Combined Oral Contraceptive Use at the University of Port Harcourt Teaching Hospital, Port Harcourt, Southern Nigeria: A-20 Year Review

Background: While the combined oral contraceptive pill (COCP) is one of the most commonly used methods of birth control especially in the developed countries, robust and current information on the pill use in developing countries including Nigeria is at best lacking. Objectives: The study was conducted to determine the prevalence rate, efficacy and side effects of COCP at the University of Port Harcourt Teaching Hospital (UPTH), Port Harcourt, Southern Nigeria. Methods: It was a retrospective analysis of all clients who used the COCP between 1st January 1997 and 31st December, 2016, at the family planning clinic of UPTH Port Harcourt. Data on sociodemographic profile, side effects and source of information were extracted from the clients’ case notes coded and fed into Excel spread sheet and analysed. Results: Of the 8310 new acceptors of modern contraceptive methods in UPTH, 399 clients used the COCP, giving a prevalence rate of 4.8%. The mean age of the acceptors was 26.42 ± 4.27 years while the mean parity was 1.90 ± 0.36. Menstrual disruption was the most common complications with 78 episodes constituting 47.0% of all the complications. One unintended pregnancy occurred during the period of observation, giving a Pearl index of 0.01. Conclusion: The study showed that although COCP is very effective, readily available, safe and reliable method of fertility control, the acceptance rate is very low and the patronage rapidly declining and may therefore go into extinction as a family planning method in Port Harcourt, Southern, Nigeria.

DNG和COC用于卵巢子宫内膜异位囊肿剥除术后控制复发的疗效比较

目的比较地诺孕素(DNG)和复方口服避孕药(COC)用于卵巢子宫内膜异位囊肿剥除术后长期管理的疗效。方法选取2020年2月至2021年8月在湖北省妇幼保健院行腹腔镜卵巢子宫内膜异位囊肿剥除术的58例患者作为研究对象,术后给予促性腺激素释放激素激动剂(GnRH-a)治疗3个月。采用随机数字表法将研究对象分为DNG组(n=28)和COC组(n=30),分别服用DNG和COC 12个月。比较两组痛经视觉模拟评分法(VAS)评分、血清糖类抗原125(CA125)、雌二醇(E_(2))、抗米勒管激素(AMH)、囊肿复发情况、月经模式、骨密度(BMD)、不良反应及成本-效果比(C/E)。结果两组痛经VAS评分、CA125、AMH比较,差异无统计学意义(P>0.05);DNG组E_(2)、股骨及腰椎BMD高于COC组(P<0.05);两组均无囊肿复发;两组不良反应总发生率比较,差异无统计学意义(P>0.05);COC组C/E低于DNG组(P<0.05)。结论DNG控制卵巢子宫内膜异位囊肿剥除术后复发的效果与COC相当,但对BMD和E_(2)的影响可能小于COC,但价格高于COC。

25岁以下未育女性人工流产后即时落实宫内节育器和短效口服避孕药的临床对照观察

目的:观察25岁以下未育女性人工流产后即时放置宫内节育器(IUD)和使用短效复方口服避孕药(COC)的可行性和使用情况。方法:将≤25岁未育早孕自愿要求人工流产的女性作为观察对象,根据其意愿术后放置IUD或使用COC避孕。IUD组148例,COC组204例,随访6个月观察两组的避孕情况。结果:两组均无妊娠发生。IUD组1例因完全脱落而终止使用,终止率为0.7%。COC组术后3月的累积停用率69.1%,6月达92.1%,停用的主要原因是嫌麻烦/不能坚持服药,占31.4%。术后1,3个月的不适主诉率IUD组高于COC组(P<0.010,P<0.001)。结论:≤25岁未育女性人工流产后即时放置IUD或使用COC避孕均可行高效。IUD组6个月续用率高;COC副作用轻,但需加强咨询,提高续用率。

