口服避孕藥和子宮內膜異位症

權威期刊人類生殖。 201164 搶鮮版

口服避孕藥和子宮內膜異位症:過去使用口服避孕藥治療重度原發性痛經與子宮內膜異位症,特別是深層浸潤子宮內膜異位症的關聯。

 

法國巴黎的研究

摘要

使用口服避孕藥(OC)和子宮內膜異位症之間的關係仍存在爭議。因此,我們比較其各種特性,使用口服避孕藥,手術病理診斷子宮內膜異位症分為表淺的子宮內膜異位症(SUP),卵巢子宮內膜異位瘤(OMA)的或深層浸潤子宮內膜異位症(DIE)。方法為橫斷面研究包括566例手術時無子宮內膜異位症者為對照,410例病理證實子宮內膜異位症,其分類為SUP47例,OMA120例及DIE243例。個人數據,包括使用口服避孕藥,在標準化下,前瞻性地收集採訪。統計分析採用非條件 logistic回歸。結果過去口服避孕藥使用者治療原發性痛經有子宮內膜異位症發病率上升(調整奇比(OR= 2.7995%可信區間(CI1.74-5.12P0.002)的機會。結論我們的數據表明,使用口服避孕藥去治療嚴重原發性痛經的病史,在以後的生活發現嚴重原發性痛經是與手術診斷子宮內膜異位症,尤其是深層浸潤子宮內膜異位症(DIE)很有關聯,。然而,這並不一定意味著使用口服避孕藥增加了子宮內膜異位症的發生的風險。以往使用口服避孕藥治療原發性痛經的病史可作為婦女子宮內膜異位症併有深層浸潤子宮內膜異位症(DIE)的一個標記。

 

PS: 截至目前為止,教課書及國際上仍建議口服避孕藥用來治療或控制子宮內膜異位症,本篇僅用於提供法國研究的觀察。

 

 

Hum Reprod. 2011 Jun 4. [Epub ahead of print]

Oral contraceptives and endometriosis: the past use of oral contraceptives for treating severe primary dysmenorrhea is associated with endometriosis, especially deep infiltrating endometriosis.

Chapron CSouza CBorghese BLafay-Pillet MCSantulli PBijaoui GGoffinet Fde Ziegler D.

Source

Service de Gynécologie Obstétrique II and Reproductive Medicine (Professor Chapron), Université Paris Descartes, Faculté de Médecine, Assistance Publique-Hôpitaux de Paris (AP- HP), Groupe Hospitalier Universitaire (GHU) Ouest, Centre Hospitalier Universitaire (CHU) Cochin Saint Vincent de Paul, Paris , France .

Abstract

BACKGROUND The relationship between the use of oral contraception (OC) and endometriosis remains controversial. We therefore compared various characteristics of OC use and the surgical diagnosis of endometriosis histologically graded as superficial peritoneal endometriosis (SUP), ovarian endometrioma (OMA) or deep infiltrating endometriosis (DIE). METHODS This cross-sectional study included 566 patients without visible endometriosis at surgery as controls, and 410 patients with histologically proven endometriosis, categorized by their worst lesions as SUP n = 47, OMA n = 120 and DIE n = 243. Personal data, including on OC use, were prospectively collected during standardized interviews. Statistical analysis was performed using unconditional logistic regression. RESULTS Past OC users had an increased incidence of endometriosis (adjusted odd ratios (OR) = 2.79, 95% confidence interval (CI) 1.74-5.12, P = 0.002) of any revised American Fertility Society stage. Women who had previously used OC for severe primary dysmenorrhea were even more frequently diagnosed with endometriosis (adjusted OR = 5.6, 95% CI 3.2-9.8), especially for DIE (adjusted OR = 16.2, 95% CI 7.8-35.3). Women who had previously used OC for other reasons also had an increased risk of endometriosis, but to a lesser extent (adjusted OR = 2.6, 95% CI 1.8-4.1). The age at which OC was initiated, duration of OC use and free interval from last OC use were not significantly different between control and endometriosis women, irrespective of histological grading. Current OC users did not show an increased prevalence of endometriosis (OR = 1.22, 95% CI 0.6-2.52). CONCLUSIONS Our data indicate that a history of OC use for severe primary dysmenorrhea is associated with surgical diagnosis of endometriosis, especially DIE, later in life. However, this does not necessarily mean that use of OC increases the risk of developing endometriosis. Past use of OC for primary dysmenorrhea may serve as a marker for women with endometriosis and DIE.

 

 



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