40岁以上高龄女性使用左炔诺孕酮宫内缓释系统的临床分析
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摘要
目的:对40岁以上高龄女性放置左炔诺孕酮宫内缓释系统(levonorgestrel-releasing intrauterine system,LNG-IUS)的临床资料进行回顾分析。方法:收集2002至2017年在本院使用LNG-IUS的高龄女性共1459例(高龄组),随机抽取同期使用LNG-IUS的20～40岁女性1501例(生育年龄组)。对比分析放置LNG-IUS的适应证、放置时间和临床效果,以及放置后的闭经、阴道点滴出血和激素副反应等发生率。结果:2组病例放置LNG-IUS的原因(Z=50.120,P=0.000)和时间(Z=33.996,P=0.000)不同;生育年龄组主要因避孕而安环(55.76%),高龄组因痛经安环者更多(36.81%);2组多选择在经期安环(65.77%vs. 72.41%);2组避孕成功率(100%vs. 100%,P=1.000)、月经量改善率(93.52%vs. 93.59%,P=0.289)无统计学差异;但高龄组痛经缓解率不如生育年龄组(89.57%vs. 91.50%,P=0.040);2组闭经(25.32%vs. 24.49%,P=0.501)、阴道点滴出血(27.32%vs. 29.95%,P=0.141)和激素副反应(14.26%vs. 13.23%,P=0.070)的发生率无统计学差异。结论:高龄女性放置LNG-IUS后治疗效果好,闭经及阴道点滴出血等副作用发生率低,是使用LNG-IUS的适宜人群。
Objective:To investigate the clinical effect of levonorgestrel-releasing intrauterine system(LNG-IUS)in women aged above40 years old. Methods:A retrospective analysis was performed for the clinical data of 1 459 women aged above 40 years old(senior group)and 1 501 aged 20-40 years old(childbearing age group)who underwent the placement of LNG-IUS in our hospital from2002 to 2017. The two groups were compared in terms of the indications,time,and clinical effect of LNG-IUS placement and incidence rates of amenorrhea,slight vaginal bleeding,and hormone-related side effects after placement. Results:There were significant differences between the two groups in the reason for LNG-IUS placement(Z=50.120,P=0.000) and time of placement(Z =33.996,P=0.000);most patients in the childbearing age group(55.76%)underwent LNG-IUS placement for contraception,while most patients in the senior group(36.81%)underwent placement due to dysmenorrhea. Most patients in these two groups underwent placement during the menstrual period(65.77% vs. 72.41%). There were no significant differences between the two groups in the success rate of contraception(100% vs. 100%,P=1.000)and improvement rate of menstrual volume(93.52% vs. 93.59%,P=0.289),but the senior group had a lower remission rate of dysmenorrhea than the childbearing age group(89.57% vs. 91.50%,P=0.040). There were no significant differences between the two groups in the incidence rates of amenorrhea(25.32% vs. 24.49%,P=0.501),slight vaginal bleeding(27.32% vs. 29.95%,P=0.141),and hormone-related side effects(14.26% vs. 13.23%,P=0.070). Conclusion:LNG-IUS placement has a good therapeutic effect in women aged above 40 years old with low incidence rates of amenorrhea,slight vaginal bleeding,and other side effects. Therefore,such women are suitable for LNG-IUS placement.
