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。     

使用Norplant皮下埋植剂阴道流血模型分析

上海医科大学妇产科医院自1984年引进Norplant,进行"中国妇女对Norplant可接受性研究"共观察1657例,木文对开始使用的548例对象的月经卡进行分析,目的是观察使用 Norplnt皮下埋植剂对象的阴道流血变化规律。结果显示使用 Norplant避孕的妇女阴道流血总和（包括滴血、流血和严重流血）的平均天数和滴血天数,在第1个90天的参考时限中分别为33．0天和21．5天;在第4个参考时限中分别为26．7和13．8天;到第20个参考时限分别降低至20．2和9．5天。闭经者在各个不同的参考时限分别占0．5～5．4％。结论是使用Norplant皮下埋植剂的妇女,总和的阴道流血天数随着使用时间的延长而逐渐减少。主要是"滴血"天数减少,而"流血"和"严重流血"的天数变化不大。     

皮下埋植剂Implanon和Norplant的临床对比性研究

目的　比较皮下埋植剂Implanon(Implanon)和皮下埋植剂Norplant(Norplant)避孕的有效性、可接受性和阴道出血的情况。方法　采用随机对照的前瞻性研究方法 ,将 10 0例健康妇女 ,分为两组 ,使用Implanon 75例 (Implanon组 ) ,使用 2 5 5 5妇女年 ;使用Norplant 2 5例 (Norplant组 ) ,使用 94 4妇女年 ,共随访 4年 ,进行临床比较性研究。结果　两组均无妊娠发生。以 90d为 1个参照时限 ,Implanon组的阴道出血 (出血或滴血 )天数 ,由第 1个参照时限平均 33d ,减少至第 16个参照时限的 2 1d ;Norplant组由平均 31d减少至 2 0d。平均每个参照时限的出血次数 ,Implanon组为 2 2 5次 ,Norplant组为 2 99次 (P <0 0 5 )。有 1次或 1次以上出血和 (或 )滴血≥ 10d的发生率 ,Implanon组由第 1个参照时限的 6 6 %下降至第 16个参照时限的 2 7% ;Norplant组由 6 9%下降至 2 2 %。Implanon组有 7例 (9% )因出血过多或出血时间过长停止使用埋植剂。Norplant组有 1例 (4% )因使用埋植剂后闭经 2年而停止使用埋植剂。平均埋入埋植剂所用时间 ,Implanon组为 11s,Norplant组为 10 3s(P <0 0 0 1) ;平均取出埋植剂所用时间 ,Implanon组为 2 7s ,Norplant组为 10 2s(P <0 0 0 1)。结论　两种皮下埋植剂避孕有效性高、     

皮下埋植避孕剂副反应及安全性的研究进展

<正>皮下埋植避孕剂是一种缓慢释放孕激素的长效可逆避孕方法,具有高效、长期、简便、可逆、安全等优点,但存在的一些副反应及安全性问题仍然影响其使用及推广,也影响到了皮下埋植避孕剂的研究及发展。1 皮下埋植引起的副反应1.1 阴道流血阴道流血模式改变是最常见的副反应,也是导致停用的最常见原因。植入后5年,由于出血模式改变导致累积停用率分别为17.0/每百妇女和15.26/每百妇女,依托孕烯植入剂的停用率为11/每百妇女[1]。皮下埋植     

青少年子宫内膜癌的诊断误区及应对策略

目的:探讨青少年子宫内膜癌的临床特征及诊断策略。方法:回顾性分析北京协和医院2007～2017年收治的青少年子宫内膜癌患者的临床表现、诊治经过及延误诊断的情况。结果:10年间北京协和医院共收治子宫内膜癌患者3312例,其中16～24岁青少年患者为21例(0. 63%)。首诊表现为阴道不规则流血者20例(95. 2%);所有患者均合并贫血(100. 0%),其中10例(47. 6%)为重度贫血; 14例(66. 7%)患者体质量指数(BMI)≥28 kg/m2。以阴道不规则流血为首诊症状的患者平均确诊时间为35个月,其中有性生活史者确诊时间为15. 0±14. 3月,无性生活史者确诊时间为64. 0±33. 1月,两组比较差异有统计学意义(P 0. 05);以阴道不规则流血为主要症状者11例(55. 0%),在确诊前按青春期功能失调性子宫出血长期行药物治疗,8例(40. 0%)行中药治疗,1例(5. 0%)因合并多囊卵巢综合征口服炔雌醇环丙孕酮片;所有该类患者(100%)初次就诊时均未行相关影像学检查、妇科查体,且未进行定期随诊。结论:青少年子宫内膜癌较为罕见,以阴道不规则流血为主要临床表现,易误诊。对于长期阴道不规则流血的年轻女性,应及时行B超检查及妇科查体并定期密切随诊,必要时行有创的活检明确诊断。     

