Concentration Changes of Medroxyprogesterone Acetate in Serum and Milk in Lactating Woman Who Used Depo Geston~

Objective To determine the concentration changes of medroxyprogesterone acetate （MPA） in serum and milk in the Chinese lactating women who used Depo Geston Methods Ten postpartum and breastfeeding women received an injectable contraceptive of Depo Geston （depo medroxyprogesterone acetate, DMPA, 150 mg/ampoule）. Serum and milk samples were collected in the 1^st, 2^st, 4^th, 6^th, 8^th 10^th and 12^th week after contraceptive injection. The concentrations of medroxyprogesterone acetate （MPA） in serum and milk were determined by radioimmunoassay. Results The highest MPA concentration in serum was observed at the 1^st week and then the level of serum MPA decreased obviously at the 2^na and 4^th week. After the 4^th week, the decline of serum MPA level slowed down. The concentration of milk MPA reached the highest level at 1^th week. But at the 2^nd week the average level of MPA in milk dropped by half The MPA concentration in the milk was changed in the range of 5.2-8.3 ng/mL in the following 10 weeks. During observation, the average ratios of concentration and area under curve （AUC） in milk/serum were both 0.55. There was a wide variation in MPA concentrations and ratios of milk/serum between subjects. Conclusion MPA concentrations maintained a certaim level at the 12^th week after DMPA injection. However, whether mather＇s intake of DMPA during feeding period has effect on children＇s growth, espcially pubertal growth, deserves further studies.

Effect of Depot Medroxyprogesterone Acetate (DMPA) on Bone Mineral Density in Women of Reproductive Age

Objective To compare bone mineral density （BMD） between users of intramuscular depot medroxyprogesterone acetate（DMPA ） and nonhormonal control subjects. Methods The study included 68 women aged between 25 and 40 years using depot medroxyprogesterone acetate for 24 months and 59 women aged between 25 and 40 years using nonhormonal contraception as control subjects. BMD of the lumbar spine and femoral neck were obtained using dual energy X-ray absorptiometry. Results At 24 months of treatment, as compared with baseline, the mean BMD in lumbar spine and femoral neck was decreased by 5.5% and 5.9%, respectively. Lumbar spine and femoral neck BMD in women who used DMPA were significantly decreased compared with the subjects in nonuser （P〈0.001）. Conclusion These results show BMD declined during using DMPA in women aged 25 -40 years old.

Effect of depot medroxyprogesterone acetate(DMPA) on bone mineral density(BMD) and evaluating changes in BMD after discontinuation of DMPA in adolescent women

Objective To compare bone mineral density （BMD） between users of intramuscular depot medroxyprogesterone acetate （DMPA） and nonhormonal subjects and evaluated the changes in BMD after discontinuation of DMPA.Methods The study included 102 women aged 16-18 years using DMPA for 24 months and 97 same-age nonusers. BMD of the lumbar spine and femoral neck were measured using dual-energy X-ray absorptiometry. The mean BMD values were compared between DMPA users （DMPA group） and nonusers （control group） and the changes of BMD during 36 months after discontinuation of DMPA were observed.Results Mean BMD at the spine and femoral neck did not differ significantly between DMPA group and control group over 12 months, but the BMD values at both anatomical sites were significantly lower in DMPA group than in control group after 24 months treatment. After DMPA discontinuation, the mean BMD values in DMPA users increased substantially. At 24 months after DMPA discontinuation, there were no significant differences between DMPA group and control group. But the values of the lumbar spine and femoral neck BMD in DMPA group were still 1.70% and 1.87%, respectively, below nonusers at 36 months after DMPA discontinuation.Conclusion The use of DMPA for short-term （ ≤12 months） had no significant effects on BMD at spine and femoral neck, but long-term exposure to DMPA had significant loss in BMD in adolescents. Bone loss occurring with DMPA use is reversible after DMPA discontinuation.

