口服避孕药的新序贯服法

序贯服法是在周期的头15天服雌激素,然后接着服5—6天的雌激素和孕激素复合片。这种服法副作用小,但失败率比复合片高,可能是由于前半个周期单用雌激素,精子仍可以较容易穿透宫颈粘液。为此,本文报道了一种新的序贯服法:头7天,每天服用50微克炔雌醇,以后的15天,每天服用50微克炔雌醇和1毫克3-去氧炔诺酮复合片,继之停药6天。在62名健康育龄的妇女,总计为554周期中(最长使用12周期),无1例妊娠。月经周期均控制在23—26天,其中92.4%为24—25天,仅有     

口服妈富隆并延长氯米芬用药时间治疗耐氯米芬的无排卵患者

目的评价常规服用氯米芬促排卵失败的妇女口服避孕药妈富隆配合延长氯米芬服用时间促排卵的治疗效果。方法114例患者在采用传统方法促排卵连续3个周期失败后,改服妈富隆2个周期以上。自停药后月经第5天开始服用氯米芬(50mg/d)促排卵,阴道B超(TVS)监测记录卵泡生长,至出现优势卵泡停服。B超监测排卵经过以及子宫内膜厚度的变化。结果114例患者在服用氯米芬5天后有37例出现优势卵泡,35例成功排卵,2例出现卵泡黄素化未破裂综合征(LUFS);延长服药时间后又有34例成功排卵,17例出现LUFS,13例出现卵泡发育,但未形成优势卵泡即闭锁;13例无卵泡发育。结论对于耐氯米芬的无排卵患者口服妈富隆联合延长氯米芬服药时间,是一种有效的促排卵方案。     

宫腔粘连综合治疗218例预后分析

目的探讨以宫腔镜电切术为主的综合治疗方法对宫腔粘连(intrauterine adhesion,IUA)预后的影响。方法对2010年1月至2013年6月湖北省妇幼保健院因IUA行电切手术的218例患者临床资料进行回顾性分析。各程度IUA根据术后补充雌激素剂量和周期数不同分为3组,A组9 mg/d,服用3周期;B组6 mg/d,服用2周期;C组4 mg/d,服用1周期。观察3周期后月经恢复及宫腔情况并随访妊娠结局。结果宫腔恢复良好86.2%(188/218),月经改善75.7%(165/218);随访8~46个月,受孕44.5%(97/218),活产48.5%(47/97)。Ⅱ度与Ⅲ度IUA的宫腔恢复率、月经改善率差异无统计学意义(P0.05),但二者与Ⅳ度以上IUA的宫腔恢复率、月经改善率差异均有统计学意义(P0.05)。在相同程度IUA中A、B、C 3组比较,宫腔恢复率、月经改善率差异均无统计学意义(P0.05)。结论以宫腔镜电切术为主的综合治疗方法对IUA治疗效果良好;轻、中度IUA预后明显好于重度IUA;适当减少雌激素剂量,缩短治疗周期对IUA预后无明显影响。     

醋炔诺酮肟探亲片的临床报告

本文报道了醋炔诺酮肟探亲片的临床应用,结果表明,本品适用于两地分居的夫妇探亲时妇女服用,可以阻止妊娠。用法是探亲当天给妇女口服本品2mg,以后每天1mg,探亲结束后继续服用2天。共试用604例妇女,计825个周期,避孕有效率高达99.75%(以周期数计)。用药后月经周期、经期、经量变化轻微,月经期间出血和撤退性出血发生率为2.16%。观察表明,本品为一新型探亲避孕片,具有避孕效率高、副反应小、服用简便等优点,值得进一步研究。     

药物流产中复方米非司酮服药方法的临床研究

目的:探讨复方米非司酮不同使用方法终止早孕的效果与安全性。方法:停经≤49d的早孕妇女120例,随机分为3组,A组服用复方米非司酮1片/24h×2d;B组服用复方米非司酮1片/12h×1d;C组服用米非司酮,晨2片,晚1片,共2d,3组均于前一药服完后d2服米索前列醇600μg,观察孕囊排出情况、出血时间、出血量及服药后的副反应,了解转经情况。结果:A、B、C组完全流产率和胃肠道副反应均无显著差异。孕囊排出时间和转经时间A、B组与C组间有差异(P<0.05),而A、B组间无显著差异。结论:复方米非司酮与米非司酮相比可加速孕囊排出,减少出血量和出血时间,提高完全流产效果;其中复方米非司酮一日疗法更为显著。     

