子宫内膜异位.ppt

口服避孕藥 財團法人奇美醫院 蔡永杰醫師 什麼是「口服避孕藥」？ 口服避孕藥是一種賀爾蒙製劑，依作用方 式分為二類 動情素與黃體素的綜合製劑 「單相型」(monophasic) 「多相型」(multiphasic)兩種 單純黃體素的製劑  Types of COCs Monophasic: All 21 active pills contain same amount of Estrogen/Progestin (E/P) Biphasic: 21 active pills contain 2 different E/P combinations (e.g., 10/11) Triphasic: 21 active pills contain 3 different E/P combinations (e.g., 6/5/10) 口服避孕藥的作用機轉 COCs: Contraceptive Benefits Highly effective when taken daily Effective immediately if started by day 7 of menstrual cycle Do not interfere with intercourse Few side effects Convenient and easy to use Can stop use COCs: Noncontraceptive Benefits Decrease menstrual flow (lighter, shorter periods) Decrease menstrual cramps May improve anemia Protect against ovarian and endometrial cancer Decrease benign breast disease and ovarian cysts Prevent ectopic pregnancy Protect against some causes of PID 口服避孕藥的成分 動情素 Ethinyl estradiol Mestranol 所謂的「低劑量」口服避孕藥指其動情素劑量小於0.05毫克(=50 ug)， 而黃體素劑量小於0.15毫克(=150ug)。  黃體素 Levonorgestrel Norethindrone 由睪脂酮改造合成。保留些微的男 性化的潛在影響。  Classification Side effects Oestrogenic Nausea, dizziness, bloating, breast engorgement, vaginal discharge, premenstrual tension, migranes Change to a more progestogenic prep/ Reduce dose of oestrogen and inc dose of progesterone. Progestogenic Vaginal dryness, inc wt, reduced libido, acne, mastalgia, depression/lethargy, scanty menses Change to more osetrogenic COCs: Who Should Not Use COCs should not be used if a woman: Is pregnant (known or suspected) Is breastfeeding ( 6 weeks postpartum) Is jaundiced (symptomatic viral hepatitis or cirrhosis) Has ischemic heart disease or stroke (current or history of) Has blood clotting disorders (deep vein thrombophlebitis or pulmonary embolus) COCs: Who Should Not Use COCs should not be used if a woman: Is a smoker and age 35 years or older Has diabetes ( 20 years duration) Has headaches (migraine) Has high blood pressure ( 180/110) Has breast cancer Has live