Melis G B, Cagnacci A, Bruni V, Falsetti L, Jasonni V M, Nappi C, Polatti F, Volpe A
Istituto di Ginecologia Ostetricia e Fisiopatologia della Riproduzione Umana, Ospedale S. Giovanni di Dio, Cagliari, Italy.
Maturitas. 1996 May;24(1-2):83-90. doi: 10.1016/0378-5122(95)01022-x.
Intravaginal estriol (E3) effectively improves postmenopausal genito-urinary disturbances, without stimulating endometrial proliferation. The aim of the present study was to evaluate the effect of intravaginal estriol (E3) plus nasal spray salmon calcitonin (sCT), to improve neurovegetative symptoms and to prevent the decline of bone mineral density (BMD) of postmenopausal women.
Two hundred and fourteen (214) healthy postmenopausal women were treated for 12 months with: (1) E3 (0.5 mg every other day) + Ca (0.5 g/day); (2) E3 + Ca + sCT (50 IU x 2/day); (3) sCT + Ca; (4) Ca. Climacteric complaints, such as hot flushes and sweating, BMD at the distal 1/10 of the radius, analyzed by dual photon absorptiometry, urinary excretion of hydroxyproline and serum alkaline phosphatase were evaluated at baseline and every 6 months. At the same time, patient compliance and drug tolerability were evaluated.
E3 but not sCT, improved hot flushes and sweating. E3 blunted but not completely counteracted the BMD decline observed in women treated with only Ca, and reduced urinary hydroxyproline excretion. sCT markedly increased BMD values and reduced both urinary hydroxyproline excretion and serum alkaline phosphatase. These effects were not potentiated by E3 coadministration. All treatments were well tolerated.
Present data indicate that the combined administration of intravaginal E3 and sCT may represent an alternative therapeutic regimen for those postmenopausal women who do not accept or have contraindications to classical hormone replacement therapy.
阴道内使用雌三醇（E3）可有效改善绝经后泌尿生殖系统紊乱，且不会刺激子宫内膜增生。本研究的目的是评估阴道内使用雌三醇（E3）加鼻喷鲑鱼降钙素（sCT）对改善绝经后妇女神经植物症状及预防骨矿物质密度（BMD）下降的效果。
214名健康绝经后妇女接受了为期12个月的治疗，治疗方案如下：（1）E3（隔日0.5mg）+钙（每日0.5g）；（2）E3+钙+sCT（每日2次，每次50IU）；（3）sCT+钙；（4）钙。在基线及每6个月时评估更年期症状，如潮热和出汗，通过双能光子吸收法分析桡骨远端1/10处的骨密度，评估羟脯氨酸尿排泄量和血清碱性磷酸酶。同时，评估患者的依从性和药物耐受性。
E3可改善潮热和出汗，而sCT不能。E3可减缓但未完全抵消仅服用钙剂的女性所观察到的骨密度下降，并减少尿羟脯氨酸排泄。sCT显著增加骨密度值，并降低尿羟脯氨酸排泄量和血清碱性磷酸酶。联合使用E3并未增强这些效果。所有治疗耐受性良好。
目前的数据表明，对于那些不接受或有经典激素替代疗法禁忌证的绝经后妇女，阴道内使用E3和sCT联合给药可能是一种替代治疗方案。
