Berenson A B, Wiemann C M, Rickerr V I, McCombs S L
Department of Obstetrics and Gynecology, The University of Texas Medical Branch at Galveston, 77555-0587, USA.
Am J Obstet Gynecol. 1997 Mar;176(3):586-92. doi: 10.1016/s0002-9378(97)70552-0.
Our goal was to evaluate both the continuation and pregnancy rates and the side effects experienced during the first year of use by adolescents who selected Norplant implants as compared with those who chose oral contraceptives for contraception. Furthermore, side effects experienced at 6 versus 12 months among Norplant implant users were compared to determine whether they diminished with continued use of this method.
We conducted a case-control study of 56 adolescents < or = 18 years old who selected implants as compared with 56 age-matched controls who chose oral contraceptive pills during the same time period.
Only 34% of patients prescribed oral contraceptives as compared with 91% of Norplant implant patients were still using their chosen method 1 year later. As a result 25% of oral contraceptive users became pregnant within 12 months as compared with none who selected Norplant implants. Side effects were reported by > 80% of patients in both groups, with menstrual irregularities reported more often by Norplant implant users than by oral contraceptive users (73% vs 5%, p = 0.01). Furthermore, Norplant implant users gained more weight than oral contraceptive users (8.7 vs 4.2 pounds) and were twice as likely to have an abnormal Papanicolaou smear. Finally, little diminution in side effects was observed during the second 6 months of Norplant implant use.
These data confirm that Norplant implants provide better protection against unintended pregnancy in an adolescent population but may be associated with more side effects. Clinicians should be aware of these findings so they can adequately counsel young patients about these two methods of contraception.
我们的目标是评估选择诺普兰皮下埋植剂的青少年在使用第一年的续用率、妊娠率以及所经历的副作用，并与选择口服避孕药进行避孕的青少年进行比较。此外，还比较了诺普兰皮下埋植剂使用者在6个月和12个月时所经历的副作用，以确定随着这种方法的持续使用副作用是否会减轻。
我们进行了一项病例对照研究，研究对象为56名年龄小于或等于18岁选择皮下埋植剂的青少年，并与同期选择口服避孕药的56名年龄匹配的对照者进行比较。
1年后，仅34%服用口服避孕药的患者仍在使用其选择的方法，而使用诺普兰皮下埋植剂的患者这一比例为91%。结果，12个月内25%的口服避孕药使用者怀孕，而选择诺普兰皮下埋植剂的患者无人怀孕。两组中均有超过80%的患者报告有副作用，诺普兰皮下埋植剂使用者报告月经不规律的情况比口服避孕药使用者更常见（73%对5%，p = 0.01）。此外，诺普兰皮下埋植剂使用者比口服避孕药使用者体重增加更多（8.7磅对4.2磅），巴氏涂片异常的可能性是口服避孕药使用者的两倍。最后，在使用诺普兰皮下埋植剂的第二个6个月期间，未观察到副作用有明显减轻。
这些数据证实，诺普兰皮下埋植剂在青少年人群中能更好地预防意外妊娠，但可能会伴有更多副作用。临床医生应了解这些发现，以便能就这两种避孕方法对年轻患者进行充分的咨询。