新型长效避孕药具的研究进展

<正>非意愿妊娠导致的人工流产可以发生宫腔粘连、子宫穿孔、生殖道感染及继发不孕等并发症,严重危害广大妇女的身心健康。目前,已有多种避孕方式可供选择。避孕套、口服避孕药是最常见的短效避孕方法,但需要坚持正确使用。长效避孕药具与短效避孕方法相比较,更高效、不依赖于使用者依从性、有更好的成本效益。主要包括宫内节育器(IUD)和皮下埋植剂(subcutaneous implants)。此外,阴道避孕环、避孕注射剂、透皮贴剂也可以归属于长效避孕药具。每     

宫血宁胶囊治疗使用长效皮下埋植避孕剂后阴道流血的临床研究

目的:观察宫血宁胶囊治疗皮下埋植避孕剂引起阴道流血的疗效,探讨阴道流血与受试者血液中内皮素(ET)和一氧化氮(NO)水平的相关关系.方法:将80例受试者,随机分为宫血宁组与安慰剂组,比较两组服药前后阴道流血模式的变化;分别采用放免法和比色法测定血清ET和NO水平.结果:以90天为参考期,宫血宁组在服药前、后总流血天数是44.7±3.2天和29.0±2.1天(P<0.05);服药后宫血宁组与安慰剂组总流血天数,分别是29.0±2.1天和43.7±2.8天(P<0.05).宫血宁组阴道流血停止者,服药前血ET为37.3±2.5 pg/ml;继续出血者,服药前血ET为18.8±1.7 pg/ml(P<0.01).结论:服用宫血宁后阴道流血模式得到改善,有利于提高皮埋剂继续使用率.     

血浆内皮素与皮下埋植剂使用者子宫异常出血相关性初步探讨

目的:初步探讨血浆内皮素与皮下埋植剂使用者子宫异常出血的相关性。方法:采用前瞻性自身对照研究方法,对29名妇女在埋植手术前后月经周期不同阶段取4次静脉血;本研究前已使用皮下埋植剂的59名随访妇女组成已埋植组,取1次静脉血。应用放免方法测定血浆内皮素、雌激素、孕激素含量。结果:29例自身对照组妇女雌激素水平不论在月经周期的哪一阶段与埋植前比较均无明显改变,埋植后月经紊乱者较月经正常者雌激素、孕激素水平也无明显差异,血浆内皮素水平月经紊乱者偏高（但尚无统计学差异）,且月经紊乱者较月经正常者埋植前月经周期各阶段血浆内皮素水平也明显增高,尤以早增期、中增期明显,P<0.05。已使用埋植剂组的59名妇女,月经紊乱者血浆内皮素水平较月经正常者血浆内皮素也明显增高,P<0.05。结论:血浆高内皮素水平可能和埋植后子宫异常出血存在一定关系。     

