Bülbül BAYTUR YEŞİM, Semra ORUÇ, Barış ÇOBAN, Fatma ESKİCİOĞLU, Rıza KANDİLOĞLU Ali

Endometriyal Hiperplazilerin Tedavisinde Vajinal Progestoron Jelin Etkinliği

Amaç: Endometriyal hiperplazilerin tedavisinde vajinal progesteron jelin etkinliğinin araştırılması. Gereç ve Yöntem: Jinekoloji polikliniğimize düzensiz adet kanaması şikayetiyle başvuran ve endometriyal biyopsi ile basit atipisiz endometriyal hiperplazi tespit edilmiş12 hasta çalışmaya dahil edildi. Grup 1 (n=6) vajinal progesteron jel ( % 8 Crinone vajinal jel, Serono Pharmaceuticals, Türkiye) adetin 15-25. günleri arasın günde bir, Gurup 2 (n=6) ise Dydrogesteron ( Duphaston 10 mg tb tablet, Solvay ilaç, Türkiye) oral yoldan adetin 15-25. günleri arası günde 2 kez 3 ay aldı. Her iki gruptaki hastaların tedavi öncesi ve sonrası endometriyal patolojileri, endometriyal kalınlıkları, kan lipid profili ve uterin arter rezistans indeksleri karşılaştırıldı. İstatistikler SPSS 10.0 programında, Wilcoxon Signed Rank test ve Mann-Whitney U testleri kullanılarak yapıldı. P<0,05 istatistiksel olarak anlamlı kabul edildi. Bulgular: Gurup 1’de endometriyal hiperplazi olguların 4’ünde (%66,6) iyileşirken, Gurup 2’de hastaların 5’inde (%83.3) iyileşti. Her iki gurup lipid profili açısından anlamlı bir farklılık göstermedi. Her iki gurubun endometriyal kalınlıkları tedavi sonrasında anlamlı ölçüde azaldı (p<0,05). Uterin arter rezistans indeksi ise Gurup 2’de tedavi öncesi ve sonrasında farklı değilken, Gurup 1’de tedavi sonrasında anlamlı ölçüde arttı (p<0,05). Sonuç: %8 crinone vajinal jel endometriyal hiperplazilerin tedavisinde etkindir. Bu etkisinde uterin kan akımının azalmasının rolü olabilir. Bu tedavinin kan lipid profili üzerine olumsuz bir etkisi yoktur.

Anahtar Kelimeler:

dydrogesteron, endometriyal hiperplazi, kan lipid profili, uterin arter Dopler

Aim: To investigate the efficacy of progesterone vaginal gel on endometrial hyperplasias. Material and Methods: Twelve patients who admitted our gynecology clinic with irregular menstrual bleeding and were diagnosed as endometrial hyperplasia with endometrial sampling were included. Group 1 (n=6) received progesterone vaginal gel (Crinone 8% vaginal gel, Serono Pharmaceuticals, Turkey) daily, between 15- 25th cycle days, whereas Group 2 (n=6) received Dydrogesterone (Duphaston 10 mg.tb, Solvay, Turkey) per os twice daily, between 15-25th cycle days for three months. Endometrial pathological findings, endometrial thickness before and after treatment, blood lipid profile were compared between groups. Statistical analysis were performed in SPSS for windows version 10.0 using Wilcoxon Signed ranks test and Mann-Whitney U test. P<0,05 was considered statisticaly significant. Results: Endometrial hyperplasia was treated in 4 patient ( 66,6%) in Group 1 and 5 patients (%83,3) in Group 2. Lipid profile was not statistically significantly different between groups. Endometrial thickness decreased significantly after treatment when compared to pre-treatment (p<0,05). Uterine artery rezistans index increased significantly in Group 1 (p<0,05), wheras no changes was observed in Group 2 (p>0,05). Conclusion: Crinone 8% vaginal gel was found effective in the treatment of endometrial hyperplasia. Decreased uterine blood flow may play a role in this effect. It has not any adverse effect on blood lipid profile

Keywords:

Crinone gel dydrogesterone, endometrial hyperplasia, blood lipid profile, uterine artery Dopler,

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Lacey CG. Premalignant & malignant disorders of the uterine corpus. In : Pernoll ML. Current. Obstetrics&Gynecologic Diagnosis&Treatment. Seventh edd. Lebanon: Appleton&Lange,1991:955- 973.
Kurman RJ, Kaminski PF, Norris JH ve ark. The behavior of endometrial hyperplasia: A long term study of untreated hyperplasia in 170 patients. Cancer 1985; 56: 403-407.
Gal D, Edman CD, Vellios F ve ark. Long-term effect of megestrol acetate in the treatment of endometrial hyperplasia. Am J Obstet Gynecol;1983: 146(3): 316-22.
Gal D. Hormonal therapy for lesions of the endometrium. Semin Oncol 1986; 13 (4Supp4):33-6.
Faludi AA, Aldrighi JM, Bertolami MC ve ark. Progesterone abolishes estrogen and/or atorvastatin endothelium dependent vasodilatory effects. Atherosclerosis 2004; 177(1): 89-96.
Chantilis SJ, Zeitoun KM, Patel SI ve ark. Use of Crinone vaginal progesterone gel for luteal support in in vitro fertilization cycles. Fertil Steril 1999; 72(5):823-9.
Levine H. Luteal support in IVF using the novel vaginal progesterone gel Crinone 8%: results of an open-label trial in 1184 women from 16 US centers. Fertil Steril 2000;74(4):836-7.
Banz C, Katalinic A, Al-Hasani S ve ark. Preparation of cycles for cryopreservation transfers using estradiol patches and Crinone 8% vaginal gel is effective and does not need any monitoring. Eur J Obstet Gynecol Reprod Biol 2002;103(1):43-7.
Casanas-Roux F, Nisolle M, Marbaix E ve ark. Morphometric, immunohistological and three- dimensional evaluation of the endometrium of menopausal women treated by oestrogen and Crinone, a new slow-release vaginal progesterone. Hum Reprod 1996; 11(2): 357-63.
Warren MP, Biller BM, Shangold MM. A new clinical option for hormone replacement therapy in women with secondary amenorrhea: effects of cyclic administration of progesterone from the sustained-release vaginal gel Crinone (4% and 8%) on endometrial morphologic features and withdrawal bleeding. Am J Obstet Gynecol1999;180(1Pt1):42-8.
De Ziegler D, Ferriani R, Moraes LA. Vaginal progesterone in menopause: Crinone 4% in cyclical and constant combined regimens.HumReprod 2000;15(supp1):149-58.
Cicinelli E, de Ziegler D,Galantino P ve ark. Twice-weekly transdermal estradiol and vaginal progesterone as continuous combined hormone replacement therapy in postmenopausal women: a 1-year prospective study. Am J Obstet Gynecol 2002;187(3):556-60.
Horn LC, Schnurrbusch U, Bilek K ve ark. Risk of progression in complex and atypical endometrial hyperplasia: clinicopathologic analysis in cases with and without progestogen treatment. Int J Gynecol Cancer 2004; 14(2): 348-53.
Levine H, Watson N. Comparison of the pharmacokinetics of crinone 8% administered vaginally versus Prometrium administered orally in postmenopausal women(3). Fertil Steril 2000; 73(3): 516-21.
de Ziegler D, Fanchin R. Progesterone and progestins: applications in gynecology. Steroids 2000; 65(10-11): 671-9.