Harel Zeev, Biro Frank, Kollar Linda, Riggs Suzanne, Flanagan Patricia, Vaz Rosalind
Division of Adolescent Medicine, Hasbro Children's Hospital, Providence, RI 02903, USA.
J Pediatr Adolesc Gynecol. 2002 Jun;15(3):153-8. doi: 10.1016/s1083-3188(02)00148-1.
BACKGROUND/OBJECTIVES: Depo-Provera-induced menstrual irregularity is believed to be secondary to relative estrogen deficiency. Weight gain associated with this contraceptive method is believed to be due to Depo-Provera's steroid-like appetite stimulation effect and to an altered tryptophan metabolism. We examined whether vitamin C, an important factor in uterine estrogen binding, and vitamin B(6), a glucocorticoid antagonist and an important coenzyme in the tryptophan-serotonin pathway, might alleviate menstrual irregularities and weight gain associated with Depo-Provera.
Fifty-five adolescent girls (age 16 +/- 1 yr, gyn age 4 +/- 1 yr, body mass index 25.2 +/- 0.9) who decided to initiate Depo-Provera (150 mg intramuscularly every 3 months) were randomly assigned to one of four groups (group 1: vitamin B(6) 50 mg plus placebo pill/day; group 2: vitamin C 500 mg plus placebo pill/day; group 3: vitamin B(6) 50 mg plus vitamin C 500 mg/day; group 4 (control): 2 placebo pills/day) for 6 months. Participants were assessed by their care providers every 3 months.
Two urban hospital-based adolescent clinics.
Number of days of bleeding during the first interval (first 3 months) as well as during the second interval (months 4-6) among groups 1, 2, and 3 did not differ statistically from days of bleeding in control group. There were no significant body mass index (BMI) changes among groups 1-3 (-0.15 +/- 0.18, 0.34 +/- 0.56, 0.01 +/- 0.31) compared with control (-0.38 +/- 0.38) during the first interval as well as during the second interval (0.68 +/- 0.37, -0.39 +/- 0.21, 0.45 +/- 0.32, compared with 0.28 +/- 0.43). When data from all 55 participants were collapsed, there was no significant change in BMI during the first 6 months of Depo-Provera use. About 48% at 3 months and 44% at 6 months were very or somewhat concerned about menstrual irregularity; 41% at 3 months and 18% at 6 months were very or somewhat concerned about weight changes. More than half (57%) at 3 months and 74% at 6 months reported less tampon/pad use, and 77% at 3 months and 78% at 6 months reported decreased menstrual cramps. Overall, 59% at 3 months and 70% at 6 months were very satisfied with Depo-Provera; 97% at 3 months and 96% at 6 months said that they would recommend Depo-Provera to a friend or a relative.
This study does not support a role for vitamin C in the prevention of Depo-Provera-induced menstrual irregularities or for vitamin B(6) in the prevention of weight changes associated with Depo-Provera. The unchanged BMI during the first 6 months of Depo-Provera use in the present study suggests that raising awareness and close follow-up may prevent weight gain among adolescent girls using this contraceptive method.
背景/目的：醋酸甲羟孕酮所致月经不规律被认为继发于相对雌激素缺乏。与这种避孕方法相关的体重增加被认为是由于醋酸甲羟孕酮的类类固醇食欲刺激作用以及色氨酸代谢改变。我们研究了子宫雌激素结合中的重要因素维生素C以及色氨酸 - 血清素途径中的糖皮质激素拮抗剂和重要辅酶维生素B6是否可以缓解与醋酸甲羟孕酮相关的月经不规律和体重增加。
55名决定开始使用醋酸甲羟孕酮（每3个月肌肉注射150mg）的青春期女孩（年龄16±1岁，妇科年龄4±1岁，体重指数25.2±0.9）被随机分配到四组之一（第1组：维生素B6 50mg加安慰剂片/天；第2组：维生素C 500mg加安慰剂片/天；第3组：维生素B6 50mg加维生素C 500mg/天；第4组（对照组）：2片安慰剂/天），为期6个月。护理人员每3个月对参与者进行一次评估。
两家城市医院的青少年诊所。
第1组﹑第2组和第3组在第一个时间段（前3个月）以及第二个时间段（第4 - 6个月）的出血天数与对照组的出血天数在统计学上无差异。在第一个时间段以及第二个时间段，第1 - 3组（-0.15±0.18，0.34±0.56，0.01±0.31）与对照组（-0.38±0.38）相比，体重指数（BMI）没有显著变化（分别为0.68±0.37，-0.39±0.21，0.45±0.32，对照组为0.28±0.43）。当汇总所有55名参与者的数据时，在使用醋酸甲羟孕酮的前6个月中BMI没有显著变化。3个月时约48%以及6个月时约44%的人非常或有点担心月经不规律；3个月时41%以及6个月时18%的人非常或有点担心体重变化。超过一半（3个月时57%以及6个月时74%）的人报告使用的卫生棉条/卫生巾减少，3个月时77%以及6个月时78%的人报告痛经减轻。总体而言，3个月时59%以及6个月时70%的人对醋酸甲羟孕酮非常满意；3个月时97%以及6个月时96%的人表示他们会向朋友或亲戚推荐醋酸甲羟孕酮。
本研究不支持维生素C在预防醋酸甲羟孕酮所致月经不规律中的作用，也不支持维生素B6在预防与醋酸甲羟孕酮相关的体重变化中的作用。本研究中使用醋酸甲羟孕酮的前6个月BMI未改变，这表明提高认识和密切随访可能预防使用这种避孕方法的青春期女孩体重增加。
