Andersson K, Stadberg E, Mattsson L A, Rybo G, Samsioe G
Department of Obstetrics and Gynecology, Ostra Hospital, Göteborg, Sweden.
Int J Fertil Menopausal Stud. 1996 Sep-Oct;41(5):476-83.
Limited data concerning serum lipids and lipoproteins are available on the effect of HRT in perimenopausal women, who commonly have marked bleeding disturbances and may have severe climacteric symptoms. Almost all previously published data have utilized a simplified form of lipoprotein analysis, which includes an estimation and not a determination of LDL cholesterol. To delineate the role of locally administered progestogen, perimenopausal women were studied for a year.
40 perimenopausal women with climacteric complaints. The continuous release of low-dose levonorgestrel from an intrauterine device was used as progestogen co-medication to estradiol in a new type of continuous combined hormone replacement therapy. Women were randomized to either cyclical treatment with 2 mg of oral estradiol valerate in combination with 250 micrograms of levonorgestrel for the last ten days (Cyclo Progynova) or continuously with 2 mg estradiol valerate orally in combination with a 20 micrograms per 24 hour levonorgestrel releasing intrauterine device.
Reduced HDL cholesterol was initially recorded in both treatment arms and disappeared after 1 year of treatment. Triglycerides were reduced in the orally treated group, but not in the device group. No changes in LDL cholesterol were noted.
The findings suggest that continuous combined HRT with intrauterine release of 20 micrograms levonorgestrel per 24 hours in perimenopausal women is neutral as far as lipid metabolism is concerned, since no alterations compared with pretreatment values could be noted after 12 months of treatment. Less marked lipid changes were obtained in perimenopausal women as compared with data on postmenopausal women. Differences in methodology may partly account for this.
关于激素替代疗法（HRT）对围绝经期女性血脂和脂蛋白影响的数据有限，这些女性通常有明显的出血紊乱，可能还有严重的更年期症状。几乎所有先前发表的数据都采用了简化的脂蛋白分析形式，其中包括对低密度脂蛋白胆固醇（LDL-C）的估算而非测定。为了阐明局部应用孕激素的作用，对围绝经期女性进行了为期一年的研究。
40名有更年期症状的围绝经期女性。在一种新型的连续联合激素替代疗法中，使用宫内节育器持续释放低剂量左炔诺孕酮作为雌二醇的孕激素辅助用药。女性被随机分为两组，一组采用周期性治疗，在最后十天口服2mg戊酸雌二醇联合250μg左炔诺孕酮（Cyclo Progynova）；另一组采用持续治疗，口服2mg戊酸雌二醇联合每24小时释放20μg左炔诺孕酮的宫内节育器。
两个治疗组最初均记录到高密度脂蛋白胆固醇（HDL-C）降低，治疗1年后消失。口服治疗组甘油三酯降低，而使用宫内节育器组未降低。未观察到LDL-C有变化。
研究结果表明，对于围绝经期女性，每24小时宫内释放左炔诺孕酮20μg的连续联合HRT在脂质代谢方面是中性的，因为治疗12个月后与治疗前值相比未发现变化。与绝经后女性的数据相比，围绝经期女性的脂质变化不太明显。方法学上的差异可能部分解释了这一点。
