黄体酮胶囊剂量对无排卵型月经不调患者性激素水平及月经周期的影响

目的:探讨黄体酮胶囊剂量对无排卵型月经不调患者性激素水平及月经周期的影响.方法:将 2021 年 1 月至 2022 年 12 月在我院就诊的 60 例无排卵型月经不调患者,随机分为两组,各 30 例.对照组口服黄体酮胶囊,1日1次,1 次 100 mg,观察组口服黄体酮胶囊,1日 2次,1次200 mg.比较临床疗效、月经周期、子宫内膜厚度、阴道流血量、阴道流血持续时间、促黄体生成素(Luteotropic hormone,LH)、卵泡刺激素(Follicle-stimulating hormone,FSH)、雌二醇(Estradiol,E2)以及不良反应情况.结果:两组总有效率无显著差异;治疗后两组LH、E2水平均低于治疗前,且观察组明显低于对照组(P＜0.05);对照组不良反应发生率明显低于观察组(P＜0.05).结论:低剂量与常规剂量对患者性激素水平及月经周期的影响差异不大,但低剂量黄体酮表现出的不良反应更少,安全性更高.     

针刺联合化痰助孕方对多囊卵巢综合征患者（痰湿困阻型）IL-6、HOMA-IR、HS-CRP、性激素及妊娠结局的影响

目的：探讨针刺联合化痰助孕方对多囊卵巢综合征（痰湿困阻型）患者的影响。方法：128例多囊卵巢综合征（痰湿困阻型）患者均于2017年9月至2021年3月于北京中医药大学第三附属医院就诊,并随机分为对照组和观察组,每组64例。对照组采用西医常规治疗,观察组联合针刺及化痰助孕方治疗,治疗3个月经周期后比较疗效。结果：治疗后观察组血清TGF-β1、IL-6、超敏C反应蛋白（HS-CRP）水平低于对照组（P<0.05）,观察组胰岛素抵抗指数（HOMA-IR）、子宫内膜厚度、卵巢体积低于对照组（P<0.05）,观察组血清雌激素（E2）水平高于对照组,促黄体生成素（LH）、促卵泡激素（FSH）水平低于对照组（P<0.05）;治疗后观察组排卵率（79.69%）、妊娠率（57.81%）均高于对照组,两组流产率差异无统计学意义（P>0.05）;观察组不良反应总发生率（7.81%）低于对照组（21.88%）,差异有统计学意义（P<0.05）。结论：对于多囊卵巢综合征（痰湿困阻型）患者而言,联合针刺及化痰助孕方效果显著,有助于减轻炎症反应,减轻胰岛素抵抗,促进排卵及妊娠,提高临床...     

自拟补肾填精活血方在排卵障碍性不孕患者辅助治疗中的效果评价

目的:评价自拟补肾填精活血方辅助治疗排卵障碍性不孕的效果.方法:选取2019年4月～2020年4月我院收治的86例排卵障碍性不孕患者作为研究对象,按照随机数字表法分为观察组和对照组,各43例.其中对照组口服克罗米芬,观察组在对照组的基础上增加口服自拟补肾填精活血方,治疗2个疗程后对比两组疗效、卵泡内径、子宫内膜厚度、血清性激素水平、排卵率及妊娠率.结果:观察组总有效率明显高于对照组(P<0.05);治疗2个疗程后,观察组血清促黄体生成素(Luteinizing hormone,LH)、垂体泌乳素(Prolanctin,PRL)、睾酮(Testosterone,T)、胰岛素水平均明显低于对照组,血清促卵泡激素(Follicle-stimulating hormone,FSH)、雌二醇(Estradiol,E2)水平明显高于对照组(P<0.05),观察组卵泡内径、子宫内膜厚度明显大于对照组(P<0.05),观察组排卵率和妊娠率明显高于对照组(P<0.05).结论:自拟补肾填精活血方辅助治疗排卵障碍性不孕患者疗效显著,可有效改善血清性激素水平,改善子宫内膜厚度及卵泡内径,促进排卵、妊娠率提高.     

