左炔诺孕酮宫内缓释系统非避孕临床应用

左炔诺孕酮宫内缓释系统(LNG-IUS)是一个载有左炔诺孕酮储库的T型支架,主要在宫腔内发挥局部孕激素作用。LNG-IUS除提供长期有效且可逆的避孕作用外,在月经过多、激素替代治疗(HRT)的内膜保护方面也有确切疗效。另有研究表明,LNG-IUS在子宫内膜异位性疾病、子宫肌瘤、子宫内膜增生症等方面也有较好的治疗作用。放置LNG-IUS后最常见的不良反应是不规则阴道出血和发生良性卵巢囊肿。     

左炔诺孕酮宫内缓释系统治疗子宫腺肌病的疗效

目的:探讨左炔诺孕酮宫内缓释系统(LNG-IUS;曼月乐)治疗子宫腺肌病的临床应用价值。方法:对36例子宫腺肌病的患者,宫内放置LNG-IUS,观察放置前后患者月经情况、痛经程度、子宫体积变化、血清CA125及不良反应。结果:放置LNG-IUS后,患者月经量显著减少,第1个月经量为原来的(35±11)%(P0.01),12个月后为(6±2)%(P0.01),26例贫血患者于放置3个月后血红蛋白恢复正常;放置1个月后患者痛经程度明显减轻,痛经评分由放置前的(2.3±0.37)分降为(1.2±0.14)分(P0.01),放置6个月后,患者的痛经症状均消失;放置LNG-IUS前子宫体积为(232.43±71.14)cm3,放置6个月后子宫体积缩小(187.74±54.07)cm3(P0.01);血清CA125于放置3个月后明显降低(P0.01),且降至正常范围;患者无明显不良反应。结论:左炔诺孕酮宫内缓释系统治疗子宫腺肌病疗效显著,安全性好,为一种较好的保守治疗手段。     

左炔诺孕酮宫内缓释系统非避孕临床应用

左炔诺孕酮宫内缓释系统(LNG-IUS)是一个载有左炔诺孕酮储库的T型支架,主要在宫腔内发挥局部孕激素作用。LNG-IUS除提供长期有效且可逆的避孕作用外,在月经过多、激素替代治疗(HRT)的内膜保护方面也有确切疗效。另有研究表明,LNG-IUS在子宫内膜异位性疾病、子宫肌瘤、子宫内膜增生症等方面也有较好的治疗作用。放置LNG-IUS后最常见的不良反应是不规则阴道出血和发生良性卵巢囊肿。     

左炔诺孕酮宫内缓释系统治疗子宫腺肌病近期疗效观察

目的:探讨左炔诺孕酮宫内缓释系统(LNG-IUS)治疗子宫腺肌病的近期临床疗效。方法:对34例子宫腺肌病的患者宫内放置LNG-IUS,观察放置前后患者痛经程度、子宫体积变化、血清CA125、月经情况及不良反应。结果:放置LNG-IUS3个月后,患者痛经程度明显减轻,痛经评分由放置前的(2.50±0.41)分降为(1.30±0.16)分(P<0.01),放置6个月后,患者的痛经症状消失;放置LNG-IUS前子宫体积为(160.15±35.05)cm3,放置6个月后子宫体积缩小(152.26±13.24)cm3(P>0.05);血清CA125放置前为(67.32±16.84)U/ml,放置3个月后明显降低(25.36±11.27)U/ml(P<0.01);放置LNG-IUS后,患者月经量显著减少,放置后3个月经量为原来的(28.00±8.00)%(P<0.01);患者无明显不良反应。结论:左炔诺孕酮宫内缓释系统治疗子宫腺肌病近期疗效显著,安全性好,为一种较好的保守治疗手段。     

左炔诺孕酮宫内缓释系统治疗妇科疾病作用探讨

目的 探讨左炔诺孕酮宫内缓释系统治疗妇科疾病作用效果。方法 选择2017年1月-2021年1月本院收治的80例妇科疾病患者开展研究,所有患者均采用左炔诺孕酮宫内缓释系统治疗,统计不同类型妇科疾病患者的治疗效果。结果 所有妇科疾病患者经治疗后的第1个月、3个月、6个月的痛经评分降低、子宫体积缩小、月经量减少、CA125水平降低,血红蛋白水平升高同治疗前对比,具有统计学意义(P<0.05);随访观察半年,发现用药期间,不良反应发生率为6.25%,不良反应发生概率较低,且经针对性治疗干预后患者均好转。结论 对于子宫腺肌瘤、子宫内膜增生、月经过多、子宫内膜息肉等妇科疾病中,采用左炔诺孕酮宫内缓释系统实施治疗,获得疗效较好,能显著降低患者的疼痛症状,减少月经量,缩小子宫体积缩,值得推荐。     