Changes in bone mineral density among women aged 19-24 years using injectable contraceptive depot medroxyprogesterone acetate

Objective To compare bone mineral density （BMD） between users of intramuscular depot medroxyprogesterone acetate （DMPA） and nonhormonal control subjects. Methods The study included 87 women aged between 19 and 24 years using DMPA （DMPA group）for 24 months and 83 same-age women using nonhormonal contraception as control group. BMD of the lumbar spine and femoral neck were measured using dual-energy X-ray absorptiometry, comparing mean BMD changes in DMPA group with the control. Results After 24 months of DMPA treatment, as compared ~ith baseline, the mean BMD in lumbar spine and femoral neck were decreased by 2.67% and 2.71%, respectively. The mean lumbar spine and femoral neck BMD in DMPA group at 24 months were not significantly different compared with baseline （P=0. 080 and P=0. 076, respectively）. In comparison, in control group, there was a trend toward increasing BMD. After 24 months of observation, the mean percentage changes from baseline in lumbar spine and femoral neck BMD were increased by 1.24% and 1.30%, respectively. There was no significantly difference compared with baseline （P=0. 436 and P=0.373, respectively）. Mean BMD at the spine and femoral neck did not differ significantly between DMPA users and nonusers over 12 months （P=0.153 and P=0.140, respectively）, but the BMD at both anatomical sites was significantly lower in DMPA group than in the control after 24 months of treatment （P=0.012 and P=0.008, respectively）. Conclusion The use of DMPA for short-term （≤12-month） had no significant effects on BMD at spine and femoral neck, but long-term exposure to DMPA had significant loss in BMD in women aged between 19 and 24 years.

Effect of depot medroxyprogesterone acetate on bone mineral density in adolescent women

Background Depot medroxyprogesterone acetate （DMPA） as a hormonal contraceptive is highly effective and widely used, but it may reduce bone mineral density （BMD） and increase the risk of osteoporosis. We compared BMD between users of intramuscular DMPA and nonhormonal subjects. Methods The study included 102 women aged between 16 and 18 years using DMPA for 24 months and 97 women aged between 16 and 18 years using nonhormonal contraception as nonusers control group. BMD of the lumbar spine and femoral neck was measured every 12 months for 24 months using dual-energy X-ray absorptiometry, comparing mean BMD changes in DMPA users and nonusers.

哺乳妇女单次注射迪波盖司通~长效避孕针后血清和乳液中MPA浓度变化

目的:探讨中国妇女哺乳期使用迪波盖司通后血清和乳液醋酸甲羟孕酮(MPA)浓度变化。方法:10名产后哺乳妇女单次注射迪波盖司通(含MPA150mg),在注射后的第1、2、4、6、8、10和12周采集血样和乳液样本,用放射免疫方法测定MPA。结果:血清MPA浓度于注射后第1周最高,到第2、4周时下降明显,第4周后浓度下降趋势逐渐缓慢。乳液MPA浓度在第1周为最高,第2周比第1周降低了约1/2,之后10周平均浓度变化波动在5.09-8.15ng/ml之间。观察期间乳液/血清MPA浓度比值和曲线下浓度面积比值均为0.55。对象之间和同一对象不同时间点乳液/血清MPA浓度存在明显个体差异。结论:哺乳期使用迪波盖司通,将导致血液和乳液中含有一定量的MPA。

卵巢子宫内膜异位囊肿的微创性诊断与治疗

目的探讨B超介导下囊肿穿刺术对卵巢子宫内膜异位囊肿(EMA)的诊断价值和术中囊内注入狄波普维拉(DMPA)维持治疗意义。方法对52例临床诊断为卵巢子宫内膜异位囊肿患者在B超下行囊肿穿刺术,观察囊液性状和并作涂片病理检查,对符合卵巢子宫内膜异位囊肿的患者,腔内注入DMPA,并进行随访。结果经穿刺术校正诊断7例,占13.46％。穿刺术使所有患者近期症状缓解,术中加用DMPA可使症状与体征复发率显著减低。对复发病例可行第二次穿刺术,或再加DMPA治疗仍能有效缓解痛经。DMPA的主要副作用可致阴道点滴状出血及停药后排卵恢复慢,用药组中近期无1例受孕。结论B超引导下的囊肿穿刺术,是对卵巢内膜异位囊肿的一种可行的微创性诊断与治疗方法,DMPA囊腔内给药和术后维持治疗能有效地控制症状和促使异位病灶萎缩。