阿胶对诱导排卵周期子宫内膜容受性的作用

目的探讨阿胶对诱导排卵助孕周期子宫内膜容受性的作用。方法将56例68周期在诱导排卵周期中接受夫精人工授精（AIH）或指导同房助孕治疗的患者随机分为A、B两组,A组为对照组,B组自月经周期第7天开始给予阿胶口服治疗,每天用生胶量30g,至下次月经或证实临床妊娠为止。结果月经周期第7天至排卵日的子宫内膜厚度增长值A组为（3．10±1．32）mm,B组为（3．88±1．54）mm,两组之间差异有统计学意义（P〈0．05）。两组子宫内膜厚度每日增加数分别为（0．49±0,23）mm和（0．62±0．26）mm,差异有统计学意义（P〈0．05）。阴道彩色B超监测排卵日的子宫动脉血流阻力指数和搏动指数B组较A组明显下降（P〈0．05）。结论阿胶能增加诱导排卵助孕周期子宫内膜的厚度,加速子宫内膜的增长并改善子宫动脉血供。     

宫腔镜子宫内膜息肉切除术后应用黄体酮栓预防复发的效果

目的 探讨子宫内膜息肉行宫腔镜治疗术后应用黄体酮栓预防复发的临床效果。方法 选取2015年1月~2017年12月在本院行宫腔镜引导下子宫内膜息肉切除手术治疗，且术后病理诊断符合子宫内膜息肉的患者220例为研究对象，根据术后治疗方法的不同分为研究组（106例）与对照组（114例），研究组术后应用黄体酮栓治疗，对照组未用药物治疗，比较两组术后3、6、12个月子宫内膜厚度，月经改变情况及复发情况。结果 研究组术后6、12个月子宫内膜厚度及复发率均优于对照组，差异有统计学差异（P＜0.05）；研究组术后3、6、12个月的月经量改善优于对照组，差异有统计学意义（P＜0.05），术后6个月经期情况比较，差异有统计学意义（P＜0.05）；术后3、12个月经期比较，差异无统计学意义（P＞0.05），9例（8.74%）出现乳房胀痛、头晕，偶有患者点滴出血等不适，均可以耐受。结论 宫腔镜术后应用黄体酮栓治疗子宫内膜息肉有助于降低复发率，改善月经情况，疗效可靠。     

溴隐亭对高泌乳素血症妇女促性腺激素诱导排卵的影响效果研究

目的 探讨溴隐亭对高泌乳素血症妇女促性腺激素诱导排卵的影响效果。方法 选取2015年6月~2016年6月我院接受治疗的60例高泌乳素血症患者,随机分为对照组和观察组各30例。对照组采用促性腺激素治疗,观察组在对照组基础上采用溴隐亭治疗,观察两组患者的治疗效果,LH（黄体生成激素）、FSH（促卵泡生长激素）、E2（雌二醇）、PRL（泌乳素）、促排卵周期数和不良反应发生率。结果 观察组患者的总有效率（93.33%）优于对照组（70.00%）,LH、FSH、LH/FSH、睾酮和胰岛素水平改善情况好于对照组,不良反应发生率（20.00%）低于对照组（3.33%）,促排卵周期数少于对照组,两组患者的治疗效果,LH、FSH、E2和PRL水平,促排卵周期数和不良反应发生率相比,差异具有统计学意义（P＜0.05）。结论 采用促性腺激素联合溴隐亭治疗高泌乳素血症患者具有较大的意义,值得推广应用。     

激素替代治疗对围绝经期综合征妇女子宫内膜厚度和 激素水平的影响分析

目的 分析并研究激素替代治疗对于围绝经期综合征的妇女子宫内膜的厚度和激素水平的影响,以便于为临床研究提供可行性参考。方法 选取我院2014年12月~2017年1月收治的围绝经期综合征患者88例,随机分为观察组和对照组,每组44例。对照组选择采用谷维素进行单独治疗,观察组患者选择采用补佳乐、黄体酮软胶囊进行治疗,观察并比较两组患者治疗前后的子宫内膜厚度以及治疗后孕酮、卵泡雌激素、雌二醇、黄体生成素等激素水平。结果 治疗前,两组患者子宫内膜厚度相比,差异无统计学意义（P＞0.05）;治疗后,两组患者子宫内膜较治疗前均明显增厚,且观察组患者子宫内膜增加厚度高于对照组患者,两组相比差异具有统计学意义（P＜0.05）。两组患者治疗后孕酮水平相比,差异无统计学意义（P＞0.05）;观察组卵泡雌激素、雌二醇均高于对照组,黄体生成素水平低于对照组,两组相比,差异具有统计学意义（P＜0.05）。结论 围绝经期综合征妇女采用激素替代治疗方法,能够有效增加患者子宫内膜的厚度,有效改善机体激素水平,值得推广使用。     

