DOI: https://doi.org/10.18370/2309-4117.2020.54.27-31

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

А. Г. Корнацька, О. В. Трохимович, М. А. Флаксемберг

Abstract


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

Keywords


uterine leiomyoma; hormonal homeostasis; treatment; gonadotropin-releasing hormone agonists; progesterone receptor antagonists; mifepristone; goserelin; reproductive age

References


Veropotvelyan, P.N., Veropotvelyan, N.P., Tsekhmistrenko, I.S., Bondarenko, A.A. “Modern understanding of uterine fibroids and its treatment.” Women's health 7.113 (2016): 16–22.

Dobrokhotova, Y.E., Ilyina, I.Y., Goncharov, I. Y. “Uterine myoma. Non-surgical treatment.” RMJ 2 (2018): 3–6.

Kaminskyi, V.V., Prokopovich, E.V. “Clinical experience of using gonadotropin-releasing hormone agonists in the treatment of uterine leiomyoma with concomitant gynecological pathology.” Women's health 10.136 (2018): 22–5.

Ferenczy, A. “Pathophysiology of uterine patology.” Hum Reprod Update 4 (2018): 312–22. DOI: 10.1093/humupd/4.4.312

Radzinskiy, V.E., Fatkullin, I.F., Bakanova, A.R., Dobretsova, T.A. Uterine fibroids: from debate to innovation. Practical recommendations. Editorial board of StatusPraesens journal. Moscow (2014): 16 p.

Tatarchuk, T.F. “Organ-preserving treatment of symptomatic uterine leiomyoma in patients of reproductive age.” Reproductive endocrinology 2.28 (2016): 94–9.

Litvak, E.O. “Influence of drug correction on morphological changes in uterine leiomyoma.” Women's health 1.137 (2019): 101–4.

Zaporozhchenko, M.B. “Uterine leiomyoma − treatment algorithms for women of reproductive age.” Woman's health 5.101 (2015): 55–8.

Panfamirov, Y.K., Zabolotnov, V.A., Karapetian, O.V., et al. “The organ-preserving treatment of uterine myoma.” Women's health 1 .77 (2013): 162–4.

Vdovychenko, Y.P., Holianovskyi, O.V., Lopushyn, V.I. “Leiomyoma: etiopathogenesis, prophylaxis, diagnostic and treatment.” Women's health 3.69 (2012): 52–61.

Zhang, Y., Gu, X., Meng, Y., et al. “Analysis of the effect of laparoscopy and hysteroscopy on ovarian function, immune function and quality of sexual life of patients with hysteromyoma at different ages” Oncol Lett 15.3 (2018): 2929–34.

Makarenko, M.V., Govseev, D.A., Gromova, O.L., et al. “Features of the course of pregnancy, childbirth and the post-late period in pregnant women with uterine leiomyoma.” Women's health 6.102 (2015): 111–3.

Kornatska, A.G., Raksha, I.I., Kolesnichenko, I.S., Chubei, G.V. “Modern views on the etiology, pathogenesis and treatment of uterine leiomyoma in women of reproductive age (literature review).” Women's health 1.97 (2015): 10–3.

Vilos, G.A., Allaire, C., Laberge, P.-Y., Leyland, N. “The management of uterine leiomyomas.” Reproductive endocrinology 24 (2015): 59–73.

Jacobsen, B.M., Horwitz, K.B. “Progesterone receptors, their isoforms and progesterone regulated transcription.” Mol Cell Endocrinol 357.1–2 (2012): 18–29.

Stewart, E.A., Cookson, C.L., Gandolfo, R.A., Schulze-Rath, R. “Epidemiology of uterine fibroids: A systematic review.” BJOG 124 (2017): 1501–12.

Wise, L.A., Laughlin-Tommaso, S.K. “Epidemiology of uterine fibroids: From menarche to menopause.” Clin Obstet Gynecol 59 (2016): 2–24.

