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폐경 후 여성의 에스트로젠 보충요법시 병합 투여된 프로제스테론이 골밀도에 미치는 영향
채희동,김광례,서창석,최영민,김석현,신창제,김정구,문신용,이진용 대한폐경학회 1997 대한폐경학회지 Vol.3 No.1
It is well established that estrogen replacement therapy prevents the bone loss associated with postmenopausal state. And progestogens used alone, given in larger amount than that in estrogen replacement therapy, have been shown to reduce the postmenopausal bone loss. However, the impacts of added progestogen during estrogen replacement therapy on the bone mineral densities(BMD) are not well known. For this purpose, we analysed the changes in BMD of 104 postmenopausal women who underwent estrogen replacement therapy at least for 12 months: 36 women received estrogen only(Premarin 0.625mg/day), 41 women received estrogen with cyclic addition of progestogen(medroxyprogesterone, MPA, 10mg/day for 12 days per month), 27 women received estrogen with daily addition of progestogen(MPA 2.5mg daily). Our data revealed that continuous use of MPA in addition to estrogen for one year significantly increased the BMD of lumbar spines(L2-4) by 7.6±1.9% compared to that of before treatment while therapy with estrogen only did not(1.7±1.0%). Also cyclic addition of MPA for one year increased the BMD of lumbar spines by 6.2±1.3% compared to that of before treatment. And the increases in BMD of lumar spines derived from continuous or cyclic use of MPA in addition to estrogen were significantly greater than that from therapy with estrogen only. There was no significant difference in increases in BMD of lumbar spines between cyclic use and continuous use of MPA. And there was no significant difference in increases in BMD of femur neck among three groups. The patients who showed a decrease in BMD by more than 3% at 12 months of treatment compared to pretreatment were as follows: In BMD of lumbar spines, 16.7%(6/36) in therapy with estrogen-only, 2.4%(1/41) in the cyclic use of MPA, 3.7%(1/27) in the continuous use of MPA; In BMD of femur neck, 25.0%(9/36) in therapy with estrogen-only, 22.0%(9/41) in the cyclic use of MPA, 11.1%(3/27) in the continuous use of MPA. The unine calcium/creatinine ratio decreased during therapy in all gropus without a significant difference among three groups. These data showed that added progestogen(MPA) during estrogen replacement therapy significantly increased the bone mineral densities(BMD) of lumbar spines, and suggest that the continuous combined regimen of estrogen and progestogen may be the regimen of choice for the prevention or treatment of postmenopausal osteoporosis
Outcomes of Fertility Preservation for Female Cancer Patients in a Single Tertiary Center
채희동,김주희,Hana Saeed Alzahrani,이사라,김성훈 연세대학교의과대학 2023 Yonsei medical journal Vol.64 No.8
Purpose: To report our experience of fertility preservation (FP) in female cancer patients. Materials and Methods: We retrospectively analyzed the medical records of female who underwent elective oocyte or embryo cryopreservation before cancer treatment between January 2015 and December 2020 at Asan Medical Center. We analyzed the type of cancer, the rate of reuse of cryopreserved oocytes or embryos, and fertility outcomes such as the resumption of menstrua tion or pregnancy. Results: A total of 174 patients underwent 182 oocyte retrieval cycles after controlled ovarian stimulation for oocyte or embryo cryopreservation. The median age of patients was 33.0 (range 19–46) years, and the patients were most unmarried female (65.52%). The majority of patients were diagnosed with breast cancer (78.16%), and the remaining were diagnosed with gastroin testinal (6.33%) and hematologic malignancies (5.75%). The maturation rate of oocyte cryopreservation was 83.33%, and the fertil ization rate of embryo cryopreservation was 72.07%. Of the 57 patients currently not undergoing cancer treatment, 34 resumed menstruating and 19 (33.33%, 19/57) returned to attempt a pregnancy. Among them, five patients succeeded in natural pregnancy. Eleven patients received frozen-thawed embryo transfer, and four patients succeeded in becoming pregnant (36.36%, 4/11). Only 6.3% of patients returned to use their gametes, and 93.7% of gametes are still in storage. Conclusion: FP in cancer patients should be considered before cancer treatment. Through continuous research on oncofertility, it is necessary to consider how to increase the return rate and provide appropriate information to cancer patients of reproduc tive age.