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[孕激素给药的现状。2. 生殖领域的孕激素治疗]

[Current status of gestagen administration. 2. Gestagen therapy in the area of reproduction].

作者信息

Völker W

出版信息

Fortschr Med. 1977 Jan 13;95(2):68-70.

PMID:556711
Abstract

The spectrum of progestin therapy has changed and expanded during the last few years. 1. The drug-therapy of choice in endometriosis is the medication of progestins for at least six months, for instance ethinyl-testosterone. If a patient wants additional children the "more gentle" dydrogesterone should be considered. 2. In the treatment of dysmenorrhea combination pills should be given, sequentials should be avoided. In the case of incompatibility of estrogens or in danger of oversuppression syndrome dydrogesterone should be applicated. 3. Dysfunctional bleedings should lead to an intense search for their cause. The treatment consists in an estrogen-progestin combination for 9 days and in cyclic continuation of this therapy for at least a further three months. In the case of hemorrhagic diathesis progestin treatment should be continued. 4. Cyclic adequate progestins have proofed to be successful in handling of hirsutism. The choice of the preparation depends on the patient's wish for children. 5. The progestin test is still the first step in diagnosis of amenorrhea. 6. Progestin therapy is indicated in progressive endometrial carcinoma. Some medical centres treat carcinoma of the mamma successfully with progestins. 7. Nowadays fast and early hormonal pregnancy tests are available. The progestin-pregnancy-test is limited to cases of premenopause. 8. The so-called short luteum phase has received considerable attention as a possible cause of infertility. In these cases a substitutional therapy of progestins should follow. Clomiphene or HCG-therapy is advisable. In short luteum phase and premenstrual spottings potent progestins should be given. 9. High dosage of progestins are in common use in the treatment of abortus imminens. 10. Combination pills and sequentials are widely used, the possible methods of a pure progestin contraception are: minipills, three-month-injections, implanted silastic capsules with progestional compounds, progestin impregnated intrauterine devices, vaginal silastic rings impregnated with progestional compounds. 11. Carcinogenesis of progestins was not detectable. 12. Some progestins are teratogenic.

摘要

在过去几年中,孕激素疗法的范围发生了变化并有所扩展。1. 子宫内膜异位症的首选药物治疗是使用孕激素药物至少六个月,例如乙炔睾酮。如果患者想要更多孩子,则应考虑使用“更温和”的地屈孕酮。2. 在痛经治疗中,应给予复方口服避孕药,应避免使用序贯避孕药。在雌激素不相容或有发生过度抑制综合征风险的情况下,应使用地屈孕酮。3. 功能失调性子宫出血应促使人们深入寻找其病因。治疗方法是采用雌激素 - 孕激素联合治疗9天,并将此疗法循环持续至少三个月。在有出血素质的情况下,应继续进行孕激素治疗。4. 周期性给予适当的孕激素已被证明在治疗多毛症方面是成功的。制剂的选择取决于患者的生育意愿。5. 孕激素试验仍然是闭经诊断的第一步。6. 孕激素疗法适用于进展期子宫内膜癌。一些医疗中心用孕激素成功治疗乳腺癌。7. 如今有快速且早期的激素妊娠试验。孕激素妊娠试验仅限于绝经前的情况。8. 所谓的黄体期短作为不孕的可能原因受到了相当多的关注。在这些情况下,应进行孕激素替代疗法。克罗米芬或人绒毛膜促性腺激素疗法是可取的。在黄体期短和经前点滴出血的情况下,应给予强效孕激素。9. 高剂量孕激素常用于治疗先兆流产。10. 复方口服避孕药和序贯避孕药被广泛使用,单纯孕激素避孕的可能方法有:迷你避孕药、三个月注射剂、植入含孕激素化合物的硅橡胶胶囊、含孕激素的宫内节育器、含孕激素化合物的阴道硅橡胶环。11. 未检测到孕激素致癌作用。12. 一些孕激素具有致畸性。

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