左炔诺孕酮宫内缓释系统的临床应用

左炔诺孕酮宫内缓释系统(levonorgestrel releasing intrauterine system,LNG-IUS)是一种新型的宫内避孕系统,每天向宫腔内释放一定量的左炔诺孕酮发挥作用。随着对LNG-IUS的应用发现其不但具有长期、高效的避孕作用,在非避孕领域中也具有新功能,尤其在子宫内膜异位症、子宫腺肌病、痛经、子宫内膜增生等妇科疾病的治疗中,具有重要意义。     

左炔诺孕酮宫内缓释系统的非避孕临床应用

左旋炔诺孕酮宫内缓释系统（LNG-IUS）是有效的避孕药物。除用于人类节育外,还可用于治疗月经过多,减少子宫内膜异位症、腺肌症患者的疼痛。其抗子宫内膜增殖的活性,还被用于在激素替代治疗期间雌激素引起的内膜增殖,治疗子宫内膜增生、子宫内膜癌及预防乳腺癌时他莫昔芬内分泌调节治疗中的内膜增殖。     

左炔诺孕酮宫内缓释系统临床应用研究

左炔诺孕酮宫内缓释系统（LNG-IUS）是一种安全、高效的宫内节育器（IUD），其通过每天释放小剂量的左炔诺孕酮至宫腔实现孕激素的非全身给药，从而开辟了在非避孕领域的许多新的应用。现就其在治疗月经过多、子宫内膜异位症和腺肌症、激素替代治疗期间的子宫内膜保护等方面进行综述。     

左炔诺孕酮宫内缓释系统临床应用研究

左炔诺孕酮宫内缓释系统(LNG-IUS)是一种安全、高效的宫内节育器(IUD),其通过每天释放小剂量的左炔诺孕酮至宫腔实现孕激素的非全身给药,从而开辟了在非避孕领域的许多新的应用.现就其在治疗月经过多、子宫内膜异位症和腺肌症、激素替代治疗期间的子宫内膜保护等方面进行综述.     

左炔诺孕酮宫内缓释系统的非避孕临床应用

左旋炔诺孕酮宫内缓释系统(LNG-IUS)是有效的避孕药物。除用于人类节育外,还可用于治疗月经过多,减少子宫内膜异位症、腺肌症患者的疼痛。其抗子宫内膜增殖的活性,还被用于在激素替代治疗期间雌激素引起的内膜增殖,治疗子宫内膜增生、子宫内膜癌及预防乳腺癌时他莫昔芬内分泌调节治疗中的内膜增殖。     

Contraceptive and noncontraceptive benefits of the LNG-IUS in a vertically integrated HMO

BACKGROUND: The study was conducted to assess outcomes among women using the levonorgestrel-releasing intrauterine system (LNG-IUS). STUDY DESIGN: The data were collected via a retrospective claims database analysis of 152 women. Two nested cohorts were further distinguished based on length of follow-up: two and three continuous years (n=73 and n=29, respectively). RESULTS: Over 90% had a single insertion, and fewer than 4% experienced an LNG-IUS-related complication. Thirteen percent of women experienced menorrhagia in the year preceding insertion; this figure dropped to 12.5%, 1.2% and 0% in the 1, 2 and 3 years postinsertion. Mean number of gynecology-related visits decreased from four to two in the overall cohort, from seven to four in the cohort with 2 years of follow-up and from nine to four in the cohort with 3 years of follow-up. CONCLUSION: LNG-IUS use prevented pregnancy in all patients and was associated with decreased vaginal bleeding starting in the second year postinsertion.     

Comparing benefits and risks of immunization

BACKGROUND: This paper uses a straightforward method of quantifying the benefits and risks of immunization, illustrated by universal immunization programs in British Columbia against invasive Haemophilus influenzae type b disease (Hib), measles, rubella, and paralytic poliomyelitis. METHODS: Data were extracted from provincial communicable disease and vaccine adverse event surveillance systems. Average disease incidence was compared before and after implementing universal immunization programs. Estimates of prevented deaths and serious disease complications were calculated and compared with expected numbers of serious vaccine-associated adverse events (VAAEs). RESULTS: Average incidence of reported cases decreased 90 to 100% over a 5-year period after implementing universal programs. These benefits were sustained or strengthened over time. Rates of reported serious VAAEs were low. DISCUSSION: The remarkable success of immunization has created a paradox. Despite a low absolute risk of serious VAAEs, the relative risk of some VAAEs can exceed risk of disease in the province.     

