Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, CT, USA.
Yale School of Public Health, Yale University, New Haven, CT, USA; Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, San Francisco, CA, USA.
J Obstet Gynaecol Can. 2024 Jul;46(7):102562. doi: 10.1016/j.jogc.2024.102562. Epub 2024 May 15.
To characterise contemporary trends in the hormonal management of endometriosis in adolescent and young adult patients with biopsy-proven endometriosis.
Retrospective chart review of women aged 14-25 years who underwent laparoscopy for pelvic pain with biopsy-proven endometriosis between January 2011 and September 2020 at an academic tertiary hospital system. The final sample included 91 patients with biopsy-confirmed endometriosis.
Combined oral contraceptives (COCs) were the most common initial treatment (64% of patients). Progestin-only formulations (low- and high-dose norethindrone acetate) were offered to younger patients (age 15.9 ± 2.7 years) than those offered COCs (19.9 ± 3.3 years) and levonorgestrel intrauterine devices (LNG-IUDs) (21.9 ± 1.7 years). Current treatments varied widely and included COCs (32%), LNG-IUDs (18%), oral progestins (low- and high-dose norethindrone, medroxyprogesterone) (14%), elagolix (9%), and leuprolide (8%). Oral adjuncts to LNG-IUD were common: usually low- or high-dose norethindrone (37% of patients with an LNG-IUD), but also included progesterone, COCs, and elagolix.
Oral progestins, LNG-IUDs, and COCs were the mainstay of initial treatment. Subsequent treatments varied widely and included COCs, LNG-IUDs, oral progestins, elagolix, leuprolide, and combinations of these agents. We observed that most young women switched between therapies, suggesting that a personalised approach is often used to determine treatment plans among the wide range of options currently available. This study helps define the spectrum of treatment regimens for endometriosis in adolescent females.
描述经活检证实的子宫内膜异位症的青少年和年轻成年患者中，激素治疗子宫内膜异位症的当代趋势。
回顾性分析 2011 年 1 月至 2020 年 9 月在一家学术三级医院系统中因盆腔痛行腹腔镜检查且活检证实为子宫内膜异位症的 14-25 岁女性患者的病历。最终样本包括 91 例经活检证实为子宫内膜异位症的患者。
最常见的初始治疗方法是复方口服避孕药（COC）（64%的患者）。与 COC（19.9 ± 3.3 岁）和左炔诺孕酮宫内节育器（LNG-IUD）（21.9 ± 1.7 岁）相比，孕激素仅配方（低剂量和高剂量醋酸去氧孕烯）用于更年轻的患者。当前的治疗方法多种多样，包括 COC（32%）、LNG-IUD（18%）、口服孕激素（低剂量和高剂量醋酸去氧孕烯、甲羟孕酮）（14%）、Elagolix（9%）和亮丙瑞林（8%）。LNG-IUD 的口服辅助剂很常见：通常是低剂量或高剂量醋酸去氧孕烯（37%的 LNG-IUD 患者），但也包括孕激素、COC 和 Elagolix。
口服孕激素、LNG-IUD 和 COC 是初始治疗的主要方法。随后的治疗方法多种多样，包括 COC、LNG-IUD、口服孕激素、Elagolix、亮丙瑞林以及这些药物的组合。我们观察到大多数年轻女性在治疗之间转换，这表明在目前可用的广泛选择中，通常采用个性化方法来确定治疗计划。本研究有助于确定青少年女性子宫内膜异位症的治疗方案范围。
