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母乳喂养期间的复方激素避孕——医生建议调查

Combined Hormonal Contraception during Breastfeeding-A Survey of Physician's Recommendations.

作者信息

Segev Lior, Weitzman Gideon, Katz-Samson Goldie, Samson Abraham O, Shrem Guy, Srebnik Naama

机构信息

Azrieli Faculty of Medicine, Bar Ilan University, Safed 1311502, Israel.

PUAH Institute: Fertility, Medicine, Halacha, Jerusalem 9547735, Israel.

出版信息

J Clin Med. 2023 Nov 15;12(22):7110. doi: 10.3390/jcm12227110.

Abstract

Until breastfeeding is established, progesterone-only pill (POP) use is preferable over combined hormonal contraception (CHC), as the latter potentially reduces milk production. Yet, POPs are often associated with breakthrough bleeding (BTB), and irregular spotting is often a reason for their cessation. Conversely, CHC is less associated with BTB but is not usually prescribed, even if breastfeeding has been established, despite its verified safety profile. Here, we surveyed physicians' perception of CHC safety during breastfeeding through an online questionnaire (N = 112). Physicians were asked if they would prescribe CHC to a woman three months postpartum, breastfeeding fully, and suffering from BTB while using POPs. Half of the physicians responded they would, 28% would not until six months postpartum, while 14% would not during breastfeeding. Of the physicians that would prescribe CHC, 58% would without any reservation, 24% would only after discussing milk reduction with the patient, 9% would use a pill with a lower hormonal dose, and 9% would only prescribe CHC 3 months postpartum. The main risk associated with CHC during breastfeeding, as perceived by physicians, is a potential decrease in breast milk production (88%). While some physicians consider CHC unsafe during breastfeeding, most health organizations consider CHC compatible with breastfeeding 5-6 weeks after birth. Thus, there is a gap in the attitude and knowledge of physicians about the safety profile of CHC, and only half acknowledge that the risk of BTB justifies the use of CHC instead of POPs while breastfeeding three months postpartum. We highlight the importance of physician's education, advocate CHC breastfeeding compatibility if breastfeeding has been established (i.e., 30 days postpartum), and underline the importance of discussing the option of CHC with patients in case POPs have unwanted side effects.

摘要

在建立母乳喂养之前,优先选择仅含孕激素的避孕药(POP)而非复方激素避孕药(CHC),因为后者可能会减少乳汁分泌。然而,POP常常与突破性出血(BTB)相关,不规则点滴出血往往是停用POP的原因。相反,CHC与BTB的相关性较小,但即使已建立母乳喂养,尽管其安全性已得到证实,CHC通常也不被处方使用。在此,我们通过在线问卷(N = 112)调查了医生对母乳喂养期间CHC安全性的看法。我们询问医生是否会给一名产后三个月、完全母乳喂养且在使用POP时出现BTB的女性开CHC。一半的医生回答会,28%的医生要到产后六个月才会开,而14%的医生在母乳喂养期间都不会开。在会开CHC的医生中,58%会毫无保留地开,24%只会在与患者讨论乳汁减少问题后开,9%会使用激素剂量较低的避孕药,9%只会在产后三个月开CHC。医生认为母乳喂养期间与CHC相关的主要风险是母乳产量可能下降(88%)。虽然一些医生认为母乳喂养期间CHC不安全,但大多数健康组织认为产后5 - 6周CHC与母乳喂养兼容。因此,医生对CHC安全性的态度和知识存在差距,只有一半的医生承认产后三个月母乳喂养时BTB的风险证明使用CHC而非POP是合理的。我们强调医生教育的重要性,主张如果已建立母乳喂养(即产后30天),CHC与母乳喂养兼容,并强调在POP有不良副作用的情况下与患者讨论CHC选择的重要性。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/35b2/10671995/a45f7a578ec7/jcm-12-07110-g001.jpg

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