<Medical Milestone>
The Pill：Emblem of Liberation
避孕藥：解放的象徵
鄭丞傑
台北醫學大學醫學系婦產學科教授
台北醫學大學附設醫院婦產部副主任暨婦癌科主任
亞太避孕醫學會(APCOC)理事
台灣性教育學會名譽理事長
台灣婦女健康學會副理事長
2011-5-20
北醫附設醫院11F會議室
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Outline
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口服避孕藥的發明史
口服避孕藥對人類的影響
口服避孕藥的沿革及其他途徑避孕藥的開發
口服避孕藥的效益與迷思
口服避孕藥的爭議
結論
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二十世紀三大靈藥
1. Antibiotics—起初為治療Syphilis之用
(Penicillin)
2. Oral Pill—人口控制
3. Viagra—治療男性勃起功能障礙(ED)
*都和Sexual and Reproductive Health有關
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The pill is one of the few drugs
to have remained essentially
unchanged decades after its
synthesis—testament to its
enduring value
Carl Djerassi, professor of
chemistry emeritus, BMJ 334 :
s15. 28 June, 2010.
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No other drug has had such an
enormous effect on religion. For
instance, Catholic couples, faced with
their church’s opposition to
contraception, often make family
planning a higher priority than avoiding
“mortal” sin.
Carl Djerassi, professor of chemistry emeritus,
BMJ 334 : s15. 28 June, 2010.
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Introducing the Pill
• 2009年, 口服避孕藥榮獲過去150年來
“藥界最偉大的創新”1
• 早在這十年前, 經濟學人雜誌認為口服避
孕藥為“20世紀最偉大的科學與技術躍
進”2
• 全世界有一億的女性使用口服避孕藥3
• 目前最常使用的避孕方法，口服避孕藥排名第3位；口服避孕
藥也是目前地理分布最廣的避孕方法4
1) Chemist+Druggist (2009). The Greatest Pharmacy Invention
2) The Economist Millennium Issue, December 1999
3) Trussell, James (2007). Contraceptive Efficacy". in Hatcher, Robert A., et al.. Contraceptive Technology (19th rev. ed.). New York:
Ardent Media. ISBN 0-9664902-0-7. http://www.contraceptivetechnology.com/table.html.
4) United Nations, Department of Economic and Social Affairs, Population Division. World Contraceptive Use, 2007/2009.
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沒有口服避孕藥的年代……
4000年以前
古埃及人：石榴種子，含有天然的雌激素，可能是
埃及人製造的混合物類似現今的避孕藥，可預防排
卵。
西元前1550年
歷史學家推測該物質可能是鱷魚的糞便，
女性在性接觸前，將其放入陰道。
中世紀
人類使用以動物腸道或魚皮製成的保險
套，有時甚至會使用亞麻布。
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沒有口服避孕藥的年代……
The classical and hellenic Greek era (year -384)
Half of a lemon as cervical cap
The middle ages (year 1000)
Use of pomegranates seeds.
High levels of Phyto-estrogens might
cause inhibition of egg development
The middle ages (year 1564)
Linen condom
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1920年代之前: 研究發展的先驅
1901
第一次進行正式的研究。來自茵斯布魯
克的生理學家Ludwig Haberland(1885年
至1932年)，證實月經會受到大腦及卵巢
內產生之荷爾蒙的調節。
1919
在動物實驗中，Ludwig Haberland發現
避孕藥的原則。他並證實將懷孕兔子的
卵巢移植到未懷孕的動物身上時，可抑
制排卵。
1923
Ludwig Haberland將胎盤萃取物注射至
具生育力的動物身上，並成功使她們得
到暫時的絕育。
1928
先靈引入第一種荷爾蒙產品Progynon®。
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1930-40年代: 研究發展的先驅
1929
Adolf Butenandt (1903 – 1995)是一位生化學家，且之後得到諾貝爾
桂冠，成功分離出第一種女性荷爾蒙雌素酮。
1933
先靈引入第一種生物黃體激素製劑Proluton®。
1934
在先靈的主實驗室，化學家Schwenk和Hildebrand共同研發出雌二醇
合成物。這是現代荷爾蒙治療產品的基礎。
Butenandt和其他科學家從豬的卵巢分離出黃體激素性荷爾蒙(黃體賀
爾蒙)。
1938
先靈的員工Hans Inhoffen和Walter Hohlweg創下歷史紀錄：
他們在主實驗室研發出炔雌醇，這是全球第一種口服活性雌激素。即
使到今日，此物質仍幾乎是每種傳統口服避孕藥的雌激素成分。科學
家也成功製造第一種人造妊娠素製劑。
1942
美國化學家Russell Marker蒐集墨西哥的野山藥根(薯蕷屬)，並用以
製造純黃體激素。
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1950年代以降
1950
Margaret Sanger是美國家庭計畫協會的創立者，遇
見了生化學家Gregory Pincus。71歲的Sanger說服
Pincus荷爾蒙避孕的需求，並結合捐助者Katherine
McCormick募集50,000美元，對其研究進行贊助。
Margaret Sanger
1951
化學家Carl Djerassi在墨西哥合成炔諾酮，這是第一
種人造口服活性黃體激素。
Katherine McKormick
1956