Sulpiride诱导的高催乳素血症的反馈机理

许多血清催乳素水平升高的生理及病理情况通常伴有无排卵及闭经,但高催乳素血症时无排卵的发病机理并未弄清,有报导在闭经溢乳和在Shlpiride引起的高催乳素血症时,雌激素反馈异常。本文观察口服Sulpiride引致高催乳素血症的月经正常妇女注射雌激素后的促性腺素释放反应。作者在5例周期规律,催乳素水平正常的妇女于周期第6～16天给予口服Sulpiride150mg/日(50mg tid),引起中度高催乳素血症,从而研究雌激素对促性腺释放的反馈作用。对服用Sulpiride3～18个月(150mg/日)有慢性明显高催乳素血     

长效口服避孕片复方十八甲对家兔脂代谢的影响

本文观察了15只雌性家兔服用复方十八甲后血脂指标的变化(OC 组)。另15只家兔服可溶性淀粉赋形剂作为对照组。实验家兔每四周给药一次,2片/只,于每服药周期的中、末期(即每周期的第2周和第4周)取空腹血测定血清脂质含量变化。连继观察28周,结果发现服用复方十八甲家兔的血清HDL-C、HDL_2-C 水平、HDL_2-C/HDL_3-C 及HDL-C/TCh 比值均明显高于对照组(P<0.05);而TCh、LDL-C 及致动脉粥样硬化指数等值明显低于对照组(P<0.05)。结果提示复方十八甲对家兔脂代谢产生良好影响。     

新型口服避孕药屈螺酮炔雌醇片的多中心随机对照临床观察

目的 观察屈螺酮炔雌醇片(商品名:优思明)用于健康育龄期妇女的避孕效果、出血模式、副作用及避孕以外的其他作用.方法 采用多中心随机对照的研究方法对768例要求避孕的健康育龄期妇女,以3:1的比例随机分配到屈螺酮组(服用屈螺酮炔雌醇片,573例)和去氧孕烯组(服用去氧孕烯-炔雌醇,195例),均服药13个周期,在服药后的第4、7、10和13个周期进行随访,观察身高、体重、月经情况等.在服药前和服药后第7、13个周期完成月经不适问卷(MDQ).结果 屈螺酮组的方法失败率(Pearl指数)为0.208/百妇女年,优于去氧孕烯组的0.601/百妇女年.两组受试者的出血模式相似,发生出血和(或)点滴出血、仅有点滴出血的天数、次数及每次出血最长时间在各个参考时相基本相似.第7个周期与服药前比较,两组受试者用药后在经期水潴留和食欲增加方面的MDQ量表评分变化、月经间期水潴留和身心健康感方面的MDQ量表评分变化,屈螺酮组(分别为-0.297、-0.057、0.033、0.150分)较去氧孕烯组(分别为-0.108、0.023、0.231、-0.023分)改善明显,两组分别比较,差异均有统计学意义(P<0.05).在皮肤异常方面,第13个周期月经前期时,屈螺酮组的改善率(18.0%,89/494)较去氧孕烯组(11.3%,19/168)明显增高,两组比较,差异有统计学意义(P<0.05);在乳房疼痛或触痛方面,在第7个周期经期时,屈螺酮组改善率(12.6%,62/494)较去氧孕烯组(5.4%,9/168)明显增高,两组比较,差异也有统计学意义(P<0.05).屈螺酮组妇女的体重呈下降趋势,去氧孕烯组反之;在第13个周期随访时,两组体重的变化(与服药前比较)分别为-0.28、0.57 kg,两组比较,差异有统计学意义(P<0.01).结论 屈螺酮炔雌醇片和去氧孕烯.炔雌醇均具有良好的避孕效果,出血模式相似,而在体重变化、经前期症状改善等方面,屈螺酮炔雌醇片优于去氧孕烯.炔雌醇.     

