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在月经前综合征 (PMS) 治疗中使用性激素释放激素 (GnRH) 类似物
Bushra Naheed1, Jan Herman Kuiper1, Fidelma O'Mahony2
1Institute for Science and Technology in Medicine, Keele University, Stoke-on-Trent, UK.
淋巴激素释放激素 (GnRH) 激动剂有效降低月经前综合征 (PMS) 症状,但可能导致更年期副作用. 在不影响症状缓解的情况下减轻这些影响的补充疗法的有效性需要进一步研究.
科学领域:
- 生殖内分泌学 生殖内分泌学
- 药理治疗妇科疾病的药理疗法
- 临床试验分析
背景情况:
- 月经前综合征 (PMS) 影响20-30%的女性,月经前失调障碍 (PMDD) 是一种严重的形式,影响日常功能.
- 激素释放激素 (GnRH) 的类似物抑制排卵,诱导低雌激素状态,可能导致更年期副作用和骨质疏松症风险.
- "添加回"疗法,涉及雌激素或孕激素,用于抵消这些不良影响在GnRH模拟治疗PMS.
研究的目的:
- 评估GnRH类似物 (agonists和antagonists) 在管理PMS的治疗效果.
- 评估GnRH类型的安全性和不良影响,有或没有附加疗法.
- 确定添加回疗法对前期综合征GnRH模拟治疗的疗效和副作用概况的影响.
主要方法:
- 通过全面的数据库搜索识别的随机对照试验 (RCT) 的系统审查和元分析.
- 纳入标准侧重于被诊断患有PMS的生育年龄妇女,不包括那些目前患有精神疾病的妇女.
- 主要结局包括整体PMS症状严重程度,生活质量和不良事件;次要结局侧重于骨健康和停止治疗.
主要成果:
- 与安慰剂相比,没有添加回复的GnRH激动剂显著改善了全球PMS症状 (高确定性证据).
- 没有添加回收的GnRH激动剂与更年期副作用的风险增加和研究撤回有关 (低至高确定性证据).
- 关于补充疗法 (提博,雌激素/孕激素) 在减少副作用或维持症状缓解方面的疗效的证据有限,并且往往不准确 (非常低至低确定性证据).
结论:
- 没有添加背后的GnRH激动剂可为PMS症状提供短期缓解,但受到更年期副作用和潜在的骨质疏松症等长期并发症的限制.
- 目前还没有足够的证据来证实,补充疗法是否可以减轻副作用,而不会影响PMS的GnRH激动剂的疗效.
- 需要进行更多的高质量的RCT和长期随访,以确定GnRH激动剂的安全性和有效性,并为PMS管理添加回疗法.
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