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PCOS

Efficacy of GnRHa plus Yasmin or Mirena in the treatment of polycystic ovarian syndrome with atypical hyperplasia in patients with adenomyosis accompanied with dysmenorrhea Speaker: Xu Linna Corresponding author :Zhang Shaofen

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PCOS

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  1. Efficacy of GnRHa plus Yasmin or Mirenain the treatment of polycystic ovarian syndrome with atypical hyperplasia in patients with adenomyosis accompanied with dysmenorrhea Speaker: Xu Linna Corresponding author :Zhang Shaofen Obstetrics and Gynecology Hospital of Fudan University China

  2. PCOS

  3. Adenomyosis

  4. Women’s Health • PCOS + Adenomyosis+ Atypical hyperplasia ?

  5. Case 1 • Name：Zhu Chunyan • Age：36 • Menstrual cycle：10/35-45days • Reproductive History:0-0-0-0 • Dysmenorrhea:9′ （VAS） • Height and weight :153CM /75kg • BMI：32

  6. Case 1 • Hemoglobin：4.3g/l • six steroid sex hormones ： • FSH:6.77mIU/ml LH:15.64mIU/ml PRL:16.08ng/ml E2:32pg/ml P:1.34ng/ml T:0.91ng/ml • thyroid related hormones TSH:2.3uIU/ml T3：1.18ng/ml T4：5.25ug/dl • insulin secretion test：INS(empty stomach)    33.09 mU/L • GLU(empty stomach)    4.8mmol/l INS(0.5h)    97.55mU/LGLU(1h)      8.1mmol/l     INS(1h)      163.02mU/L • GLU(2h)      6.2mmol/l      INS(2h)      127.28mU/L • GLU(3h)      5.8mmol/l      INS(3h)      72. mU/L • Facial acne: severity • Hirsutism：+ acanthosis：+

  7. The process of the diagnosis and treatment The first day of hospitalization: B ultrasound reveal:the size of uterine is 94*101*75mm3,theendometrial thickness is 23mm（ double lining ）.Two ovaries is polycystic ovary.

  8. The process of the diagnosis and treatment 1.by the diagnostic uterine curettage and pathological examination Atypical endometrial hyperplasia 2. blood transfusion to improve the severe anemia 3. Yasmin treated for 3 days(1# tid po) then discharge from hospital Yasmin 1# bid po for 5days,without vaginal bleeding followed with Yasmin 1# qd po*14 days

  9. The process of the diagnosis and treatment  4. Zoladex（ GnRHA） was subcutaneously injected at a dose of 3.6mg for 6 times (once every 28 day) to induce pseudo-menopause

  10. The process of the diagnosis and treatment 5.Followed by oral administration of Yasmin for three cycles 6.Afterwards, curettage was performed before the next menstruation Pathology showed proliferative endometrium

  11. Pathology Atypical endometrial hyperplasia Proliferative endometrium

  12. The process of the diagnosis and treatment 7.With administration of Mirena in combination with DMBG (0.85mg bid po) for 12  cycles after the menstruation

  13. Results

  14. Case 2 • Name：Zhang Ziyi • Age：17 • Menstrual cycle：10/35-90days • Reproductive History:0-0-0-0 • Dysmenorrhea:9′ （VAS） • Height and weight :171CM /95kg • BMI：32.4

  15. Case 2 • Hemoglobin：6.7g/l • six steroid sex hormones ： • FSH:6.77mIU/ml LH:15.75mIU/ml PRL:9.08ng/ml E2:49pg/ml P:1.64ng/ml T:1.1ng/ml • thyroid related hormones TSH:3.8uIU/ml T3：1.51ng/ml T4：5.32ug/dl • insulin secretion test： INS(empty stomach)    35.23 mU/L • GLU(empty stomach) 4.8mmol/l INS(0.5h)    93.25mU/LGLU(1h)      8.3mmol/l     INS(1h)      173.02mU/L • GLU(2h)      6.7mmol/l      INS(2h)      167.18mU/L • GLU(3h)      5.9mmol/l      INS(3h)      85.45 mU/L • Facial acne: severity • Hirsutism：+ acanthosis：+

  16. The process of the diagnosis and treatment 1.B ultrasound reveal：the size of uterine is96*85*75mm3,theendometrial thickness is 22mm( double lining )Two ovaries is polycystic ovary 2.by the diagnostic uterine curettage and pathological examination:atypical endometrial hyperplasia 3.Then diane-35+norethindrone for bleeding stop and ferrous succinate to improve the severe anemia

  17. The process of the diagnosis and treatment 4.Zoladex（GnRHA） was subcutaneously injected at a dose of 3.6mg for 6 times (once every 28 day) to induce pseudo-menopause 5.followed by oral administration of Yasmin for three cycles 6.Afterwards, curettage was performed before the next menstruation Pathology showed proliferative endometrium

  18. Pathology Atypical endometrial hyperplasia Proliferative endometrium

  19. The process of the diagnosis and treatment 7.With administration of Yasmin in combination with DMBG (0.85mg) for 12  cycles after the menstruation

  20. Results

  21. CONCLUSION GnRHa treatment with either Yasmin or Mirena can effectively alleviate endometrial hyperplasia, relieve dysmenorrhea, diminish adenomyotic lesions, and reduce serum insulin and testosdterone levels in PCOS patients with atypical endometrial hyperplasia and adenomyosis accompanied with dysmenorrhea.

  22. Women’s Health

  23. Thank You For Your Attention !

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