Principles of hormonal treatment of menstrual disorders
Endocrinology / / May 22, 2016
Hormone therapy of menstrual disorders is aimed at the normalization of neurohormonal relationship underlying the clinical manifestations of disease.The basic principles of hormone therapy is the replacement of the missing function of the endocrine glands in its initial violation (replacement therapy) or stimulation of the activity of the gland hormones triple if the disease is the consequence of a breach of regulatory effects (stimulation therapy).However, this division into a stimulating and replacement therapy is largely conditional, as replacement therapy in relation to the same hardware can be challenging to her iron-dependent.
there are certain schemes that can be used as a basis for the treatment of hormone treatment of menstrual disorders.However, the diagram shows only the basic treatment principle, which in each case should be individualized.
replacement therapy is indicated for the initial decrease in ovarian activity (hypoplasia of the ovaries), causing amenorrhea II
Creating the mother of the menstrual cycle is a variant of substitution therapy.In severe uterine hypoplasia and absence of sufficient endometrial proliferation using estrogen and progesterone can reproduce the endometrial cycle, t. E. By the expression of endometrial proliferation to a state corresponding to the mean follicular phase of the cycle, and then get through the introduction of progesterone secretory transformation.In addition, periodic administration of hormones in a certain rhythm (if ovarian hypoplasia caused by violation of regulatory influences) alter the functional state of the hypothalamic-pituitary system, and leads to further self-adjustment of the trigger of the menstrual cycle.For this purpose, can be recommended drugs estrone (estrone) 10 000-20 000 IU intramuscularly every other day for 20 days.Then progesterone is administered for 7 days (0.5% oil solution) in 10 ml daily.Folliculin may be replaced by 0.1% to 1 mL diethylstilbestrol intramuscularly every other day, or 0.1 to 1% Sinestrola ml daily as well as estradiol dipropionate (1 ml every 3 days for 20 days).Then just as estrone and after therapy, progesterone is administered to 10 mg during 7 days.
In sharp degrees of hypoplasia of genitals to stimulate their development, we recommend long-term administration of estrogen (2-4 months).To do this, you can assign estrogenic drugs or long-acting analogues - estradiol-dipropionate or diethylstilbestrol 1 mL of 0.1% -1.0 1 every 3 days by intramuscular injection.Diethylstilbestrol 0.5% - 1.0 are encouraged to nominate 1 every 7-10 days.Per os recommended to assign 0.2 mg of ethinyl estradiol, diethylstilbestrol 0,001 sublingual daily.Preparations estrone less convenient due to the duration of treatment and the need for frequent injections.The criterion for the duration of the treatment is to increase the size of the uterus gipotrofichnoy and cytological picture of vaginal smears.Upon reaching proliferation corresponding average normal follicular phase of the cycle, it is recommended to stop administering estrogen and progesterone to designate the same doses as in the creation of uterine cycle.In case of bleeding while menstrualnopodobnoe some estrogen treatment should be discontinued and a switch to replacement therapy with estrogen and progesterone.
menstrual cycle successfully reproduced drugs prolonged action.The 1-day treatment is given intramuscularly 1 ml of a 20 mg prolonged release estradiol (delestrogen), containing 20 mg of estradiol valeryanata.On the 15th day of treatment administered 5 mg delestrogen and 250 mg of long-acting progesterone (delaluton), containing 250 mg hydroxyprogesterone caproate,.14 days after the second injection begins menstrualnopodobnoe bleeding.
In milder cases, hypoplasia of the ovaries is recommended for oral ethinyl estradiol 0.02 mg or diethylstilbestrol to 0,001 sublingually for 20 days.From 20-day cycle assigned for 7 days pregnin 2 tablets (0,005 mg per 1 tablet) 3 times daily or 10 mg progesterone intramuscularly for 7 days.It should be noted that diethylstilbestrol is contraindicated in diseases of the liver, and sometimes causes nausea and vomiting.
Cyclic replacement therapy should be done at least 3-5 consecutive cycles.
stimulating therapy aims at the establishment of ovulatory menstrual cycle.It is used in cases where amenorrhea and other cycle disorders are a consequence of regulatory influences, and is not effective in lesions of ovarian parenchyma.
supportive therapy may be directed to: a) recovery of ovarian function introduction gonadotropin-releasing hormone;b) restoration of the function of the hypothalamic centers that regulate the activity of the pituitary, which is achieved by the introduction of shock doses of estrogen and progesterone, the introduction of drugs such as nonsteroidal clomiphene.
Treatment Principle HCG is to induce the maturation of ovarian follicles using a follicle-stimulating hormone, and then create a corpus luteum phase luteinizing hormone.In some cases, such as when some of anovulatory cycles when there is sufficient follicular growth and development, it is recommended to treat with the drugs only luteinizing action, which is used as human chorionic gonadotropin (hCG).HCG is recommended to introduce a day of 1500 units from the 12th day of the cycle 3-4 times.
