Evaluation of the effectiveness of adjuvant anti-progestogen therapy after conservative myomectomy in women of reproductive age

GYNECOLOGY ◽  
2019 ◽  
Vol 21 (4) ◽  
pp. 19-23
Author(s):  
Yanina A Lebedeva ◽  
Inna I Kovalenko ◽  
Oleg L Molchanov ◽  
Dmitrii V Baibuz ◽  
Natalia V Kulikova

Relevance. Due to the high prevalence of uterine fibroids in young women and the possible effect on reproductive potential, the development, implementation and application of the most benign treatment methods are a priority. Aim. To evaluate the effectiveness of adjuvant anti-progestogen therapy after conservative myomectomy in women of reproductive age. Materials and methods. A comparative analysis of the results of treatment of patients of reproductive age with uterine myoma has been carried out. Group 1 (n=38) included patients who underwent conservative myomectomy and/or hysteroresectoscopy without subsequent anti-relapse drug therapy. The average age is 31.5 years (4.6). Group 2 (n=43) included patients after conservative myomectomy who received mifepristone as anti-relapse therapy after surgery. The average age is 31.9 years (4.5). Results. Mifepristone therapy, as an adjuvant treatment after conservative myomectomy, can significantly reduce the risk of recurrence, stabilize the size of the uterus, reduce the severity of clinical manifestations in the form of pain syndrome and heavy menstruation associated with relapse, thereby improving the reproductive health of women. Conclusions. The use of adjuvant anti-progestogen therapy after conservative myomectomy in women of reproductive age is a very effective method for treating uterine fibroids and can be considered as a therapy of choice in such patients.

GYNECOLOGY ◽  
2021 ◽  
Vol 23 (2) ◽  
pp. 117-124
Author(s):  
Viktor E. Radzinskii ◽  
Mekan R. Orazov ◽  
Ljudmila M. Mihaleva ◽  
Madina A. Bekulova

Endometriosis remains an unresolved problem in gynecology. The urgency of the fight against this disease is due to its high prevalence among women of reproductive age. Endometriosis, especially its infiltration forms, affects all aspects of the patients life, its clinical manifestations pelvic pain, dyspareunia, dysmenorrhea, dyschezia, lead to social disadaptation, problems in personal life, depression and anxiety. The socio-economic burden of the disease motivates researchers to further study the pathogenesis of endometriosis and search for pathogenetically justified pharmacological solutions.


2020 ◽  
Vol 13 (4) ◽  
pp. 297-304
Author(s):  
M. M. Vysotskiy ◽  
I. I. Kuranov ◽  
O. B. Nevzorov

Aim: to characterize the function of the reproductive system in women after organ-preserving surgery for uterine myoma: hysteroresectoscopic (HRS) myomectomy and laparoscopic (LS) myomectomy.Materials and methods. Forty one patients were examined and divided into 2 groups: Group 1 – 18 patients after HRS myomectomy and Group 2 – 23 patients after LS myomectomy. The control group included 20 healthy women of reproductive age.Results. The HRS operation led to a significant decrease in the production of anti-Mullerian hormone (AMH), estradiol and progesterone, while the levels of luteinizing (LH) and follicle-stimulating (FSH) hormones increased. After myomectomy performed by the laparoscopic access, the levels of estradiol, progesterone, and AMH decreased but the levels of both LH and FSH increased so that the ratio LH/FSH remained unchanged. Almost all indices of gonadotropic and steroid hormone production became normalized over 6 months of the postoperative period.Conclusion. The main factors of unfavorable prognosis in patients with ovarian tecoma are tumor necrosis, degree of malignancy and mitotic activity.


2021 ◽  
Vol 4 (3) ◽  
pp. 225-228
Author(s):  
L.V. Saprykina ◽  
◽  
D.M. Ibragimova ◽  
M.R. Narimanova ◽  
◽  
...  

