A Clinical Study to Evaluate Efficacy of KVGAP’S Femicare Syrup on Raktapradara w.s.r to Dysfunctional Uterine Bleeding

Dysfunctional uterine bleeding (Raktapradara) is the commonest gynaecological disorder affecting the quality women’s life of reproductive age group. A clinical study was conducted with KVGAP’S Femicare Syrup on 28 patients of DUB. KVGAP’S Femicare syrup is a polyherbal Ayurvedic formulation prepared from ingredients like Ashoka, Ashwagandha, Gokshura, Guduchi, Shatavari, Manjhistha, Usheera, Kumari, Sariva, Pippali, and Shilajathu. The parameters assessed were number of bleeding episodes, excessive bleeding, investigators global assessment scale, VAS for pain, participants overall assessment scale, clot and interval (number of days of the cycle). Patients were assessed at the beginning of the trail, after 1 month and after 2 months. 56.52%, 73.08%, 77.6%, 85%, 81.93%, 100% improvement were observed in the clinical parameters assessed (number of bleeding episodes, excessive bleeding, investigators global assessment scale, VAS for pain, participants overall assessment scale, clot) respectively. Results were statistically significant. Interval didn’t show any changes. Out of 28 patients in this study, 1 patient shown mild improvement, 11 patients (39%) were shown moderate improvement and 16 patients (57%) had marked improvement. Overall effect of the treatment was 77.31%. This study showed that KVGAP’S Femicare syrup showed promising results in treating DUB. Hence it can be concluded that KVGAP’S Femicare Syrup is effective and safe in the management of dysfunctional uterine bleeding.

Identification and verification of effective components of Huanghuai for dysfunctional uterine bleeding based on network pharmacology and molecular docking / 中草药·英文版

Objective: The Huanghuai (HH), which is made from the dried roots of Scutellaria baicalensis (Huangqin in Chinese) and the dried flowers and buds of Sophora japonica (Huaihua in Chinese), is a traditional Chinese formula used to treat dysfunctional uterine bleeding (DUB) (Benglou in Chinese) and proven to treat hemostasis effectively in our previous study. Network pharmacology and molecule docking were performed to study the underlying mechanism of Huanghuai (HH), and pharmacodynamic experiments were conducted to verify its curative effect. Methods: TCMSP, UniProt, GeneCards, STRING, DAVID databases, and Cytoscape 3.7.2 were utilized for the construction of a compound-target-pathway network. Docking the potential effective components with potential targets. The HPLC analysis of the potential effective components was performed. In vivo, the hot plate test model was used to study the analgesic activity, the egg white was used to study the swollen reaction in the sole in mice, and the hemostasis effect was studied by the capillary method, tail-breaking method and abortion uterus test. Results: The results showed that six compounds (acacetin, beta-sitosterol, wogonin, baicalein, kaempferol and quercetin) and four potential targets (PTGS2, AKT1, TP53 and TNF) in the compound-target-pathway network were the potential material basis for HH to treat DUB. It can be seen that the binding energy of the acacetin, wogonin, baicalein, beta-sitosterol, kaempferol and quercetin in HH docked with the receptor proteins PTGS2, AKT1, TP53, and TNF were far less than −5.0 kJ/mol, which means the molecules have low conformational energy, stable structure and high binding activity. And the result of HPLC analysis showed that acacetin, wogonin, baicalein, kaempferol and quercetin were the potential effective components of the hemostasis mechanism of HH, beta-sitosterol was removed due to low content. In vivo testing of the potential effective components, it revealed that the group of potential effective components identified by HPLC could increase the pain threshold, inhibit the swelling hind paws of mice induced by egg white, reduce the bleeding time and clotting time, reduce uterine bleeding, decrease the uterine weight, increase the content of Ca and ET-1, and reduce the content of NO in uterine homogenate tissue, and decrease of E

A study on the correlation of clinical and ultrasonography diagnosis with histopathological outcome in cases of hysterectomy

