Effects of progestogens used in menopause hormone therapy on the normal breast and benign breast disease in postmenopausal women

Abstract

Hormone replacement therapy in menopause is used to improve climacteric syndrome in women whose quality of life is affected. However, given the wide variety of progestogens available, it is important to evaluate their differential benign changes (radiological, cellular, and clinical) on the breast. This review aimed to determine the different benign changes of progestogens used in postmenopausal combined hormone therapy on the breast (radiological, cellular, and clinical), in women without mammary pathology, in order to establish their safety profile. A systematic review of the literature was carried out with a balanced search strategy for the identification of relevant references in the MEDLINE, BVSalud, EMBASE, ProQuest, and Cochrane databases until November 2019. The search terms used were ‘menopause’ or ‘hormonal replacement therapy’ or ‘progestins’ or ‘estrogen’ or ‘mastodynia’ or ‘benign breast disease’ or ‘mammography’. Data were collected from the ‘eligible’ articles by two researchers (ARF and SHA), and possible discrepancies in inclusion were resolved by consensus. A total of 1886 articles were identified; 60 full-text articles were reviewed, and 17 articles that met the inclusion criteria were included for the qualitative analysis. In conclusion, combined hormone replacement therapy is associated with benign effects on the breast, such as mastodynia and increased mammographic density.

摘要

更年期激素替代疗法用于改善更年期综合征妇女受到影响的生活质量。然而, 鉴于孕激素种类繁多, 评估其在乳房上的良性变化(放射、细胞和临床)非常重要。本综述旨在确定绝经后联合激素治疗中使用的孕激素在无乳腺病变的妇女中的不同良性变化(放射、细胞和临床), 以确定其安全性。截至2019年11月, 在MEDLINE、BVSalud、EMBASE、ProQuest和Cochrane数据库中采用平衡搜索策略检索相关参考文献。使用的搜索术语是“绝经”或“激素替代治疗”或“孕激素”或“雌激素”或“乳房疼痛”或“良性乳腺疾病”或“乳房X线检查”。两个研究人员(ARF和SHA)从“合格”文章中收集数据, 通过协商一致解决了纳入中可能存在的差异。共鉴定出1886篇文章；对60篇全文文章进行了审查, 并纳入了17篇符合纳入标准的文章进行定性分析。总之, 联合激素替代治疗与对乳房的良性影响有关, 如乳房疼痛和乳房X检查密度增加。

Keywords:

• Menopause
• climacteric
• hormone replacement therapy
• combined therapy
• progestin
• progestogens
• breast density
• mastodynia

Potential conflict of interest

The authors of this systematic review declare themselves free of conflicts of interest. No laboratory or pharmaceutical company was involved in the scientific or economic development of this study.

Source of funding

Nil.