Endometriosis is a common condition in women of childbearing age and can be extremely harmful to young women, mainly in terms of pain and impact on fertility. Endometriosis is a diffuse disease that can affect multiple organs and has a complex histopathological typology that includes peritoneal, ovarian, deep nodular, and other lesions.
Endometriosis is a common disease in women of childbearing age and can be extremely harmful to young women, mainly in terms of pain and impact on fertility. Endometriosis is a diffuse disease that can affect multiple organs and has a complex histopathological typology that includes peritoneal, ovarian, deep nodular, and other lesions. The etiology of the disease is unknown and the lesions are widespread, and current treatments are unable to achieve a complete cure. Therefore, there are various clinical treatments for endometriosis, including surgery, medication, interventional therapy, and Chinese herbal medicine. Each treatment method has its own indications and limitations, so it should be considered and evaluated for different age groups, symptoms, lesion location and scope, disease stage and patient’s fertility requirements, which is also in line with today’s clinical “individualization” and “humanization This is also in line with the requirements of today’s clinical “individualized” and “humanized” treatment.
The importance of drug treatment
At present, the clinical treatment for cases without a clear diagnosis is first considered surgical treatment.
The purpose of surgical treatment is to clarify the diagnosis, remove the flesh lesion, perform a comprehensive assessment and staging (AFS staging), and provide a basis for the next step (pharmacological) treatment.
For older patients who are menopausal and have no fertility requirements, “radical” surgical treatment, i.e. total hysterectomy + double adnexal resection, can be performed. For young patients with fertility requirements, conservative surgery with excision of the lesion is usually used, but the recurrence rate after surgery is about 50%, and medication should be applied after surgery to control the development of the lesion and slow down the recurrence.
Drug therapy is an important tool in the treatment of endometriosis. The premise of drug therapy is that a clear diagnosis must be made to exclude the possibility of malignant transformation, and experimental drug use is not advocated. Drug therapy plays a role in controlling the development of the disease and slowing down recurrence that cannot be replaced by other methods.
It includes symptomatic treatment to suppress pain, oral contraceptive treatment and pseudo-menopause treatment, etc.
Pseudo-menopause treatment is used to block the hypothalamic-pituitary-ovarian axis, which in turn inhibits the synthesis and release of gonadotropins, resulting in lower estrogen levels in the body and atrophy of the ectopic endometrium, and is indicated for patients with chronic pelvic pain, significant menstrual dysmenorrhea, fertility requirements and no ovarian cyst formation.
In addition, drug combination with surgical treatment can enhance the efficacy of surgical treatment and delay the recurrence of endometriosis lesions. Preoperative medications such as gonadotropin-releasing hormone agonist (GnRH-a) or pseudo-menopausal drugs are more commonly used and given for 3-6 months before surgery to shrink the lesions, reduce pelvic adhesions and congestion, and help correct anemia.
It can reduce the difficulty of surgery and reduce side injuries. For conservative surgery, incomplete surgery or postoperative pain relief, 3-6 months of medication can suppress residual lesions and delay recurrence of endometriosis.
Pseudopregnancy therapy and pseudo-menopause therapy
Currently, there are also various options available in pharmacological treatment, including systemic and topical medications. Pseudopregnancy therapy or pseudomenopause therapy is a common pharmacological treatment for endometriosis in clinical practice.
Pseudopregnancy therapy: Commonly used medications include oral contraceptives and progestins, which are the first-line medications for endometriosis and have slightly lower overall efficacy than pseudo-menopausal therapy.
Topical medications are progestins placed into the body through a vehicle, such as an IUD containing progestin, which works by lowering local estrogen levels in the pelvis. It is mainly used in cases after the overall condition has been controlled by surgery and medication.
Endometriosis in unmarried women is mainly characterized by dysmenorrhea, and its incidence is higher in girls with dysmenorrhea. Oral contraceptives may be used to relieve pain as these patients do not have a need to have children at this time.
Pseudo-menopausal therapy: Commonly used drugs include progesterone receptor antagonists, androgen derivatives (progesterone), and GnRH-a analogues, which are the second-line drugs for endometriosis.
