scholarly journals New approaches to prophylaxis of endometrium hyperplasia relaps in premenopausal women

2021 ◽  
pp. 63-72
Author(s):  
V.O. Beniuk ◽  
V.H. Ginzburg ◽  
D.O. Govsieiev ◽  
V.F. Oleshko ◽  
T.V. Kovaliuk ◽  
...  

Research aim: to evaluate the effectiveness of therapy aimed at preventing endometrial hyperplasia recurrence in premenopausal women.Materials and methods. Clinical and paraclinical examinations of 76 premenopausal women were carried out. Transvaginal ultrasound was performed, levels of estradiol, progesterone, homocysteine, folic acid, serum HOMA index evaluated, body mass index and blood pressure assessed. Women were divided into two groups after histological results obtained: the main group included 40 women who received oral progestins (dydrogesterone 10 mg) twice a day in combination with Depapilin® 395 mg twice a day; the comparison group included 36 women who received only oral progestins (dydrogesterone 10 mg) twice a day. Comparison of the therapy effectiveness was performed 6 and 9 months after the start of treatment.Results. Endometrial thickness stabilized within 9 months in women of the main group, and was within the physiological norm (before treatment – 22 ± 3.1 mm, 6 months after the start of treatment – 8,3 ± 0.46 mm, after 9 months – 9,7 ± 0.31 mm, p <0.05). The positive treatment effect consisted in a significant decrease in the frequency of endometrial hyperplasia recurrence, which was 17 (17.5%) cases in the main group and 16 (44.4%) cases in the comparison group (p <0.05). Women of the main group also showed stable normalization of the level of estrogen and progesterone, a steady decrease in the level of homocysteine and a synergistic increase in the level of folic acid, normalization of blood pressure and reduction of body mass index.Conclusions. Depapilin® inclusion in the basic therapy of endometrial hyperplasia in premenopausal aged women is pathogenetically justified due to the complex effect of the drug components on the extragonadal estrogens synthesis and the antiproliferative effect on the endometrium.

2021 ◽  
Vol 10 (2) ◽  
pp. 2676-2680
Author(s):  
Priya M Gokula ◽  

Endometrial Hyperplasia is referred as the endometrial cells of uterus, which keep on growing or multiplying instead of shedding because of high levels of estrogen and low or insufficient levels of progesterone. It is a pre-malignant condition but which are not invasive in nature. EH usually occurs in women between 50 – 55 yrs. Endometrium being a hormone dependent tissue depends on estrogen and progesterone for proliferation and shedding. Endometrial thickness gradually increases day by day. EH is caused by PCOS and chronic anovulation in premenopausal women. Obesity, lynch syndrome are other causes of EH. In 1994, WHO classified this EH into four groups. In 2014, WHO revised this classification into two types, one is endometrial Hyperplasia (without atypia) and second one is atypical endometrial hyperplasia or EIN. Patient with EH experiences abnormal uterine bleeding, bleeding in between periods etc… Age, nulliparity, obesity, smoking, diabetes mellitus are the risk factors and is diagnosed by endometrial biopsy, dilation, and curettage, a transvaginal ultrasound, hysteroscopy. Management of EH is based on its types. Hyperplasia without atypia is managed by the levonorgestrel-releasing intrauterine system (LNG-IUS), oral progestogens, and surgery. Atypical EH is managed by surgery hysterectomy


Diagnostics ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. 442
Author(s):  
Norbert Stachowicz ◽  
Agata Smoleń ◽  
Michał Ciebiera ◽  
Tomasz Łoziński ◽  
Paweł Poziemski ◽  
...  

Background: Abnormal uterine bleeding (AUB) represents a common diagnostic challenge, as it might be related to both benign and malignant conditions. Endometrial cancer may not be detected with blind uterine cavity sampling by dilatation and curettage or suction devices. Several scoring systems using different ultrasound image characteristics were recently proposed to estimate the risk of endometrial cancer (EC) in women with AUB. Aim: The aim of the present study was to externally validate the predictive value of the recently proposed scoring systems including the Risk of Endometrial Cancer scoring model (REC) for EC risk stratification. Material and methods: It was a retrospective cohort study of women with postmenopausal bleeding. From June 2012 to June 2020 we studied a group of 394 women who underwent standard transvaginal ultrasound examination followed by power Doppler intrauterine vascularity assessment. Selected ultrasound features of endometrial lesions were assessed in each patient. Results: The median age was 60.3 years (range ±10.7). The median body mass index (BMI) was 30.4 (range ± 6.0). Histological examination revealed 158 cases of endometrial hyperplasia (EH) and 236 cases of EC. Of the studied ultrasound endometrial features, the highest areas under the curve (AUCs) were found for endometrial thickness (ET) (AUC = 0.76; 95% CI: 0.71–0.81) and for interrupted endomyometrial junction (AUC = 0.70, 95% CI: 0.65–0.75). Selected scoring systems presented moderate to good predictive performance in differentiating EC and EH. The highest AUC was found for REC model (AUC = 0.75, 95% CI: 0.70–0.79) and for the basic model that included ET, Doppler score and interrupted endometrial junction (AUC = 0.77, 95% CI: 0.73–0.82). REC model was more accurate than other scoring systems and selected single features for differentiating benign hyperplasia from EC at early stages, regardless of menopausal status. Conclusions: New scoring systems, including the REC model may be used in women with AUB for more efficient differentiation between benign and malignant conditions.