Pron, G., Mocarski, E., Bennett, J., et al. “Pregnancy after uterine artery embolization for leiomyomata: the Ontario multicenter trial.” Obstet Gynecol 105 (2015): 67–76.

Baranov, V.S., Ivaschenko, T.E., Yarmolinskaya, M.I. “Comparative systems genetics view of endometriosis and uterine leiomyoma: Two sides of the same coin?” Syst Biol Reprod Med 62 (2016): 93–105.

Ciebiera, M., Ali, M., Prince, L., et al. “The Evolving Role of Natural Compounds in the Medical Treatment of Uterine Fibroids.” J Clin Med 9.5 (2020): 1479.

Lagana, A.S., Vergara, D., Favilli, A., et al. “Epigenetic and genetic landscape of uterine leiomyomas: a current view over a common gynecological disease.” Arch Gynecol Obstet 296.5 (2017): 855–67.

Yu, O., Scholes, D., Schulze-Rath, R., et al. “A US population-based study of uterine fibroid diagnosis incidence, trends, and prevalence: 2005 through 2014.” Am J Obstet Gynecol 219.6 (2018): 591–4.

Tonoyan, N.M., Kozachenko, I.F., Frankevich, V.E., et al. “Recurrences of uterine fibroids. The modern view on the problems of diagnosis, treatment, and prognosis.” Obstet Gynegol 3 (2019): 32–8.

Resta, L. “Uterine myomas and histopathology.” In: Tinelli, A., Malvasi, A. Uterine myoma, myomectomy and minimally invasive treatments. Springer. Berlin (2015): 27–38.

Fernandez, H., et al. “Impact of uterine fibroids on quality of life: A national cross-sectional survey.” Eur J Obstet Gynecol Reprod Biol 229 (2018): 32–7.


GOST Style Citations


1. Веропотвелян, П.Н. Современное представление о миоме матки и ее лечении / П.Н. Веропотвелян, Н.П. Веропотвелян, И.С. Цехмистренко, А.А. Бондаренко // Здоровье женщины. – 2016. – №7 (113). – С. 16–22.

2.      Доброхотова, Ю.Э. Миома матки. Безоперационное лечение / Ю.Э. Доброхотова, И.Ю. Ильина, И.Ю. Гончаров // РМЖ. Мать и дитя. – 2018. – №2. – С. 3–6.

3.      Каминский, В.В. Клинический опыт применения агонистов гонадотропин-рилизинг-гормона в лечении лейомиомы матки с сопутствующей гинекологической патологией / В.В. Каминский, Е.В. Прокопович // Здоровье женщины. – 2018. – №10 (136). – С. 22–25.

4.      Ferenczy, A. “Pathophysiology of uterine patology.” Hum Reprod Update 4 (2018): 312–22. DOI: 10.1093/humupd/4.4.312

5.      Радзинский, В.Е. Миома матки: от дискуссий к инновациям. Практические рекомендации / В.Е. Радзинский, И.Ф. Фаткуллин, А.Р. Баканова, Т.А. Добрецова. – М.: Редакция журнала StatusPraesens, 2014. – 16 с.

6.      Татарчук, Т.Ф. Органосохраняющее лечение симптомной лейомиомы матки у пациенток репродуктивного возраста / Т.Ф. Татарчук // Репродуктивна ендокринологія. – 2016. – №2 (28). – С. 94–99.

7.      Литвак, Е.О. Влияние медикаментозной коррекции на морфологические изменения лейомиомы матки / Е.О. Литвак // Здоровье женщины. – 2019. – №1 (137). – С. 101–104.

8.      Запорожченко, М.Б. Лейомиома матки – алгоритмы лечения женщин репродуктивного возраста / М.Б. Запорожченко // Здоровье женщины. – 2015. – № 5 (101). – С. 55–58.

9.      Панфамиров, Ю.Н. Органосберегающий подход в лечении миомы матки / Ю.Н. Панфамиров, В.А. Заболотнов, О.В. Карапетян // Здоровье женщины. – 2013. – № 1 (77). – С. 162–164.