利用两样本孟德尔随机化方法探究复方口服避孕药与乳腺癌发病风险的关系

目的:利用两样本孟德尔随机化方法探究评估抗复方口服避孕药(combined oral contraceptive,COC)对乳腺癌风险的影响。方法:对基于与COC高度相关的单核苷酸多态性的全基因组关联研究的合并数据进行二次数据分析,并选择雌激素和孕激素水平作为工具变量,分别采用逆方差加权、MR-Egger回归和加权中位数方法进行两样本孟德尔随机化分析,以评估COC、雌激素及孕激素与乳腺癌和ER^(+)/ER^(-)乳腺癌之间的关联。我们分别采用逆方差加权、MR-Egger回归和加权中位数方法进行两样本孟德尔随机化分析。最后进行敏感性分析来评估结果的稳定性和可靠性。结果:逆方差加权、MR-Egger回归和加权中位数方法三种方法均显示COC的使用与乳腺癌(包括ER^(+)/ER^(-)乳腺癌)的发生无显著风险关联(P均>0.05)。结论:孟德尔随机化结果显示COC的使用与乳腺癌发病风险之间无关。

妇产科医生对复方短效口服避孕药的雌激素剂量和服药方案的认知调查研究

目的了解当前我国妇产科医生对不同种类复方短效口服避孕药(COC)服药方案及其雌激素剂量的认识和适应症应用情况,以期为临床个体化用药决策提供参考。方法2022年8月至12月在全国20个省、自治区、直辖市的155家医院邀请妇产科医生进行问卷调查,了解其对国内目前五种常用COC的雌激素剂量和服药方案的认知及适应症应用情况。采用卡方检验、Bonferroni法、Crame' s V系数、雷达图等方法对数据进行统计分析及归纳总结。结果向653名妇产科医生发放调查问卷,回收有效问卷650份,回收率99.54%。妇产科医生对国内目前五种常用COC的知晓率差别较大,其中以屈螺酮炔雌醇片(Ⅱ)(20μg/片,87.69%;24/4方案,84.77%)知晓率最高,去氧孕烯炔雌醇片(20μg/片,45.69%;21/7方案,83.54%)最低。对于治疗痤疮、经前焦虑障碍、易怒、抑郁、经前综合征、多毛症和多囊卵巢综合征,28.77%~31.69%的妇产科医生选择24/4方案,37.54%~47.85%的妇产科医生选择雌激素剂量20μg/片的COC;其中对改善易怒症状(χ^(2)=9.403,P=0.009)方面,硕士及以上妇产科医生选择选择24/4方案的比例高于本科及以下学历者,差异有统计学意义。在改善月经周期规律性、治疗月经过多、经期周期控制效果方面,49.38%~50.00%的妇产科医生选择两方案效果相似,44.46%~56.31%的妇产科医生选择两剂量效果相似;其中在改善月经周期规律性(χ^(2)=8.402,P=0.015)和治疗月经过多(χ^(2)=6.451,P=0.040)方面,选择两剂量相似的副主任医师及以上的比例高于主治医师及以下者,差异均有统计学意义。妇产科医生对不同雌激素剂量和服药方案的选择呈弱相关(0.2<Cramer's V<0.3,P<0.05)。结论国内妇产科医生对不同COC的知晓率参差不齐,普遍存在对COC的作用机制认知不足。鉴于COC应用的广泛性,建议对妇产科医生加强COC药物作用机制的相关培训,了解雌孕激素剂量、种类与服药方案的关系,准确掌握适应症,以期更好地提供个体化推荐用药。

屈螺酮炔雌醇致青年女性罕见部位静脉血栓形成一例

1病例资料患者女性,20岁,因“阵发性右下腹疼痛2 d”于2022年12月2日就诊于我院急诊。查体无肌紧张、压痛、反跳痛,急诊行腹部CT示:十二指肠水平段腔内可见囊样低密度,考虑为未消化食团,暂临床观察。后因症状未缓解,进一步检查全腹增强CT(图1A)示:“下腔静脉及双侧肾静脉内血栓形成、同时提示右下肺动脉栓塞”。急诊以“急性肺血栓栓塞症”收入我科。

Comparison of Drospirenone-with Cyproterone Acetate-Containing Oral Contraceptives, Combined with Metformin and Lifestyle Modifications in Women with Polycystic Ovary Syndrome and Metabolic Disorders： A Prospective Randomized Control Trial