Gregory Pincus教授及其同事Min Chuh Chang以及
哈佛大學的婦產科醫師John Rock，對60名女性受試
者首次進行試驗。同年，Pincus成功在波多黎各及
海地對6,000名受試者首次進行大型試驗。
Gregory Pincus
Chang Min-chueh
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1960年代: 口服避孕藥問世
1960
引進美國公司製造的Enovid®，作為美國的避孕藥。
1961
柏林圍牆將德國分為東德與西德。1961年6月1日也是醫學革命。拜
耳先靈西藥部(當時為先靈AG)將歐洲第一種口服避孕藥Anovlar®引
進德國，之後並於同一年在澳洲上市。該避孕藥僅可經由藥局購買，
且必須要有處方。200位頂尖的歷史學家，認為無論是愛因斯坦的相
對論或原子彈，甚或電腦及網路的威力，在20世紀對社會的衝擊均
不及避孕藥的影響。
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Before the Pill: 1, 2, 3… and counting
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After the Pill
UN Global Birth Rates
1960s: 8.5 children per woman
1970s: 6.1 children per woman
2009: 2.9 children per woman
Reduction due to ....
• Better level of education
• Increased access to & use of
contraception
• Urbanisation
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21st Century Woman
• Assuming Sexual
activity between the
ages of 20 and 45
years, wishing to have
only 2 children, this
woman will spend
86% of that time trying
to prevent pregnancy.
(Guttmacher Inst)
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The Pill and women’s empowerment
• The Pill launched women into a new era of career and economical
empowerment.
– Allowed women to invest in education and career, by prolonging the
age of marriage
• 1960: Relentless social pressure to marry; in US often a wife by 20, 70%
married by 24, a mother by 25.
– Related to a significant increase in college attendance and graduate
rates for women in the US.1
• Number of female entrants to professional schools began a steep climb
around 1970
• Sharp rise in women’s presence in law, medicine and other professions from
1970 to 2000
1) Goldin, Claudia, and Lawrence Katz (2002). "The Power of the Pill: Oral Contraceptives
and Women’s Career and Marriage Decisions". Journal of Political Economy 110 (4): 730–
770.
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The Pill and women’s health
• Protects women’s health1
–
–
–
–
•
Reduces maternal mortality
Prevents unwanted / high-risk pregnancies
Reduces the need for unsafe abortions
Protects against diseases such as ovarian and endometrial cancer
Women on the Pill may live longer, and have a lower rate of death from
any cause, including heart disease and all cancers2
1) World Health Organization Family Planning and Population Division of Family Health (1995). Health benefits of family planning.
2) Hannaford, P. et al. Mortality among contraceptive pill users: cohort evidence from Royal College of General Practitioners’ Oral
Contraception Study. BMJ 2010;340:c927
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The Pill and women’s quality of life
• Advances women’s well-being1
– With effective family planning, women have better health and
more energy for personal development, career and
community activities
• Non-contraceptive benefits of the Pill help enhance
women’s quality of life
– Reduces distressing premenstrual symptoms
– Reduces heavy menstrual bleeding
– Treats acne
• Access to contraception was the biggest contributor to
an increase in “life satisfaction” for 450,000 women in
12 European countries (1975 – 1998) because it:2
– Increased their investment in education
– Increased their probability of working and their level of
income
1) World Health Organization Family Planning and Population Division of Family Health
(1995). Health benefits of family planning.
