Jesam C, Salvatierra A M, Schwartz J L, Fuentes A, Croxatto H B
Instituto Chileno de Medicina Reproductiva (ICMER), José Victorino Lastarria 29, apt. 101, Santiago, Santiago, Chile, 8320165; Instituto de Investigaciones Materno Infantil (IDIMI), Faculty of Medicine Universidad de Chile, Santa Rosa 1234, Santiago, Santiago, Chile, 8360160.
Instituto Chileno de Medicina Reproductiva (ICMER), José Victorino Lastarria 29, apt. 101, Santiago, Santiago, Chile, 8320165.
Contraception. 2014 Aug;90(2):168-73. doi: 10.1016/j.contraception.2014.04.011. Epub 2014 May 5.
Cyclooxygenase-2 (COX-2) is expressed in all female reproductive organs. Therefore, inhibitors of COX-2 may affect reproductive function. We evaluated the effect of extended administration of meloxicam on ovulation and the menstrual cycle. Our hypothesis was that meloxicam administered from menstrual cycle day 5- 22 could interfere with follicular rupture, without disrupting the menstrual cycle, and could be a potential non-hormonal contraceptive method.
The study was conducted in 56 healthy sterilized women. Before the onset of treatment and after the end of treatment, participants were observed during a control cycle to ensure that they had progesterone (P₄) serum levels (>12 nmol/l) consistent with ovulation. Participants were treated for 18 days, during three consecutive cycles. They were randomized to 15 or 30 mg/day. The menstrual cycle was monitored with serial ultrasound and hormone assays in blood.
Fifty-six volunteers completed the study. In 55% of cycles treated with 15 mg/day and in 78% of cycles treated with 30 mg/day (p<0.001) we observed dysfunctional ovulation defined as follicular rupture not preceded 24-48 h earlier by an LH peak or preceded by a blunted LH peak (<21 IU/l) or not followed by an elevated serum P₄ level >12 nmol/l. Ovulation was observed in 44.6% and in 21.7% of women in the lower dose group and the higher dose group, respectively. There were no differences between the two doses in other parameters measured. There were no serious adverse events and adverse events were not different between doses or between control and treated cycles.
Although administration of meloxicam on menstrual cycle days 5- 22 resulted in a dose-dependent inhibition of ovulation, more than 20% of subjects had normal ovulation with the highest dose.
Previous studies have shown that oral meloxicam can delay follicle rupture. This study investigated daily oral meloxicam as a non-hormonal contraceptive. Since ovulation occurs in over 20% of cycles even with a high dose of 30 mg daily, it is not likely that the approach would be a highly effective contraceptive strategy.
环氧化酶-2（COX-2）在所有女性生殖器官中均有表达。因此，COX-2抑制剂可能会影响生殖功能。我们评估了美洛昔康长期给药对排卵和月经周期的影响。我们的假设是，从月经周期第5天至22天给予美洛昔康可能会干扰卵泡破裂，而不会扰乱月经周期，并且可能是一种潜在的非激素避孕方法。
该研究在56名健康的绝育女性中进行。在治疗开始前和治疗结束后，在一个对照周期内观察参与者，以确保她们的血清孕酮（P₄）水平（>12 nmol/l）与排卵一致。参与者连续三个周期接受18天的治疗。她们被随机分为15毫克/天或30毫克/天。通过连续超声检查和血液激素测定来监测月经周期。
56名志愿者完成了研究。在15毫克/天治疗的周期中，55%出现了排卵功能障碍，在30毫克/天治疗的周期中，78%出现了排卵功能障碍（p<0.001），排卵功能障碍定义为卵泡破裂前24 - 48小时没有出现促黄体生成素（LH）峰值，或者之前LH峰值降低（<21 IU/l），或者之后血清P₄水平没有升高至>12 nmol/l。低剂量组和高剂量组分别有44.6%和21.7%的女性出现排卵。在其他测量参数方面，两种剂量之间没有差异。没有严重不良事件，且不同剂量组之间以及对照周期和治疗周期之间的不良事件没有差异。
尽管在月经周期第5天至22天给予美洛昔康会导致排卵受到剂量依赖性抑制，但最高剂量时仍有超过20%的受试者排卵正常。
先前的研究表明口服美洛昔康可延迟卵泡破裂。本研究调查了每日口服美洛昔康作为一种非激素避孕方法。由于即使每日高剂量30毫克，仍有超过20%的周期会排卵，所以这种方法不太可能成为一种高效的避孕策略。