Background: Hysterectomy is the most commonly performed gynaecological operation throughout the world due to different causes of pelvic pathology. Fewer studies have been performed describing the relationship between preoperative clinical, ultrasonological diagnosis and histopathological outcome.Methods: Authors report 100 cases with benign gynecological disorders who underwent hysterectomy. Authors excluded malignant cases from the study. A preoperative diagnosis was formed based on clinical and ultrasound examination and it was compared with the histopathological report of the hysterectomy specimen.Results: In this study the most common preoperative diagnosis for hysterectomy was fibroid uterus (39%) among which 94.87% showed positive correlation with HPE. Correlation for adenomyosis was 100% between preoperative diagnosis and HPE outcome. Correlation for DUB was poor. 57.14% of the preoperatively diagnosed DUB cases showed adenomyosis on HPE. One case of fibroid showed adenocarcinoma of endometrium on HPE.Conclusions: The study fulfills the aim of finding the efficacy of clinical and USG findings in diagnosing gynecological disorders accurately. Clinical examination is not always adequate. USG is the most important, simple and easily accessible investigation. There is one missed malignant case in this study which is a major shortcoming of clinical evaluation.

Targeted treatments for dysfunctional uterine bleeding based on endometrial thickness

Background: Dysfunctional uterine bleeding is a common presentation to both general practitioner and gynaecologists which can have a significant effect on a woman’s quality of life. The aim of this study is to assess the effectiveness of treating dysfunctional uterine bleeding according to endometrial thickness.Methods: This study was a hospital based prospective study undertaken in gynecology outpatient clinic of Central Women’s Hospital, Mandalay, Myanmar for one-year period (2016). A total of 60 patients were recruited and divided into 3 groups based on endometrial thickness and offered targeted hormonal treatments. At the end of the one-month treatment, patients were asked to return for a follow-up visit and from their menstrual diaries, the number of bleeding days and bleeding scores were assessed and calculated.Results: Among sixty women with dysfunctional uterine bleeding, 55% of patients had endometrial thickness less than 6 mm, 25% had endometrial thickness 6-11 mm, with 20% of patients having endometrial thickness more than 11 mm. After one month of study period, treatment was found to be effective in 86.6% of the patients according to bleeding days and in 70% of the patients according to bleeding score.Conclusions: In women presenting with dysfunctional uterine bleeding, increased endometrial thickness was found to be associated with increased BMI. In the treatment of dysfunctional uterine bleeding, when the endometrial thickness of the patient was assessed and hormonal treatment was given according to the endometrial thickness, treatment was proven to be effective.

Ormeloxifene versus combined oral contraceptive pills to control blood loss in cases of dysfunctional uterine bleeding

Background: Dysfunctional uterine bleeding is one of the most often encountered gynecologic problems causing anemia, reduced quality of life and unnecessary hysterectomies. A prospective study was conducted on women with DUB to study the effect of ormeloxifene versus combined oral contraceptive pills in controlling blood loss in them.Methods: 100 Women with DUB were enrolled randomly in three groups. After baseline assessment each patient in group A was treated with iron tablets, containing 100 mg elemental iron and folic acid 1.5 mg, for three months and were termed as control group. Group B patients were treated with ormeloxifene in dose of 60 mg twice a week for twelve weeks. Group C patients were treated with combined oral contraceptive pills for twenty- one days starting from third day of their LMP. The treatment was continued for three consecutive cycles. The efficacy of the studied drugs was analyzed by comparing the baseline and post treatment PBAC score, haemoglobin level and endometrial thickness, using appropriate statistical tests.Results: Ormeloxifene was more effective than only iron or combined oral contraceptive therapy in controlling menstrual blood loss (79.11% versus 58.57%). There was a reduction in endometrial thickness in group receiving ormeloxifene as well as in the group receiving combined oral contraceptive pills (p=0.486), however this was statistically not significant.Conclusions: Ormeloxifene was significantly better than combined OCP in reduction of menstrual blood flow in cases of DUB. It has better compliance and marked improvement in subjective symptoms as compared to OCP.