2) Pezzini S. The Economic Journal. 2005;115:C208–C227.
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The Pill also benefits
children and communities
• Reduces infant mortality1
– Using contraceptives to end
childbearing after 4 births helps reduce
infant mortality rates
• Benefits the community1
– Effective family planning helps relieve
the pressures on economic, social
and natural resources faced by
rapidly growing populations
1) World Health Organization Family Planning and Population
Division of Family Health (1995). Health benefits of family
planning.
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From the words of a man…
• “… It would be one of the greatest triumphs of humanity, one of
the most tangible liberations from the constraints of nature to which
mankind is subject, if we could succeed in raising the responsible
act of procreating children to the level of a deliberate and
intentional activity and in freeing it from its entanglement with
the necessary satisfaction of a natural need.”
- Sigmund Freud, 1898
• With the Pill, this hope has finally become reality for women 50
years ago
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R&D 的努力: (1) 雌激素的劑量再降低
方向: 荷爾蒙成分的劑量再降低
– 如此一來降低早期口服避孕藥的副作用而同時
能夠維持可靠的避孕效果 (99.9% efficacy)

1960所 Enovid®其所含的雌激素高達80 – 100 µg

在今日含drsp的悅己 Yasmin® 與悅姿 Yaz® 所含雌激素已經降低
到20 – 30 µg
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Bayer Schering Pharma:
At the forefront in contraception right from the start
Anovlar®
First COC
in Europe
* 1961
Microgynon®
First low-dose
COC
1972
Microlut®
First POP
in Europe
1973
Diane35®
First COC
+ Acne **
1979
Triquilar®
First threephasic COC
1985
Mirena®
First IUS
1987
Femovan®
First COC
with GSD
COC: Combined Oral Contraceptive
IUS: Intrauterine System
POP: Progestin-only Pill
#Year
of first launch
is indicated for treatment of acne in women requiring contraception
##Diane-35
1990
Qlaira®
First in a new
class of COC
to deliver E2
Yasmin®
First COC
with DRSP
1995
2001
Valette®
First COC
with DNG
LNG: Levonorgestrel
EE: Ethinyl Estradiol
E2: Estradiol
2006
2009
YAZ®
First
24-4 day COC
with DRSP
GSD: Gestodene
DRSP: Drospirenone
DNG: Dienogest
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R&D 的努力: (2)黃體素與劑型配置的創新
• 產出更多除了避孕以外新穎的額外好處
– 1978: Diane(黛麗安)® – 避孕並可以治療痤瘡
– 2000: Yasmin(悅己)® – 利用新型黃體素
drospirenone (drsp) 來避免因為體液滯留造成
體重增加或手腳水腫, 並且對於經前症狀有正向
幫助
– 2008: YAZ(悅姿)® – 全世界第一顆FDA通過口
服避孕藥用來治療經前不悅(premenstrual
dysphoric disorder; PMDD) 的口服避孕藥
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drsp® 的兩大特性
drsp具有抗礦物皮質酮效果
解決傳統OC體重增加問題
•Antimineralocorticoid
• drsp 會和aldosterone
receptors酫固酮接受體結合
並封鎖酫固酮在腎臟的相關
作用增加鈉及水分的排除
drsp具有抗雄性化效果
有效治療青春痘
•Antiandrogenic
• 直接和雄性素受體競爭，鎖住
雄性素相關作用改善雄性化
相關作用例如皮脂增生出油,
粉刺,青春痘等
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R&D 的努力: (3) 劑型配置的創新減少副作用
Hormone - Withdrawal Symptoms 21天劑型的避孕藥停藥期間副作用機率增加
in 21/7-Day COC Users (cont.) –
縮短停藥期至3-4天可有效降低荷爾蒙消退性症狀副作用
Symptoms
Pelvic pain骨盆腔痛
Headaches頭痛
Breast tenderness乳脹
Bloating/swelling水腫
Use of pain meds吃止痛
劑
Hormone
Treatment
(21 days)
%
HormoneFree
(7 days)
%
21
53
19
16
43
70
70
58
38
69
Sulak P et al. Obstet Gynecol 2000; 95: 261–266.
