变化。结果表明，0.625毫克结合马雌激素与2.5毫克醋酸甲羟孕酮的连续方案作为绝经后患者的主要激素替代疗法是有益的。
