两种国产皮下埋植剂月经异常主诉的危险因素分析

本文采用国家“八、五”科技攻关项目“国产皮下埋植避孕方法多中心研究(扩大应用)”资料,分析中国妇女使用国产皮下埋植剂后月经异常发生率及影响因素.月经异常是皮下埋植剂最主要的副反应,埋植后半年内,一半以上的妇女主诉有月经异常发生.采用单因素和 Logistic多元逐步回归对月经异常副反应进行分析.结果表明:月经异常主诉与年龄、文化程度、体重、埋植时是否哺乳、末次妊娠结局、末次避孕方法和埋植剂类型有关.年纪轻的妇女主诉有月经异常者多于年纪大的妇女;文化程度高的妇女主诉有月经问题的比例高于文化程度低的妇女;体重轻者较体重重者月经异常主诉多;哺乳期埋植的妇女“出血”主诉较不哺乳妇女少,但“稀少闭经”主诉多于不哺乳妇女;末次妊娠结局为人流的妇女“出血”主诉较多;埋植前使用口服药的妇女”出血”主诉较少,埋植前使用IUD的妇女”稀少闭经”主诉较少;Ⅰ型埋植剂使用者“稀少闭经”主诉高于Ⅱ型使用者.本研究结果提示:应在手术前根据使用者年龄、文化程度、以往避孕史和体检情况等耐心、细致、正确和全面地做好咨询服务工作.以提高皮下埋植避孕方法的可接受性.

Risk Factors for Menstrual Irregularities with 2 Types of Domestic Levonorgestrel Subdermal Implants (Cla implant and Sino -implant)

Data from the national key research "A multicentre study of Cla implant and Sino - implant (expanded application)" which was approved by the State Commission of Family Planning of China were analysed to study factors that may be associated with menstrual irregularities due to use of levonorgestrel subdermal implants (Cla implant and Sino - implant) among Chinese women. Menstrual irregularities were the most common side-effects with implants. During the first 6 months of use more than half of the users reported menstrual irregularities. Chi - square test and stepwise logistic regression were used to analyse the relationship of selected subject characteristics to the risk of menstrual irregularities. The results showed that menstrual irregularities were associated with women's age, education level, body weight, breast-feeding, the outcome of last pregnancy, prior contraceptive use and the type of implant. Younger women were more likely to have menstrual irregularities than older ones. Women with higher education level were more likely to report menstrual irregularities than less educated women. Women with lighter body weight had more menstrual irregularities than those with heavier weight. Women experienced less frequent menstruation, irregular bleeding and spotting but more infrequent/ scanty menstruation and amenorrhea if they were breast -feeding at the time of insertion. Women whose last pregnancy ended in induced abortion were more likely to have frequent menstruation, irregular bleeding and spotting. Women who had used OCs before implant insertion were less likely to have frequent menstruation, irregular bleeding and spotting and women who had used IUDs before implant insertion were less likely to have infrequent/scanty menstruation and amenorrhea. Cla implant users had more infrequent/scanty menstruation and amenorrhea than Sino -implant users. Identifying potential risk factors mentioned above may promote providers to counsel women with patience and without bias and make the decision of method choice.