A prospective study of thyroid dysfunction in dysfunctional uterine bleeding

Background: Dysfunctional uterine bleeding is abnormal uterine bleeding in the absence of any palpable pelvic pathology and demonstrable extra genital causes. Thyroid dysfunction is the systemic disease most often associated with abnormal uterine bleeding. Aim was to evaluate thyroid function test in women with DUB; to assess bleeding pattern in thyroid dysfunction.Methods: Prospective observational study was done in the department of obstetrics and gynaecology, Vanivilas hospital, Bangalore from august 2018 to July 2019. Pre structured and predesigned proforma filled. All routine blood investigations including serum T3, T4, TSH, USG were advised. These patients were categorized as euthyroid, subclinical hypothyroid, hypothyroid or hyperthyroid based on thyroid profile.Results: 0.5% belonged to the age group of 31-40 years, prevalence of subclinical hypothyroidism is 11%, there were 5.5% of cases of hypothyroidism and 1.5% case of hyperthyroidism.Conclusions: Thyroid screening must be done mandatory for all the cases of DUB and prompt response to treatment with thyroxine would avoid unnecessary surgeries, hormonal treatment, and associated comorbities.

Transcervical resection of endometrium as a conservative management of dysfunctional uterine bleeding in premenopausal patients

Background: Dysfunctional uterine bleeding (DUB) affects 10% to 15% women of reproductive age group. A prospective observational study was performed to study the efficacy, rate of satisfaction and adverse effects of Transcervical resection of endometrium (TCRE) in the treatment of DUB in premenopausal women.Methods: 30 patients with DUB attending the hospital underwent TCRE and patients were followed up after 6 week, 3 months, 6 months up to 1 year and there bleeding score was calculated. Their response to treatment, complications and satisfaction rate were studied.Results: 43.3% of the women in this study were in the age group of 40-44 years. Post TCRE, 43.33% (n=13) had hypomenorrhea. 33.33% (n=10) had regular cycle, 13.33% (n=4) women had amenorrhea and 10% (n=3) had no response and underwent hysterectomy. 86.66% (n=26) women were satisfied with the treatment whereas 13.33% (n=4) were not satisfied. One patient had uterine perforation and serosal bowel injury due to extended cautery injury. Bleeding reduced considerably and a statistically significant (paired t-test, p-value <0.05) difference was observed in pre and post procedure (6 weeks, 3 months, 6 months and 1 year) bleeding scores.Conclusions: Considering advantages like shorter operative time, uterine conservation and early mobility TCRE is a procedure of choice in patients in whom hysterectomy is either technically difficult or medically contraindicated or in those who are not suitable for long term medical management.

Efficacy and safety of ormeloxifene in the management of dysfunctional uterine bleeding

Background: The term dysfunctional uterine bleeding (DUB) is used for abnormal uterine bleeding occurring in the absence of identifiable pathology. A number of drugs are available for management of DUB- nonsteroidal anti-inflammatory drugs, tranexamic acid, ethamsylate, hormones like Oral contraceptives progestins etc. The present study was done to determine the efficacy and safety of ormeloxifene in the management of DUB.Methods: This prospective clinical study involved 50 cases with DUB who were treated with ormeloxifene 60 mg tablet twice a week for first 12 weeks and the once a week for next 12 weeks. They were followed after 6 months of therapy. The outcome was studied by assessment of menstrual blood loss by PBAC score, Hb level in g/dl, endometrial thickness in mm, relief of dysmenorrheal and any side effects of drugs.Results: The median PBAC score was significantly reduced from 316 to 52 after 6 months of therapy. The mean Hb concentration was significantly increased from 7.8 g/dl to 9.1 g/dl at 6 months of therapy. The mean endometrial thickness was reduced from 10 mm to 7.9 mm after 6 months of therapy. 66% of women showed marked subjective improvement in symptoms. Amenorrhea was the main side effect (12%).Conclusions: Ormeloxifene has significant effect in reducing endometrial thickness, decreasing the amount of menstrual blood loss, reducing dysmenorrhea and thereby improving the general condition of the patient. It is definitely a better alternative to hysterectomy in women who wish to avoid surgeries and maintain their reproductive functions.