Aim: to assess the efficacy of the alternative treatment for cervicitis in women of reproductive age and premenopausal women. Patients and Methods: this pilot comparative study included 60 women of reproductive age and premenopausal women (25–45 years) with cervicitis who were divided into two groups. Group 1 women (n=30) received multi-component herbal preparation (Tukofitol cream) once daily for 20 days. Group 1 women were subdivided into two subgroups. In women of subgroup 1A (n=14), opportunistic flora in relevant titers was identified, and these women were prescribed systemic antibacterial treatment. In women of subgroup 1B, no opportunistic flora in relevant titers was identified, and these women were prescribed with multi-component herbal preparation only. Group 2 women (controls, n=30) were also subdivided into two subgroups. In subgroup 2A (n=16), women received systemic antibacterial treatment and Povidone Iodine vaginal to manage opportunistic flora. In subgroup 2B (n=14), no opportunistic flora in relevant titers was identified, and a watchand- wait approach was applied. Before treatment and 30 days, subjective symptoms typical for cervicitis were evaluated, laboratory tests and colposcopy were performed. Results: two women from each group have withdrawn from the study. In group 1, more rapid improvement of cervicitis symptoms vs. group 2 (p<0.05) was reported. Moreover, no growth of opportunistic flora was more commonly seen in group 1 (100%) compared to group 2 (92.85%, p>0.05). Conclusion: the improvement of subjective criteria and laboratory test results has demonstrated that treatment was effective in both groups. In the lack of opportunistic flora in relevant titers, multi-component herbal preparation as monotherapy can be prescribed to reduce symptoms of inflammation. KEYWORDS: cervicitis, inflammation of the cervix, Tukofitol, reproductive age, premenopausal age, treatment, diagnostics, colposcopy, opportunistic microbes, sexually transmitted infections, monotherapy. FOR CITATION: Saprykina L.V., Ibragimova D.M., Narimanova M.R. Cervicitis: potentialities of alternative treatment. Russian Journal of Woman and Child Health. 2021;4(3):225–228 (in Russ.). DOI: 10.32364/2618-8430-2021-4-3-225-228.


2010 ◽  
Vol 7 (1) ◽  
pp. 52-57
Author(s):  
I A Ilovayskaya ◽  
V Yu Zektser ◽  
A V Il'in ◽  
N P Goncharov ◽  
I I Dedov

We examined 56 normoprolactinemic women of reproductive age (18-45 y.o.) with isolated hypogonadotropic hypogonadism (group 1) initially and on treatment with 2 mg of 17beta-estradiol and 10 mg of dydrogesterone in sequenced manner (HRT), duration of HRT was from 18 to 42 (median 36) months; 45 healthy women (20-38 y.o.) were included in control group 2. Initially hypercholesterolemia was observed in 50% of cases in group 1 and 6.6% in group 2 (z=12,29, p=0,0005); nevertheless, the difference in lipid levels between groups 1 and 2 was not statistically significant: total cholesterol levels 5,2 (4,3; 6,0) mmol/l and 4,63 (4,15; 5,15) mmol/l respectively (1vs2, р=0,1); triglycerides 0,8 (0,62; 1,3) mmol/l and 0,76 (0,6; 0,85) mmol/l (1vs2, р=0,08); HDL 1,89 (1,24; 2,1) mmol/l and 1,79 (1,44; 2,8) mmol/l (1vs2, p=0,85); LDL 2,7 (2,2; 3,2) mmol/l and 2,75 (2,3; 3,3) mmol/l (1vs2, p=0,64). In group 1 decrease of total cholesterol and triglycerides concentrations was found on HRT: total cholesterol 4,8 (3,95; 5,1) mmol/l (before vs on treatment p=0,041), triglycerides 0,65 (0,6; 0,9) (before vs on treatment p=0,044) respectively, changes in HDL and LDL levels were not revealed. Initial concentrations of Ca++, P, and alkaline phosphatase (AP) were within normal range in all women. However, concentrations of Ca++ and AP were higher in group 1 compared to group 2: Ca++ 1,13 (1,08; 1,19) mmol/l and 1,05 (1,03; 1,09) mmol/l (1vs2, p=0,0016); AP 161,5 (141,8; 183) IU/l and 141,0 (119; 151) IU/l (1vs2, p=0,044). On HRT reduce in Ca++ and AP concentrations was observed: Ca++ concentrations 1,05 (1,03; 1,10) mmol/l (before vs on treatment p=0,004), AP 139 (112; 143) IU/l (before vs on treatment p=0,004). HRT was accompanied by improvement of clinical symptoms, had no influence on thyroid function, and provoked physiological rise of prolactin levels.Thus, despite lacking the expressed biochemical disorders, isolated hypogonadotropic hypogonadism in women of reproductive age have hidden negative impact on lipid and mineral metabolism. Long term HRT is safe and significantly improved parameters of lipid and mineral homeostasis in this cohort of patients.


