Bleeding patterns after use of levonorgestrel emergency contraceptive pills

OBJECTIVE: The objective of this study was to describe bleeding after use of an emergency contraceptive pill (ECP) regimen consisting of 1.5 mg of levonorgestrel in a single dose. METHODS: We asked 120 women who had been treated with the regimen to keep daily bleeding diaries for 9 weeks. We compared bleeding patterns observed after treatment with usual patterns reported by the participants and with patterns observed in a prior study on women who had not taken ECPs. RESULTS: Treatment in the first 3 weeks of the menstrual cycle significantly shortened that cycle as compared both with the usual cycle length and with the cycle duration in a comparison group. The magnitude of this effect was greater the earlier the pills were taken. In contrast, the duration of the first menstrual period after treatment increased significantly with cycle week of treatment and was longer in women who used the treatment than in those who did not. Intermenstrual bleeding occurred in only 5% of women in the first cycle after treatment. CONCLUSIONS: The effect of the single-dose levonorgestrel ECP regimen on the timing and duration of the next menstrual period depends on when during the cycle the pills are taken. Intermenstrual bleeding following treatment is uncommon.     

左炔诺孕酮宫内缓释系统治疗围绝经期功血患者子宫内膜超声结果分析

目的:探讨左炔诺孕酮宫内缓释系统(LNG-IUS)治疗围绝经期功能失调性子宫出血患者子宫内膜超声结果分析.方法:60例围绝经期功血患者行彩色多普勒超声检测后进行诊断性刮宫,观察不规则出血率、月经量、痛经症状、子宫形态、宫腔及内膜厚度及子宫内膜活检.结果:治疗3个月子宫内膜(0.7±0.2)cm,6个月(0.4±0.1)...     

A study of some practical aspects of high temperature liquid chromatography in pharmaceutical applications

In the pharmaceutical industry fast and efficient separation techniques play an increasing role among analytical methods because the samples to be investigated grow both in complexity and number, and there is an increasing time pressure to complete the analysis. Reducing the analysis time without decreasing the efficiency is possible using higher pressures, elevated temperatures, smaller particle sizes, or a combination of these approaches. Recently developed chromatographic techniques such as the UHPLC (ultra high performance liquid chromatography) and HTLC (high temperature liquid chromatography) are highly promising in meeting these demands. In this study, high temperature liquid chromatography (HTLC) with a zirconia-based column and temperatures elevated up to 150°C was used. We investigated the chromatographic behaviour of a steroid active pharmaceutical ingredient (levonorgestrel) and its structurally related impurities as model compounds. The effect of the temperature in the range of 50-150°C and the flow-rate in the range of 0.5-3.0 ml/min, and using methanol as an organic modifier, were studied for optimisation of the separation method.     

左炔诺孕酮宫内缓释系统治疗子宫内膜单纯性增生过长的研究

目的：探讨左炔诺孕酮宫内缓释系统（曼月乐）治疗子宫内膜单纯性增生过长的疗效及可能作用机制。方法：选取 2011年11月—2012年2月门诊应用曼月乐治疗子宫内膜单纯性增生过长的患者60例,观察放置曼月乐6个月后的子宫内膜活检病理变化及经阴道超声测量子宫内膜厚度、子宫动脉血流[阻力指数（RI）、搏动指数（PI）]及月经模式的改变。结果：2例由于阴道持续性点滴出血提前取出,58例子宫内膜转归正常。放置曼月乐前后子宫内膜厚度、RI分别为（1.52±0.33） cm、（0.62±0.14）cm和0.64±0.07、0.79±0.08,差异均有统计学意义（P＜0.05或P＜0.01）,PI分别为1.98±0.51、1.96±0.04,差异无统计学意义（P＞0.05)。放置曼月乐后经量明显减少,24例表现为月经稀发,32例表现为闭经。结论：曼月乐是治疗子宫内膜单纯性增生过长的简单有效方法,对子宫动脉血流的影响是其可能的作用机制。     

左炔诺孕酮宫内缓释系统治疗功能失调性子宫出血的疗效分析

目的：观察左炔诺孕酮缓释系统治疗功能失调性子宫出血的临床疗效和安全性。方法选取218例功能失调性子宫出血患者,在患者的宫腔内放置左炔诺孕酮缓释系统进行治疗。分别于放置前与放置后第3、6、12个月时观察并记录子宫内膜厚度、外周血血红蛋白、月经量、月经周期的数据及不良反应。结果治疗后随访12个月,患者的子宫内膜厚度逐渐变薄,月经量逐渐减少,月经周期逐渐延长,月经周期外周血血红蛋白浓度逐渐上升,与置入前比较,差异均有统计学意义（P<0.05）。不良反应发生率为2.75%（6/218）,表现轻微可耐受或自行缓解。结论对功能失调性子宫出血患者采用左炔诺孕酮缓释系统进行治疗,可以有效改善子宫内膜厚度,减少子宫出血量,矫正子宫功能,改善贫血症状,不良反应少,临床疗效满意且安全可靠。     

