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Hormonal contraception in women with polycystic ovary syndrome: choices, challenges, and noncontraceptive benefits. 多囊卵巢综合征妇女的激素避孕:选择、挑战和非避孕益处。
Q3 OBSTETRICS & GYNECOLOGY Pub Date : 2017-02-02 eCollection Date: 2017-01-01 DOI: 10.2147/OAJC.S85543
Anderson Sanches de Melo, Rosana Maria Dos Reis, Rui Alberto Ferriani, Carolina Sales Vieira

Polycystic ovary syndrome (PCOS) is an endocrine disorder among women of reproductive age characterized by chronic anovulation and polycystic ovary morphology and/or hyperandrogenism. Management of clinical manifestations of PCOS, such as menstrual irregularities and hyperandrogenism symptoms, includes lifestyle changes and combined hormonal contraceptives (CHCs). CHCs contain estrogen that exerts antiandrogenic properties by triggering the hepatic synthesis of sex hormone-binding globulin that reduces the free testosterone levels. Moreover, the progestogen present in CHCs and in progestogen-only contraceptives suppresses luteinizing hormone secretion. In addition, some types of progestogens directly antagonize the effects of androgens on their receptor and also reduce the activity of the 5α reductase enzyme. However, PCOS is related to clinical and metabolic comorbidities that may limit the prescription of CHCs. Clinicians should be aware of risk factors, such as age, smoking, obesity, diabetes, systemic arterial hypertension, dyslipidemia, and a personal or family history, of a venous thromboembolic event or thrombophilia. This article reports a narrative review of the available evidence of the safety of hormonal contraceptives in women with PCOS. Considerations are made for the possible impact of hormonal contraceptives on endocrine, metabolic, and cardiovascular health.

多囊卵巢综合征(PCOS)是一种以慢性无排卵和多囊卵巢形态和/或雄激素过多为特征的育龄妇女内分泌疾病。多囊卵巢综合征的临床表现,如月经不规律和雄激素分泌亢进症状,包括生活方式的改变和联合激素避孕药(CHCs)的管理。CHCs含有雌激素,通过触发肝脏合成性激素结合球蛋白来降低游离睾酮水平,从而发挥抗雄激素特性。此外,孕激素存在于CHCs和孕激素避孕药抑制黄体生成素的分泌。此外,某些类型的孕激素直接拮抗雄激素对其受体的作用,并降低5α还原酶的活性。然而,多囊卵巢综合征与临床和代谢合并症有关,这可能限制了CHCs的处方。临床医生应该意识到静脉血栓栓塞事件或血栓形成的危险因素,如年龄、吸烟、肥胖、糖尿病、全身性动脉高血压、血脂异常、个人或家族史。这篇文章报道了一篇关于激素避孕药在多囊卵巢综合征妇女中安全性的现有证据的叙述性综述。考虑到激素避孕药对内分泌、代谢和心血管健康的可能影响。
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引用次数: 33
Oral contraceptive and acute intestinal ischemia with mesenteric venous thrombosis: a case report. 口服避孕药合并急性肠缺血并发肠系膜静脉血栓1例。
Q3 OBSTETRICS & GYNECOLOGY Pub Date : 2017-01-27 eCollection Date: 2017-01-01 DOI: 10.2147/OAJC.S124625
Aude Béliard, Lucie Verreth, Pascale Grandjean

Background: Venous thrombosis is a serious complication of combined contraceptive usage. However, mesenteric venous thrombosis and intestinal necrosis are infrequently seen in women using oral contraceptives, and in such cases diagnosis is often delayed.

Case presentation: We report the case of a 38-year-old obese female patient who presented with acute abdominal pain. A bowel infection was first diagnosed and treated with antibiotics. Contrast-enhanced tomography of the abdomen revealed diffuse ischemia of the small intestine with superior mesenteric thrombosis. Laparotomy with segmental resection of both small and large bowel was performed. No predisposing factor of mesenteric venous thrombosis was demonstrated except association of the combined contraceptive with obesity.

