Algorithm for management of patients of the period of menopausal transition with recurrence of anomalous uterine bleeding associated with beneficial proliferative changes of endometry

Aim. To compile an algorithm for managing patients during the menopausal transition with a relapse of abnormal uterine bleeding associated with benign proliferative changes in the endometrium and evaluate its outcomes. Materials and methods. The observation of 150 patients aged 4555 years who had recurrence of abnormal uterine bleeding due to benign proliferative changes of the endometrium. All patients underwent hysteroresectoscopic ablation of the endometrium according to the monopolar coagulation-vaporization technique using Olympus equipment (Japan). The patients were divided into two groups. One group was formed by 98 women who, before hysteroscopic ablation of the endometrium, received hormonal preparations for 14 months, with the help of which suppressive changes in the uterine mucosa up to 34 mm were achieved. The other group consisted of 52 patients of the menopausal transition who did not receive preoperative drug therapy, and the thinning of the endometrium before hysterectomy was performed instrumentally. After hysteroresectoscopy, the period of clinical and instrumental observation was 2 years. Results. Based on the results of the study, an algorithm has been compiled for the treatment of women during the menopausal transition with abnormal uterine bleeding, including at the first stage a clinical, laboratory and instrumental examination with the selection of a group of patients to be treated by endometrial ablation, and at the second stage, measures for the preoperative thinning of the uterine mucosa, at the third stage performing hysteroresectoscopic ablation of the endometrium; and at the fourth stage dynamic monitoring during ie 2 years. The preoperatively achieved medical atrophy of the endometrium, followed by hysteroresectoscopy, contributes to an improvement of 20.3% in the results of treatment of patients in comparison with mechanical thinning of the endometrium before hysteroresectoscopy. In general, the developed algorithm increases the effectiveness of anti-relapse treatment to 92.8%. Conclusion. In practical health care, the proposed algorithm should be used, including successive steps. Following the algorithm, a differentiated approach to the choice of therapeutic tactics is carried out, taking into account not only morphological changes in the endometrium, but also the associated gynecological and somatic pathology of the patient, as well as justifying the conduct of preoperative preparation for hysteroresectoscopic ablation of the endometrium and determining the order of subsequent dynamic observation.

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COMPARATIVE EFFICACY OF HORMONAL DRUGS FOR THE PREPARATION OF THE ENDOMETRIUM FOR ABLATION IN PREMENOPAUSAL PATIENTS

V F Snegirev Archives of Obstetrics and Gynecology ◽

10.18821/2313-8726-2019-6-3-151-156 ◽

2019 ◽

Vol 6 (3) ◽

pp. 151-156

Author(s):

Sergey P. Sinchikhin ◽

E. V Kostenko ◽

L. V Stepanyan

Keyword(s):

Endometrial Hyperplasia ◽

Effective Means ◽

Abnormal Uterine Bleeding ◽

Endometrial Ablation ◽

Uterine Bleeding ◽

Comparative Efficacy ◽

Gonadotropin Releasing Hormone Agonist ◽

Results Of Treatment ◽

Uterine Mucosa ◽

Premenopausal Patients

The aim of the study is to compare the effectiveness of the use of hormonal drugs before hysteroresectoscopic ablation of the endometrium in premenopausal patients with abnormal uterine bleeding. Were examined 145 women aged from 45 to 54 years with recurrent endometrial hyperplasia, which were divided into three groups depending on the preoperative use of one of the hormonal drugs (gestagen preparation, microdose estrogen-gestagen contraceptive, gonadotropin-releasing hormone agonist - GnRHa). When medication-induced endometrial atrophy was achieved, the patients underwent hysteroresectoscopic endometrial ablation using the coagulation vaporization technique. The results of the study showed the feasibility of preoperative thinning of the uterine mucosa to improve the results of treatment of its benign changes. The most effective means for accelerating the attainment of drug regression of the endometrium were GnRHa, whose effectiveness was 95.7%. The estrogen-gestagen-containing contraceptive and gestagen preparation showed an efficacy of 65.3% and 42.8%, respectively. The results of the study should be considered when choosing the optimal tactics for management of premenopausal patients with abnormal uterine bleeding.

