去氧孕烯炔雌醇配合诊断性刮宫治疗绝经过渡期功能性子宫出血的临床观察

目的：探讨诊断性刮宫（诊刮）后加用去氧孕烯炔雌醇（妈富隆）治疗绝经过渡期子宫出血的临床效果。方法：对56例确诊为绝经过渡期功血患者行诊刮后口服去氧孕烯炔雌醇治疗1～3个周期,比较血色素、经量及治疗前后子宫内膜厚度情况。结果：去氧孕烯炔雌醇止血效果好,月经量减少,贫血得以纠正,停药后恢复正常月经周期,子宫内膜厚度变薄。结论：去氧孕烯炔雌醇治疗绝经过渡期功血有显著疗效。     

口服避孕药预防宫颈子宫内膜异位症的效果观察

目的：探讨预防宫颈物理治疗术后（宫颈自凝刀治疗）发生宫颈子宫内膜异位症的有效方法。方法：2008年3月～2013年3月,在广东省高要市人民医院妇科门诊因宫颈疾病行宫颈自凝刀治疗患者,随机分为2组,观察组50人,术后当天始坚持口服去氧孕烯炔雌醇3个周期,对照组48人,术后未服口服避孕药,观察对比2组患者宫颈子宫内膜异位症的发病率。结果：服用去氧孕烯炔雌醇组无1例发生宫颈子宫内膜异位症,对照组宫颈子宫内膜异位症发病率8．33％（4／48）。宫颈子宫内膜异位症的发生率与未服用口服避孕药组对比,有显著性差异（P＜0．05）。结论：口服避孕药可以预防宫颈物理治疗术后宫颈子宫内膜异位症的发生。     

诊刮联合妈富隆治疗围绝经期功血的疗效观察

目的探究诊刮联合去氧孕烯炔雌醇片(商品名:妈富隆)治疗围绝经期功能失调性子宫出血(功血)的临床效果。方法80例围绝经期功血患者,按照治疗方法不同分成对照组与观察组,各40例。对照组单纯给予诊刮治疗,观察组接受诊刮联合妈富隆治疗。比较两组患者治疗前后的血红蛋白水平和治疗效果。结果治疗前,观察组患者血红蛋白水平(87.14±6.53)g/L与对照组的(88.02±7.01)g/L比较差异无统计学意义(P>0.05);治疗后,两组患者血红蛋白水平均高于治疗前,且观察组患者血红蛋白水平(108.95±4.62)g/L高于对照组的(90.37±5.73)g/L,差异有统计学意义(P<0.05)。对照组患者治疗有效率为7.50%,观察组患者治疗有效率为50.00%;观察组患者治疗有效率明显高于对照组,差异有统计学意义(P<0.05)。结论对于围绝经期功血患者,临床给予诊刮联合妈富隆治疗效果确切,能够有效改善患者血红蛋白水平,值得推荐。     

鲜益母草胶囊联合去氧孕烯炔雌醇对人工流产术后月经恢复及炎症水平的影响

目的:观察鲜益母草胶囊联合去氧孕烯炔雌醇(妈富隆)用于人工流产术后恢复的疗效。方法:选取130例人工流产术患者为研究对象,分为研究组和对照组各65例。对照组术后予以妈富隆治疗,研究组在此基础上加用鲜益母草胶囊,统计2组阴道出血及月经恢复情况,比较血清炎症因子及卵巢激素水平变化,记录不良反应及术后并发症情况。结果:研究组术后阴道出血时间、月经恢复时间均短于对照组,阴道出血量少于对照组(P<0.05)。术后1周,2组炎症因子水平均下降,且研究组低于对照组(P<0.05)。治疗后,2组卵巢激素水平均较治疗前升高,且研究组均高于对照组(P<0.05)。治疗期间,2组药物不良反应总发生率比较,差异无统计学意义(P>0.05)。术后3个月内,研究组并发症总发生率为6.15%,低于对照组的18.46%(P<0.05)。结论:鲜益母草胶囊联合妈富隆可有效缓解人工流产后阴道出血症状,改善卵巢激素分泌功能,抑制炎症反应,预防术后并发症。     