Conclusion: This report highlights the need for clinicians to suspect venous mesenteric thrombosis in women of reproductive age with acute abdominal pain and poor physical findings. Detailed personal history including prescriptions should help to quickly and accurately determine the problem.

背景:静脉血栓形成是联合使用避孕药的严重并发症。然而,在使用口服避孕药的妇女中,肠系膜静脉血栓形成和肠坏死并不常见,在这种情况下,诊断往往被推迟。病例介绍:我们报告一个38岁的肥胖女性患者谁提出了急性腹痛。最初诊断为肠道感染,并使用抗生素治疗。腹部造影显示小肠弥漫性缺血伴肠系膜上血栓形成。施行剖腹手术并节段性切除小肠和大肠。除联合避孕药与肥胖相关外,未发现肠系膜静脉血栓形成的易感因素。结论:本报告强调临床医生有必要怀疑育龄妇女急性腹痛和身体检查不佳的肠系膜静脉血栓形成。详细的个人病史,包括处方,应该有助于快速准确地确定问题。
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引用次数: 4
Long-acting reversible contraception use among residents in obstetrics/gynecology training programs. 住院医师妇产科培训项目中长效可逆避孕的使用情况。
Q3 OBSTETRICS & GYNECOLOGY Pub Date : 2017-01-10 eCollection Date: 2017-01-01 DOI: 10.2147/OAJC.S126771
Rachel E Zigler, Jeffrey F Peipert, Qiuhong Zhao, Ragini Maddipati, Colleen McNicholas

Background: The objective of the study was to estimate the personal usage of long-acting reversible contraception (LARC) among obstetrics and gynecology (Ob/Gyn) residents in the United States and compare usage between programs with and without a Ryan Residency Training Program (Ryan Program), an educational program implemented to enhance resident training in family planning.

Materials and methods: We performed a web-based, cross-sectional survey to explore contraceptive use among Ob/Gyn residents between November and December 2014. Thirty-two Ob/Gyn programs were invited to participate, and 24 programs (75%) agreed to participate. We divided respondents into two groups based on whether or not their program had a Ryan Program. We excluded male residents without a current female partner as well as residents who were currently pregnant or trying to conceive. We evaluated predictors of LARC use using bivariate analysis and multivariable Poisson regression.

Results: Of the 638 residents surveyed, 384 (60.2%) responded to our survey and 351 were eligible for analysis. Of those analyzed, 49.3% (95% confidence interval [CI]: 44.1%, 54.5%) reported current LARC use: 70.0% of residents in Ryan Programs compared to 26.8% in non-Ryan Programs (RRadj 2.14, 95% CI 1.63-2.80). Residents reporting a religious affiliation were less likely to use LARC than those who described themselves as non-religious (RRadj 0.76, 95% CI 0.64-0.92). Of residents reporting LARC use, 91% were using the levonorgestrel intrauterine device.

Conclusion: LARC use in this population of women's health specialists is substantially higher than in the general population (49% vs. 12%). Ob/Gyn residents in programs affiliated with the Ryan Program were more likely to use LARC.

