与荷尔蒙避孕相关的异常子宫出血
Sarina Schrager1, Kelita Fox2, Rachel Lee2
1University of Wisconsin, Madison, Wisconsin.
American family physician
|February 23, 2024
概括
异常的子宫出血在荷尔蒙避孕中很常见. 本指南为各种方法提供治疗算法,包括子宫内器械和植入物,以减少停止治疗和意外怀孕.
科学领域:
- 生殖健康 生殖健康
- 避孕药是一种避孕药,用于避孕.
- 妇科 妇科医生 妇科
背景情况:
- 异常子宫出血 (AUB) 是荷尔蒙避孕的常见副作用.
- AUB可能导致方法中止和意外怀孕.
- 有效的管理策略对于持续使用避孕药物至关重要.
研究的目的:
- 为临床医生提供基于证据的算法,用于管理各种荷尔蒙避孕药使用者的AUB.
- 提供针对不同避孕方法量身定制的具体治疗建议.
- 通过解决出血问题来改善患者对避孕措施的坚持.
主要方法:
- 关于使用荷尔蒙避孕药对AUB进行管理的当前文献的审查和综合.
- 开发特定避孕方法的临床算法:莱沃诺格斯特勒宫内避孕装置 (IUD),Depot-medroxyprogesterone acetate (DMPA),孕激素植入物,仅含孕激素的药丸 (POP) 和组合激素避孕 (CHC).
- 包括治疗选择,如NSAIDs,雌激醇,联合口服避孕药,以及调整药片方案或无激素间隔.
主要成果:
- 对不同类型的荷尔蒙避孕药概述了具体的管理策略.
- 对于levonorgestrel IUDs:确保正确的放置,考虑NSAIDs作为第一线,然后是雌激素.
- 对于DMPA/植入物:可以使用联合口服避孕药或NSAID. 对于诺雷丁龙的POPs:切换到多斯匹雷农的POPs可能有所帮助. 对于CHC:调整雌激素剂量,无激素间隔,或考虑多西环林. 对于连续的CHC:实施无激素间隔.
结论:
- 量身定制的治疗算法可以有效地管理与荷尔蒙避孕相关的AUB.
- 解决AUB可以提高患者满意度和有效避孕方法的延续率.
- 临床医生应在开始时就潜在的出血模式向患者提供咨询,并提供适当的管理策略.
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