ABSTRACT
Objective: To study the effect of raloxifene on endometrial histopathology of menopausal women. Methods: Thirty-one patients under raloxifene treatment (60 mg/day) for a six-month period and submitted to diagnostic videohysteroscopy at the Climateric Outpatients Clinic, Department of Gynecology and Obstetrics, Hospital do Servidor Público Estadual Francisco Morato de Oliveira, in the city of São Paulo, and at Hospital Guilherme Álvaro, in the city of Santos, from September 10th, 2003 to June 22nd, 2004, were analyzed. Guided endometrial biopsy was performed on all patients on the anterior wall, using a 3-mm or 5-mm biopsy forceps. A 3-mm or 5-mm hysteroscope was used with TV imaging by an endocamera. The results of the hysteroscopic tests were compared before and six months after the use of raloxifene. Results: The comparison between both biopsies was performed by means of the McNemars test (marginal homogeneity test), and showed a descriptive level of 0.001 that indicates difference between the estrogen effects assessed at different moments. The estrogen effect on the endometrial tissue did not increase in any of the 31 patients analyzed. Twenty-one patients (68%) showed smaller estrogen effect in the final evaluation. Conclusions: The study showed no evidence of endometrial stimulation of raloxifene and, in fact, many women presented less estrogen effect after its use.
Objetivo: Estudar o efeito do raloxifeno sobre a histopatologia endometrial em mulheres menopausadas. Métodos: Foram estudadas 31 pacientes usuárias de raloxifeno (60 mg/dia) por um período de seis meses e que realizaram vídeo-histeroscopias diagnósticas nos ambulatórios de Climatério do Serviço de Ginecologia e Obstetrícia do Hospital do Servidor Público Estadual "Francisco Morato de Oliveira", São Paulo, e do Hospital Guilherme Álvaro, da cidade de Santos (SP), de 10 de setembro de 2003 a 22 de junho de 2004. Em todas as pacientes foi realizada biópsia endometrial dirigida em parede anterior com pinça de biópsia de 3 ou 5 mm. Os histeroscópios utilizados foram de 3 ou 5 mm de calibre com visualização da imagem em monitor de televisão por endocâmera. Os resultados dos exames histeroscópicos foram comparados antes e seis meses após o uso do raloxifeno. Resultados: A comparação entre os resultados das duas biópsias, feita por meio do teste de McNemar (teste de homogeneidade marginal), obteve nível descritivo igual a 0,001, o que indica diferença entre os efeitos estrogênicos avaliados em diferentes instantes. O efeito estrogênico no endométrio não se acentuou em nenhuma das 31 pacientes analisadas. Em 21 pacientes (68%) foi observado, ao final, menor efeito estrogênico em relação ao exame inicial. Conclusões: O estudo não mostrou evidências de que o raloxifeno tenha efeito estimulante sobre o endométrio, tendo sido observada inclusive menor ação estrogênica após o uso da droga em um número alto de casos.
ABSTRACT
Objective To explore the therapeutic mechanism of kidney-tonifying and blood-activating herbal medicine for anovulatory dysfunctional uterine bleeding(ADUB).Methods Thirty-seven ADUB patients were randomized into two groups.Group A(N=25)was treated with Gongxue Yin(mainly composed of Fructus Psoraleae,Radix Dipsaci,Fructus Corni,Pollen Typhae,Radix Notoginseng,Radix Codonopsis,Os Draconis,Concha Ostreae,Herba Hedyotis Diffusae),and group B(N=17)received medroxyprogesterone.One menstrual cycle constituted one treatment course and the treatment lasted 3 continuous courses.Histostain-plus(HP)immunohistochemical assay was adopted to test the Bcl-2 and Bax protein expression in endometrium of the two groups.Ten healthy volunteers served as the control.Results Bcl-2 protein expression was higher in endometrium of ADUB patients at proliferative stage or with proliferative changes than that at secretory phase of the normal control group(P0.05).Conclusion Both progesterone and kidney-tonifying and blood-activating herbal medicine decrease endometrial Bcl-2 protein expression and increase Bax expression,by which inducing the endometrial cell apoptosis in patients with anovulatory dysfunctional uterine bleeding.But their detailed mechanism may be different.
ABSTRACT
To observe the effect of kidney reinforcing and blood nourishing herbal medicines in treating anovulatory sterility (AS) and its mechanism. Two hundred and seventy six cases of AS with hypopituitarism confirmed by the examination of blood sexual hormones were divided into three groups to receive the treatment of promoting ovulation. Group A was treated with modified Zhenwu Decoction and Reinforcing Qi and Nourishing Yin Powder (one dose per day) from the third day of menstrual cycle (MC) to the ovulating day; Group B with clomiphene (50mg/d) from the fifth day of MC, with human chorionic gonadotrophin (HCG) added, 10?000?U im in the day of follicle maturity and Group C with human menopausal gonadotrophin (HMG) 25 U/d im from the eighth day of MC and then with HCG added, 10 000 U im in the day of follicle maturity. After treatment, the cases were asked to have sexual intercourse for three nights. Ovulation time was monitored by ultrasound B imaging for one time every other day until follicle became maturity (1 8?cm?1 8?cm).Early pregnancy was detected by HCG test.Ninety three MC were ovulatory among 167 MC in Group A, the ovulation rate being 55 68%; 182 among 230 in Group B , the rate being 79 13% and 88 among 134 in Group C , the rate being 65 67%. Multisample ? 2 test showed that the ovulation rate in Group A was lower than that in Group B and Group C (? 2=9 345, P