Faúndes A, Alvarez-Sanchez F, Brache V, Jimenez E, Tejada A S
Department of Obstetrics and Gynecology, Faculty of Medical Sciences, Universidade Estadual de Campinas, Brazil.
Adv Contracept. 1991 Mar;7(1):85-94. doi: 10.1007/BF01850722.
The main side effect associated with the use of Norplant contraceptive implants is a disruption of the menstrual bleeding pattern. To explore the relationship between bleeding and hormonal changes, we analyzed the estradiol (E2) and progesterone (P) patterns that preceded bleeding episodes or that corresponded to periods of amenorrhea in 103 cycles observed among 82 women using Norplant subdermal implants. Five different bleeding patterns were defined: 'normal' (24-45 day cycles), oligomenorrhea (46-90 day cycles), amenorrhea (over 90 day cycles), irregular/frequent bleeding (less than 25 day cycles), and prolonged bleeding (continuous bleeding/spotting for more than 10 days). All 'normal' cycles were associated with a rise followed by a fall in E2 levels preceding bleeding. In half of the 'normal' cycles (28/54), a rise and fall of P was also observed. The same pattern was found in oligomenorrheic cycles, but only two of 12 cycles had a rise and fall of both E2 and P. None of the subjects with amenorrhea had luteal activity. Six of the nine amenorrheic cycles displayed persistently low E2 levels (below 75 pg/ml). The remaining three had a moderate elevation in E2 levels during the sampling period. Sixty percent of the subjects who showed irregular/frequent bleeding (15/25) had low E2 levels (less than 75 pg/ml), without luteal activity, and bleeding occurred without clear evidence of a further drop in E2 levels. In the remaining 40%, bleeding was preceded by a rise and drop of E2 without luteal activity, with the exception of one women, who exhibited a rise and fall of both E2 and P. Samples were obtained in only three subjects during continuous bleeding. One had low E2 levels, and the remaining two bled continuously, in spite of having E2 levels in the normal range. We conclude that ovarian hormones continue to influence endometrial shedding during the use of Norplant contraceptive implants.
使用诺普兰皮下避孕埋植剂的主要副作用是月经出血模式紊乱。为探究出血与激素变化之间的关系，我们分析了82名使用诺普兰皮下避孕埋植剂的女性所经历的103个周期中，出血发作之前或与闭经期相对应的雌二醇（E2）和孕酮（P）模式。定义了五种不同的出血模式：“正常”（周期为24 - 45天）、月经过少（周期为46 - 90天）、闭经（周期超过90天）、不规则/频繁出血（周期少于25天）以及出血时间延长（持续出血/点滴出血超过10天）。所有“正常”周期在出血前均伴有E2水平先升高后下降。在一半的“正常”周期（28/54）中，还观察到P有升高和下降。月经过少的周期中也发现了相同模式，但12个周期中只有2个同时出现了E2和P的升高和下降。闭经的受试者均无黄体活动。9个闭经周期中有6个显示E2水平持续较低（低于75 pg/ml）。其余3个在采样期间E2水平有中度升高。出现不规则/频繁出血的受试者中有60%（15/25）E2水平较低（低于75 pg/ml），无黄体活动，且出血发生时没有明显证据表明E2水平进一步下降。在其余40%的受试者中，除一名女性同时出现E2和P的升高和下降外，出血前E2有升高和下降但无黄体活动。在持续出血期间仅对3名受试者进行了采样。一名E2水平较低，其余两名尽管E2水平在正常范围内仍持续出血。我们得出结论，在使用诺普兰皮下避孕埋植剂期间，卵巢激素继续影响子宫内膜脱落。
