国际生殖健康/计划生育杂志

国际生殖健康/计划生育 ›› 2013, Vol. 32 ›› Issue (4): 236-239.

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单纯孕激素长效避孕方法的出血模式改变及对策

金 力   

  1. 100730 北京，中国医学科学院 北京协和医学院 北京协和医院妇产科
  • 收稿日期:1900-01-01 修回日期:1900-01-01 出版日期:2013-07-15 发布日期:2013-07-15

Management of Irregular Vaginal Bleeding Induced by the Progestin only Contraceptives

JIN Li   

  1. Department of Obstetrics and Gynecology，Peking Union Medical College Hospital，Chinese Academy of Medical Science & Peking Union Medical College，Beijing 100730，China
  • Received:1900-01-01 Revised:1900-01-01 Published:2013-07-15 Online:2013-07-15

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摘要： 单纯孕激素避孕方法主要分为肌内注射、皮下埋植剂及宫腔缓释系统。该类方法避孕安全、有效、可逆，几乎适合所有育龄妇女，特别是有血栓风险者。但有一定不良反应，主要为月经模式改变，表现为不规则出血或闭经，影响其长期使用。但发生机制尚不清楚，可能与子宫内膜炎症、血管充盈、管壁变薄、金属蛋白酶和环氧化酶活性增加等有关。治疗方法主要采用相应的对症止血，具有较好的效果。但在应用前做好咨询工作，对改善依从性具有重要临床意义。

关键词: 避孕, 孕激素类, 子宫不规则出血, 闭经, 治疗

Abstract: There are three kinds of progesterone only contraceptives（POCs）， intramuscular injection， implants and levonorgestrel-intrauterine system（LNG-IUS）. POCs offer the safe，effective and reversible contraceptive options，particulary for women with the risk of venous thromboembolism. Breakthrough or irregular bleeding （BTB） and amenorrhea are the main side-effects，which often lead to discontinuation. The exact pathophysiological mechanisms of BTB remain unclear，but they are likely to relate to the chronic endometritis，thin and dilated wall of vessels in subendometrium，high expression of COX-2 and MMP-9. Many effective methods are tried to stop bleeding. The most important thing is to consult the women carefully before their utilization of POCs.

Key words: Contraception, Progestins, Metrorrhagia, Amenorrhea, Treatment