复方炔雌醚对育龄妇女肾上腺皮质功能的影响

对口服长效避孕药复方炔雌醚的育龄妇女进行了尿中皮质类固醇及血浆皮质醇浓度的测定,并与正常对照组(103例)作了比较。结果发现54例妇女服药半年后尿中17-OH水平降低,其中28例服药延长到一年时,尿中三类皮质激素(17-OH、17-KS 及17-KGS)浓度均减少。66例曾服复方炔雌醚片2年以上的妇女,尿中三类皮质激素水平亦降低。20例曾短期应用短效避孕药的妇女,血浆皮质醇浓度在正常范围,其中3例服用复方炔雌醚片7～8周期后,皮质醇水平明显升高。本研究提示上述变化可能与复方炔雌醚片对垂体—肾上腺皮质功能及皮质激素代谢酶系的影响有关。     

不同剂量替勃龙联合牡蛎碳酸钙片对绝经后妇女骨质疏松症影响的临床研究

目的：对绝经后妇女应用小剂量替勃龙联合牡蛎碳酸钙片为期3年的前瞻性研究。方法：服药剂量每日1.25mg（1/2量组）加牡蛎碳酸钙片3片50例和每日0.625mg（1/4量组）加牡蛎碳酸钙片3片50例。用于药前及药后每6个月随诊,分别观察骨密度、尿Ca/Cr比值、子宫大小、子宫内膜厚度,乳腺腺体密度变化、血生化检查等。结果：两组经SPA测量骨密度均有上升。其中1/2量组治疗后上升6.8%,与治疗前相比有显著差异（P〈0.001）,1/4量组治疗后上升2.3%,与治疗前相比无显著差异（P〉0.05）;两组尿Ca/Cr比值相应的下降率分别为10.2%与7.5%;两组子宫内膜厚度虽有所增加,但平均厚度均未超过0.5cm;两组乳腺腺体密度无明显变化;两组血生化值无明显差异。结论：绝经后妇女应用1/2量替勃龙联合牡蛎碳酸钙片3片可提高骨密度,1/4量替勃龙联合牡蛎碳酸钙片3片可维持骨量;对子宫内膜无明显刺激作用;对乳腺腺体密度无明显改变。结果显示替勃龙联合牡蛎碳酸钙片能有效地用于防治绝经后妇女骨质疏松症,副作用小,值得推广。     

三种低剂量、复方口服避孕药的临床比较性研究

本文应用随机化双盲法,对三种低剂量含雌、孕甾体激素避孕药(含18-甲基炔诺酮及炔雌醇的复方三相制剂,含18-甲基炔诺酮150μg及炔雌醇30μg的固定剂量制剂,含炔诺酮600μg及炔雌醇35μg的Ⅰ号避孕药)进行比较性研究。共收集合格健康育龄妇女279例;其中复方三相制剂96例,固定剂量制剂93例,Ⅰ号避孕药90例。按生命表法统计,其6个月的每百妇女累积续用率:复方三相制剂82.3,左旋18-甲基炔诺酮/炔雌醇固定剂量制剂81.6,Ⅰ号避孕药80.9,三组间在统计学上无显著差别。副反应的发生率,三组间亦甚相似。有关出血类型:在复方三相制刺中月经周期较为规则,滴血最为少见,行经期长度亦较少受影响。研究证实复方三相制剂是一种有效的低剂量口服避孕药,值得进一步研究。     

Abnormal uterine bleeding: medical treatment with vaginal danazol and five-year follow-up

STUDY OBJECTIVE: To evaluate the clinical efficacy and patient satisfaction of long-term danazol delivered vaginally as treatment for heavy menstrual bleeding. DESIGN: Prospective study (Canadian Task Force classification II-3). SETTING: University hospital. PATIENTS: Twenty premenopausal women with endometrial hyperplasia or endometrial polyps. INTERVENTION: After curettage or hysteroscopic-directed biopsies, women used one 200-mg tablet of danazol vaginally every day, continuing the therapy as long as they were totally satisfied with it. MEASUREMENTS AND MAIN RESULTS: Women were instructed to keep a diary of menstrual bleeding and to rate blood loss on a visual analog scale from zero (no blood loss) to 10 (gushing-type bleeding). They were seen every month for 3 months, then every 3 months for 9 months, and then every 6 months for 4 years for Papanicolau smear, pelvic examination, and transvaginal ultrasonography. They were asked to bring their diary of menstrual bleeding. They were asked about side effects and their satisfaction with the therapy. Peripheral blood was drawn for blood count and serum chemistries. Hysteroscopic-directed biopsies were repeated after 3 months of therapy in women with endometrial hyperplasia. The severity of blood loss was significantly reduced in all women after 3 months of treatment. All women with endometrial hyperplasia had regression of hyperplastic endometrium. None of the women with endometrial polyps had sonographic signs of recurrence during therapy. Only 10 women (50%) completed 1-year follow-up, and only 5 women (25%) completed 5-year follow-up. CONCLUSION: These results suggest that long-term administration of vaginal danazol after curettage or hysteroscopic-directed biopsy is both efficacious and safe in women with heavy menstrual bleeding, but the rate of discontinuance is high.     

