Efficacy, Psychological And Quality Of Life Analysis Of Endometriosis Patients Treatment With GnRHa And DMPA

Objective:To investigate the clinical efficacy of gonadotropin-releasing hormone agonist(Gn RHa) and long-medroxyprogesterone acetate(DMPA) treatment in endometriosis, and trends of psychological status and quality of life before and after the drug treatment,and the extent of its possible influencing factors.Methods: A prospective case study method of investigation in our hospital’s 63 pati-ents with endometriosis in November 2013- March 2015, depending on the use of drugs which 63 cases were divided into two groups, Gn RH-a group, 39 cases use leuprolide 3.75 mg / 28 d × 6, 24 cases DMPA group, use long-acting medroxyproge-sterone acetate 150 mg / 28 d × 6.Record the change of ectopic lesion 、volume change of serum CA125 and side effects before and after treatment, and at the same time use Symptom Checklist(SCL-90), endometriosis Health Questionnaire(EHP-5) to assess the mental score and quality of life in patients, and to analysis the possible influencing factors.Result:The first part of the results:(1) After six months treament the size of ovarian cysts in Gn RHa-group and the DMPA group are reduced by about 56.8%, 50.0%compared with the treatment before one week. The difference was significant(p<0.05)(2) After 6 months treatment,the mean serum CA125 of Gn RHa group is approximately dropped by 62.5% compared with the treatment before one week,DMPA group approximately dropped by 53.4%,The difference was significant(p<0.05).(3)After treatment, the dysmenorrhea VAS scores of three month and six month were significantly lower than before, the difference was significant(p<0.01),but the difference was not significant between the two groups(p> 0.05).The second part of the results:1.SCL-90 scale show:(1) After 3 months and six monthstreatment,in the aspect of the average and total socre, the Gn RHa group declined in somatization,anxiety and force factor(P<0.05), whereas the DMPA group declined in somatizati-on, hostility, sleep and alimentary factor(P<0.05).(2) Compared with the two grou-ps before drug treament, except for sleep and food factor, the average and total socre had no significant difference in other factors(p>0.05). With exception of force and hostility factor, the other factors were not significantly different after drug treatment(P> 0.05).(3)Before treatment, dysmenorrhea VAS and age showed a significant positive correlation with the SCL-90 totalscore(r1 = 0.421, r2 = 0.305,respectively).(4)logistic regression analysis showed that low estrogen symptoms,dysmenorrhea, irregular vaginal bleeding were not independent predictors of the SCL-90 positive screening(p> 0.05).2.EHP-5 scale show:(1) After 3 months and 6 monthsdrug treatment, the tot-al score of the two groups was lower than before drug treatment in pain, powerl-essness, emotional state, work, relationships with children and sexual life, the diff-erences were statistically significant(p <0.05). Total score between the two groups was not statistically significant(p> 0.05).(2) Correlation analysis showed that dysm-enorrhea VASand age score had a positive correlation with EHP-5 score b(r1 =0.704, r2 = 0.491, respectively), before drug treatment.(3) Spearman rank corre-lation analysis showed that there was a correlation between low estrogen sympt-oms and mood swing(r=0.353), andirregular vaginal bleeding had a correlatio-n withsexual life and treatment expectations(r1=0.410,r2=0.296).Conclusion:(1) Gn RHa and DMPA may have similar effects in narrowing endometriosis lesio-ns, reducing the CA125 level and alleviating dysmenorrhea.(2) Gn RHa can impro-ve patients the negative psychological aspects of somatization,,force anxiety,where-as DMPA may improve patients the negative psychological aspects of somatizatio-n, hostility, sleeping and eating, both of which can improve the patients’ mental state.(3) Both Gn RHa and DMPA can improve the quality of life, mainly in the aspect of pain, powerlessness, emotional state, work, relationships with children, sexual life.(4) Duringthe follow-up period of 6months,low estrogen symptoms and irregular bleeding after the drug treatment have less impact on psychologica-l and thequality of life compared with dysmenorrhea.(5) dysmenorrhea is the main reason for the generate negative psychology and the decrease of the quality of life in endometriosis patients.