Symptom experience after discontinuing use of estrogen plus progestin
Symptom experience after discontinuing use of estrogen plus progestin
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DOI：
10.1001/jama.294.2.183
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发表时间：
2005-07-13
影响因子：
120.7
通讯作者：
Hays, J
中科院分区：
文献类型：
--
作者：
Ockene, JK;Barad, DH;Hays, J
背景对妇女停止绝经期激素治疗后的经历知之甚少。目的描述在一项大型雌激素加炔雌醇试验中妇女停止干预后的症状和管理策略。设计、设置和参与者对8405名妇女进行横断面调查（89.9%; N = 9351），仍在服用研究药物（结合马雌激素加甲羟孕酮[CEE + MPA]或安慰剂）当雌激素加孕激素干预（妇女健康倡议）停止时。调查在停止日期后8至12个月邮寄。Logistic回归模型血管痉挛症状和疼痛或僵硬症状作为功能的前治疗和基线symptoms.Main结果测量症状（血管痉挛或疼痛和僵硬）和管理strategy.Results响应者的平均（SD）年龄在试验停止日期为69.1（6.7）岁。他们平均服用了5.7年的学习药丸。总体而言，21.2%的前CEE + MPA和4.8%的安慰剂组受访者报告了停用研究药物后的中度或重度血管痉挛症状，基线时（随机化）分别有55.5%和21.3%的受访者报告了这些症状。与前安慰剂组的受访者相比，前CEE + MPA组的受访者更有可能出现中度或重度血管痉挛症状（校正比值比[AOR] 5.82; 95%置信区间[CI]，4.92-6.89）和疼痛或僵硬症状（AOR，2.16; 95% CI，1.95-2.40）。在基线时有这些症状的女性中，血管痉挛症状（AOR，5.36; 95% CI，4.51-6.38）和疼痛或僵硬症状（AOR，3.21; 95% CI，2.90-3.56）也更可能发生。妇女报告了广泛的战略，以管理symptoms.Conclusions超过一半的女性血管痉挛症状随机活动CEE + MPA也报告了这些症状后，停止使用的研究药丸。然而，这些参与者不包括不愿意被随机分组或早些时候停止服用研究药物的女性。当建议妇女用尽可能短的时间激素治疗更年期症状时，应考虑这些发现。研究替代策略来管理更年期症状是必要的。
Context Little is known about women's experiences after stopping menopausal hormone therapy.Objective To describe women's symptoms and management strategies after stopping the intervention in a large estrogen plus progestin trial.Design, Setting, and Participants Cross-sectional survey of 8405 women (89.9%; N = 9351) at 40 clinical centers who were still taking study pills (conjugated equine estrogens plus medroxyprogesterone [CEE + MPA] or placebo) when the estrogen plus progestin intervention (Women's Health Initiative) was stopped. Surveys were mailed 8 to 12 months after the stop date. Logistic regression was used to model vasomotor symptoms and pain or stiffness symptoms as functions of former treatment and baseline symptoms, adjusted for appropriate covariates.Main Outcome Measures Symptoms (vasomotor or pain and stiffness) and management strategies.Results Respondents' mean (SD) age at trial stop date was 69.1 (6.7) years. They averaged 5.7 years of taking study pills. Moderate or severe vasomotor symptoms after discontinuing study pill use were reported by 21.2% of former CEE + MPA and 4.8% of placebo group respondents overall and by 55.5% and 21.3%, respectively, with these symptoms at baseline (randomization). Compared with respondents in the former placebo group, moderate or severe vasomotor symptoms (adjusted odds ratio [AOR] 5.82; 95% confidence interval [CI], 4.92-6.89) and pain or stiffness symptoms (AOR, 2.16; 95% Cl, 1.95-2.40) were more likely in respondents in the former CEE + MPA group. Both vasomotor symptoms (AOR, 5.36; 95% Cl, 4.51-6.38) and pain or stiffness symptoms (AOR, 3.21; 95% Cl, 2.90-3.56) also were more likely in women with these symptoms at baseline. Women reported a wide range of strategies to manage symptoms.Conclusions More than half of the women with vasomotor symptoms at randomization to active CEE + MPA also reported these symptoms after discontinuing use of the study pills. However, these participants did not include women who were unwilling to be randomized or who had stopped taking the study pills earlier. These findings should be considered when advising women to treat menopausal symptoms with hormone therapy for as short duration as possible. Investigation of alternative strategies to manage menopausal symptoms is warranted.