OBJECTIVES: Hysteroscopic adhesiolysis (HA) remains the mainstay on treatment for intrauterine adhesions (IUA). The fertility outcome of patients with moderate and severe intrauterine adhesions after HA is still far from satisfactory. Estrogen combined with progesterone is the most common treatment; however, they do not help in improving the fertility rate to the maximum because of the limitations. This retrospective, non-randomized controlled study will assess the effects of traditional Chinese medicine Yangmo decoction after HA in restoration of the endometrium and improvement of the fertility rate. METHODS: A total of 427 patients, who met the inclusion criteria, aged between 20 and 45 years and diagnosed with moderate or severe IUA underwent HA at the Third Xiangya Hospital from January to August 2021, were enrolled for this study. Participants were assigned into 2 groups: A Yangmo decoction group (n=213, patients were given Yangmo decoction consisting of Ginseng flower, Sanchi flower, Daidai flower, Snow lotus, Licorice and so on after HA), and an estrogen and progesterone group (n=214, patients were given estrogen and progesterone after HA). The following basic information was collected retrospectively for both groups, including age, parity, history of abortion, menstrual status, and times of hysteroscopic interventions. American Fertility Society (AFS) score was used by a senior surgeon and the density of opening of endometrial glands was evaluated during HA. The parameters were obtained from three-dimensional transvaginal ultrasound (3D-TVUS) preoperatively and postoperatively, to evaluate the efficacy of Yangmo decoction, estrogen, and progesterone. All patients were followed up on telephone to determine the fertility rate until 6 months from the last HA. RESULTS: Based on the basic information collected preoperatively, there were no significant differences between the groups (all P>0.05). Postoperatively, patients in the Yangmo decoction group had a better surgical success rate with a more significant AFS reduction (P<0.001), better density of opening of endometrial glands in the uterine cavity (P<0.000 1) after HA, and a better fertility rate (40.4%) in the time of 6 months after the last HA than those of the estrogen and progesterone group. CONCLUSIONS Yangmo decoction has better therapeutic efficacy in the treatment of intrauterine adhesion after HA than the combined effect of estrogen and progesterone. Yangmo decoction helps restore the endometrium and improve the fertility rate, therefore, it can be adopted as a routine practice for IUA patients who have fertility requirements.
Humans ; Young Adult ; Adult ; Middle Aged ; Retrospective Studies ; Progesterone/therapeutic use* ; East Asian People ; Medicine, Chinese Traditional ; Estrogens/therapeutic use*

OBJECTIVETo observe the clinical efficacy of bushen huoxue recipe (BHR) combined estrogen and progesterone in treating premature ovarian failure (POF), and to explore an effective treatment program of POF by integrative medicine.

METHODSTotally 265 POF patients were randomly assigned to 3 groups, i.e., Group I (86 cases, treated by BHR),Group II (88 cases,treated by conjugated estrogens and medroxyprogesterone acetate), and Group III (91 cases,treated by BHR +conjugated estrogens and medroxyprogesterone acetate). The therapeutic course for each group was 6 months. The main symptoms (including menstrual cycle, hectic fever, night sweat, vaginal dryness, and low libido), laboratory indices [including follicle stimulating hormone (FSH), luteotropic hormone (LH), estradiol (E2), and inhibin B (INH-B)], B-ultrasound indicators (including endometrial thickness, ovarian volume, and antral follicle count), and adverse reactions were observed in the three groups at the end of treatment and 6 months after treatment.

RESULTSCompared with before treatment, the main symptoms, laboratory indices, and B-ultrasound indicators were statistically improved in the three groups at the end of treatment and 6 months after treatment (P <0.05, P <0.01). Better effects were obtained in Group III in improving symptoms of the menstrual cycle, vaginal dryness, and low libido, lowering levels of FSH and LH, elevating levels of E2and INH-B, and ameliorating the endometrial thickness, the ovarian volume, and the antral follicle count (P <0.05, P <0.01). No obvious adverse reaction occurred in the three groups.

CONCLUSIONBHR combined estrogen and progesterone showed better clinical efficacy than use of BHR or estrogen/progesterone alone, indicating it was an effective treatment program for POF.

Adult ; Drugs, Chinese Herbal ; therapeutic use ; Estrogens ; therapeutic use ; Female ; Humans ; Integrative Medicine ; Primary Ovarian Insufficiency ; drug therapy ; Progesterone ; therapeutic use

Adult ; Drug Therapy, Combination ; Drugs, Chinese Herbal ; therapeutic use ; Estrogens ; therapeutic use ; Female ; Humans ; Phytotherapy ; Primary Ovarian Insufficiency ; drug therapy ; Progesterone ; therapeutic use

OBJECTIVETo investigate the effects of progesterone and progestin on the expressions of regulated on activation, normal T cell expressed and secreted (RANTES) in eutopic endometrium from patients with endometriosis.

