| Objective To evaluate the effectiveness and safety of different doses of Menopausal Hormone Therapy(MHT),and to explore the benefits and risks of low dose and ultra-low dose MHT drugs for treating perimenopausal syndrome and the timing of MHT reduction.Methods 1.A retrospective analysis of 135 perimenopausal and early menopausal women from January 2016 to December 2020 at our Hospital who suffered from perimenopausal syndrome and received MHT.The age of first visit was 40-60 years old.According to the different doses of estrogen in the MHT regimen,the patients were divided into 2 groups:group A(low dose group,N=100),and group B(ultra-low dose group,N=35).According to different cyclic medication regimens,they are divided into two subgroups.The group A1 uses the cycle sequential method(17 β-estradiol 1.0 mg+dydrogesterone 10.0 mg after the cycle 14 days,N=50),and the group A2 uses continuous combination Method(17 β-estradiol 1.0 mg+drospirenone 2.0 mg,N=50);The group B1 used the cycle sequential method(17 β-estradiol tablets 0.5 mg+dydrogesterone 5.0 mg from 14 days after the cycle,N=18),and the group B2 used the continuous combination method(17 β-estradiol tablets 0.5 mg+drospirenone 1.0 mg),N=17).Record the modified Kupperman index of each group before treatment and after 6 cycles of treatment 12 cycles of treatment.Record the sex hormone levels,lipid metabolism indicators,glucose metabolism indicators,endometrial thickness,Breast imaging reporting and data system changes before treatment and after 12 cycles of treatment.And the occurrence of adverse reactions in each group.2.An observational study was conducted on 50 perimenopausal syndrome patients currently using ultra-low doses.Among them,17 patients started MHT treatment with ultra-low doses.For the remaining 33 patients,the MHT treatment time ranged from 2 months to 6 years from low-dose reduction to ultra-low-dose,and analyze the age,timing,modified Kupperman score before and after the use of ultra-low dose,and the occurrence of adverse reactions.,To discuss the best time to use ultra-low doses.Results Group by estrogen dose:1.1 The modified Kupperman index after 6 cycles and 12 cycles of treatment in each group were significantly lower than before treatment(P<0.05).After 6 cycles and 12 cycles of treatment,there was no significant difference in modified Kupperman index between group A1 and B1(P>0.05);After 6 cycles and 12 cycles of treatment,group A2 and group B2 had no significant difference in modified Kupperman index(P>0.05).1.2 After 12 cycles of treatment,the levels of Follicle Stimulating Hormone(FSH)and Luteinizing Hormone(LH)in groups A1 and A2 decreased and the level of Estradiol(E2)increased compared with before treatment(P<0.05);There was no significant difference in FSH、LH and E2 levels compared with before treatment in group B1(P>0.05).FSH in group B2 was lower than before treatment(P<0.05),and there was no significant difference in LH and E2 levels(P>0.05).After 12 cycles of treatment,the FSH level in group A1 was lower than that in group B1(P<0.05),and the levels of LH and E2 did not change significantly(P>0.05);After 12 cycles of treatment,the levels of FSH and LH in group A2 were lower than those in group B2(P<0.05).There was no significant change in E2 level(P>0.05).1.3 After 12 cycles of treatment,Fasting Insulin(FINS)in group A1 decreased compared with before treatment,and High Density Lipoprotein-Cholesterol(HDL-C)increased compared with before treatment(P<0.05);Fasting Plasma Glucose(FPG)in group A2 increased compared with before treatment(P<0.05);HDL-C in group B1 decreased compared with before treatment(P<0.05);total cholesterol(TC)in group B2 decreased compared with before treatment(P<0.05).The remaining glucose and lipid metabolism indexes of each group had no significant difference compared with those before treatment(P>0.05).After 12 cycles of treatment,there were no significant differences in the glucose and lipid metabolism indexes between the A1 group and the B1 group(P>0.05);After 12 cycles of treatment,the FPG and TG levels in the A2 group were higher than those in the B2 group(P<0.05),and the other glucose and lipid metabolism indexes were all There is no significant difference(P>0.05).1.4 After 12 cycles of treatment,the BMD values of A1 and B1 groups had no significant difference compared with those before treatment(P>0.05);the BMD values of A2 and B2 groups were higher than those before treatment(P<0.05).After 12 cycles of treatment,there was no significant difference in BMD value between group A1 and group B1(P>0.05);After 12 cycles of treatment,group A2 and group B2 had no significant difference in BMD value(P>0.05).1.5 After 12 cycles of treatment,the endometrial thickness of each group had no significant difference compared with that before treatment(,P>0.05).After 12 cycles of treatment,there was no significant difference in endometrial thickness between group A1 and group B1(P>0.05);After 12 cycles of treatment,there was no significant difference in endometrial thickness between group A2 and group B2(P>0.05).1.6 After 12 cycles of treatment,the Breast imaging reporting and data system of each group of had no significant difference compared with that before treatment(P>0.05).After 12 cycles of treatment,there was no significant difference in the Breast imaging reporting and data system between A1 group and B1 group(P>0.05);After 12 cycles of treatment,there was no significant difference between A2 group and B2 group in the Breast imaging reporting and data system(P>0.05).1.7 After 12 cycles of treatment,there were 5 cases of breast tenderness(10.00%),8 cases of vaginal bleeding(16.00%)in group A1;4 cases of breast tenderness(8.00%),7 cases of vaginal bleeding(14.00%)in group A2;1 cases of vaginal bleeding(5.56%)in group B1;1 cases of vaginal bleeding(5.89%)in group B2;.After 12 cycles of treatment,there was no significant difference in the incidence of breast tenderness and vaginal bleeding between group A1 and B1(P>0.05);after 12 cycles of treatment,there was no significant difference in the incidence of breast tenderness and vaginal bleeding between group A2 and B2(P>0.05).2 A study of 50 perimenopausal and early menopausal women currently using ultra-low doses.The age of the research subjects at menopause was concentrated at 48.8±4.0 years,and the age at the time of using ultra-low doses was concentrated at 52.0 ± 4.1 years.The modified Kupperman index was concentrated at 6.00 points(2.00,18.75)before the ultra-low dose,and the modified Kupperman index was concentrated at 7.00 points(4.00,10.25)after the ultra-low dose for half a year.There was no significant difference in the modified Kupperman score before and after the ultra-low dose was used Learning significance(P=0.126).Conclusion Ultra-low-dose MHT therapy may not be as good as low-dose in stabilizing glucose metabolism and improving sex hormone levels,may be better than low-dose in improving TG levels.Ultra-low-dose has better tolerability.Both can effectively relieve perimenopausal symptoms.The drospirenone+17 β estradiol regimen may have better than the dydrogesterone+17 β estradiol regimen in bone mineral density protection.Clinically,ultra-low doses can be considered for older patients with well-controlled menopausal symptoms. |
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