Obstetrics and Gynecology, University of Colorado Anschutz Medical Campus, Aurora, CO.
Division of Adolescent Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO.
J Pediatr Adolesc Gynecol. 2021 Feb;34(1):33-39. doi: 10.1016/j.jpag.2020.08.017. Epub 2020 Sep 9.
To identify why adolescents with polycystic ovary syndrome (PCOS) chose the etonogestrel (ENG) contraceptive implant, to determine the 12-month continuation rate, and to characterize factors related to discontinuation.
DESIGN, SETTING, AND PARTICIPANTS: Retrospective chart review of adolescents seen at a tertiary care children's hospital between July 1, 2008, and August 30, 2019, with PCOS diagnosis confirmed per National Institutes of Health criteria and ≥12-month ENG follow-up.
Demographic characteristics, reasons for ENG insertion and removal, and information on other hormonal/contraceptive therapies were collected. Patients were categorized as ENG continuers (use ≥12 months) or discontinuers (removal at <12 months), and groups were compared.
A total of 96 patients met inclusion criteria (age 17.7 ± 2.2 years, body mass index 34.8 ± 8 kg/m). Reasons for ENG were documented in 74% (51% contraception, 32% ease of use, 15% other, 13% estrogen avoidance). In all, 27% had never been sexually active, and 67% had had prior sexual activity. Treatments prior to ENG placement included 74% combined hormonal contraception, 20% medroxyprogesterone acetate withdrawal, and 17% depot medroxyprogesterone. A total of 77% continued ENG at 12 months. The main reasons for discontinuation were bleeding (41%), concern about weight gain (23%), and mood changes (18%). No preimplantation characteristics were independently predictive of continuation, although 100% of patients with type 2 diabetes (n = 11) continued. Patients who sought additional care, including telephone calls (41% vs 12%, P = .006) and clinic visits (64% vs 20%, P < .001) were more likely to discontinue.
The ENG implant was well tolerated in adolescents with PCOS and similar to published 12-month continuation rates.
确定患有多囊卵巢综合征（PCOS）的青少年选择依托孕烯（ENG）避孕植入物的原因，确定 12 个月的续用率，并确定与停药相关的因素。
设计、地点和参与者：回顾性分析 2008 年 7 月 1 日至 2019 年 8 月 30 日在一家三级儿童保健医院就诊的患有 PCOS 且至少接受 12 个月 ENG 随访的青少年患者的病历。
收集人口统计学特征、ENG 插入和移除的原因以及其他激素/避孕治疗的信息。患者分为 ENG 续用者（使用≥12 个月）或停药者（<12 个月时取出），并对两组进行比较。
共有 96 名患者符合纳入标准（年龄 17.7±2.2 岁，体重指数 34.8±8kg/m²）。ENG 的使用原因记录在案的占 74%（51%用于避孕，32%使用方便，15%用于避免雌激素，13%用于其他原因）。总共有 27%的人从未有过性行为，67%的人有过性行为。ENG 植入前的治疗包括 74%的联合激素避孕药、20%的醋酸甲羟孕酮停药和 17%的 depot 醋酸甲羟孕酮。共有 77%的患者在 12 个月时继续使用 ENG。停药的主要原因是出血（41%）、担心体重增加（23%）和情绪变化（18%）。尽管 100%（n=11）的 2 型糖尿病患者继续接受治疗，但没有植入前的特征能独立预测是否继续治疗。寻求额外治疗的患者（包括电话咨询 41% vs 12%，P=.006）和门诊就诊 64% vs 20%，P<.001）更有可能停药。
ENG 植入物在患有 PCOS 的青少年中耐受性良好，与已发表的 12 个月续用率相似。
