PDF(Pubmed)
Abstract：
BACKGROUND: Contraceptive use has complex effects on sexual behaviour and mood, including those related to reduced concerns about unintended pregnancy, direct hormonal effects and effects on endogenous sex hormones. We set out to obtain robust evidence on the relative effects of three contraceptive methods on sex behaviours, which is important for guiding contraceptive choice and future contraceptive developments.
METHODS: This is a secondary analysis of data from the Evidence for Contraceptive Options and HIV Outcomes (ECHO) randomized trial in which 7,829 HIV-uninfected women from 12 sites in Eswatini, Kenya, South Africa and Zambia seeking contraception were randomly assigned to intramuscular depot-medroxyprogesterone acetate (DMPA-IM), the copper intrauterine device (Cu-IUD) or the levonorgestrel (LNG) implant. Data collected for 12 to 18 months using 3-monthly behavioural questionnaires that relied on recall from the preceding 3 months, were used to estimate relative risk of post-baseline sex behaviours, as well as sexual desire and menstrual bleeding between randomized groups using modified Poisson regression.
RESULTS: We observed small but generally consistent effects wherein DMPA-IM users reported lower prevalence of specified high risk sexual behaviours than implant users than Cu-IUD users (the \'>\' and \'<\' symbols indicate statistically significant differences): multiple sex partners 3.6% < 4.8% < 6.2% respectively; new sex partner 3.0% < 4.0% <5.3%; coital acts 16.45, 16.65, 17.12 (DMPA-IM < Cu-IUD); unprotected sex 65% < 68%, 70%; unprotected sex past 7 days 33% <36%, 37%; sex during vaginal bleeding 7.1%, 7.1% < 8.9%; no sex acts 4.1%, 3.8%, 3.4% (DMPA-IM > Cu-IUD); partner has sex with others 10% < 11%, 11%. The one exception was having any sex partner 96.5%, 96.9% < 97.4% (DMPA-IM < Cu-IUD). Decrease in sexual desire was reported by 1.6% > 1.1% >0.5%; amenorrhoea by 49% > 41% >12% and regular menstrual pattern by 26% <35% < 87% respectively.
CONCLUSIONS: These findings suggest that women assigned to DMPA-IM may have a modest decrease in libido and sexual activity relative to the implant, and the implant relative to the Cu-IUD. We found more menstrual disturbance with DMPA-IM than with the implant (and as expected, both more than the Cu-IUD). These findings are important for informing the contraceptive choices of women and policymakers and highlight the need for robust comparison of the effects of other contraceptive methods as well.
METHODS: This is a secondary analysis of data from the Evidence for Contraceptive Options and HIV Outcomes (ECHO) randomized trial in which 7,829 HIV-uninfected women from 12 sites in Eswatini, Kenya, South Africa and Zambia seeking contraception were randomly assigned to intramuscular depot-medroxyprogesterone acetate (DMPA-IM), the copper intrauterine device (Cu-IUD) or the levonorgestrel (LNG) implant. Data collected for 12 to 18 months using 3-monthly behavioural questionnaires that relied on recall from the preceding 3 months, were used to estimate relative risk of post-baseline sex behaviours, as well as sexual desire and menstrual bleeding between randomized groups using modified Poisson regression.
RESULTS: We observed small but generally consistent effects wherein DMPA-IM users reported lower prevalence of specified high risk sexual behaviours than implant users than Cu-IUD users (the \'>\' and \'<\' symbols indicate statistically significant differences): multiple sex partners 3.6% < 4.8% < 6.2% respectively; new sex partner 3.0% < 4.0% <5.3%; coital acts 16.45, 16.65, 17.12 (DMPA-IM < Cu-IUD); unprotected sex 65% < 68%, 70%; unprotected sex past 7 days 33% <36%, 37%; sex during vaginal bleeding 7.1%, 7.1% < 8.9%; no sex acts 4.1%, 3.8%, 3.4% (DMPA-IM > Cu-IUD); partner has sex with others 10% < 11%, 11%. The one exception was having any sex partner 96.5%, 96.9% < 97.4% (DMPA-IM < Cu-IUD). Decrease in sexual desire was reported by 1.6% > 1.1% >0.5%; amenorrhoea by 49% > 41% >12% and regular menstrual pattern by 26% <35% < 87% respectively.