Evaluation of d-norgestrel 1.0 mg in cyclic regimen

111 women took a total of 584 cycles of 1.0 mg norgestrel for 21 days out of a 28 day cycle, in a trial of a low-dose progestin-only oral contraceptive, intended to avoid the side effects of estrogen and the menstrual irregularity of mini-pills. This study followed an 18 month blind trial of norgestrel, .5, 1.0 and 1.5 mg in 100 patients, which found the 1.0 mg dose most suitable. 33.6% of these subjects had used pills within the last 90 days, and all were private patients of the Western Gynecological and Obstetrical Clinic, Inc. 97.7% of menstrual cycles before, and 81% during the trial were 21-35 days in length; the mean cycle length was 28.8 days before, and 29.0 days during treatment. Menses lasted a mean of 4.8 days before and 5.6 days during norgestrel. Menstrual flow became lighter in most, but breakthrough bleeding increased from 1.8% to 10%, spotting from 6.3% to 30.7%, and amenorrhea from 4.5% to 11.1%. Dropouts included 10 for bleeding, 5 for weight gain, 3 for acne, and 1 each for edema, generalized somatic complaints, irritability, depression and decreased libido. One pregnancy resulted from patient failure. The authors concluded that, except for the "fastidious," most women should not object to this degree of irregular bleeding, once it becomes "individualized."     

New protocol of clomiphene citrate treatment in women with hypothalamic amenorrhea.

OBJECTIVE: To determine if a new protocol of administration of clomiphene citrate (CC) is effective in menstrual cycle recovery in women with hypothalamic secondary amenorrhea. DESIGN: This was an open-label study. PATIENTS: Patients comprised a group of eight women with secondary amenorrhea. Interventions. An oral preparation containing CC (50 mg/day) was administered for 5 days followed by a double dose (100 mg/day) for another 5 days, initiated on day 3 after estrogen/progestogen-induced withdrawal bleeding. If ovulation and vaginal bleeding occurred, treatment continued in the two next months with 100 mg/day from day 3 to day 7 day of the cycle. MAIN OUTCOME MEASURES: Cycle control was evaluated at each visit, when patients recorded bleeding patterns and tablet intake. Data on the intensity and duration of bleeding were collected. RESULTS: Six patients responded to the first cycle of CC administration, resuming normal menstrual cycles. The other two patients failed to menstruate after the first 10 days of treatment with CC and repeated the same protocol. After the second administration, these two women also had normal menstrual bleeding. CONCLUSIONS: The present data show that this new protocol of CC treatment may be useful to restore normal menstrual cycles in young women with hypothalamic amenorrhea.     

Menstrual changes after tubal sterilization

The authors used data from a multicenter prospective study of female sterilization surgery to study changes in menstrual function following tubal sterilization. Duration of menstrual bleeding, menstrual cycle length, cycle regularity, amount of menstrual bleeding, menstrual pain, and intermenstrual bleeding were examined. The authors followed 2456 women for two years after tubal sterilization surgery. Each woman served as her own control; her menstrual function at the two-year follow-up interview was compared with her menstrual function at the preoperative interview. Except for menstrual pain among women who underwent unipolar electrocoagulation procedures, there was no increase in the prevalence of adverse menstrual function after tubal sterilization. For all menstrual variables, 50% or more of women with adverse function preoperatively had an improvement by two years after tubal sterilization.     

Treatment of primary and secondary dysmenorrhea with a novel 'frameless' intrauterine levonorgestrel-releasing drug delivery system: a pilot study.