METHODSWe collected the samples of endometrium from patients with endometriosis before operation or after insertion of levenorgestrel releasing intrauterine system (LNG-IUS), administration of oral medroxyprogesterone (MPA), or injection of gonadotrophic hormone releasing hormone agonist (GnRHa). Reverse transcription-polymerase chain raction was used to assay the expression of RANTES mRNA. On the other hand, progesterone (Po) and tumor necrosis factor-alpha (TNFalpha) of different concentrations and different manners were used to treat cultured cells in vitro. RANTES secretion was evaluated in the culture medium using ELISA. In order to evaluate the effect of Po on the secretion of RANTES under stimulation of TNFalpha, the cells were cultured in medium containing 100 U/ml TNFalpha and Po of different concentrations for 24 hours. After the pretreatment of Po for 48 hours at different concentrations, TNFalpha (100 U/ml, 16 h) was added to observe whether Po inhibits RANTES or not.

RESULTSThe expression of RANTES mRNA in eutopic endometrium of patients with endometriosis was significantly higher than in control group (28.0 +/- 9.0 vs. 22.0 +/- 5.6, P < 0.05). Following the exposures to LNG-IUS (24.0 +/- 4.2 vs. 25.9 +/- 4.2, P > 0.05) or GnRHa (23.0 +/- 12.9 vs. 26.9 +/- 5.2, P > 0.05), the expression of RANTES mRNA had no change. MPA significantly increased the expression of RANTES mRNA (42.6 +/- 3.1 vs. 24.3 +/- 5.7, P < 0.05). Po itself had no significant effect on the secretion of RANTES. Stimulated by Po and TNFalpha at the same time, the secretion of RANTES significantly increased. After pretreatment with Po for 48 hours, the reaction of RANTES to the stimulating effect of TNFalpha was down-regulated.

CONCLUSIONThe eutopic endometrium of patients with endometriosis has high chemotactic activity. It may be feasible to prevent and treat endometriosis with progestins.

Cells, Cultured ; Chemokine CCL5 ; biosynthesis ; Endometriosis ; drug therapy ; metabolism ; Endometrium ; drug effects ; metabolism ; Female ; Gonadotropin-Releasing Hormone ; agonists ; Humans ; Intrauterine Devices, Medicated ; Levonorgestrel ; therapeutic use ; Medroxyprogesterone ; therapeutic use ; Progesterone ; pharmacology ; therapeutic use ; Progestins ; therapeutic use ; Transforming Growth Factor alpha ; pharmacology

Antineoplastic Agents ; therapeutic use ; Aromatase Inhibitors ; therapeutic use ; Breast Neoplasms ; drug therapy ; metabolism ; pathology ; Female ; Humans ; Neoadjuvant Therapy ; Neoplasm Staging ; Nitriles ; therapeutic use ; Postmenopause ; Receptor, ErbB-2 ; metabolism ; Receptors, Estrogen ; metabolism ; Receptors, Progesterone ; metabolism ; Remission Induction ; Triazoles ; therapeutic use

OBJECTIVETo observe the effect of Bushen Peiyuan Principle (BSPY, a TCM principle for tonifying Kidney and nourishing primordial energy) in treating patients with postmenopausal coronary heart disease (PCHD) instead of hormone treatment.

METHODSTwenty-five healthy women, who were monepaused for over 5 years but without CHD complication were allocated in Group A, 25 patients with PCHD complication suffered from estrogen contraindications such as embolism, hysteromyoma and mammary adenoma, were arranged in Group B, and 25 patients of PCHD without above-mentioned complications were divided into Group C. Group B and C was treated with BSPY and hormone replacement therapy respectively, and the drugs for hypolipidemics were withdrawn 1 month before the study. All the patients were observed for 3.5 months, with their blood levels of estradiol (E2) and lipids determined before and after treatment.

RESULTSBefore treatment, the level of E2 in the two treated groups was lower than that in the normal group significantly (P < 0.01), and the parameters of blood lipids were abnormal in them. These abnormalities were improved after treatment significantly (P < 0.05 or P < 0.01). The level of E2 raised significantly (P < 0.01) after treatment in patients of Group C, with withdrawal vaginal bleeding presented in 90% of less than 56 years in age. In the Group B after treatment, level of E2 showed a slight rising and withdrawal vaginal bleeding was not found but with improvement of symptoms and signs better than that in Group C.

CONCLUSIONUsing BSPY in treating PCHD displayed significant adjustment on disturbance of blood lipid spectrum and improvement on clinical manifestations. As compared with the therapeutic effect of hormone replacement therapy, the risk of carcinogenesis caused by endometrial hyperplasia could be avoided because the blood level of E2 is only slightly increased by BSPY.

Coronary Disease ; blood ; drug therapy ; Drug Therapy, Combination ; Drugs, Chinese Herbal ; therapeutic use ; Estradiol ; blood ; Female ; Humans ; Middle Aged ; Phytotherapy ; Postmenopause ; Progesterone ; therapeutic use

Animals ; Animals, Newborn ; Brain Edema ; prevention & control ; Hypoxia-Ischemia, Brain ; prevention & control ; Progesterone ; therapeutic use ; Rats ; Rats, Wistar

BACKGROUNDFew studies have given suggestions on appropriate individual progesterone dosage in patients with progesterone deficiency. This study was designed to provide a reference for the clinical use of oral progesterone by exploring the relationship among Body Mass Index (BMI), dosage of progesterone, and serum progesterone concentration. Many gynecology and obstetrics doctors are unfamiliar with progesterone treatment. Our study is intended to help determine the dosage of oral progesterone.

