Gynecological Therapy

A woman is looking at a tablet while talking to a doctor.

Problems with menstruation, painful periods, endometriosis – gynecological diseases can seriously impair a woman's feeling of well-being and quality of life. The origin of these diseases can lie in hormonal imbalances.

Acne therapy due to hormonal imbalance

A high production of male sex hormones (Androgen) in women can, for example, lead to acne and hirsutism (male-type body/facial hair). A woman should aware that the imbalance hormone will lead another serious problem and disorders, i.e. disorders of the menstrual cycle or the development of ovarian cysts. Women with high androgen level also an increased risk of infertility.

A hormonal preparation with the active ingredients Cyproterone Acetate (CPA) and Ethinyl Estradiol provides anti-androgenic effects which can be used to treat acne caused by excess of Androgen hormone with contraceptive effect.

Endometriosis

Endometriosis is a chronic, progressive disease where tissue that resembles the lining of the womb (the endometrium) is found outside the womb, forming endometriotic lesions, which cause pain and inflammation.

These lesions are most often found on the ovaries and other organs within a woman’s pelvis but can also spread to other parts of the body. Left untreated the endometriotic lesions will continue to proliferate throughout the pelvis and in some cases may require surgery. There is no cure for endometriosis and treatment of the diseases aims to relieve pain, slow the growth of lesions, preserve fertility (where desired) and/or to prevent the disease from coming back after successful treatment. Endometriosis is also a common reason for infertility.

Reasons not fully explored

Many millions of women suffer from Endometriosis. It is estimated that 5% – 10% of all women of childbearing age are affected. Yet the disease goes undiagnosed in many women. Often the symptoms are initially interpreted as normal menstrual complaints. A definite diagnosis can only be made by performing a laparoscopy. If an endometriotic lesion is detected, it can be surgically removed, if necessary, for infertility treatment. However, about half of the women experience symptoms again after surgery.

The causes of the disease have still not been fully explained. Most experts believe that a reflux of menstrual blood carries cells from the uterine lining via the Fallopian tubes into the abdominal cavity. Other researchers believe that the cells spread from the uterus via lymph and blood vessels.

While the current standard therapy in terms of efficacy (GnRH analogues) relieves the pain, it can also lead to severe side-effects of hypoestrogenism, such as decreased bone mineral density and hot flushes. For these reasons, it is not suitable as a long-term therapy.

New Real-World Evidence Highlights Efficacy and Safety of Dienogest in the Long-Term Treatment of Asian Women with Endometriosis¹.

24-month results from a Pan-Asian real-world study show that Dienogest 2 mg effectively reduced endometriosis-associated pelvic pain (EAPP) and improved health-related quality of life (HRQoL) in Asian women with endometriosis. The important findings are from the ENVISIOeN (Effectiveness of Dienogest in improving quality of life in Asian women with Endometriosis) study which evaluates the long-term efficacy and safety of Dienogest in the treatment of endometriosis in Asian women in real world clinical practice. The study was conducted in 36 sites across six Asian countries i.e. Indonesia, South Korea, Thailand, the Philippines, Singapore, Malaysia.

_{Reference :

1. Poster on Effectiveness of Dienogest in Improving Quality of Life in Asian Women with Endometriosis in Routine Clinical Practice (ENVISIOeN) presented at the 8th Asian Conference on Endometriosis 2019.}

Menstrual Regulation and Abnormal Uterine Bleeding

In certain occasions and events, such as hajj and umrah, honeymoon, vacation, or competitive athletic/sporting events, women can adjust their menstruation cycle. Menstrual regulation can be done by bring forward or postponing the cycle.

One of the methods that can be used to do menstrual regulation is by consuming Progestion Pills.

Abnormal Uterine Bleeding
Abnormal Uterine Bleeding refers to all menstrual disorders in case of blood volume or duration. Prevalence of Abnormal Uterine Bleeding in reproductive women is 10% – 30%, while in perimenopause women the prevalence is increasing to 50%.

Abnormal Uterine Bleeding can be divided into three :

Acute Abnormal Uterine Bleeding, heavy menstrual bleeding which often accompanied by low hemoglobin thus need immediate treatment to prevent further blood loss
Chronic Abnormal Uterine Bleeding, Abnormal Uterine Bleeding which happen in three or more months
Intermenstrual bleeding, uterine bleeding which happen in between of 2 regular menstrual cycle

Abnormal Uterine Bleeding caused by hormonal disorder can be treated by Progestin Pills.

Norethisterone 5 mg is similar to the natural female hormone progesterone to treat the following :

Dysfunctional bleeding
regulation of menstrual cycle
primary and secondary amenorrhea (no menstrual period)
premenstrual complaints (premenstrual syndrome)
endometriosis (a disease caused by womb- lining tissue growing outside the womb).

_{Sources :

1. https://www.nichd.nih.gov/health/topics/amenorrhea/conditioninfo/treatments

2. Primolut Product Information Indonesia 2018}

_{Advice for patients : Each body reacts differently to medicines. Therefore, it is impossible to tell which medicine works best for you. Please consult your physician.}

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