1. 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

2. PCOS

3. Adenomyosis

4. Women’s Health PCOS + Adenomyosis+ Atypical hyperplasia ?

5. Case 1 Name ： Zhu Chunyan Age ： 36 Menstrual cycle ： 10/35-45days Reproductive History:0-0-0-0 Dysmenorrhea:9′ （ VAS ） Height and weight :153CM /75kg BMI ： 32

6. 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) 33.09 mU/L GLU(empty stomach) 4.8mmol/l INS(0.5h) 97.55mU/L GLU(1h) 8.1mmol/l INS(1h) 163.02mU/L GLU(2h) 6.2mmol/l INS(2h) 127.28mU/L GLU(3h) 5.8mmol/l INS(3h) 72. mU/L Facial acne: severity Hirsutism ： + acanthosis ： +

7. 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.

8. 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

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

10. 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

11. Pathology Atypical endometrial hyperplasiaProliferative endometrium

12. 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

13. Results the uterus volum （ 0.52 3*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 183.34 5 3 133 28 0.23 70 3 rd month 185.13 5 4 137 25 0.35 71 6 th month 189.44 6 4 139 23 0.43 68 12 th month 193.68 6 4 138 22 0.49 69

14. Case 2 Name ： Zhang Ziyi Age ： 17 Menstrual cycle ： 10/35-90days Reproductive History:0-0-0-0 Dysmenorrhea:9′ （ VAS ） Height and weight :171CM /95kg BMI ： 32.4

15. 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) 35.23 mU/L GLU(empty stomach) 4.8mmol/l INS(0.5h) 93.25mU/L GLU(1h) 8.3mmol/l INS(1h) 173.02mU/L GLU(2h) 6.7mmol/l INS(2h) 167.18mU/L GLU(3h) 5.9mmol/l INS(3h) 85.45 mU/L Facial acne: severity Hirsutism ： + acanthosis ： +

16. 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

17. 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

18. Pathology Atypical endometrial hyperplasia Proliferative endometrium

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

20. 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 171.13 6 3 121 25 0.41 84 3 rd month 175.28 5 4 128 23 0.69 83 6 th month 183.71 6 4 135 26 0.65 85 12 th month 187.43 6 5 138 27 0.56 85

21. 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.

22. Women’s Health

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