米非司酮与双炔失碳酯联合用于紧急避孕的临床观察

目的探讨低剂量米非司酮配伍双炔失碳酯应用于紧急避孕的效果。方法将142例月经规律的合格妇女随机分为2组，观察组(66例)在避孕失败或无保护性性交后72h内开始服用米非司酮10mg 双炔失碳酯5mg，对照组(76例)在避孕失败或无保护性性交后72h内开始服用单剂量米非司酮10mg，观察两组避孕效果、不良反应及月经情况。结果采用经典Dixon法计算，观察组避孕有效率为90．6％，对照组避孕有效率为67．4％，观察组诱导出血率低于对照组，但月经变化及不良反应无明显差异。结论米非司酮10mg 双炔失碳酯5mg为安全有效、服用简便的紧急避孕方法。     

每周口服米非司酮避孕的临床研究

目的:研究每周一次口服米非司酮25mg或50mg用于常规避孕的可行性。方法:志愿参加避孕研究的健康妇女共33例,随机分为二组,自月经d2-3口服米非司酮,每例观察6个周期。A组(16例)每周口服米非司酮25mg;B组(17例)每周口服50mg。另在A组、B组中各选2例,每例服药前1个周期及服药后2-6个周期间,于黄体中期各取子宫内膜共2次作自身对照,测定子宫内膜形态学改变,应用免疫组化法检测基质金属蛋白酶(MMP)-9和MMP-26的表达。结果:A组共服药50个周期,1例妊娠,4例闭经,1例妇女经量极少;B组共服药81个周期,无1例妊娠,5例闭经,4例经期仅点滴出血。服药后与服药前比较内膜明显变薄,主要表现为基质和腺体发育不同步,大部分腺上皮分泌活动不明显。与对照周期相比,服药后二组MMP-9和MMP-26在子宫内膜腺上皮和基质细胞的表达均显著降低。结论:每周一次口服米非司酮(25mg或50mg)妇女的月经周期改变较大,临床避孕效果理想。每周口服50mg米非司酮可能是比较合适的剂量。但闭经率较高,且闭经的出现不可预测,妇女对其的可接受性较差。     

米非司酮配伍米索前列醇用于黄体期避孕的研究

目的　探讨在黄体期无保护性生活后 ,使用米非司酮配伍米索前列醇避孕的效果、副反应和对月经的影响。方法　对因多次无保护性生活或无保护性生活结束超过 12 0h要求紧急避孕的69 9例妇女 ,于预期月经来潮前 10d内服用米非司酮 10 0mg ,并于服用米非司酮 48h后加服米索前列醇 40 0 μg。观察是否妊娠和下次月经的情况。 结果　 699例妇女中失访 1例 ,妊娠 2 5例 ,妊娠率 (即失败率 )为 3 6%。妊娠危险性随性生活次数的增多而增加。 673例妇女月经来潮 ,其中 3 81例( 56 6% )在预期月经日± 3d来潮 ,月经提前或延迟超过 7d者分别占 2 2 %和 8 5%。服药后 1周内的主要副反应为腹泻、腹痛 ( 3 1 1% )和恶心、呕吐 ( 2 0 4% )。结论　在黄体期使用米非司酮配伍米索前列醇 ,是一种可选择的避孕补救方法     

醋炔诺酮肟避孕片对子宫内膜组织学和阴道细胞学的影响

本文报告了38例服醋炔诺酮肟避孕片(其中26例服探亲片、12例服事后片)和3例不服药的健康妇女的子宫内膜活检结果及11名服酮肟探亲片妇女12个周期的阴道细胞学观察结果。所有服药妇女的子宫内膜发育均受不同程度抑制,对在周期早期开始服药者内膜的抑制作用较后期服药者明显。表明药物干扰了内膜的发育和分泌,这可能是该药避孕作用的主要机理。阴道细胞学检查表明,服药后阴道细胞因保持较低的雌激素影响而缺乏正常的周期变化,提示在周期的早期开始服药可能抑制排卵。     

长效避孕针醋酸甲孕酮的临床续用情况分析

目的对154例以醋酸甲孕酮150mg避孕的续用情况进行了临床分析.结果该药的避孕效果为100%,但不规则出血发生率为7.8%;点滴出血发生率高达57.2%;闭经发生率高达30.5%.因这些原因停止使用的占95.5%.64.9%的妇女在第一次注射DMPA后因出现出血问题,而停止使用DMPA(其中发生闭经的妇女占15%),.54例坚持接受两次以上注射DMPA44例(占总数的28.6%)于第二次注射后停用(其中发生闭经的妇女占63.6%).闭经的总例数为47例(30.5%).21例未产妇中,仅4例连续用药2次,9例闭经,12例月经紊乱而终止使用.经产妇与未产妇的续用率相比经产妇高于未产妇.未产妇对月经的改变的可接受性要差.     

