Endometriosis (endometriosis) is a common chronic disease in gynecology, which seriously affects the quality of life and fertility of patients, and will bring a heavy burden on family and society.According to the "Guidelines for the diagnosis and treatment of endometriosis (third edition)" in 2021, the treatment of internal disease therapy drugs is mainly divided into non -steroidal anti -inflammatory drugs, progesterone, compound oral contraceptives, and gonadotropin release hormone agonists(GNRH-A) and five major categories of traditional Chinese medicine, of which high-efficiency progesterone drugs are first-tier or A-level recommended drugs at home and abroad. The mechanism of action is to inhibit the HPO shaft through negative feedback, resulting in low estrogen state in the body, and can cause endometrial endometriumThe molting -like change eventually led to endometrial atrophy.
E progression is an important chemical substance in the human body. It is mainly secreted by the particle luteal cells of the ovaries. It is mainly progesterone (progesterone).Physiological functions include inhibiting ovulation and promoting endometrium secretion; promoting the growth of breast glands, preparing lactation; improve the body temperature and relax the smooth muscle of the blood vessels and digestive tract.At the same time, because progesterone is an important intermediate of biological synthesis such as androgen, estrogen, adrenocorticoids and other biological synthesis, the physiological effects of various hormones can be played to varying degrees.Common progesterone includes progesterone, ground flexion, pyrine, hydroxylthone, cyclopyalone, alcohol ketone, sodolone, left pupar progesterone, oxygenne, and gexione element.Because most progesterone drugs are testosterone derivatives, the receptor has poor selectivity. In addition to the activity of progesterone, it can also be combined with other steroid hormone receptors. It has other auxiliary activity such asrogen and glucocorticoids.Adverse reactions such as weight gain can also change the level of lipid metabolism and increase the risk of cardiovascular disease.Among them, Dinosuin tablets belong to the new generation of artificial synthetic progesterone. The combination of progesterone receptors has a high degree of selectivity, which can efficiently inhibit and convert it into the endometrium.Obvious inhibitory effect.At the same time, the impact of estrogen, sugar, salt, and lipid metabolism is small, the incidence of adverse reactions is relatively low, and long -term use of effectiveness, safety and tolerance, but some users will have abnormal uterine bleeding.
Abnormal uterine hemorrhage is a common adverse reaction for all single progesterone hormone drugs. It is almost unavoidable. The most common in the first month. The bleeding mode is manifested as dripping bleeding, irregular bleeding or amenorrhea.The mechanism is mainly related to increasing endometrial vascular crispness during the medication period. The endometrial vascular lumen dilation, increased vascular density and structural integrity are damaged, the matrix metal protease is raised, and the degradation of extractive metal substrate, vascular, and endometrial epithelial base membrane degradation, To promote endometrial crash and increase the risk of bleeding.
(1) Before medication, it is necessary to communicate with patients to communicate with patients with patients. It is necessary. It is necessary to inform the patient that bleeding is not a sign of invalid or recurrence of the disease.As long as it is not a large amount of bleeding in a short period of time and does not cause anemia, you can take medicine.Generally speaking, if the amount of vaginal bleeding is less than a daily sanitary napkin, you don’t have to worry too much, you can continue to observe; if the amount of bleeding increases or has other serious adverse reactions, you can go to the gynecological clinic.
(2) During the treatment of drugs, with the extension of the medication time, irregular bleeding can be automatically stopped, and it will gradually enter amenorrhea. It is the purpose of drug treatment. It will be beneficial to the treatment of the disease.The average menstrual recovery is later, and you can enter the state of pregnancy under the guidance of a doctor.
(3) The current literature report shows that the treatment of norcin on the first day of menstruation may help reduce irregular bleeding in the early stages of treatment; if the patient’s bleeding is severe or merged adenomy muscle disease and has severe uterine bleeding, it can beFirst use GNRHA for 1-6 months, and then give meninopatin treatment.
(4) For the new high -efficiency progesterone, the nodin, if the bleeding occurs in the first few months, and affects the quality of the patient’s life, the following "three seven seven" solutions can be adopted.If bleeding occurs after a long period of time, and B-ultrasound can stop the medicine for 5-7 days when the thickness of the endometrium is too thin, and the endometrium is restored;Or estradol-transparent stickers (5-7 days) for treatment.At the same time, it is important to note that there is no significant improvement after treatment of abnormal bleeding, and ultrasound examination is required to exclude other organic lesions.
In summary, abnormal bleeding is a known adverse event that receives progesterone drugs.Summary analysis of previous clinical trials shows that as the treatment time is prolonged, the frequency and bleeding intensity of bleeding and bleeding have gradually decreased. The overall tolerance of the bleeding mode is good, and the treatment exit rate is low.Therefore, in the face of unavoidable drug adverse reactions, clinicians and pharmacists should fully inform to improve patient compliance, follow up for a long time, and jointly formulate a lifelong management plan with patients.
Author: Wei Anhua (Ministry of Pharmacy, Tongji Hospital affiliated to Tongji Medical College of Huazhong University of Science and Technology)
【references】
[1] The Chinese Medical Association’s Obstetrics and Gynecologist Branch, the Chinese Medical Association’s Obstetrics and Gynecology Branch of the Uterine Endometriosis Cooperation Group., 2021,56 (12): 812-824.
[2] The Professional Committee of Endometriosis of the Obstetrics and Gynecologists of the Chinese Medical Doctors Association, the Obstetrics and Gynecology Branch of the Chinese Medical Association Obstetrics and Gynecology Branch.. Chinese Women’s Magazine, 2018, 53 (12): 836-841.
[3] Compound oral contraceptives clinical application of Chinese expert consensus expert group. Chinese women’s obstetrics magazine, 2015 (2): 81-91
[4] Nice Guideline. Heavy Menstrual Bleeding: Assessment and Management. 2018.
[5] HICKEY M, Fraser is. Clinical Implications of DisturBances of Uterine Vascular Morphology and Function [J]. Practt Resolin ObSaecol. 2000, 14: 937-95-95 1. 1.
[6] Murji A, Jihua Leengr et al. Use of dienogest in Endometriosis: Comments [J]. Curr Med Res. 2020 MAR 31: 1-13.
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