Levonorgestrel-releasing Intrauterine System – The discontinuing story

Levonorgestrel-releasing Intrauterine System (LNG-IUS) is licensed for use as a contraceptive, for the treatment of heavy menstrual bleeding and during estrogen replacement therapy. It is publicized as a local source of progestogen with minimal systemic adverse effects. However, there is overwhelming evidence of elevated serum and tissue levels of levonorgestrel, and high discontinuation and dissatisfaction rates amongst users. The guidelines of The National Institute for Health and Clinical Excellence (NICE), United Kingdom recommended that the healthcare professionals should be aware that upto 60% of women discontinue using LNG-IUS within 5 years because of unscheduled bleeding, pain, and/or systemic progestogenic adverse effects. This article highlights these issues to healthcare professionals to ensure that the rates of adverse effects are not underestimated, and full information are made available to women to enable them making an informed choice.     

子宫内膜异位症保守性手术后药物治疗进展

子宫内膜异位症（EMs）是育龄妇女的常见病,保守性手术后复发率高,有必要予以术后药物治疗。目前的术后用药多样,但几乎都表现为用药依赖,往往需要数年甚至更久的维持用药。口服避孕药、孕激素因其经济、方便,不良反应少,可作为术后治疗的一线选择;而促性腺激素释放激素类似物长期用药的益处相比于其昂贵的医疗费用及不良反应优势并不明显,因而与达那唑、孕三烯酮等作为二线用药。而左炔诺孕酮宫内缓释系统特别适用于合并子宫肌腺病的EMs患者。另外免疫调节、基因靶向治疗为其提供了新的治疗思路。     

Migration of levonorgestrel IUS in a patient with complex medical problems: what should be done?

Patients with complex medical problems should be counselled about the need for highly effective contraception. As failure resulting in pregnancy, could cause significant morbidity and mortality. The LNG–IUS has gained great popularity and generally has a low side effect profile; however, perforation of the uterus and migration of the device is a potentially serious complication known to be associated with its use. The current accepted management is removal of the device from the abdominal cavity in order to prevent further morbidity. However this is not always a simple matter in patients who have complex medical problems and who are deemed unfit for surgery. Each time the patient comes for renewal of the contraceptive method, clinicians need to reassess the risks and benefits. This is particularly relevant in patients who have complex medical problems where special attention needs to be given, not only to immediate risks but also to long-term ones. Careful individualised counselling and consideration are paramount and perhaps it would have been prudent to discuss vasectomy with this patient and her husband (as the first line of contraception), as this may have avoided the ensuing complications arising from the chosen method.     

多发性子宫内膜息肉电切术后不同治疗方式效果对比研究

目的 对比分析多发性子宫内膜息肉电切术后宫腔内放置左炔诺孕酮宫内缓释系统与口服炔雌醇环丙孕酮片的效果。方法 选取2015年1月至2017年6月信宜市人民医院收治的86例多发性子宫内膜息肉患者分为研究组和对照组,均给予宫腔镜下子宫内膜息肉电切术,研究组术后放置左炔诺孕酮宫内缓释系统,对照组术后口服炔雌醇环丙孕酮片,比较两组治疗前、治疗后3、6、12、24、36个月子宫内膜厚度、息肉复发率、月经改善率、并发症发生率的差异。结果 与治疗前相比,治疗后3、6、12个月两组子宫内膜厚度均显著变薄,而治疗后24、36个月研究组子宫内膜厚度较对照组变薄(P＜0.05);治疗后3、6、12个月两组息肉复发率、月经改善率无显著性差异(P＞0.05),治疗后24、36个月研究组息肉复发率分别为6.98%、11.63%,较对照组的25.58%、32.56%显著降低(P＜0.05),月经改善率分别为95.35%、93.02%,较对照组的79.07%、76.74%显著提高(P＜0.05);治疗后3、6、12、24、36个月两组并发症发生率无显著性差异(P＞0.05)。结论 相较于口服炔雌醇环丙孕酮片,多发性子宫内膜息肉电切术后宫腔内放置左炔诺孕酮宫内缓释系统效果更优,患者的子宫内膜厚度显著变薄,月经情况得到改善,复发率降低,并且安全性较高,值得推广。     

左炔诺孕酮宫内缓释系统对功能失调性子宫出血治疗效果的初步观察

目的观察左炔诺孕酮宫内缓释系统（曼月乐）对功能失调性子宫出血的临床疗效。方法对58例子宫内膜诊刮病理诊断为功能失调性子宫出血患者放置曼月乐,在放置前和放置满24个月内定期B超监测子宫内膜厚度,观察患者血红蛋白情况、置环后病理变化及月经改善情况。结果置环前子宫内膜厚度为（16.5±7.3）mm,置环24个月子宫内膜厚度为（3.1±1.4）mm,两者比较有显著性差异（P〈0.05）;放置曼月乐6个月后患者血红蛋白显著升高[（98.5±13.1）vs（123.0±8.4）g/L,P〈0.05];置环后病理变化显示子宫内膜增生过长的表现消失。结论曼月乐不但能从临床方面有效地控制月经,对功血有持续的疗效,对增生过长的子宫内膜也有抑制作用。