Contraceptive efficacy of emergency contraception with levonorgestrel given before or after ovulation

Background

The contraceptive efficacy of emergency contraceptive pills containing levonorgestrel (LNG-EC) has been estimated in most previous studies by judging the day of ovulation from presumptive menstrual cycle data, thus providing poorly reliable estimates.

Methods

In the present study, the efficacy of LNG-EC was determined in 393 cycles by dating ovulation on the basis of reliable hormonal and ovarian parameters validated by a database constructed in a separate study. In addition, the efficacy was determined separately for cycles in which LNG-EC was given before or after ovulation.

Results

For the 148 women who had sexual intercourse during the fertile days, the overall accumulated probability of pregnancy was 24.7, while altogether 8 pregnancies were observed. Thus, the overall contraceptive efficacy of LNG-EC was 68%. Among the 103 women who took LNG-EC before ovulation (days −5 to −1), 16 pregnancies were expected and no pregnancy occurred (p<.0001). Among the 45 women who took LNG-EC on the day of ovulation (day 0) or thereafter, 8 pregnancies occurred and 8.7 were expected (p=1.00). These findings are incompatible with the inhibition of implantation by LNG-EC in women. The same cases were also analyzed using the presumptive menstrual cycle data, and important discrepancies were detected between the two methods.

Conclusion

The efficacy of LNG-EC has been overestimated in studies using presumptive menstrual cycle data. Our results confirm previous similar studies and demonstrate that LNG-EC does not prevent embryo implantation and therefore cannot be labeled as abortifacient.     

Levonorgestrel-releasing and copper intrauterine devices and the risk of breast cancer

Background

This study compares the risk of breast cancer for levonorgestrel-releasing intrauterine devices (LNG_IUD) versus copper IUDs (CU_IUD) in women younger than 50 years of age.

Study Design

Retrospective, population-based, case-control study using cancer registers in Finland and Germany, powered to exclude a 1.5-fold risk of breast cancer.

Results

Analysis of 5113 breast cancer cases diagnosed 2000–2007 and 20,452 controls — matched by year of birth and area of residence — yielded relative risk estimates approaching unity with 95% CI crossing 1.0 for all comparisons, including ever-use of LNG_IUD versus CU_IUD (adjusted OR, 0.99; 95% CI, 0.88–1.12) and current use at time of diagnosis (adjusted OR, 0.85; 95% CI, 0.52–1.39), as well as for sub-analyses by country, age, tumor characteristics and period, recency and duration of use prior to diagnosis.

Conclusion

This study does not indicate an increased risk of breast cancer for users of LNG_IUD. No indications for tumor promotion or tumor induction were found.     

曼月乐治疗月经过多的临床应用

目的探讨左炔诺孕酮宫内缓释系统（商品名曼月乐）治疗月经过多的临床疗效。方法观察103例月经量〉80 m l的患者宫内放置LNG-IUS后月经周期、月经期、月经量、血红蛋白及子宫内膜厚度的变化情况。结果放置LNG-IUS后3个月,患者月经周期未出现显著变化,月经期表现为放置后1个月显著延长,但随后恢复正常;月经量较治疗前显著减少,差异有统计学意义（P〈0.05）;治疗前、后子宫内膜厚度也显著变小,差异有统计学意义（P〈0.05）;患者治疗后血红蛋白水平也较治疗前显著增加。结论 LNG-IUS治疗月经过多疗效显著。     

A pilot study of levonorgestrel concentrations and bleeding patterns in women with epilepsy using a levonorgestrel IUD and treated with antiepileptic drugs

Objectives

We explored levonorgestrel (LNG) concentrations, bleeding patterns and endometrial thickness in women with epilepsy (WWE) initiating an LNG-intrauterine device (IUD) co-administered with antiepileptic drugs (AEDs).

重度子宫内膜异位症术后左炔诺孕酮宫内缓释系统联合GnRH-a辅助治疗效果

目的:探讨左炔诺孕酮宫内缓释系统(LNG-IUS)联合促性腺激素释放激素类似物(GnRH-a)辅助手术治疗重度子宫内膜异位证(EMT)临床疗效及对卵巢功能的影响。方法:选择2018年1-12月手术治疗的重度EMT患者100例,随机分为观察组与对照组各50例,均行腹腔镜手术,术后对照组给予GnRH-a治疗,观察组给予LNG-IUS联合GnRH-a治疗,比较两组术前、术后6个月和12个月时临床效果及性激素、卵巢储备功能水平。结果:两组痛经、性交疼评分及血清CA125水平治疗后均较治疗前下降(P<0.05),观察组术后12个月痛经评分(1.66±1.09分)低于术后6个月(2.06±1.33分),且低于同期对照组(2.04±1.23分),术后12个月血清CA125水平(9.82±1.84 mg/L)低于术后6个月(12.42±2.62 mg/L)(均P<0.05)。两组术后血清促卵泡刺激激素(FSH)、促黄体生成素(LH)及雌二醇(E2)水平较术前下降,但观察组血清E2水平高于对照组(均P<0.05);③两组术后卵巢窦状卵泡数(F0)及卵巢基质动脉血流收缩期峰值(PSV)均较术前降低,但术后12个月较术后6个月增高(P<0.05),两组间未见差异(P>0.05)。结论:LNG-IUS联合GnRH-a辅助手术治疗重度EMT有助于提高治疗效果,改善性激素水平,且不影响卵巢储备功能恢复。     

左炔诺孕酮的多晶型研究

目的:研究紧急避孕药左炔诺孕酮的多晶型现象。方法:通过多种物理(化学)方法对左炔诺孕酮进行多晶型筛选,采用粉末X射线衍射(PXRD)技术对筛选得到的多晶型样品进行表征。结果:左炔诺孕酮具有低溶解性与低渗透性性质,通过多晶型筛选获得左炔诺孕酮的α、β、B 3种晶型。3种晶型样品PXRD图谱的衍射峰位置、衍射峰数量、衍射峰强度、衍射峰几何拓扑等特征均存在明显差异。结论:左炔诺孕酮存在α、β、B 3种晶型,通过PXRD技术可对左炔诺孕酮3种晶型进行鉴别。     

子宫内膜异位症治疗中左炔诺孕酮宫内缓释系统的治疗效果及安全性评估

目的 分析左炔诺孕酮宫内缓释系统对子宫内膜异位症治疗的临床疗效与安全性。方法 选择我院2016年5月～2017年4月所收治的66例子宫内膜异位症患者作为本次研究的对象,采取随机数字表法将66例患者分为对照组和实验组,各33例,对照组采取口服米非司酮进行治疗,实验组则采取左炔诺孕酮宫内缓释系统进行治疗,分析对比两组患者各项指标的变化情况以及不良反应发生率等。结果 经过治疗,实验组患者有效率（96.97%）优于对照组（75.76%）,差异具有统计学意义（P＜0.05）。 且治疗后,实验组血清 TIMP-1（134.5±36.2）、MMP-9（132.6±42.2）,MMP-9/TIMP-1（1.07±0.25）显著低于对照组。 两组不良反应无明显差异（P＞0.05）。结论 左炔诺孕酮宫内缓释系统对于子宫内膜异位症患者的治疗效果更加有效,能够对患者的子宫内膜厚度、血清学相关指标、激素水平大幅度改善,无明显的不良反应,且安全性高,值得在临床中广泛推广应用。