Factores de riesgo para cáncer de endometrio en premenopáusicas con hemorragia uterina disfuncional / Risk factors for endometrial cancer in pre-menopausal women with dysfunctional uterine hemorrhage

El objetivo de la investigación fue establecer los factores de riesgo para cáncer de endometrio en premenopáusicas con diagnóstico de hemorragia uterina disfuncional. Se realizó un estudio observacional en mujeres con diagnóstico de hemorragia uterina disfuncional. Se evaluaron la asociación entre la histología endometrial y los factores de riesgo para el cáncer de endometrio, de ellos se analizaron: irregularidades del ciclo menstrual, diabetes mellitus, nuliparidad, hipertensión, obesidad y edad mayor de 40 años. La regresión logística se utilizó para investigar la importancia relativa de cada factor de riesgo. El estudio incluyó 266 mujeres con edad promedio de 41 años. La prevalencia de los factores de riesgo fue la siguiente: edad mayor de 40 años (67,2 %), menstruaciones irregulares (22,1 %), nuliparidad (16,9 %), obesidad (10,1 %), hipertensión (8,6 %) y diabetes (2,2 %). Los resultados de la biopsia endometrial incluyeron: 14 casos (5,2 %) de hiperplasia simple, 16 casos (6,0 %) de hiperplasia compleja y 4 casos (1,5 %) de hiperplasia con atipia. No se observaron casos de adenocarcinoma de endometrio. Se encontró que las menstruaciones irregulares eran el único factor de riesgo estadísticamente significativo asociado a alteración de la histología endometrial (p = 0,0132). En el grupo de pacientes con menstruaciones regulares y sin factores de riesgo, la incidencia de biopsia anormal observada fue inferior al 1 %. Las irregularidades del ciclo menstrual aumentan la probabilidad de un resultado anormal de la biopsia a un 14,2 %. Se concluye que las mujeres premenopáusicas diagnosticadas con hemorragia uterina disfuncional cuyos ciclos menstruales son regulares tienen un riesgo insignificante de desarrollar hiperplasia endometrial.

The objective of the research was to establish risk factors for endometrial cancer in pre-menopausal women with a diagnosis of dysfunctional uterine hemorrhage. An observational study was conducted in women with a diagnosis of dysfunctional uterine bleeding. The association between endometrial histology and risk factors for endometrial cancer analyzed were menstrual cycle irregularities, diabetes mellitus, nulliparity, hypertension, obesity and age over 40 years. Logistic regression was used to investigate the relative importance of each risk factor. The study included 266 women with an average age of 41 years. The prevalence of risk factors was the following: age over 40 years (67,2 %), irregular menses (22,1 %), nulliparity (16,9 %), obesity (10,1 %), hypertension (8,6 %) and diabetes (2,2 %). The results of the endometrial biopsy included: 14 cases (5,2 %) of simple hyperplasia, 16 cases (6,0 %) of complex hyperplasia and 4 cases (1,5 %) of complex hyperplasia with atypia. No cases of endometrial adenocarcinoma were observed. It was found that irregular menses were the only statistically significant risk factor associated with alteration of endometrial histology (p = 0.0132). In the group of patients with regular menses and without risk factors, the incidence of abnormal biopsy observed was less than 1 %. The irregularities of the menstrual cycle increases the probability of an abnormal result of the biopsy to 14,2 %. It is concluded that premenopausal women diagnosed with dysfunctional uterine bleeding whose menstrual cycles are regular have a negligible risk of developing endometrial hyperplasia.

Histopathological Study Of Endometrial Lesions In Patients In A Tertiary Care Hospital In North Telangana

Introduction:Abnormal uterine bleeding (AUB) is considered one of the most common and challenging problems presenting to the gynecologist. Histopathological examination of endometrial biopsy is gold standard diagnostic tool in evaluation of AUB. Our study is aimed at determining the spectrum of endometrial pathologies in different age group patients presenting with AUB at our hospital which caters largely to women living in rural area. Materials & Methods : The present study is a retrospective and prospective study done for a period of one year in department of Pathology. All hysterectomy cases and endometrial biopsy cases were considered in the present study. Complete patient history, clinical and radiological findings were considered. Results: A total of 100 cases were included in our study and out of them the most common lesion was proliferative phase constituting upto 33 cases followed by secretory phase.The most common age group was in between 31-40 years. The most common complaint was abnormal uterine bleeding. Conclusion: Histopathological examination of endometrium is gold standard diagnostic tool in evaluation of AUB and there is an age specific association of endometrial lesions.