89例子宫内膜异位症临床治疗效果观察

目的：探讨长效醋酸甲孕酮（DMPA）治疗子宫内膜异位症（EM）的临床疗效、安全性和副反应发生情况。方法：选取临床上确诊为EM的，并自愿使用DMPA治疗的患者共89例，均于月经周期第1～5天首次臀部深层肌肉注射DMPA 150mg，此后每间隔（90±7）天注射1次，半年为1疗程。每例患者必须治疗1～2个疗程。结果：用药前痛经发生率为92．1％，用药后痛经发生率下降为10．1％，且通经程度明显减轻；B超测得囊肿、结节病灶由用药前的（16．23±0．11）cm^2、（13．23±3．61）cm^2，分别缩小到（4．01±0．11）cm^2、（1．62±0．36）cm^2，经统计学分析，结果有显著性差异。内分泌测定卵泡刺激素、黄体生成激素、孕酮用药前后无显著性变化，E2用药前后虽有显著性变化，但均在卵泡早期水平；副反应主要为点滴出血、经期延长、闭经等月经问题。结论：DMPA治疗子宫内膜异位症临床效果明显、安全、副反应小、价格低廉。

肌注醋酸甲羟孕酮避孕对25～40岁妇女骨矿物质密度的影响

目的:探讨肌肉注射避孕药醋酸甲羟孕酮(DMPA)对骨矿物质密度的影响。方法:随机选择68例应用DMPA避孕的25～40岁女性,每3个月肌注DMPA1次,用药24个月;同时选择59例25～40岁从未应用激素避孕药的女性做为对照,应用双能X光线吸收法测量腰椎和股骨颈骨矿物质密度(BMD)。结果:用药组用药2年后腰椎和股骨颈平均BMD从基础值1.106±0.110g/cm2和0.913±0.100g/cm2下降到1.045±0.103g/cm2和0.855±0.100g/cm2,分别下降了5.5%和5.9%,与对照组相比明显降低(P<0.01)。结论:25～40岁女性肌注醋酸甲羟孕酮避孕导致骨矿物质密度降低。

