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| 發表人 | 討論主題 | 發表時間 | 討論數 |
| 盧令一 | Oral Contraceptive Use and Incident Urinary Incontinence in Premenopausal Women | 2009/6/28 下午 06:13:17 | 0 |
| 原 文 | 題 目 | Oral Contraceptive Use and Incident Urinary Incontinence in Premenopausal |
| 作 者 | Mary K. Townsend | |
| 出 處 | J. of Urology, 181(5):2170-2175 | |
| 出版日期 | 2009 | |
| 評 論 |
由哈佛大學等主持的大型調查（Nurses’ Health Study）發現，停經後婦女只要曾經持續使用口服避孕藥（OCPs），就會增加尿失禁的風險，其原因尚不清楚，但推測可能與膀胱collagen fiber組成的改變有關。這個結果引起作者群的興趣，進而對停經前婦女做了相似的調查。 Nurses’ Health Study II從116671位25~42歲的女性護理人員中，篩選了21864位有效問卷（37~54歲）加以分析，雖然曾使用OCPs的人較多是經產婦、吸菸、或是後來接受子宮切除者，但是去除這些因素之後，仍然發現口服避孕藥使用超過5年以上，相對就比較容易產生尿失禁。而使用OCPs的時間越久，日後發生尿失禁的風險就越高；而停藥時間越久，相對發生尿失禁的機會就會較低。而發生尿失禁的種類則主要是urge incontinence而非 SUI；但若針對從未生產過的女性（人數過少）來說，OCPs則可能造成日後SUI。 口服避孕藥是百年來女性自主的一大突破，但是對尿失禁的影響則並不清楚，以往類似的研究並沒有發現兩者有顯著的關聯性，但是過去的研究對研究對象的分類、避孕藥的使用方式、尿失禁的定義、甚至統計的方式都不是很嚴謹。本篇也有一些bias，例如問卷沒辦法分辨急尿是否是因為膀胱或是尿道發炎造成，也沒有詢問使用避孕藥的原因，另外對象大部分是白種人，結果的代表性就比較不足。雖然如此，本篇文章的結果強調口服避孕藥與日後尿失禁的發生還是有關連性，而且主要以urge incontinence為主，而對從未生產過的女性來說，反而可能與SUI的關聯性較大。相信這個有趣的結果可以提供後續對女性尿失禁的預防及治療的研究提供另一個思考的方向。 |
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| abstract |
Purpose Recent data in postmenopausal women indicate that current and past use of exogenous hormones is related to urinary incontinence risk. Little is known about exogenous hormones and risk of urinary incontinence in younger women. We investigated the association between oral contraceptive pills and incident urinary incontinence in premenopausal women enrolled in the Nurses Health Study II. Materials and Methods Participants reported use of oral contraceptive pills from 1989 to 2001. Among 21,864 premenopausal women 37 to 54 years old reporting no urinary incontinence in 2001 we identified 749 with incident urinary incontinence at least weekly between 2001 and 2003. Odds ratios and 95% confidence intervals were estimated using multivariable logistic regression. Results Women who had ever used oral contraceptive pills had a statistically significant 27% (95% CI 1–59) increased odds of experiencing urinary incontinence at least weekly compared with those who never used oral contraceptive pills. In women with 10 or more years of use the odds ratio increased to 1.48 (95% CI 1.13–1.95). Ever using oral contraceptive pills was specifically associated with urgency urinary incontinence (OR 2.48, 95% CI 1.07–5.76) rather than stress urinary incontinence (OR 1.04, 95% CI 0.78–1.40). Although we had limited information on urinary tract infection, control for urinary tract infection did not alter these findings. Conclusions Use of oral contraceptive pills may be associated with a modest increase in the odds of urinary incontinence among premenopausal women. However, this is one of the first reports of such an association and, thus, further research is needed to confirm our findings and investigate possible mechanisms. |
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