VAGINAL BLEEDING PATTERNS AMONG WOMEN USING ONE NATURAL AND 8 HORMONAL METHODS OF CONTRACEPTION
VAGINAL BLEEDING PATTERNS AMONG WOMEN USING ONE NATURAL AND 8 HORMONAL METHODS OF CONTRACEPTION
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DOI：
10.1016/0010-7824(88)90038-8
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发表时间：
1988-08-01
期刊：
影响因子：
2.9
通讯作者：
BELSEY, EM
中科院分区：
文献类型：
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作者：
BELSEY, EM
共有5257名妇女使用了九种不同的避孕方法，一种自然避孕方法和八种激素避孕方法，获得了月经日记记录。本文提出了阴道出血模式的比较分析。分析程序遵循最近世卫组织出血模式分析讲习班的建议，其中包括将每个受试者的日记划分为连续的90天参考期，计算每个周期的10个指标，并根据是否有“临床上重要的”出血障碍对妇女进行分类。总的来说，这一分析的结果证实了以前的研究结果。使用自然方法的妇女，她们是根据月经周期的规律精心挑选的，在每90天的周期中，平均有3次出血/点滴发作，每次5天，妇女内部或妇女之间的差异很小。服用联合口服避孕药的受试者比其他任何治疗组有更规律的模式，发作时间短（4天），无出血间隔23-24天。单独服用孕激素药物的人发作频率更高，时间更长，间隔时间更短，更难以预测。与人们普遍认为的相反，只服用孕激素的药片比服用联合药片产生的点滴时间要少，而且几乎没有点滴发作。近一半的阴道环使用者在每个经期都经历了一些月经紊乱；他们最常见的问题是不规则、不频繁或持续出血。使用长效注射剂醋酸甲羟孕酮的妇女，有完全不可预测的模式，出血/点滴发作不频繁但持续时间长。闭经的发生率从第一次注射期间的不到10%上升到第四次注射期间的40%以上。卫生组织1985年建议的分析方法仍然需要大量改进。然而，它们比以前用于世卫组织试验的方法更敏感，并产生易于理解的、有临床意义的出血模式特征。
Menstrual diary records were obtained from a total of 5257 women using nine different methods of contraception, one natural and eight hormonal. This paper presents a comparative analysis of their vaginal bleeding patterns. The analytic procedures follow the recommendations of a recent WHO workshop on bleeding pattern analysis, which involve dividing each subject''s diary into successive 90-day reference periods, calculating ten indices for each period, and classifying women according to whether they have "clinically important" bleeding disturbances. In general, the findings of this analysis confirm those of previous studies. Women using the natural method, who were deliberately selected for the regularity of these menstrual cycles, averaged three bleeding/spotting episodes of length 5 days in each 90-day-period, with very little variability within or between women. Subjects given a combined oral contraceptive had more regular patterns than any other treated group, with short (4-day) episodes and 23-24 day bleeding-free intervals. Progestogen-only pill users had more frequent, longer episodes and shorter, less predictable intervals than combined pill users. Contrary to widely held beliefs, the progestogen-only pills produced fewer spotting days than the combined pills, and almost no spotting episodes at all. Nearly half of vaginal ring users experienced some menstrual disturbance in each period; their most common problems were irregular, infrequent or prolonged bleeding. Women using the long-acting injectable, depot medroxyprogesterone acetate, had totally unpredictable patterns, with infrequent but prolonged bleeding/spotting episodes. The incidence of amenorrhea rose from just under 10% in their first injection interval to over 40% in their fourth. The methods of analysis recommended by WHO in 1985 still require substantial refinement. Nevertheless, they are more sensitive than those used previously for WHO trials and produce an easily understood, clinically meaningful characterization of bleeding patterns.