Comparing the health risks and benefits of contraceptive choices

Simulation models were used to compare the health consequences of birth control methods currently relied on by American women with those of using no method. The incidence of morbidity and mortality related to unintended pregnancies, live births, abortions, upper genital tract infections, tubal infertility, cardiovascular disease and reproductive cancers were estimated for hypothetical cohorts of 100,000 women aged 15-44. Women who never use any method and who never have an abortion would have an average of 18 births during their reproductive lifetime, compared with no more than five among women using any of the available birth control methods. Consequently, use of any method prevents more deaths from pregnancy and childbirth than are associated with method use. The proportion of women who would become infertile--estimated by taking into account the likelihood of developing upper genital tract infections and the probability that any pregnancies that occurred would be ectopic--is reduced substantially if women at low risk of sexually transmitted diseases use any method and if women at high risk use oral contraceptives or barrier and spermicide methods. Oral contraceptive use has a relatively small, independent effect on the risk of cardiovascular diseases, but it greatly augments that risk in combination with smoking and increased age. When ovarian, endometrial and breast cancers are considered together, there will be approximately 110 fewer diagnoses of these three cancers per 100,000 ever-users of the pill aged 15-54 than among 100,000 never-users; furthermore, prior to age 45, 100,000 ever-users will experience 10 fewer deaths from ovarian or endometrial cancers than never-users of the pill.(ABSTRACT TRUNCATED AT 250 WORDS)     

The non-contraceptive effects of the levonorgestrel-releasing intrauterine device

Clinical trials have consistently shown that the IUD that releases 20 g levonorgestrel daily (LNG-IUD-20) has a contraceptive efficacy comparable to, if not surpassing, the Copper T380 and the Multiload Copper-375 IUDs.The focus of this review is the device's non-contraceptive effects — the beneficial ones, such as reduction of menorrhagia, a therapeutic effect on dysmenorrhea, and prevention of ectopic pregnancy, as well as the deleterious ones, such as amenorrhea, spotting and irregular bleeding, hormonal side-effects, and functional ovarian cysts. Also discussed are the possibility of a preventive effect on pelvic inflammatory disease, the effects of the IUD on postpartum/lactating women, fertility return after removal and other safety issues.In general, the LNG-IUD-20's non-contraceptive benefits are substantive, carry important medical and public health implications, and far outweigh the device's deleterious effects, which are either medically mild or transient in nature, and can usually be managed satisfactorily by counseling.A better understanding of these effects, both beneficial and deleterious, of this hormone-releasing IUD should lead to more effective patient counseling, which, in turn, should improve user quality of life, minimize unnecessary removals, and maximize continuation of use.

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Resumen Los ensayos clínicos realizados señalaron sistemáticamente que el DIU que descarga 20 g de levonorgestrel diariamente (LNG-DIU-20) tiene una eficacia anticonceptiva similar o incluso superior a la de los DIU CuT380 y Multiload Cu375.Este examen se centra en los efectos no anticonceptivos del dispositivo, los benéficos, tales como la reducción de la menorragia, el efecto terapéutico sobre la dismenorrea y la prevención del embarazo ectópico, así como los perjudiciales, por ejemplo, la amenorrea, las pérdidas y el sangrado irregular, los efectos secundarios hormonales y los quistes ováricos funcionales. También se examina la posibilidad de un efecto preventivo de la enfermedad inflamatoria pélvica (PID), los efectos del DIU sobre mujeres de posparto/lactantes, el retorno de la fecundidad después del retiro y otras cuestiones de seguridad.En general, los beneficios no anticonceptivos de los LNG-DIU-20 son significativos, tienen importantes repercusiones médicas y de salud pública, y compensan con creces los efectos perjudiciales del dispositivo, que son médicamente ligeros o bien de naturaleza pasajera, y pueden ser manejados satisfactoriamente, en términos generales, mediante un asesoramiento adecuado.Una mejor comprensión de los efectos, tanto benéficos como perjudiciales, de estos DIU de descarga hormonal habrá de llevar a un mayor asesoramiento de pacientes, lo cual, a su vez, mejorará la calidad de vida de las usuarias, reducirá al mínimo los retiros innecesarios y aumentará al máximo la continuación del uso.