CONCLUSIONS: These findings suggest that women assigned to DMPA-IM may have a modest decrease in libido and sexual activity relative to the implant, and the implant relative to the Cu-IUD. We found more menstrual disturbance with DMPA-IM than with the implant (and as expected, both more than the Cu-IUD). These findings are important for informing the contraceptive choices of women and policymakers and highlight the need for robust comparison of the effects of other contraceptive methods as well.
摘要：
背景：避孕药具的使用对性行为和情绪有复杂的影响，包括那些减少对意外怀孕的担忧，直接激素作用和对内源性性激素的影响。我们着手获得关于三种避孕方法对性行为的相对影响的有力证据，这对于指导避孕方法的选择和未来避孕方法的发展具有重要意义。
方法：这是对避孕选择和艾滋病毒结局的证据（ECHO）随机试验数据的二次分析，该试验来自埃斯瓦蒂尼的12个地点的7,829名未感染艾滋病毒的妇女，肯尼亚,寻求避孕的南非和赞比亚被随机分配到肌内储库-醋酸甲羟孕酮（DMPA-IM），铜宫内节育器（Cu-IUD）或左炔诺孕酮（LNG）植入物。使用3个月的行为问卷收集12至18个月的数据，这些问卷依赖于前3个月的召回，用于估计基线后性行为的相对风险，以及使用改良泊松回归分析随机分组之间的性欲和月经出血。
结果：我们观察到较小但总体上一致的影响，其中DMPA-IM使用者报告的特定高风险性行为的患病率低于植入使用者，低于Cu-IUD使用者（\'>\'和\'<\'符号表示统计学上的显着差异）：多个性伴侣分别为3.6%<4.8%<6.2%；新性伴侣3.0%<4.0%<5.3%；性伴侣；性70%;过去7天无保护性行为33%<36%,37%;性交时阴道出血7.1%,7.1%<8.9%;无性行为4.1%,3.8%,3.4%（DMPA-IM>Cu-IUD）；伴侣与他人发生性关系10%<11%，11%。唯一的例外是有96.5%的性伴侣，96.9%<97.4%(DMPA-IM1.1％>0.5％；闭经49％>41％>12％，月经规律分别为26％<35％<87％。
结论：这些研究结果表明，接受DMPA-IM治疗的女性，相对于植入物，性欲和性活动可能有适度下降，和相对于Cu-IUD的植入物。我们发现DMPA-IM比植入物更多的月经紊乱(正如预期的那样，两者都比Cu-IUD多)。这些发现对于告知妇女和决策者的避孕选择非常重要，并强调需要对其他避孕方法的效果进行强有力的比较。
方法：这是对避孕选择和艾滋病毒结局的证据（ECHO）随机试验数据的二次分析，该试验来自埃斯瓦蒂尼的12个地点的7,829名未感染艾滋病毒的妇女，肯尼亚,寻求避孕的南非和赞比亚被随机分配到肌内储库-醋酸甲羟孕酮（DMPA-IM），铜宫内节育器（Cu-IUD）或左炔诺孕酮（LNG）植入物。使用3个月的行为问卷收集12至18个月的数据，这些问卷依赖于前3个月的召回，用于估计基线后性行为的相对风险，以及使用改良泊松回归分析随机分组之间的性欲和月经出血。
结果：我们观察到较小但总体上一致的影响，其中DMPA-IM使用者报告的特定高风险性行为的患病率低于植入使用者，低于Cu-IUD使用者（\'>\'和\'<\'符号表示统计学上的显着差异）：多个性伴侣分别为3.6%<4.8%<6.2%；新性伴侣3.0%<4.0%<5.3%；性伴侣；性70%;过去7天无保护性行为33%<36%,37%;性交时阴道出血7.1%,7.1%<8.9%;无性行为4.1%,3.8%,3.4%（DMPA-IM>Cu-IUD）；伴侣与他人发生性关系10%<11%，11%。唯一的例外是有96.5%的性伴侣，96.9%<97.4%(DMPA-IM
结论：这些研究结果表明，接受DMPA-IM治疗的女性，相对于植入物，性欲和性活动可能有适度下降，和相对于Cu-IUD的植入物。我们发现DMPA-IM比植入物更多的月经紊乱(正如预期的那样，两者都比Cu-IUD多)。这些发现对于告知妇女和决策者的避孕选择非常重要，并强调需要对其他避孕方法的效果进行强有力的比较。