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.     

围排卵期应用左炔诺孕酮对着床期子宫内膜整合素表达的影响

目的:研究合成孕激素左炔诺孕酮对子宫内膜着床期整合素亚单位表达的影响。方法:20名妇女,随机分为两组,在LH-2日(LH-2组)或LH+2日(LH+2组)服用左炔诺孕酮0.75 mg/次,bid。每组妇女在服药周期前一个周期于LH-2日或LH+2日服用安慰剂,作为对照周期。两组均以超声波和尿LH峰检测确定服药日。每一周期均于LH+7日取子宫内膜标本。用整合素亚单位a1、a4、avb3抗体,以免疫组化和计算机图象分析方法检测和评价这些亚单位的表达。结果:两组在服用左炔诺酮后亚单位a1染色强度降低,但avb3无变化。亚单位a4在LH-2组明显降低,在LH+2组则差别不明显,而两组集合也是明显降低的。结论:妇女紧急避孕应用左炔诺酮后,其子宫内膜整合素亚单位a1和a4的表达与甾体激素的调控密切相关,有关机理尚需进一步研究。     

复方米非司酮治疗皮埋避孕术后阴道异常出血的临床观察

目的:探讨复方米非司酮对皮下埋植避孕术后阴道异常出血的治疗效果。方法:62例皮下埋植避孕术异常出血的妇女随机分为观察组(每月服用复方米非司酮1片,共服6片)和对照组(服用安慰剂),每组31例。结果:观察组服用药期间出血天数较对照组减少(P<0.05),长期不规则出血比例也低于对照组(P<0.05),但滴血天数和停药后出血/滴血天数组间无明显差异(P>0.05)。结论:皮下埋植避孕术阴道异常出血应用复方米非司酮能够缩短出血天数,减少长期不规则出血、滴血天数,但出血模式没有变化。     

人工流产术后即刻放置依托孕烯植入剂避孕的可行性研究

目的:探讨人工流产术后是否可即刻放置依托孕烯植入剂进行避孕。方法:要求避孕的66例因非意愿妊娠行人工流产术后妇女即刻放置依托孕烯植入剂为研究组,另同期征集84例健康妇女于月经期放置该植入剂作为对照组,术后1、6、12个月随访,随访阴道出血情况,植入剂取出原因,并在放置12个月时进行满意度调查。结果:在放置12个月期间所有对象均未怀孕。研究组闭经/出血稀发发生率为53.0%,出血频发/出血延长发生率为15.1%,对照组闭经/出血稀发发生率为58.4%,出血频发/出血延长发生率为27.3%;满12个月时,研究组取出20例,续用率为69.7%,满意度为69.6%;对照组取出22例,续用率为73.8%,满意度为72.6%。结论:人工流产术后即刻放置依托孕烯植入剂与月经期放置效果相同,人工流产术后妇女即刻放置依托孕烯植入剂进行避孕也是一个较合适的放置时机。     

四环素影响口服避孕药的作用而发生妊娠

口服避孕药的病人,同时服其他药物包括抗菌素,可能引起避孕失败和突破性出血。过去报导过利福平,以后发现引起避孕药失败的原因是增加了炔诺酮和炔雌醇在肝内的代谢率。1975年曾有3例妇女应用氨苄青霉素后妊娠的报道。本文报道服避孕药的妇女发生突破性出血或妊娠与应用四环素有关的病例。患者20岁,服避孕药4年。服药期间,有左侧偏头痛增加症状。近两年服用Microgynon30μg(含炔雌醇30μg、右旋18甲基炔诺酮150μg)无突破性出血。1978年10月16日有过正常撤退性出血。因患鼻窦炎服用四环素5天。前3天每6小时500mg,     

A clinical report of norethisterone-3-oxime-acetate vacation pill]

This paper reported the clinical application of Norethisterone-Oxime-Acetate used as a "vacation" pill. The result indicated that pregnancy could be prevented in women who received this drug orally when they themselves or their husband came home on leave. A dose of 2 mg was administered for women on the 1st day when the couples live together, then followed by 1 mg daily successively and an additional pill was given on the morning next to the end of the leave. A high efficacy of 99.75% in terms of cycles proved in 604 women with 825 treated cycles of 604 women. The changes in menstrual cycles, the duration of menstrual bleeding and the amount of flow after treatment were very slight. The incidence of the intermenstrual bleeding and withdrawal bleeding were 2.16%. The author's observation showed that Norethisterone-oxime-Acetate is an active contraceptive pill and possesses the advantages of not only high efficacy, low side effect, but also convenience in use.     

