Postoperative hormonal therapy by buserilin in the patients with genital endometriosis

Abstract

Subject: Optimization of the postoperative stage of treatment by analogs of gonadoliberin in the genital endometriosis patients (E).

Full Text

Material and methods. 46 women curing by intranasal buserelin after surgical deleting of visible E foci in peritoneum and ovaries.

Results. The developed algorithm of examination and treatment allows to achieve the proof in 98% of E patients.

Conclusions. It is necessary to keep strictly the sequential steps in E treatment algorithm. A scheduled surgical stage of E treatment should be precede by the diagnostic screening for revealing the pathogenetic mechanism of dysfunction in hypothalamo- hypophisial-ovarian system resulting in E development. Hormonal screening can reveal the secondary character of this dysfunction by the thyroid or adrenal genesis, for example. If the surgery is urgent this screening can be carry out in the postoperative stage.

The second stage is the surgical deleting of all visible E foci. It allows to reduce the whole time of treatment, volume and duration of the subsequent inhibitory hormonal therapy, to decrease negative effects of the hormone large doses on different female extragenital organs and systems. The surgery stage of treatment can be limited or even eliminated (at adenomyosis) if woman reproductive plans are not realized.

The third obligatory stage of E treatment should be the complete turn off hypothalamo-hypophisial system resulting in ovary block and developing of a temporary amenorrhea from endometrium atrophy. Only this allows to achieve the liquidation of the hidden E foci. The drug (gestagens, testosteron derivates, gonadoliberin analogs) is choosing individually with relation to the degree of E, individual portability and possible negative effects. In this position buserilin has one lack - the loss of calcium which may compensated easily.

Criteria of the drug dose sufficiency is not only complete losing of menstruation, but also absence of the hidden cycles showing a complete ovary inhibition. The temporary appearance of hot flash is the reliable marker of ovary turning off. The time of ovary turning off should not be less than 6-8 months.

The last stage of E treatment is the prophylaxis of its recurrences. For patients, interested in the subsequent pregnancy, the prophylaxis is achieved by restoring of ideal menstrual cycles. Monophasic COC provides as the prophylaxis of hyperplastic processes, as the contraceptions for majority other women. Hyperprolactinemy is the contraindication for COC. The restoring of menstrual cycles by selective doses of dopamin agonists in these patients is the prophylaxis of the E recurrences, but does not provide the contraceptive effect. The contraception must be non hormonal for these women. For the patients with a thyroid or adrenal genesis of E is necessary the corresponding hormonal therapy starting from the diagnosis installation.

The prophylaxis of any hyperplastic processes must last until the end of reproductive period of life. The age turn off of the ovarian function eliminates a hormonal basis of these diseases. In some transition age women (after 45 years) medicamental pseudomenopause can accelerates the beginning of the natural menopause.