持續的結合荷爾蒙療法可以控制子宮內膜異位之疼痛


  Sept. 19, 2003-根據一篇發表於9月號Fertility & Sterility的一項預期性、自我控制的實驗結果,持續的聯合荷爾蒙療法可以控制子宮內膜異位的疼痛。
  
  米蘭大學的Paolo Vercellini博士表示,藉由口服避孕藥(OC) 延長生理期,通常可用來緩解女性與生理期有關的症狀,而且具有良好的耐受性,如果長期連續地使用可以減輕子宮內膜異位及與生理期相關女性疼痛症狀。
  
  在一個第三級的子宮內膜異位醫療中心,50名女性在前一年之內,除了週期性服用OC之外,還進行子宮內膜異位的手術,以持續使用含有乙炔基雌二醇的OC(0.02 毫克)加上desogestrel(0.15 毫克)持續治療二年的時間。
  
  在研究期間,19名女性(38%)報告生理不順,18名女性(36%)報告點狀出血,而13名女性(26%)報告突然出血的情形。出血事件的平均時間多於七天,這七天內她們便停止服用OC,發生次數為5.5 ± 2.1次。
  
  在二年的追蹤期間,視覺模擬量表測得這些患者生理不順的情形有所改善(從基準線的75 ± 13進步至31 ± 17),在言語評價表中(從 2.4 ± 0.5到 0.7 ± 0.6)。七名女性(14%)報告中度或嚴重的不良副作用。在最後的評估中,13名女性(26%)對療法很滿意,27人(54%) 滿意,一人(2%)不確定,8人 (16%) 不滿意,及一名女性(2%)很不滿意。
  
  OC 的連續的使用對於症狀性子宮內膜異位和與生理期相關疼痛的女性是有效的,這是不希望再生育的患者非手術的治療選擇,這個療程結合疼痛舒緩、避免雌性激素之失效、良好的耐受性、可立即停止使用的可能性、避孕、價格低廉,以及最重要的是無限期延長治療的可能性。最近的研究顯示,單階段的Ocs會向下調控細胞增生,並增加子宮內膜的細胞壞死。

Continuous Combined Hormone Th

By Laurie Barclay, MD
Medscape Medical News

Sept. 19, 2003 — Continuous combined hormone therapy may be appropriate for women with endometriosis pain not controlled by cyclic therapy, according to the results of a prospective, self-controlled trial published in the September issue of Fertility & Sterility.

"Delaying menses by extending the duration of [oral contraceptive (OC)] pill use is generally an effective and well-tolerated modality for relief of menstruation-related symptoms in women using OCs cyclically," write Paolo Vercellini, MD, from the University of Milan in Italy, and colleagues. "Long-term continuous OC use can be proposed to women with symptomatic endometriosis and menstruation-related pain symptoms."

At a tertiary care and referral center for patients with endometriosis, 50 women who underwent surgery for endometriosis in the previous year and had recurrent dysmenorrhea despite cyclic OC use were treated for two years with continuous use of an OC containing ethinyl estradiol (0.02 mg) and desogestrel (0.15 mg).

During the study period, 19 women (38%) reported amenorrhea, 18 women (36%) reported spotting, and 13 women (26%) reported breakthrough bleeding. The mean number of bleeding episodes lasting more than seven days, leading to suspension of OC for seven days, was 5.5 ± 2.1.

At two-year follow-up, dysmenorrhea improved on a visual analog scale (from 75 ± 13 at baseline to 31 ± 17) and on a verbal rating scale (from 2.4 ± 0.5 to 0.7 ± 0.6). Seven women (14%) reported moderate or severe adverse effects. At final evaluation, 13 women (26%) were very satisfied with therapy, 27 (54%) were satisfied, one (2%) was uncertain, eight (16%) were dissatisfied, and one woman (2%) was very dissatisfied.

"Continuous use of an OC can be considered an effective, nonsurgical treatment alternative in women with symptomatic endometriosis and menstruation-related pain symptoms who do not want children," the authors write. "This regimen combines relief of pain, prevention of estrogen deprivation effects, good tolerability, possibility of immediate suspension, contraception, low costs, and, most important, possibility of prolonging therapy indefinitely. Finally, monophasic OCs have recently been demonstrated to down-regulate cell proliferation and enhance apoptosis in the endometrium of patients with endometriosis."

Fertil Steril. 2003;80:560-563

Reviewed by Gary D. Vogin, MD

    
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