OBJECTIVES: To evaluate the effect on menstrual pain in women with primary and secondary dysmenorrhea of a novel 'frameless' intrauterine drug delivery system (IUS), FibroPlant-levonorgestrel (LNG) (Contrel Research, Belgium), releasing 14 microg of LNG per day. An ancillary objective was to evaluate the effect of the new IUS on menstrual blood loss. STUDY DESIGN: An open label, non-comparative ongoing pilot study. Eighteen insertions were performed in women between 16 and 52 years of age by the first author. Four insertions were performed in nulligravid women. Eight women were categorized as having primary dysmenorrhea and 10 as having secondary dysmenorrhea. Twelve women complained of heavy bleeding. Three women had significant fibroids and three were suspected to have adenomyosis. RESULTS: The trial covers a period from a minimum of 3 months up to 33 months. By the end of August 2001, 12 recruited women had at least 12 months' follow-up and six had between 3 months and 1 year. All women reported much reduced pain, or no pain at all, and strongly reduced bleeding which started as soon as 1 month after insertion of the FibroPlant-LNG IUS. There was one exception; this woman had significant fibroids. She reported much reduced bleeding but this was not as pronounced as in the other women in the study. All women are continuing to use the method. CONCLUSION: The results of this preliminary study suggest that the FibroPlant-LNG IUS, releasing 14 microg ofLNG per day, is a safe and effective method for the treatment of primary and secondary dysmenorrhea. The absence ofa frame is particularly advantageous in these women. Of significant added importance is the high effectiveness in reducing menstrual bleeding, a symptom often present in women with menstrual pain complaints, and the fact that the system provides effective contraception. The low daily release rate of LNG from the FibroPlant-LNG IUS results in a virtual absence of hormonal side-effects.     

Treatment of primary and secondary dysmenorrhea with a novel 'frameless' intrauterine levonorgestrel-releasing drug delivery system: a pilot study

Objectives: To evaluate the effect on menstrual pain in women with primary and secondary dysmenorrhea of a novel 'frameless' intrauterine drug delivery system (IUS), FibroPlant-levonorgestrel (LNG) (Contrel Research, Belgium), releasing 14 μg of LNG per day. An ancillary objective was to evaluate the effect of the new IUS on menstrual blood loss. Study design: An open label, non-comparative ongoing pilot study. Eighteen insertions were performed in women between 16 and 52 years of age by the first author. Four insertions were performed in nulligravid women. Eight women were categorized as having primary dysmenorrhea and 10 as having secondary dysmenorrhea. Twelve women complained of heavy bleeding. Three women had significant fibroids and three were suspected to have adenomyosis. Results: The trial covers a period from a minimum of 3 months up to 33 months. By the end of August 2001, 12 recruited women had at least 12 months' follow-up and six had between 3 months and 1 year. All women reported much reduced pain, or no pain at all, and strongly reduced bleeding which started as soon as 1 month after insertion of the FibroPlant-LNG IUS. There was one exception; this woman had significant fibroids. She reported much reduced bleeding but this was not as pronounced as in the other women in the study. All women are continuing to use the method. Conclusion: The results of this preliminary study suggest that the FibroPlant-LNG IUS, releasing 14 μg of LNG per day, is a safe and effective method for the treatment of primary and secondary dysmenorrhea. The absence of a frame is particularly advantageous in these women. Of significant added importance is the high effectiveness in reducing menstrual bleeding, a symptom often present in women with menstrual pain complaints, and the fact that the system provides effective contraception. The low daily release rate of LNG from the FibroPlant-LNG IUS results in a virtual absence of hormonal side-effects.     

Treatment Modalities in Adolescents Who Present with Heavy Menstrual Bleeding

Study Objective

On this study we sought to determine the relationship of bleeding disorders to iron deficiency anemia. Additionally, this study was undertaken to examine all current treatment modalities used in a menorrhagia clinic with respect to heavy menstrual bleeding management to identify the most effective options for menstrual management in the setting of an underlying bleeding disorder.

