Belsey E M
Special Programme of Research, Development and Research Training in Human Reproduction, World Health Organization, Geneva, Switzerland.
Contraception. 1988 Aug;38(2):207-25. doi: 10.1016/0010-7824(88)90039-x.
This paper describes the relationship between menstrual bleeding patterns recorded and reasons for discontinuing method use given by women using one of four types of hormonal contraception: combined oral pills, progestogen-only oral pills, a vaginal ring or depot-medroxyprogesterone acetate (DMPA). The women were recruited to five clinical trials, each of which lasted at least 48 weeks. The subject's reason for discontinuation was recorded if she stopped contraceptive use before the scheduled time. Overall, the reason expressed for discontinuing method use was a close reflection of the subject's experience. Among women using either type of oral contraceptive or a vaginal ring, subjects who discontinued for a non-menstrual reason or were lost to follow-up had bleeding patterns which did not differ markedly from those of women who continued method use. Only in the DMPA group was there any evidence that women who complained of non-menstrual side effects or were lost to follow-up might have ceased method use because they were unwilling or unable to tolerate their bleeding patterns. Subjects who discontinued because of amenorrhea had few bleeding/spotting days and at least one prolonged bleeding-free interval; women who complained of longer bleeding had long episodes and short intervals. Women who reported heavier bleeding had patterns which were similar to, but less extreme, than those of subjects who reported longer bleeding. The complaint of irregular bleeding, however, did not concur with the bleeding patterns recorded, regardless of contraceptive method. The predominant menstrual disturbance in this group of women was frequency of bleeding. They had no special difficulty in predicting either the time of onset or the length of their bleeding episodes. There were marked differences between individuals in terms of their acceptance of bleeding disturbances. Nevertheless, the results of this study confirm the importance of counselling. Women using DMPA tolerated far greater menstrual disruption than subjects using any other method. Subjects using an oral contraceptive were unlikely to have been warned of potential bleeding problems; when they encountered any, they tended to cease method use. In contrast, subjects using DMPA would have been advised to expect irregular patterns and possibly amenorrhea; prepared for such disturbances, their perseverance was remarkable.
本文描述了使用四种激素避孕方法之一的女性所记录的月经出血模式与她们给出的停止使用该方法的原因之间的关系。这四种激素避孕方法分别是复方口服避孕药、单纯孕激素口服避孕药、阴道环或醋酸甲羟孕酮长效避孕针（DMPA）。这些女性被招募参加了五项临床试验，每项试验至少持续48周。如果受试者在预定时间之前停止使用避孕方法，会记录其停止使用的原因。总体而言，所表达的停止使用方法的原因密切反映了受试者的经历。在使用任何一种口服避孕药或阴道环的女性中，因非月经原因停止使用或失访的受试者的出血模式与继续使用该方法的女性的出血模式没有明显差异。只有在DMPA组中有证据表明，抱怨有非月经副作用或失访的女性可能因不愿意或无法忍受其出血模式而停止使用该方法。因闭经而停止使用的受试者出血/点滴出血天数很少，且至少有一个延长的无出血间隔期；抱怨出血时间较长的女性出血期长且间隔短。报告出血量较大的女性的出血模式与报告出血时间较长的受试者相似，但程度较轻。然而，无论采用何种避孕方法，关于不规则出血的抱怨与所记录的出血模式并不一致。这群女性中主要的月经紊乱是出血频率。她们在预测出血发作的时间或持续时间方面没有特别困难。在对出血紊乱的接受程度方面，个体之间存在显著差异。尽管如此，本研究结果证实了咨询的重要性。使用DMPA的女性比使用其他任何方法的受试者能耐受更大的月经紊乱。使用口服避孕药的受试者不太可能被警告过潜在的出血问题；当她们遇到任何出血问题时，往往会停止使用该方法。相比之下，使用DMPA的受试者会被建议预期会有不规则模式甚至可能闭经；由于对此类紊乱有所准备，她们的坚持程度令人瞩目。