妈富隆复方口服避孕药的使用对江苏农村地区已婚育龄妇女生活质量的影响

目的：评价妈富隆复方口服避孕药（简称妈富隆）的使用对江苏省农村地区已婚育龄妇女生活质量的影响。方法：采用自填式问卷前瞻性调查772例首次使用妈富隆妇女使用前后生活质量变化。结果：①使用妈富隆后妇女的生活质量问卷总分和身体健康、情绪、劳动／工作／学习、生活状态、想象力、总体身心愉悦状况和总体满意程度等项目的评分较使用前均显著提高（P〈0．05）；②生活质量问卷总分≥57的妇女所占比例在使用妈富隆前后分别为11．50％和11．79％，总分≤45的妇女比例由使用前9．09％上升到使用后的11．65％；③多元线性回归分析显示，位于苏南地区（系数=－1．02，95％CI：－1．84，－0．19）和发生副反应（系数=－1．45，95％CI：－2．38，－0．53）不利于使用妈富隆后妇女的生活质量改善。结论：妈富隆的使用有利于江苏省农村地区已婚育龄妇女生活质量改善，总体改善效果低于发达国家。     

Postoperative desogestrel for pelvic endometriosis-related pain: a randomized controlled trial

Objective: To determine the effectiveness of desogestrel for relieving endometriosis-related pain.

Methods: A double-blinded randomized placebo-controlled trial was conducted in 40 patients who had endometriosis with moderate-to-severe dysmenorrhea or chronic pelvic pain undergoing laparoscopic conservative surgery. After surgery, patients were randomized to desogestrel or placebo group. Outcomes included changes in visual analog scale (VAS) of dysmenorrhea, pelvic pain and dyspareunia, patient satisfaction, and adverse effects.

Results: Forty patients were randomized to desogestrel group (n?=?20) and placebo group (n?=?20). At month 6, the desogestrel group had significantly lower median VAS of overall pelvic pain, dysmenorrhea and noncyclic pelvic pain. Comparing with the placebo group, the desogestrel group had greater reduction in VAS of overall pain, dysmenorrhea and pelvic pain, but comparable reduction in VAS of dyspareunia. No patient in the desogestrel group but 4 patients in the placebo group still had moderate-to-severe pelvic pain at 6?months postoperatively. The proportion of patients who rated the treatment as very satisfied was higher in the desogestrel group than in the placebo group. There was no serious adverse event during the study period.

Conclusions: Desogestrel is effective and acceptable for postoperative therapy for patients with moderate-to-severe pain related to endometriosis.     

A prospective study on the effects on hemostasis of two oral contraceptives containing drospirenone in combination with either 30 or 20 microg ethinyl estradiol and a reference containing desogestrel and 30 microg ethinyl estradiol

PURPOSE: In this open-label, randomized study, we assessed the effects on hemostasis of two combined oral contraceptives containing drospirenone (DRSP) as progestogen component. METHODS: Three milligrams of DRSP, a progestogen with antimineralocorticoid activity, was combined with either 30 or 20 microg ethinyl estradiol (EE) (DRSP/30EE; DRSP/20EE) and compared with a preparation containing 150 microg desogestrel (DSG) and 30 microg ethinyl estradiol (DSG/30EE). A total of 75 healthy female volunteers aged 18-35 years were enrolled. The hemostasis variables were measured in the medication-free precycle (baseline); in the first, third and sixth treatment cycle; and in the follow-up phase. The target variables for comparison were the relative changes from baseline to Cycle 6. RESULTS: Data of 25 volunteers in each group were valid for the per-protocol evaluation. Most changes in hemostasis variables were similar in the three treatment groups. All procoagulatory variables and the anticoagulatory variable protein C antigen increased slightly, while protein S antigen and activity decreased. For fibrinogen and protein S activity, the changes were statistically significant: less pronounced with DRSP/20EE compared to DSG/30EE at Cycle 6. There were no statistically significant differences in the changes of antifibrinolytic variables, the global clotting tests and D-dimer. All pairwise comparisons of DRSP/30EE vs. DSG/30EE yielded nonsignificant results; however, there was a trend of a lower impact of DRSP/20EE on nearly all hemostatic parameters compared to the 30EE products. All three study treatments were safe and well tolerated by the volunteers and provided adequate contraceptive reliability. CONCLUSION: The changes in the hemostatic variables for DRSP/20EE were less pronounced compared to DSG/30EE and DRSP/30EE. The results were in accordance with previous reports on effects of similar OCs.     