背景:本研究的目的是估计美国妇产科(Ob/Gyn)住院医师中长效可逆避孕(LARC)的个人使用情况,并比较有和没有瑞安住院医师培训计划(Ryan Program)的项目的使用情况。瑞安住院医师培训计划是一项旨在加强住院医师计划生育培训的教育项目。材料和方法:我们进行了一项基于网络的横断面调查,以探讨2014年11月至12月期间妇产科住院医师的避孕使用情况。邀请32个妇产科项目参与,其中24个项目(75%)同意参与。我们将受访者分为两组基于他们的节目是否有瑞安计划。我们排除了目前没有女性伴侣的男性居民以及目前怀孕或试图怀孕的居民。我们使用双变量分析和多变量泊松回归评估LARC的预测因子。结果:在接受调查的638名居民中,384人(60.2%)回复了我们的调查,351人符合分析条件。在这些分析中,49.3%(95%置信区间[CI]: 44.1%, 54.5%)报告了目前的LARC使用情况:瑞安计划中70.0%的居民使用LARC,而非瑞安计划中的26.8% (RRadj 2.14, 95% CI 1.63-2.80)。有宗教信仰的居民比无宗教信仰的居民更不可能使用LARC (RRadj 0.76, 95% CI 0.64-0.92)。在报告使用LARC的居民中,91%使用左炔诺孕酮宫内节育器。结论:该人群中女性健康专家使用LARC的比例明显高于普通人群(49%对12%)。瑞安项目附属项目的妇产科住院医师更有可能使用LARC。
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引用次数: 11
Psychosocial correlates of patient-provider family planning discussions among HIV-infected pregnant women in South Africa. 南非感染艾滋病毒的孕妇中患者-提供者计划生育讨论的社会心理相关性。
Q3 OBSTETRICS & GYNECOLOGY Pub Date : 2017-01-01 Epub Date: 2017-04-03 DOI: 10.2147/OAJC.S134124
Violeta J Rodriguez, Ryan R Cook, Stephen M Weiss, Karl Peltzer, Deborah L Jones

Patient-provider family planning discussions and preconception counseling can reduce maternal and neonatal risks by increasing adherence to provider recommendations and antiretroviral medication. However, HIV-infected women may not discuss reproductive intentions with providers due to anticipation of negative reactions and stigma. This study aimed to identify correlates of patient-provider family planning discussions among HIV-infected women in rural South Africa, an area with high rates of antenatal HIV and suboptimal rates of prevention of mother-to-child transmission (PMTCT) of HIV. Participants were N=673 pregnant HIV-infected women who completed measures of family planning discussions and knowledge, depression, stigma, intimate partner violence, and male involvement. Participants were, on average, 28 ± 6 years old, and half of them had completed at least 10-11 years of education. Most women were unemployed and had a monthly income of less than ~US$76. Fewer than half of the women reported having family planning discussions with providers. Correlates of patient-provider family planning discussions included younger age, discussions about PMTCT of HIV, male involvement, and decreased stigma (p < 0.05). Depression was indirectly associated with patient-provider family planning discussions through male involvement (b = -0.010, bias-corrected 95% confidence interval [bCI] [-0.019, -0.005]). That is, depression decreased male involvement, and in turn, male involvement increased patient-provider family planning discussions. Therefore, by decreasing male involvement, depression indirectly decreased family planning discussions. Study findings point to the importance of family planning strategies that address depression and facilitate male involvement to enhance communication between patients and providers and optimize maternal and neonatal health outcomes. This study underscores the need for longitudinal assessment of men's impact on family planning discussions both pre- and postpartum. Increasing support for provision of mental health services during pregnancy is merited to ensure the health of pregnant women living with HIV and their infants.