Background：While combined oral contraceptives （COCs） are commonly used to treat polycystic ovary syndrome （PCOS）,comparative data regarding metabolic effects of different progestogens on this patient population are missing.This study aimed to compare the different effects of drospirenone （DRP）-containing COCs with cyproterone acetate （CPA）-containing COCs,combined with metformin and lifestyle modifications in women with PCOS and metabolic disorders.Methods：Ninety-nine women with PCOS and a metabolic disorder between January 2011 and January 2013 were enrolled into this prospective randomized clinical trial.Participants were randomized into two groups such as DRP-containing COCs,and CPA-containing COCs.Participants took COCs cyclically for 6 months,combined with metformin administration （1.5 g/d） and lifestyle modifications （diet and exercise）.Clinical measures and biochemical and hormone profiles were compared.Comparisons for continuous variables were evaluated with paired and unpaired Student＆#39;s t-tests.The Wilcoxon signed rank test was used when the data were not normally distributed.Analysis of covariance was used to control for age,body mass index （BMI）,and baseline data of each analyzed parameter when compared between the two groups.Results：A total of 68 patients have completed the study.The combination regimen of COCs,metformin,and lifestyle modifications in these patients resulted in a significant decrease in BMI,acne,and hirsutism scores when compared to baseline levels in both groups （P 〈 0.05）.Blood pressure （BP） was significantly different in the CPA group when compared to baseline （75.14 ± 6.77 mmHg vs.80.70 ± 5.60 mmHg,P 〈 0.01）,and after 6 months of treatment,only the change in systolic BP was significantly different between the two groups （4.00 [-6.00,13.00] mmHg vs.-3.50 [-13.00,9.00] mmHg,P =0.009）.Fasting glucose,fasting insulin,and homeostasis model assessment-insulin resistance decreased significantly in the DRP group （5.40 ± 0.41 mmol/L vs.5.21 ± 0.32 mmol/L,P =0.041;13.90 [10.50,18.40] μU/ml vs.10.75 [8.60,13.50] μU/ml,P =0.020;3.74 [2.85,4.23] vs.2.55 [1.92,3.40],P =0.008） but did not differ between the two groups.While individual lipid profiles increased in both groups,no statistically significant difference was observed.Conclusions：DRP-containing COCs combined with metformin and lifestyle modifications could better control BP and correct carbohydrate metabolism in women with PCOS and metabolic disorders compared with CPA-containing COCs.

2021-2022年妇产科医生复方短效口服避孕药处方知信行网络调查

目的:了解妇产科医生对复方短效口服避孕药(COC)的认知、态度和行为,为我国COC的应用和推广提供参考。方法:2021年6月-2022年4月,经全国计划生育工作网络招募调查对象,在全国21个省份招募自愿参加的妇产科医生为研究对象,用自制问卷进行线上调查。问卷内容主要包括调查对象基本信息和COC知信行情况。采用潜在类别分析、Cochran-Mantel-Haenszel检验、两水平二分类logistic回归分析等方法对数据进行统计分析。结果:共发出1600份调查问卷,回收有效问卷1450份,回收率90.63%。调查对象的COC总体认知得分集中趋势为[73.2(60.6,80.3),COC]优缺点、作用机制、禁忌证和非避孕应用的认知得分依次为[72.9(52.1,77.1)]、[80.0(80.0,100.0)]、[77.8(66.7,88.9)]、[88.9(77.8,100.0)]。针对COC应用的态度,阻碍因素中“老百姓对COC不了解”(85.2%)和“增加静脉血栓等心血管疾病风险”(75.5%)占比较高,促进因素中“对象有避孕需求且无禁忌证”(89.9%)、“对象有治疗需求且无禁忌证”(86.9%)和“对象不适合上环”(84.9%)占比较高。两水平二分类logistic回归分析显示,COC知识掌握较好(OR=1.74,95%CI 1.25~2.44)、高推荐意愿(OR=4.33,95%CI 2.77~6.76)的妇产科医生在临床实践中推荐COC用于避孕需求的频率较高。结论:我国妇产科医生对COC的认知、态度存在不足,并影响其对COC的临床实践行为。建议加强对妇产科医生避孕药具知识的培训,以为服务对象提供高质量的避孕咨询和指导服务。

Effect of Two Kinds of Different Combined Oral Contraceptives Used on Bone Mineral Density in Women of Reproductive Age

Objective To compare bone mineral density （BMD） among users of ethinylestradiol/ desogestrel, ethinylestradiol/cyproterone acetate and nonhormonal control subjects. Methods The study included 154 women aged 25-40 years. Forty-six women were using ethinylestradiol/desogestrel （group A） and 55 women using ethinylestradiol/cyproterone acetate （group B）for 24 months and 53 women using nonhormonal contraception as control subjects （group C）. BMD of the lumbar spine and femoral neck were obtained using dual energy X-ray absorptiometry, comparing mean BMD changes in combined oral contraceptives （COCs） users with nonusers. Results For 24 months of treatment, lumbar spine and femoral neck BMD values in women who used ethinylestradiol/desogestrel and ethinylestradiol/cyproterone acetate were not significantly different compared with the baseline and the values of subjects in nonuser （P〉0.05）. Conclusion There was no statistical difference in BMD between the users of ethinylestradiol/desogestrel or ethinylestradiol/cyproterone acetate and nonusers.