2020 ◽  
Vol 5 ◽  
pp. 29-32
Author(s):  
O. M. Proshchenko

The article presents an assessment and analysis of the most important medical and social risk factors for long-term postoperative urogenital disorders in women of reproductive age after radical surgical treatment for uterine fibroids. Radical operations for uterine fibroids cause an increase in the proportion of urogenital disorders, the clinical manifestations of which have a negative impact on the physical, psycho-emotional form and social significance of women in society. A survey of 80 women aged 40 to 50 years, the main group included 40 patients who underwent vaginal hysterectomy, the comparison group consisted of 40 patients with hysterectomy performed by abdominal access. Data on the assessment of pelvic floor condition and urogenital dysfunction using a standardized POP-Q system, both at the stage of preoperative observation and for 3 and 5 years after surgery. Сonducted surveys, filling diaries of pain, urination, physical examination and bimanual examination, determination of the pH of the vaginal contents, colposcopy, evaluated the index of the vaginal condition, the state of the microbiota of the mucous membranes, a comprehensive urodynamic examination, cystometry, ultrasound examination of the pelvic organs and assessment of ovarian structure.The most important risk factors are identified, which would allow to form groups of patients that require individualized approaches in the choice of surgical techniques and rehabilitation program. These included obstetric and gynecological history (birth of large fetuses, episiotomies, birth injuries, high birth parity); ovarian surgery, the use of gonadotropin-releasing hormone agonists. chronic diseases of the respiratory system and gastrointestinal tract, accompanied by increased intra-abdominal pressure; the presence of stigmas of undifferentiated connective tissue dysplasia; clinical manifestations of pelvic floor failure and functional disorders of the urethral sphincter. When choosing a method and access in case of surgical treatment for uterine fibroids, it is advisable to take into account the presence of pelvic prolapse and initial dysuric manifestations in women, the functional state of the sphincter apparatus and urethral hypermobility, obstetric and gynecological pathology and previous surgery on the organs of the uterus. the patient, her awareness of possible complications, the surgeon’s experience and his choice of surgical techniques.


2021 ◽  
Vol 6 (5) ◽  
pp. 45-50
Author(s):  
B. V. Sokolov ◽  
◽  
O. M. Yuzko

For a long time, Ukraine has been showing negative dynamics between birth and death rates. The demographic situation in any country is an important indicator. Therefore, the issue of women's health and ability to reproduce is significant and urgent. The purpose of the study was to analyze current data from domestic and foreign literature on provoking factors, etiology and pathogenesis of uterine fibroids, new approaches to treatment and the impact of this pathology on a woman's reproductive potential. Hyperplastic processes of the uterus in women of reproductive age are among the most common gynecological diseases. Uterine leiomyoma is the most common benign proliferative pathology. The presence of uterine leiomyoma leads to disorders of women's reproductive health, is one of the causes of infertility, in addition, significantly affects the quality of life of the patient due to constant pain, excessive uterine bleeding, dysfunction of adjacent organs. Many studies confirm the unfavorable course of pregnancy and the postpartum period in women with fibroids, namely: complicated pregnancy, reproductive losses, birth defects and postpartum complications. Despite the intensive work of scientists, the implementation of a large number of studies, the pathogenesis to this day remains multifaceted and poorly understood. Results and discussion. After analyzing current data from domestic and foreign literature on provoking factors, etiology and pathogenesis of uterine fibroids, the review article presents data on current opportunities, new approaches to treatment and the impact of this pathology on a woman's reproductive potential. For a long time, the pineal gland with the hormone melatonin has not been studied. During the scientific research, the review of the current domestic and foreign literature on the potential inhibitory effect of melatonin on uterine fibroid cells, and the direct and indirect effect on fertility was reviewed and analyzed. As a result of analysis of experimental and clinical data presented in the literature, it can be argued that melatonin has the ability not only to regulate biological rhythms, but also that it is promising to study metabolic and immunomodulatory effects, as well as antitumor effects, which gives us a chance to reduce surgery of this group of patients. Conclusion. The information presented in the review suggests that melatonin has the potential as a therapeutic agent for clinical trials against uterine leiomyoma in women of reproductive age. Therefore, there is a need to study deeply the etiopathogenesis of uterine leiomyoma and in particular the effect of melatonin on growth, reduction of surgical interventions, the impact on the pre- and postoperative period, and to determine melatonin as a therapeutic drug


