绝经后宫内节育器去留的安全性研究

The Safety of IUD in Situ after Menopause

自１９６０年全国推广宫内节育器（ＩＵＤ）至今己有千万妇女进入绝经期，绝经后ＩＵＤ应予取出，但因种种因素尚有相当比例绝经后妇女并未取出ＩＵＤ。作为异物的ＩＵＤ长期不取是否安全？尚未报道。本研究调查了普查对象中绝经后妇女２６５８例，其中未取ＩＵＤ者３０２例（ＩＵＤ组）和无ＩＵＤ妇女２５４例进行比较。通过病史询问和妇科检查结果提示：１．绝经后未取ＩＵＤ者平均绝经年龄为４９．７３岁，明显高于对照组（４８．９９）；子宫明显萎缩者与对照组相似；对健康情况无明显影响；患病史中ＩＵＤ组明显低于对照组。２．通过２７６例宫腔分泌物直接涂片检查，白细胞和细菌计数与对照组相似。３．１２８例同时取出ＩＵＤ，取器困难率于绝经＜２年者为５％，≥２年者１８％～３５％。根据本研究结果，绝经后未取ＩＵＤ者未见明显的危害性，但建议有条件取器者应在１年内取器，如绝经２年以上遇有取器困难而临床又无症状，不宜强行取器，以免造成严重创伤，可严密随访。

Millions upon millions of women with IUD in situ have entered their menopause stage since the promotion of IUD in our country in 1960.It is no longer necessary for menopause women to retain their IUDs.Nevertheless,due to various reasons there are still considerable ratio of the broad masses of the women who still haven't had their IUDs removed. Is it safe for women after menopause with IUD in the uterus for long duration?This study was carried out during mass gynecological screening in 12 townships of Shanghai.Among 2658 post menopausal women,302 cases still had their IUDs in situ(IUD group)and 254 cases bad no IUDs(eontrol group).The histories and pelvic examination in menopause women revealed the following results(1)The mean age of menopause in IUD group was 49.73±3.70,significantly higher than that in the control group(48.99±3.93). Gynecological exams showed similar percentage of significant atrophy of uterus in both groups.Postmenopausal retention of IUD had no significant effect upon health.The morbidity of pelvic diseases showed signifieantly a lower rate in the IUD group than that in the control.(2)276 cases of examinations of uterine secretion showed that the WBO and baeteria counts in IUD group were similar to the control.(3)128 cases of postmenopausal IUD were removed.The percentage of difficulty in reachal were around 5% in women with menopause<2 years,and 18-35% in women>2 years.No signifieant harm had yet been found in those postmenopausal IUD retainers in this study. Therefore,it is suggeeted that if condition permits,the optimal time for postmenopausal removals will be within one year.IUD may be retained in those women whose menopausal durations are over 2 years with difficulty in IUD removal,but without any clinical symptoms.The wearers should be under close observation and follow-ups.