London Andrew, Jensen Jeffrey T
John Hopkins School of Medicine, Baltimore, MD, USA; The Maryland Center for Sexual Health, Lutherville, MD, USA.
Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, OR, USA.
Int J Gynaecol Obstet. 2016 Jul;134(1):8-12. doi: 10.1016/j.ijgo.2015.10.028. Epub 2016 Mar 20.
Although most low-dose combined oral contraceptives (COCs) include 7-day hormone-free intervals (HFIs), these COCs could incompletely suppress ovarian activity.
To review the impact of HFIs on ovarian suppression and tolerability, and evaluate the utility of COCs without traditional 7-day HFIs.
PubMed was searched for clinical studies published in English between January 1980 and April 2015 on the impact of HFIs and HFI modifications in COCs.
Articles assessing contraceptive efficacy or tolerability as the primary focus were included.
Abstracts of 319 articles were screened.
Analysis of the 161 articles selected revealed that suppression of ovarian activity with low-dose COCs with 7-day HFIs is suboptimal. Loss of ovarian suppression during 7-day HFIs is commonly associated with follicular development, and most dominant follicles appear during this period. By contrast, increased ovarian suppression was noted in regimens that shortened or eliminated the HFI, or that substituted low-dose ethinyl estradiol for the HFI.
Extended regimens with modified HFIs may provide greater ovarian suppression with the potential for increased contraceptive effectiveness. Additional research is needed to evaluate whether COC regimens that include 10μg ethinyl estradiol instead of an HFI may improve tolerability.
尽管大多数低剂量复方口服避孕药（COC）包含7天的无激素间隔期（HFI），但这些COC可能无法完全抑制卵巢活动。
综述无激素间隔期对卵巢抑制和耐受性的影响，并评估无传统7天无激素间隔期的复方口服避孕药的效用。
检索PubMed，查找1980年1月至2015年4月期间发表的关于复方口服避孕药中无激素间隔期及其调整的影响的英文临床研究。
纳入以评估避孕效果或耐受性为主要重点的文章。
筛选了319篇文章的摘要。
对所选的161篇文章进行分析发现，含7天无激素间隔期的低剂量复方口服避孕药对卵巢活动的抑制效果欠佳。在7天无激素间隔期内卵巢抑制作用的丧失通常与卵泡发育有关，且大多数优势卵泡在此期间出现。相比之下，在缩短或取消无激素间隔期，或用低剂量炔雌醇替代无激素间隔期的方案中，卵巢抑制作用增强。
调整无激素间隔期的延长方案可能会提供更强的卵巢抑制作用，从而有可能提高避孕效果。需要进一步研究来评估含10μg炔雌醇而非无激素间隔期的复方口服避孕药方案是否能提高耐受性。