p-value
<0.001
<0.001
<0.001
<0.001
<0.001
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MSD – Opportunity To Leverage Organon’s
Strong Heritage in Women’s Health
• Organon >40 years of experience in
hormonal contraception
1981
• Innovation Over Time - An impressive
series of “firsts”…
1988
1998
• First low dose estrogen COC
• First and only single-rod contraceptive implant
• Only oral estrogen free contraceptive with a
12-hour missed pill window
1999
2001
• First and only once-a-month contraceptive ring
• First ‘natural’ monophasic COC (licensed from Theramex)
2011+
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蜜蕊娜 Mirena IUS 的裝置
儲藥槽內含主成份
黃體素Levonorgestrel
52 mg
每日定量釋放
20 mcg/day
有效作用長達五年
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
Mirena 蜜蕊娜子宮內投藥系統(IUS)
•局部作用於子宮
•除了避孕的效果外，並有效改善
經血過多、腺肌症、內膜異位等
問題
•保持生育能力
•五年有效、經濟方便
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Implanon
• First introduced in 1998
• First and only single rod
subdermal long-acting hormonal
contraceptive implant
• Contains 68mcg etonogestrel
(progestogen)
• Flexible matchstick size implant
inserted in forearm
• 99.9% effective over 3 years
• Reversible: rapid return to
fertility
Please note Implanon has not been marketed in Taiwan.
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Implanon NXT
• New Features:
– Implant retained in needle
before insertion
– Single movement with slider
– Product shaped to support
easy subdermal insertion
– Addition of Barium Sulfate for
localization via x-ray and CT
Scan
– Launches ongoing in Europa: UK,
Ireland, Germany, Netherlands,
Austria, Belgium, Finland,
Denmark, Norway, other
Please note Implanon NXT has not been marketed in Taiwan.
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NuvaRing 舞悠陰道避孕環
• First introduced in 2002
• Releases 15 mcg EE plus 120
mcg etonogestrel per day
• First and only monthly method
– 3 weeks in, 1 week removed
• Vaginal ring – self-administered
• Steady release of hormones
providing excellent cycle control
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Non-oral hormonal methods
Other methods
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Unintended Pregnancies Remain an Issue
200
Planning status
Annual pregnancies
worldwide (millions)
150
Outcome
Abortion
Unplanned
Unplanned birth
100
50
Planned
Planned birth
0
All pregnancies
Bongaarts J & Westoff CF. Studies in Family Planning 2000;31:193–202
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OC Market Overview in Taiwan
The Major OC Brand in cycle
500,000
450,000
400,000
YASMIN
350,000
DIANE
GYNERA
300,000
LUNAR
MELIANE
250,000
MERCILON
YAZ
200,000
MARVELON
150,000
EVRA
NUVARING
100,000
50,000
0
2007yr
2008yr
2009yr
2010yr
source: IMS 2010Q4
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口服避孕藥的三大作用原理
抑制排卵
使子宮頸黏液層變稠，
讓精子/病原菌不易進入
干擾子宮內膜分泌，
抑制受精卵著床
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口服避孕藥的基本成分
雌激素
+
黃體素
雌激素劑量高低決定劑量多寡：
各品牌使用黃體素不同，各黃體素
也有不同特性，常見的有：
≥50 µg
= 高劑量
30-35 µg = 低劑量
20 µg
= 超低劑量
• DRSP(用於先靈悅己)
• CPA (用於黛麗安)
• levonorgestrel (用於家計系列，
溫不妊及事後丸)
• gestodene (用於祈麗安)
• norgestrel (用於美適濃)
• norgestimate (用於莉芙錠)
*劑量越低不一定越好
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服用口服避孕藥對健康的附加好處
和月經相關的好處
規律月經
降低經痛-50%
降低經血過多-50%
降低缺鐵性貧血-50%
和卵巢相關的好處
和皮膚相關的好處
減少面皰,多毛症
(具抗雄性配方之OCs)
和乳房相關的好處
良性乳房纖維瘤-40%
和子宮相關的好處
降低卵巢癌風險-40%
子宮內膜癌罹患率-40%
改善PCOS
(具抗雄性配方之OCs)
減少骨盆腔炎-50%
卵巢囊腫風險-49~78%
改善子宮肌瘤-17%
改善子宮內膜異位
Adapted from: Drife J.O. The Benefits and Risks of Oral Contraceptives
Today. 2nd edition 1996: Parthenon Publishing, Carnforth UK, p.23
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迷思#1：避孕藥會造成癌症?