缓释左旋-18甲基炔诺酮皮埋避孕剂对骨密度和骨代谢的影响

对采用 Norplant R埋植剂和仿制 Norplant的国产埋植剂 型避孕的育龄妇女骨密度和骨代谢改变进行了 1年的随机前瞻性临床观察。 6 1例正常妇女被分为两组 :Norplant埋植剂组 30例 ,国产埋植剂组 31例。两组于埋植前和埋植后第 12个月时采用双能 X线骨密度测定仪 (DEXA)分别测定了腰椎 L2 ～ L4、股骨近端骨密度和骨矿含量。两组妇女埋植后第 12个月时腰椎 L2 ～ L4骨密度和骨矿含量均较埋植前明显增加 (P<0 .0 1) ,Norplant组骨密度平均增加2 .40 % ,骨矿含量平均增加 3.34 % ,国产埋植剂组分别增加 2 .75 %和 4.47% ;从年龄分析 ,以 2 5～ 2 9岁组腰椎 L2 ～ L4骨密度埋植后增加最为显著 ,Norplant组 P<0 .0 5 ,国产埋植剂组 P<0 .0 1。国产埋植剂组妇女埋植后第 12个月时股骨大粗隆骨密度和骨矿含量较埋植前明显增加 (P<0 .0 1) ;国产埋植剂组妇女空腹尿羟脯氨酸 /肌酐比值埋植后第 12个月时较埋植前明显下降 (P<0 .0 1) ;对使用妇女腰椎、股骨骨密度和骨代谢生化指标的影响 ,在两种埋植剂之间埋植前后比较均无显著差别 (P>0 .0 5 )。左旋 - 18甲基炔诺酮皮埋避孕剂对绝经妇女的骨骼是非有害的 ,对年轻妇女骨峰值的获得无明显影响。     

人工流产术后药物干预对子宫内膜影响的临床观察

目的:评价在人工流产术后口服短效避孕药优思明及单纯雌激素补佳乐对减少术后阴道流血时间、促进术后子宫内膜恢复、缩短首次月经恢复时间及减少术后并发症的临床疗效。方法:选择来我院因非意愿妊娠者要求行无痛人工流产者为研究对象,随机分为对照组即未用药组(n=200),优思明组(n=100)和补佳乐组(n=100)。3组均于术后2周及月经转归后1个月、3个月后随诊。观察术后阴道流血时间、术后2周子宫内膜厚度、首次月经恢复时间及术后3个月内并发症的发生情况。结果:①优思明组术后阴道流血时间短于对照组和补佳乐组,差异均有统计学意义(P<0.05);②优思明组术后2周子宫内膜略厚于对照组,但差异无统计学意义(P>0.05),补佳乐组术后2周子宫内膜厚度大于对照组和优思明组,差异有统计学意义(P<0.05)。③优思明组术后首次月经恢复时间短于对照组和补佳乐组,差异有统计学意义(P<0.05)。④用药组(优思明组和补佳乐组)术后并发症发生率均低于对照组,差异有统计学意义(P<0.05);用药组宫腔积液发生率低于对照组,差异有统计学意义(P<0.05)。结论:人工流产术后立即服用单纯雌激素对子宫内膜厚度的恢复优于避孕药,术后并发症的发生率更低。     

Effects of two different regimens of continuous hormone replacement therapy on endometrial histopathology and postmenopausal uterine bleeding

Objective: To compare the effects of frequently used two different regimens of combined continuous hormone replacement therapy; 0.625 mg conjugated equine estrogen (CEE) + 2.5 mg medroxyprogesterone acetate (MPA) and 1 mg 17β estradiol (E2) + 0.5 mg norethindrone acetate (NETA), on endometrial histopathology and postmenopausal uterine bleeding. Materials and methods: Two hundred and forty-six outpatient subjects aged 41–57 years were enrolled in the study conducted at the menopause clinic between November 2003 and November 2004. One hundred and thirty-nine patients were assigned to receive 0.625 mg conjugated equine estrogen + 2.5 mg medroxyprogesterone acetate (CEE/MPA), whereas 107 patients were to receive 17β estradiol + 0.5 mg norethindrone acetate (E2/NETA). Inclusion criteria of the study were: normal values of endometrial thickness at basal evaluation, women with intact uterus, at least 12 months of amenorrhea, normal vaginal smear, bilateral mammography and biochemical blood parameters. All women were questioned every 3 months for vaginal bleeding/spotting. Endometrial sampling was performed by Pipelle catheter in the 12th month of therapy. Results: For the first 3 months, vaginal bleeding/spotting rate for the CEE/MPA group was 38.7%, whereas it was higher (45%) in the E2/NETA group. For the second 3-month period, vaginal bleeding/spotting frequencies were 41.1 and 37.8%, respectively. In the third 3-month period 30.6 and 29.6%, and in the fourth 3-month period, 18.5 and 12.5% of the patients reported vaginal bleeding or spotting. None of the results of endometrial sampling have shown findings of cancer histopathology. Conclusion: Compared to CEE/MPA regimen, E2/NETA therapy has not shown more favorable effects on postmenopausal bleeding abnormalities. Irregular endometrial proliferation was seen more with the E2/NETA regimen.     