Abnormal Uterine Bleeding / Sangramento uterino anormal

Abstract Abnormal uterine bleeding is a frequent condition in Gynecology. It may impact physical, emotional sexual and professional aspects of the lives of women, impairing their quality of life. In cases of acute and severe bleeding, women may need urgent treatment with volumetric replacement and prescription of hemostatic substances. In some specific cases with more intense and prolonged bleeding, surgical treatment may be necessary. The objective of this chapter is to describe the main evidence on the treatment of women with abnormaluterinebleeding, both acuteand chronic.Didactically,thetreatmentoptions were based on the current International Federation of Gynecology and Obstetrics (FIGO) classification system (PALM-COEIN). The etiologies of PALM-COEIN are: uterine Polyp (P), Adenomyosis (A), Leiomyoma (L), precursor and Malignant lesions of the uterine body (M), Coagulopathies (C), Ovulatory dysfunction (O), Endometrial dysfunction (E), Iatrogenic (I), and Not yet classified (N). The articles were selected according to the recommendation grades of the PubMed, Cochrane and Embase databases, and those in which the main objective was the reduction of uterine menstrual bleeding were included. Only studies written in English were included. All editorial or complete papers that were not consistent with abnormal uterine bleeding, or studies in animal models, were excluded. The main objective of the treatment is the reduction of menstrual flow and morbidity and the improvement of quality of life. It is important to emphasize that the treatment in the acute phase aims to hemodynamically stabilize the patient and stop excessive bleeding, while the treatment in the chronic phase is based on correcting menstrual dysfunction according to its etiology and clinical manifestations. The treatment may be surgical or pharmacological, and thelatterisbasedmainlyonhormonaltherapy,anti-inflammatorydrugsandantifibrinolytics.

Resumo O sangramento uterino anormal é uma afecção frequente que pode afetar negativamente aspectos físicos, emocionais, sexuais e profissionais, piorando a qualidade de vida das mulheres. Nos casos de sangramento intenso e agudo, as mulheres podem necessitar de tratamento de urgência, com reposição volumétrica e substâncias hemostáticas. Há situações que necessitam de tratamento prolongado, e ainda situações em que o tratamento cirúrgico pode ser necessário. O objetivo deste estudo é descrever as principais evidências sobre o tratamento das mulheres com sangramento uterino anormal, tanto na fase aguda quanto na crônica. A apresentação do tratamento foi baseada no sistema de classificação (PALM-COEIN, na sigla em inglês) da Federação Internacional de Ginecologia e Obstetrícia (FIGO). As etiologias do PALMCOEIN são: Pólipo uterino (P), Adenomiose (A), Leiomiomia (L), lesões precursoras e Malignas do corpo uterino (M), Coagulopatias (C), distúrbios da Ovulação (O), disfunção Endometrial (E), Iatrogênicas (I), e não classificadas nos itens anteriores (N). Os artigos foram selecionados conforme os graus de recomendação das bases de dados PubMed, Cochrane e Embase que tivessem como objetivo o tratamento do sangramento uterino anormal em mulheres. Somente artigos escritos em inglês foram incluídos. Todos os editoriais ou papers completos que não tratassem de sangramento uterino anormal, ou estudos baseados em modelos animais, foram excluídos. O tratamento tem como objetivo a redução do fluxo menstrual, reduzindo morbidade e melhorando a qualidade de vida. O tratamento na fase aguda visa estabilizar hemodinamicamente a paciente e estancar o sangramento excessivo, enquanto a terapia da fase crônica é baseada na correção da disfunção menstrual, conforme sua etiologia ou conforme a manifestação clínica. O tratamento pode ser cirúrgico ou medicamentoso, sendo o segundo baseado principalmente em fármacos hormonais, anti-inflamatórios ou antifibrinolíticos.

Discussion on Experience of ZHANG Liang-ying in Treating Polycystic Ovary Syndrome ;Combined with Dysfunctional Uterine Bleeding / 中国中医药信息杂志

Polycystic ovary syndrome (PCOS) and dysfunctional uterine bleeding (DUB) are common gynecologic endocrine diseases, and their etiology, pathology, diagnosis and treatment are related but also distinguishing. Some patients have PCOS and DUB at the same time, which is difficult to cure. Professor ZHANG Liang-ying has treated these patients with staging treatment based on syndrome differenciation, and has received desiable efficacy.