血管生成素与功能失调性子宫出血

近年研究血管生成素（Angiopoietin,Ang）及其受体系统是调控血管完善性的重要因子,参与子宫内膜生理性及病理性血管生成。正常月经周期中Ang-1对排卵后期子宫内膜血管发育,尤其对哺乳动物子宫内膜螺旋动脉的生长具有重要作用。在功能失调性子宫出血Ang-2可能促进异常子宫内膜血管生成,从而促进其病理发生过程。     

多囊卵巢综合征促排卵治疗临床研究

目的观察来曲唑（LE）和克罗米芬（CC）治疗多囊卵巢综合征（PCOS）排卵障碍的临床疗效。方法将符合PCOS排卵障碍及中医辨证属肾阴虚型的60例患者随机分为两组：LE组（LE＋中药,n=30）,CC组（CC＋中药,n=30）。1个月经周期为1个疗程,观察3个月经周期内两组的卵泡发育、排卵、子宫内膜和受孕的情况。结果排卵情况：两组的卵泡直径≥16mm,卵泡数、排卵率差异无统计学意义（P〉0.05）,均无卵巢过度刺激综合征（OHSS）发生;子宫内膜及宫颈粘液情况：LE组人绒毛膜促性腺激素（hCG）日子宫内膜平均厚度、A型内膜、宫颈粘液平均评分与CC组比较差异有统计学意义（P〈0.05）;受孕情况：LE组妊娠率为73.33%,CC组妊娠率为56.67%,两组比较差异有统计学意义（P〈0.05）。结论 LE与CC均有促卵泡生长作用,LE可作为CC反应不良患者促排卵的替代治疗,LE较CC有较高的妊娠率,可能与其不影响子宫内膜容受性有关。     

PCOS并发MS育龄妇女诱导排卵前行预处理的临床意义

目的探讨多囊卵巢综合征（PCOS）并发代谢综合征（MS）的育龄妇女在诱导排卵前予口服避孕药及比格列酮行预处理的临床意义。方法回顾性分析2010年1月至2012年12月于广东医学院附属医院生殖医学中心确诊PCOS的育龄妇女383例,均有排卵稀发或排卵障碍。分为对照组（无并发Ms者,直接诱导排卵治疗）106例;观察组A（并发MS者,直接诱导排卵治疗）52例;观察组B（并发MS者,诱导排卵治疗前行预处理）225例。比较三组患者的优势卵泡个数、子宫内膜厚度及妊娠成功率。结果观察组B和对照组临床妊娠率均高于观察组A,差异有统计学意义（P〈0．05）;观察组B的临床妊娠与对照组相似,差异无统计学意义（P〉0．05）;三组患者诱导排卵的优势卵泡个数、子宫内膜厚度比较差异无统计学意义（P〉0．05）。结论PCOS并发Ms育龄妇女诱导排卵前行预处理具有临床意义。     

曲普瑞林联合屈螺酮炔雌醇在子宫腺肌症患者辅助治疗过程中的应用效果探究

目的:探讨曲普瑞林联合屈螺酮炔雌醇在子宫腺肌症患者辅助治疗过程中的应用效果.方法:选取2018年10月至2020年2月我院子宫腺肌症患者96例,依据随机数字表法分为研究组(n=48)及对照组(n=48).两组均采取左炔诺孕酮宫内节育系统,在此基础上对照组采取屈螺酮炔雌醇,研究组在对照组基础上采取曲普瑞林,均治疗6m.统...     

