Zhang Shaofen
Fudan University
Title: Efficacy of GnRHa plus Yasmin or Mirena in the treatment of polycystic ovarian syndrome with a typical hyperplasia in patients with adenomyosis accompanied with dysmenorrhea
Biography
Biography: Zhang Shaofen
Abstract
Objective: To investigate the efficacy of GnRHa plus Yasmin or Mirena in the treatment of polycystic ovarian syndrome (PCOS) with a typical hyperplasia in patients with adeno myosis accompanied with dysmenorrhea. Methods: The patients of PCOS with severe dysmenorrhea of adenomyosis had severe abnormal uterine bleeding and a typical hyperplasia confirmed by the diagnostic uterine curettage, accompanied by high insulin and high testosterone levels in blood plasma. Through blood transfusion and hormone hemostasis, the patients' condition was stable. After menstruation, we started GnRHa treatment. GnRHa was subcutaneously injected at a dose of 3.6mg each time for 6 times (once every 28 day) to induce pseudo-menopause, followed by oral administration of Yasmin for three cycles. Afterwards, curettage was performed before the next menstruation since the discontinuance of Yasmin, followed by administration of Yasmin or Mirena, each in combination with DMBG (0.85mg) for 12 cycles. During this 12 cycles-long period, endometrial thickness (two-layer), menstrual amount, uterus volume, dysmenorrhea severity (VAS score), hemoglobin level, serum insulin level, androgen level and body weight were measured at each fellow-up regularly. Results: After the treatment, a conversion from atypical hyperplasia into simple hyperplasia or proliferative endometrium was observed, with marked decreases in endometrial thickness (22mm vs. 4mm), uterus volume (251.04cm3 vs. 180cm3) and menstrual amount and the menstrual cycle became regular, along with alleviated dysmenorrhea (7’ vs. 3’). Meanwhile, hemoglobin level was increased (4-6g/l vs. 13.2g/l) and serum insulin and androgen levels were reduced; patient body weight also dropped, which declined from 102kg to 87kg in one case. Conclusions: GnRHa treatment with either Yasmin or Mirena can effectively alleviate endometrial hyperplasia, relieve dysmenorrhea, diminish adenomyotic lesions and reduce serum insulin and androgen levels in PCOS patients with a typical endometrial hyperplasia and adenomyosis accompanied with dysmenorrhea.