Progestogens for endometrial protection in combined menopausal hormone therapy: A systematic review

IF 6.1 1区医学 Q1 ENDOCRINOLOGY & METABOLISM Best practice & research. Clinical endocrinology & metabolism Pub Date : 2024-01-01 DOI:10.1016/j.beem.2023.101815

Petra Stute (Deputy Head Gynecological Endocrinology and Reproductive Medicine) , Linus Josef Walker (Medical Doctoral Student) , Astrid Eicher (Medical Doctoral Student) , Elena Pavicic (Medical Doctoral Student) , Argyrios Kolokythas (Gynecologic Reproductive Endocrinology and Infertility Fellow) , Susanne Theis (Senior Physician Gynecological Endocrinology and Reproductive Medicine) , Marc von Gernler (Information Specialist) , Michael von Wolff (Head Gynecological Endocrinology and Reproductive Medicine) , Sabrina Vollrath (Senior Physician Gynecological Endocrinology and Reproductive Medicine)

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Abstract

Menopausal women with an intact uterus choosing estrogens for menopausal symptom relief require a progestogen for endometrial protection. The aim of this systematic review was to evaluate the risks of endometrial hyperplasia resp. malignancy with different progestogens used in combined MHT. Overall, 84 RCTs were included. We found that 1) most studies were done with NETA, followed by MPA, MP and DYD and LNG, 2) most progestogens were only available as oral formulations, 3) the most frequently studied progestogens (oral MP, DYD, MPA, oral and transdermal NETA, transdermal LNG) were assessed in continuously as well as in sequentially combined MHT regimens, 4) FDA endometrial safety criteria were only fulfilled for some progestogen formulations, 5) most studies demonstrated endometrial protection for the progestogen dose and time period examined. However, 6) study quality varied which should be taken into account, when choosing a combined MHT, especially if off-label-use is chosen.

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更年期激素联合疗法中用于保护子宫内膜的孕激素：系统综述

子宫完整的更年期妇女在选择雌激素缓解更年期症状时，需要使用孕激素来保护子宫内膜。本系统综述旨在评估在联合 MHT 中使用不同孕激素导致子宫内膜增生和恶性肿瘤的风险。共纳入了 84 项 RCT 研究。我们发现：1）大多数研究都是针对 NETA 进行的，其次是 MPA、MP、DYD 和 LNG；2）大多数孕激素只有口服制剂；3）最常研究的孕激素（口服 MP、DYD、MPA、口服和透皮 NETA、透皮 LNG、MP、DYD 和 LNG）都是评估子宫内膜增生和恶性肿瘤风险的药物、4）只有部分孕激素制剂符合美国食品及药物管理局的子宫内膜安全性标准，5）大多数研究表明，在所研究的孕激素剂量和时间段内，对子宫内膜有保护作用。然而，6）研究质量参差不齐，在选择联合 MHT 时应加以考虑，尤其是在标签外使用的情况下。

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来源期刊

Best practice & research. Clinical endocrinology & metabolism 医学-内分泌学与代谢

CiteScore

11.90

自引率

0.00%

发文量

审稿时长

6-12 weeks

期刊介绍： Best Practice & Research Clinical Endocrinology & Metabolism is a serial publication that integrates the latest original research findings into evidence-based review articles. These articles aim to address key clinical issues related to diagnosis, treatment, and patient management. Each issue adopts a problem-oriented approach, focusing on key questions and clearly outlining what is known while identifying areas for future research. Practical management strategies are described to facilitate application to individual patients. The series targets physicians in practice or training.