Endometriosis (endometriosis) is a chronic disease that requires long -term medication. The main purpose is to reduce postoperative recurrence. Treatment symptoms such as relieve pain, reduce the more monthly, delay lesions and symptom recurrence.
There are many drugs for the treatment of internal diseases. Commonly used such as GNRHA, oral contraceptives, high -efficiency progesterone (including oral high -efficiency progesterone and left pupaeurone intrauterine slow release system, which are Manyuele Ring), and Chinese medicine.
① What is the medicine of GNRHA?
The gonadotropin release hormone (GNRH) is 10 peptide hormone secreted by the hypothalamus. GNRH can stimulate the pituitary synthetic oval estrogen (FSH) and the lutein formin (LH).
The activity of GNRHA (GNRH agonist) is 50-100 times the natural GnRH.After 10-15 days, the drug can make the pituitary GNRH receptor desensitivity, produce a lowering effect, and reduce the FSH and LH significantly, resulting in the reduction of ovarian hormones.Planting and growing.
This kind of human temporary menopause can also be called reversible drug ovarian resection.Therefore, GNRHA has long been used to treat or relieve a variety of gynecological hormone dependencies for a long time.At present, the most clinical application of gynecological diseases is endometriosis and uterine smooth fibroids.
② The type and usage of GNRHA
At present, the injection GNRHA drugs that are currently used in my country include Liangbingrein, Gosherin, and Quptarin.
▶ The corresponding commodity names are: Anton, Boynuokang, Bayi, Nolech, Diffin, etc.
These GNRHA dosage forms and injection methods are slightly different, but the efficacy in the body is the same.GNRHA with different commodity names can be replaced in a period of time, but it should be paid to different injection methods.
● Anti Naitong (Elephant Speed acid Blond Pingreilin Micro Board): 3.75mg per branch, subcutaneous injection, once every 28 days;
● Boynorkang (Smoothing micro -ball for injection of acetic acid): 3.75mg per branch, subcutaneous injection, once every 28 days;
● Bayi (Elephant Speed Platinic acid Blipylin Microfin): 3.75mg per branch, subcutaneous injection, once every 28 days;
● Nore (Gosarin lyshellin implant): 3.6mg per branch, injection under the abdominal wall skin, every 28 days;
● Diffelin (injecting sibirinic acid incertic acid): 3.75 mg per branch, muscle injection, once every 28 days;
③ Can GNRHA with different commodity names be replaced?
Patients treated with GNRHA for postoperative symptoms are recommended on time.In the case of different types of drugs in local hospitals, several gnrha can be replaced, but you need to pay attention to the corresponding dosage and injection methods.
During GNRHA’s medication, you must adhere to the treatment of calcium supplement. If severe low estrogen symptoms, such as hot sweat and sleep disorders, it is recommended to perform anti -additional treatment. There is a detailed explanation in the following.
④ How long will GNRHA recover ovulation after medication, when will menstruation come?
After GNRHA injected 2-3 stitches, the ovary recovered ovulation in about 2 months after the last injection of GNRHA, and menstruation recovered in about 2 and a half months to 3 months.
Therefore, if the pre -processed treatment was prepared for GNRHA treatment, surgery within two and a half months after the last injection was possible.
If the surgery is expected to postpone two months after the last time the last medication is extended, patients can add another needle GnRha in the local area according to the 28 -day medication period.After the epidemic is over, return to the hospital for an appointment.
⑤ Patients who have been treated with GNRHA for a long time can the interval between medication in a very period?
Reproductive EM and AM need to treat patients with long -term GNRHA treatment. The GNRHA medication period can be appropriately extended, and one needle is injected every 6 weeks.Vaginal bleeding may occur for more than 6 weeks of medication.
⑥ Common side effects and treatment of GNRHA treatment
The side effects are the symptoms and osteoporosis caused by low estrogen.GNRHA causes the body to be in a low estrogen state, producing symptoms of menopausal periods, such as heat, vaginal dryness, lack of sexual desire, emotional instability, and sleep disorders. Long -term application leads to a decrease in bone density.
The side effects of the low stimulus state caused by the treatment of GNRHA can take the plant neurological symptoms of Lifamin jointly mediation, such as hot and sweating and improving sleep, but it does not change the level of estrogen during the treatment of GnrhaImprove the above, no treatment effect on bone loss.