Reference period analysis of vaginal bleeding with triphasic oral contraceptive agents containing norethindrone or levonorgestrel: a comparison study.

The World Health Organization recommends the use of fixed reference periods for quantification of the incidence and severity of vaginal bleeding when patients use various forms of contraception. Ninety- and 110-day reference periods were used in the analysis of data from daily menstrual diaries kept by 72 healthy women in a one-year study of oral contraceptive agents containing ethinyl estradiol and either norethindrone or levonorgestrel. Analysis of bleeding patterns reported during both 90-day and 110-day periods revealed fewer days of bleeding and/or spotting overall with norethindrone than with levonorgestrel (e.g., a mean of 16.06 vs. 19.55 days, respectively, over the first 90-day period; P = .013) and significantly shorter bleeding and/or spotting episodes with the norethindrone preparation. This trend persisted when data were adjusted for a day-1 pill start. Using either method of analysis, duration of bleeding episodes was shorter among subjects taking norethindrone than levonorgestrel. Pills were missed in both study groups, but more women in the LNG/EE group missed from 1 to 3 pills in at least one cycle (31 vs. 21 in the NET/EE group). The between-group difference in bleeding events may be due to intrinsic hormonal differences in regimens or to the greater number of pills missed among levonorgestrel users.     

A comparison of cycle control with monophasic levonorgestrel/ethinylestradiol 100 micrograms/20 micrograms versus triphasic norethindrone/ethinylestradiol 500-750-1000 micrograms/35 micrograms: a multicenter, randomized, open-label study.

OBJECTIVES: This multicenter, randomized, open-label study was undertaken to compare the effects on menstrual cycle control of two oral contraceptive regimens: monophasic levonorgestrel (LNG) 100 micrograms/ethinylestradiol (EE) 20 micrograms (Alesse or Loette) and triphasic norethindrone (NET) 500-750-1000 micrograms/EE 35 micrograms (OrthoNovum 7/7/7). METHODS: Healthy women with normal menstrual cycles were enrolled and completed up to four cycles of study medication. A total of 384 cycles in the LNG/EE group and 400 cycles in the NET/EE group were evaluable for analysis of cycle control. RESULTS: For all treatment cycles, the percentage of cycles classified as normal was consistently higher in the LNG/EE group than in the NET/EE group. By cycle 4, 69.9% of cycles with LNG/EE and 54.4% with NET/EE (p < 0.05) were normal. In individual cycles, consistently lower occurrences of intermenstrual bleeding (total bleeding and/or spotting) were seen for the LNG/EE group, although these differences were not statistically significant. Withdrawal bleeding characteristics were comparable between the two groups, except for the length of the latent period, which was significantly longer in the LNG/EE group. The incidence of treatment-emergent adverse events was similar in the two groups. CONCLUSION: This study indicates that the monophasic LNG/EE 100 micrograms/20 micrograms provides better cycle control than the multiphasic NET/EE product, despite its lower EE dose.     

Oral contraceptives and their minor side effects: comparison of three low-dose estroprogestinic combinations

3 groups of women aged 19-25 with normal weight and in good physical health were studied. In the first group, 40 subjects received a monophasic oral contraceptive (OC) containing .15 mg of levonorgestrel (LNG) and .03 mg of ethinyl estradiol (EE). In the second group, 32 women received a triphasic OC containing LNG and EE (.05 mg of LNG + .03 mg of EE; .075 mg of LNG + .04 mg of EE; .125 mg of LNG + .03 mg of EE). In the third group, 34 women received a monophasic OC containing .15 mg of desogestrel (DSG) and .03 mg of ethinyl estradiol (EE). The observation lasted 6 month, involving 646 menstrual cycles. 3 months and 6 months later, checkups were conducted to find out about characteristics of the cycles, spotting or BTB (hemorrhagic rupture), weight change, and other minor disorders. After 3 months, spotting occurred in 4.1% of the monophasic LNG group, in 5.8% of the monophasic DSG group, and in 1% of the triphasic group (significantly higher in the DSG group). Heavy bleeding decreased from 25% in the LNG group, 25% in the triphasic group, and 17.6% in the DSG group to 0 after 6 months. Likewise, dysmenorrhea disappeared in all 3 groups. Weight change occurred in 50% of the LNG group, in 57% of the triphasic group, and in 76% of the DSG group. Premenstrual disorders, such as mastodynia, dropped from 40 to 25% in the LNG group, from 75 to 50% in the triphasic group, and from 54.5 to 36.3% in the DSG group after 6 months. Depression decreased from 20 to 8.3% in the LNG group and from 18.1 to 4.5% in the DSG group. Acne fell from 25% to 0 in the triphasic group and from 31.8 to 9 in the DSG group. These OCs were well tolerated without major differences between their minor side effects.     