Hormone replacement therapy: effect of progestin dose and time since menopause on endometrial bleeding

OBJECTIVE: To analyze the effects of two continuous combined hormone replacement regimens on bleeding profiles in postmenopausal women, based on progestin dose and time since the patient's last spontaneous menstrual period. METHODS: A randomized, double-masked, multicenter trial was conducted in 1724 women recruited from 99 sites. Six hundred seventy-eight women received a continuous regimen of oral conjugated equine estrogens (CEE), 0.625 mg/day, combined with medroxyprogesterone acetate (MPA), 2.5 or 5.0 mg/day, for 1 year. RESULTS: After 1 year, no bleeding was reported by over 89% of women. More women in the 5.0 mg/day MPA group than in the 2.5 mg/day MPA group reported no bleeding (93.8% versus 89.5%; P<.089). Of those women who had had their last menstrual period 3 years ago or less, a significantly higher percentage in the 5.0 mg/day MPA group (72.4%) did not experience bleeding after three cycles compared with the 2.5 mg group (59.0%; P<.001). Although the percentage of patients without bleeding was also higher in the 5.0 mg/day MPA group after six cycles and 1 year, the differences between groups were not statistically significant. Of the women who had their last menstrual period more than 3 years ago, 94.7% of those in the 5.0 mg/day MPA group and 90.7% of those in the 2.5 mg/day MPA group reported no bleeding at 1 year. CONCLUSION: A continuous combined regimen of CEE plus 5.0 mg MPA may be more suitable for women closer to the onset of menopause or for women starting therapy who are unwilling to tolerate irregular bleeding. The improved bleeding profile with CEE and 5.0 mg/day MPA is likely to enhance compliance with hormone replacement therapy.     

Norgestrel and ethynyl estradiol: a new low-dosage oral agent for fertility control

To study the safety and efficacy of a norgestrel-ethinyl estradol oral contraceptive compound, 300 Mexican women, 16-42 years of age were orally administered .5 mg norgestrel and .05 mg ethinyl estradiol (Ovral) daily over a total of 3175 study cycles. Most of the women were poor., uneducated and of high parity. None of the patients in the study became pregnant, even in the cycles where 1 or more doses were omitted. The menstrual cycle remained basically unaltered with breakthrough bleeding or spotting sometimes reported, usually when doses were missed. Unexplained amenorrhea occurred in 1.2% of the cycles. Though 5% of the women were ovulatory at one time of another as determined by pregnandiol levels, no pregnancy resulted, which is probably explained by changes in the cervical mucus caused by the pills making an inhospitable environment for sperm migration. Psychosomatic-related side-effects included nausea, headache and decreased libido in less than 1% of the cycles. Chloasma aggravated by poor dietary intake occurred in .5% of the cycles. No malignant, peripheral vascular or other serious disease occurred during the treatment and no significant endometrial alterations were seen.     

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.     

Duration of Menstruation

Menstrual length was analysed in 2,342 women attending the Shepherd Foundation. Prolonged menses were more common in Australian and New Zealand born, in women with irregular, short or long menstrual cycles, menstrual pain, high parity, and an intrauterine device. In contrast to women with premenstrual tension and menstrual pain, psychological factors, smoking and drinking were not more common in women with increased menstrual length. It is concluded that somatic factors alone control menstrual length, and results in the present study support the hypotheses that both the hypothalamic-pituitary system and prostaglandins may be involved in this control. Evidence was found that the use of the contraceptive pill reduces the incidence of premenstrual tension when menstrual length is also reduced.     

Oral contraception by means of progestagen-only micropills taken continuously in the light of four recent trials (author's transl)]

An extensive review of the literature, supplemented by experimentation on progestagen-only minipills taken continuously finds the 4 most effective progestagens. They were tested for 4358 cycles in 483 women. In general lynestrenol and norethisterone acetate give fairly regular cycles with a longer menstrual period. Intermenstrual bleeding is frequent at the beginning but tends to regulate itself. D-norgestrel seems to give shorter cycles with less intermenstrual bleeding. NOrgestrienone gives longer cycles with less bleeding. Problems include spotting or amenorrhea which are often worrisome for the patient. The advantage of the minidose progestagen-only pill is that it has no estrogen and therefore can be used when estrogen is contraindicated: in the case of tumors, history of thromboembolism, disorders of lipid metabolism, fibromatosis, mastitis, prediabetes, and arterial hypertension.     

