Belsey E M
Special Programme of Research, Development and Research Training in Human Reproduction, World Health Organization, Geneva, Switzerland.
Contraception. 1988 Aug;38(2):181-206. doi: 10.1016/0010-7824(88)90038-8.
Menstrual diary records were obtained from a total of 5257 women using nine different methods of contraception, one natural and eight hormonal. This paper presents a comparative analysis of their vaginal bleeding patterns. The analytic procedures follow the recommendations of a recent WHO workshop on bleeding pattern analysis, which involve dividing each subject's diary into successive 90-day reference periods, calculating ten indices for each period, and classifying women according to whether they have "clinically important" bleeding disturbances. In general, the findings of this analysis confirm those of previous studies. Women using the natural method, who were deliberately selected for the regularity of their menstrual cycles, averaged three bleeding/spotting episodes of length 5 days in each 90-day period, with very little variability within or between women. Subjects given a combined oral contraceptive had more regular patterns than any other treated group, with short (4-day) episodes and 23-24 day bleeding-free intervals. Progestogen-only pill users had more frequent, longer episodes and shorter, less predictable intervals than combined pill users. Contrary to widely-held beliefs, the progestogen-only pills produced fewer spotting days than the combined pills, and almost no spotting episodes at all. Nearly half of vaginal ring users experienced some menstrual disturbance in each period; their most common problems were irregular, infrequent or prolonged bleeding. Women using the long-acting injectable, depot medroxyprogesterone acetate, had totally unpredictable patterns, with infrequent but prolonged bleeding/spotting episodes. The incidence of amenorrhea rose from just under 10% in their first injection interval to over 40% in their fourth. The methods of analysis recommended by WHO in 1985 still require substantial refinement. Nevertheless, they are more sensitive than those used previously for WHO trials and produce an easily understood, clinically meaningful characterization of bleeding patterns.
共收集了5257名使用九种不同避孕方法的女性的月经日记记录，其中一种是自然避孕法，八种是激素避孕法。本文对她们的阴道出血模式进行了比较分析。分析程序遵循了世界卫生组织最近一次关于出血模式分析研讨会的建议，即将每个受试者的日记分为连续的90天参考期，计算每个时期的十个指标，并根据女性是否有“具有临床重要性”的出血紊乱进行分类。总体而言，该分析结果证实了先前研究的结果。使用自然避孕法的女性，因其月经周期规律而被特意挑选，在每90天的周期中平均有三次持续5天的出血/点滴出血事件，女性个体内部和之间的差异很小。服用复方口服避孕药的受试者比其他任何治疗组的模式都更规律，出血事件短（4天），无出血间隔为23 - 24天。仅使用孕激素避孕药的使用者比服用复方避孕药的使用者有更频繁、更长的出血事件，且间隔更短、更不可预测。与普遍看法相反，仅使用孕激素避孕药的女性出现点滴出血的天数比复方避孕药少，几乎没有点滴出血事件。近一半使用阴道环的女性在每个时期都经历了一些月经紊乱；她们最常见的问题是出血不规律、稀少或持续时间长。使用长效注射剂醋酸甲羟孕酮避孕的女性出血模式完全不可预测，出血/点滴出血事件稀少但持续时间长。闭经发生率从首次注射间隔时的略低于10%上升到第四次注射间隔时的超过40%。世界卫生组织1985年推荐的分析方法仍需大幅改进。然而，它们比以前用于世界卫生组织试验的方法更敏感，并且能对出血模式进行易于理解且具有临床意义的描述。