 ’07年英國皇家學院家醫科發表一項針對英國女性使用口服
避孕藥與癌症關聯性的研究 。(The Royal College of General
Practitioners’ OC Study,簡稱RCGP Oral Contraception Study)
 該研究涵蓋了339,000婦女年未使用避孕藥的婦女，以及
744,000婦女年使用過避孕藥的人的癌症罹患率。
 該研究指出，使用口服避孕藥和降低罹患數種癌症風險有關，
特別是在降低幾種婦癌方面，相對風險如下 (*statistical
significance)：
─ 子宮癌 0.58* (相較一般人減少42%風險)
─ 直腸癌 0.72* (相較一般人減少28%風險)
─ 乳癌 0.98
Prof. C. Philip Hannaford et al, Cancer risk among users of oral contraceptives. BMJ
2007 ;335:651
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RCGP Study: OC and Lifetime Cancer Risk
RCGP Cohort Study: 1968 – 2004
Hannaford et al BMJ. September 2007
OC Users n = 23,377
Never n = 23,796Users
Organ
RR
CI
Breast
0.98
(0.98 – 1.10)
Ovary
0.54
(0.40 – 0.71)
Uterine Body
0.58
(0.42 – 0.79)
Cervix
1.33
(0.92 – 1.94)
Colo-rectal
0.72
(0.58 – 0.90)
Any Cancer
0.88
(0.83 – 0.94)
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Ovarian Cancer & OC’s
Reanalysis of Data from 45 Studies
Collaborative Group, Lancet 2008; 371:303-314
Duration OC
RR
Less than 1 yr
1.00
1 – 4 yrs
0.78
5 – 9 yrs
0.64
10 – 14 yrs
0.56
> 15 yrs
0.42
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口服避孕藥不增加乳癌風險
• 新近研究指出，使用口服避孕藥並不會增加乳癌罹患機率2。
– ‘02年於新英格蘭醫學雜誌刊登，由美國國家疾病管制中
心發表的論文指出，使用口服避孕藥和增加乳癌罹患風
險並無關聯1 ！
– ’06年研究指出，使用口服避孕藥並未增加乳癌風險3
– ‘07年RCGP Oral Contraception Study英國皇家學院家醫
科發表之大規模研究指出：使用口服避孕藥者罹患乳癌
的機率和未使用者相同4。
(1).Marchbanks PA et al. Oral contraceptives and the risk of breast cancer. N Engl J Med. 2002 Jun 27;346(26):2025-32.
(2) Heinemann LAJ, Lewis MA, Kühle-Habicj D, Braendle W, Moehner S. The risk of breast tumours and lifetime history of
oral contraceptive use. Geburtsh Frauenheilk 2002:750-757.Adapted from: Drife J.O.
(3)Vessey M & Painter R. Br J Cancer 2006: 95:385-9
(4) Prof. C. Philip Hannaford et al, Cancer risk among users of oral contraceptives. BMJ 2007 ;335:651
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口服避孕藥具有正面的好處
• 2010二月: 避孕藥可預防卵巢癌及子宮內膜癌[i]
[i] National Cancer Institute. Oral Contraceptives Reduce Long-Term Risk of
Ovarian Cancer. Retrieved from
http://www.cancer.gov/cancertopics/prevention/ovarian/oral-contraceptives on
February 23, 2010
• 根據ＢＭＪ2010三月的研究結果，來自招募
46000 位女性，追蹤近 40 年，觀察超過百萬女
性的研究:
(1) 長期服用口服避孕藥的女性，相較於未曾服用
過的女性，不論什麼死因，包括所有癌症和心
臟疾病，死亡率都較低，尤其是腸癌、子宮癌、
卵巢癌。約為每年每 10 萬女性，少了 52 人。
(2) 長期使用避孕藥不會增加死亡風險
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口服避孕藥對子宮頸癌的影響
•某些流行病學研究指出長期使用口服避孕藥可能和增加子
宮頸癌風險有關，但是仍有爭議點：
– 相對風險1：
• 使用>5年;5-9年；>10年的風險分別為1.1,1.6 & 2.2
– 但子宮頸癌的重要致病因子是透過性行為所傳染的人類乳突病
毒(HPV)，特別是HPV16 &HPV18型，其他都是次要的輔助因
子( Co-factor)，也就是說如果沒有HPV感染(如無性行為)，長
期使用避孕藥也幾乎不可能罹患子宮頸癌2,3。
– 不確定性伴侶的”安全性”時，應加用阻隔式方法(如保險套)來
預防STIs。
(1)Smith JS, Green J, Berrington de Gonzalez A, et al. Cervical cancer and use of hormonal
contraceptives: a systematic review. Lancet 2003; 361:1159-1167. (2) Miller K, Blumenthal P,
Blanchard K. Oral contraceptives and cervical cancer: critique of a recent review.