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Resumé Les essais cliniques ont invariablement montré que le DIU libérant chaque jour 20 g de lévonorgestrel (LNG-IUD-20) a une utilité contraceptive comparable, sinon supérieure, à celle des dispositifs Copper T380 et Multiload Copper-375.Le présent article est axé non seulement sur les effets non contraceptifs du dispositif, ceux qui sont bénéfiques, tels qu'une réduction de la ménorragie, un effet thérapeutique sur la dysménorrhée, la prévention des grossesses ectopiques, mais aussi sur les effets délétères tels que l'aménorrhée, les microrragies et les pertes sanguines irrégulières, les effets hormonaux secondaires et les kystes fonctionnels ovariens. Y est examinée aussi la possibilité d'un effet préventif des maladies pelviennes inflammatories, les effets du DIU chez les femmes lors du post-partum et de la lactation, le retour à la fécondité après le retrait et d'autres aspects de sécurité.En général, les avantages non contraceptifs du LNG-IUD-20 sont considérables, ont d'importantes incidences médicales et en matière de santé publique, et compensent très largement les effets délétères du dispositif, lesquels sont soit bénins du point de vue médical soit passagers et peuvent en général être convenablement surmontés en demandant conseil.Une meilleure connaissance des effets, bénéfiques et délétères, de ce DIU libérant des hormones devrait permettre de mieux conseiller les patientes, ce qui devrait du même coup améliorer la qualité de la vie des utilisatrices, réduire au minimum les retraits inutiles du dispositif et maximaliser la poursuite de son utilisation.

     

Migration of Implanon

OBJECTIVE: To determine whether or not migration of the Implanon rod does occur if correctly positioned and, if indeed migration does occur, to measure the degree of such migration. METHODS: A prospective study of 100 women who requested and had Implanon rods inserted by one fully trained health care professional holding the Faculty of Family Planning and Reproductive Health Care Letter of Competence in Subdermal Contraceptive Implant Techniques. Measurements were made from the insertion site to the distal end of the rods at 3 and 12 months post-insertion. RESULTS: Of the 100 women studied, 95 were seen for follow-up at 3 months. There was no migration of Implanon in 58 (61%) patients. Of the remaining 37 (39%) patients where migration had occurred, 34 showed migration caudally and only three demonstrated cranial migration. With regard to the degree of migration, all but one case showed this to be less than 2 cm either cranially or caudally. At 1-year follow-up 87 patients were seen. No migration was noted in 39 (45%) patients. In the remaining 48 (55%) patients where migration had occurred, 44 showed migration caudally and only four demonstrated cranial migration, which in one case was over 2 cm. With regard to the degree of migration, all but one case showed this to be less than 2 cm either cranially or caudally. The measurement in the single case showing migration over 2 cm at 3 months remained the same at the 1-year follow-up. CONCLUSIONS: These results show that up to 1 year after insertion of Implanon significant migration of the rod does not occur. The degree of migration noted in all cases except one was less than 2 cm. Where migration was noted, in the majority of cases this occurred caudally towards the insertion site. There were no cases of deep migration.     

Comparing the benefits of diet and exercise in the treatment of dyslipidemia

BACKGROUND: Lifestyle changes are advocated as a first line of treatment for dyslipidemia. However, few studies have directly compared various combinations of diets and exercise. METHODS: In a randomized controlled pilot study, we compared the standard lifestyle recommendations (NCEP step I diet with regular exercise) and more intense interventions including the NCEP step I diet with a supervised aerobic exercise program and the step II diet with and without a supervised aerobic exercise program. We measured risk factors, dietary intake, time on treadmill, and health-related quality of life at baseline and after 3 months. RESULTS: Out of 198 eligible subjects, 47 (24%) were willing to participate and 41 completed the study. No significant change were observed with standard lifestyle recommendations. In contrast, participants in the more intense interventions lost weight (-1.7 to -3.7 kg) and reduced their total cholesterol (-4% to -6%), low-density lipoprotein cholesterol (-6%), and systolic blood pressure (-7.3 to -8.8 mmHg). Participants in the exercise program significantly increased their exercise capacity (1.6 to 1.9 METS). Overall, each 10% reduction in body weight was associated with a 7.6% reduction in low-density lipoprotein cholesterol. CONCLUSION: Standard lifestyle recommendations had little effect on blood lipid levels but more intense lifestyle interventions may be effective at improving blood lipids, other risk factors, and quality of life.