scholarly journals Results of combined treatment of uterine leiomyoma in women of reproductive age

2021 ◽  
Vol 25 (3 (99)) ◽  
pp. 132-137
Author(s):  
M. Flaksemberg
Keyword(s):  
Uterine Leiomyoma ◽  
Receptor Gene ◽  
Combined Treatment ◽  
Pain Syndrome ◽  
Disease Recurrence ◽  
Reproductive Age ◽  
Pelvic Pain Syndrome ◽  
Preoperative Preparation ◽  
Women Of Reproductive Age ◽  
Medication Selection

The purpose of the work. To study the effectiveness of the combined treatment of uterine leiomyoma (UL), taking into account the possibility of realizing reproductive function.Material and methods. The total number of women of reproductive age examined with a large UL (a dominant node more than 50 mm in diameter) was 94. At the first stage, all patients received preoperative preparation. At the first stage all patients received preoperative preparation. 35 patients with concomitant endometrial hyperplasia and/or with the presence of the progesterone receptor gene polymorphism PGR progins received aGn-RH in an average therapeutic dose once in 28 days, 3 injections. 59 patients with the reference genotype without endometrial pathology received mifepristone 50 mg daily for 3 months. After preoperative preparation, the patients underwent conservative myomectomy by laparotomy. Menstrual function, pelvic pain syndrome, size of leiomatous nodules, drug tolerance, frequency of pregnancy and recurrence were assessed. Statistical data processing was performed using Microsoft Excel software. The main statistical indicators such as frequency, mean and standard deviation were taken into account. The results were considered significant at p < 0.05.Results. Excessive menstruation and AUB occurred in 81.9% of patients. Amenorrhea occurred in 79.8% of patients after 1 month of therapy and in all patients after 3 months. Recovery of menstruation was noted in 10.6% of patients a month after the operation, in 59.6% of patients after two months and on the third cycle menstruation resumed in all patients. The frequency of pain syndrome unrelated to the menstrual cycle decreased from 52.1% to 9.6%, dyspareunia from 12.8% to 4.3%, dysmenorrhea from 47.9% to 8.5%. According to ultrasound data, after 1 month in the group of women receiving aGn-RH the size of the nodules decreased by an average of 22.9%, and after mifepristone by 16.9%, and after 3 months by 51.4% and 45.8%. The uterine volume decreased by 28.6% and 30.5%. Starting from the second month of treatment, symptoms caused by estrogen deficiency were noted in 39.4% of patients treated with aGn-RH and 20.3% in the mifepristone group. Overall, the treatment was defined as effective in 88.6% of the women treated with aGn RH and 93.2% of those treated with mifepristone. Relapse occurred in 11.4% of women after aGn-RH and in 5.1% of those in the mifepristone group. Pregnancy occurred in 69.2% of patients and resulted in delivery in 90.8% of cases.Conclusions. The use of preoperative hormonal preparation and a differentiated approach to medication selection leads to normalization of the patient's condition and a reduction in the size of the nodules, which allows organ-preserving surgical treatment with minimal uterine trauma. Preference should be given to anti-gestagens because, with equal efficiency compared to aGn-RH, they are better tolerated by patients and have a more pronounced positive effect on process stabilization and disease recurrence. This combined approach improves treatment efficiency to 91.5%, preserves the uterus in reproductive-age women and promotes pregnancy in 69.2% of cases.

Use of mifepristone for preoperative preparation of reproductive age women with uterine leiomyoma

2017 ◽  
pp. 107-110
Author(s):  
А. Kornatska ◽  
◽  
G. Chubei ◽  
M. Flaksemberg ◽  
◽  
...  
Keyword(s):  
Uterine Leiomyoma ◽  
Pain Syndrome ◽  
Reproductive Age ◽  
Preoperative Preparation ◽  
Women Of Reproductive Age ◽  
Clinical Indicators ◽  
Reproductive Age Women ◽  
Key Words Leiomyoma ◽  
Hormonal Preparation ◽  
Leiomyoma Of The Uterus

The objective: was to evaluate the possibility of using mifepristone (Gynestril) as a hormonal preparation for conservative myomectomy. Patients and methods. The effect of a three-month course of mifepristone (Gynestril) at a dose of 50 mg per day on the dynamics of clinical indicators, ultrasound, the results of surgical treatment in 30 women of reproductive age with uterine leiomyoma was studied. Results. The use of an antigestagenic drug for preoperative preparation led to a decrease in the incidence of pain syndrome, dysfunction of the pelvic organs in most patients. The presence of amenorrhea in 90% of women contributed to the normalization of hemoglobin. The positive dynamics of the mioma nodes sizes and the uterus made it possible to reduce the time of operative intervention and the volume of intraoperative blood loss. Conclusion. The use of antigestagen preparations, in particular mifepristone (Gynestril), for the purpose of preoperative preparation, allows obtaining the most positive result of organ-preserving treatment of uterine myoma in reproductive age women. Key words: leiomyoma of the uterus, reproductive age, preoperative preparation, mifepristone, Gynestril.

