LOGO Efficacy of Gn RHa plus Yasmin or

L/O/G/O Efficacy of Gn. RHa plus Yasmin or Mirena in the treatment of polycystic ovarian syndrome with atypical hyperplasia in patients with adenomyosis accompanied with dysmenorrhea Speaker: Xu Linna Corresponding author : Zhang Shaofen Obstetrics and Gynecology Hospital of Fudan University China

PCOS

Adenomyosis

Women’s Health • PCOS + Adenomyosis+ Atypical hyperplasia ?

Case 1 • • Name：Zhu Chunyan Age： 36 Menstrual cycle： 10/35 -45 days Reproductive History: 0 -0 -0 -0 Dysmenorrhea: 9′ （VAS） Height and weight : 153 CM /75 kg BMI： 32

Case 1 • Hemoglobin： 4. 3 g/l • six steroid sex hormones ： • FSH: 6. 77 m. IU/ml LH: 15. 64 m. IU/ml PRL: 16. 08 ng/ml E 2: 32 pg/ml P: 1. 34 ng/ml T: 0. 91 ng/ml • thyroid related hormones TSH: 2. 3 u. IU/ml T 3： 1. 18 ng/ml T 4： 5. 25 ug/dl • insulin secretion test：INS(empty stomach) 33. 09 m. U/L • GLU(empty stomach) 4. 8 mmol/l INS(0. 5 h) 97. 55 m. U/L GLU(1 h) 8. 1 mmol/l INS(1 h) 163. 02 m. U/L • GLU(2 h) 6. 2 mmol/l INS(2 h) 127. 28 m. U/L • GLU(3 h) 5. 8 mmol/l INS(3 h) 72. m. U/L • Facial acne: severity • Hirsutism：+ acanthosis：+

The process of the diagnosis and treatment The first day of hospitalization: B ultrasound reveal: the size of uterine is 94*101*75 mm 3, the endometrial thickness is 23 mm（ double lining ）. Two ovaries is polycystic ovary.

The process of the diagnosis and treatment 1. by the diagnostic uterine curettage and pathological examination Atypical endometrial hyperplasia 2. blood transfusion to improve the severe anemia 3. Yasmin treated for 3 days(1# tid po) then discharge from hospital Yasmin 1# bid po for 5 days, without vaginal bleeding followed with Yasmin 1# qd po*14 days

The process of the diagnosis and treatment 4. Zoladex（ Gn. RHA） was subcutaneously injected at a dose of 3. 6 mg for 6 times (once every 28 day) to induce pseudo-menopause

The process of the diagnosis and treatment 5. Followed by oral administration of Yasmin for three cycles 6. Afterwards, curettage was performed before the next menstruation Pathology showed proliferative endometrium

Pathology Atypical endometrial hyperplasia Proliferative endometrium

The process of the diagnosis and treatment 7. With administration of Mirena in combination with DMBG (0. 85 mg bid po) for 12 cycles after the menstruation

Results the endometrial Dysmenorrha hemoglobin uterus thickness severity(VAS level volum score) cm 3 g/l （ 0. 523*a *b*c） cm 3 183. 34 5 3 133 serm insuln level m. U/L Testosterone level ng/m. L body weigh t KG 28 0. 23 70 3 rd month 185. 13 5 4 137 25 0. 35 71 6 th month 189. 44 6 4 139 23 0. 43 68 12 th month 193. 68 6 4 138 22 0. 49 69 1 st month

Case 2 • • Name：Zhang Ziyi Age： 17 Menstrual cycle： 10/35 -90 days Reproductive History: 0 -0 -0 -0 Dysmenorrhea: 9′ （VAS） Height and weight : 171 CM /95 kg BMI： 32. 4

Case 2 • Hemoglobin： 6. 7 g/l • six steroid sex hormones ： • FSH: 6. 77 m. IU/ml LH: 15. 75 m. IU/ml PRL: 9. 08 ng/ml E 2: 49 pg/ml P: 1. 64 ng/ml T: 1. 1 ng/ml • thyroid related hormones TSH: 3. 8 u. IU/ml T 3： 1. 51 ng/ml T 4： 5. 32 ug/dl • insulin secretion test： INS(empty stomach) 35. 23 m. U/L • GLU(empty stomach) 4. 8 mmol/l INS(0. 5 h) 93. 25 m. U/L GLU(1 h) 8. 3 mmol/l INS(1 h) 173. 02 m. U/L • GLU(2 h) 6. 7 mmol/l INS(2 h) 167. 18 m. U/L • GLU(3 h) 5. 9 mmol/l INS(3 h) 85. 45 m. U/L • Facial acne: severity • Hirsutism：+ acanthosis：+

The process of the diagnosis and treatment 1. B ultrasound reveal： the size of uterine is 96*85*75 mm 3, the endometrial thickness is 22 mm( double lining )Two ovaries is polycystic ovary 2. by the diagnostic uterine curettage and pathological examination: atypical endometrial hyperplasia 3. Then diane-35+norethindrone for bleeding stop and ferrous succinate to improve the severe anemia

The process of the diagnosis and treatment 4. Zoladex（Gn. RHA） was subcutaneously injected at a dose of 3. 6 mg for 6 times (once every 28 day) to induce pseudo-menopause 5. followed by oral administration of Yasmin for three cycles 6. Afterwards, curettage was performed before the next menstruation Pathology showed proliferative endometrium

Pathology Atypical endometrial hyperplasia Proliferative endometrium

The process of the diagnosis and treatment 7. With administration of Yasmin in combination with DMBG (0. 85 mg) for 12 cycles after the menstruation

Results the uterus endometrial dysmenorra hemoglobin volum(0. 5 thickness severity(VAS level 23*a*b*c) score) cm 3 g/l 3 cm serm insuli n level m. U/L Testoste r-one level ng/m. L body weight KG 1 st month 171. 13 6 3 121 25 0. 41 84 3 rd month 175. 28 5 4 128 23 0. 69 83 6 th month 183. 71 6 4 135 26 0. 65 85 12 th month 187. 43 6 5 138 27 0. 56 85

CONCLUSION Gn. RHa treatment with either Yasmin or Mirena can effectively alleviate endometrial hyperplasia, relieve dysmenorrhea, diminish adenomyotic lesions, and reduce serum insulin and testosdterone levels in PCOS patients with atypical endometrial hyperplasia and adenomyosis accompanied with dysmenorrhea.

Women’s Health

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