METHODSThis was a block randomized, open-label, prospective clinical trial. Eighty women undergoing cessation of menses were recruited, given oral progesterone therapy for 10 consecutive days. They were randomly assigned to four groups (four different doses of progesterone, n = 20): group A 100 mg/d, group B 200 mg/d, group C 300 mg/d, and group D 400 mg/d.

RESULTSSeventy-four patients (92.5%, 74/80) completed the study. It was observed that administration of progesterone significantly increased serum progesterone concentration in the four groups (all P < 0.001). And there is a positive correlation between the increase and dosage (r(p) = 0.613, P < 0.001). A further linear regression analysis found the major regression equation: when 18.5 kg/m(2) ≤ BMI < 24 kg/m(2), Y = 8.4820×10(0.003X) (R(2) = 0.425, P < 0.001); Y was the increase of serum progesterone concentration in nmol/L, and X was the dosage of oral progesterone in mg/d.

CONCLUSIONSSerum progesterone levels went up linearly as the dosage increased. The higher the patient's BMI, the higher dosage would be needed to achieve the same serum progesterone concentration. The appropriate dosage of oral progesterone for different patients can be roughly calculated in light of the results of this study.

Administration, Oral ; Adult ; Body Mass Index ; Female ; Humans ; Menstruation Disturbances ; drug therapy ; Progesterone ; administration & dosage ; therapeutic use

Antibodies, Monoclonal ; therapeutic use ; Antibodies, Monoclonal, Humanized ; therapeutic use ; Antineoplastic Agents ; therapeutic use ; Antineoplastic Combined Chemotherapy Protocols ; therapeutic use ; Breast Neoplasms ; classification ; metabolism ; pathology ; surgery ; therapy ; Carcinoma ; classification ; metabolism ; pathology ; surgery ; therapy ; Cetuximab ; Chemotherapy, Adjuvant ; Cyclophosphamide ; therapeutic use ; Female ; Fluorouracil ; therapeutic use ; Humans ; Lymphatic Metastasis ; Methotrexate ; therapeutic use ; Neoplasm Staging ; Receptor, ErbB-2 ; metabolism ; Receptors, Estrogen ; metabolism ; Receptors, Progesterone ; metabolism ; Trastuzumab

BACKGROUNDLymphangioleiomyomatosis (LAM) is a rare disease that predominantly affects young females. It is considered as an "orphan" life-threatening disease of unknown etiology, with uncertain clinical prognosis, and no effective treatment. LAM can arise sporadically or in association with tuberous sclerosis complex (TSC), an autosomal inherited syndrome characterized by hamartoma-like tumor growth and pathologic features that are distinct from manifestations of pulmonary LAM. The clinical course of LAM is characterized by progressive dyspnea on exertion, recurrent pneumothorax, and chylous fluid collections.

METHODSFourteen cases of LAM from Zhongshan Hospital, Fudan University are reviewed, twelve were confirmed by lung biopsy, one by retroperitoneal lymphangioleiomyoma resection, and one by autopsy.

RESULTSAll 14 patients were women, aged 18 to 69 years (mean 43.3 years, median 46.5 years). Haemoptysis (57.1%) and chylothorax (35.7%) were more frequent than those described in previous case series. Extrapulmonary findings such as renal angiomyolipoma (AML), enlarged abdominal lymph nodes, liver AML and retroperitoneal lymphangioleiomyoma were seen in 21.4%, 14.3%, 7.14% and 7.14% in 14 cases respectively, which is remarkably lower than in the previously reported. Abnormal smooth muscle cells (LAM cells) were found to line the airways, bronchioles, lymphatics and blood vessels leading to airflow obstruction and replacement of the lung parenchyma by cysts. There were some surprises in the autopsy case as several LAM cell emboli were found in the veins of mediastinum lymph nodes; LAM cells were found to be disseminated in soft tissues adjacent to the ilium.

CONCLUSIONSWomen with unexplained recurrent pneumothorax, tuberous sclerosis, or a diagnosis of primary spontaneous pneumothorax or emphysema in the setting of limited or absent tobacco use should undergo high-resolution computed tomography (HRCT) scan screening for LAM. Routine abdominal and pelvic imaging examinations should be performed to detect extrapulmonary involvement. The autopsy studies histologically suggested that LAM could be a multisystemic disease and LAM cells might possess metastatic potential.

Adolescent ; Adult ; Aged ; Contraceptives, Oral, Synthetic ; Female ; Humans ; Immunohistochemistry ; Lymphangioleiomyomatosis ; diagnosis ; drug therapy ; metabolism ; pathology ; surgery ; Medroxyprogesterone ; therapeutic use ; Middle Aged ; Ovariectomy ; Progesterone ; therapeutic use ; Progestins ; therapeutic use ; Young Adult