我国长效口服避孕药的系统评估

目的:评估复方炔诺孕酮和复方左炔诺孕酮两种长效口服避孕药的有效性、安全性和可接受性。方法:见“我国常用口服避孕药和宫内节育器系统评估方法概述”(中国计划生育学杂志, 2005年1期17页)。结果:一项随机对照临床试验的结果显示,复方左炔诺孕酮的失败率(校正Pearl指数:1 1 /100妇女年)显著低于复方炔诺孕酮(2 3 /100妇女年) (P<0 05),复方左炔诺孕酮和复方炔诺孕酮1年续用率分别为82 05 /100妇女和73 62 /100妇女,副反应和月经紊乱是两种长效药停用的主要原因;其他研究提示,复方炔诺孕酮的1年失败率2 0 /100妇女,恶心、头昏和白带增多等副反应发生率超过50%,且白带增多不随服药周期的增加而减少,其它副反应,如恶心、头昏、头痛和经量改变等随使用周期的延长而减少;部分研究的临床和实验室检测结果显示,复方左炔诺孕酮和复方炔诺孕酮对血压、血脂和肝功能等指标有影响。结论:已有的数据表明长效口服避孕药的有效性低于其它长效激素类避孕方法和短效口服避孕药。长效口服避孕药中雌激素含量是目前使用的短效口服药中1个月炔雌醇合计量的4 8倍,基于现有资料和已被证实的长期使用高剂量雌激素的危险性,建议临床不提倡使用长效口服避孕药。

Systematic Review of Once-a-month Pills in China

Objective: To evaluate the efficacy, safety and acceptability of compound norgestrel and compound levonorgestrel. Methods: Refer to 'Introduction of Methodology of Systematic Review of Commonly Used Oral Contraceptives and IUDs in China' Fang Kejuan, et al. Chinese Journal of Family Planning, 2005, 13(1):17]. Results: A total of 26 papers were identified, 17 of which were included. In one randomized clinical trial, compared with compound norgestrel, compound levonorgestrel had significantly lower adjusted Pearl Index, and significantly higher 1-year continuation rate (P<0.05). Other studies showed that the 1-year failure rates of compound norgestrel were about 2 per 100 women. Incidences of increased leucorrhea were over 50% in most of included papers. No data were available on the association of once-a-month pills with thromboembolism, stroke or myocardial infarction. Conclusion: Based on the available data, the efficacy of once-a-month pills was lower than that of other long-term hormonal contraceptives, or daily pills which were used correctly and consistently. It is recommended that the National Population and Family Planning Commission should no longer provide once-a-month pills.