甲地孕酮硅橡胶避孕环对人垂体、性腺激素和子宫内膜的影响

利用气相层析和放射免疫法测定了10例使用甲地孕酮硅橡胶阴道环(下称硅甲环)妇女尿中的E_1、E_2、E_3、P_2和LH 的含量,并用光学显微镜观察了子宫内膜的变化。实验证明10例使用硅甲环妇女中:有7例排卵,尿中LH、E_1、E_2、E_3和P_2的分泌曲线与正常组相似,但分泌总量减少,尿中三种雌激素的比例为E_3>E_1>E_2,该组的子宫内膜虽属分泌期,但腺体发育较差;2例不排卵,LH、E_1、E_2、E_3和P_2不出现典型的分泌曲线;另1例不排卵兼有突破性出血,尿中LH、E_1、E_2、E_3及P_2的分泌量在整个周期中波动甚大,三种雌激素的比例异常,这类不排卵型的子宫内膜仍处于增生期。本工作表明硅甲环对妇女下丘脑—垂体—性腺轴的影响较小,其避孕环节主要是影响卵泡的发育和黄体的正常功能。

INFLUENCE OF SILIASTIC VAGINAL RING(SVR)IMPREGNATED WITH MEGESTROL ACETATE ON HUMAN GONADOTROPIN,SEX HORMONES AND THE ENDOMETRIUM

Urinary concentrations of LH estimated by RIA, E_1(estrone),E_2(estradiol)E_3(es-triol)and P_2(pregnanediol)as determined by gas chromatography were studied in a groupof 10 normal women using siliastic vaginal rings impregnated with megestrol acetate.Theendometria curetted on the 21st day of the cycle were also examined under the light micro-scope.The results showed that 7 out of 10 cases were ovulatory;the hormonal profiles ofLH、E_1、E_2、E_3 and P_2 were similar to those of the normal,but the total amount of sexhormones excreted,except the LH concentration,was less,and the proportion of thethree estrogenic metabolites was E_3>E_1>E_2.The development of the endometria was slig-htly suppressed,though they were in the saecretory phases.Two cases were anovulatory;their urinary concentrations of LH、E_1、E_2、E_3 and P_2 did not exhibit the typical hormonalexcretory patterns as observed in normal ovulatory women.One case had irregularbreakthrough bleeding;the concentrations of LH、E_1,、E_2、E_3、and P_2 fluctuated dramati-cally throughout the cycle,and the proportion of the three estrogenic metabolites wasabnormal.The endometria curetted on the 21st day of the cycle from those anovulatorywomen using SVR still remained at the proliferative stage.This work indicated that SVR,in most cases,disturbed the function of the hypothalamic-pituitary-ovarian axis onlyslightly.It seems that SVR contraception exerts its influence chiefly on the developmentof the follicle and the normal function of the corpus luteum.