延期使用左炔诺孕酮Ⅰ型皮下埋植剂避孕的有效性观察

目的探讨延期使用左炔诺孕酮Ⅰ型皮下埋植剂避孕的有效性.方法对299例使用左炔诺孕酮Ⅰ型埋植剂超过5年以上的妇女,观察其避孕的有效性及子宫内膜的形态学变化.结果延期使用组月经表现较为正常,累积妊娠率为0.33/100妇女年.植入后平均体重和血红蛋白均增加,与植入前比较差异有显著性,P＜0.05.对48例延期使用者进行观察,宫腔镜直视下见子宫内膜变薄者37例,占77.08%,且内膜覆盖良好;光镜下子宫内膜腺体数量减少,分布不均匀,部分呈萎缩型改变,间质蜕膜样改变,疏松,轻度水肿;电镜下腺上皮细胞呈低柱状,胞体变小,微绒毛脱落,稀疏,分泌颗粒减少,线粒体肿胀,外膜消失,基质变淡,甚至呈空泡状,粗面内质网扩张,此外,间质细胞出现细胞凋亡.结论延期使用左炔诺孕酮Ⅰ型皮下埋植剂避孕是有效的,可抑制子宫内膜的发育,对子宫内膜是安全的;体重和血红蛋白的增加不是影响左炔诺孕酮埋植剂延期使用的因素.     

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、     

Norplant皮下埋植避孕法对子宫内膜影响的临床病理研究

<正> Norp1ant皮下埋植剂(以下简称埋植剂)避孕是一项新的、女用的长效避孕方法,避孕效果好,继续使用率高,可逆性强,已有44个国家355,000人应用。现将30例应用Norplant皮下埋植剂避孕妇女的31人次及埋植剂取出后置宫内节育器时采取子宫内膜3例介绍如下:     

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。     

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。     

Norplant使用者子宫内膜中层粘连蛋白、血管内皮生长因子及CD_(34)含量的研究

对未使用 Norplant和使用 Norplant0 .5年、1年及 2年以上的无不规则子宫出血与有不规则子宫出血的人子宫内膜进行研究 ,比较观察形态学变化以及内膜中层粘连蛋白、血管内皮生长因子及内皮细胞的 CD34 的含量 ,结果显示 1 .Norplant使用者子宫内膜增殖期特点消失 ;2 .血管内皮变薄 ;3.不规则出血的内膜中血管基膜层粘连蛋白、血管内皮生长因子明显减少。提示 Norplant使用者子宫不规则出血与内膜血管内皮变薄、血管基膜层粘连蛋白及血管内皮生长因子的减少有密切关系     

缓释左旋-18甲基炔诺酮皮埋避孕剂

时采用NorplantR埋植剂和仿制Norplant的国产埋植剂I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.61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＜0.01),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25～29岁组腰椎L2～L4骨密度埋植后增加最为显著,Norplant组P＜0.05,国产埋植剂组P＜0.01.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＜0.01);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＜0.01);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＞0.05).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.     

雌激素防治LNG皮下埋植剂所致不规则阴道流血的临床观察

目的 :观察长效雌激素尼尔雌醇及短效雌激素炔雌醇对使用 L NG皮下埋植剂半年内不规则阴道流血的防治效果。方法 :L NG皮下埋植剂使用者 6 5人 ,长效组、短效组各2 0人、对照组 2 5人。长效组及短效组分别给予尼尔雌醇 ( CEE3 ,5mg,每月一次 )、炔雌醇 ( EE,0 .0 5mg,qd× 2 0 d,月经 d5开始服用 )治疗半年 ,对照组不用药 ,研究结束时Doppler超声检查。结果 :与短效组比 ,长效组出血次数减少 ( P<0 .0 5) ,最长流血天数减少 ( P<0 .0 5)而出血天数并未减少。使用雌激素治疗后卵巢动脉阻力下降 (长效组 P<0 .0 5,短效组 P<0 .0 5) ,但不影响子宫和卵巢的大小以及子宫的血供 ,对子宫内膜的厚度也无影响。结论 :雌激素对防治皮埋剂使用后不规则阴道流血有效。     

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     

国产长效皮下埋植避孕剂与Norplant多中心临床对比研究

目的 :观察两种国产皮下埋植避孕剂 I型、II型和 Norplant埋植剂的避孕效果、副反应和可接受性。方法 :采用前瞻性、随机分配原则的研究方法 ,在全国 1 0个临床中心开展本专题临床研究。统一研究方法 ,统一科研表格。每年随访一次 ,共随访 5年。结果 :共接收对象 2 999例。国产 型组 1 0 0 1例 , 型组 1 0 0 0例 ,Norplant组 998例。 5年随访率为 99.8%。 5年末 ,国产 型组 ,妊娠 3例 ,粗累积妊娠率 0 .4/1 0 0妇女。国产 型组 ,妊娠 5例 ,粗累积妊娠率 0 .7/1 0 0妇女。Norplant组无妊娠 ,三组间无统计学差异 ( P>0 .0 5 )。三组均无宫外孕发生。 5年末 ,三组共终止 82 2例。继续累积使用率 ,分别为 73.9,68.4和 75 .5 /1 0 0妇女。经 Log- Rankχ2 检验 ,三组无统计学意义 ( P>0 .0 5 )。月经问题是终止的主要原因。随埋植时间延长 ,月经出血模式正常比率明显增加。血红蛋白有上升趋势。 5年内未发生重大健康问题。结论 :国产皮埋剂 I型、II型和 Norplant是高效、长效、安全的节育方法     

