口服避孕药

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TypesofCOCsMonophasic:All21activepillscontainsameamountofEstrogen/Progestin(E/P)Biphasic:21activepillscontain2differentE/Pcombinations(e.g.,10/11)Triphasic:21activepillscontain3differentE/Pcombinations(e.g.,6/5/10)4口服避孕藥的作用機轉SuppressovulationEndometriumatrophyThickencervicalmucusReducespermtransportFailurerateis0.2-0.5per100womanyears5COCs:ContraceptiveBenefitsHighlyeffectivewhentakendailyEffectiveimmediatelyifstartedbyday7ofmenstrualcycleDonotinterferewithintercourseFewsideeffectsConvenientandeasytouseCanstopuse1Hatcheretal1998.6COCs:NoncontraceptiveBenefitsDecreasemenstrualflow(lighter,shorterperiods)DecreasemenstrualcrampsMayimproveanemiaProtectagainstovarianandendometrialcancerDecreasebenignbreastdiseaseandovariancystsPreventectopicpregnancyProtectagainstsomecausesofPID口服避孕藥的成分動情素Ethinylestradiol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(=50ug)，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。ClassificationTypeofprogesteroneMonophasicpillsTriphasicpillsLevonorgestrelMicrogynon30/EEOvranette(30EE)Eugynon(30EE)TrinodialLogynonNorethisteroneOvysmen/Brevinor(35EE)Norimin(35)Loestrin20/30TrinovumBinovumSynphaseNorgestimateCilest(35EE)DesogestrolMercilon20EEMarvelon30EEGestogeneFemodene(30EE)Minulet(30EE)Femodette(20EE)Tri-MinuletDrospirenoneYasmin(30EE)SideeffectsOestrogenicNausea,dizziness,bloating,breastengorgement,vaginaldischarge,premenstrualtension,migranesChangetoamoreprogestogenicprep/Reducedoseofoestrogenandincdoseofprogesterone.ProgestogenicVaginaldryness,incwt,reducedlibido,acne,mastalgia,depression/lethargy,scantymensesChangetomoreosetrogenic10COCs:WhoShouldNotUseCOCsshouldnotbeusedifawoman:Ispregnant(knownorsuspected)Isbreastfeeding(6weekspostpartum)Isjaundiced(symptomaticviralhepatitisorcirrhosis)Hasischemicheartdiseaseorstroke(currentorhistoryof)Hasbloodclottingdisorders(deepveinthrombophlebitisorpulmonaryembolus)Source:WHO1996.11COCs:WhoShouldNotUseCOCsshouldnotbeusedifawoman:Isasmokerandage35yearsorolderHasdiabetes(20yearsduration)Hasheadaches(migraine)Hashighbloodpressure(180/110)HasbreastcancerHaslivertumorsHastoundergomajorsurgerywithprolongedbedrestSource:WHO1996.12COCs:ConditionsRequiringPrecautionsIs3weekspostpartum(evenifnotbreastfeeding)Hasunexplainedvaginalbleeding(onlyifseriousproblemsuspected)Hashighbloodpressure(160/110)HasahistoryofbreastcancerHassymptomaticgallbladderdiseaseIstakingdrugsforepilepsy(phenytoinorbarbiturates)ortuberculosis(rifampin)Source:WHO1996.ProgesteroneonlyPill(POP)BecomingincreasinglypopularTheycanbeusedwithnoagelimits,insmokers,duringlactationandevenforwomenatriskofVTEEfficacyFailurerateof0.3-5per100womanyearsModeofactionMainlythickeningcervicalmucusAtrophyofendometrium,hindersimplantationInterferewithtubaltransportofovaProgesteroneonlyPill(POP)TypeofprogesteronPOPNorethisterone350mcgMicronorNoridayLevonorgestrel30mcgMicroval,NorgestonDinorgestrel75mcgNeogestEtynodioldiacetate500mcgFemulenDisogestrel75mcgCerazetteIndications21dayspostpartum.6wks-6mthspostpartumpartiallyorfullyBFAge35andsmokeBMI35MultipleriskforCVSThoseatriskofVTE,incpersonalhxHyptcontrolledwithmedsDM/CHD/valvularproblemsCIN/endometrialca/ovariancaFHxBreastcaSCDContraindicationsUncontrolledhypertensionActivehepatitis/decompensatedcirrhosis/livertumoursMalabsorptionCurrentDVTUndiagnosedGenitaltractbleedingRecenttrophoblasticdxwithhighbHCGCurrentIHDCurrentbreastCaPastseveresideeffectsAcuteporphyria口服避孕藥的臨床用途避孕月經異常、亂經痛經子宮內膜異位症卵巢功能性水瘤經前症候群多囊性卵巢多毛症青春痘試管嬰兒治療PolycysticOvarianSyndrome(PCOS)多囊性卵巢FeaturesofPCOSClinicalfeaturesMenstrualirregularitiesHirsutismAlopeciaAcneAnovulatoryinfertilityRecurrentmiscarrageEndocrinefeaturesAndrogen↑LH↑Estrogen↑Prolactin↑MetabolicfeaturesObesity.InsulinresistanceLipidabnormalitiesTypeIIDM多囊性卵巢(PCOS)此類女性患者常伴有月經不規則、數月才來一次月經、甚至暫時不來月經的症狀。此類患者如不想生育，可服用避孕藥來維持規則的人為月經週期，不但患者可以心安，也可以避免經常催經的困擾。宮能異常性子宮出血(DysfunctionalUterineBleeding)Bleedingfromtheuterineendometriumunrelatedtoanatomiclesionsoftheuterus.Forexample,disruptionofnormalovarianfunctionoranovulation,midcyclestainingassociatedwithovulation,menstrualirregularityassociatedwithcorpusluteumdefect.經血過多Menseslastslongerthan7daysoramenstrualbloodlossexceeding60to80ml.月經異常、亂經此類患者會有月經太多、太長、非常不規則的症狀，這種異常經檢查後，如果是無排卵性的亂經或沒有女性生殖器官的病灶，可以試著服用避孕藥一段時間，以調整經期。COCs:MenstrualBloodLossandAnemiaDecreasemenstrualbloodloss(20mlversus35ml)Preventirondeficiencyanemia(50%)Improveexistingirondeficiencyanemia痛經(Dysmenorrhea)Menstrualpainbeginswiththeonsetofmenstruationandlastsforafewhours.Itordinarilyhasaspasmodic,colik,labor-likenaturebutissometimesdescribedasanachingorheavinessinthelowerabdomen.痛經(Dysmenorrhea)原發性經痛(PrimaryDysmenorrhea)Menstrualpainobservedintheabsenceofanyidentifiablepelviclesionandduetofactorsintrinsicintheuterus次發性經痛(SecondaryDysmenorrhea)Menstrualpainobservedinthepresenceofotherpelvicdisease