Bone mineral density in young women with long-standing amenorrhea: Limited effect of hormone replacement therapy with ethinylestradiol and desogestrel

To assess bone mineral density (BMD) at different skeletal sites in women with hypothalamic or ovarian amenorrhea and the effect of estrogen-gestagen substitution on BMD we compared BMD of 21 amenorrheic patients with hypothalamic or ovarian amenorrhea with that of a control population of 123 healthy women. All amenorrheic patients were recruited from the outpatient clinic of the Division of Gynecological Endocrinology at the University of Berne, a public University Hospital. One hundred and twenty-three healthy, regularly menstruating women recruited in the Berne area served as a control group. BMD was measured using dual-energy X-ray absorptiometry (DXA). At each site where it was measured, mean BMD was lower in the amenorrheic group than in the control group. Compared with the control group, average BMD in the amenorrheic group was 85% at lumbar spine (p<0.0001), 92% at femoral neck (p<0.02), 90% at Ward's triangle (p<0.03), 92% at tibial diaphysis (p<0.0001) and 92% at tibial epiphysis (p<0.03). Fifteen amenorrheic women received estrogen-gestagen replacement therapy (0.03 mg ethinylestradiol and 0.15 mg desogestrel daily for 21 days per month), bone densitometry being repeated within 12–24 months. An annual increase in BMD of 0.2% to 2.9% was noted at all measured sites, the level of significance being reached at the lumbar spine (p<0.0012) and Ward's triangle (p<0.033). In conclusion BMD is lower in amenorrheic young women than in a population of normally menstruating, age-matched women in both mainly trabecular (lumbar spine, Ward's triangle, tibial epiphysis) and mainly cortical bone (femoral neck, tibial diaphysis). In these patients, hormone replacement therapy resulted in a limited recovery of BMD. Therefore, early hormone replacement therapy is mandatory for young amenorrheic women to minimize bone loss.     

A randomized study over 13 cycles to assess the influence of oral contraceptives containing ethinylestradiol combined with drospirenone or desogestrel on carbohydrate metabolism

In this open-label, randomized study we compared the influence of a new oral contraceptive containing 30 μg ethinylestradiol and 3 mg drospirenone (Yasmin™) with a reference preparation containing 30 μg ethinylestradiol and 150 μg desogestrel (Marvelon™) on variables of carbohydrate metabolism by means of oral glucose tolerance tests at baseline and in the 6th and 13th treatment cycle. The mean levels of fasting glucose and insulin were similar at baseline and after 13 treatment cycles, whereas C-peptide and free fatty acid levels decreased slightly in both groups. All blood glucose and insulin values measured in the oral glucose tolerance tests were within normal ranges, despite a slight increase in the mean areas under the curves of 0–3 h [AUCs (0–3 h)] of both variables from baseline to treatment cycle 13. Differences between both treatments were not statistically significant. The mean AUCs (0–3 h) for C-peptide were not markedly changed in any treatment group. Free fatty acid levels decreased by 42% in the drospirenone group and increased by 48.9% in the desogestrel group, in terms of means of individual changes. Both preparations were well tolerated and equally efficacious regarding contraception and cycle control. The mean body weight was slightly decreased in most cycles during treatment with the drospirenone combination, as compared to baseline, while it was slightly increased versus baseline in all cycles during treatment with the desogestrel combination. The combination with drospirenone had less impact on blood pressure than the combination with desogestrel. In conclusion, Yasmin, a combined low-dose oral contraceptive with 30 μg ethinylestradiol and 3 mg of the novel progestogen drospirenone, as well as the reference Marvelon, containing 30 μg ethinylestradiol and 150 μg desogestrel had little impact on carbohydrate metabolism when used for 1 year. The observed changes were small and not suggestive of a clinically relevant deterioration of carbohydrate metabolism.     

Primary dysmenorrhea treatment with a desogestrel-containing low-dose oral contraceptive

This randomized, double-blind, placebo-controlled exploratory study examined the efficacy and safety of a low-dose oral contraceptive (Mircette®), desogestrel/ethinyl estradiol [DSG/EE] and ethinyl estradiol [EE]) in relieving the symptoms of dysmenorrhea. Twenty-three clinics in the United States enrolled 77 women (age ≤32 years) with primary dysmenorrhea documented for at least four consecutive cycles. Forty participants received DSG/EE&EE and 37 received placebo for four consecutive 28-day cycles. The intensity of menstrual-related distress was measured with the Menstrual Distress Questionnaire (MDQ). Patient diaries were used to assess number of school/work days missed as well as the use of rescue medication. Participants receiving DSG/EE&EE recorded reduced menstrual pain severity, lower total MDQ scores, and significantly less menstrual cramping. No significant change in bloating, anxiety, loneliness, weight gain, or acne was reported. The DSG/EE&EE formulation shows promise for the treatment of primary dysmenorrhea and was well tolerated by the participants in this study.