Cromer B A, Smith R D, Blair J M, Dwyer J, Brown R T
Department of Pediatrics, Columbus Children's Hospital, College of Medicine, Ohio State University.
Pediatrics. 1994 Nov;94(5):687-94.
Levonorgestrel implants (Norplant) and medroxyprogesterone acetate injections (Depo-Provera) represent additional contraception options for adolescents. The purpose of this study was to examine prospectively clinical profiles among adolescents who chose one of the two long-term contraceptives compared with profiles among those who chose the combined oral contraceptive pill (OCP).
Girls who needed contraception and did not require confidentiality were presented with a contraceptive menu consisting of Norplant (n = 58), Depo-Provera (n = 66), or OCP (n = 75). At baseline and follow-up visits over 6 months, patients were interviewed regarding gynecologic history, side effect symptoms, and satisfaction. The average age of subjects was 15.5 years (range 11 to 20 years); 66% were African-American and 34% white.
Significantly more teens who chose Depo-Provera (73%) reported having used some method of birth control previously than those selecting either Norplant (30%) or OCP (26%). Adolescents who chose either Norplant (34%) or Depo-Provera (43%) were significantly more likely to have been pregnant previously than those choosing OCP (12%). Those selecting Depo-Provera were significantly more likely to report a history of genital infection with Chlamydia trachomatis (42%) than those in the other two contraceptive groups (22%). Prevalences of reported recent depression and fatigue before initiation of treatment were high, exceeding 35% across the three groups. A total of 105 and 40 adolescents were assessed at 3 and 6 months, respectively. At follow-up, more than 80% of OCP users maintained regular menstrual cycles, whereas over 80% of those choosing Norplant or Depo-Provera had disrupted cycles. Complaints of nausea and dizziness among Norplant users and fatigue among Depo-Provera and OCP users increased significantly between the baseline and follow-up visits. Reports of local reactions to the Norplant device were common but not clinically significant. Blood pressure readings, facial acne, and body mass index did not change over time in any treatment group. Subjects in the Norplant and Depo-Provera groups appreciated freedom from daily compliance to maintain contraceptive effectiveness and the "hidden" nature of the method. Appointment compliance at the end of 6 months was 78% for Depo-Provera, 40% for Norplant, and 46% for OCP.
The implant and injection forms of contraception appear to be especially popular among girls with previous pregnancies or birth control use. The common occurrences of medical symptoms and sexually transmitted diseases before initiation of therapy underscore the importance of baseline evaluation. Norplant users may be warned about nausea and dizziness as well as minor local symptoms around the insertion site and unpredictable uterine bleeding patterns. Adolescent patients choosing Depo-Provera may expect amenorrhea by the end of 6 months of therapy along with possible fatigue. Early intervention may be needed with adolescents who choose Norplant or OCP to encourage better compliance with follow-up appointments.
左炔诺孕酮植入剂（诺普兰）和醋酸甲羟孕酮注射剂（狄波 - 普维拉）是青少年可选择的其他避孕方式。本研究的目的是前瞻性地研究选择这两种长效避孕方法之一的青少年的临床特征，并与选择复方口服避孕药（OCP）的青少年的特征进行比较。
向需要避孕且不需要保密的女孩提供一份避孕选择清单，其中包括诺普兰（n = 58）、狄波 - 普维拉（n = 66）或OCP（n = 75）。在基线和6个月的随访中，就妇科病史、副作用症状和满意度对患者进行访谈。受试者的平均年龄为15.5岁（范围11至20岁）；66%为非裔美国人，34%为白人。
选择狄波 - 普维拉的青少年（73%）报告此前使用过某种避孕方法的比例显著高于选择诺普兰（30%）或OCP（26%）的青少年。选择诺普兰（34%）或狄波 - 普维拉（43%）的青少年此前怀孕的可能性显著高于选择OCP（12%）的青少年。选择狄波 - 普维拉的青少年报告沙眼衣原体生殖器感染史的比例（42%）显著高于其他两个避孕组（22%）。治疗开始前报告近期有抑郁和疲劳症状的比例较高，三组均超过35%。分别在3个月和6个月时对105名和40名青少年进行了评估。随访时，超过80%的OCP使用者月经周期规律，而选择诺普兰或狄波 - 普维拉的使用者中超过80%月经周期紊乱。诺普兰使用者的恶心和头晕投诉以及狄波 - 普维拉和OCP使用者的疲劳症状在基线和随访之间显著增加。对诺普兰装置的局部反应报告很常见，但无临床意义。任何治疗组的血压读数、面部痤疮和体重指数随时间均无变化。诺普兰组和狄波 - 普维拉组的受试者赞赏无需每日服药就能维持避孕效果以及该方法的“隐蔽性”。6个月末的预约依从率，狄波 - 普维拉为78%，诺普兰为40%，OCP为46%。
植入式和注射式避孕方法在有过怀孕史或使用过避孕方法的女孩中似乎特别受欢迎。治疗开始前常见的医学症状和性传播疾病凸显了基线评估的重要性。应告知诺普兰使用者有关恶心、头晕以及植入部位周围轻微局部症状和不可预测的子宫出血模式的情况。选择狄波 - 普维拉的青少年患者可能预期在治疗6个月末出现闭经以及可能出现疲劳。对于选择诺普兰或OCP的青少年可能需要早期干预，以鼓励他们更好地遵守随访预约。
