Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, VIC, Australia.
Rev Endocr Metab Disord. 2012 Dec;13(4):301-8. doi: 10.1007/s11154-012-9227-3.
Erratic, "unscheduled", vaginal bleeding continues to be the greatest disadvantage associated with widespread use of long-acting, progestogen-only methods of contraception. As a consequence, it is also the main reason for premature discontinuation of use of these methods in most cultures. From other perspectives, these methods have high acceptability, very high contraceptive efficacy and a range of valuable, added, non-contraceptive health benefits. There has been widespread awareness of the variability of these vaginal bleeding patterns associated with long-acting methods for several decades and much research has been invested into studying their patterns and implications. Considerable research has also been directed towards trying to understand the underlying mechanisms responsible for the unpredictable bleeding. Much has been clarified about the multiple mechanisms contributing to the appearance of superficial, thin-walled fragile vessels within the endometrium of many of those women with troublesome bleeding, but there is still little understanding of why some women develop these vessels and others have no fragile vessels (and may therefore develop amenorrhea). We now have several medical approaches to reliably stopping a prolonged episode of troublesome bleeding, but no good therapy to produce long-lasting relief from recurrence of erratic bleeding in predisposed women. Future understanding of the variability in individual endometrial responses in different women may be a key to solving this frustrating symptom.
不规则、“无计划”的阴道出血仍然是广泛使用长效、单纯孕激素避孕方法相关的最大缺点。因此，这也是这些方法在大多数文化中提前停止使用的主要原因。从其他角度来看，这些方法具有很高的可接受性、非常高的避孕效果，以及一系列有价值的、额外的非避孕健康益处。几十年来，人们已经广泛意识到与长效方法相关的这些阴道出血模式的可变性，并且已经投入了大量研究来研究它们的模式和影响。还针对试图理解导致不可预测性出血的潜在机制进行了大量研究。对于许多有出血问题的女性，子宫内膜中出现表面薄而脆弱的小血管的多种机制已经得到了很好的阐明，但为什么有些女性会出现这些血管，而有些女性没有脆弱血管（因此可能会出现闭经），仍然知之甚少。我们现在有几种可靠的方法可以停止长时间的出血，但对于易发生不规则出血的女性，没有很好的治疗方法可以长期缓解其复发。未来对不同女性个体子宫内膜反应的可变性的理解可能是解决这一令人沮丧的症状的关键。
