Increase of estrogen dose deteriorates mood during progestin phase in sequential hormonal therapy
Increase of estrogen dose deteriorates mood during progestin phase in sequential hormonal therapy
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DOI：
10.1210/jc.2002-020755
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发表时间：
2003-05-01
影响因子：
5.8
通讯作者：
Bäckström, T
中科院分区：
文献类型：
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作者：
Björn, I;Sundström-Poromaa, IS;Bäckström, T
先前的研究表明，在序贯激素替代疗法（HRT）中添加黄体酮会导致负面情绪和身体症状。经前综合征的病史、黄体酮的类型和黄体酮的剂量迄今已被证明会影响激素替代治疗期间黄体酮引起的不良情绪症状。本研究的目的是比较两种不同剂量的雌二醇联合黄体酮在绝经后激素替代治疗期间对情绪的不良影响。在这项随机、双盲、交叉研究中，28名围绝经期妇女在每个治疗周期的第17-28天连续服用2毫克或3毫克雌二醇，并添加10毫克醋酸甲孕酮。主要的结果测量是情绪和身体症状保持在每日评定量表上。与黄体酮一起，高剂量的雌激素引起的负性情绪症状明显多于低剂量。3 mg雌二醇在黄体酮周期的紧张、易怒和抑郁情绪均显著增强（P< 0.001）。在3mg雌二醇周期的黄体酮期，身体症状也增加（P< 0.001），而积极情绪症状受影响较小。阳性情绪随雌激素剂量改变的唯一因素是友好情绪，在高雌二醇周期的孕激素期与低雌二醇周期的孕激素期相比，友好情绪有所下降（P < 0.05）。我们的结论是，在序贯激素治疗的黄体酮期，雌激素剂量的增加加重了负面情绪和身体症状。
Previous studies have indicated that the addition of progestins during sequential hormonal replacement therapy (HRT) causes negative mood and physical symptoms. History of premenstrual syndrome, type of progestin, and dose of progestin have thus far been shown to influence the progestin-induced adverse mood symptoms during HRT.The aim of this study was to compare adverse mood effects of two different doses of estradiol, in combination with a progestin, during postmenopausal HRT. Twenty-eight perimenopausal women were included in this randomized, double-blind, crossover study comparing 2- or 3-mg continuous estradiol, with an addition of 10 mg medroxyprogesterone acetate on d 17-28 during each treatment cycle. The main outcome measures were mood and physical symptoms kept on a daily rating scale. Together with the progestin, the higher dose of estrogen caused significantly more negative mood symptoms than the lower dose. Tension, irritability, and depressed mood were all significantly augmented during the progestin phase of cycles with 3 mg estradiol ( P< 0.001). Physical symptoms also increased during the progestin phase of 3-mg estradiol cycles ( P< 0.001), whereas positive mood symptoms were less affected. The only positive mood that changed with estrogen dose was friendliness, which decreased during the progestin phase of high estradiol cycles compared with cycles with lower estradiol ( P < 0.05).Our conclusion is that an increase of the estrogen dose accentuates negative mood and physical symptoms during the progestin phase of sequential hormonal therapy.