2016 ◽  
Vol 2016 ◽  
pp. 1-7 ◽  
Author(s):  
Mohamed Laban ◽  
Sherif H. Hussain ◽  
Alaa S. Hassanin ◽  
Waleed M. Khalaf ◽  
Mohamed K. Etman ◽  
...  

The aim is to compare hysteroscopy, two-dimensional transvaginal ultrasound (2D TVUS), and three-dimensional (3D) Virtual Organ Computer-aided AnaLysis™ (VOCAL) to detect endometrial polyps (EPs) in premenopausal women with abnormal uterine bleeding (AUB). This prospective study was done at Ain Shams Maternity Hospital, Egypt, from March 5, 2015, to December 30, 2015, enrolling 118 premenopausal women with AUB. 2D TVUS, 3D VOCAL, and hysteroscopy were done. 109 patients reached final analysis. 36 women (33%) were diagnosed with EP by 2D TVUS. 50 (45.9%) had EP by hysteroscopy. Endometrial thickness was 10.1 mm by 2D TVUS and endometrial volume was 4.92 mL by VOCAL in women with EP by hysteroscopy compared to 9.9 mm and 3.50 mL in women with no EP, respectively (P=0.223;P=0.06). 2D TVUS has sensitivity, specificity, and positive and negative predictive values of 54%, 84.7%, 75%, and 68.5%, respectively. Endometrial thickness of >7.5 mm has sensitivity, specificity, positive and negative predictive values, and overall accuracy of 82%, 37.3%, 52.6%, 71%, and 57.8%, respectively. Endometrial volume of >1.2 mL has sensitivity, specificity, positive and negative predictive values, and overall accuracy of 90%, 42.4%, 57%, 83.3%, and 64.2%, respectively. 3D VOCAL may be used as a noninvasive method for the diagnosis of EP in premenopausal women with AUB.


Author(s):  
Kumarasamy Akalyaa ◽  
Pattacheravanda Nanaiah Shakuntala ◽  
Ramaiah Renuka

Background: As the rate of obesity is increasing in women in the recent years, the incidence of endometrial cancer increases as the body mass index (BMI) increases. Despite the clear evidence linking endometrial cancer and obesity, there is limited public awareness of this relationship. This study was undertaken to evaluate the association of BMI and endometrial pathology in premenopausal women with abnormal uterine bleeding (AUB).Methods: An analytical case control study was conducted in 100 women between the age group of 40 to 55, with AUB in the Department of Obstetrics and Gynecology, ESIC-PGIMSR Bangalore between January 2018 and June 2019. The menstrual patterns and endometrial pattern by histopathology were analysed in women with BMI of 18.5 to 24.99 and ≥25.Results: The mean age of women participated in the study group of between 40- 55 years was 44.83. The mean duration of symptoms was 10.18 months in the cases group and 8.52 months in the control group. The menstrual patterns were comparable and there was no significant difference in both the groups. The mean endometrial thickness, mean BMI, hyperplasia with or without atypia were all higher in the cases group. The frequency of occurrence of atypical endometrial hyperplasia was higher in women with increasing BMI.Conclusions: We found increased BMI to be an important independent risk factor for the development of endometrial hyperplasia with atypia which is a precursor to endometrial carcinoma in premenopausal women with AUB. 


2018 ◽  
Vol 9 (2) ◽  
pp. 31-35
Author(s):  
Pravin Shrestha ◽  
Smita Shrestha ◽  
Vibha Mahato

Background: Abnormal Uterine Bleeding is defined as any deviation from a normal menstrual pattern. It is one of the common presentation in extremes of ages. However endometrial hyperplasia and carcinoma are commoner in perimenopausal and postmenopausal women warranting investigations like ultrasonography and endometrial biopsy.Aims and Objective: The aim of the study was to note the endometrial thickness by transabdominal ultrasonography and observe the histopathological pattern in women presenting with abnormal Uterine Bleeding.Material and Methods: Premenopausal women more than 45 years of age and the postmenopausal patients, without any pelvic pathology were included in the study. Endometrial thickness was measured by transabdominal sonography and endometrial biopsy was done. Tissue obtained was sent for histopathological examination.Results: A total of 105 patients were studied. Majority (92%) of patients were premenopausal. Proliferative Endometrium (32%) was the most common finding in premenopausal and atrophic endometrium (37.5%) in postmenopausal group. Malignancy was higher in a postmenopausal group (12.5%) as compared to the premenopausal group (2%). Malignancy was not seen when endometrial thickness was less than 11mm in the premenopausal age group. Endometrial hyperplasia was also more common when the thickness was more than 11mm.In postmenopausal group12.5% of patients, had complex hyperplasia.25% had simple hyperplasia and malignancy was seen in 12.5% of patients. When endometrial thickness was less than 5 mm, hyperplasia and malignancy was not seen.Conclusion: Measurement of Endometrial thickness and histopathological workup in patients above 45 years presenting with abnormal uterine bleeding will be helpful in detecting endometrial hyperplasia and carcinoma.Asian Journal of Medical Sciences Vol.9(2) 2018 31-35