Comparison of the Clinical Effects and Improvement of Serum Hormone Levels of Kidney Tonifying and Blood Circulation Recipe and Mirena in the Treatment of Perimenopasual Dysfunctional Uterine Bleeding / 现代生物医学进展

Objective:To compare the clinical effects and improvement of serum hormone levels of kidney tonifying and blood circulation recipe and mirena in the treatment of perimenopasual dysfunctional uterine bleeding.Methods:92 cases of perimenopausal patients with dysfunctional uterine bleeding in our hospital from July 2013 to November 2016 were selected and divided into group A and group B with 46 cases in each group.Group A was orally administered with kidney tonifying and blood circulation recipe,and group B was administered with mirena.Both groups were treated for 3 periods.The efficacy and incidences of adverse effect in two groups were observed.The levels of serum hormones and hemoglobin (Hb),and endometial thickness (ET) were detected in two groups.The indices of serum hormone included follicle-stimulating hormone (FSH),luteinizing hormone (LH),progestone (P) and estradiol (E2).Results:No significant difference was found in the total effective rate between two groups (P＞0.05).After treatment,the levels of serum FSH,LH,E2 and P as well as ET and Hb in both groups were all significantly lower than those before treatment (P＜0.01),and the levels of serum FSH,LH,E2 and P as well as ET of group B were significantly lower than those of group A (P＜0.01),no significant difference in the Hb level between two groups (P＞0.05).The incidence of adverse reactions of group B (15.22％) was significantly higher than that of group A(0％) (P＜0.01).Conclusions:The kidney tonifying and blood circulation recipe had similar effect as mirena in the treatment of perimenopasual dysfunctional uterine bleeding,while mirena had strong improving effect in serum hormone level and ET,kidney tonifying and blood circulation recipe had higher security.

Observation on the effect of Marvelon on perimenopausal dysfunctional uterine bleeding / 中国生化药物杂志

Objective To investigate the clinical effect of Marvelon on perimenopausal dysfunctional uterine bleeding.MethodsIn December 2014 to December 2015, 90 cases with premenopausal dysfunctional uterine bleeding in Anji people's hospital were randomly divided into the observation group and the control group, 45 cases in each group.The control group were given curettage, on the basis of the control group, the observation group was given Marvelon.The clinical efficacy was compared between the two groups.Results①The total effective rate in the observation group 91.1% was higher than that in the control group 71.1% (P<0.05).②After treatment, Estradiol (201.3±12.5) pmol/L, progesterone (1.6±0.9) nmol/L, FSH (1.3±0.2) IU/L in the observation group;estradiol (305.3±19.5) pmol/L, progesterone (2.8±1.1) nmol/L, FSH (2.9±0.9) IU/L in the control group, the differences were statistically significant between the two groups (P<0.05).ConclusionThe clinical effect is better which Marvelon was used on perimenopausal dysfunctional uterine bleeding, it is worthy of application.

Study on the Mechanism of Celosia cristata N-butanol Extracts in the Improvement of Dysfunctional Uter-ine Bleeding of Rats / 中国药房

OBJECTIVE:To study the improvement effect of Celosia cristata n-butanol extracts on dysfunctional uterine bleed-ing of rats,and explore its mechanism. METHODS:60 pregnant SD rats were randomly divided into blank group,model group, Gongxuening capsule group (positive control,0.07 g/kg) and C. cristata n-butanol extracts high-dose,medium-dose,low-dose groups(4.32,2.16,1.08 g/kg),10 in each group. Except for the blank group,rats in other groups were intragastrically given mife-pristone and misoprostol on 7th of pregnancy for resulting incomplete abortion to induce models of dysfunctional uterine bleeding. Then rats in administration groups were intragastrically given relevant medicines,rats in blank group and model group were intra-gastrically given normal saline once every morning and evening,for 7 d. On 8th d of pregnancy,uterine bleeding amount,and thromboxane (TXA2),prostacyclin (PGI2) and tumor necrosis factor α(TNF-α) contents in serum were determined. RESULTS:Compared with blank group,uterine bleeding amount in model group was significantly increased(P<0.01),TXA2 content in se-rum was significantly reduced,PGI2 and TNF-α contents were significantly increased(P<0.01). Compared with model group,uter-ine bleeding amounts in administration groups were significantly reduced,TXA2 content in serum was significantly increased(P<0.01);PGI2 and TNF-α contents in serum in Gongxuening capsule group and C. cristata n-butanol extracts high-dose group and TNF-α content in serum in C. cristata n-butanol extracts medium-dose group were significantly reduced (P<0.01). CONCLU-SIONS:C. cristata n-butanol extracts show obvious improvement effect on incomplete drug abortion-induced dysfunctional uterine bleeding of rats,and the mechanism may be related to the regulation of TXA2/PGI2 dynamic balance and inhibition of TNF-α tran-sient secretion.

