Using some hormones in obstetrics and gynecology

2021-01-31 12:00 AM

In the case of uterine fibroids that do not want surgery because of the need for reproduction, testosterone propionate 25mg intramuscularly can be used per week. Menstruation can return to normal and fertility is maintained

Androgen use

Be careful when using androgens for women because there is a risk of masculine symptoms such as beard, mustache, male-style leg hair, large clitoris and sometimes no recovery. However, it can be used to treat some necessary cases.

Treatment of hemorrhagic menorrhagia in fibroids constant testosterone:

According to our experience: In the case of uterine fibroids that do not want surgery because of the need of reproduction, testosterone propionate 25mg can be used intramuscularly every week. Menstruation can return to normal and fertility is maintained. But when pregnant, testosterone therapy must be stopped. This treatment method is based on the community effect of testosterone with the sex hormones of the ovaries to inhibit the activity of the hypothalamus and pituitary, thereby reducing the secretion of estrogen of the ovaries.

Use anti-androgens

Treatment of hirsutism with cyproterone acetate (brand name Androcur).

In hirsutisms can use Androcur 50mg per day to take 1-2 tablets in combination with ethinylestradiol 0.035mg daily from day 1-21 of the menstrual cycle.

You can also take Androcur 50mg daily 1-2 tablets from day 1-10 of the menstrual cycle in combination with ethinylestradiol 50mcg from day 1-21 of the menstrual cycle.

Strong inhibition of gonadotropin leads to suppression of oocyte release and contraception.

Use anti-estrogens

Treatment of breast cancer with tamoxifen (brand name Tamoten).

Preventing metastasis, breast cancer recurrence after surgery. More effective when breast cancer is the case with estradiol or progesterone receptors.

But tamoxifen is an anti-estrogen, so it can increase secretion of gonadotropins, thereby increasing the activity of the ovaries and risking cancer of the uterus lining. Therefore, it is necessary to monitor overproduction of the uterine lining, polyps, and cancer of the uterine lining. There is also to monitor liver function, embolism complications.

Use of corticosteroids

Treatment of adrenal - genital syndrome.

In the adrenal-genital syndrome, the adrenal cortex lacks 21-hydroxylase enzyme, so it cannot synthesize cortisol. Therefore, the pituitary gland is not suppressed and ACTH is secreted. Eventually androgens are increased secretion. Androgens in the adrenal cortex increase the secretion of women, causing signs of masculinity, beard growth, acne, loose and amenorrhea, and amenorrhea and androgen inhibits gonadotropin hormones that prevent the ovaries from working.

Treatment using corticosteroids to replace the deficiency of corticosteroids, while inhibiting the ACTH of the pituitary gland, helping the adrenal cortex reduce androgen secretion and re-secretion of gonadotropic hormones, stimulating the ovaries.

Dexamethasone, prednisolone can be used for the above purposes.

Prednisolone 5mg per day orally 1-2 capsules for 20 days. After redness can reduce the dose to 1 tablet per day. A woman can resume her period and become pregnant.

Use of gonadotropic hormones

Use of FSH, LH, hCG in e the treatment of infertility

Stimulates follicle development and oocyte release.

Humegon, Nco-Pcrgonal, Mctrodin, Puregon can be used as brand-name drugs containing FSH or both FSH and LH to stimulate follicle growth.

Pregnyl and Profasi can be used as medicines containing hCG to stimulate fertility and lute formation.

The principle is as follows:

Humegon, Inductor or Neo-pcrgonal (contains 75 FSH units and 75 LH units in each ampoule), inject 1-4 ampoules into muscle per day, starting during the first week of menstrual cycle, the dose increases gradually according to payment ovarian speech monitored by ultrasound, uterine index, estradiol quantitative in the blood. The maximum dose should not exceed 4 ampoules per day if only 1 oocyst is needed.

Metro din can be used, but Metro din only contains FSH with 75 LH-free units, resulting in poor stimulation of the follicles to secrete. Therefore, it is difficult to monitor by cervical index and estrogen quantification. Development of follicles can only be monitored by ultrasound.

For the above reasons, people often use Humegon and Neo-pergonal in gynecological treatment for easy follow-up. Metrodin is often used for research and some authors use it to stimulate multiple follicles at the same time, for in vitro fertilization.

After 48 hours of oocystic maturation tests were detected, hCG was injected with a single dose of 5,000 - 10,000 units into the muscle. The author recommends another injection 2 days later. According to experience, the dose of 9000 units is the most successful, no need and no second injection is needed because it causes too much irritation, indicated by multiple pregnancies and the glandular follicle appears fast and dangerous.

In the case of stimulating normal infertility treatment, if probing shows signs of multiple oocysts with ripening, to avoid over-irritation, people stop the treatment, do not continue injecting hCG because hCG is the same. The cause is mainly over-irritating in this case.

Using agonist hormone Gn - RH

Agonist hormone Gn - RH, which contains synthetic substances containing amino acids, has the same effect as Gn-RH. But it is used for two different purposes, either to stimulate the pituitary gland, or to suppress the pituitary, depending on the dose and administration.

To stimulate pituitary gland in infertility treatment, often in combination with pituitary suppression FSH, LH, hCG or used in the treatment of endometriosis, before high dose FSH to stimulate multiple follicles nine, do in vitro fertilization.

Irritation of the pituitary gland

Use triptorelin (brand-name Decapeptyl) 0.1 mg subcutaneously, 1 ampoule daily starting from day 2 of the menstrual cycle until 1 day before hMG is intended. Average injection in 10 - 12 days. This option is applicable to the treatment of infertility due to lack of oocyte.

Pituitary suppression

In the case of infertility treatment.

Decapeptyl 3.75mg is injected subcutaneously on day 2 of the menstrual cycle to suppress the pituitary until ovarian estradiol levels drop below 50 pg/ml, usually 15 days later. Then it will start for HMG. In this case, the ovarian stimulation relies entirely on foreign gonadotropins since the endogenous gonadotropins are eliminated because the pituitary is suppressed.

In the case of endometriosis treatment.

Dccapcptyl 3.75mg intramuscularly to initiate treatment within the first 5 days of the menstrual cycle, then once every 4 weeks. Total time of injection 4-6 months.