2016 ◽  
Vol 22 (2) ◽  
pp. 66-69
Author(s):  
Veronika S. Pshennova ◽  
O. V Aleksandrov

The article presents the results of study demonstrating that though evident symptoms of pulmonary hypertension were absent (maximal systolic tension was within standards both in males and females of main group) reliable increasing of blood pressure in pulmonary artery in comparison with control group under increasing of body mass index, waist volume and index waist/hips. At that, in males of main group under obesity degree I and II average blood pressure exceeded limits of standards.


2021 ◽  
pp. 52-56
Author(s):  
T. G. Malanicheva ◽  
N. V. Ziatdinova ◽  
I. N. Serdinskaya

Introduction. Traditional antiallergic therapy for atopic dermatitis, including allergen elimination, therapeutic cosmetic skin care, external anti-inflammatory therapy and antihistamines, does not always lead to the desired result. On this basis, the search for new methods of treatment is urgent and promisingAim. To study the clinical efficacy of a combination of Lactobacillus rhamnosus GG and prebiotics in children in the first years of life with atopic dermatitis (AD).Materials and methods. The observed children were divided into 2 parts: 30 children aged from 1 month to 3 years old, patients with AD constituted the main group, it differed in that these patients were synbiotic (combination of Lactobacillus rhamnosus GG and prebiotics) – 1 sachet per day for 14 days. This drug was prescribed as part of complex therapy. The remaining 25 children with AD made up a comparison group, which was characterized by the fact that children received only antiallergic therapy without symbiotic. Clinical methods of blood pressure examination, laboratory instrumental and specific allergological methods were carried out.Results and discussion. Against the background of the therapy in children with blood pressure in the main group, общий overall treatment effect was higher and amounted to 86.6 + 4.0%, and in the comparison group – 76.0 + 3.9%, p < 0.05. This was manifested in a decrease in the duration of the exacerbation period by 1.4 times, the prevalence of a high individual therapeutic effect by 1.5 times, a decrease in the SCORAD index by 4 times against the background of an increase in the number of bifidobacteria and lactobacilli in the intestine. The revealed clinical efficacy was noted against the background of an increase in the number of bifidobacteria and lactobacilli in the intestine.Conclusions. The obtained results allow us to recommend a combination of Lactobacillus rhamnosus GG and prebiotics in children in the first years of life as part of complex therapy to increase the effectiveness of treatment.


Author(s):  
M. V. Gubanova ◽  
N. N. Kushnarenko ◽  
T. M. Karavaeva

Aim. The aim of the study was to develop the model for establishing early diagnosis of hypertension in patients with gout. The model was based on data of 24-hour blood pressure monitoring.Material and Methods. A total of 69 patients with gout were enrolled in a single-stage cross-sectional prospective study. Three study groups were assigned as follows: group 1 (main group) comprised hypertensive men with gout (n = 41); group 2 (comparison group) comprised normotensive men with gout (n = 28); group 3 (control) included relatively healthy men  (n = 30). Daily blood pressure monitoring was performed on an outpatient basis using a BPLab device (Peter Telegin, Russia).Results. The significant intergroup differences were found in the following parameters: lowest, mean, and highest 24-hour systolic blood pressure (SBP) values in patients of main and comparison groups (р < 0.001) and in patients of main and control groups (р < 0.001); mean and maximum 24-hour diastolic blood pressure (DBP) values in patients of main and comparison groups (р < 0.001) and in patients of main and control groups (р < 0.001); lowest, mean, and highest 24-hour pulse blood pressure (PBP) values in patients of main and comparison groups (р < 0.001) and in patients of main and control groups (р < 0.001); mean, and maximum 24-hour PBP values in patients of comparison and control groups (р < 0.001). Median values of the lowest, mean, and highest 24-hour SBP in hypertensive patients with gout were significantly higher than the corresponding values in normotensive patients with gout and healthy men of group 3 (p < 0.001). Median values of mean and maximum 24-hour DBP in main group were higher than the corresponding values in comparison group and control group (p < 0.001). Median values of the lowest, mean, and highest 24-hour PBP in hypertensive patients with gout exceeded the corresponding values of patients of control group (p < 0.001). Median values of the mean and maximum 24-hour PBP in main group exceeded the corresponding values of patients of comparison group (p < 0.001). Based on the binary logistic regression model, the prognostic algorithm for hypertension development in gout patients was created using the parameters of 24-hour blood pressure monitoring as predictors and the cut-off K value. If the value of K was > 0.54, then the hypertension development was predicted in gout patients. The sensitivity of developed diagnostic model was 0.84, and the specificity was 0.95.Conclusion. Тhe proposed model, based on the assessment of average-daily values of the lowest, mean, and highest SBP, allowed to establish early diagnosis of hypertension in patients with gout with the accuracy of up to 90%.


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