L/O/G/O Efficacy of GnRHa plus Yasmin or Mirena in the treatment of polycystic ovarian syndrome with atypical hyperplasia in patients with adenomyosis accompanied with dysmenorrhea Speaker: Xu Linna Corresponding author :Zhang Shaofen Obstetrics and Gynecology Hospital of Fudan University China

PCOS

Adenomyosis

Women’s Health PCOS + Adenomyosis+ Atypical hyperplasia ?

Case 1 Name ： Zhu Chunyan Age ： 36 Menstrual cycle ： 10/35-45days Reproductive History: Dysmenorrhea:9′ （ VAS ） Height and weight :153CM /75kg BMI ： 32

Case 1 Hemoglobin ： 4.3g/l six steroid sex hormones ： FSH:6.77mIU/ml LH:15.64mIU/ml PRL:16.08ng/ml E2:32pg/ml P:1.34ng/ml T:0.91ng/ml thyroid related hormones TSH:2.3uIU/ml T3 ： 1.18ng/ml T4 ： 5.25ug/dl insulin secretion test ： INS(empty stomach) mU/L GLU(empty stomach) 4.8mmol/l INS(0.5h) 97.55mU/L GLU(1h) 8.1mmol/l INS(1h) mU/L GLU(2h) 6.2mmol/l INS(2h) mU/L GLU(3h) 5.8mmol/l INS(3h) 72. mU/L Facial acne: severity Hirsutism ： + acanthosis ： +

The process of the diagnosis and treatment The first day of hospitalization: B ultrasound reveal:the size of uterine is 94*101*75mm 3,the endometrial thickness is 23mm （ double lining ）.Two ovaries is polycystic ovary.

1.by the diagnostic uterine curettage and pathological examination Atypical endometrial hyperplasia 2. blood transfusion to improve the severe anemia 3. Yasmin treated for 3 days(1# tid po) then discharge from hospital Yasmin 1# bid po for 5 days,without vaginal bleeding followed with Yasmin 1# qd po*14 days The process of the diagnosis and treatment

4. Zoladex （ GnRHA ） was subcutaneously injected at a dose of 3.6mg for 6 times (once every 28 day) to induce pseudo-menopause

The process of the diagnosis and treatment 5.Followed by oral administration of Yasmin for three cycles 6.Afterwards, curettage was performed before the next menstruation Pathology showed proliferative endometrium

Pathology Atypical endometrial hyperplasiaProliferative endometrium

The process of the diagnosis and treatment 7.With administration of Mirena in combination with DMBG (0.85mg bid po) for 12 cycles after the menstruation

Results the uterus volum （ *a*b*c ） cm3 endometrial thickness Dysmenorrha severity(VAS score) cm 3 hemoglobin level g/l serm insuln level mU/L Testoster- one level ng/mL body weigh t KG 1 st month rd month th month th month

Case 2 Name ： Zhang Ziyi Age ： 17 Menstrual cycle ： 10/35-90days Reproductive History: Dysmenorrhea:9′ （ VAS ） Height and weight :171CM /95kg BMI ： 32.4

Case 2 Hemoglobin ： 6.7g/l six steroid sex hormones ： FSH:6.77mIU/ml LH:15.75mIU/ml PRL:9.08ng/ml E2:49pg/ml P:1.64ng/ml T:1.1ng/ml thyroid related hormones TSH:3.8uIU/ml T3 ： 1.51ng/ml T4 ： 5.32ug/dl insulin secretion test ： INS(empty stomach) mU/L GLU(empty stomach) 4.8mmol/l INS(0.5h) 93.25mU/L GLU(1h) 8.3mmol/l INS(1h) mU/L GLU(2h) 6.7mmol/l INS(2h) mU/L GLU(3h) 5.9mmol/l INS(3h) mU/L Facial acne: severity Hirsutism ： + acanthosis ： +

The process of the diagnosis and treatment 1.B ultrasound reveal ： the size of uterine is96*85*75mm 3,the endometrial thickness is 22mm( double lining )Two ovaries is polycystic ovary 2.by the diagnostic uterine curettage and pathological examination:atypical endometrial hyperplasia 3.Then diane-35+norethindrone for bleeding stop and ferrous succinate to improve the severe anemia

The process of the diagnosis and treatment 4.Zoladex （ GnRHA ） was subcutaneously injected at a dose of 3.6mg for 6 times (once every 28 day) to induce pseudo-menopause 5.followed by oral administration of Yasmin for three cycles 6.Afterwards, curettage was performed before the next menstruation Pathology showed proliferative endometrium

Pathology Atypical endometrial hyperplasia Proliferative endometrium

The process of the diagnosis and treatment 7.With administration of Yasmin in combination with DMBG (0.85mg) for 12 cycles after the menstruation

Results the uterus volum(0.5 23*a*b*c) cm 3 endometrial thickness dysmenorra severity(VAS score) cm 3 hemoglobin level g/l serm insuli n level mU/L Testoster -one level ng/mL body weight KG 1 st month rd month th month th month

CONCLUSION GnRHa treatment with either Yasmin or Mirena can effectively alleviate endometrial hyperplasia, relieve dysmenorrhea, diminish adenomyotic lesions, and reduce serum insulin and testosdterone levels in PCOS patients with atypical endometrial hyperplasia and adenomyosis accompanied with dysmenorrhea.

Women’s Health

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