口服与阴道用激素避孕药使用期间卵巢抑制的配对分析。
Matched-pairs analysis of ovarian suppression during oral vs. vaginal hormonal contraceptive use.
机构信息
Mailman School of Public Health, Columbia University, New York, NY 10032, USA.
出版信息
Contraception. 2011 Nov;84(5):e1-4. doi: 10.1016/j.contraception.2011.05.003. Epub 2011 Jun 16.
BACKGROUND
This study was conducted to compare ovarian suppression during oral vs. vaginal hormonal contraceptive use. Secondary aims included comparison of endometrial thickness and bleeding patterns.
METHODS
In two open-label trials assessing ovarian suppression, 33 compliant women completed both studies. They first used oral contraceptive pills (OCs) [randomized to either 20 mcg ethinyl estradiol (EE)/100 mcg levonorgestrel (LNG) or 30 mcg EE/150 mcg LNG] and subsequently used contraceptive vaginal rings (CVRs) (daily release of 15 mcg EE/120 mcg etonogestrel), all 21/7-day regimens. Participants had at least one run-in cycle using each contraceptive method prior to evaluation. During one cycle of each method, women underwent biweekly transvaginal sonography to measure ovarian follicular diameters and endometrial thickness. We also noted presence of a corpus luteum or a ruptured follicle as a marker of ovulation. Participants recorded bleeding days on paper calendars. We used matched-pairs analyses as appropriate.
RESULTS
During follow-up, we identified at least one ovarian follicle ≥8 mm in 20/33 (61%) OC users and 12/33 (36%) CVR users (matched-pairs analysis, p=.02). Similar trends were seen for larger follicles; however, we had limited statistical power to evaluate these differences. Median follicular diameter among OC users was larger than median follicular diameter among CVR users (p=.01). We did not observe a corpus luteum or ruptured follicle in any participant during either study. Endometrial thickness was similar during OC and CVR use (mean 4.1±1.4 vs. 4.1±1.6 mm, p=.9), as was the number of bleeding or spotting days (mean 2.1±2.4 vs. 1.9±2.1, p=.8). Oral contraceptive pill dose was unrelated to follicle diameter, endometrial thickness or bleeding.
CONCLUSIONS
Ovarian follicles ≥8 mm were more common in 33 compliant women during OC use than during CVR use, indicating that CVR use results in greater ovarian suppression than OC use.
背景
本研究旨在比较口服和阴道用激素避孕药避孕期间的卵巢抑制情况。次要目的包括比较子宫内膜厚度和出血模式。
方法
在两项评估卵巢抑制的开放性标签试验中，33 名符合条件的女性完成了两项研究。她们首先使用口服避孕药（OC）[随机分为 20 mcg 乙炔雌二醇（EE）/100 mcg 左炔诺孕酮（LNG）或 30 mcg EE/150 mcg LNG]，随后使用避孕阴道环（CVR）（每日释放 15 mcg EE/120 mcg 依托孕烯），均为 21/7 天方案。在评估之前，每位参与者至少有一个周期的每种避孕方法的使用经历。在每种方法的一个周期中，女性每两周进行一次经阴道超声检查，以测量卵巢卵泡直径和子宫内膜厚度。我们还记录黄体或破裂卵泡的存在作为排卵的标志物。参与者在纸质日历上记录出血天数。我们使用了适当的配对分析。
结果
在随访期间，我们在 33 名 OC 用户中的 20 名（61%）和 33 名 CVR 用户中的 12 名（36%）（配对分析，p=.02）中至少发现了一个≥8mm 的卵巢卵泡。对于更大的卵泡，也出现了类似的趋势；然而，我们的统计能力有限，无法评估这些差异。OC 用户的卵泡直径中位数大于 CVR 用户的卵泡直径中位数（p=.01）。在两项研究中，我们都没有观察到任何参与者的黄体或破裂卵泡。OC 和 CVR 使用期间的子宫内膜厚度相似（平均 4.1±1.4 毫米 vs. 4.1±1.6 毫米，p=.9），出血或点滴天数也相似（平均 2.1±2.4 天 vs. 1.9±2.1 天，p=.8）。OC 剂量与卵泡直径、子宫内膜厚度或出血无关。
结论
在 33 名依从性好的女性中，OC 使用期间≥8mm 的卵巢卵泡比 CVR 使用期间更常见，这表明 CVR 使用比 OC 使用导致更大的卵巢抑制。
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