Contraception. 2004 May;69(5):347-51. (3) Moodley J. Combined oral contraceptives and
cervical cancer. Current Opinion in Obstetrics & Gynecology. 16(1):27-29, February 2004.
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迷思#2：避孕藥會影響生育能力?
• 真相：大部分女性停止服用避孕藥後會迅速恢復服用前的生育能力。
• 生育能力會受年齡的影響，許多女性在較年輕時以服用避孕藥作為避
孕工具，等到決定停藥時，她們的年齡已降低了她們懷孕的機率，因
此造成避孕藥會影響生育能力的錯誤觀念。避孕藥實際上可預防子宮
外孕與肌瘤，這些狀況可能都會影響生育能力。
• 針對服用避孕藥前經期不順的女性，可能需要一段時間生育能力才會
恢復。
• Human Reproduction’ 2002年第17期發表的研究證實：
– 延長使用口服避孕藥的期間，可明顯的增加於停藥後12個月內成功
懷孕的機率，尤其當使用口服避孕藥的期間至少>5年。
– 延長使用口服避孕藥的期間，也會降低較晚受孕／不易受孕的風險，
長期使用口服避孕藥也和改善生育力有關聯。
– 服用口服避孕藥期間的長短與否並沒有任何不利於懷孕的缺點；相
反的，高達74%的口服避孕藥使用者可成功地在停藥後的6個月內
成功受孕！
• 準備受孕前，無需等停藥超過2-3個月。
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迷思#3：避孕藥需要吃一陣子停一陣子?
•
吃一陣子，停一陣子起源於早期對口服避孕藥長期使用的影響及安
全性不清楚。迄今口服避孕藥已被人類使用超過40年，是少數幾種
被研究最透徹的藥品品項之一。
•
任意停用反倒增加意外懷孕風險。研究顯示，1/4的女性會在“刻意
進行的停藥期“意外受孕1。
•
刻意進行停用對身體並無額外特殊好處。規律性地服完一包OC‘s後
的停用期，其實已給身體足夠的 “休息” 1 。(約每3週停1次)
(1) Guillebaud J. Contraception Today, Fourth edition 2000, Martin Dunitz, London: p.58.
Leidenberger F.A. Klinische Endokrinologie für Frauenärzte 1992, Springer Verlag Berlin, Heidelberg:
p.401-402.
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迷思#4：避孕藥對停藥後的懷孕胎兒會有不良影響?
• 答案是不會。
– 廣泛的流行病學研究顯示在懷孕前使用口服避孕
藥並未有增加流產或生產缺陷的發生1。
– 口服避孕藥也無增加男胎女嬰化or女胎男嬰化的
機率1 。
– 有限的研究顯示，無意間在懷孕初期使用口服避
孕藥並未觀察到畸胎機率有增加的情況1 。
Guillebaud J. et al. Contraception-a user‘s guide. Third edition 2000, Oxford University Press, London:
p.30.
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血栓發生率比較
無血栓危險因子
者的原發性血栓
EURAS/Ingenix(無
風險因子 + 有風險
因子者6)
其它研究1,2,3,4
未使用避孕
藥/一般大眾
1 /10,000
5 per 10,000
5 /10,000
避孕藥使用
者
3 /10,000
9-14/ 10000
4 /10,0005
懷孕女性
6 /10,000
29/10000
20 /10000(未校正)
29*/10000 (校正後)
(adjusted to the age
distribution of
Caucasians in the
U.S.) 1,2,3
1 James AH, Venous thromboembolism during pregnancy and the postpartum period: Incidence, risk factors and mortality: Amer Journal of Obstetrics and Gynecology
2006; 194: 1311-5.