Continuous oral contraceptives: are bleeding patterns dependent on the hormones given?

OBJECTIVE: To estimate whether progestin type or estrogen dose influences bleeding patterns, adverse effects, or satisfaction with combined oral contraceptives dosed continuously. METHODS: This was a randomized, double blind, 4-arm active treatment study. Subjects received either 100 microg levonorgestrel/20 microg ethinyl estradiol (E2) (20LNG group), 100 microg levonorgestrel/30 microg ethinyl E2 (30LNG group), 1,000 microg norethindrone acetate/20 microg ethinyl E2 (20NETA group), or 1,000 microg norethindrone acetate/30 microg ethinyl E2 (30NETA group) for 180 days. Subjects logged bleeding events and adverse effects on a daily menstrual calendar. An exit survey measured satisfaction with bleeding patterns. RESULTS: One hundred thirty-nine women were enrolled. Patients in the 20NETA and 30NETA arms had significantly more days of amenorrhea than the 30LNG arm in the second 90 days (P < .008). The 30LNG group reported more spotting days than the 20NETA group over the entire study period (P < .008) and the 30NETA group for the second 90 days (P < .008). Only a small number of bleeding days were reported with no differences between groups. No differences in adverse effects between groups were found. Women in the 30LNG arm reported lower levels of satisfaction with their bleeding patterns than the other groups (30LNG compared with 20NETA, P = .01; 30LNG compared with 30NETA, P = .001). CONCLUSION: The addition of 10 microg of ethinyl E2 to a 20 microg ethinyl E2 pill containing levonorgestrel or norethindrone acetate did not improve bleeding patterns. During continuous dosing, the use of oral contraceptives containing 1,000 microg norethindrone acetate resulted in more days of amenorrhea and fewer days of spotting than preparations containing 100 microg levonorgestrel. LEVEL OF EVIDENCE: I.     

Menstrual bleeding patterns in pre- and perimenopausal women: a population-based prospective diary study

BACKGROUND: To investigate natural menstrual bleeding patterns in pre- and perimenopausal women, a prospective observational population study was carried out. METHODS: A total of 1616 (80.8%) of a population-based sample of 2000 Danish women aged 45-54 years answered an initial questionnaire. Of 1059 women with natural gynecological functions, 951 (89.8%) completed 1 year of daily recording of bleeding. Of these women, 592 were pre- or perimenopausal and were included in this study. MAIN OUTCOME MEASURES: Length and heaviness of bleeding episodes, including frequency of spotting, flooding and prolonged bleeding, according to regularity of cycles. RESULTS: The proportion of women with irregular cycles increased from 58.3% at age 45-46 years to 100% at age 53-54 years (P < 0.001). Irregularity of cycles was accompanied by increased variation in both length and subjective assessment of heaviness of bleeding episodes in the individual woman and between women (P < 0.001). Episodes of spotting (P < 0.001) and prolonged bleeding (10 days or more) (P < 0.001) were more common in women with irregular cycles. Subjective assessment of heaviness of bleeding episodes, however, was higher in women with regular cycles (P < 0.001). One or more episodes of flooding were recorded by 24.0% of all women irrespective of regularity of cycles (P = 0.40) but more frequently in younger women (P < 0.001). CONCLUSIONS: Irregularity of cycle lengths at the end of the fertile period is common, and is accompanied by an increased inter- and intraindividual variation in the length and heaviness of bleeding episodes, including increased frequency of prolonged bleeding and spotting.     