Oral estrogen hormone reverse adding treatment can improve the level of low estrogen to a certain extent, thereby alleviating the symptoms of menopausal periods and reducing bone loss.
Lifomin, 0.28g/piece, orally, 1 tablet each time, twice a day.
For anti -plus treatment, it is specially recommended for patients with GNRHA for more than 6 months, but the level of estrogen in peripheral blood before the anti -addition treatment and the period of medication.
▶ Drugs that can be applied are: compound oral contraceptive pills, alternatives, oral estrogen +/- progesterone, estrogen permeable paste or gel, vaginal estrogen, etc.
The choice of these types of medication, medication pathway and time need to be individualized according to the specific situation of the patient.
⑦Gnrha must insist on supplementing calcium and phosphoric acid salt during treatment
GNRHA uses side effects that reduce bone density, and increases bone density reduction in GNRHA to increase risk increases.
Therefore, during the period of GNRHA, we must adhere to the treatment of calcium supplement. It is recommended to add 600mg of calcium daily to ensure enough sunlight time. Drink more milk. If necessary, add VITD intake to prevent osteoporosis.
⑧ What should I do if the vaginal bleeding treated by the first needle GnRHA?
▶ The first needle GNRHA should be injected within the 1-5 days of menstrual period, and one needle is injected every 28 days after that.
Because GNRHA’s first dining in the early days, it had a brief stimulus to the reactive effect of Pyphoid cells to release LH and FSH, that is, "ignition effect", which briefly increased ovarian hormones for about 7 days.
Therefore, about 10-14 days after GNRHA’s first needle injection, patients will experience vaginal bleeding for about 7-19 days.This is the special response after the treatment of GNRHA treatment, please don’t panic.There is no need to go to the case when the bleeding is not required, and it can be observed temporarily.
A few patients with anemia with anemia and anemia, the vaginal bleeding effect caused by the ignition effect of the first needle GNRHA treatment may increase the anemia. It is recommended that local hospitals take timely hemostasis treatment.important.
Compound short -acting oral contraceptive pill
① Compound short -acting oral contraceptive pills are one of the first choice for long -term management of endometriosis
The recurrence short -acting oral contraceptive pill is a compound preparation with progesterone as the main and supplemented by estrogen. The main mechanism is to inhibit ovulation.
In addition to effective contraceptives, contraceptives can also regulate the menstrual cycle of patients with internal diseases, relieve dysmenorrhea, and reduce the recurrence of internal diseases.
Short -acting oral contraceptives are currently long -term management of the long -term management of rotation. Such medicines such as Mom Fulong, You Siming, You Siyue and so on.
② What should I do if I forget to take medicine one day?
If you find a leak, make up for it as soon as possible, try to make up within 24 hours, and then continue to take the next piece according to the original plan.
For more than 24 hours, the contraceptive effect may be caused and a small amount of bleeding can be guided. There are contraceptives that patients should take protective measures for tool contraception at the same time.A small amount of vaginal bleeding can be temporarily observed.
③ Will menstruation come during the medicine?Is it possible to get pregnant?
Menstruation will come normally during the medicine, but the amount of menstruation may be reduced.
Patients with oral Fulong and You Siming are usually menstruation within 7 days of cyclical discontinuation; patients with oral Yueyue usually come to menstruation during oral white pills.There are very few unexpected pregnancy without leakage.
④ Can patients with oral Yueyue switch to You Siming?
Both Yue Siyue and Yoshiming are allybolone, and the content is the same. Only the estrogen content is slightly different.You Siming is a non -prescription medicine, and patients can buy them in a pharmacy.Patients with oral Yueyue are not convenient for buying You Siyue from the hospital.
You Siming has 21 tablets per box, for 21 days per cycle. After 7 days of stopping the medicine, the next cycle (second box of medicine) starts.
You Siyue 28 tablets (24 white slices, 4 pieces of powder) each, for 28 days of a weekly cycle, non -stop medicine, start the next cycle (second box of medicine).
⑤ What are the side effects of contraceptives?
