Lauren Ee Murphy, Zhong E Chen, Valerie Warner, Sharon T Cameron
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引用次数: 1
Abstract
Introduction: Unprotected intercourse after oral emergency contraception (EC) significantly increases pregnancy risk. This underlies the importance of promptly starting effective, ongoing contraception - known as 'quick starting'. However, theoretical concern exists that quick starting might interact with EC or hormonal contraception (HC) potentially causing adverse side effects.
Method: A systematic review was conducted, evaluating quick starting HC after oral EC [levonorgestrel 1.5 mg (LNG) or ulipristal acetate 30 mg (UPA)]. PubMed, EMBASE, The Cochrane Library, ICTRP, ClinicalTrials.gov and relevant reference lists were searched in February 2016. A lack of comparable studies prevented meta-analysis.
Results: Three randomised controlled trials were identified. Two biomedical studies suggested HC action was unaffected by quick starting after UPA; one study examined ovarian quiescence (OR 1.27; 95% CI 0.51-3.18) while taking combined oral contraception (COC). Another assessed cervical mucus impenetrability (OR 0.76; 95% CI 0.27-2.13) while taking progestogen-only pills (POP). Quick starting POP reduced the ability of UPA to delay ovulation (OR 0.04; 95% CI 0.01-0.37). Side effects (OR 1.22; 95% CI 0.48-3.12) and unscheduled bleeding (OR 0.53; 95% CI 0.16-1.81) were unaffected by quick starting COC after UPA. Another study reported higher self-reported contraceptive use at 8 weeks among women quick starting POP after LNG, compared with women given LNG alone (OR 6.73; 95% CI 2.14-21.20).
口服紧急避孕药(EC)后无保护性交显著增加妊娠风险。这说明了迅速开始有效、持续避孕的重要性——即“快速开始”。然而，理论上存在的担忧是，快速启动可能与EC或激素避孕(HC)相互作用，可能导致不良副作用。方法:对口服EC[左炔诺孕酮1.5 mg (LNG)或醋酸乌普利司酯30 mg (UPA)]后快速启动HC进行系统评价。2016年2月检索PubMed、EMBASE、Cochrane Library、ICTRP、ClinicalTrials.gov及相关参考文献。缺乏可比研究妨碍了meta分析。结果:纳入3项随机对照试验。两项生物医学研究表明，UPA后快速启动不影响HC作用;一项研究检测卵巢静止(OR 1.27;95% CI 0.51-3.18)，同时服用联合口服避孕药(COC)。另一项评估宫颈粘液不穿透性(OR 0.76;95% CI 0.27-2.13)，同时服用纯孕激素药片(POP)。快速启动的POP降低了UPA延迟排卵的能力(OR 0.04;95% ci 0.01-0.37)。副作用(OR 1.22;95% CI 0.48-3.12)和计划性出血(OR 0.53;95% CI 0.16-1.81)不受UPA后快速启动COC的影响。另一项研究报告，与单独服用LNG的女性相比，LNG后快速启动POP的女性在8周时自我报告的避孕药具使用率更高(OR 6.73;95% ci 2.14-21.20)。
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