围绝经期宫内节育器滞留对生殖健康的影响

Effect of intrauterine device retention on reproductive health during perimenopausal period

目的探讨围绝经期宫内节育器(IUD)滞留的安全性。方法采用分层整群随机抽样方法,对围绝经期IUD滞留妇女612例和围绝经期非IUD避孕538例进行生殖健康和围绝经期症状问卷调查及相应的健康检查,采用Logistic多元回归方法对围绝经期IUD组与IUD滞留相关因素进行分析。结果IUD组与非IUD组比较,IUD组可以降低月经周期不规则的发生比例,腰腹疼症状IUD组明显高于非IUD组,附件炎发生比例低于非IUD组,子宫肌瘤或肥大发生比例IUD组低于非IUD组,对经期和痛经的影响随着放置IUD的时间延长明显下降,差异均有统计学意义(P<0.05);不同种类IUD对月经周期、经期、经量和痛经的影响差异有统计学意义(P<0.05);2组经量、痛经和经期,围绝经期症状,阴道炎和宫颈糜烂发生比例,血红蛋白水平比较,差异无统计学意义(P>0.05);但不同IUD种类对围绝经期妇女的月经异常有一定影响。多因素分析显示,放置IUD不同年限对月经周期、经量无显著性影响(P>0.05)。结论围绝经期IUD滞留未增加月经改变、围绝经期症状、妇科疾病及贫血的发生,应对围绝经期妇女IUD种类的匹配情况做进一步研究。

Objective To investigate the safety of intrauterine device （IUD） retention during perimenopausal period. Methods A total of 612 women with IUD retention （IUD group） and 538 women who did not use IUD （non-IUD group） during perimenopausal period were selected by using a stratified cluster random sampling method. Health examinations were carried out on these women and a questionnaire was administered. The two groups were compared on a number of symptoms. Results Women in the IUD group had lower rate of irregular menstrual cycle （ P 〈 0. 05 ） compared with women in the non-IUD group. No differences were observed in prevalence rates of menorrhea, abnormal menstrual length and dysmenorrheal, and other perimenopausal symptoms between the two groups. However, lumbago and abdominal pain, nonannex inflammation and hysteromyoma, and metrauxe were more common in the IUD group than in the non- IUD group （ Ps 〈 0. 05）. There were no significant differences in vaginitis, cervical erosion, and hemoglobin level between the two groups. Differences were noted in symptoms during menstrual period among different types of IUD. Multivariate analyses showed that duration of IUD usage had no effect on menorrhea and menstrual cycle. Conclusion IUD retention during perimenopausal period does not increase the likelihood of menstrual changes, menopause symptoms, gynecological diseases and anemia. Further studies are need on the effect of different types of IUD.