Generally, it is safer to use contraceptives, but sometimes irregular bleeding and reduced menstrual flow may occur. Individuals may also have headache symptoms. When symptoms are mild, they can be observed.
Under normal circumstances, amenorrhea will not occur. If amenorrhea and the degree of side effects are severe, it is recommended to see a doctor.
⑥ Outpatient clinic for oral contraceptives during long -term management
Patients who accept long-term management of oral contraceptives should be clinic every 3-6 months, or if the treatment effect is satisfactory and stable, the outpatient clinic can be temporarily extended, and the clinic can be passed on line.
① What is Manue Mile Ring?What is the role?
Manue Music Ring is an intrauterine heterochrome with high -efficiency progesterone (L -Rotor Nonone Palace internal slow -release system). The main role is local slow -release progesterone, which can significantly reduce menstrual flow and relieve dysmenorrhea.
② What are the side effects of Man Yuele?
The main adverse reactions in the treatment of Manyuele Ring is vaginal bleeding. The duration varies from person to person. It can also have reactions such as menstrual scarcity, amenorrhea and leucorrhea.
Vaginal bleeding (only sanitary pads are required daily) generally do not need to be treated. If vaginal bleeding is large (a daily wet sanitary napkin), or the pain is not relieved, you need to go to the doctor in time.
In addition, some patients may have ovarian physiological cysts, which can be observed and reviewed regularly.This cyst ultrasonic inspection is mostly below 5cm, and the boundary is clear. There is no echo area in the sac. Generally, it is not necessary to deal with it.
In addition, the chance of taking vaginitis with Manyuele Ring may also increase. If the vaginal secretion increases and has odor, the medication should be checked.
③ How long can Man Yuele Ring continue to use?
The drugs in the Man Yuele Ring can be released slowly for about 4-5 years. However, due to the size of the uterus, the shape of the uterine cavity, the lesion, and the patient’s own factors, it may be moved or falling off, and the renewal time may be shortened.
④ Ultrasonic reminder ring moved down, do you need to take it out?
If the symptoms are satisfactory, the bottom end of the ring is above the inner level of the cervix, and it does not need to be treated.
If the symptoms are not satisfactory, for example, the pain relief is not obvious or even worse, or the menstrual flow suddenly increases, or the ring is seen at the outer mouth of the cervix, then it should be removed.
⑤ Patients treated by Man Yuele Ring Patient Clinic
The clinic should be followed every 3-6 months, or the treatment effect is satisfied with the treatment effect and the condition is stable.
Di Nuo Eternication (Weisan Ning)
① What kind of medicine is the plasticin?What is the role?How to take it?
Dinotin progesterone is a new type of high -efficiency progesterone in China. The current domestic product name is: San Ning, the dose is 2mg per tablet.
Wei Sanning can effectively alleviate dysmenorrhea, reduce menstrual flow, and reduce the recurrence of internal diseases.
It is generally started on the 2-5 days of the menstrual cycle, 1 piece daily, and continuously take it continuously.It is best to take a fixed time every day, such as before or in the morning, it is not easy to forget.
What are the side effects of Dinuo progesterone?
The main adverse reactions are irregular vaginal bleeding, extension of menstrual cycle, and amenorrhea.
The frequency of irregular bleeding occurred in the first three months, and decreased after continuous medication.The medication lasts for 6 months, and about 30%of patients will occur during medication.The above side reactions can generally recover after stopping taking the medicine, so don’t worry too much.
The amount of vaginal bleeding is small and less than the amount of 1 sanitary napkin daily. You can continue to observe; if the amount of bleeding increases or other symptoms, you can consult your doctor online.For vaginal bleeding, you can temporarily discontinue drugs.
Other rare side effects such as headache, breast pain, and weight gain, etc., you can consider symptomatic treatment or regulating lifestyle, such as controlling diet and exercise.
③ Do you need contraception during the reigning progesterone?
Contradicances are required during the medication. Non -hormone contraceptive measures are recommended, such as condoms.
The clinic should be followed every 3-6 months, or the treatment effect is satisfactory and the condition is stable.
This article is quoted from: Dai Yi, Leng Jinhua.During the epidemic period of new coronary pneumonia, the consensus of experts in patients with endometriosis treats follow -up.2020-02