The effect of RU 486 administered during the early luteal phase on bleeding pattern, hormonal parameters and endometrium

The purpose of the present study was to investigate the effect of a single dose of RU 486 administered very early in the secretory phase on endometrial development and levels of progesterone receptors, on plasma levels of gonadotrophins and ovarian hormones and on the pattern of menstrual bleeding. Twenty-four regularly menstruating subjects participated and were studied during a control, a treatment and a follow-up cycle. In the treatment cycle, a single dose of 200 mg RU 486 was given in the evening of the second day after the urinary LH peak. Plasma was collected from cycle day 10 until menstruation in both control and treatment cycles. The lengths of the control, treatment and follow-up cycles were equal. Three of the subjects had slight vaginal bleeding in association with RU 486 intake which, however, did not disturb their normal menstrual rhythm. Plasma levels of oestradiol, progesterone and FSH were not affected in the treatment cycle, whereas LH levels increased slightly. The elimination half-life of RU 486 was 28.6 h. An endometrial biopsy was taken 12, 36 or 84 h (LH + 3, LH + 4 and LH + 6) after drug intake (eight subjects in each group) and another biopsy was taken on the corresponding day in the control cycle. The specimens were assessed by morphometric analysis and for cytosolic progesterone receptor concentrations. Endometrial biopsies taken 12 h (on LH + 3) after RU 486 intake contained significantly (P less than 0.001) lower levels of cytosolic progesterone receptors than in the control cycle, but levels at 36 and 84 h were similar.(ABSTRACT TRUNCATED AT 250 WORDS)     

青春期功能失调性子宫出血的调经治疗研究

目的:探讨人工周期调经对青春期功能失调性子宫出血(青春期功血)的临床效果及其安全性。方法:回顾性分析85例患者,经人工周期调经(50例,观察组)和口服复合避孕药调经(35例,对照组)6个周期治疗后,两组撤药性岀血时间及不良反应,以及治疗结束后第3月末和第6月末临床总有效率。结果:治疗期间两组撤药性岀血时间及不良反应发生率差异无统计学意义(P0.05),治疗结束后第3月末和第6月末复查临床总有效率,观察组明显高于对照组(P0.05)。结论:在调理青春期功血中人工周期调经效果较复合避孕药效果好。     

Emotional aspects of menstrual dysfunction

Psychological factors are the most common cause of menstrual dysfunction. Emotionally-induced disturbance at the hypothalamic level can lead to irregular cycles, dysfunctional uterine bleeding, or amenorrhea. Mild disturbances are usually associated with an ample amount of endometrial lining, and a period of withdrawal bleeding can usually be produced with progesterone. Where there is a deficiency of estrogen and consequently insufficient endometrial lining for withdrawal bleeding, organic pituitary and/or hypothalamic disease must be excluded. The psyche can also influence the uterus and ovary directly.     

Effect of oral administration of dydrogestrone versus vaginal administration of natural micronized progesterone on the secretory transformation of endometrium and luteal endocrine profile in patients with premature ovarian failure: a proof of concept

BACKGROUND: We aimed to explore the endometrial histology and endocrine profiles on day 21 of an artificial cycle in patients with premature ovarian failure (POF) treated with oral dydrogesterone (DG) or vaginal micronized progesterone. METHODS: The study was designed as a prospective pilot study at an academic reproductive medicine unit. Six POF patients were included in the study. After estrogen endometrial priming, patients were randomized to receive DG or progesterone in two subsequent cycles. The main outcome measure was the endometrial histology and the endocrine profiles on day 21 of the cycle. RESULTS: Development of endometrial glands corresponded to an early secretory phase in five out of six cases supplemented with DG (out-phase). In contrast, five out of six cases treated with micronized progesterone showed an endometrium corresponding to a mid-luteal phase (in-phase) (P = 0.021 versus DG). There was a significant difference in the mean progesterone value [8.6 versus 0.3 microg l(-1) (P = 0.013)], the mean LH value [12.9 versus 22.5 IU l(-1) (P = 0.049)] and the mean FSH value [13.0 versus 23.9 IU l(-1) (P = 0.047)] between the progesterone and DG group, respectively, on day 21 of the cycle. CONCLUSIONS: After estrogen endometrial priming in POF patients, exogenous vaginal micronized progesterone is more effective than oral DG in creating an 'in-phase' secretory endometrium and induces significantly higher progesterone and lower LH and FSH serum concentrations on day 21 of the cycle.     