2012 ◽  
Vol 2012 ◽  
pp. 1-7
Author(s):  
Mehmet Balin ◽  
Ahmet Çelik ◽  
M. Ali Kobat ◽  
Adil Baydas

Background/Objective. It is known that menopause or lack of endogenous estrogen is a risk factor for endothelial dysfunction and CAD. Lectin-like oxidized low-density lipoprotein receptor-1 (LOX-1) is involved inmultiple phases of vascular dysfunction.The purpose of the current study was to determine the association between soluble LOX-1 (sLOX-1) and pregnancy followed by delivery in women of reproductive age.Materials/Methods. Sixty-eight subjects with pregnancy followed by delivery (group 1) and 57 subjects with nongravidity (group 2) were included in this study. Levels of sLOX-1 were measured in serum by EL SA.Results. Plasma levels of sLOX-1 were significantly lower in Group 1 than Group 2 in women of reproductive age ( ng/mL and , resp., ). There were strong correlations between sLOX-1 levels and the number of gravida (, ). The levels of sLOX-1 highly correlated with the number of parous (, ).Conclusion. Our study demonstrated that serum sLOX-1 levels were associated with pregnancy followed by delivery that might predict endothelial dysfunction. We conclude that pregnancy followed by delivery may delay the beginning and progress of arteriosclerosis and its clinical manifestations in women of reproductive age.


Author(s):  
Olha Proshchenko ◽  
Iryna Ventskivska ◽  
Natalia Kamuz

The article presents an analytical assessment of long-term postoperative consequences in women of reproductive age after hysterectomy for uterine fibroids. The aim of the study to determine the structure of long-term results of hysterectomy for uterine fibroids in women of reproductive age using different approaches to the possibility of optimizing the diagnostic algorithm in the preoperative period in the future. Materials and methods – 160 women aged 40 to 50 years with symptomatic uterine fibroids, who underwent hysterectomy performed by vaginal, laparoscopically assisted vaginal, abdominal, were examined. Research methods are the following: physical examination of patients, assessment of pelvic floor (cough test, Valsalva maneuver, “Stop Test” with Kegel cones), diagnosis of urogenital dysfunction using a standardized POP-Q system; instrumental examination:, complete urodynamic testing, cystometry, (for assessment of the severity of urinary incontinence the classification of the International Continence Society (ICS) was used); assessment of the patient’s quality of life on the 10th day after surgery, 3, 6, 12 months and three years after surgery using the international standard questionnaire MOS SF-36; study of the local infectious status of the female body (bacteriological and bacterioscopic examination of discharge from vagina and urethra, determination of vaginal pH Results and their discussion. The structure of distant postoperative manifestations was determined (after 36 months of postoperative monitoring): clinical manifestations of intestinal function discomfort in the same degree in patients of three subgroups, 2.4 and 2.9 times less often in group I patients indicated chronic pelvic pain, in 1.7 times less often - for genitourinary disorders, vaginal prolapse in a third of cases, especially in women with abdominal HE and classic vaginal HE (30.0±5.0 % and 37.8±5.0 %, respectively, against 17.8±4.0 % – in the group with laparotomically assisted HE). Conclusions. Given the data on genitourinary disorders and vaginal prolapse in almost a third of observations after hysterectomy for uterine fibroids, it is advisable to consider additional examination of latent signs of genitourinary syndrome at the preoperative stage to optimize the choice of access, the volume of surgical treatment.


