Avila W S, Grinberg M, Melo N R, Aristodemo Pinotti J, Pileggi F
Instituto do Coração do Hospital das Clínicas-FMUSP, São Paulo, SP.
Arq Bras Cardiol. 1996 Apr;66(4):205-11.
To analyse efficacy, tolerance and adverse events of reversible contraceptives in women with cardiac disease.
We studied prospectively during 24-39 (mean = 29) months, 89 women with heart disease with a mean age of 25.6 (16-42) years. Rheumatic heart disease was present in 73 (82%) cases, congenital heart disease in 11 (11%), coronary artery disease in 2 (2%) and cardiomyopathy in 3 (3%) case. The patients were divided in three groups: GCO--35 patients taking combined oral contraceptives (30 micrograms ethinyl estradiol and 75 micrograms gestodene--COs); GIT--27 using injectable progestagens (depot medroxyprogesterone acetate-DMPA) and GUID--27 with intrauterine device (IUD).
In GCO occurred 4 (11.4%) cases of arterial hypertension, 1 (2.8%) of a transient cerebral isquemic attack, 3 (8.5%) of spotting, 1 (2.8%) of amnorrhea e 1 (2.8%) pregnancy. Interruption of this method occurred in 4 (11.4%) cases due to hypertension (2), pregnancy (1) and amenorrhea (1). In group GIT there were 2 (7.4%) cases of arterial hypertension, 18 (66.6%) of amenorrhea, and 3 (11.1%) of spotting. Interruption of use occurred in 5 (18.5%) due to amnorrhea (2), weight gain (2) and headache (1). In GUID there was 1 (3.7%) case of infeccion, 1 (3.7%) pregnancy and 1 (3.7%) spontaneous expulsion of IUD. Interruption of use took place in 3 (11.1%) cases due to infeccion, pregnancy and expulsion. The comparation between the groups demonstrated a difference in the incidence of amenorrhea (p < 0.005) and descontinuation of use of the method (p < 0.025).
Use of reversible contraceptives in heart disease women was associated with an acceptable cardiovascular risk. Efficacy and side effects of the methods were comparable in the groups, however intolerance was more observed in GIT.
分析可逆性避孕药在心脏病女性中的疗效、耐受性及不良事件。
我们对89名平均年龄为25.6岁（16 - 42岁）的心脏病女性进行了为期24至39个月（平均29个月）的前瞻性研究。其中73例（82%）为风湿性心脏病，11例（11%）为先天性心脏病，2例（2%）为冠状动脉疾病，3例（3%）为心肌病。患者被分为三组：GCO组——35名服用复方口服避孕药（30微克炔雌醇和75微克孕二烯酮——COs）的患者；GIT组——27名使用注射用孕激素（醋酸甲羟孕酮长效注射剂——DMPA）的患者；GUID组——27名使用宫内节育器（IUD）的患者。
GCO组发生4例（11.4%）动脉高血压，1例（2.8%）短暂性脑缺血发作，3例（8.5%）点滴出血，1例（2.8%）闭经和1例（2.8%）妊娠。该方法因高血压（2例）、妊娠（1例）和闭经（1例）中断使用4例（11.4%）。GIT组有2例（7.4%）动脉高血压，18例（66.6%）闭经，3例（11.1%）点滴出血。因闭经（2例）、体重增加（2例）和头痛（1例）导致5例（18.5%）中断使用。GUID组有1例（3.7%）感染，1例（3.7%）妊娠和1例（3.7%）宫内节育器自发排出。因感染、妊娠和排出导致3例（11.1%）中断使用。组间比较显示闭经发生率（p < 0.005）和方法停用率（p < 0.025）存在差异。
心脏病女性使用可逆性避孕药与可接受的心血管风险相关。各组方法的疗效和副作用具有可比性，但GIT组观察到更多不耐受情况。
