Epidemiology Branch and the Biostatistics and Computational Biology Branch, National Institute of Environmental Health Sciences, and Public Health and Epidemiology Practice, Westat, Durham, North Carolina; and the Department of Radiology, Henry Ford Health Systems, Detroit, Michigan.
Obstet Gynecol. 2022 May 1;139(5):797-807. doi: 10.1097/AOG.0000000000004745. Epub 2022 Apr 5.
Investigate the association between use of depot medroxyprogesterone acetate (DMPA) (an injectable progestin-only contraceptive) and leiomyoma development.
We conducted a cohort study in the Detroit, Michigan, area that involved four clinic visits at 20-month intervals over 5 years (2010-2018) and used a standardized ultrasonography protocol to prospectively measure leiomyomas 0.5 cm or more in diameter. Participants were 1,693 self-identified Black women aged 23-35 years with no prior leiomyoma diagnosis and no hysterectomy. For this substudy, years since last use of DMPA was ascertained from questionnaire data at every visit. Leiomyoma incidence was defined as the first visit with an observed leiomyoma among women who were leiomyoma-free at enrollment. Depot medroxyprogesterone acetate associations were examined with Cox models. Leiomyoma growth was calculated as the change in log-volume for leiomyomas matched at successive visits and was modeled using linear mixed models accounting for clustered data. Leiomyoma loss, defined as a reduction in leiomyoma number in successive visits, was modeled using Poisson regression. All models used time-varying exposure and covariates.
Of participants with at least one follow-up visit (N=1,610), 42.9% had ever used DMPA. Participants exposed to DMPA within the previous 2 years experienced reduced leiomyoma development during the subsequent observation interval compared with never users, including lower leiomyoma incidence (5.2% vs 10.7%), adjusted hazard ratio 0.6 (95% CI 0.4-1.0), 42.0% lower leiomyoma growth (95% CI -51.4 to -30.7) and 60% greater leiomyoma loss (adjusted risk ratio 1.6, 95% CI 1.1-2.2). Excess leiomyoma loss was also seen for those who used DMPA 2-4 years before the visit compared with never users, 2.1-fold increase (95% CI 1.4-3.1).
Recent use of DMPA was associated with reduced leiomyoma development and increased leiomyoma loss. Such changes in early leiomyoma development in young women could delay symptom onset and reduce the need for invasive treatment.
研究使用长效醋酸甲羟孕酮（DMPA）（一种注射用单纯孕激素避孕药）与子宫肌瘤发展之间的关系。
我们在密歇根州底特律地区进行了一项队列研究，该研究涉及四次 20 个月间隔的临床访视，历时 5 年（2010-2018 年），并使用标准化超声检查方案前瞻性测量直径 0.5 厘米或以上的子宫肌瘤。参与者为 1693 名自我认定的年龄在 23-35 岁之间、无先前子宫肌瘤诊断且未行子宫切除术的黑人女性。对于这项子研究，通过每次就诊时的问卷数据确定最后一次使用 DMPA 的年份。子宫肌瘤的发病率定义为在无子宫肌瘤的女性中首次就诊时观察到子宫肌瘤的时间。使用 Cox 模型检查 DMPA 与子宫肌瘤的关系。通过线性混合模型计算对数体积变化来计算子宫肌瘤的生长，该模型考虑了连续就诊时的聚类数据。使用泊松回归模型计算子宫肌瘤的减少，定义为连续就诊时子宫肌瘤数量的减少。所有模型均使用随时间变化的暴露因素和协变量。
在至少有一次随访就诊的参与者中（n=1610），42.9%的参与者曾使用过 DMPA。与从未使用者相比，在过去 2 年内接触过 DMPA 的参与者在随后的观察间隔期间子宫肌瘤的发展减少，包括较低的子宫肌瘤发病率（5.2%比 10.7%），调整后的危险比为 0.6（95%CI 0.4-1.0），子宫肌瘤生长减少 42.0%（95%CI-51.4 至-30.7），子宫肌瘤减少 60%（调整后的风险比 1.6，95%CI 1.1-2.2）。与从未使用者相比，在就诊前 2-4 年使用 DMPA 的参与者也出现了子宫肌瘤过度减少，增加了 2.1 倍（95%CI 1.4-3.1）。
最近使用 DMPA 与子宫肌瘤的发展减少和子宫肌瘤的过度减少有关。年轻女性早期子宫肌瘤发展的这种变化可能会延迟症状发作并减少对侵入性治疗的需求。
