课件：曼月乐临床应用.ppt

* 众多的研究结果显示， * 一线治疗：口服避孕药 二线治疗：高效孕激素 雄激素衍生物(丹那唑、孕二烯酮) 促性腺激素释放激素激动剂(GnRH-a) GnRH-a+反向添加(Add-back) 二线无效，考虑手术 * Summary of the studies in which LNG-IUSR was inserted for the treatment of endometriosis, adenomyosis and associated pelvic pain * In conclusion, both treatments were effective in the pain control for up to 3 years of follow-up. For women who do not wish to become pregnant in the near future LNG-IUS may be the treatment of choice for endometriosis, since it may be used for 5 years and provides contraceptive protection as well as pain control. * 使用LNG-IUS的妇女应当考虑到出血方式的预期变化，尤其在月经周的前几天内，并且可能持续6个月以上。因此她们应当考虑坚持至少6个周期以观察治疗的效果。[D(GPP)] * Objective To investigate the long-term effects of a levonorgestrel-releasing intrauterine system on the endometrium and lipid profile of breast cancer patients taking tamoxifen. Study design A total of 142 postmenopausal women taking tamoxifen were included in the study. A levonorgestrel-releasing intrauterine system was fitted to 70 women in the study group; a further 72 women acted as the control group. All women were followed for 36 months. Serum lipids were measured at the begining and at the end of 36 months. Endometrial biopsies were obtained by hysteroscopy at the beginning and at the end of the 36th month in both groups. Results After 36 months, there were minor changes in serum lipids, fewer endometrial polyps and no endometrial hyperplasia in the study group compared to the control group. Conclusion The levonorgestrel-releasing intrauterine system does not affect serum lipid levels significantly and may prevent the increased risk of endometrial polyps and hyperplasia associated with the use of tamoxifen in women with breast cancer. This may reduce the need for investigation of side-effects in women taking tamoxifen and also reduce patient discomfort while improving treatment adherence. * * 避孕：在月经周期的前7天内 流产后：术后即刻放置 产后：分娩后4-8周 － 无禁忌，避免用金属探针 － 操作轻柔，预防穿孔 月经过多：在月经周期