Endometriosis子宫内膜异位课件解析.ppt

“He who knows endometriosis knows gynecology”  Surgery: Pros and cons Pros Proven efficacy Cons Invasive Costly Certain risks Due to high recurrence risk (~50% 5 yrs), 2nd surgery may be needed Increases the risk of damaging ovaries, and the risk of premature ovarian failure Medical treatment: Expectant treatment Use NSAIDs Asprin Other analgesics such as ibuproten Selective COX-2 inhibitors Little impact, if any, on endometriotic lesions Follow-up Medical treatment Principles (for current treatment modalities) To suppress ovarian estrogen production (GnRH-a and danazol) necessary for the development and maintenance of ectopic endometrium To induce a pseudo-pregnency (progestins and OC), which suppresses ovulation and estrogen production With reduced estrogen production, endometriotic lesions may shrink in size or may be eliminated All are short-term; recurrence after termination All have various side-effects ~10% simply do not respond to pregestin therapy Progestin treatment Based on a serendipitous finding that pregnancy relieves the sysmptoms of endometriosis Mechanism of action (MOA) Suppresses ovulation Suppress the growth of endometriotic lesions Reduce inflammation Progestins Oral Norethisterone acetate Cyproterone acetate Dienogest Intramuscular route Medroxiprogesterone acetate Intrauterine route Levonorgestrel-releasing IUD Side-effects Spotting, hot-flashes, breakthrough bleeding GnRH agonists treatment MOA Negative feedback control of ovarian estrogen production Method of administration Injection Side-effects Hot-flashes loss of libido vaginal dryness, decreased bone density Quite expensive Danazol treatment Danazol is a modified androgen 2.5-3.5% of activity of methyl testosterone MOA Antagonizes estrogen at the tissue level Blocks estrogen receptor sites Suppresses ovulation (and thus estrogen production) Alters pulsatile GnRH release patterns Side-effects: weight gain, acne, hirsutism, … Decreased use after GnRHa introduction Treatment wi