患者-提供者计划生育讨论和孕前咨询可以通过提高对提供者建议和抗逆转录病毒药物的依从性来降低孕产妇和新生儿的风险。然而,感染艾滋病毒的妇女可能不会与提供者讨论生育意图,因为她们预计会有负面反应和耻辱。本研究旨在确定南非农村地区艾滋病毒感染妇女中患者-提供者计划生育讨论的相关性,该地区产前艾滋病毒感染率高,艾滋病毒母婴传播(PMTCT)的预防率不理想。参与者是N=673名感染艾滋病毒的孕妇,她们完成了计划生育讨论和知识、抑郁、耻辱、亲密伴侣暴力和男性参与的测量。参与者的平均年龄为28±6岁,其中一半完成了至少10-11年的教育。大多数妇女失业,月收入低于76美元。不到一半的妇女报告说与医疗服务提供者讨论过计划生育。患者-提供者计划生育讨论的相关因素包括年龄更小、关于预防母婴传播的讨论、男性参与和耻辱感减少(p < 0.05)。抑郁症与患者与医生通过男性参与的计划生育讨论间接相关(b = -0.010,偏差校正95%置信区间[bCI][-0.019, -0.005])。也就是说,抑郁症减少了男性的参与,反过来,男性的参与增加了患者与提供者计划生育的讨论。因此,通过减少男性参与,抑郁症间接减少了计划生育的讨论。研究结果指出,解决抑郁症和促进男性参与的计划生育战略对于加强患者和提供者之间的沟通以及优化孕产妇和新生儿健康结果具有重要意义。这项研究强调需要纵向评估男性对计划生育讨论的影响,包括产前和产后。为确保感染艾滋病毒的孕妇及其婴儿的健康,应增加对提供怀孕期间心理健康服务的支持。
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引用次数: 6
HIV is always with me: men living with perinatally acquired HIV and planning their families. 艾滋病毒一直伴随着我:围产期感染艾滋病毒的男性正在计划他们的家庭。
Q3 OBSTETRICS & GYNECOLOGY Pub Date : 2017-01-01 Epub Date: 2017-06-21 DOI: 10.2147/OAJC.S137789
Marisa Echenique, Rachel S Bookman, Violeta J Rodriguez, Richard P LaCabe, JoNell Efantis Potter, Deborah L Jones

Once expected to not survive childhood, youth with perinatally-acquired HIV have now reached young adulthood are of reproductive age and sexually active. Given the health impact of pregnancy among YPHIV, understanding reproductive decision making may inform preconception counseling strategies. Most literature regarding reproductive health among YPHIV focuses on women, overlooking one of the most important factors influencing the reproductive decision making process, male sexual partners. This manuscript examined attitudes, perceptions and experiences of young men with perinatally-acquired HIV (YMPHIV) regarding family planning and relationships, safer sex, disclosure, stigma and psychological health. Participants (n = 21) were YMPHIV aged 18-24 recruited in Miami, Florida. Focus groups (n = 4) were conducted; qualitative data were analyzed using grounded theory. HIV disclosure, stigma, fertility intentions, safer preconception knowledge, attitudes and practices, family planning communication with medical providers and family, and mental health emerged as themes. Results suggest that despite accurate knowledge regarding healthy preconception practices, psychopathology, substance use, and stigma, impact the uptake of HIV healthcare interventions. Effective interventions on preconception counseling may require more tailored approaches than knowledge-based psychoeducation alone, such as inclusion of psychological treatment, which could be offered in HIV healthcare settings to optimize health outcomes.

感染围产期获得性艾滋病毒的青少年曾经被认为无法活过童年,但现在他们已经进入了育龄和性活跃的青年期。考虑到怀孕对YPHIV患者健康的影响,了解生殖决策可以为孕前咨询策略提供信息。大多数关于艾滋病毒感染者生殖健康的文献都集中在女性身上,忽视了影响生殖决策过程的最重要因素之一——男性性伴侣。这篇论文研究了感染围产期获得性艾滋病毒(YMPHIV)的年轻男子对计划生育和关系、安全性行为、披露、耻辱和心理健康的态度、看法和经历。参与者(n = 21)是在佛罗里达州迈阿密招募的18-24岁的mphiv。进行焦点小组(n = 4);定性数据分析采用扎根理论。艾滋病毒的披露、耻辱、生育意图、更安全的孕前知识、态度和做法、与医疗提供者和家庭的计划生育沟通以及心理健康成为主题。结果表明,尽管对健康的孕前实践、精神病理学、物质使用和污名有准确的了解,但影响艾滋病毒保健干预措施的吸收。对孕前咨询的有效干预可能需要比仅以知识为基础的心理教育更有针对性的方法,例如包括心理治疗,这可以在艾滋病毒保健机构中提供,以优化健康结果。
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引用次数: 1
Improving adolescent knowledge of emergency contraception: challenges and solutions. 提高青少年紧急避孕知识:挑战和解决办法。
Q3 OBSTETRICS & GYNECOLOGY Pub Date : 2016-11-22 eCollection Date: 2016-01-01 DOI: 10.2147/OAJC.S97075
Sujatha Seetharaman, Sophia Yen, Seth D Ammerman