Effect of Combined Oral Contraceptive Use on Bone Mineral Density in Adolescent Females

Objective To compare adolescents＇ bone mineral density （BMD） between users of combined oral contraceptive （Marvelon, desogestrel/ethinylestradiol） and no.nhormonal control subjects. Methods The study included 127 women who aged between 16 and 18 years using Marvelon for 24 months and 115 women who aged between 16 and 18 years using nonhormonal contraception as control subjects. BMD of the lumbar spine and femoral neck were obtained using dual energy X-ray absorptiometry. Results After 24 months of Marvelon use, as compared with baseline, the mean BMD in lumbar spine and femoral neck were decreased by 0.30% and 0.61%, respectively. While in the nonusers group, the mean BMD were increased by 1.88% and 1.10%, respectively. Lumbar spine and femoral neck BMD in women who used Marvelon were not significantly different compared with the subjects who used nonhormonal contra- ception （P〉0. 05）. Conclusion Two years of Marvelon use had no significant effect on BMD, but it remains unknown whether longer than 2 years of use has a significant adverse effect on the attainment of peak bone mass.

Post-marketing Surveillance for Combined Oral Contraceptive Containing Desogestrel(Marvelon~) in Chinese Rural Areas

To assess the side effects and the continuation rate of combined oral contraceptive （COC） containing desogestrel （Marvelon） during 12 months. Methods This was a post-marketing surveillance study on Marvelon COC among 870 healthy rural women in 5 different counties of Jiangsu Province during 12 months. Results About 24.02% of the women who used Marvelon COC experienced side effects during 12 months. Gastrointestinal disorder, bleeding/spotting and chloasma were ranked the first three in the side effects. The rate of side effects of Marvelon COC users during the first 3 months in southern area of Jiangsu was significantly higher than that of users in northern area of Jiangsu. Most of the users did not experience obvious weight changes i.e., loss or increase in weight of more than 5 kg during 12 months. Blood pressure and biochemical indicators of almost 99% among users were within the normal range. The gross cumulative continuation rate for 12 months was 83.14%; the most common medical reason for discontinuation was gastrointestinal disorder. There was an increased risk of discontinuation use among women with lower educational level. Conclusion Marvelon COC brought fewer side effects and was well accepted when applied in Chinese rural women.

口服避孕药后脑静脉血栓形成伴出血性脑梗死1例

患者女,28岁,无明显诱因出现头痛伴恶心、呕吐3天;2年前于外院诊断为“多囊卵巢综合征”,后自行口服达英-351次/日至今。查体:精神状态稍差。实验室检查:D-二聚体1.31μg/ml,纤维蛋白原4.16g/L,部分凝血酶原时间25.60s。头颅CT:右颞叶见大片状不均匀低密度影,内见多发结节状及小斑片状稍高密度影,CT值39~50HU。

上海市普陀区妇婴保健院门诊复方口服避孕药使用分析与现状思考

目的:调查分析上海市普陀区妇婴保健院门诊复方口服避孕药(combined oral contraceptives,COCs)的使用情况,为促进COCs的合理用药提供依据。方法:通过普陀区妇婴保健院信息系统选取于2022年1月1日—12月31日使用过COCs的所有门诊处方,排除未收费和退药的处方,共1027张,收集其使用者的年龄、主要临床诊断、用药品种和用法用量等信息,对相关信息进行汇总、筛选和分析。结果:1027张COCs门诊处方中,使用者年龄最小为11岁,最大为55岁,20~39岁是COCs的主要使用年龄段,有841名(81.9%)。1027条COCs用药记录中,排名前3位的临床诊断分别为异常子宫出血、多囊卵巢综合征和子宫内膜异位症,均为非避孕用途,临床诊断为女性避孕的COCs用药记录仅有46条(4.5%)。炔雌醇环丙孕酮片最常使用于治疗多囊卵巢综合征,屈螺酮炔雌醇片最常使用于治疗异常子宫出血,2种COCs在普陀区妇婴保健院的临床使用差异具有统计学意义(P<0.001)。结论:普陀区妇婴保健院的COCs使用未见明显不合理问题,使用者多为育龄期女性,以治疗妇科内分泌疾病为主,单纯用于避孕的使用者较少。

