孕激素用于绝经期组合激素治疗中的子宫内膜保护:系统性审查
Petra Stute1, Linus Josef Walker2, Astrid Eicher2
1Department of Obstetrics and Gynecology, University Clinic Inselspital, Friedbuehlstrasse 19, 3010 Bern, Switzerland.
Best practice & research. Clinical endocrinology & metabolism
|August 27, 2023
概括
对于更年期激素治疗 (MHT),各种孕激素提供子宫内膜保护. 然而,并非所有配方都符合FDA的安全标准,研究质量各不相同,影响了联合MHT的选择.
科学领域:
- 生殖内分泌学 生殖内分泌学
- 妇科瘤学 妇科瘤学
背景情况:
- 对于更年期症状的雌激素治疗,需要在未损坏子宫的妇女同时服用孕激素,以预防子宫内膜增生和恶性瘤.
- 组合MHT疗法需要仔细选择孕激素,以获得最佳的子宫内膜安全.
研究的目的:
- 系统地审查和评估与组合激素治疗 (HT) 中使用的不同孕激素相关的子宫内膜增生和恶性瘤风险.
- 评估各种孕激素配方是否符合FDA的子宫内膜安全标准.
- 分析随机对照试验 (RCT) 的证据质量,研究结合性HT中的孕激素.
主要方法:
- 84个随机对照试验 (RCT) 的系统综述.
- 对孕激素类型 (NETA,MPA,MP,DYD,LNG),配方 (口服,透皮) 和组合HT疗法 (连续,序列) 的分析.
- 在研究结果和遵守FDA安全标准的基础上对子宫内膜保护的评估.
主要成果:
- 大多数被纳入的研究都使用了诺格斯蒂 (NETA),美德乙酸 (MPA),美格斯特乙酸 (MP),迪恩格斯特 (DYD) 和莱沃诺格斯特勒 (LNG).
- 几种孕激素在检查剂量和持续时间时显示出子宫内膜保护,但只有一些配方符合FDA子宫内膜安全标准.
- 研究质量差异很大,需要仔细考虑,特别是在非标签使用的组合HT时.
结论:
- 在联合MHT中选择孕激素需要考虑配方,FDA安全性合规性以及支持证据的质量.
- 研究质量的变化需要谨慎,特别是在考虑非标签使用组合MHT时.
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