Globally, unintended adolescent pregnancies pose a significant burden. One of the most important tools that can help prevent unintended pregnancy is the timely use of emergency contraception (EC), which in turn will decrease the need for abortions and complications related to adolescent pregnancies. Indications for the use of EC include unprotected sexual intercourse, contraceptive failure, or sexual assault. Use of EC is recommended within 120 hours, though is most effective if used as soon as possible after unprotected sex. To use EC, adolescents need to be equipped with knowledge about the various EC methods, and how and where EC can be accessed. Great variability in the knowledge and use of EC around the world exists, which is a major barrier to its use. The aims of this paper were to 1) provide a brief overview of EC, 2) discuss key social determinants affecting knowledge and use of EC, and 3) explore best practices for overcoming the barriers of lack of knowledge, use, and access of EC.

在全球范围内,青少年意外怀孕构成了重大负担。可以帮助预防意外怀孕的最重要工具之一是及时使用紧急避孕措施,这反过来又将减少对堕胎和与少女怀孕有关的并发症的需求。使用EC的适应症包括无保护的性交、避孕失败或性侵犯。建议在120小时内使用EC,但如果在无保护的性行为后尽快使用EC最有效。为了使用电子商务,青少年需要具备各种电子商务方法的知识,以及如何和在哪里可以获得电子商务。世界各地对电子商务的认识和使用存在很大差异,这是其使用的主要障碍。本文的目的是1)提供电子商务的简要概述,2)讨论影响电子商务知识和使用的关键社会决定因素,以及3)探索克服缺乏电子商务知识,使用和获取障碍的最佳实践。
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引用次数: 12
Predictors of non-use of intrauterine contraception among women aged 18-49 years in a general practice setting in the UK. 英国18-49岁女性不使用宫内避孕的预测因素
Q3 OBSTETRICS & GYNECOLOGY Pub Date : 2016-10-21 eCollection Date: 2016-01-01 DOI: 10.2147/OAJC.S116994
Susan H Walker, Victoria L Newton, Lesley Hoggart, Mike J Parker

Objectives: Our research examined the barriers to the uptake of intrauterine contraception (IUC) by women in a general practice (GP) setting in the UK. This study reports predictors of non-use of IUC in this context.

Design: We used a mixed method Qual/Quant approach in which the initial qualitative research provides a framework for subsequent larger quantitative surveys. Utilizing findings derived from 30 qualitative interviews, a quantitative survey was developed and distributed to a pragmatic sample of 1,195 women, aged 18-49 years, who were recruited through 32 participating GP practices in an area of England, UK. Outcome measures were percentage of attributes or responses in the sample and use or non-use of IUC. Results were analyzed using descriptive statistical analysis and binary logistic regression, using use/non-use as a binary response variable.

Results: Attitudinal variables, which were the strongest predictors of non-use of IUC, were an adverse opinion on long-acting aspect of IUC (odds ratio [OR]=8.34), disliking the thought of IUC inside the body (OR=3.138), concerns about IUC causing difficulties becoming pregnant in the future (OR=2.587), concerns about womb damage (OR=2.224), having heard adverse opinions about levonorgestrel-releasing intrauterine system (Mirena®) (OR=2.551), having an adverse opinion of having light, irregular periods (OR=2.382) and, having an adverse opinion of having no periods (OR=2.018).

Conclusion: Concerns about the long-acting nature of IUC and persisting concerns about the safety of IUC may act as barriers to its use. Information for women, tailored to specifically address these concerns, is needed.

Implications: Clinicians should provide more reassurance and information to potential users of IUC to increase their confidence about the possibility of removing IUC early or on request. They should also specifically seek to alleviate concerns about internal damage, damage to the womb, or damage to future fertility from using the methods.

