Xiao B, Zeng T, Wu S, Sun H, Xiao N
National Research Institute for Family Planning, WHO Collaborating Centre for Research in Human Reproduction, Haidian District, Beijing, People's Republic of China.
Contraception. 1995 Jun;51(6):359-65. doi: 10.1016/0010-7824(95)00102-g.
In the present study 14 women after 6 years' use of levonorgestrel-releasing IUD were investigated for the changes of LH, progesterone (P), estradiol (E2), prolactin (PRL) and serum binding globulin (SHBG) in relation to the levonorgestrel levels throughout a segment of 26-40 days with the aim of comparing the hormonal profiles with those during the first year of use of Lng-IUD. Ultrasound scanning was used to follow the development of follicles along with the RIA measurement of hormones. The results of serum LH, P and E2 showed ovulation in 11 cases with either normal menstrual cycles (5 cases), prolonged or irregular cycles (4 cases) or with amenorrhea for 2-3 years (2 cases). One case showed insufficiency of luteal function and 2 cases showed anovulation but with follicular hyperactivity. Higher percentages of ovulatory cycles (78.5%) were found after 6 years of use. No case of complete suppression of ovulation was found. Anovulatory cycles only constituted 14.3%. Clinically, the development of follicles followed by ultrasound scanning further confirmed the hormonal findings. The persistent enlargement of follicles coincided with high levels of E2. After 6 years of use, the serum levels of levonorgestrel were still maintained at mean levels of 314.26 pmol/L and 470.63 pmol/L in the ovulatory and anovulatory groups, respectively. It is concluded that over two-thirds of the cases have ovulatory cycles after long-term use of Lng-IUD; the contraceptive effect is mainly due to its local action on the endometrium, with much less effect on the ovarian function.
在本研究中，对14名使用左炔诺孕酮宫内节育器6年的女性进行了调查，以研究在26至40天的时间段内，促黄体生成素（LH）、孕酮（P）、雌二醇（E2）、催乳素（PRL）和血清结合球蛋白（SHBG）与左炔诺孕酮水平的变化关系，目的是将激素谱与使用左炔诺孕酮宫内节育器第一年时的情况进行比较。采用超声扫描跟踪卵泡发育情况，并通过放射免疫分析法测定激素水平。血清LH、P和E2的检测结果显示，11例有排卵，其中月经周期正常者5例，月经周期延长或不规律者4例，闭经2至3年者2例。1例黄体功能不全，2例无排卵但卵泡活动亢进。使用6年后发现排卵周期的比例较高（78.5%）。未发现完全抑制排卵的情况。无排卵周期仅占14.3%。临床上，超声扫描跟踪卵泡发育进一步证实了激素检测结果。卵泡持续增大与E2水平升高同时出现。使用6年后，排卵组和无排卵组的血清左炔诺孕酮水平分别维持在平均314.26 pmol/L和470.63 pmol/L。结论是，长期使用左炔诺孕酮宫内节育器后，超过三分之二的病例有排卵周期；其避孕效果主要归因于对子宫内膜的局部作用，对卵巢功能的影响较小。