2 Heit JA. The epidemiology of venous thromboembolism in the community: implications for prevention and management. J Thrombolysis 2006; 21: 23-29
3 Silverstein MD, Heit JA, Mohr DN, Petterson TM, O’Fallon WM, Melton LJ, 3rd. Trends in the incidence of deep vein thrombosis and pulmonary embolism: a 25-year
population-based study. Arch Intern Med 1998; 158:585-593.
4 Jick S et al. Risk of Venous thromboembolism in women using a contraceptive patch and oral contraceptives containing norgestimate and 3µg of ethinyl estradiol.
Contraception 73 (2006) 223-228
5James AH, Venous thromboembolism during pregnancy and the postpartum period: Incidence, risk factors and mortality: Amer Journal of Obstetrics and Gynecology
2006; 194: 1311-5.
6.EURAS Study ;Dinger JC al. Contraception 2007 ; 75(5):344-54
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導致靜脈栓塞的危險因子
•
•
•
•
•
•
•
•
•
年紀增長
BMI 身體質量指數增加
體重增加
某些心血管疾病因子 (如三酸甘油脂增高)
懷孕/ 生產 / 產後階段
基因遺傳因素, 凝血異常
家族或個人有VTE病史
使用雌激素和黃體素複合製劑
鮮少移動(如臥床、長途飛行、創傷或開刀等)
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口服避孕藥對心血管的影響
• 服用口服避孕藥和缺血性中風的關聯
– 缺血性中風極少發生在年輕的育齡婦女1：
– 20-24歲：6例/100萬名
– 40-44歲：16例/100萬名
– 使用低劑量口服避孕藥並未增加缺血性中風的風險3。
– 有長期偏頭痛的使用者風險較高3。
(1). T.M. Farley, O. Meirik and J. Collins, Cardiovascular disease and combined oral contraceptives: reviewing the evidence and balancing
the risks. Hum Reprod Update 5 (1999), pp. 721–735. (2) WHO Collaborative Study of Cardiovascular Disease and Steroid Hormone
Contraception. Ischaemic stroke and combined oral contraceptives: results of an international, multicentre, case-control study. Lancet
1996;348:498-505. (3) S.M. Schwartz, D.B. Petitti, D.S. Siscovick, W.T. Longstreth, Jr., S. Sidney, T.E. Raghunathan et al., Stroke and use
of low-dose oral contraceptives in young women: a pooled analysis of two US studies. Stroke 29 (1998), pp. 2277–2284.
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誰不適合使用口服避孕藥?
哪些人適合使用口服避孕藥?
“For many young women the most suitable
initial method currently remains a modern
, low-estrogen,combined OC, backed by
good counselling. Once periods have been
established there appear to be no problems
of the pill for teenagers, as compared with
women with their early 20s” *
年輕、健康女性使用低劑量口服避孕藥
利多於弊。
年輕健康女性、35歲以上不吸煙的女性
且均無高血壓或其他上述疾病相關風險
的人可以安心地使用口服避孕藥。
*John Guillebaud (Medical Director of Margaret Pyke
Center, London, UK) , p3 of Contraception Today,
4th edition. 2000.
女性已有/曾有下列症狀，不適用OC
• BMI > 39
• 自身或家族有血栓症病史
• 出現持續性高血壓
• 併有焦點神經症狀的偏頭痛
• 出現或曾有中風或心肌梗塞的徵兆.
• 併有血管問題的糖尿病
• 肝功能異常及肝功能指數不正常
• 胸部或生殖器官的癌症
• 現有或曾有肝臟腫瘤(良性或惡性)
• 已懷孕或有懷孕的可能性
• 需要授乳(OC會影響乳汁分泌)
• 35歲以上+吸菸
• 不明原因的陰道出血
• 對口服避孕藥的任一成分過敏 Jeng
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The Pill Disaster and Breast Cancer Mortality
Overall the standardized mortality rates were highest in
countries where most women had been exposed to
either the Pill and/or HRT. Four times more women died
of breast cancer in the USA than in Japan where,
although the contraceptive Pill had not been allowed,
there had been some hormone use.
Standardized Mortality Rates
Gambia
3.4
Japan
21.9
England and Wales
56.1
Australia NSW
59.6
Scotland
62.5
USA (white)
89.2.
