| Objective:To evaluate the efficacy and safety of different doses of menopausal hormone therapy(MHT)in perimenopausal women with menopausal symptoms.Methods:A retrospective analysis of 2437 cases of perimenopausal syndrome in the gynecologic endocrinology clinic from 2012 to 2017.450 perimenopausal women who received MHT were enrolled in this study.The patients were divided into three groups:A(the standard dose group,n=62),B(the low-dose group,n= 322)and C(the ultralow-dose group,n=66).28 days were regarded as one treatment cycle.The continuous sequential regimen were used.Reproductive hormones,clinical biochemical assays,modified Kupperman menopausal index(mKMI),breast ultrasonography were performed prior to medication.After one cycle and three cycles of treatment,reproductive hormone assays and mKMI were performed.After six cycles of treatment,reproductive hormones,clinical biochemical measurements,and mKMI were reassessed and breast ultrasound,or mammography were examined.The occurrence of breast tenderness was recorded.Results:Before treatment,there was no significant difference in general characters and all clinical observation indexes among the 3 groups(p>0.05 for all).After 1,3 and 6 cycles,the mKMI scores of 3 groups were all significantly decreased(p<0.001 for all).The mKMI scores among groups were statistically significant(p =0.014)after 6 cycles.For 3 groups,the follicle stimulating hormone(FSH)decreased significantly,and the estradiol(E2)increased significantly after 1,3,and 6 cycles of treatment(p<0.001 for all).There was no change in high-density lipoprotein cholesterol(HDL-C)levels before and after treatment in group A(p>0.05).HDL-C levels in group B and C increased significantly after treatment(p<0.01 for both).Low-density lipoprotein cholesterol(LDL-C)levels in group A and B decreased significantly after 6 treatment(p<0.01 for both).There was no change in LDL-C levels(p>0.05)before and after treatment in group C.The fasting blood glucose and fasting insulin in group A and B were decreased after treatment(p<0.01 for all).There were no changes in the thickness,size and dilatation of mammary glands for 3 groups before and after treatment(p>0.05 for all).7 cases(10.6%)in group A,14 in group B(4.3%)and 1 in group C(1.6%)had breast distention,but the difference was not statistically significant(p =0.063).Conclusions:The different doses of MHT could effectively relieve the menopausal symptoms in perimenopausal women.The standard-dose and low-dose MHT were superior to the ultralow-dose MHT in improving metabolism.The ultralow-dose MHT had advantages in tolerance.The different doses of MHT in the observation period had no effect on the breast.Therefore,menopausal women with different symptoms should weigh the advantages and disadvantages and develop individualized treatment plans. |