目的:我们的研究检查了在英国的全科医生(GP)设置的妇女接受宫内避孕(IUC)的障碍。本研究报告了在这种情况下不使用IUC的预测因素。设计:我们使用了一种混合方法,即质量/定量方法,其中最初的定性研究为随后更大规模的定量调查提供了一个框架。利用从30个定性访谈中得出的结果,制定了一项定量调查,并分发给1195名年龄在18-49岁之间的女性,她们是通过英国英格兰地区32个参与全科医生实践招募的。结果测量是样本中属性或反应的百分比以及使用或不使用IUC。结果分析采用描述性统计分析和二元逻辑回归,使用/未使用作为二元响应变量。结果:态度变量是不使用宫内节育器的最强预测因子,对宫内节育器长效方面持负面看法(比值比[OR]=8.34)、不喜欢宫内节育器的想法(OR=3.138)、担心宫内节育器会导致未来怀孕困难(OR=2.587)、担心子宫损伤(OR=2.224)、听说过对左炔诺孕酮释放宫内系统(mrena®)有负面看法(OR=2.551)、对有光、光、光、光、光等不良看法。月经不规律(OR=2.382)和认为没有月经(OR=2.018)。结论:对IUC长效性的担忧和对IUC安全性的持续担忧可能成为其使用的障碍。需要为妇女提供专门针对这些问题的信息。意义:临床医生应该为IUC的潜在使用者提供更多的保证和信息,以增加他们对早期或应要求切除IUC的可能性的信心。他们还应该特别寻求减轻对内部损害的担忧,对子宫的损害,或使用这些方法对未来生育能力的损害。
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引用次数: 6
Using contraception counseling to further improve adherence. 利用避孕咨询进一步提高避孕率。
Q3 OBSTETRICS & GYNECOLOGY Pub Date : 2016-10-13 eCollection Date: 2016-01-01 DOI: 10.2147/OAJC.S114036
Fatema Zehra Juma, Tamkin Abas
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引用次数: 0
Depo-Provera (depot medroxyprogesterone acetate) use after bariatric surgery. 减肥手术后使用醋酸甲孕酮(Depo-Provera)。
Q3 OBSTETRICS & GYNECOLOGY Pub Date : 2016-09-29 eCollection Date: 2016-01-01 DOI: 10.2147/OAJC.S84097
Clarissa Lam, Amitasrigowri S Murthy
In the US, obesity rates are increasing greatly. The Centers for Disease Control and Prevention estimates that 68.5% of Americans, including 63.9% of adult women older than 20 years, are overweight (body mass index between 25 kg/m2 and 29.9 kg/m2) or obese (body mass index >30 kg/m2). In light of this, it is not surprising that the rates of bariatric surgery have also been increasing. When considering the metabolic changes associated with both bariatric surgery and contraceptive use, in combination with the unique medical considerations of obese women, it is indisputable that clear guidelines are needed when counseling obese patients of reproductive age after bariatric surgery. In this literature review, we focus on depot medroxyprogesterone acetate (DMPA) and the implications of its use in obese women, preweight and postweight loss following bariatric surgery. Both DMPA use and bariatric surgery are known to cause bone loss, but it is still unclear whether there is an additive effect of the two factors on bone loss and whether either of these factors directly leads to an increased risk of bone fracture. The current consensus guidelines do not impose a restriction on the use of DMPA after bariatric surgery. DMPA use is associated with weight gain, and it is unclear whether weight loss blunting occurs with the use of DMPA after bariatric surgery. Prior studies had demonstrated an association with weight gain in adolescents, and therefore, those prescribing DMPA use after bariatric surgery in adolescents should proceed with caution. Adult women do not have a similar response to the use of DMPA. DMPA use has rarely been associated with increased risk of venous thromboembolism (VTE). The obesity-associated increase in VTE should be mitigated by surgically induced weight loss. The concurrent use of DMPA in the post bariatric surgical period should not further increase the risk of VTE.
在美国,肥胖率正在大幅上升。疾病控制和预防中心估计,68.5%的美国人,包括63.9%的20岁以上成年女性,超重(体重指数在25 kg/m2至29.9 kg/m2之间)或肥胖(体重指数>30 kg/m2)。鉴于此,减肥手术的比率也一直在增加就不足为奇了。考虑到与减肥手术和避孕相关的代谢变化,结合肥胖妇女独特的医疗考虑,在减肥手术后对育龄肥胖患者进行咨询时,需要明确的指导方针,这是无可争议的。在这篇文献综述中,我们重点关注醋酸甲孕酮(DMPA)及其在肥胖女性、减肥手术后体重减轻前和体重减轻后的应用意义。已知使用DMPA和减肥手术都会导致骨质流失,但目前尚不清楚这两种因素是否存在骨质流失的叠加效应,以及这两种因素是否直接导致骨折风险增加。目前的共识指南没有对减肥手术后使用DMPA施加限制。DMPA的使用与体重增加有关,目前尚不清楚减肥手术后使用DMPA是否会导致体重减轻。先前的研究已经证明DMPA与青少年体重增加有关,因此,那些在青少年减肥手术后使用DMPA的医生应该谨慎行事。成年女性对使用DMPA没有类似的反应。使用DMPA很少与静脉血栓栓塞(VTE)风险增加相关。肥胖相关的静脉血栓栓塞增加应该通过手术诱导的体重减轻来缓解。在减肥手术后同时使用DMPA不应进一步增加静脉血栓栓塞的风险。
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引用次数: 1
New developments in intrauterine device use: focus on the US. 宫内节育器使用的新进展:以美国为重点。
Q3 OBSTETRICS & GYNECOLOGY Pub Date : 2016-09-13 eCollection Date: 2016-01-01 DOI: 10.2147/OAJC.S85755
Anita L Nelson, Natasha Massoudi