Low-dose hormone therapy in the perimenopause.

OBJECTIVE: To evaluate the effects of low-dose hormone therapy (LD-HT) on bleeding pattern and vasomotor symptoms in perimenopausal women. METHODS: In a prospective, open-label study at an University clinic, 120 perimenopausal women suffering from irregular menstrual cycles and hot flushes were randomized to micronized 17beta-estradiol 1 mg plus dydrogesterone 10 mg sequential added (LD-HT; group A: 60 subjects) or dydrogesterone 10 mg from day 15 to 28 (group B: 60 subjects). Number and severity of hot flushes and bleeding pattern were assessed throughout the study. RESULTS: Women in group A experienced a significant reduction in number of hot flushes while no significant variation was observed in group B. The incidence of cyclic bleeding was 86% in group A and 76% in group B, the mean duration was significantly lower in group A than in group B. CONCLUSIONS: LD-HT may control both irregular bleeding and hot flushes in perimenopausal women.     

Clinical study of the use of a new tri-phasic pill

The paper reports the results of a study to assess the contraceptive efficacy of a new triphasic pill (Trinovum - Cilag AG). The pill was administered to 50 women aged between 18 and 41 years for 12 months, giving a total of 600 menstrual cycles. Data confirm the value of this pill which ensures excellent contraceptive efficacy and is well tolerated by patients with very few adverse effects.     

The relationship of bleeding patterns to daily reproductive hormones in women approaching menopause

OBJECTIVE: To discover early hormonal predictors of menopause and the stages of the menopausal transition and to understand the hormonal basis behind the bleeding abnormalities common in the menopausal transition. METHODS: A cohort of 804 women aged 42-52 collected first void urine samples daily for one complete menstrual cycle or 50 days (whichever came first) once a year for 3 years. Urine was assayed for excreted levels of follicle-stimulating hormone, luteinizing hormone, estrogen metabolites, and progesterone metabolites, which were normalized for creatinine concentration. Anovulation was defined by an algorithm based on progesterone secretion. Menstrual bleeding parameters were derived from daily calendars. Correlations among bleeding characteristics, hormone concentrations, and other potential clinical predictors were analyzed using multivariable logistic regression models. RESULTS: An ethnically diverse population of women (mean age of 47) with a majority in the early perimenopause was studied. Approximately 20% of all cycles were anovulatory. Short cycle intervals (fewer than 21 days) were common early in the menopause transition and were associated with anovulation (44%). Long cycle intervals (more than 36 days) also were associated with anovulatory cycles (65%). Both short (1-3 days) and long (more than 8 days) duration of menstrual bleeding were associated with anovulation (18% and 23%, respectively). Women with anovulatory cycles were less likely to report heavy menstrual bleeding as compared with those with ovulatory cycles. Heavy bleeding was not associated with steroid hormone concentrations but was associated with obesity and with the self-reported presence of leiomyomata. CONCLUSIONS: Among women in the early menopause transition, abnormalities in timing of menstrual bleeding (cycle intervals or bleeding duration) have a hormonal basis and are frequently associated with anovulation. In contrast, abnormally heavy periods do not appear to have a steroid hormonal basis and are less likely after anovulatory cycles. Heavy periods are associated with obesity and leiomyomata. LEVEL OF EVIDENCE: II.     

Immediate postpartum oral contraception

Oral contraceptives were administered on Postpartum Day 5 to 363 patients, 83 of whom were breast-feeding, to determine if bleeding quantity could be reduced and menstrual periods established earlier in the puerperium, to evaluate the effect on lactation, and to note if side effects could be minimized by initiating pill usage earlier postpartum; 245 patients, of whom 91 were breast-feeding, served as controls. All of the women were patients at the U.S. Air Force Hospital in Wiesbaden, West Germany. 54% of the lactating mothers on the pill were successfully breast-feeding at 6 weeks compared with 59% of the controls. 87% of the patients taking pills had their 1st menstrual period before 6 weeks postpartum compared with 23% of the controls. No significant decrease in quantity of bleeding was noted. Patients taking the pill did report a weight gain. The uterus returned to normal size sooner in the group taking the pill and there was less breast tenderness. 65% of the multigravida mothers taking the pill thought they had a more favorable postpartum course, 24% saw no difference, and 11% thought their postpartum experience was less favorable. Patient acceptance was excellent and no major porblems were encountered.