Clinical and sonological features in endometriomas in women of reproductive age

2016 ◽  
pp. 85-89
Author(s):  
О. Shapoval ◽  
Keyword(s):  
Endometrial Hyperplasia ◽  
Benign Tumor ◽  
Pain Syndrome ◽  
Reproductive Age ◽  
Control Group ◽  
Women Of Reproductive Age ◽  
Ovarian Endometriosis ◽  
Gynecological Examination ◽  
Different Characteristics ◽  
Ovarian Endometriomas

The objective: to study the prevalence of ovarian endometriosis in women of reproductive age, the features of clinical and ultrasound picture of endometriosis. Patients and methods. The study involved 22 patients with endometriomas, the control group – 50 women gynecological and somatically healthy. Results. The incidence of ovarian endometriomas in the structure of benign tumor-like formations of ovaries is 0.62%. In 72.73% of ovarian endometriomas occur on a background of concomitant gynecological pathology. Clinically, in 77.27% of cases there is a pain syndrome, in 59.09% – algomenorrhea, in 13.64% – infertility; 18.18% of cases endometriomas remain «dumb» and proceed with the erased clinical picture. Sonologically in patients with endometriomas adenomyosis, endometrial hyperplasia, changes in the contralateral ovary are determined. Conclusion. Without additional methods of diagnostic gynecological examination may identify the 3 cm tumor-like formation of the ovary with different characteristics, which does not allow to differentiate endometrioma from inflammation, functional and ovarian tumors. Ultrasound can diagnose pathological ovarian formation of 1 cm, detailing the nature of the cyst. Key words: endometriosis, reproductive age, retrospective analysis, ultrasound.

Clinical and anamnestic characteristics of patients with adenomyosis, accompanied by pelvic pain syndrome

GYNECOLOGY ◽  
2018 ◽  
Vol 20 (6) ◽  
pp. 77-80
Author(s):  
M R Orazov ◽  
V E Radzinsky ◽  
M B Khamoshina ◽  
A O Dukhin ◽  
L R Toktar ◽  
...  
Keyword(s):  
Pelvic Pain ◽  
Chronic Pelvic Pain Syndrome ◽  
Pain Syndrome ◽  
Reproductive Age ◽  
Pelvic Pain Syndrome ◽  
Common Disease ◽  
Contributing Factors ◽  
High Prevalence ◽  
Inflammatory Processes ◽  
History Of

Pelvic pain syndrome associated with adenomyosis is a common disease in women of reproductive age. Frequency of detection in the population varies from 10 to 53%. The aim - to study the clinical and anamnestic risk factors of pelvic pain, with adenomiose. Materials and methods. The study included 120 (n=120) patients with diffuse adenomyosis with pain and painless form of the disease who underwent examination and treatment in the gynecological Department of the Central clinical hospital №6 of Russian Railways in Moscow. Each patient was provided with an individual card, which was encrypted 171 sign. The studied parameters reflected the passport and anthropometric data, information about education, social status, presence of occupational hazards, complaints, illness. Results. Burdened gynecological and somatic histories, manifested a low health index, a more pronounced hereditary a family history of neoplastic diseases are contributing factors, and high prevalence of postponed surgeries, chronic, long-term ongoing inflammatory processes of the pelvic organs to create a favorable background for the further progression of chronic pelvic pain syndrome in adenomiose.

scholarly journals Treatment algorithm for uterine leiomyoma for women of reproductive age taking into account genetic factors

2021 ◽  
Vol 3 ◽  
pp. 81-86
Author(s):  
А.G. Kornatska ◽  
M.A. Flaksemberg ◽  
O.Y. Borysiuk ◽  
G.V. Chubei ◽  
Z.I. Rossokha
Keyword(s):  
Hormonal Therapy ◽  
Gene Polymorphisms ◽  
Uterine Leiomyoma ◽  
Endometrial Hyperplasia ◽  
Receptor Gene ◽  
Uterine Cavity ◽  
Preoperative Preparation ◽  
Estrogen Receptor Gene ◽  
Esr1 Gene ◽  
Minor Alleles