A clinical study on the contraceptive effect of vaginal application of levonorgestrel]

50 healthy women aged 27-39 were screened and participated in an clinical study on the vaginal application of levonorgestrel (LNG) as a contraceptive. Among the 50 women, 27 had live births and 23 had abortions as the result of their last pregnancy within 5 years. They had regular menstruation for the past 3 months, and no disease of the liver, heart, or urinary system. 0.75 mg LNG tablets produced by Beijing Pharmaceutical Manufacturers were chosen for the study. All the participants were instructed to put one tablet into the upper end of vagina every other day from the seventh day of the menstrual cycle with 8 tablets per cycle. 258 cycles of pills were used by the 50 participants. 953 acts of sexual intercourse were recorded during the study with 3.69 per cycle on average. Even though pills were missed in 28 cycles, there was only 1 case of pregnancy. The pill use affected the duration of the menstrual cycle, with mean duration of 27.8 days + or - 4.1 days. Vaginal bleeding occurred in 13 cycles (4.06). Side effects including sickness, backache, breast pain, and increased vaginal secretion occurred only in 3.89% of the cycles, which was much lower than in oral administration. No vaginal infection occurred in any of the cases. 10 participants dropped out before the end of study, including 1 who became pregnant. 44 participants, including 4 drop-outs, wanted to continue with the method. Vaginal application of progesterone is a promising means of contraception. But, as the study has a small sample size and short duration, is further research to prove the advantage of vaginal application over oral administration in terms of effectiveness, side effects, longterm safety, an acceptability.     

Treatment of menorrhagia with a novel 'frameless' intrauterine levonorgestrel-releasing drug delivery system: a pilot study.

OBJECTIVE: To evaluate the effect on menstrual blood loss of a novel 'frameless' intrauterine drug delivery system, the FibroPlant levonorgestrel intrauterine system (IUS), releasing 14 microg of levonorgestrel/day. An ancillary objective was to evaluate the contraceptive performance. STUDY DESIGN: This was an open-label, non-comparative ongoing pilot study. Thirty-two insertions were performed in fertile women aged between 31 and 51 years for the treatment of menorrhagia, as well as for contraceptive purposes. Fifteen women who developed excessive bleeding were fitted with the FibroPlant levonorgestrel IUS immediately following the removal of a copper-bearing intrauterine device (IUD), the GyneFix IUD. To discriminate between menorrhagia and normal menstrual blood loss, women were evaluated using a simple visual assessment technique. The trial covered a period from a minimum of 1 month up to 23 months. RESULTS: At the time of study analysis, the total number of woman-months was 361. Fourteen of the women had had the FibroPlant levonorgestrel IUS in place for more than 1 year, and 29 women for 6 months or more. All women reported greatly reduced bleeding. However, no cases of amenorrhea resulting from endometrial suppression were encountered. The reduction of bleeding was substantial after 1 month of treatment and decreased further over the next months to remain stable thereafter. The mean bleeding score before treatment was 338 (range 185-740) in the group who had had no prior use of an IUD and 368 (range 185-890) in the group with prior IUD use. The mean bleeding score dropped to a mean score of 70 (range 5-210) in the 'no prior IUD use' group and to a mean score of 52 (range 3-150) in the 'prior IUD use' group, after 1-23 months of follow-up. This result is highly statistically significant (p < 0.001). There were no statistical differences in bleeding scores before and during treatment between the two groups of women, with or without prior use of the copper IUD. Significant spotting was rare after the first 3 months following insertion. No complications (e.g. infection, expulsion or perforation) or pregnancies occurred. The FibroPlant levonorgestrel IUS was well tolerated by all women involved in the study and no systemic hormonal side-effects were reported.CONCLUSION: The FibroPlant levonorgestrel IUS is effective in significantly reducing the amount of menstrual blood loss in women with menorrhagia. Strong endometrial suppression is the principal mechanism explaining both the effect on menstrual blood loss and the contraceptive performance of the IUS. There were no differences in bleeding scores before and during treatment between the two groups of women with or without prior use of the copper IUD, suggesting that the development of heavy bleeding was not related to the use ofthe IUD. The therapeutic effect of this contraceptive method is highly desirable, particularly in women with heavy bleeding or anemia in developing countries, as other treatment modalities are less effective, more costly, more invasive or inaccessible. The low daily release rate of levonorgestrel from the FibroPlant levonorgestrel IUS results in a low incidence of hormonal side-effects and reduces the likelihood of amenorrhea. The simple design characteristics and revolutionary anchoring system minimize the occurrence of complaints of pain and the incidence of expulsion.