浅谈人工流产后立即应用复方口服避孕药的临床研究

目的探究人工流产后立即应用复方口服避孕药的临床效果。方法选取120例人工流产患者,根据随机数字表法分为试验组与对照组,各60例。对照组仅服用常规抗生素及缩宫药物治疗,试验组在对照组基础上增加复方口服避孕药治疗。比较两组临床效果。结果试验组术后出血时间、月经复潮时间均短于对照组,术后出血总量少于对照组,子宫内膜厚度厚于对照组(P<0.05)。试验组并发症发生率为3.33%,低于对照组的15.00%,差异有统计学意义(P<0.05)。护理前,两组焦虑、抑郁、愤怒、孤独心理状态评分比较差异无统计学意义(P>0.05);护理后,两组焦虑、抑郁、愤怒、孤独心理状态评分均低于护理前,且试验组低于对照组,差异有统计学意义(P<0.05)。结论人工流产后立即服用复方口服避孕药,可达到优化康复指标、降低并发症发生率、改善患者心理状态的效果,值得推广。

Comparison of Risks of Thromboembolism of Drospirenone-Containing and Nondrospirenone -Containing Combined Oral Contraceptive Use: A Meta-Analysis

This study aimed to estimate the risk of venous thromboembolism(VTE),arterial thromboembolism(ATE),and other side effects following the use of drospirenone(DRSP)-containing combined oral contraceptives(COCs).When compared with non-DRSP-containing COCs,DRSP-containing COCs decreased the risk of VTE by 15%in the overall study population,although this was not statistically significant(adjusted hazard ratio/risk ratio[95%confidence interval]0.85[0.69,1.04]).DRSP-containing COCs also showed significant benefits in terms of ATE risk.The body mass index of the subjects significantly decreased by 0.64 kg/m^(2) after taking the DRSP-containing COCs for 6 months.We concluded that DRSP-containing COCs were safe for use and could be broadly recommended.

妈富隆复方口服避孕药的使用对江苏农村地区已婚育龄妇女生活质量的影响

目的:评价妈富隆复方口服避孕药(简称妈富隆)的使用对江苏省农村地区已婚育龄妇女生活质量的影响。方法:采用自填式问卷前瞻性调查772例首次使用妈富隆妇女使用前后生活质量变化。结果:①使用妈富隆后妇女的生活质量问卷总分和身体健康、情绪、劳动/工作/学习、生活状态、想象力、总体身心愉悦状况和总体满意程度等项目的评分较使用前均显著提高(P<0.05);②生活质量问卷总分≥57的妇女所占比例在使用妈富隆前后分别为11.50%和11.79%,总分≤45的妇女比例由使用前9.09%上升到使用后的11.65%;③多元线性回归分析显示,位于苏南地区(系数=-1.02,95%CI:-1.84,-0.19)和发生副反应(系数=-1.45,95%CI:-2.38,-0.53)不利于使用妈富隆后妇女的生活质量改善。结论:妈富隆的使用有利于江苏省农村地区已婚育龄妇女生活质量改善,总体改善效果低于发达国家。

宫腔镜子宫内膜息肉切除术后口服避孕药或放置左炔诺孕酮宫内缓释系统对预防复发的作用

目的探讨子宫内膜息肉宫腔镜手术后口服避孕药或放置左炔诺孕酮宫内缓释系统(曼月乐)对预防复发的效果。方法 2009年1月～2011年10月门诊宫腔镜子宫内膜息肉切除术且病理证实为子宫内膜息肉116例,由患者知情选择术后处理方法。34例宫腔镜手术后1个月开始应用复方短效口服避孕药12个月(避孕药组),39例宫腔镜术后1个月放置曼月乐(曼月乐组),43例仅行宫腔镜手术切除息肉(对照组)。术后3、6、12个月随访,比较3组复发率,以及月经和血红蛋白情况。结果术后均完成12个月随访。复发率避孕药组2.9%(1/34),曼月乐组2.6%(1/39),对照组18.6%(8/43),3组间复发率差异有显著性(χ2=8.649,P=0.013),对照组复发率是另外2组的6倍。术后3、6、12个月避孕药组和曼月乐组月经量少的构成比均明显高于对照组(P=0.000)。术后12个月避孕药组和曼月乐组血红蛋白明显高于对照组(P<0.05)。结论宫腔镜术后应用复方短效口服避孕药或左炔诺孕酮宫内缓释系统可以降低子宫内膜息肉复发率,不良反应轻,创伤小,值得临床推广。