Objective:To investigate the clinical effect of levonorgestrel-releasing intrauterine system(LNG-IUS)in women aged above40 years old. Methods:A retrospective analysis was performed for the clinical data of 1 459 women aged above 40 years old(senior group)and 1 501 aged 20-40 years old(childbearing age group)who underwent the placement of LNG-IUS in our hospital from2002 to 2017. The two groups were compared in terms of the indications,time,and clinical effect of LNG-IUS placement and incidence rates of amenorrhea,slight vaginal bleeding,and hormone-related side effects after placement. Results:There were significant differences between the two groups in the reason for LNG-IUS placement(Z=50.120,P=0.000) and time of placement(Z =33.996,P=0.000);most patients in the childbearing age group(55.76%)underwent LNG-IUS placement for contraception,while most patients in the senior group(36.81%)underwent placement due to dysmenorrhea. Most patients in these two groups underwent placement during the menstrual period(65.77% vs. 72.41%). There were no significant differences between the two groups in the success rate of contraception(100% vs. 100%,P=1.000)and improvement rate of menstrual volume(93.52% vs. 93.59%,P=0.289),but the senior group had a lower remission rate of dysmenorrhea than the childbearing age group(89.57% vs. 91.50%,P=0.040). There were no significant differences between the two groups in the incidence rates of amenorrhea(25.32% vs. 24.49%,P=0.501),slight vaginal bleeding(27.32% vs. 29.95%,P=0.141),and hormone-related side effects(14.26% vs. 13.23%,P=0.070). Conclusion:LNG-IUS placement has a good therapeutic effect in women aged above 40 years old with low incidence rates of amenorrhea,slight vaginal bleeding,and other side effects. Therefore,such women are suitable for LNG-IUS placement.
引文
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[8]Jiang W,Shen Q,Chen M,et al.Levonorgestrel-releasing intrauterine system use in premenopausal women with symptomatic uterine leiomyoma:a systematic review[J].Steroids,2014,86:69-78.
[9]Dos Santos IK,de Lima Nunes R,Soares GM,et al.Exercise and reproductive function in polycystic ovary syndrome:protocol of a systematic review[J].Syst Rev,2017,6(1):264.
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[11]Magon N,Chauhan M,Goel P,et al.Levonorgestrel intrauterine system:current role in management of heavy menstrual bleeding[J].Journal of Mid-Life Health,2013,?4(1):8-15.
[12]Eralil GJ.The Effectiveness of levonorgestrel-releasing intrauterine system in the treatment of heavy menstrual bleeding[J].J Obstet Gynaecol India,2016,66(S1):505-512.
[13]Chen YJ,Hsu TF,Huang BS,et al.Postoperative maintenance levonorgestrel-releasing intrauterine system and endometrioma recurrence a randomized controlled study[J].American Journal of Obstetrics&Gynecology,2017,216(6):582.e1-9.
[14]Taneja A,Kaur S,Soni RK.Evaluating the efficacy of levonorgestrel intrauterine system and danazol for relief of postoperative pain in endometriosis[J].J Clin Diagn Res,2017,11(7):10-12.
[15]Carvalho NM,Chou V,Modesto W,et al.Relationship between user satisfaction with the levonorgestrel-releasing intrauterine system and bleeding patterns[J].J Obstet Gynaecol Res,2017,43(11):1732-1737.
[16]Aleknaviciute J,Tulen JHM,De Rijke YB,et al.The levonorgestrel-releasing intrauterine device potentiates stress reactivity[J].Psychoneuroendocrinology,2017,80:39-45.
[17]Kai J,Middleton L,Daniels J,et al.Usual medical treatments or levonorgestrel-IUS for women with heavy menstrual bleeding:long-term randomised pragmatic trial in primary care[J].Br J Gen Pract,2016,66(653):e861-870.
[18]Mejia M,McNicholas C,Madden T,et al.Association of baseline bleeding pattern on amenorrhea with levonorgestrel intrauterine system use[J].Contraception,2016,94(5):556-560.
[19]Cim N,Soysal S,Sayan S,et al.Two years follow-up of patients with abnormal uterine bleeding after insertion of the levonorgestrel-releasing intrauterine system[J].Gynecol Obstet Invest,2017[Epub ahead of print].DOI:10.1159/000480012.
[20]Ji F,Yang XH,Ai Xing Zi AL,et al.Role of levonorgestrel-releasing intrauterine system in dysmenorrhea due to adenomyosis and the influence on ovarian function[J].Clin Exp Obstet Gynecol,2014,41(6):677-680.
[2]Costescu DJ.Levonorgestrel-releasing intrauterine systems for long-acting contraception:current perspectives,safety,and patient counseling[J].International Journal of Womens Health,2016,8:589-598.
[3]Zhao S,Deng J,Wang Y,et al.Experience and levels of satisfaction with the levonorgestrel-releasing intrauterine system in China:a prospective multicenter survey[J].Patient Prefer Adherence,2014,8:1449-1455.
