The Clinical Study In Individualized Treatment Of Diphereline After Enucleation Of Chocolate Cyst

Objective:The endometriosis is occurring with increasing frequency in recent years. The aim of treatment is to remove the focus of infection,ease the pain and resolve reproductive problems.Many methods have been used to treat this problem,but they all didn't have the expected results.It's hard to permanently heal,even though operative treatment is the chief method.Endometriosis is estrogen-dependent disease, the growth and maintain of ectopic endometrium is also dependent on estrogen.So the drug treatment is very importment.Over the past decade,GnRH-a has been widely used in the management of endometriosis.However,patient acceptance of GnRH-a and the duration of GnRH-a use are limited by two main drawbacks.One is the marked hypoestrogenic state that causes various manifestations,and the other is the initial flare phenomenon that occurs after GnRH-a injection and before pituitary down-regulation.Endometriosis is an uncommon entity with its uncertain causes, varied clinical manifestations,and all different medical therapies with obvious adverse effects.These have brought lots of difficulties to its curing.Accordingly we conducted the clinical observational study in order to improve the patient compliance and acceptance.Contents:In order to assess the endocrinological changes associated with Diphereline as well as their clinical situation,we performed a prospective clinical study of patients who underwent enucleation of chocolate cyst.Methods:A prospective clinical study involving 31 patients who underwent enucleation of chocolate cyst was carried out.These patients were administered Diphereline 3.75mg from 3 to 6 times,28 days apart.We evaluated the symptoms of genital bleeding and hot flashes during Diphereline treatment,as well as the levels of serum FSH,LH and estradiol at the first and third weekend after the start of treatment.Results:In our study,menstruation-like bleeding after treatment was observed in 35.5%of the patients.Severe hot flashes,one of the side effects most often observed with GnRH-a treatment,occurred in 41.9%of the patients after treatment.We divided all the patients into 2 groups according to the genital bleeding(i.e,the group of menstruation-like bleeding and the group of abnormal genital bleeding).Statistically difference of estradiol was found in the first weekend after the treatment between the 2 groups(Z=-2.612,P＜0.01).The estradiol was positively correlated to the days of genital bleeding(r=0.587).According to the severe hot flashes we divided the patients into 2 groups and found that the serum FSH and FSH/LH ratio was statistically difference in the 3 weekend after treatment(Z=-2.247,P＜0.05;Z= -2.200,P＜0.05).The serum FSH and FSH/LH ratio were inversely correlated to the degree of hot flashes(r=-0.541;r=-0.588).Conclusion:(1)These differences in the endocrinological changes in response to Diphereline might be derived from the patient's individual difference.So the individualized treatment of Diphereline after enucleation of chocolate cyst is necessary.(2) In the abnormal genital bleeding group,a relatively longer period of time is required for a patient to achieve amenorrhea,because the flare-up phenomenon of Diphereline causes unfavorable rise of gonadotropins and subsequently of sex steroids in the circulation and then the serum E₂ level gradually decreases.The estradiol at the first weekend after the start of Diphereline treatment can predict the abnormal genital bleeding.These patients received "expected therapy". (3)The rapid FSH or FSH/LH decrease induced severe hot flash in less than one-half of the patients in the present study.These patients received "add-back therapy" and the compliance tended to decrease.The serum FSH and FSH/LH ratio at the third weekend after the start of Diphereline treatment can predict the degree of hot flashes and help us to choice the best treatment plan.