2007年3月28日，欧洲妇产科学会Schindler教授应苏威公司的邀请，来中国进行演讲，中国妇产科网特邀北京协和医院妇产科田秦杰教授对他进行了专访。

         Schindler教授在北京的巡回演讲课程：月经紊乱，点击此进入课程学习。

Schindler教授专访稿

2007-3-28

Q1.
Dr Tian：Dr Schindler，on behalf of chinese ob/gyn doctors, we would like to welcome you to beijing and give us a lecture this afternoon. I want to know how many times have you been to china?
Dr Schindler：If this is the visit here, it is the third time.
Dr Tian: Oh, really?
Dr Schinlder: Yes.

Q2.
Dr Tian: So, what's the impression about the changes of china and the impression about chinese ob/gyn?  
Dr Schindler: I can look at the time spent 1981 until now, and I think there is a dramatic  change for that.    Particular for the whole country, with the development and with the outlook,    in particular of in beijing here in 2008 with the Olympic Games. I think there's dramatic development.

Q3.
Dr Tian: Ok, thank you. And is there any academic exchange between Germany and China now?   
Dr Schindler：I think not only now, it already been the past.    And my first visit was associated with an exchange program which was supported by the Chinese goverment    as well as by the German goverment. In particular through our medical school at Essen.

Q4.
Dr Tian: I see, OK. Great. What's your topic today?  
Dr Schindler：We want to talk today about menstrual disorder, in particular about the use of dydrogesterone, Duphaston.   
Dr Tian: You know the dysfunctional bleeding is a big problem in china now。  
Dr Schindler：I don't know that.
Dr Tian: It's a big probelm, especially for the rural areas, but doctors don't know how to use the drugs especially the hormones, progesterone and estrogen. So I think may be this afternoon's lecture will give us great help. 
Dr Schindler：I hope so.

Q5.
Dr Tian: You know we have several types of progesterones.  What's your opinion about dydrogesterone,Duphaston in luteal support compared with other progestins especially the microprogesterone?  
Dr Schindler：First of all, we have to differentiate. When you say luteal phase, you would have to ask me what women.    Is the women who is concerned to get pregnant or is pregnant. Or is the women who just like adolescents or   premenopausal women who has menstrual bleeding disturbance, or has a corpus luteal insuffeciency, by this having cycle disturbance. These are two different things. If we look at the first part, maybe the women want to get pregnant, the cycle is stimulated. You support the corpus luteum, then you can only use progestines who are not androgenic who are not anti-androgenic, because that androgenic one will jeopardise the female fetus and anti-androgenic one as the male fetus. So dydrogesterone and microprogesterone, as you mentioned, for this part, there are only these two. And of course there is the third one. It is the depo preparation. 17α-hydroxyprogesterone. But this you can not use in luteum fasion.  Can you use something like that for the long term treatment for instance pregnancy.  So actually for your question, luteal support, concern going want to get pregnant or finally being pregnant.   Only two preparations, dydrogesterone as duphaston and micropregesterone.  of course, Dydrogesterone compare with oral icropresgesterone,
there are some unique advangtages, which will be introdcued in my lecture today.   
Dr Schindler:Now we get to the others, the other would be the young lady who has not fully develop the cycle, who have PCO, for instance, who has anovulation, or who has corpus luteum insufficiency, then either one.  Of course you can use whole array of compound of progestogens. And you can use also progestins in some particular fact like   a women who has acne, which might be a problem in china.  
Dr Tian: Still be a big problem for chinese women.  
Dr Schindler：I know. I know.  I visited. I walked around in marvellous park in beijing and I am looking at the students,   the women, I know the acne is the problem.  So that's why I mentioned in particular that would be particular group of progestins.  This particular group we call anti-androgenic progestins. There we have actually 4, I would say. One is cyproterone acetate. the second one is chlormadinone, the third is dienogest, and the fourth is drospirenone. So
there are four  anti-androgenic progestins. Away from this special indication. You can use the other progesterone, 19-nortestosterone as well, if you don't have a problem with acne. And you can give it in the second half part of the cycle to support similar to the normal cycle.

