14子宫内膜异位症.pptVIP

* Nonmedical options for endometriosis patients include expectant management, pregnancy, or menopause. Interruption of ovulation and menses in pregnancy and menopause leads to atrophy of endometrial implants and stops the development of new lesions. During pregnancy, sex hormone levels are consistently high, causing endometriosis lesions to atrophy over time. Menopause causes endometriosis lesions to regress due to lack of hormonal stimulation. These may provide viable alternatives for a small number of women with mild or moderate disease. * * Endometriosis treatment using pharmacologic agents attempts to interrupt the menstrual cycle, halting normal variations in estrogen and progesterone levels and inducing pseudomenopause or pseudopregnancy. When estrogen and progesterone production are halted, neither normal endometrium nor endometriotic lesions cycle. ? Historically, a variety of drugs have been used to produce pseudopregnancy, including continuous oral contraceptives and progestins. Methyltestosterone, an androgen, was also used to induce atrophy of the endometrium and endometriotic lesions. ? The first drug developed specifically to treat endometriosis was danazol (Danocrine? /Sanofi Pharmaceuticals, Inc.). The drug effectively interrupted menstrual cycling and had fewer side effects than the earlier androgens. However, ovarian hormone suppression is not complete with danazol. ? Subsequently, GnRH agonists were introduced to suppress pituitary and ovarian function. Several agonists are available to manage endometriosis. * * Consistent levels of a GnRH agonist leads to persistent activation of GnRH receptors. This activation results in an initial release of LH and FSH previously produced and stored in the pituitary. However, the release is rapidly followed by down-regulation of GnRH receptor expression and profound suppression of LH and FSH secretion. As a result, the production of estrogens and progesterone in the ovaries falls to levels similar to thos