Effect of a combined oral contraceptive containing 3 mg of drospirenone and 30 microg of ethinyl estradiol on the human endometrium.

OBJECTIVE: To provide an in-depth assessment of the effects of the combined oral contraceptive containing 30 microg of ethinyl estradiol and 3 mg of drospirenone (Yasmin, Schering AG, Berlin) on the endometrium by means of endometrial morphometry in comparison to an untreated cycle. DESIGN: The open, multicenter study consisted of one untreated precycle and 13 treatment cycles. SETTING: Four gynecologic clinics in Belgium, The Netherlands, and Switzerland were involved. PATIENT(S): Forty women with a history of regular menstrual cycles. INTERVENTION(S): Before the commencement of the trial, 3 months without any hormonal intake was obligatory. The first endometrial sample was done in the untreated precycle, adjusted to the day of LH peak plus 5 to 6 days. During the medication phase, endometrial samples were taken at cycle 3, 6 and 13. MAIN OUTCOME MEASURE(S): Primary outcome measure of the study was the morphologic assessment of the endometrium with measures such as glandular diameter, glandular epithelial height, and number of vacuolated cells per 1,000 glandular cells. Furthermore, the endometrial thickness was measured by ultrasound. RESULT(S): After 13 cycles of medication use the endometrium had an atrophic appearance in 63% of the subjects. The size of the glands, the glandular epithelial height, and the number of glands per square millimeter were already significantly reduced after 3 months' use. Histological and ultrasonographical evaluation of the endometrium indicated a suppression of the proliferative activity of the endometrium. CONCLUSION(S): The combination of 30 microg of ethinyl estradiol with 3 mg of drospirenone induces changes of the endometrium that are comparable with other combined oral contraceptives and exhibits a marked antiproliferative effect on the endometrium. The medication was proven to be an effective oral contraceptive and revealed good cycle control characteristics.     

Norplant皮下埋植后子宫内膜形态和雌、孕激素受体含量的变化

目的探讨Ｎｏｒｐｌａｎｔ皮下埋植后子宫内膜形态和雌、孕激素受体（ＥＲ、ＰＲ）含量的变化与子宫异常出血的关系。方法应用免疫组化、ＷｅｓｔｅｒｎＢｌｏｔ和原位杂交技术结合计算机图像分析,观察１６例Ｎｏｒｐｌａｎｔ皮下埋植后和２３例正常周期的内膜的形态学改变、细胞增殖状态及ＥＲ、ＰＲ蛋白及其ｍＲＮＡ的表达。结果埋植Ｎｏｒｐｌａｎｔ后,内膜ＤＮＡ含量降低;螺旋动脉数量减少,腺体的构成比例降低;腺体构成比例与雌二醇（Ｅ２）水平呈正相关,与子宫异常出血呈负相关,与年龄和体重无相关性,随使用期延长,腺体构成比增加。埋植后,内膜ＥＲ含量低于月经周期各期水平,但ＰＲ含量相当于或高于月经周期最高水平。ＥＲ、ＰＲｍＲＮＡ表达减弱,以ＥＲｍＲＮＡ表达降低更明显。结论内膜腺体和螺旋动脉再生修复不良和ＥＲ、ＰＲ表达异常,可能是Ｎｏｒｐｌａｎｔ致子宫异常出血的病理学基础     

Endometrial changes in women receiving oral contraceptives

Endometrial changes in 105 women taking a variety of oral contraceptive pills for periods ranging from 2 to 60 months were studied. Individual response, as measured by endometrial change, varied greatly. Among the changes noted were: 1) atrophic proliferative glands with hypertrophic decidual stroma; 2) nodular stromal hyperplasia; 3) myometrial hyperplasia; 4) capillary thickening with endothelial proliferation and fibrin thrombi; 5) increased lymphatics simulating micorcysts; and 6) atypical hyperplasia of decidual cells. Endometrial stromal reaction seemed greatest in women who had taken pills for the longest time.     