Q6.
Dr Tian: So you have talked lot about the differnces of progesterone.  What are the major consideration when you select progesterone.   
Dr Schindler：First of all, as I said already before. If we have any way on the reproduction or in getting pregnant,  it would be only these two-dydrogesterone and micropregesterone.  If she has androgenic effect, that means acne, for instance, then it would be the anti-androgenic progeterones. If she has no problem whatever, then you can use 19-nortestosterone as well.   
Dr Tian: Great. I think you will give us an excellent lecture this afternoon.   
Dr Schindler: I hope so.  
Dr Tian: Thank you very much.   
Dr Schindler: Thank you.

问题2:
田秦杰教授：您对中国和中国的妇产科医生印象如何？  
Schindler教授：我想从1981年到现在已经有了巨大的变化，整个国家的发展和面貌，尤其是北京，2008年将要举办奥运会，我想是有了巨大的变化。

问题3:
田秦杰教授：好的，谢谢。现在德国和中国之间有些学校之间的交流吗？     
Schindler教授：我想不仅仅是现在，过去就有。我第一次来中国其实就是得到了中国政府和德国政府的支持才来的。尤其是我现在所在埃森的学校（有交流）。

问题4:
田秦杰教授：好的，您今天（演讲的）题目是什么？     
Schindler教授：我会讲到月经紊乱，尤其是使用地屈孕酮（达芙通）的使用。     
田秦杰教授：您知道在中国功血仍是一个严重的问题……     
Schindler教授：我不知道。     
田秦杰教授：这仍然是一个大问题，尤其是边远地区，医生们不知道怎么样用药，尤其是雌激素孕激素这类的药物，所以我希望您今天下午的讲座会对我们有帮助。     
Schindler教授：希望会。

问题5:
田秦杰教授：您知道我们有数种孕激素，有关黄体支持时选择地屈孕酮和其它类型的孕激素，尤其是微粒化的黄体酮相比较，您有什么意见？     
Schindler教授：首先，我们必须要鉴别。当你说黄体期，你必须要问是哪个妇女。是准备要怀孕的妇女呢？还是已经怀孕的妇女？ 还是那些存在着月经紊乱的青春期或者绝经前的妇女？或是因为黄体功能不足导致的月经紊乱患者？他们可以分为两类， 对于第一部分的患者，我们只能使用那些没有雄激素活动或者没有抗雄激素活性的孕激素，因为具有雄激素活性的孕激素可能会对女胎造成危险，而具有抗雄激素活动的孕激素会对男胎造成危险。对于这部分的患者，你只能使用这两种孕激素--即地屈孕酮(达芙通)和微粒化孕酮。当然地屈孕酮和口服微粒化孕酮比较有更为独特的优势,在我今天的演讲中会介绍到.  当然还有第3种，就是17α羟孕酮，但是这个你不能用于那样的黄体支持治疗，尤其是象妊娠那样的长期治疗。因此对于你的问题，黄体支持，我们要关注的是妇女准备怀孕还是最终受孕，这种情况下只有两种制剂可以使用，地屈孕酮，即达芙通和微粒化的黄体酮。 现在我们来说一下另外的妇女，那些青年的女性，还没有形成规律的周期，譬如患有多囊卵巢，不排卵，或者是那些黄体功能不足，那么就可以任何一种孕激素均可使用。 当然，对于某些特殊的情况，譬如说对于痤疮的患者，这可能在中国也是一个问题。     
田秦杰教授：是的，在中国人也是一个大问题。     
Schindler教授：我知道！我知道！我参观的时候，我在北京的公园里面，我看到了！那些学生、妇女，痤疮是一个问题。在这种情况下就要选择有抗雄激素活性的孕激素。除了这种特殊的指征外，如果你没有痤疮的问题，也可以使用其它的孕激素，譬如19-去甲睾酮，你可以用于月经周期后半期的支持以恢复正常的周期。

问题6:
田秦杰教授：您刚才谈到了不同类型孕激素的区别，您在选择孕激素的时候主要考虑的是什么呢？     
Schindler教授：首先，我想我刚才提到过，如果是育龄期妇女准备妊娠，那么只能使用那两种--地屈孕酮和微粒化黄体酮。如果她有雄激素的效应，譬如说她有痤疮，那么就会选择抗雄激素活性的孕激素。如果她没有特别的问题，那么你就可以选择19-去甲睾酮。
田秦杰教授：我希望您下午可以给我们一个非常好的讲座。
Schindler教授：我希望如此。     
田秦杰教授：非常感谢。     
Schindler教授：谢谢。