Effectiveness and acceptability of progestogens in combined oral contraceptives - a systematic review.
Effectiveness and acceptability of progestogens in combined oral contraceptives - a systematic review.
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DOI：
10.1186/1742-4755-1-1
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发表时间：
2004-06-03
影响因子：
3.4
通讯作者：
Gülmezoglu AM
中科院分区：
文献类型：
--
作者：
Kulier R;Helmerhorst FM;Maitra N;Gülmezoglu AM
口服避孕药（OC）的孕激素成分发生了变化，因为人们认识到，它们的化学结构可以影响轻微的不良和有益作用的谱。本综述的目的是评价目前可用的低剂量OC含有炔雌醇和不同的孕激素的避孕效果，周期控制，副作用和继续率。检索科克伦对照试验注册库、MEDLINE和EMBASE数据库。考虑纳入报告临床结局的随机试验，并评估方法学质量和有效性。22项试验被纳入审查。18项研究由制药公司赞助，只有5项研究尝试设盲。不同干预措施之间的大多数比较包括一到三个试验，通常涉及不到500名妇女。与第一代孕激素相比，第二代孕激素的停药率更低（RR 0.79; 95% CI 0.69-0.91）。与第一代孕激素相比，单相和三相制剂的周期控制似乎更好（RR 0.69; 95% CI 0.52-0.91）和（RR 0.61; 95% CI 0.43-0.85）。与第二代避孕药相比，第三代避孕药的经间期出血较少（RR 0.71; 95% CI 0.55-0.91）。孕二烯酮（GSD）的避孕效果与左炔诺孕酮（LNG）相当，并且具有相似的点状出血、突破性出血和无撤退性出血的模式。屈螺酮（DRSP）在避孕有效性、周期控制和副作用方面与去氧孕烯（DSG）相似。在所有可接受性指标中，第三代和第二代孕激素优于第一代。目前的证据表明，GSD在避孕效果和大多数周期控制指标方面与LNG相当。GSD也与DSG相当。DRSP与DSG相当。未来的研究应该集中在独立进行的设计良好的随机试验，特别是比较第三代和第二代孕激素。
The progestogen component of oral contraceptives (OCs) has undergone changes since it was recognized that their chemical structure can influence the spectrum of minor adverse and beneficial effects. The objective of this review was to evaluate currently available low-dose OCs containing ethinylestradiol and different progestogens in terms of contraceptive effectiveness, cycle control, side effects and continuation rates. The Cochrane Controlled Trials Register, MEDLINE and EMBASE databases were searched. Randomized trials reporting clinical outcomes were considered for inclusion and were assessed for methodological quality and validity. Twenty–two trials were included in the review. Eighteen were sponsored by pharmaceutical companies and in only 5 there was an attempt for blinding. Most comparisons between different interventions included one to three trials, involving usually less than 500 women. Discontinuation was less with second-generation progestogens compared to first–generation (RR 0.79; 95% CI 0.69–0.91). Cycle control appeared to be better with second-compared to first-generation progestogens for both, mono-and triphasic preparations (RR 0.69; 95% CI 0.52–0.91) and (RR 0.61; 95% CI 0.43–0.85), respectively. Intermenstrual bleeding was less with third- compared to second-generation pills (RR 0.71; 95% CI 0.55–0.91). Contraceptive effectiveness of gestodene (GSD) was comparable to that of levonorgestrel (LNG), and had similar pattern of spotting, breakthrough bleeding and absence of withdrawal bleeding). Drospirenone (DRSP) was similar compared to desogestrel (DSG) regarding contraceptive effectiveness, cycle control and side effects. The third- and second-generation progestogens are preferred over first generation in all indices of acceptability. Current evidence suggests that GSD is comparable to LNG in terms of contraceptive effectiveness and for most cycle control indices. GSD is also comparable to DSG. DRSP is comparable to DSG. Future research should focus on independently conducted well designed randomized trials comparing particularly the third- with second-generation progestogens.