妇产科曼月乐临床应用演示文稿.ppt

* Objective To investigate the long-term effects of a levonorgestrel-releasing intrauterine system on the endometrium and lipid profile of breast cancer patients taking tamoxifen. Study design A total of 142 postmenopausal women taking tamoxifen were included in the study. A levonorgestrel-releasing intrauterine system was fitted to 70 women in the study group; a further 72 women acted as the control group. All women were followed for 36 months. Serum lipids were measured at the begining and at the end of 36 months. Endometrial biopsies were obtained by hysteroscopy at the beginning and at the end of the 36th month in both groups. Results After 36 months, there were minor changes in serum lipids, fewer endometrial polyps and no endometrial hyperplasia in the study group compared to the control group. Conclusion The levonorgestrel-releasing intrauterine system does not affect serum lipid levels significantly and may prevent the increased risk of endometrial polyps and hyperplasia associated with the use of tamoxifen in women with breast cancer. This may reduce the need for investigation of side-effects in women taking tamoxifen and also reduce patient discomfort while improving treatment adherence. * * 避孕：在月经周期的前7天内 流产后：术后即刻放置 产后：分娩后4-8周 － 无禁忌，避免用金属探针 － 操作轻柔，预防穿孔 月经过多：在月经周期的第7天，预防脱落 1．原则上在除外妊娠的任何情况下均可放置LNG-IUS (在月经来潮的7天以内放置为最佳) 2．阴道分娩后4周或4周以上或转经后子宫恢复正常； 剖宫产妇女放置时间为剖宫产6个月后 3．负压吸宫术和钳刮术后、中期妊娠引产后24h内清宫术后即时 (中孕流产后较早孕流产后放置脱落率有所升高；人工流产后即时 放置不增加并发症的发生率) 4．早孕自然流产、药物流产正常转经后子宫恢复正常 5．更换新的LNG-IUS可以在任何时间进行 * 除外妊娠 解释月经生理 闭经不是绝经的征象 闭经的益处 减少出血，避免铁的负平衡 方便 减少支出 不影响性生活 取器后月经即可恢复 药物治疗效果不好 不是取器指征 * 不规则出血和滴血，是单纯孕激素避孕方法存在的共性问题，发生率较高，持续时间较长，子宫内膜进一步抑制而发展为闭经 由于出血量很少，并不会导致贫血，无需特殊治疗 曼月乐?子宫内膜保护作用 Critchley HO, et al. Hum Reprod. 1998. LNG-IUS 相似点 持续诱导子宫内膜腺体萎缩、间质蜕膜 样变，有效对抗雌激素诱发的内膜增 优势 子宫局部药物作用 针对子宫内膜达到高效药物浓度 全身副作用小 与传统 序贯口服孕酮100mg/d 比较 阴道放置孕酮100～200mg/d HRT联合曼月乐?治疗RCT研究 Boon J, et al. Maturitas. 2003. 0 20 40 60 80 第13周期 100 第26周