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EXPERIENCE OF LONG-TERM USE OF DIENOGEST FOR THE TREATMENT OF ADENOMYOSIS

"Medical & pharmaceutical journal "Pulse" ◽

10.26787/nydha-2686-6838-2021-23-5-92-99 ◽

2021 ◽

pp. 92-99

Author(s):

Kalinkina O.B. ◽

Tezikov Yu.V. ◽

Lipatov I.S. ◽

Aravina O.R.

Keyword(s):

Drug Therapy ◽

Clinical Manifestation ◽

Clinical Manifestations ◽

Pain Syndrome ◽

Management Plan ◽

Uterine Bleeding ◽

Dynamic Monitoring ◽

Good Tolerability ◽

Selection Of

Endometriosis refers to a chronic, often recurrent disease that requires the appointment of a long-term management plan and the patient with the appointment of therapy that effectively affects the clinic of this disease, at the same time having good tolerability, ensuring the patient's adherence to this method of treatment. This dictates the need for careful selection of a drug that meets such requirements. Moreover, studies of drug therapy for endometriosis should also be prolonged. In this case, they allow you to qualitatively assess the effectiveness of a particular type of treatment in the context of routine clinical practice. The main clinical manifestations of endometriosis of the uterine body-adenomyosis are pain syndrome, manifested by various types of pain (dysmenorrhea, dyspareunia, dyschesia, chronic pelvic pain) and the presence of abundant uterine bleeding. The presented clinical case demonstrates the effectiveness of long-term (for 36 months) use of dienogest at a dosage of 2 mg per day (the drug Vizanna) in a continuous mode in the treatment of a patient with adenomyosis. By the 4th month of therapy, the pain syndrome, manifested by dysmenorrhea and dyspareunia, which is the leading clinical manifestation of this pathology in the patient, was completely stopped. The proposed type of therapy has also demonstrated its effectiveness in relation to another clinical manifestation of the disease - heavy uterine bleeding. By the 6th month of therapy, the patient had developed persistent amenorrhea. Good tolerability and the absence of side effects, along with a pronounced clinical effect, led to a high adherence of the patient to this type of drug therapy and allowed her to continue it in the future with dynamic monitoring.

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Neglected case of uterine leiomyoma: Case report

Medicinski pregled ◽

10.2298/mpns0810525n ◽

2008 ◽

Vol 61 (9-10) ◽

pp. 525-528

Author(s):

Dejan Nincic ◽

Aljosa Mandic ◽

Dragan Zikic ◽

Bratislav Stojiljkovic ◽

Katarina Mastilovic ◽

...

Keyword(s):

Case Report ◽

Surgical Treatment ◽

Clinical Laboratory ◽

Uterine Fibroids ◽

Abnormal Uterine Bleeding ◽

Uterine Bleeding ◽

Imaging Evaluation ◽

Abdominal Tumor ◽

Adequate Treatment ◽

Good General Condition

Introduction. Uterine leimyomas are the most common gynaecologacal tumors and represent 30% of all benign gynecological tumors. The vast majority of leiomyomas are asymptomatic and do not need to be treated. Pelvic pain and abnormal uterine bleeding should be considered as the most important reasons for surgical treatment of uterine fibroids. Case report. A female patient, age 69, was treated at the Institute of Oncology in Sremska Kamenica because of a huge abdominal tumor. Major symptoms were increased body temperature, abnormal uterine bleeding and extensive abdominal enlargement. After the clinical, laboratory and imaging evaluation, the offered hysterectomy was performed. The evacuated tumor was 18 kg heavy and 40 cm in length. The pathohystological diagnosis was leiomyoma per magnum. The patient was released after 11 days of hospitalization without any postoperative complications and in good general condition. Discussion. Uterine fibroids can be managed medically and surgically. Hysterectomy should be performed in every case with dominant symptoms like abnormal uterine bleeding, tumor growth and increasing abdominal pain (when other causes are excluded) in postmenopausal women. This particular case is an example of low general and health culture of the reported patient and maybe caused by fear from medical and surgical treatment. Sometimes, making a diagnosis of the nature of pelvic tumor is very hard, but by respecting diagnostic procedure an adequate treatment of those patients can be ensured.

