Principles of hormonal treatment of dysfunctional uterine bleeding
Endocrinology / / August 12, 2017
At present, for the treatment of dysfunctional uterine bleeding is used progesterone, estrogens and androgens.However, hormone therapy can be carried out only after dilatation and curettage of the endometrium.uterine curettage in patients with juvenile bleeding must be carried out only as a last resort, if all the hormonal and symptomatic treatment methods are ineffective, especially when increasing anemia.The histological study scraping exclude malignant diseases of the uterus is removed hyperplastic endometrium and kroveotdelenie stop temporarily.However, uterine curettage should only be carried out to stop the bleeding, because it brings only a temporary effect.
application of progesterone with dysfunctional uterine bleeding is based on its ability to induce secretory transformation of hyperplastic endometrium and on the ability to influence the regulation of sexual cycle through the hypothalamic centers, which leads to the restoration of normal ovulatory cycle.
the presence of dysfunctional uterine bleeding progesterone is administered at 10 mg for 7 days by intramuscular injection.In the treatment of bleeding progesterone either decreases or stops gradually.However, after the introduction of progesterone krovootdelenie strengthened again due to falling levels of progesterone during the secretory rejection of the changed mucosa.This new enhancement krovootdeleniya like menstrual bleeding occurs, however, it may be very abundant in some cases, since the endometrium could be hyperplastic sharply, especially in patients who had a long delay periods.In addition, the duration and intensity krovootdeleniya depends on uterine capacity.In cases of abundant krovootdeleniya recommended to appoint intramuscularly uterus reducing drugs (ergotamine, pituitrin, pregnantol, mammofizin, genofort) and administered by intramuscular injection of 10 mg of gelatine.
more effective method is the introduction of large doses of progesterone shock (from 50 to 200 mg intramuscularly) once or over a short period of time.The introduction of large doses of progesterone for the first time short courses offered Zondek.It is recommended to be administered by intramuscular injection of 25-30 mg of progesterone (5-6 ml of 0.5% solution) for 3 days in a row during bleeding.Just as in the treatment of small doses of progesterone bleeding initially decreases and then, after stopping the treatment, re-amplified and lasts for 4-5 days.
the purpose of fast creation of high blood concentrations of progesterone used intravenous drugs progesterone action (lyuteotsiklin, prolyudon).After intravenous administration of 10 to 20 mg of these drugs stop bleeding after 8-10 hours in 80% of patients.Just as with intramuscular progesterone, 3-4 days krovootdelenie again amplified by the rejection of secretory changes in the endometrium.
For the treatment of dysfunctional uterine bleeding can be used with drugs progestativnym action employed in sublingual tablets and orally.Pregnin (ethinyl-testosterone) used sublingual bleeding during 2 tablets three times a day for 7 days.Pregnin inferior to the power of their actions progesterone, and it better be used to prevent a recurrence.
There are currently highly active synthetic drugs, surpassing the activity of progesterone.These include nortestosterone derivatives (e.g., orgasteron - ethynyl-nortestosterone) and substituted derivatives of progesterone (17-a-hydroxyprogesterone acetate, 6-methyl, 17-a-hydroxyprogesterone acetate, etc.).Preparation orgasteron recommended during uterine bleeding 5mg (tablet) for 6-7 days, or 15-20 mg per day orally for 3 consecutive days.After treatment begins strengthening krovootdeleniya, after which it stops completely.To prevent a recurrence of such require several courses of treatment.The great advantage of synthetic drugs progestativnogo action than their high activity, is also a possibility of oral administration.Their effectiveness is greatly enhanced in the combined use together with an estrogen.
Treatment of estrogen
In principle among estrogens can get a temporary hemostatic effect much faster than when using progesterone as bleeding starts, or as a result of the level of estrogen in the blood drop or due to the fact that is available even a relatively high level of estrogen issufficient to maintain proliferation of the epithelium.By increasing the level of estrogen by their exogenous administration can delay the disintegration of necrotic endometrium.However, in the future, not to get a new gain of bleeding, need a long time and gradually lowering the estrogen dose.Treatment with estrogen alone to start with the introduction of large doses of 5-10 mg of estradiol-dipropionate, 1 mL of 2% sinestrola or 1 mL of 1% diethylstilbestrol propionate intramuscularly per day.If bleeding on the next day is not reduced estrogen dose should be increased;if slowed or stopped, the dose of estrogen should be gradually reduced to 1/10 every day for 20-25 days.Some authors offer to treat bleeding stilbenes.
combined treatment with estrogen and progestins
estrogen treatment alone gives the combined use of estrogen and progesterone.The use of high doses of estrogens and progesterone in the form of short-day courses 2-3 or disposable injection (called "scraping hormonal") based on the fact that estrogens cause rapid increase hemostatic effect due to their level in the blood, whereas progesterone cause secretory transformationendometrial.There is evidence of the successful use with dysfunctional uterine bleeding 125-250 mg once 17 oksiprogesteron-caproate and 10-20 mg of estradiol-monobenzoate species intramuscularly, 17 mg of estradiol-valeryanata and 6 mg of ethinyl-nortestosterone, 3-6 mg of 17-ethinyl-19-nortestosterona acetate in combination with ethynyl estradiol at a ratio of 100: 1. from the available domestic drugs recommended to inject 1 mL of estradiol dipropionate and 25-30 mg of progesterone (6.5 ml of a 0.5% oil solution) intramuscularly for 3 consecutive days.For all types of combined estrogen and progesterone therapy stopped bleeding within the period of 8-10 hours to 1 day.Subsequent bleeding that accompanies separation of secretory transformed endometrium was observed 2-4 days after discontinuation of treatment.
- 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
Therapeutic effect of androgens is based on their anti-estrogen action and ability to cause atrophy of the proliferative endometrium.In addition, the hemostatic effect of androgens is attributed to their influence on the contractile ability of the uterus and endometrium vessels (vasoconstrictor effect).If at a young age there are concerns in the treatment of bleeding androgens disrupt ovulation, the menopause is not specifically seeks to restore ovulatory cycle.Therefore, androgen drugs can be one of the treatments for menopausal bleeding.
During dysfunctional uterine bleeding is recommended to prescribe large doses of androgens.Treatment should be started daily administration of 50 mg testosterone propionate intramuscularly (1 USD 5% oil solution), until bleeding stops (7-10 days).After the cessation of bleeding dose reduced to 50 mg 2 times a week, and then to 25 mg, and finally 10 mg of 2 and 3 times a week.Treatment continues for as long as for cytology vaginal smears will be no proliferation phenomena.
Methyltestosterone has weaker peripheral effect on the sexual organs and the lining of the uterus.Therefore, with strong uterine bleeding, which need a fast hemostatic effect, methyltestosterone ineffective.This drug is often used for the prevention of recurrence of the disease.Methyltestosterone can be recommended for prolonged periods, when retained their right rhythm, premenstrual tension, accompanied by breast engorgement and spotting before menstruation.In such cases, methyltestosterone assigned to the 15th day of the cycle of 2 tablets three times a day (30 mg) sublingually prior to menstruation.