2021 ◽  
Vol 18 (3) ◽  
pp. 254-262
Author(s):  
E. V. Bolotova ◽  
A. V. Dudnikova ◽  
V. A. Krutova ◽  
N. S. Prosolupova

Background: Obesity is considered a global epidemic and is one of the most significant medical and social problems. Research in recent years shows that in 25-45% of cases of obesity, polycystic ovary syndrome (PCOS) is detected. The influence of obesity on the pathogenesis of metabolic disorders in this category of patients remains controversialAims: to determine the frequency and structure of metabolic disorders in obese women in combination with polycystic ovary syndrome (PCOS).Materials and methods: A single-center cross-sectional sample survey of women of reproductive age was conducted. The study included clinical anthropometry with measurement of body weight, height, waist circumference (OT) and hip circumference (OB), followed by calculation of body mass index (BMI) and OT/OB ratio, and measurement of blood pressure (BP). A biochemical blood test was performed, the hormonal status was examined, and an ultrasound examination of the pelvic organs was performed.Results: A survey of 136 women of reproductive age was conducted. Group 1 included obese women without PCOS (59 patients), group 2 included obese women in combination with PCOS (45 patients), and the control group included 38 healthy women. Group 1 included obese women without PCOS (59 patients), and group 2 included obese women with PCOS (45 patients), in the control group — 38 healthy women. Among group 2 patients, dyslipidemia, visceral obesity, arterial hypertension, insulin resistance, hyperinsulinemia, and hyperuricemia were significantly more common (p<0,05). Correlations between BMI and triglycerides, testosterone and total cholesterol were found (p<0,05). Obese and PCOS patients had significantly higher levels of C-reactive protein(CRP), fibrinogen, anti-Müllerian hormone (AMH), and hepatic transaminases (p<0,05). Vitamin D deficiency was detected in 13,2% of patients, and insufficiency — in 22,7% of patients. There is a statistically significant correlation between the level of 25 (OH)D and indicators of BMI, follicle-stimulating hormone, luteinizing hormone (p<0,05), the level of AMH (p=0,008).Conclusions: A high frequency of metabolic disorders in obese women in combination with PCOS has been identified, which necessitates early screening, diagnosis and treatment of these disorders to strengthen reproductive health and prevent chronic non-communicable diseases.


2021 ◽  
pp. 3-9
Author(s):  
Andrii Semeniuk

The aim. Minimization of the frequency of recurrence of endometrial hyperplasia (EH) in women of reproductive age with overweight (OW) depending on the tactics of treatment. Materials and methods. 90 women of reproductive age with endometrial hyperplasia and OW were selected. They, in turn, were divided into three groups: group 1 – 30 women who took a gonadotropin-releasing hormone agonist (GnRH agonist), namely at a dose of 3.75 mg intramuscularly once every 28 days; group 2 – 30 women who used progestin (norethisterone) at a dose of 10 mg per day from day 16 to 25 of the cycle, group 3 – 30 women who took combined oral contraception (COC) (30 mcg ethinyl estradiol and 150 mcg desogestrel) in a cyclic mode 21/7. Evaluation of the effectiveness of therapy included a clinical picture of the disease 6 months after the start of treatment, assessment of the variability of the average values of endometrial thickness and uterine size on ultrasound (US) of the pelvis 6 months after treatment. Also analyzed the effectiveness of therapy based on the results of morphological examination of the endometrium in a biopsy of the uterine mucosa, performed 6 months after the start of treatment. In addition, a general analysis of the frequency of EH recurrence was performed 6–24 months after treatment. Results. The results showed that in the group in which women were prescribed GnRH agonist, there was a significantly higher effectiveness of treatment, in particular the absence of uterine bleeding and menstrual disorders (MD). At the same time, in the other norethisterone group, 53.3 % (16) of women had intermenstrual uterine bleeding. In patients in the group in which women received COC, uterine bleeding was observed in 30.0 % (i.e. 9) of patients (p <0.05). Immediately after treatment, the average values of endometrial thickness in patients of group 1, according to ultrasound, was 3.59±0.47 mm, which was significantly less than in women of groups 2 and 3 – 6.81±0.59 mm (p<0.001) and 7.58±0.69 mm (p<0.001). In addition, patients in group 1 at 3, 6, 12, 24 months after the end of hormone therapy were registered significantly lower average values of endometrial thickness, compared with patients receiving norethisterone and estrogen-progestogen drugs. Conclusions. In a comparative evaluation of the effectiveness of treatment of endometrial hyperplastic processes in overweight women, it was found that the recurrence rate after 6–24 months occurs in 6.7 % (i.e. 2) of patients after GnRH agonist therapy, in 33.3 % (i.e. in 10) patients receiving norethisterone (p<0.001), and in 50 % (i.e. 15) of women treated with COC (p<0.001).


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