Reduced vaginal bleeding in postmenopausal women who receive combined norethindrone acetate and low-dose ethinyl estradiol therapy versus combined conjugated equine estrogens and medroxyprogesterone acetate therapy

OBJECTIVE: The purpose of this study was to compare the effects on vaginal bleeding patterns of continuous combined hormone replacement therapy with norethindrone acetate and ethinyl estradiol versus conjugated equine estrogens and medroxyprogesterone acetate. STUDY DESIGN: Three hundred fifty-seven postmenopausal women were selected randomly (in a blinded manner) to 12 months of treatment with 1 mg norethindrone acetate/5 microg ethinyl estradiol, placebo, or open-label 0.625 mg conjugated equine estrogens/2.5 mg medroxyprogesterone acetate (conjugated equine estrogens/medroxyprogesterone acetate [CEE/MPA]; Prempro). The incidence and duration of vaginal bleeding were assessed throughout the study. Statistical analyses used Cochran-Mantel-Haenszel methodology and analysis of variance. RESULTS: At 3 months, 1 mg norethindrone acetate/5 microg ethinyl estradiol therapy reduced the incidence of bleeding (12% vs 23%; P <.029) and bleeding and/or spotting (22% vs 44%; P <.001), compared with conjugated equine estrogens/medroxyprogesterone acetate therapy. The mean duration of bleeding and bleeding and/or spotting were also reduced with 1 mg norethindrone acetate/5 microg ethinyl estradiol therapy versus conjugated equine estrogens/medroxyprogesterone acetate (P =.004 and P <.001, respectively). The incidence of cumulative amenorrhea at every monthly interval was significantly better with 1 mg norethindrone acetate/5 microg ethinyl estradiol therapy versus conjugated equine estrogens/medroxyprogesterone acetate therapy (P <.05). Associated adverse event (ie, headache, breast pain) incidence rates were similar in the 2 active treatment groups. CONCLUSION: The 1 mg norethindrone acetate/5 microg ethinyl estradiol therapy provides significantly better control of vaginal bleeding than conjugated equine estrogens/medroxyprogesterone acetate therapy at all time points investigated in this 12-month study.     

A 5-year follow-up study on the use of a levonorgestrel intrauterine system in women receiving hormone replacement therapy.

OBJECTIVE: To investigate endometrial histology, bleeding, and the effects of replacing the levonorgestrel intrauterine system (LNG IUS, Mirena/Levonova, Leiras Oy, Turku, Finland) after 5 years of combined use with estrogen. DESIGN: Prospective cohort study. SETTING: Private outpatient clinic. PATIENT(S): Forty postmenopausal women started hormone replacement therapy with LNG IUS and either a patch (50 microg/24 h) or oral (2 mg) estradiol valerate protocol. Thirty-nine completed 12 months of treatment. Twenty-nine of them had used LNG IUS with continuous estradiol replacement therapy for 5 years. Seven of them volunteered to a 3-month treatment-free period before reinsertion; 22 opted for immediate reinsertion. INTERVENTION(S): Endometrial sampling for histology, endometrial thickness, and location of the LNG IUS by ultrasound at removal and after washout. The women completed bleeding diaries from 3 months prior to removal to 3 months after reinsertion. MAIN OUTCOME MEASURE(S): Endometrial histology was evaluated and estrogen and progestin effects were also investigated. Endometrial thickness was measured. Bleeding was examined based on bleeding diaries. The investigator and the women evaluated the insertion, removal, and reinsertion of the LNG IUS. RESULT(S): At 6 and 12 months endometrial histology was nonproliferative. At removal, all endometria were suppressed and a strong progestin effect was seen. The thickest endometrium was 3.6 mm. After washout, all seven endometria were atrophic. Before the IUS was replaced, 26 women were amenorrheic, whereas three had minor spotting. After replacement 5 women had no bleeding and an additional 10 women had only spotting. The bleeding or spotting discontinued within 18 days. The insertion of LNG IUS was characterized as easy by the investigator and it was well tolerated by the women. Cervical dilatation and/or paracervical blockade was used in 10 insertions. CONCLUSION(S): Intrauterine levonorgestrel effectively protects against endometrial hyperplasia. In most women it induces amenorrhea, which is only temporarily affected by replacement of the LNG IUS.     

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.