Effect of the Yuzpe regimen of emergency contraception on markers of endometrial receptivity

This exploratory study was designed to determine whether treatment with the Yuzpe regimen of emergency contraception altered endometrial integrin expression or other markers of uterine receptivity. Nineteen parous women were followed for two menstrual cycles. In the second cycle, each participant took 100 mg ethinyl oestradiol and 1 mg norgestrel on the day of the urinary luteinizing hormone (LH) surge and repeated the dose 12 h later. In both cycles, endometrial biopsy, phlebotomy and vaginal sonogram were performed 8-10 days after the urinary LH surge. No significant difference was found between untreated and treated cycles in most measures of endometrial histology or in endometrial expression of beta3 integrin subunit, leukaemia inhibitory factor, glycodelin, or progesterone receptors assessed by immunohistochemical techniques. Five statistically significant changes were noted in treated cycles: a reduction in endometrial MUC-1 expression, an increase in endometrial oestrogen receptor, lower luteal phase serum oestrogen concentration, reduced endometrial thickness, and greater proportion of glandular supranuclear vacuoles. The relationship of these findings to the contraceptive action of the Yuzpe regimen is unclear.     

Mechanisms of abnormal uterine bleeding

Over the past 10 years there has been an upsurge of interest in the mechanisms underlying normal and disturbed menstrual bleeding. These studies have particularly focused on the mechanisms underlying the common problems of menorrhagia associated with ovulatory and anovulatory dysfunctional uterine bleeding (DUB) and of unpredictable breakthrough bleeding during hormonal contraceptive use. A wide range of abnormalities of endometrial morphology and function have been demonstrated, but it is still not clear how all the pieces of this complex jigsaw puzzle fit together. Ovulatory DUB is predominantly associated with decreased endometrial vasoconstriction and vascular haemostatic plug formation, leading to defective control of the volume of blood which is lost during menstruation. By contrast, breakthrough bleeding is associated with a wide range of molecular disturbances which appear to result in unpredictable vessel breakdown through disturbed endometrial angiogenesis, increased vascular fragility and loss of the integrity of the endothelial, epithelial and stromal supporting structures. Anovulatory DUB is very poorly understood, but may be associated with disturbed angiogenesis, fragile vessels and defective haemostatic processes. Little is known about the actual mechanisms of the common problem of abnormal bleeding associated with specific genital tract pathologies such as uterine myomata.     

Endometrial lysosomal enzyme activity in ovulatory dysfunctional uterine bleeding, IUCD users and post-partum women

The aim of this study was to evaluate the role of lysosomal enzymes in excessively heavy menstruation by comparing women with menorrhagia due to dysfunctional bleeding or intrauterine contraceptive device (IUCD) use with those with normal menstrual periods or with amenorrhoea associated with breastfeeding. This was a prospective cohort investigation of the activity of four endometrial lysosomal enzymes in three contrasting groups: (i) women with ovulatory dysfunctional uterine bleeding and users of intrauterine contraceptive devices; (ii) breastfeeding post-partum women in whom there are long periods of amenorrhoea, particularly in the early months post-partum; and (iii) normal cycling women. It was found that the total activity of lysosomal enzymes, particularly acid phosphatase and N-acetyl-beta-D-glucosaminidase, was markedly elevated (P < 0.001) in IUCD-exposed endometrium, and endometrium from women with dysfunctional uterine bleeding when compared with endometrium from women with a history of entirely normal menstrual periods or that in post-partum breastfeeding women. The activity of alpha-L-fucosidase was moderately elevated in IUCD users (P < 0.05) and ovulatory dysfunctional uterine bleeding (P < 0.05), whereas alphaD-mannosidase activity was elevated in ovulatory dysfunctional uterine bleeding (P < 0.05), but decreased in IUCD users (P < 0.01). No significant differences were observed in the lysosomal enzyme activities of breastfeeding post-partum women and normal cycling women. These results show that total endometrial tissue activity of four lysosomal enzymes was substantially increased throughout the cycle in most circumstances in women with two different causes for increased menstrual bleeding. This suggests a contributory role to the increased bleeding.