Evidencias en indicaciones de la progesterona / Evidence in progesterone prescription

Resumen ANTECEDENTES: la progesterona es una hormona esteroide con participación en la ovulación, implantación, embarazo y regulación de la función uterina durante el ciclo menstrual y de otros órganos, como la glándula mamaria. Por su mecanismo de acción, la progesterona está indicada en distintos padecimientos ginecológicos y obstétricos: síndrome premenstrual, amenaza de aborto, parto pretérmino, hemorragia uterina disfuncional y mastalgia relacionada con el ciclo menstrual. OBJETIVO: evaluar la seguridad y eficacia de la progesterona en pacientes con: síndrome premenstrual, amenaza de aborto y de parto pretérmino, hemorragia uterina disfuncional, mastalgia y terapia hormonal en la menopausia. METODOLOGÍA: revisión sistemática de la evidencia científica acerca de las distintas indicaciones de la progesterona. RESULTADOS: se encontraron 92 artículos de los que se seleccionaron 41 para revisión. CONCLUSIONES: la evidencia clínica evaluada acerca de las indicaciones de la progesterona demuestra ventajas en eficacia y seguridad en los diferentes esquemas.

Abstract BACKGROUND: Progesterone is a steroid hormone involved in ovulation, implantation, pregnancy and regulation of uterine function during the menstrual cycle and other organs such as the mammary gland. Because of its mechanism of action, progesterone is indicated in different gynecological and obstetric conditions: premenstrual syndrome, threatened abortion, preterm birth, dysfunctional uterine bleeding and mastalgia related to the menstrual cycle. OBJECTIVE: To evaluate the safety and efficacy of progesterone in patients with: premenstrual syndrome, threatened abortion, preterm birth, dysfunctional uterine bleeding, mastalgia and hormone therapy in menopause. MATERIAL AND METHODS: Systematic review of scientific evidence about different indications of progesterone. RESULTS: We found 92 articles from wich 41 were selected for review. CONCLUSIONS: The clinical evidence evaluated on different indications of progesterone demonstrates advantages in efficacy and safety in different regimens.

Comparison of the Efficacy and Safety of Levonorgestrel Intrauterine System and Mifepristone in the Treatment of Perimenopausal Dysfunctional Uterine Bleeding / 中国药房

OBJECTIVE:To compare the efficacy and safety of levonorgestrel intrauterine system and mifepristone in the treat-ment of perimenopausal dysfunctional uterine bleeding. METHODS:200 patients with perimenopausal dysfunctional uterine bleed-ing were randomly divided into observation group (100 cases) and control group (100 cases). Patients in the observation group placed levonorgestrel intrauterine system (containing levonorgestrel 52 mg),patients in control group received Mifepristone cap-sule 10 mg/d,oral,the treatment course for 2 groups were 3 months. Clinical efficacy,endometrial thickness,menstruation(PBAC score),hemoglobin level before and after treatment and incidence of adverse reaction in 2 groups were observed. RESULTS:After treatment,the total effective rate in observation group was significantly higher than control group,incidence of adverse reactions was significantly lower than control group,the differences were statistically significant(P<0.01). Before treatment,there were no significant differences in the endometrial thickness,PBAC score and hemoglobin level between 2 groups;after treatment,endome-trial thickness and PBAC score were significantly lower than before,and observation group was lower than control group;hemoglo-bin level was significantly higher than before,and observation group was higher than control group,the differences were statistical-ly significant(P<0.01 or P<0.05). CONCLUSIONS:The efficacy and safety of levonorgestrel intrauterine system are significant-ly superior to mifepristone in the treatment of perimenopausal dysfunctional uterine bleeding.

A comparative study on the effectiveness of ormeloxifene versus norethisterone in the management of perimenopausal dysfunctional uterine bleeding.

