Gynecology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
Academic Center for Research On Adenomyosis and Endometriosis, Department of Clinical Sciences and Community Health, Università Degli Studi Di Milano, Milan, Italy.
Arch Gynecol Obstet. 2024 Oct;310(4):1823-1829. doi: 10.1007/s00404-024-07713-w. Epub 2024 Aug 28.
Products that may reduce menstrual flow from the endometrial cavity to the vagina (i.e. tampons and menstrual cups) could facilitate retrograde menstruation and the spillage of blood into the myometrium, two mechanisms which could be major determinants in endometriosis and adenomyosis pathogenesis. The aim of this narrative review is to summarize the evidence regarding the mechanical role menstrual products may have in the pathogenesis of these two conditions. Evidence in this regard is inconclusive. While Darrow and colleagues observed that 14 or more years of tampon use were associated with endometriosis (OR 3.6; 95% CI, 1.04-13.5); in Meaddough and colleagues' retrospective study, the percentage of women using pads only was significantly higher among those with endometriosis than among those without the condition (31% vs 22%). Three further groups failed to find an association between endometriosis/adenomyosis and any type of menstrual product. The only case that may be considered as a sort of proof-of-concept of the association between products potentially reducing anterograde menstrual flow and endometriosis was reported by Spechler and colleagues, who described the case of a 41 year-old who developed endometriosis after having used a menstrual cup on a regular basis. However, the number of studies on the subject is scarce, study populations are exiguous and a greater attention to temporality of endometriosis onset in relation to when women started habitually using a specific menstrual product is needed. Confounding variables including type and quantity of endocrine disruptors contained in menstrual products should also be addressed. At the present moment, no recommendation can be provided on the safety of one type of menstrual product compared to another.
产品可能会减少从子宫内膜腔到阴道的经血流量（即卫生棉条和月经杯），从而促进经血逆流和血液溢出到子宫肌层，这两种机制可能是子宫内膜异位症和子宫腺肌病发病机制的主要决定因素。本叙述性综述的目的是总结有关月经产品在这两种疾病发病机制中可能具有的机械作用的证据。这方面的证据尚无定论。虽然达罗（Darrow）及其同事观察到，使用卫生棉条 14 年或以上与子宫内膜异位症有关（OR 3.6；95%CI，1.04-13.5）；但在米道（Meaddough）及其同事的回顾性研究中，患有子宫内膜异位症的女性中使用护垫的比例明显高于没有该疾病的女性（31%比 22%）。另有三个小组未能发现子宫内膜异位症/子宫腺肌病与任何类型的月经产品之间存在关联。唯一可以被认为是与潜在减少经血向前流动的产品与子宫内膜异位症之间关联的“概念验证”的案例是由斯佩克勒（Spechler）及其同事报告的，他们描述了一名 41 岁女性的病例，该女性在经常使用月经杯后患上了子宫内膜异位症。然而，关于这个主题的研究数量很少，研究人群也很少，需要更加注意子宫内膜异位症发病的时间与女性开始习惯性使用特定月经产品之间的时间关系。还应解决包含在月经产品中的内分泌干扰物的类型和数量等混杂变量。目前，不能就一种类型的月经产品与另一种产品相比的安全性提供任何建议。