[4]Lal S,Kriplani A,Kulshrestha V,et al.Efficacy of mifepristone in reducing intermenstrual vaginal bleeding in users of the levonorgestrel intrauterine system[J].Int J Gynaecol Obstet,2010,109(2):128-130.
[5]Jacobstein R,Shelton JD.The levonorgestrel intrauterine system:a pragmatic view of an excellent contraceptive[J].Glob Health Sci Pract,2015,3(4):538-543.
[6]Mi-La K,Ju SS.Clinical applications of levonorgestrel-releasing intrauterine system to gynecologic diseases[J].Obstetrics&Gynecology Science,2013,56(2):67-75.
[7]Heikinheimo O,Inki P,Schmelter T,et al.Bleeding pattern and user satisfaction in second consecutive levonorgestrel-releasing intrauterine system users:results of a prospective 5-year study[J].Hum Reprod,2014,29(6):1182-1188.
[8]Jiang W,Shen Q,Chen M,et al.Levonorgestrel-releasing intrauterine system use in premenopausal women with symptomatic uterine leiomyoma:a systematic review[J].Steroids,2014,86:69-78.
[9]Dos Santos IK,de Lima Nunes R,Soares GM,et al.Exercise and reproductive function in polycystic ovary syndrome:protocol of a systematic review[J].Syst Rev,2017,6(1):264.
[10]Korjamo R,Mentula M,Heikinheimo O.Immediate versus delayed initiation of the levonorgestrel-releasing intrauterine system following medical termination of pregnancy--1 year continuation rates:a randomised controlled trial[J].BJOG,2017,124(13):1957-1964.
[11]Magon N,Chauhan M,Goel P,et al.Levonorgestrel intrauterine system:current role in management of heavy menstrual bleeding[J].Journal of Mid-Life Health,2013,?4(1):8-15.
[12]Eralil GJ.The Effectiveness of levonorgestrel-releasing intrauterine system in the treatment of heavy menstrual bleeding[J].J Obstet Gynaecol India,2016,66(S1):505-512.
[13]Chen YJ,Hsu TF,Huang BS,et al.Postoperative maintenance levonorgestrel-releasing intrauterine system and endometrioma recurrence a randomized controlled study[J].American Journal of Obstetrics&Gynecology,2017,216(6):582.e1-9.
[14]Taneja A,Kaur S,Soni RK.Evaluating the efficacy of levonorgestrel intrauterine system and danazol for relief of postoperative pain in endometriosis[J].J Clin Diagn Res,2017,11(7):10-12.
[15]Carvalho NM,Chou V,Modesto W,et al.Relationship between user satisfaction with the levonorgestrel-releasing intrauterine system and bleeding patterns[J].J Obstet Gynaecol Res,2017,43(11):1732-1737.
[16]Aleknaviciute J,Tulen JHM,De Rijke YB,et al.The levonorgestrel-releasing intrauterine device potentiates stress reactivity[J].Psychoneuroendocrinology,2017,80:39-45.
[17]Kai J,Middleton L,Daniels J,et al.Usual medical treatments or levonorgestrel-IUS for women with heavy menstrual bleeding:long-term randomised pragmatic trial in primary care[J].Br J Gen Pract,2016,66(653):e861-870.
[18]Mejia M,McNicholas C,Madden T,et al.Association of baseline bleeding pattern on amenorrhea with levonorgestrel intrauterine system use[J].Contraception,2016,94(5):556-560.
[19]Cim N,Soysal S,Sayan S,et al.Two years follow-up of patients with abnormal uterine bleeding after insertion of the levonorgestrel-releasing intrauterine system[J].Gynecol Obstet Invest,2017[Epub ahead of print].DOI:10.1159/000480012.
[20]Ji F,Yang XH,Ai Xing Zi AL,et al.Role of levonorgestrel-releasing intrauterine system in dysmenorrhea due to adenomyosis and the influence on ovarian function[J].Clin Exp Obstet Gynecol,2014,41(6):677-680.