The Therapy Of GnRH-a In Endometriosis After Operation

Objective The endometriosis cause of disease is so far not yet very clear. The disease is occuring with increasing frequency in recent years. It's next to only uterine myoma. Major features of endometriosis are pain, difficulty with reproduction and sexual intercourse. 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. After operation, taking medicine is so important to lower recurrence. Endometriosis is estrogen-dependent disease, the growth and maintain of ectopic endometrium is also dependent on estrogen. this study is to explore the therapeutic efficacy of GnRH-a in patients who suffered from endometriosis after conservatism operation.Methods We collect 112 cases with endometriosis and infertility who accept conservatism operation, coming from the First Hospital of Jilin University and Longnan Hospital of Daqing, in 2005,1-2007,1. they had been proved by pathological diagnosis. We divied them into therapy group and control group. The therapy group (plus GnRH-a (3.75mg /28days, im, 3 months) after conservatism operation ) has 60 cases, the control group has 52 cases,two groups has no difference in age, body height, weigh, gravidity-parity, r-AFS Criteria for EMS andoperation method. each group was divided into mild and severe groups according to r-AFS. Follow up 1 year. Data of remission, recurrence and pregnancy after treatment were collected and analyzed.Biopsies 30 cases with ectopic endometrium, including 30 cases eutopic endometrium tissues from 30 patients above, were examed for expression of GnRH-R using immunohistochemistry. Normal endometrium tissues from 30 patients with uterine myoma were used as control.Results there was significant difference in the ratios of remission and recuurence between therapy and control group (X~2=4.67, P<0.05; X~2=5.04, P<0.05). there was significant difference in the ratios of recuurence and pregnancy between therapy and control groups in severe EMS group (X~2=7.51, P=0.0065; X~2=1.51, P<0.05), the different results of the ratios of recuurence and pregnancy in mild EMS group (X~2=0, P>0.95;X~2=0.14, P>0.05). there was significant difference between the eutopic and ectopic endometrium in the expression of GnRH-R (66.67%, 100%, P<0.05); The relative amousts of GnRH-R is eutopic and ectopic endometrium of the patients with endometriosis(100%, 66.67%) both were higher than those in the normal endometrium (16.67%) (X~2=42.89 , P<0.05, X~2=10.00 ,P<0.05).Conclusion GnRH-a is effective in treatment of endometriosis after conservatism operation, not only in remission, but also in recuurence. Using GnRH-a after conservatism operation may increasethe opportunity of pregnancy in severe endometriosis.whether to adopt the therapy of GnRH-a after conservatism operation for pregnancy in mild endometriosis or not dependeds on the recent desire on bleeding of patients. GnRH-a can connect with GnRH-R of pituitary and effect, GnRH-a may connect with GnRH-R of eutopic and ectopic endometrium and effect.