Effect of a new oral antiandrogen-estrogen combination on the endometrium: histological and ultrastructural scanning electron microscopy study

Endometrial biopsies were obtained in 12 volunteers between 18 and 35 years old who had used SHB 209 AE oral contraceptive during the previous six months. Three main types of endometrial patterns were observed: proliferative, very similar to a normal proliferative phase; early secretory: similar to early postovulatory endometrium; late secretory: characterized by diffuse predecidual changes in the stroma. At SEM after one week a great prevalence of nonciliated cells was observed. During the 2nd and the 3rd week, the endometrial surface appears still flattened with scanty glandular outlets.     

Contraceptive implants

In response to the need of some women for long-acting, effective and safe contraceptives, the scientific community developed non-biodegradable progestational subdermal implants that act by making the cervical mucus viscous, with ovulation inhibition and thinning of the endometrial lining. The contraceptive protection is within 24 hours and the cumulative failure rate is low. Contraceptive implants require little or no motivation following adequate counselling. In current use are multirod implants (Norplant I and Norplant II Jadelle) and single rod implant (Implanon and Uniplant). Although menstrual symptoms associated with progestational regimens are the major compliance and acceptability factors within the first year of use, menstrual disturbance generally improves. Continuation rates for implant use are high among those who have had adequate pre-insertion counselling because the perceived advantages greatly outweigh the nuisance effects. Other side effects of implants are similar to those observed with hormonal pills--headache, weight changes, mood swings and abdominal bloating. Training of physicians and nurses in the art of insertion and removal techniques is a pre-requisite for a successful implant programme. This should also be backed by integration of implants into the national commodity logistics systems to ensure adequate local budgetary provision for contraceptive implant procurement rather than reliance on donor supply.     

Paracrine regulation of endometriotic tissue

Endometriosis is a chronic estrogen-dependent gynecological disease, characterized by pelvic pain and infertility, defined as the presence of endometrial glands and stroma within the pelvic peritoneum and other extrauterine sites. In the peritoneal cavity endometrial cells adhere, proliferate and induce an inflammatory response. Despite a long history of clinical and experimental research, the pathogenesis of endometriosis is still controversial. Abnormal immunological activation, the endocrine milieu and the peritoneal environment all dramatically affect endometriotic tissue function. Recent studies suggest that the peritoneal fluid of women with endometriosis contains an increased number of activated macrophages and other immune cells that secrete various local products, such as growth factors and cytokines, which exert a paracrine action on endometriotic cells. Since the peculiar biological characteristics of eutopic endometrium from women with endometriosis differ from endometrium of normal subjects, an important role in the pathogenesis of this complex disease has been suggested. All of these factors contribute to enhanced proliferative and angiogenic activity and a number of functional and structural changes, resulting in the particular behavior of this tissue.     

Paracrine regulation of endometriotic tissue.

Endometriosis is a chronic estrogen-dependent gynecological disease, characterized by pelvic pain and infertility, defined as the presence of endometrial glands and stroma within the pelvic peritoneum and other extrauterine sites. In the peritoneal cavity endometrial cells adhere, proliferate and induce an inflammatory response. Despite a long history of clinical and experimental research, the pathogenesis of endometriosis is still controversial. Abnormal immunological activation, the endocrine milieu and the peritoneal environment all dramatically affect endometriotic tissue function. Recent studies suggest that the peritoneal fluid of women with endometriosis contains an increased number of activated macrophages and other immune cells that secrete various local products, such as growth factors and cytokines, which exert a paracrine action on endometriotic cells. Since the peculiar biological characteristics of eutopic endometrium from women with endometriosis differ from endometrium of normal subjects, an important role in the pathogenesis of this complex disease has been suggested. All of these factors contribute to enhanced proliferative and angiogenic activity and a number of functional and structural changes, resulting in the particular behavior of this tissue.     

Norplant users with irregular bleeding. Ultrasonographic assessment and evaluation of serum concentrations of estradiol and progesterone

OBJECTIVE: To determine the changes in thickness and pattern of endometrium among Norplant (Leiras, Leiras Oy, Turku, Finland) users who have irregular bleeding and to correlate these changes with estradiol and progestrone concentrations. STUDY DESIGN: Ultrasonographic evaluation (vaginal ultrasound) and serum sampling were performed on Norplant users who presented with complaints of bleeding at their first visit to the Family Planning Clinic, Department of Obstetrics and Gynecology, Chulalongkong Hospital, Bangkok, Thailand, between October 1, 1998, and March 31, 1999. RESULTS: A total of 85% (44/52 cases) of the subjects had estradiol concentrations < 50 pg/mL, and none had any luteal activity (progesterone concentration < 3 ng/mL). The endometrial thickness remained thin and very thin (3-6 mm = 50%, < 3 mm = 48%). A hyperechoic pattern in the endometrium was found in 90% of the subjects. There was a weak, negative correlation between estradiol concentration and endometrial thickness (P < .05, r = -.337). CONCLUSION: Norplant users with irregular bleeding were usually characterized by low estradiol concentrations, absence of luteal activity and a thin, hyperechoic pattern in the endometrium.