醋酸甲孕酮致闭经的安全性研究

Evaluation of Safety in Chinese Women with Amenorrhea Following Injection of Depot medroxyprogesterone for Contraception

目的 确定醋酸甲孕酮（ＤＭＰＡ） 作为避孕针使用致闭经后是否会出现雌激素水平低落，以评价ＤＭＰＡ的安全性。方法 对４４ 例使用ＤＭＰＡ后闭经时间中位数（ Ｍ）为１８ 个月的妇女，进行病史询问、妇科检查、血清雌二醇（Ｅ２）和促卵泡激素（ＦＳＨ）测定及阴道细胞学检查。结果 所有对象在闭经后均未出现类似绝经期综合征的症状和生殖道萎缩；血清Ｅ２ 的Ｍ 为１５０．５ ｐｍｏｌ／Ｌ（ 相当于正常月经周期中卵泡早期水平） ，血清ＦＳＨ 的Ｍ为１４．０ＩＵ／Ｌ，两者之间无负相关关系，闭经时间长短与血清Ｅ２ 和ＦＳＨ水平之间也无相关性（ Ｐ＞ ０．０５）；雌激素与阴道细胞学影响的不同程度（轻、中、高度） 之间无相关性（ Ｐ＞ ０．０５） ，但与用药总量、末次注射药物距阴道细胞涂片时间的长短和是否停药，差异有极显著性（Ｐ＜０．０１）。结论 ＤＭＰＡ致闭经后没有表现出雌激素缺乏，且卵巢一定程度的抑制是可逆的。

Objective To determine whether serum estradiol (E 2) level was low after Depot medroxyprogesterone (DMPA) induced amenorrhea for contraception, thus to evaluate the safety of using DMPA. Methods Forty four chinese women with amenorrhea after injecting DMPA were investigated, and the median period of amenorrhea was 18 months. Syptoms, pelvic examination, serum E 2 and follicular stimulating hormone (FSH) levels, and vaginal cytology were examined. Results Women with amenorrhea had neither symptoms nor genital atrophy that similar to menopausal syndrome. The median level of serum E 2 was 150.5 pmol/L (equal to the level of early follicular phase), and the median level of serum FSH was 14.0 IU/L. There were no correlation between E 2 and FSH levels, and no correlation between amenorrhea period and E 2 or FSH levels ( P >0.05) as well. No significant relationship between estrogen effects by vaginal cytology and the time period of amenorrhea was found. However, the estrogen effect was significantly correlated to the interval from last injection to vaginal smear tested. Conclusion It could be concluded that though DMPA may induce amenorrhea, it will not lower serum E 2 levels, and the inhibition of ovarian function is reversible.