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Penggunaan GnRH agonis

pada endometriosis

Andon Hestiantoro

Divisi Imunoendokrinologi Reproduksi


Bagian Obstetri dan Ginekologi
Fakultas Kedokteran Universitas Indonesia/
RS. Dr. Cipto Mangunkusumo
JAKARTA
Definisi

Endometriosis : pertumbuhan kelenjar dan


jaringan endometrium ektopik di luar
rongga uterus (termasuk pertumbuhan di
otot uterus)
Faktor Faktor Faktor Faktor
genetik endokrin imunologi mekanik

Haid membalik

Metaplasia
coelomic
Implantasi

Susukan
endometriosis

Invasif Limfatik
progresif Pembuluh darah

Etiologi dan histogenesis endometriosis


Neuron
GnRH

Eminensia
mediana
Gonadotropin releasing hormone
(GnRH alamiah)

Pyro
Glu
His Trp Ser Tyr Gly Leu Arg Pro Gly CONH2

Endopeptidase Carboxyamide
peptidase

GnRH agonist D-leu D-trp

Pyro
Glu
His Trp Ser Tyr Leu Arg Pro NH-Ethylamide

D-his D-ser
GnRH analog
GnRH agonist
Pulsatil : memicu sekresi FSH/LH
Kontinyu : awal memicu FSH/LH (up-
regulation), kemudian menekan sekresi
FSH/LH (down-regulation).

GnRH antagonist
Kompetitif inhibitor
Menghambat sekresi FSH/LH
Reseptor
GnRH

Kompleks GnRH+reseptor GnRH


FSH
GnRh
alamiah GnRH
agonist
(Pulsatil)
(Pulsatil)

Reseptor
GnRh
Jam

FSH
GnRH
agonist
GnRh
alamiah (Kontinyu)

Hari

FSH
GnRH
GnRh antagonist
alamiah

Hari
GnRH
FSH agonist Flare-Up

Down regulated

7 Hari
Masalah kesehatan terkait endometriosis

Pelvic pain

Dysmenorrhea Infertility
Jenis terapi endometriosis
Medikamentosa
Progestogen
Antiprogestogen
Danazol
Kontrasepsi oral
GnRH agonis
Penghambat aromatase
Terapi imunologi
Antiangiogenesis

Pembedahan
Bedah Laparoskopi
Laparotomi
The Cochrane Library, Volume (3).2005
The Cochrane Library, Volume (3).2005
The Cochrane Library, Volume (3).2005
Pre or post-operative medical treatment with nafarelin in stage
IIIIV endometriosis: a French multicenter study

Alain Audeberta, Philippe Descampsb, Henri Marret, Laure Ory-Lavolleed, Franois Bailleul and Samir
Hamamah

Abstract
Objectives: To determine the effectiveness of a 6-month course of nafarelin in the treatment of stage IIIIV
endometriosis and to determine if pre-operative use of nafarelin facilitates surgery.
Design: Prospective, multicenter, clinical trial.
Setting: Eight university hospitals and two private practice institutions in France. Patients: Fifty-five patients with
stage III and IV endometriosis. Two were excluded. Interventions: The severity of endometriosis was assessed at the
time of laparoscopy and patients were randomized to have either laparosopic surgery at that time following 6 months
of nafarelin therapy (n=28), or laparoscopic surgery following 6 months of nafarelin therapy (n=25). All had 200 g
intranasal nafarelin twice a day for 6 months and a second look laparoscopy.
Main outcome measure: Clinical efficacy, tolerance to the treatment. Results: Efficacy and tolerance to the treatment
were the same in both groups. AFS scores compared on both laparoscopies were significantly better if nafarelin was
given prior to surgery (P=0.007).

Conclusions: This preliminary study shows that in cases of combined medico-


surgical treatment for stage IIIIV endometriosis, preoperative medical
treatment with GnRH-a gives a better AFS score improvement, but no
conclusion was possible whether preoperative treatment facilitates surgery.

Eur J Obstet Gynecol Reprod Biol. 1998;79(2):145-8


The Cochrane Database of Systematic Reviews
The Cochrane Library, Volume (3).2005
The Cochrane Library, Volume (3).2005
The Cochrane Library, Volume (3).2005
Terapi medikamentosa dan kehamilan

Curr Womens Health Rep 2003;3(5):389-94


Terapi medikamentosa dan kehamilan

N Engl J Med 2001; 345(4): 266-275


N Engl J Med 2001; 345(4): 266-275
N Engl J Med 2001; 345(4): 266-275