Öz
Aim: To investigate the efficacy of
progesterone vaginal gel on endometrial
hyperplasias.
Material and Methods: Twelve patients
who admitted our gynecology clinic with
irregular menstrual bleeding and were
diagnosed as endometrial hyperplasia with
endometrial sampling were included. Group 1
(n=6) received progesterone vaginal gel
(Crinone 8% vaginal gel, Serono
Pharmaceuticals, Turkey) daily, between 15-
25th cycle days, whereas Group 2 (n=6)
received Dydrogesterone (Duphaston 10 mg.tb,
Solvay, Turkey) per os twice daily, between
15-25th cycle days for three months.
Endometrial pathological findings, endometrial
thickness before and after treatment, blood
lipid profile were compared between groups.
Statistical analysis were performed in SPSS for
windows version 10.0 using Wilcoxon Signed
ranks test and Mann-Whitney U test. P<0,05
was considered statisticaly significant.
Results: Endometrial hyperplasia was
treated in 4 patient ( 66,6%) in Group 1 and 5
patients (%83,3) in Group 2. Lipid profile was not statistically significantly different between
groups. Endometrial thickness decreased
significantly after treatment when compared to
pre-treatment (p<0,05). Uterine artery rezistans
index increased significantly in Group 1
(p<0,05), wheras no changes was observed in
Group 2 (p>0,05).
Conclusion: Crinone 8% vaginal gel was
found effective in the treatment of endometrial
hyperplasia. Decreased uterine blood flow may
play a role in this effect. It has not any adverse
effect on blood lipid profile
Anahtar Kelimeler
Crinone gel dydrogesterone endometrial hyperplasia blood lipid profile uterine artery Dopler
Kaynakça
- Lacey CG. Premalignant & malignant disorders of the uterine corpus. In : Pernoll ML. Current. Obstetrics&Gynecologic Diagnosis&Treatment. Seventh edd. Lebanon: Appleton&Lange,1991:955- 973.
- Kurman RJ, Kaminski PF, Norris JH ve ark. The behavior of endometrial hyperplasia: A long term study of untreated hyperplasia in 170 patients. Cancer 1985; 56: 403-407.
- Gal D, Edman CD, Vellios F ve ark. Long-term effect of megestrol acetate in the treatment of endometrial hyperplasia. Am J Obstet Gynecol;1983: 146(3): 316-22.
- Gal D. Hormonal therapy for lesions of the endometrium. Semin Oncol 1986; 13 (4Supp4):33-6.
- Faludi AA, Aldrighi JM, Bertolami MC ve ark. Progesterone abolishes estrogen and/or atorvastatin endothelium dependent vasodilatory effects. Atherosclerosis 2004; 177(1): 89-96.
- Chantilis SJ, Zeitoun KM, Patel SI ve ark. Use of Crinone vaginal progesterone gel for luteal support in in vitro fertilization cycles. Fertil Steril 1999; 72(5):823-9.
- Levine H. Luteal support in IVF using the novel vaginal progesterone gel Crinone 8%: results of an open-label trial in 1184 women from 16 US centers. Fertil Steril 2000;74(4):836-7.
- Banz C, Katalinic A, Al-Hasani S ve ark. Preparation of cycles for cryopreservation transfers using estradiol patches and Crinone 8% vaginal gel is effective and does not need any monitoring. Eur J Obstet Gynecol Reprod Biol 2002;103(1):43-7.
- Casanas-Roux F, Nisolle M, Marbaix E ve ark. Morphometric, immunohistological and three- dimensional evaluation of the endometrium of menopausal women treated by oestrogen and Crinone, a new slow-release vaginal progesterone. Hum Reprod 1996; 11(2): 357-63.
- Warren MP, Biller BM, Shangold MM. A new clinical option for hormone replacement therapy in women with secondary amenorrhea: effects of cyclic administration of progesterone from the sustained-release vaginal gel Crinone (4% and 8%) on endometrial morphologic features and withdrawal bleeding. Am J Obstet Gynecol1999;180(1Pt1):42-8.
- De Ziegler D, Ferriani R, Moraes LA. Vaginal progesterone in menopause: Crinone 4% in cyclical and constant combined regimens.HumReprod 2000;15(supp1):149-58.
- Cicinelli E, de Ziegler D,Galantino P ve ark. Twice-weekly transdermal estradiol and vaginal progesterone as continuous combined hormone replacement therapy in postmenopausal women: a 1-year prospective study. Am J Obstet Gynecol 2002;187(3):556-60.
- Horn LC, Schnurrbusch U, Bilek K ve ark. Risk of progression in complex and atypical endometrial hyperplasia: clinicopathologic analysis in cases with and without progestogen treatment. Int J Gynecol Cancer 2004; 14(2): 348-53.
- Levine H, Watson N. Comparison of the pharmacokinetics of crinone 8% administered vaginally versus Prometrium administered orally in postmenopausal women(3). Fertil Steril 2000; 73(3): 516-21.
- de Ziegler D, Fanchin R. Progesterone and progestins: applications in gynecology. Steroids 2000; 65(10-11): 671-9.
Öz
Amaç: Endometriyal hiperplazilerin
tedavisinde vajinal progesteron jelin
etkinliğinin araştırılması.
