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 Womens 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. Womens Health 23