长效醋酸甲羟孕酮对子宫内膜异位症大鼠疗效及副作用探讨

目的 建立实验用SD大鼠子宫内膜异位症模型,观察长效醋酸甲羟孕酮(depot medroxy progesterone acetate,DMPA)对子宫内膜异位症(endometriosis,EMs)大鼠的疗效,评估其对大鼠骨密度及骨代谢生化指标的影响,为指导临床用药提供参考.方法 建立大鼠EMs模型,将40只大鼠随机均分为4组,每组10只,A组为灭菌水对照组(灭菌水0.05 ml/kg×6.25),B组为DMPA低剂量组(0.025 ml/kg×6.25),C组为DMPA中剂量组(0.05 ml/kg×6.25),D组为DMPA高剂量组(0.1 ml/kg×6.25),观察治疗前后大鼠异位囊肿体积的变化以及大鼠股骨、腰椎及全身骨密度和血清骨生化代谢指标的改变.结果 ①异位囊肿体积变化:治疗后,各组EMs大鼠的异位囊肿体积较治疗前明显缩小,而A组异位囊肿体积无明显改变(tA=0.39,PA=0.71,tB=65.35,PB<0.05,tC=37.61,PC<0.05,tD=50.43,PD<0.05);②骨密度:仅D组大鼠腰椎骨密度(bone mineral density,BMD)较治疗前下降(PD<0.05);③血清骨代谢生化指标:A、B组Ⅰ 型胶原交联C-末端肽(C-terminal telopeptide of typeⅠcollagen,CTX-Ⅰ)、Ⅰ 型胶原交联N-末端肽(N-terminal telopeptide of typeⅠcollagen,NTX-Ⅰ)、Ⅰ 型前胶原氨基端前肽(procollagen typeⅠN-terminal peopeptide,PINP)、骨碱性磷酸酶(bone-alkaline phosphatase,BALP)较治疗前均无明显变化;C、D组骨吸收指标(CTX-Ⅰ、NTX-Ⅰ)较治疗前明显升高,骨形成标志物(PINP、BALP)较治疗前下降,差异均有统计学意义(tA-NTX-Ⅰ=-1.26,PA-NTX-Ⅰ=0.25;tB-NTX-Ⅰ=-1.96,PB-NTX-Ⅰ=0.091;tC-NTX-Ⅰ=-23.74,PC-NTX-Ⅰ<0.05;tD-NTX-Ⅰ=-18.49,PD-NTX-Ⅰ<0.05;tA-CTX-Ⅰ=-0.20,PA-CTX-Ⅰ=0.85;tB-CTX-Ⅰ=0.24,PB-CTX-Ⅰ=0.82;tC-CTX-Ⅰ=-4.05,PC-CTX-Ⅰ<0.05;tD-CTX-Ⅰ=-5.01,PD-CTX-Ⅰ<0.05);C、D组血清E2与骨代谢生化指标的相关性分析示:NTX-Ⅰ、CTX-Ⅰ 与血清E2浓度呈负相关(r=-0.51,-0.72;P<0.05);而PINP、BALP的表达与血清E2浓度呈正相关(r=0.69,0.63;P<0.05).结论 DMPA可抑制EMs大鼠异位内膜生长,使其呈增殖抑制或萎缩性改变对异位囊肿有一定的缩复作用;DMPA对EMs大鼠骨骼影响与血清E2低表达密切相关,血清E2对骨密度的影响可能存在"浓度阈值窗"效应,只有当中、高剂量DMPA导致血清E2浓度低于该阈值窗下限时,才会引起骨形成活性减弱,骨吸收活性增强,骨转换率增加;且DMPA使用剂量越大,血清E2浓度越低,骨转换率越高,骨量流失越快,BMD出现下降的时间越早.

The Use of Hormonal Contraceptives and Preeclampsia among Ghanaian Pregnant Women

Hormonal contraceptives (HC) are thought to play a role in the pathogenesis of cardiovascular diseases. The study evaluated the use of HC as a primary cause of preeclampsia (PE) among Ghanaians. This study comprised 30 preeclamptic women and 30 healthy normotensive pregnant women with over 20 weeks of gestation at the Comboni Hospital, Ghana using a randomized case-control study. Blood pressure, weight, height, socio-demographics, medical and previous obstetric history were taken and recorded. Blood samples were collected for the estimation of homocysteine and fasting lipids. Estimated foetal weight (EFW) and infant birthweight (BWT) were obtained from maternal records. This study was carried out in 2019. 80.0% of women with PE used the hormonal contraceptive “depot medroxyprogesterone acetate” (DMPA) prior to pregnancy. The use of DMPA was associated with about thirty-fold increase in the odds of developing PE (OR = 29.71, p < 0.001). Systolic blood pressure (P < 0.001), diastolic blood pressure (P < 0.001), triglycerides (P = 0.024), LDL-C (P = 0.026), and homocysteine levels (P < 0.001) were significantly elevated in the PE cases than the normal pregnant (NP) women, whilst EFW (P < 0.001), BWT (P < 0.001) and HDL-C levels (P = 0.001) were significantly reduced in the PE cases when compared to NP women. 50% and 47% of PE cases had intrauterine growth restriction and low birthweight infants, respectively. In conclusion, DMPA use predisposes women to a high risk of developing PE. DMPA could partly contribute to endothelial dysfunction, hyperhomocysteinaemia, dyslipidaemia and excessive weight gain, all of which characterize PE.

