Ovarian suppression in normal-weight and obese women during oral contraceptive use: a randomized controlled trial
Ovarian suppression in normal-weight and obese women during oral contraceptive use: a randomized controlled trial
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使用口服避孕药期间正常体重和肥胖女性的卵巢抑制：一项随机对照试验
DOI：
10.1783/147118910793048566
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发表时间：
2010
影响因子：
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通讯作者：
Ellie Golightly
中科院分区：
文献类型：
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作者：
Ellie Golightly
一些研究表明，肥胖女性在使用复方口服避孕药（COC）期间比正常体重女性更容易发生意外怀孕，但这是否是由于服用COC的生理差异或行为差异尚不清楚。本文旨在回答这个问题，并报道了在美国纽约州纽约进行的一项肥胖和正常体重妇女服用COC的随机双盲试验。招募的女性体重指数（BMI）在19.0和24.9之间，或在30.0和39.9之间。使用的COC是乙炔炔雌醇（E2）和左炔诺孕酮的形式，参与者随机接受30/150或20/100 μg制剂，其中21粒活性药丸和7粒非活性药丸。因为肥胖的女性比正常体重的女性更容易无排卵，研究人员只招募了月经规律和超声扫描卵巢正常的女性。通过测量血液左炔诺孕酮水平和卵巢抑制来监测依从性，通过超声扫描和血液孕酮水平来监测排卵。该研究发现，使用COC的女性持续存在卵巢抑制，这与肥胖或正常体重的女性以及低剂量和高剂量制剂没有什么不同。然而，在试验中，17%的妇女使用COC不一致或根本没有，尽管报告了正确的使用，并且毫不奇怪，这些妇女的排卵率很高。一个意想不到的发现是，肥胖女性比体重正常的女性更容易不一致地使用COC。为什么这是不清楚的，虽然作者指出，肥胖与贫困和社会剥夺的标志有关，这些因素也可能影响谁参加提供经济报酬的试验。这项研究是有用的，因为它表明，正常体重和肥胖的妇女都可以有信心的实质性卵巢抑制，如果使用高或低剂量的COC正确，因此，肥胖妇女使用COC一贯不意外怀孕的风险较高。它还强调了帮助妇女选择一种她们一贯使用舒适的避孕药具的重要性，以减少意外怀孕的风险。
Some studies have shown that obese women are more likely to experience unintended pregnancy during combined oral contraceptive (COC) use than normal-weight women, but whether this is due to physiological differences or behavioural differences in taking COC is unclear. This paper aimed to answer that question and reports on a randomised double-blind trial of COC in obese and normal-weight women in New York, NY, USA. Women were recruited with a body mass index (BMI) of either between 19.0 and 24.9, or between 30.0 and 39.9. The COC used was in the form of ethinylestradiol (E2) and levonorgestrel, and participants were randomised to receive either a 30/150 or a 20/100 μg preparation, with 21 active and seven inactive pills. Because women who are obese are more likely to be anovulatory than normal-weight women, the investigators only recruited women with regular periods and normal ovaries on ultrasound scan. Compliance was monitored by measuring blood levonorgestrel levels and ovarian suppression, and ovulation by ultrasound scan and blood progesterone levels. The study found that women who were using the COC consistently had substantial ovarian suppression, and this was no different for obese or normal-weight women, and for both low-dose and high-dose preparations. However, 17% of the women in the trial used the COC inconsistently or not at all, despite reporting correct use, and unsurprisingly there were high rates of ovulation in these women. An unexpected finding was that obese women were more likely to be using the COC inconsistently than women in the normalweight group. Why this was is unclear, although the authors noted that obesity is associated with poverty and markers of social deprivation, and such factors may also influence who takes part in a trial offering financial remuneration. This study is useful because it demonstrates that both normal-weight and obese women can be confident of substantial ovarian suppression if using either highor low-dose COC correctly, and thus obese women using the COC consistently are not at higher risk of unintended pregnancy. It also highlights the importance of helping women choose a contraceptive that they are comfortable using consistently, to decrease the risk of unintended pregnancy.