Dahiya Pushpa, Dalal Monika, Yadav Anu, Dahiya Krishna, Jain Shaveta, Silan Vijay
Department of Obstetrics and Gynaecology, Pt. B.D. Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India.
Department of Obstetrics and Gynaecology, Pt. B.D. Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India.
Eur J Obstet Gynecol Reprod Biol. 2016 Aug;203:147-51. doi: 10.1016/j.ejogrb.2016.05.009. Epub 2016 May 20.
To compare the efficacy, acceptability and compliance of combined hormonal vaginal ring (CVR), with combined hormonal pills (CHP) in patients with heavy menstrual bleeding (HMB).
This prospective study was conducted in 50 women with HMB in age group of 25-40 years. Patients were divided in two groups of 25 each and followed for six treatment cycles. In each group, cycle comprised of three weeks of CVR (releases 15μg of EE and 120μg of the etonogestrel per day) or CHP (containing 30μgm of EE and 150μgm of LNG) use, followed by one ring or pill free week. After each cycle, patients were evaluated about the amount of blood loss and duration of bleeding by the pictoral blood assessment chart (PBAC), early bleeding (EWB), continued bleeding (CWB), intermenstrual bleeding, intended bleeding, compliance, and user acceptability. The collected data were analyzed using the Chi square test, t-test and ANOVA test.
Reduction in PBAC score for CVR (70.73%) and CHP group (70.02%), duration of bleeding and incidence of EWB was comparable among the two groups. The incidence of intermenstrual bleeding was lower in CVR than in CHP group in cycle 3 and 4 with significant p value. The incidence of CWB was significantly lower and the incidence of intended bleeding pattern in CVR group was significantly higher in cycle 3, 4, 5 and 6, signifying better cycle control. Compliance was also higher in CVR (88%) than CHC (75.33% of all cycles).
This trial suggests that both the CVR and CHP are very effective short-term treatments for HMB in reproductive age group. However, women had better cycle control and compliance with CVR. This may be an attractive option among the wide variety of medications used to treat HMB.
比较复方激素阴道环（CVR）与复方激素避孕药（CHP）治疗月经过多（HMB）患者的疗效、可接受性和依从性。
这项前瞻性研究纳入了50名年龄在25至40岁的月经过多女性患者。患者被分为两组，每组25人，随访六个治疗周期。每组的一个周期包括连续三周使用CVR（每天释放15μg炔雌醇和120μg依托孕烯）或CHP（含30μg炔雌醇和150μg左炔诺孕酮），随后停药一周。每个周期结束后，通过图片式失血评估图（PBAC）评估患者的失血量和出血持续时间、早期出血（EWB）、持续出血（CWB）、经间期出血、预期出血情况、依从性和使用者可接受性。使用卡方检验、t检验和方差分析对收集的数据进行分析。
CVR组（70.73%）和CHP组（70.02%）的PBAC评分降低情况、出血持续时间和EWB发生率在两组间相当。在第3和第4周期，CVR组的经间期出血发生率低于CHP组，p值具有统计学意义。在第3、4、5和6周期，CVR组的CWB发生率显著更低，预期出血模式发生率显著更高，表明周期控制更好。CVR组的依从性（88%）也高于CHC组（所有周期的75.33%）。
该试验表明，CVR和CHP都是治疗育龄期月经过多的非常有效的短期疗法。然而，女性使用CVR时周期控制更好且依从性更高。在用于治疗月经过多的多种药物中，这可能是一个有吸引力的选择。