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Ormeloxifene in acute heavy menstrual bleeding in menopausal transition

Asian Journal of Medical Sciences ◽

10.3126/ajms.v12i8.35603 ◽

2021 ◽

Vol 12 (8) ◽

pp. 88-93

Author(s):

Subha Shrestha ◽

Babita Thapa ◽

Sebina Baniya ◽

Vivek Pandey

Keyword(s):

Medical Therapy ◽

Transition Period ◽

Endometrial Thickness ◽

Abnormal Uterine Bleeding ◽

Uterine Bleeding ◽

Heavy Menstrual Bleeding ◽

Menopausal Transition ◽

Menstrual Bleeding ◽

Common Side Effect ◽

Subjective Improvement

Background: Ormeloxifene, a selective estrogen receptor modulator, is a safer, cost effective and convenient dosing medical therapy in heavy menstrual bleeding of acute abnormal uterine bleeding. Aims and Objective: The study aimed to find the effectiveness of Ormeloxifene as 1st line therapy for heavy menstrual bleeding in menopausal transition women to prevent unnecessary hysterectomies and improve quality of life. Materials and Methods: This descriptive study was conducted at Lumbini Medical College for a period of one year. Sixty-five cases of acute Abnormal Uterine Bleeding with heavy menstruation during menopausal transition period were provided with Ormeloxifene therapy of 60 milligrams dose two times per week after evaluating pre treatment hemoglobin percentage, Pictorial Blood Loss Assessment Chart (PBAC) score and endometrial thickness. The dose of the drug was reduced to 60 mg weekly after 3rd month if subjective improvement was documented and continued for further 3 months. Results: There was a statistically significant reduction in mean PBAC score, mean endometrial thickness and rise in hemoglobin level. Eighty percentages of women had marked subjective improvement of symptoms, 87.7% women had reduction of blood clots, 15. 8% women had relief from dysmenorrheal pain and 50.8% women had regularization of menstrual pattern after 6 months. Amenorrhea (25.3%) was the most common side effect reported in 6 months therapy. Conclusion: Ormeloxifene is an effective 1st line medical therapy in acute heavy menstrual bleeding in menopausal transition women.

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Management of patients with uterine bleeding during menopausal hormone therapy

Лечащий врач ◽

10.51793/os.2021.24.3.006 ◽

2021 ◽

Author(s):

А.З. Хашукоева ◽

М.В. Бурденко ◽

А.В. Оверко ◽

Т.Е. Рыжова ◽

М.С. Сафонина

Keyword(s):

Life Expectancy ◽

Hormone Therapy ◽

Uterine Bleeding ◽

Menopausal Hormone Therapy ◽

Menopausal Transition ◽

Therapeutic Effects ◽

Climacteric Syndrome ◽

Climacteric Symptoms ◽

Long Life ◽

Selection Of

Тенденции по увеличению продолжительности жизни, которые наблюдаются в последние десятилетия, напрямую затрагивают деятельность акушера-гинеколога ввиду того, что женщинам необходимо не только прожить долгую жизнь, но и снизить количество заболеваний, развитие которых нередко связано с наступлением периода менопаузального перехода и постменопаузы. Задача врачей – помочь пациенткам максимально мягко войти в период постменопаузы, минимизировав проявления климактерического синдрома. В настоящее время наиболее эффективным методом терапии ранних климактерических симптомов является менопаузальная гормональная терапия. В статье рассмотрены современные подходы к проведению менопаузальной гормональной терапии при возникновении менопаузальных расстройств, подходы к подбору менопаузальной гормональной терапии с учетом особенностей каждой конкретной пациентки. Рассматриваются терапевтические эффекты и возможности менопаузальной гормональной терапии, проблемы ее приемлемости, а также ведение пациенток в постменопаузальном периоде с маточными кровотечениями. The trends in life expectancy that have been observed in recent decades directly affect the activities of an obstetrician-gynecologist due to the fact that women need not only to live a long life, but also to reduce the number of diseases, the development of which is often associated with the onset of the menopausal transition and postmenopause. The task of doctors is to help patients to enter the postmenopausal period as gently as possible, minimizing the manifestations of the climacteric syndrome. Currently, the most effective method of treating early climacteric symptoms is menopausal hormone therapy. The article discusses modern approaches to the conduct of menopausal hormone therapy in the event of menopausal disorders, approaches to the selection of menopausal hormone therapy, taking into account the characteristics of each individual patient. The therapeutic effects and possibilities of menopausal hormone therapy, the problems of its acceptability, as well as the management of postmenopausal patients with uterine bleeding are considered.

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