But very often necessary to combine the use of drugs with the action of FSH and LH due to insufficient development of follicles.As preparations with FSH activity was often used serum gonadotrophin from pregnant mares (FFA).FFA Staemler recommends administered starting from 300 IU per day for 4 days, and then for 12 days, gradually reducing the dose.Simultaneously with FFA hCG is administered in doses of 250 units for 4 days, 4 days 500 IU and 1500 IU 4 days intramuscularly.However, the FFA does not have a synergistic action with CG, so as better to use follicle stimulating hormone FSH preparations pituitary gonadotropins or drug from the urine of postmenopausal women.As
FFA and pituitary FSH animal produce antibodies in humans and therefore can not be applied continuously.The best effect is obtained when treating gonadotropic preparations derived from human pituitaries.The pioneer of this type of treatment were Gemzell etc. By using human pituitary FSH Crook recommends the following regimen:. Total dose of pituitary FSH equivalent to 4000-72000 IU IRP-HMG (relative international standard of gonadotropins from the urine of postmenopausal women).It is given in 3 injections for 8 days.After 2 days, introduced XG 12000-24000 ED 1 again after the last injection of FSH.The author received a reproduction of a normal menstrual cycle with his characteristic magnitude and dynamics of excretion of estrogen and pregnandiol.9 In the treatment of women with amenorrhea and low levels of gonadotropins Crook all of them made of ovulation and pregnancy 7.
Treatment of shock doses of progesterone and estrogen
In the absence of severe atrophy of sexual organs and, in particular atrophy of the endometrium, may be recommended shock doses of progesterone and progesterone with estrogen.At the same time following the treatment cycle can be fixed right the cyclical activity of hypothalamic centers achieved during treatment.Shock dose of progesterone is recommended mainly in the presence of the normal state of the genital organs with pronounced proliferative smears, which is an indirect sign of endometrial proliferation and the presence of well-developed follicles.In the presence of atrophic changes in the genitals to pre-estrogen therapy to the highest possible degree of proliferation.The ratio of doses of estrogen with progesterone should be 1/20 or 1/30.Mostly prescribers for parenteral administration.It is recommended to be administered 1 mg estradiol-dipropionate and 25-30 mg of progesterone (together) by intramuscular injection for 3 consecutive days.Krovootdelenie comes after the abolition of administration of hormones on the 3-4th day.After a successful first year of treatment is recommended to spend 3-4 more of the same course of treatment with the 21-th to 23-day cycle.With the help of functional diagnostics tests determined the presence of monophasic or biphasic menstrual cycle.If monophasic cycle, treatment should be continued until a two-phase cycle.At irregular anovulatory cycles, which are based on the premature death of the follicle (polimenoreya), the introduction of estrogen can prevent the premature onset of krovootdeleniya.If simultaneously with estrogens administered progestins, may be obtained secretory transformation of the endometrium.In short anovulatory cycles (17 to 20 days) treatment should start no later than 2 days before the anticipated onset of bleeding.
recommended for sublingual use ethinyl estradiol and 0.01 mg pregnin 2 tablets (1 tablet of 0.005 mg) three times a day with 15-16 to 25-26 of the first cycle of the day.Parenteral recommended 5-10 thousand. IU estrone and 10 mg of progesterone on the same days of the cycle.After increasing the duration of the cycle (after 2-3 courses of treatment) is recommended to go for the treatment of shock doses of progesterone with estrogen to establish spontaneous ovulatory cycles.
- ovarian hormones.Estrogens
- ovarian anatomy
- ovarian hormones.Androgens
- menstrual cycle Hormonal
- menstrual irregularities
- tests of functional diagnostics of ovarian activity
- Violation monthly rate.Amenorrhea
- Violation of the menstrual cycle with monthly rhythm disorder.Opsomenoreya
- Violation of the menstrual cycle with monthly rhythm disorder.Polimenoreya
- Treatment of chronic adrenal insufficiency
- Diseases thymus (thymus) gland
- relationship with the thymus gland endocrine glands
- thymus gland and its physiology
- Violation bleeding intensity in the menstrual cycle.Dysfunctional uterine bleeding
treatment with clomiphene
The literature notes the successful use of the drug clomiphene to induce ovulation.Clomiphene is a substance nonsteroidal nature (analogue hlorotrianizina) with a pronounced effect on the hypothalamic-pituitary system.In high doses, this drug has anti-estrogenic effects, inhibits ovulation.In small and medium doses, it has such an impact on gipotalamogipofizarno-ovarian system in which processes are stimulated ovulation.Action clomiphene through the hypothalamus by the fact that a number of patients in the treatment of clomiphene increases appetite and tested tides.According to several authors, clomiphene causes the release of pituitary gonadotropins.At the same time capable of clomiphene in in vitro conditions and processes directly stimulate estrogen biosynthesis in placenta preparations.
clomiphene is administered for 21 days to 25 mg as a citrate salt.If the dose is ineffective, it was increased to 50 or even 100 mg.
Clomiphene is not effective in lesions of ovarian parenchyma.
In 20 of the 25 patients treated with clomiphene led to the type of ovulatory menstrual cycle.Clomiphene is effective in treating some forms of amenorrhea, anovulatory cycles, syndromes Cheari - Frommelya and Stein - Leventhal.
clomiphene dose should be chosen with care, because it often gives complications in the form of education follicular and luteal ovarian cysts.