The role of hormone replacement therapy in endometrial polyp formation
The role of hormone replacement therapy in endometrial polyp formation
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DOI：
10.1016/j.maturitas.2004.06.002
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发表时间：
2005-03-14
期刊：
影响因子：
4.9
通讯作者：
Mollamahmutoglu, L
中科院分区：
文献类型：
--
作者：
Oguz, S;Sargin, A;Mollamahmutoglu, L
目的：评估不同方案的激素替代治疗（HRT）对子宫内膜息肉形成的医源性影响，调整其他因素的混杂效应，如年龄、产次、体重和绝经状态。方法：2685例绝经期患者中，375例（13.9%）符合条件。患者被随机分为三种HRT类型，并形成三个相等的组。第一组接受Premelle 2.5 mg（组-I）（0.625 mg结合雌激素+2.5 mg甲羟孕酮），第二组接受Kliogest（组-II）（2 mg雌二醇+1 mg炔诺酮），最后一组接受Livial（组-III）（2.5 mg替勃龙），至少持续36个月，不间断。术后18个月行宫腔镜检查，每6个月复查一次，直至术后第3年，以发现新的和复发的子宫内膜息肉。结果：多元回归分析显示，HRT类型、绝经晚、肥胖增加了子宫内膜息肉的发生。在组I中检测到5个息肉，在组II中检测到10个息肉，在组III中检测到2个息肉。G-II组与G-I组、G-II组与G-III组比较差异有统计学意义（P < 0.05），G-I组与G-III组比较差异无统计学意义（P > 0.05）。第3、4次宫腔镜检查息肉检出率为82.3%。子宫内膜息肉复发4例（23.5%），其中G-I期1例，G-II期3例，差异无统计学意义（P > 0.05）。所有标本均未检出恶性肿瘤。结论：子宫内膜息肉的形成可能与雌孕激素的种类和剂量有关。特别是具有高抗雌激素活性的孕激素可能在子宫内膜息肉的发展中起重要的预防作用。(c)2004爱思唯尔爱尔兰有限公司保留所有权利。
Objective: To evaluate the iatrogenic effect of different protocols of hormone replacement therapy (HRT) on endometrial polyp formation adjusting for the confounding effects of other factors such as age, parity, weight and menopausal status at menopause. Methods: Out of 2685 menopause patients 375 (13.9%) eligible patients were enrolled. Patients were randomized to three HRT types and three equal groups were formed. The first group received Premelle 2.5 mg (Group-I) (0.625 mg conjugated estrogen + 2.5 nag medroxyprogestorone), the second received Kliogest (Group-II) (2 mg estradiol + 1 mg norethisterone) and the last received Livial (Group-III) (2.5 mg tibolone) at least for 36 months without giving a break. After the first 18 months patients had their first office hysteroscopy and it was repeated in every 6 months until the end of third year to find out new and recurrent endometrial polyps. Results: Multiple regression analysis revealed that the type of HRT, late menopause and obesity increased the occurrence of endometrial polyps. In Group-I five polyps, in Group-II ten polyps and in Group-Ill two polyps were detected. There were significant differences between G-II and G-I and G-II and G-III (P < 0.05), but there was no significant difference between G-I and G-III (P > 0.05). 82.3% of the polyps were detected in the third and fourth hysteroscopic examinations. Endometrial polyp recurrence was encountered in 4 (23.5%) patients, 1 in G-I and 3 in G-II without a significant difference (P > 0.05). No malignancy was detected in any of the specimen. Conclusion: We observed that endometrial polyp formation may be dependent on the type and dosage of the estrogen and progestogen. Especially a progestogen with high antiestrogenic activity may play an important preventive role in the development of endometrial polyps. (c) 2004 Elsevier Ireland Ltd. All rights reserved.