围绝经期及绝经期妇女取环的临床观察及体会

Survey on the Intrauterine Devices Removed from the Women in Perimenopausal and Menopausal Period

目的探讨影响围绝经期及绝经期妇女取环困难度的相关因素及有效方法。方法对235例要求取环的围绝经期及绝经期妇女行取环术,对个人基本情况、取环过程及结局进行观察,分析患者年龄、绝经年限、宫颈萎缩程度、置环年限、文化程度、工作情况、居住环境、体检情况、妊娠史及流产史与取环困难度的关系。结果患者年龄、绝经年限、重度宫颈萎缩与取环困难度呈正相关(P<0.05);无稳定工作、未定期体检者取环困难率高于有稳定工作、定期体检者(P<0.01);置环年限≥20年者取环困难率高于置环年限<20年者(P<0.05)。结论绝经期妇女应尽早取环,最好围绝经期妇女症状稳定后即取环;对于宫颈萎缩严重、组织坚硬的妇女,可用米非司酮与米索前列醇软化宫颈,降低取环难度;做好宣教工作,普及节育环相关知识,督促妇女定期体检。

Objective To investigate the factors for the difficulty of removing intrauterine devices （IUD） among women in perimenopausal and menopausal period. Methods The IUDs were removed among 235 women in perimenopausal and menopausal period. The general data, removing process and results were observed. The correlation among the difficulty of IUD re- moving, the patients＇ age, menopause time, the degree of cervical atrophy, IUD placing time, education level, working condi- tion, living environment, health examination, gravidity and abortion was analyzed. Results Patients＇ age, menopause time and severe cervical atrophy were positively correlated with the difficulty of removing IUDs （ P 〈 0.05 ） . Patients who had no stable work and no regular health examination had more difficulty in removing IUDs （P 〈 0. 01 ） . Patients who placed IUDs I〉20 years had more difficulty in removing IUDs compared with those who placed IUDs 〈 20 years （ P 〈 0. 05 ） . Conclusion The IUDs of menopausal period women should be removed as early as possible. The IUDs of perimenopausal period women should be removed after stabilization of symptoms. Mifepristone and misoprostol can be used to soften cervix for those who had severe cervical atrophy and hard tissues. Propaganda and education should be emphasized and women should be supervised to take regular health examina- tions.