Gereç ve Yöntem: Jinekoloji
polikliniğimize düzensiz adet kanaması
şikayetiyle başvuran ve endometriyal biyopsi
ile basit atipisiz endometriyal hiperplazi tespit
edilmiş12 hasta çalışmaya dahil edildi. Grup 1
(n=6) vajinal progesteron jel ( % 8 Crinone
vajinal jel, Serono Pharmaceuticals, Türkiye)
adetin 15-25. günleri arasın günde bir, Gurup 2
(n=6) ise Dydrogesteron ( Duphaston 10 mg tb
tablet, Solvay ilaç, Türkiye) oral yoldan adetin
15-25. günleri arası günde 2 kez 3 ay aldı. Her
iki gruptaki hastaların tedavi öncesi ve sonrası
endometriyal patolojileri, endometriyal
kalınlıkları, kan lipid profili ve uterin arter
rezistans indeksleri karşılaştırıldı. İstatistikler
SPSS 10.0 programında, Wilcoxon Signed
Rank test ve Mann-Whitney U testleri
kullanılarak yapıldı. P<0,05 istatistiksel olarak
anlamlı kabul edildi.
Bulgular: Gurup 1’de endometriyal
hiperplazi olguların 4’ünde (%66,6)
iyileşirken, Gurup 2’de hastaların 5’inde
(%83.3) iyileşti. Her iki gurup lipid profili
açısından anlamlı bir farklılık göstermedi. Her
iki gurubun endometriyal kalınlıkları tedavi
sonrasında anlamlı ölçüde azaldı (p<0,05).
Uterin arter rezistans indeksi ise Gurup 2’de
tedavi öncesi ve sonrasında farklı değilken,
Gurup 1’de tedavi sonrasında anlamlı ölçüde
arttı (p<0,05).
Sonuç: %8 crinone vajinal jel
endometriyal hiperplazilerin tedavisinde
etkindir. Bu etkisinde uterin kan akımının
azalmasının rolü olabilir. Bu tedavinin kan
lipid profili üzerine olumsuz bir etkisi yoktur.
Anahtar Kelimeler
dydrogesteron endometriyal hiperplazi kan lipid profili uterin arter Dopler
Kaynakça
- Lacey CG. Premalignant & malignant disorders of the uterine corpus. In : Pernoll ML. Current. Obstetrics&Gynecologic Diagnosis&Treatment. Seventh edd. Lebanon: Appleton&Lange,1991:955- 973.
- Kurman RJ, Kaminski PF, Norris JH ve ark. The behavior of endometrial hyperplasia: A long term study of untreated hyperplasia in 170 patients. Cancer 1985; 56: 403-407.
- Gal D, Edman CD, Vellios F ve ark. Long-term effect of megestrol acetate in the treatment of endometrial hyperplasia. Am J Obstet Gynecol;1983: 146(3): 316-22.
- Gal D. Hormonal therapy for lesions of the endometrium. Semin Oncol 1986; 13 (4Supp4):33-6.
- Faludi AA, Aldrighi JM, Bertolami MC ve ark. Progesterone abolishes estrogen and/or atorvastatin endothelium dependent vasodilatory effects. Atherosclerosis 2004; 177(1): 89-96.
- Chantilis SJ, Zeitoun KM, Patel SI ve ark. Use of Crinone vaginal progesterone gel for luteal support in in vitro fertilization cycles. Fertil Steril 1999; 72(5):823-9.
- Levine H. Luteal support in IVF using the novel vaginal progesterone gel Crinone 8%: results of an open-label trial in 1184 women from 16 US centers. Fertil Steril 2000;74(4):836-7.
- Banz C, Katalinic A, Al-Hasani S ve ark. Preparation of cycles for cryopreservation transfers using estradiol patches and Crinone 8% vaginal gel is effective and does not need any monitoring. Eur J Obstet Gynecol Reprod Biol 2002;103(1):43-7.
- Casanas-Roux F, Nisolle M, Marbaix E ve ark. Morphometric, immunohistological and three- dimensional evaluation of the endometrium of menopausal women treated by oestrogen and Crinone, a new slow-release vaginal progesterone. Hum Reprod 1996; 11(2): 357-63.
- Warren MP, Biller BM, Shangold MM. A new clinical option for hormone replacement therapy in women with secondary amenorrhea: effects of cyclic administration of progesterone from the sustained-release vaginal gel Crinone (4% and 8%) on endometrial morphologic features and withdrawal bleeding. Am J Obstet Gynecol1999;180(1Pt1):42-8.
- De Ziegler D, Ferriani R, Moraes LA. Vaginal progesterone in menopause: Crinone 4% in cyclical and constant combined regimens.HumReprod 2000;15(supp1):149-58.
- Cicinelli E, de Ziegler D,Galantino P ve ark. Twice-weekly transdermal estradiol and vaginal progesterone as continuous combined hormone replacement therapy in postmenopausal women: a 1-year prospective study. Am J Obstet Gynecol 2002;187(3):556-60.
- Horn LC, Schnurrbusch U, Bilek K ve ark. Risk of progression in complex and atypical endometrial hyperplasia: clinicopathologic analysis in cases with and without progestogen treatment. Int J Gynecol Cancer 2004; 14(2): 348-53.
- Levine H, Watson N. Comparison of the pharmacokinetics of crinone 8% administered vaginally versus Prometrium administered orally in postmenopausal women(3). Fertil Steril 2000; 73(3): 516-21.
- de Ziegler D, Fanchin R. Progesterone and progestins: applications in gynecology. Steroids 2000; 65(10-11): 671-9.
Ayrıntılar
| Diğer ID | JA88GU68YA |
|---|---|
| Bölüm | Araştırma Makalesi |
| Yazarlar | |
| Yayımlanma Tarihi | 1 Mayıs 2004 |
| Gönderilme Tarihi | 1 Mayıs 2004 |
| Yayımlandığı Sayı | Yıl 2004 Cilt: 6 Sayı: 2 |