Background: Menstrual disorders are the second most common gynecological condition resulting in hospital referrals. Dysfunctional Uterine Bleeding is defined as abnormal uterine bleeding in the absence of organic disease. Menorrhagia (menstrual blood loss >80 ml per cycle) affects 10-33% of women at some stage in their lives. Approximately 90% of dysfunctional uterine bleeding result from anovulation and 10% occur with ovulatory cycles. Only half of women complaining of heavy menstrual bleeding fit the clinical criteria of more than 80 ml blood loss per cycle. Among women aged 30-49, one in 20 consults her general practitioner each year with menorrhagia . it can be managed both medically and surgically. Material and methods: Thirty women presenting with DUB were randomly allocated to 2 equal groups, Group-A, which received 60 mg ormeloxifene twice a week for 12 weeks and Group-B, which received 5 mg norethisteron twice daily for 21 days for 3 months. The primary outcome measures were reduction in menstrual blood loss which was measured by fall in PBAC (Pictorial Blood loss Assessment Chart) score, rise in hemoglobin level and reduction in endometrial thickness Results: The reduction in mean PBAC score with ormeloxifene (277.33 to 70.11) was significantly more than that seen with norethisterone (246 to 108.5) after 3 months of therapy (p<0.05). The increase in hemoglobin level and reduction in endometrial thickness were also found to be significantly more with ormeloxifene than norethisterone (9.68 g %to 11.07 g% vs. 10.17 g% to 10.58 g%, p<0.05, and 7.8 mm vs. 6.7 mm to 5.9 mm, p<0.05, respectively). No major side effects were reported in any group. Conclusion: Ormeloxifene was found to be more effective than norethisterone in reducing blood loss and reducing endometrial thickness

Clinical Observation of Mifepristone Cycle Therapy in the Treatment of Perimenopausal Dysfunctional Uter-ine Bleeding / 中国药房

OBJECTIVE:To observe the efficacy and safety of mifepristone cycle therapy in the treatment of perimenopausal dysfunctional uterine bleeding. METHODS:Totally 116 patients with perimenopausal dysfunctional uterine bleeding were randomly divided into control group and observation group. Control group was given Mifepristone tablet 10 mg from 3 d after diagnostic cu-rettage on an empty stomach for continuous 90 d,once a day. Observation group was given Mifepristone tablet 10 mg from 3 d af-ter diagnostic curettage on an empty stomach,once a day,and it was stopped after continuous 5 d. Then it continued 5 d from the first day of menstruation,and lasted 3 menstrual cycles. The clinic data was observed,including clinical efficacy,estradiol(E2),fol-licle-stimulating hormone (FSH),luteinizing hormone (LH),progesterone (P),hemoglobin (Hb),endometrial thickness,men-strual conditions and recurrence in 2 groups before and after treatment were observed,and the incidence of adverse reactions were recorded. RESULTS:After treatment,E2,FSH,LH and P in 2 groups were significantly lower than before,and observation group was lower than control group,the differences were statistically significant(P0.05). Total effective rate in observation group significantly higher than control group,normal proportion of menstruation were significantly better than control group,the differences were statistically sig-nificant(P0.05). CONCLUSIONS:Mifepristone cycle therapy has significant efficacy in the treatment of perimenopausal dysfunctional uterine bleeding,can significantly improve the hormone level and the establishment of normal menstrual cycle and re-duce endometrial thickness,with good safety.

XIWU MIXTURE COMBINED WITH MARVELON IN THE TREATMENT OF PERIMENOPA-USAL DYSFUNCTIONAL UTERINE BLEEDING / 现代医院

Objective To observe the clinical effect of Siwu mixture combined with Marvelon in the treat-ment of perimenopausal dysfunctional uterine bleeding.Methods 148patients with perimenopausal dysfunctional u-terine bleeding were randomly divided into observation group and control group with 74 cases in each group the control group was treated by Marvelon alone, the observation group was treated with Siwu mixture on the basis of the control group.Results After treatment, the established indexes in the observation group were significantly better than the control group (p <0.05); the clinical total effective rate of the observation group was 93.2%, the control group was 73%, there was statistical significance in the observation group compared with the control group (X2 =9.512,p =0.004).Conclusion The safety and effectiveness of Siwu mixture combined with Marvelon in the treatment of peri-menopausal functional uterine bleeding is extremely satisfactory and is worth further promotion.