Pseudo-menopausal therapies mainly suppress FSH
, LH peak, inhibit ovarian steroid hormone synthesis and release, which in turn inhibits the growth of endometriosis lesions, causing ectopic lesions to dry up and shrink, stabilizing the progression of the disease and relieving clinical symptoms.
GnRH-a
is currently recognized as the most effective drug for the treatment of endometriosis. Ovulation can be resumed in the ovaries within 3 months after stopping the drug, creating a chance of conception for patients who require fertility. The use of this drug quickly lowers the body’s hormone levels and results in a series of low estrogen symptoms.
The main ones are hot flashes, sweating, impatience, headache, insomnia, vaginal dryness, loss of libido, depression and bone loss. Therefore, this method should not be used for a long time, usually for 3-6 months.
Both progesterone and GnRH-a analogs are used for therapeutic purposes by lowering estrogen levels, but the mechanisms are different. Pregnant trienone is a triene synthetic hormone with certain anti-progestational and estrogenic effects, which can inhibit the release of gonadotropins, suppress ovarian secretory function, lower serum estrogen and progesterone levels, inhibit ectopic endometrial growth, stabilize the lesion and bring the disease under control.
Clinical application of progesterone
Compared with other drugs, the characteristics of progesterone are mainly shown as follows.
(1) The drug has a long half-life of up to 28 h. It only needs to be taken twice a week, which is less and more convenient, while other similar oral drugs need to be taken daily, so patients taking pregnatrienone have better compliance;
(2) Compared with danazol, the efficacy of progesterone is similar, but the incidence of adverse effects of progesterone is lower, the effect on liver function is less and reversible, and the drug is rarely discontinued due to high transaminases;
(3) Pregnant trienolone is slightly less effective than GnRH-a in the treatment of endometriosis, but the side effects caused by low estrogen levels are significantly lower than those of GnRH-a. Compared with GnRH-a, the medical cost of progesterone is lower than that of GnRH-a.
Compared with G nRH – a, progesterone has lower medical costs, is less expensive, has milder effects, and has less adverse effects.
(4) Pregnant trienolone has a weak androgen-like effect, and long-term use may lead to increased appetite, facial acne, and other symptoms of androgen increase. Therefore, even though the effect is mild, it should not be taken for a lifetime.
It may cause increased appetite, facial acne, and other symptoms of androgen increase. Therefore, although the effects are mild, you should not take the medication for the rest of your life.
Endometriosis is an indication drug for progesterone, and other estrogen-dependent diseases such as adenomyosis and uterine fibroids can be treated with this drug.
Symptoms of uterine fibroids include.
(1) Abnormal uterine bleeding, heavy menstrual flow, prolonged menstrual cycle, which may lead to anemia;
(2) Compression symptoms: anterior wall fibroids compressing the bladder may cause frequent and urgent urination; posterior wall fibroids compressing the rectum may cause constipation; lower uterine fibroids may compress the ureter and cause hydronephrosis.
The use of progesterone can reduce the size of fibroids by lowering estrogen levels.
However, this therapy will not make the fibroids disappear and can be used for preoperative pretreatment. In anemic patients who cannot tolerate surgery due to intraoperative blood loss, drugs can be used to reduce the size of the fibroids and relieve the compression symptoms. In the literature, it has been reported that after 3 months of progesterone use, the size of the fibroids decreased.
In patients with anaemia who cannot tolerate surgery due to haematological reasons, it is possible to first reduce the size of the fibroid with drugs to relieve the compression.
For adenomyosis patients with fertility requirements and perimenopause, progesterone can be used to relieve symptoms; for adenomyosis patients without fertility requirements who have excessive menstruation and severe anemia, endometrial removal by hysteroscopy combined with progesterone treatment can cure anemia, relieve dysmenorrhea and delay disease recurrence.
Pregnant trienone combined with surgical treatment can improve the efficacy of surgery and is divided into preoperative and postoperative medication. Pre-operative administration of progesterone
It can correct anemia, reduce lesions, reduce pelvic adhesions and congestion, and facilitate surgical operation, by taking 2.5 mg twice a week on the first day of menstrual cycle for 3-6 months.
for 3-6 months. For conservative surgery, incomplete excision of lesions or postoperative pain relief, medication should be given for 3-6 months after surgery.
The purpose is to suppress residual lesions and delay the recurrence of endometriosis.