青春期女性应用孕激素避孕药对骨健康的影响

单纯孕激素避孕药醋酸甲羟基孕酮因高效、长效而被广泛应用,这种避孕方法 明显降低了青春期女性的妊娠率.但是,醋酸甲羟基孕酮也有许多副作用,尤其是对骨矿物质密度的影响,因此人们担心青春期女性应用醋酸甲羟基孕酮对骨健康产生不利影响.该文就近年来有关青春期女性应用醋酸甲羟基孕酮对骨矿物质密度影响的研究进行综述.

左炔诺孕酮宫内缓释系统与长效醋酸甲羟孕酮治疗子宫内膜异位症的临床疗效

目的:比较左炔诺孕酮宫内缓释系统(LNG-IUS)与长效醋酸甲羟孕酮(Depot-MPA)治疗子宫内膜异位症的临床疗效。方法:保守性手术后即刻或单纯疼痛复发后患者87例,42例放置LNG-IUS,45例在3年内每隔3个月肌注长效醋酸甲羟孕酮(Depot-MPA)150 mg,比较临床症状控制情况、复发率、依从性、骨密度。结果:两种治疗方案均能控制临床疼痛症状及复发率。LNG-IUS治疗组患者依从性优于长效醋酸甲羟孕酮治疗组。LNG-IUS治疗组腰椎及股骨颈Wards三角区骨密度(BMD)变化幅度比长效醋酸甲羟孕酮治疗组大。结论:LNG-IUS治疗组可以有效地控制子宫内症膜异位症的临床症状和复发率,患者依从性好,骨密度可以得到改善,而长效醋酸甲羟孕酮治疗组出现骨密度下降。

醋酸甲羟孕酮针剂在哺乳期妇女避孕中的应用

目的:寻求哺乳期妇女运用醋酸甲羟孕酮(DMPA)避孕的最佳投药剂量。方法:将受试对象分为DM-PA组和未使用DMPA的产后哺乳期妇女,排除不符合研究标准者,纳入研究对象共319例,DMPA150mg组83例,100mg组80例,75mg组81例,未使用DMPA组75例,DMPA组每3个月深部肌肉注射1次,共4次。结果:非DMPA组避孕成功率为80.00%,150mg与100mgDMPA组避孕成功率均为100.00%,75mg组成功率为98.77%,3个不同剂量DMPA组避孕成功率均显著高于非DMPA组(P<0.01),但3组间差别无统计学意义(P>0.05)。发生的副反应中,点滴出血75mg组为4.94%,明显低于150mg组的16.87%(P<0.05)和100mg组的10.00%(P<0.05)。结论:75mgDMPA用于哺乳期妇女避孕不影响其有效性,且可减少副反应发生率,可作为我国哺乳期妇女运用DMPA避孕的最佳投药剂量。

年轻女性应用醋酸甲羟孕酮避孕针避孕对骨矿物质密度的影响

目的 醋酸甲羟孕酮注射避孕药因使用简便、高效而广泛应用,但可降低骨矿物质密度,增加骨质疏松症风险,该文观察年龄19-24岁女性应用DMPA 24个月,与年龄类似非激素避孕妇女比较,评估DMPA对腰椎和股骨颈BMD的影响。方法 选择87例年龄19-24岁女性应用DMPA 24个月,83例年龄相仿女性应用非激素避孕作为对照组,应用双能X线吸收法检测腰椎和股骨颈BMD,每12个月检测1次,连续24个月,比较两组腰椎和股骨颈BMD的改变。结果 用药24个月,与基础值相比,腰椎和股骨颈BMD呈下降趋势,分别降低2.67%和2.71%,但无统计学差异（P=0.080和P=0.076）。而非激素避孕对照组腰椎和股骨颈BMD呈上升趋势,分别升高1.24%和1.30%,与基础值相比无统计学差异（P=0.436和P=0.373）。用药第1年,DMPA用药组与对照组相比,平均腰椎和股骨颈BMD值没有明显差异（P=0.153和P=0.140）;但用药第2年,两组BMD值有明显差异（P=0.012和P=0.008）。结论 年轻女性短期应用DMPA（〈12个月）对腰椎和股骨颈BMD没有明显不利影响,但长期应用对BMD有不利影响。