放置曼月乐环和口服避孕药治疗子宫腺肌病的疗效对比观察

目的对比放置曼月乐环和低剂量复方口服避孕药(COC)治疗子宫腺肌病患者疼痛和月经过多的临床效果。方法 62例主诉疼痛和月经过多的子宫腺肌病患者随机分为曼月乐环组和COC组。采用视觉模拟评分法(visual analogue scale,VAS)评估疼痛程度,用月经日记评估月经血量和超声检查估计子宫体积的变化。对比两组患者治疗6个月前后的疼痛程度、月经量和子宫体积的变化情况。结果两种方法治疗6个月后,疼痛均明显减轻,而且曼月乐环组与COC组相比效果更为明显(P<0.01);两种治疗方法均显著减少子宫出血量,子宫体积明显缩小,且曼月乐环组比COC组显著(P<0.01)。结论曼月乐环和COC用于子宫腺肌病的治疗,均能减轻相关疼痛及减少月经出血量,放置曼月乐环比口服COC疗效更好。

屈螺酮炔雌醇片(Ⅱ)的临床应用观察

目的评估屈螺酮炔雌醇片(YAZ)服药后出血模式、月经周期控制、药物不良反应和避孕效果。方法本研究为开放标签、单组Ⅳ期临床药物试验,2017年2月至2018年2月共50例22~41岁要求避孕的健康妇女服用YAZ 6个周期,在服药第1、4、6周期后进行随访。观察意外妊娠数、周期控制、出血模式、药物不良反应,以及痛经、痤疮的变化情况;以Pearl指数(PI)评价避孕的有效性。结果 47例受试者完成了6个周期的观察,无1例妊娠。出血/点滴出血平均天数随服药时间的延长逐渐下降,从第1服药周期的(7.66±5.27)d下降至第6服药周期的(4.85±1.83)d(P=0.035);从服药第2周期至第6周期,撤退性出血的发生率从95.74%(45/47)下降至91.48%(43/47),95.0%以上撤退性出血为正常出血、少量出血和点滴出血,发生撤退性出血的平均周期天数与服用药物前平均月经周期天数无显著改变[(27.02±6.89)d vs.(28.65±3.94)d,P>0.05];痛经和中度痤疮缓解程度均在50%以上。治疗中出现不良事件者24例,主要为头痛、皮疹、鼻咽炎和眼炎、阴道出血、潮热。结论 YAZ有良好的避孕效果,出血模式接近于正常周期,周期控制良好,对于缓解痛经和面部痤疮也有效果。

天津市妇产科医务人员对复方口服避孕药的KAP研究

目的了解天津市妇产科医务人员对复方口服避孕药(COCs)的知识、态度和行为(KAP)现状,为制定有效的干预措施提供参考依据。方法分层整群随机抽样方法抽取天津市各级医疗机构的妇产科医务人员382例,采用自填式复方口服避孕药KAP问卷进行调查,调查内容包括:一般情况、COCs知识知晓情况、COCs相关态度、提供COCs咨询服务的情况、COCs处方行为及相关知识培训需求等。结果被调查者对COCs的适应证、非避孕益处、与癌症及出生缺陷关系等知晓程度较低。医生的COCs知识得分高于护士;职称和学历越高,知识得分越高。90.11%的被调查者认为加强漏服后指导有助于减少漏服造成的妊娠;加强对COCs误解的解释工作(81.04%)和加强对COCs不良反应的处理和随访(62.09%)有助于减少停服。仅25.82%的被调查者能提供详细的COCs咨询服务;42.96%的妇产科医生拒绝为以避孕为目的的40岁以上女性开具COCs;93.13%的医务人员有相关知识培训需求。结论今后应通过一系列干预措施加强妇产科医务人员的COCs知识培训,改善COCs相关态度和行为,使其能为广大育龄女性和COCs适应证患者提供更加全面、正确的COCs咨询和医疗服务。