Conserving therapy for symptomatic uterine leiomyoma in patient of reproductive age

Татарчук, Т. Ф; Косей, Н. В.; Редько, Н. А.; Яроцкая, Н. В.; Джупин, В. А.

doi:10.18370/2309-4117.2016.28.94-100

Cited by 4 publications

(1 citation statement)

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“…Міома матки (ММ) є поширеною доброякісною пухлиною репродуктивної системи жінки і складає від 30 до 50% популяції [1,2]. Щодо вагітних жінок, дані наукових джерел різняться, надаючи показники частоти міоми у популяції вагітних від 10 до 53,5% [3,4].…”

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To the Question on Uterine Fibroids During Pregnancy

Татарчук¹,

Kosey²,

Регеда³

et al. 2021

AAGU

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Uterine fibroids is an extremely common tumor of the female reproductive system, among whose manifestations are infertility, spontaneous abortions, incorrect fetal position, placenta previa, premature delivery, bleeding during and after delivery, and an increased risk of cesarean section. According to the literature, myomas are changing in size during pregnancy and in the postpartum period. Aim of the study. To assess the dynamics of uterine fibroid size change during pregnancy and the effect of an existing uterine fibroid on the course of pregnancy and labor. Materials and methods. Outpatient records of patients aged 24 to 45 years (mean age 33.36 ± 4.63 years) who were diagnosed with Pregnancy and uterine fibroids from 2016 to 2021 at Verum Medical Center were evaluated (n = 57). The size of the fibroids (volume and diameter) before, during (I or II prenatal screening) and after pregnancy (first pelvic ultrasound after delivery) was used for statistical analysis. Forty-one of the 57 patients had pelvic ultrasound before, during, and after pregnancy and were included in the statistical analysis of changes in uterine myoma size. Results. Among the patients included in the statistical analysis, uterine fibroids increased in volume by 194.38% ± 86.9 (40.98% ± 18.4 in diameter) during pregnancy, and decreased by 53.98% ± 14.93 in diameter and by 54.28% ± 29.62 of baseline in the postpartum period. A significant number of fibroids (39.47%) did undergo involutionary changes and were not visualized in the first postpartum ultrasound. The live birth rate was high at 90% (64% of deliveries were through natural childbirth and 26% through cesarean section). Conclusions. There was no effect of intramural, intramural-subserosal, and subserosal uterine fibroids with an average diameter of £20 mm on pregnancy and live birth in women. A great amount of uterine fibroids nearly triple in size during pregnancy, but after delivery they return to their original size and even halve in size. This can be regarded as a confirmation of the absence of a negative effect of pregnancy, or, possibly, a positive effect on uterine fibroid size, which requires further investigation.

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To the Question on Uterine Fibroids During Pregnancy

Татарчук¹,

Kosey²,

Регеда³

et al. 2021

AAGU

View full text Add to dashboard Cite

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Features of hormonal homeostasis in women of reproductive age with uterine leiomioma in the dynamics of treatment

Корнацька

Трохимович

Флаксемберг

2020

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Objective of the study was to determine the characteristics of hormonal homeostasis in women with uterine leiomyoma in the course of treatment.Materials and methods. The hormonal status of 60 women with uterine leiomyoma at the age of 26–45 years was studied. 30 women received treatment with a progesterone receptor antagonist – mifepristone 50 mg per day for 3 months, 30 women received therapy with a gonadotropic-releasing hormone agonist goserelin 3.6 mg per day for 3 menstrual cycles. The control group consisted of 20 healthy women of reproductive age.Results. Uterine leiomyoma was associated with the absence of a preovulatory peak of luteinizing hormone and follicle-stimulating hormone against the background of relative increase of estradiol in the follicular phase of menstrual cycle and progesterone increase in the periovulatory period. Subclinical hypothyroidism was established in 23.3% of women with uterine leiomyoma, and hyperandrogenism of mixed genesis in 13.3% of women with uterine leiomyoma. A relative increase of cortisol was noted in 21.7% of patients with uterine leiomyoma, that is indicates on the chronic stress as one of the triggers for pathogenesis of hormonal disorders due to uterine leiomyoma. Mifepristone did not affect the serum concentrations of sex hormones and gonadotropins, that is indicates the drug effect is at the local level only. Gonadotropic-releasing hormone agonists leads to inhibition of the pituitary-ovarian axis, manifested by changes in hormonal homeostasis in the form of temporary hypoestrogenia and hypoprogesteronemia against the background of a significant decrease of gonadotropins, which is reversible and allows to use these drugs to restore reproductive function in women with uterine leiomyoma. Conclusions. The established changes in hormonal homeostasis are determined by the peculiarities of the combination of concomitant endocrine pathology and functional state of the reproductive system, and hyperproliferative process arises as a result of the endocrine system dysfunction. Mifepristone does not change hormonal homeostasis, and goserelin leads to a hypoestrogenism and hypoprogesteronemia, which is temporary and reversible

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Optimization of diagnostic studies in patients with adenomiosis and/or hyperplastic processes of endometrium

Mielikhova

Gryshchenko

Лазуренко

et al. 2021

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Study objective: to optimize diagnostic measures in patients with adenomyosis and/or hyperplastic endometrial processes (HEP).Material and methods. The study included 128 patients aged from 27 to 53 years. The first group included 38 (29.6%) patients with a grade I–II adenomyosis, the second group included 41 (32.1%) patients with a combination of grade I–II adenomyosis and HEP and/or uterine leiomyoma, the third group included 39 (30.5%) women with only HEP, the fourth (control) group included 10 (7,8%) women without endometrial pathology. Patients underwent hysteroscopy with targeted biopsy, elucidated the pathomorphological features of connective tissue component of the endometrium and uterus transitional zone, studied specific markers of adenomyosis progression, namely vascular endothelial growth factor and Ki-67 proliferation index, and also determined the parameters of shear wave ultrasound elastography.Results. Routine histological examination of adenomyosis was confirmed only in 11 (30.6%) cases out of 36 suspected, while HEP (polyps, glandular hyperplasia) and hyperplastic pathology of endocervix (polyps) – in 34 (97.1%) cases out of 35 suspected. Ki-67 antigen expression was positive in the nuclei of epithelial cells in the adenomyosis glands and in the cytogenic stroma cells. A greater value of expression was in the epithelium of glands in superficially located heterotopies – with grade I–II adenomyosis compared with other studied groups. Shear wave elastography showed significant differences in the myometrium color between the first, third and control groups. The unchanged myometrium in all patients of the control group was characterized by staining in shades of blue, while in 9 (90%) patients the color was uniform.Conclusion. It is recommended to use a shear wave ultrasound elastography in laboratory and instrumental examination with determination of Ki-67 proliferation protein expression and intensification of the neovascularization process in endometrial biopsy specimens to improve the diagnosis of adenomyosis.

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Conserving therapy for symptomatic uterine leiomyoma in patient of reproductive age

Cited by 4 publications

References 4 publications

To the Question on Uterine Fibroids During Pregnancy

To the Question on Uterine Fibroids During Pregnancy

Features of hormonal homeostasis in women of reproductive age with uterine leiomioma in the dynamics of treatment

Optimization of diagnostic studies in patients with adenomiosis and/or hyperplastic processes of endometrium

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