To Evaluate The Effect Of GnRH Agonist Combined With Add-back Therapy In The Treatment Of Endometriosis And The Influence On Lipid Profile And Coagulation Function

Hypoestrogenism of post-menopausal women result in lipid metabolic disorder, but lipid profile is associated with the risk of coronary artery disease,and dyslipelemia can lead to dysfunction of blood coagulation.GnRHa which was widely used in the treatment of endometriosis can cause hypoestrogenism,but by now there was not an uniform conclusion about the effect of GnRHa on lipid level and coagulation function,and little research about the effect of add-back therapy which use GnRHa plus estrogen progestin on lipid metabolic and coagulation function.ObjectiveThis research focus on the effect of add back therapy which use goserelin plus progynova and dydrogesterone on coagulation and lipid metabolic,to explore a new add back therapy with relatively little impact on coagulation and lipid metabolic,and to observe the difference of the incidence and characteristics of colporrhagia between GnRH-a and add back therapy.Materials and MethodsThis research collected 70 patients with endometriosis at ages that ranged from 20 to 50 who had been diagnosed by surgery(laparoscopically,limited in two months, rAFSâ…¢-â…£).According to the method of treatment,70 patients were divided into two groups evenly and randomly,group-G(GnRHa) and group-A(add back therapy).The patients of group-G accepted injections of Zoladex(3.6mg,i.h.) once 28 days for three times.In addition to injection of Zoladex,the patients of group-A took extra 0.5mg progynova patch(1mg/patch) and 5mg dydrogesterone(10mg/patch) orally everyday during the injection of Zoladex.All patients need write patients diary cards which were used to record the frequency and severity of vaginal bleeding during the treatment period.Before and after the treatment,all patients were evaluated individual pain level by visual analogue scale(VAS),and been collected their peripheral venial blood pretherapy and post-treatment to determine their levels of Lee index:Follicle stimulating hormone(FSH),estradiol(E₂);serum total cholesterol(TC),triglyceride (TG),high-density lipoprotein(HDL),low-density lipoprotein(LDL);prothrombin time(PT),international normalization ratio(INR),activated partial thromboplasting time(APTT),prothrombin time(PT),fibrinogen(Fbg).After the menstruation came back,Evaluated individual pain level by VAS again.Result1,After three months treatment,the level of serum FSH and E₂ in both group declined significantly compared with the level before treatment(P＜0.01);the level of serum FSH in group G was significantly higher than that in group A (P＜0.01);and the level of serum E₂ in group A was 25.61±19.36 pg/ml significantly higher than that in group G(P＜0.05).After the treatment,the value of the total score of the pain level and algopareunia was significantly decreased in both groups(P＜0.05).After the menstruation came back,the value of the total scores of the pain level,pelvic pain,algopareunia were a little increased or descend in both groups compared with those of last stage of treatment,while the difference was insignificant.And the score of dysmenorrhea was significantly decreased in both groups(P＜0.01).2,The incidence of uterine bleeding in cycle one was 90.6%in group G and 93.8% in group A respectively,and the incidence descented 15.6%and 21.9%in cycle two respectively,then descented 6.3%and 12.5%) respectively(P＞0.05).There was no difference in the characteristics of uterine bleeding during treatment period between two groups(P＞0.05).Irregular spotting and minor hemorrhage were the most frequent bleeding pattern.3,Blood lipid levels in both group were within normal limits before and after three months treatment.After the treatment the levels of TC and TG in group G was significantly higher than that before the treatment(P＜0.05),and the changes of HDL and LDL were not significant.There was no difference in lipid changes in group A.There was no difference in the coagulation between two groups before and after three months treatment,and all indexes were within normal limits.The levels of PT and INR were significantly decreased in group G after the treatment(P＜0.01),and the level of APTT was also decresed(P＜0.05).Levels of coagulation in group A were not different compared with the level before treatment.ConclusionCompared with GnRHa therapy,this"add-back"therapy which use progynova 0.5mg/d plus dydrogesterone 5mg/d could relieve the pain of women with endometriosis as same as the effect of GnRHa alone and cannot lead to the increasing of vaginal bleeding volume and days of uterine bleeding prolonged.The blood lipid level and coagulation had little change during treatment of"add-back"therapy.