10.    Вдовиченко, Ю.П. Лейоміома матки: етіопатогенез, профілактика, діагностика та лікування / Ю.П. Вдовиченко, О.В. Голяновський, В.І. Лепушин // Здоровье женщины. – 2012. – № 3 (69). – С. 52–61.

11.    Zhang, Y., Gu, X., Meng, Y., et al. “Analysis of the effect of laparoscopy and hysteroscopy on ovarian function, immune function and quality of sexual life of patients with hysteromyoma at different ages” Oncol Lett 15.3 (2018): 2929–34.

12.    Макаренко, М.В. Особливості гормонального гемостазу у хворих з доброякісними гіперпластичними процесами грудних залоз / М.В. Макаренко, Д.О. Говсєєв, О.Л. Громова, Л.І. Мартинова, О.В. Тян // Здоровье женщины. − 2016. − № 9. − С. 72–74.

13.    Корнацька, А.Г. Сучасні погляди на етіологію, патогенез та лікування лейоміоми матки у жінок репродуктивного віку (огляд літератури) / А.Г. Корнацька, І.І. Ракша, І.С. Колесниченко, Г.В. Чубей // Здоровье женщины. – 2015. – № 1 (97). – С. 10–13

14.    Vilos, G.A., Allaire, C., Laberge, P.-Y., Leyland, N. “The management of uterine leiomyomas.” Reproductive endocrinology 24 (2015): 59–73.

15.    Jacobsen, B.M., Horwitz, K.B. “Progesterone receptors, their isoforms and progesterone regulated transcription.” Mol Cell Endocrinol 357.1–2 (2012): 18–29.

16.    Stewart, E.A., Cookson, C.L., Gandolfo, R.A., Schulze-Rath, R. “Epidemiology of uterine fibroids: A systematic review.” BJOG 124 (2017): 1501–12.

17.    Wise, L.A., Laughlin-Tommaso, S.K. “Epidemiology of uterine fibroids: From menarche to menopause.” Clin Obstet Gynecol 59 (2016): 2–24.

18.    Pron, G., Mocarski, E., Bennett, J., et al. “Pregnancy after uterine artery embolization for leiomyomata: the Ontario multicenter trial.” Obstet Gynecol 105 (2015): 67–76.

19.    Baranov, V.S., Ivaschenko, T.E., Yarmolinskaya, M.I. “Comparative systems genetics view of endometriosis and uterine leiomyoma: Two sides of the same coin?” Syst Biol Reprod Med 62 (2016): 93–105.

20.    Ciebiera, M., Ali, M., Prince, L., et al. “The Evolving Role of Natural Compounds in the Medical Treatment of Uterine Fibroids.” J Clin Med 9.5 (2020): 1479.

21.    Lagana, A.S., Vergara, D., Favilli, A., et al. “Epigenetic and genetic landscape of uterine leiomyomas: a current view over a common gynecological disease.” Arch Gynecol Obstet 296.5 (2017): 855–67.

22.    Yu, O., Scholes, D., Schulze-Rath, R., et al. “A US population-based study of uterine fibroid diagnosis incidence, trends, and prevalence: 2005 through 2014.” Am J Obstet Gynecol 219.6 (2018): 591–4.

23.    Tonoyan, N.M., Kozachenko, I.F., Frankevich, V.E., et al. “Recurrences of uterine fibroids. The modern view on the problems of diagnosis, treatment, and prognosis.” Obstet Gynegol 3 (2019): 32–8.

24.    Resta, L. “Uterine myomas and histopathology.” In: Tinelli, A., Malvasi, A. Uterine myoma, myomectomy and minimally invasive treatments. Springer. Berlin (2015): 27–38.

25.    Fernandez, H., et al. “Impact of uterine fibroids on quality of life: A national cross-sectional survey.” Eur J Obstet Gynecol Reprod Biol 229 (2018): 32–7.





Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.

ISSN 2411-1295 (Online), ISSN 2309-4117 (Print)