膜性痛经：子宫内膜异位症治疗的一种并发症。
Membranous dysmenorrhea: a complication of treatment for endometriosis.
机构信息
From the Department of Obstetrics and Gynecology, Division of Pediatric and Adolescent Gynecology, Long Island Jewish Medical Center/Steven and Alexandra Cohen Children's Medical Center of New York, and the Department of Obstetrics and Gynecology and Women's Health, Albert Einstein College of Medicine, New York, New York.
出版信息
Obstet Gynecol. 2010 Aug;116 Suppl 2:488-490. doi: 10.1097/AOG.0b013e3181d4473c.
BACKGROUND
Progesterones are frequently used to treat endometriosis. Exaggerated response of the endometrium to high levels of progesterone can result in a decidualization reaction. Decidualization may cause an exacerbation of symptoms of dysmenorrhea associated with endometriosis.
CASE
A 16-year-old girl with uterine didelphys and obstructed hemivagina presented with irregular bleeding and severe abdominal cramping after resection of the vaginal septum. Persistent endometriosis treated with norethindrone acetate resulted in severe colicky abdominal pain and expulsion of a decidual cast.
CONCLUSION
Membranous dysmenorrhea can occur in response to excess progesterones. An understanding of the physiologic response of the endometrium to treatment will guide us to a high clinical suspicion of this rare entity when symptoms worsen in response to progesteronal treatment for endometriosis.
背景
孕激素常被用于治疗子宫内膜异位症。子宫内膜对高水平孕激素的过度反应可导致蜕膜化反应。蜕膜化可能导致与子宫内膜异位症相关的痛经症状加重。
病例
一名 16 岁的双子宫和单侧阴道闭锁患者，在阴道纵隔切除术后出现不规则出血和严重腹痛。经醋酸甲羟孕酮治疗持续的子宫内膜异位症后，出现严重的绞痛性腹痛并排出蜕膜铸型。
结论
膜性痛经可因孕激素过多而发生。了解子宫内膜对治疗的生理反应将有助于我们在子宫内膜异位症孕激素治疗后症状加重时，对这种罕见疾病产生高度的临床怀疑。
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