McPherson K, Steel CM, Dixon JM. ABC of breast diseases. Breast cancer-epidemiology,
risk factors, and genetics. BMJ. 2000 Sep 9;321(7261):624-8
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The Pill Disaster and Breast Cancer Mortality
DMPA and other OC's are known to deplete folic acid which
arrests cell division creating folate fragile sites on DNA strands
which in turn makes them susceptible to viral invasion (eg: HPV)
as well as other potential mutagens. These drugs can also create
a cellular zinc deficiency which further exacerbates abnormal cell
division and differentiation (5,6). Since the early 1960's, when
contraceptive hormone use began, the occurrence rate of
endocervical adenocarcinoma has increased, especially in young
white women (7). Over the past fifty years, the rate has gone from
5% to almost 25% and it continues to rise (8). Contraceptive
hormone changes in cervical cells should not be taken lightly.
They are clearly early signs of disease change, and if left ignored
(eg: no increased micronutrient support or rest from the
hormones) could manifest into cancer, heart disease, or stroke.
Suzanne L. Adams, 21 July 2007
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The Pill Disaster and Breast Cancer Mortality
One of the biggest reasons why the "The Pill"
is so bad is because it depletes folic acid.
When women, especially those with poor
dietary and lifestyle practices, stop taking it
and try to conceive, their offspring have a
much greater risk of developing birth defects
of brain and spinal cord as well as others such
as heart defects, cleft palate, mental
retardation, etc.
SUZANNE L. ADAMS, 28 April 2007
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The Pill Disaster and Breast Cancer Mortality
Synthetic estrogen, regardless of the kind, is a known
carcinogen and growth hormone. Would you give it to your
daughter or mother, especially on a daily basis, if you paid
attention to this fact? Finally, the reason why pesticides are
thought to be carcinogenic is because they mimic the effects
of estrogen as they are so similar in their molecular structure
they bind where estrogen should bind. In conclusion, we are
being inundated with estrogen exposure from many sources,
including those of which we have no control over. Synthetic
estrogen is probably the most toxic carcinogen ever invented.
I thank God for the WHO studies which finally proved how
deadly this steroid drug has been and still is.
SUZANNE L. ADAMS, 28 April 2007
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The Pill: A Notoriously Booby Trapped Panacea
"The explosion of medical litigation in the most litigious of all
countries, the United States, started in the 1960s with the pill, with
consequences—beneficial and counterproductive—that greatly
affected the regulatory process for many other drugs." (Carl Djerassi)
The explosion of medical litigation is also one of the biggest financial
burdens in the US healthcare system, the cost of which is passed on
in the form of prohibitively high healthcare costs and insurance
premiums for patients, employers, and physicians. This problem has
risen to a crisis level and is now crippling the once world class US
healthcare system where it is causing many doctors to either retire
early or sacrifice once lucrative careers to pursue other professional
options.
David V Picella, 23 April 2007
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The Bitter Pill – A Disaster not a Breakthrough
How can use of a carcinogen be a great medical breakthrough? Organic chemist Carl
Djerassi repeats many of the myths about the Pill claiming unrealistic enormous
benefits. He appears unaware, or chooses to ignore the fact, that the Pill was
classified as "carcinogenic to humans" (Group 1) by the International Agency for
Research on Cancer (IARC) in 2005.2
The incidence of breast cancer has doubled since the introduction of the Pill in the
UK. Breast cancer now affects nearly one in 7 women over a life time. It is the
commonest cause of death from cancer up to age 60. The Pill (progesterones and
oestrogens) also increase the risk of cervical cancers, and also ovarian cancers when
given as HRT. The Pill increases the risk of numerous vascular, mental and
immunological diseases and also congenital abnormalities if taken during pregnancy.
The carcinogenic and vascular effects of progesterones and oestrogens are confirmed
so quickly that the world’s largest HRT trials have been terminated prematurely.
A chapter in my book, “The Bitter Pill” gives the evidence for the Pill being “Even
Worse than Smoking” by causing migraine, heart attacks and cervical cancer in a
much shorter time. A synergistic effect with smoking has now increased lung cancer
deaths in women.
Ellen C G Grant, 9 January 2007
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Thank you for your attention !!!
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