The objective: to determine the association of estrogen receptor gene polymorphisms ESR1 and progesterone PGR with the development of uterine leiomyoma (UL) and to develop a patient management algorithm based on the results of ultrasound and genetic studiesMaterials and methods. Comprehensive examination was made for 90 women with intramural myoma in the age from 26 to 45 years, which additionally included determination of the presence of the Progins polymorphism of the PGR gene and polymorphic variants A351G and T397C of the ESR1 gene. Further treatment depended on the polymorphisms of the studied genes, the number and size of myomatous nodules (MN) and their position in relation to the uterine cavity.Results. Minor alleles for the estrogen receptor gene ESR1 T397C were detected in 87.2% of women with MN over 40 mm in diameter, while they were 54.2% in women with MN less than 20 mm (p<0.05). The minor alleles of ESR1 gene locus A351G were also significantly more common in women with large MN compared to LU less than 20 mm – 69.2% versus 37.5% (p<0.05). The polymorphism of the progesterone receptor regulator gene PGR Progins was found in 33.3% of patients with small size LU and from 7.7% to 18.5% in women with large LU and MN larger than 20 mm in diameter at ultrasound.Treatment was started with hormonal therapy and in the presence of the T1/T1 genotype of the PGR Progins gene and the absence of endometrial hyperplasia according to histological examination, was prescribed hormonal therapy with mifepristone 50 mg daily for 3 months, followed by monitoring of the course of the disease.GnRH agonists were prescribed as preoperative preparation in the case of detection of PGR Progins gene polymorphisms (T1/T2 or T2/T2 genotypes), endometrial hyperplasia and MN over 40 mm. In the case of small nodules that do not deform the uterine cavity and an ESR1 gene reference genotype, contraceptive OCs were recommended for six months or more to stabilise LU growth. MN over 30 mm distorting the uterine cavity and the presence of ESR1 minor alleles of the oestrogen receptor gene were the grounds for surgical treatment of such an LU.As a result of this approach, the incidence of pain syndrome decreased by almost 4.7 times, menstrual disorders in the form of hyperpolymenorrhoea and AUB by 8 times. An improvement in general well-being was subjectively reported by 64.4% of the patients, «without change» – by 24.4% of the patients. Only 11.1% of women reported a worsening of subjective sensations, which was associated with the side effects of therapy. The size of the lymph nodes decreased considerably in 44.4% of the patients, a partial effect was noticed by 26.7% of the women. There was observed no growth of the nodes in the patients during treatment or after it. A pregnancy occurred in 68.5% of the patients and ended in childbirth in 86.5% of cases.Conclusion. Consideration of the patient’s genetic status contributes to the improvement of LU treatment outcomes. The most effective is to prescript mifepristone in patients with MN under 40 mm, including multiple ones, when the operation is associated with a high risk. In the case of larger mets (over 50 mm), hormonal therapy is less effective and can be used for preoperative preparation. This approach allows to control symptoms and reduce the size of the node in 72.2% of patients and in 68.5% of cases the pregnancy can be achieved.

scholarly journals MODERN METHODS OF COMPLEX CORRECTION OF PSYCHOSOMATIC DISORDERS IN PATIENTS WITH EXTERNAL GENITAL ENDOMETRIOSIS

2020 ◽  
Vol 73 (12) ◽  
pp. 2623-2626
Author(s):  
Nikolay A. Shcherbina ◽  
Liliya V Potapova ◽  
Irina N. Shcherbina ◽  
Oksana P. Lipko ◽  
Olga V. Mertsalova ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Pelvic Pain ◽  
Pain Syndrome ◽  
Reproductive Age ◽  
Quality Analysis ◽  
Psychological State ◽  
Pelvic Pain Syndrome ◽  
Psychosomatic Disorders ◽  
Pain Mechanisms

The aim: About 10% of socially active women of reproductive age suffer from endometriosis, is determined by the frequent occurrence of menstrual and reproductive functions disorders, and pelvic pain syndrome in patients. The difficulties of therapeutic treatment of chronic pain syndrome in external genital endometriosis (EGE) are associated with polymorphism of pain mechanisms, and delayed diagnosis and treatment. The aim of the study is to improve the effectiveness of the treatment of external genital endometriosis. Material and methods: We examined 60 female patients of reproductive age, 40 – with histologically verified diagnosis of external genital endometriosis and 20 healthy women. We used the following methods of examination: general clinical, instrumental, endoscopic, morphological, the Visual Analogue Scale (VAS) to quantify pain, the Beck Depression Scale and the SF-36 questionnaire. Results: Before the treatment of patients with EGE, VAS scale scores indicated pain in 100% of patients, the indicators of depression and level of anxiety go beyond the normative. The results of the pre-treatment questionnaire indicated lower quality of life scores on the scales of physical and mental health components. As a result of treatment there was significant decrease in the manifestations of pain, depression and anxiety, with women receiving complex therapy (hormone therapy got antidepressants and non-drug correction methods). Сonclusions: Chronic pelvic pain syndrome associated with EGE and accompanied by an unfavorable psychological state, depressive states, anxiety symptoms, and psychosomatic disorders. New approaches to the treatment of clinical manifestations of EGE are needed, taking into account patients’ psycho-emotional status and the life quality analysis. We pathogenetically justified the use of drugs that affect the psychosomatic status of patients with EGE and showed that they could significantly improve the quality of life.