Many more women in the US today rely upon intrauterine devices (IUDs) than in the past. This increased utilization may have substantially contributed to the decline in the percentage of unintended pregnancies in the US. Evidence-based practices have increased the number of women who are medically eligible for IUDs and have enabled more rapid access to the methods. Many women enjoy freedom to use IUDs without cost, but for many the impact of the Affordable Care Act has yet to be realized. Currently, there are three hormonal IUDs and one copper IUD available in the US. Each IUD is extremely effective, convenient, and safe. The newer IUDs have been tested in populations not usually included in clinical trials and provide reassuring answers to older concerns about IUD use in these women, including information about expulsion, infection, and discontinuation. On the other hand, larger surveillance studies have provided new estimates about the risks of complications such as perforation, especially in postpartum and breastfeeding women. This article summarizes significant features of each IUD and provides a summary of the differences to aid clinicians in the US and other countries in advising women about IUD choices.

与过去相比,如今越来越多的美国女性依赖于宫内节育器(iud)。这种增加的利用率可能大大有助于美国意外怀孕百分比的下降。基于证据的做法增加了医学上有资格获得宫内节育器的妇女人数,并使她们能够更迅速地获得这些方法。许多妇女享受免费使用宫内节育器的自由,但对许多人来说,《平价医疗法案》的影响尚未实现。目前,美国有三种激素宫内节育器和一种铜宫内节育器。每个宫内节育器都非常有效、方便和安全。新型宫内节育器已在通常不包括在临床试验中的人群中进行了测试,并为这些妇女使用宫内节育器提供了令人放心的答案,包括有关排出、感染和停药的信息。另一方面,更大规模的监测研究提供了关于穿孔等并发症风险的新估计,特别是在产后和哺乳期妇女中。本文总结了每种宫内节育器的重要特征,并提供了不同之处的总结,以帮助美国和其他国家的临床医生建议妇女选择宫内节育器。
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引用次数: 40
期刊
Open access journal of contraception
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