scholarly journals Characteristics of Uterine Hyperplastic Processes in Women with Obesity

2016 ◽  
Vol 23 (3) ◽  
Author(s):  
O. M. Makarchuk ◽  
Abdulrakhman Abdulbaset Moslem
Keyword(s):  
Uterine Leiomyoma ◽  
Metabolic Disorders ◽  
Significant Risk ◽  
Reproductive Age ◽  
Sexual Disorders ◽  
Control Group ◽  
Histological Structure ◽  
Obese Women ◽  
Women Of Reproductive Age ◽  
Endometrial Polyps

Introduction. Analysis of uterine leiomyoma incidence indicates not only its growth but also the increase in the number of women of early reproductive age. However, the problem of trigger mechanisms for its development is still uncertain and actual.The objective of the research was to assess the characteristic features of hyperplastic processes in uterus on the background of dishormonal and metabolic disorders.Materials and methods. 60 women of reproductive age with uterine leiomyoma participated in the clinical trial. They gave their informed written consent. The control group consisted of 20 healthy women of reproductive age. Statistical analysis was conducted using material package “STATISTICA for Windows®-6.0” and methods of odds ratio (OR) calculating and its 95% Confidential Interval (95% CI).Results and their discussion. According to the results of the research the main factors contributing to uterine fibroid development in women with obesity were determined. They included: the age of 30-45 years, instrumental intervention in the womb (abortion, diagnostic curettage, etc. (OR = 8.2; 95% CI: 5.1-13.5)); chronic inflammatory diseases of genitalia (OR = 7.9; 2.9-21.9); hormonal imbalances (fibro-cystic breast disease, thyroid disorders (OR = 8.61; 3.1-23.8), liver and gastrointestinal tract disorders (OR = 5.8; 2.1-15.9) sexual disorders and stress inductive factors (OR = 2.6; 1.4-7.1) (usually fibroids occur in 1-2 years after severe stress). There is a significant percentage of adenomyosis and endometrial hyperplastic processes. Growth of tumors in women with obesity increases to 35-40 years of age, and is associated not only with a progressive decrease in the functional activity of the ovaries, their sensitivity to gonadotrophic stimulation, but also with chronic functional exertion of regulation systems on the background of metabolic disorders of hemostasis and homeostasis in this category of women.Conclusions. One of the most significant risk factors for hyperplastic processes of the reproductive organs is obesity and associated metabolic disorders. In case of metabolic disorders activity and hepatocytes on the background of obesity the number of combined forms of hyperplastic processes in the uterus increases by 1.9 times. The main risk factor for fibroids in obese women is hepatocytes dysfunction on the background of a high percentage of hepatobiliary pathology, endocrine pathology – 68.3% (thyroid dysfunction, fibro-cystic breast changes). Morphological and histological structure of endometrium in obese women leads to the growth of endometrial polyps (36.66%).

scholarly journals Rectal cream “Hem” (as suppositories) in treatment of chronic abacterial prostatitis

2021 ◽  
Vol 22 (4) ◽  
pp. 97-102
Author(s):  
N. P. Naumov ◽  
P. A. Scheplev ◽  
S. К. Martazinova
Keyword(s):  
Chronic Prostatitis ◽  
Chronic Pelvic Pain Syndrome ◽  
Pain Syndrome ◽  
Reproductive Age ◽  
Pelvic Pain Syndrome ◽  
Russian Company ◽  
Study Objective ◽  
Bacterial Agent ◽  
Lower Urinary

Chronic prostatitis is one of the most common disorders in men of reproductive age. In 5-10 % of cases, prostatitis is caused by bacterial infection. In 80-90 % of patients, bacterial agent cannot be detected, and chronic abacterial prostatitis is diagnosed per the National Institute of Health classification (NIH, 1995).Even with combination therapy using drugs of different groups, chronic prostatitis is a recurrent disorder and can lead to development of symptoms in the lower urinary tract and chronic pelvic pain syndrome decreasing patients' quality of life.Phytotherapy and beekeeping products with anti-inflammatory, pain-relieving, immunostimulating effects has a certain place in the treatment of chronic prostatitis.The study objective is to evaluate the effectiveness and safety of rectal cream “Hem” (as suppositories) manufactured by Russian company ADONIS CNPG and TM LCC in patients with chronic abacterial prostatitis.

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