Conserving therapy for symptomatic uterine leiomyoma in patient of reproductive age
Keywords:submucous leiomyoma of the uterus, STEP-W classification, hysteroscopic resection of node, abnormal uterine bleeding, iron deficiency anemia, ulipristal acetate, hydroxide iron (III) complex polymaltose, endometrium
Uterine leiomyoma is the most common benign tumor. The clinical incidence of this disease varies from 30 to 50%, morphological rate is up to 80%. Often uterine leiomyoma occurs asymptomatic until a certain period and can be spontaneously detected during routine examination and often have only one symptom which women can ignore – heavy menstruation over the past months or years. It is often develop iron deficiency syndrome and anemia.
Management of patients with uterine leiomyoma in the last decades has dramatically changed – expectant management replaced early response since its diagnosis. Prevention of further tumor growth, stabilization or decrease its size are objectives of treatment at the detection stage.
A clinical case of organ-saving surgical treatment of symptomatic uterine submucosal leiomyoma accompanied by abnormal uterine bleeding with subsequent development of posthemorrhagic anemia of moderate severity in patients of reproductive age is described in the article. According to STEP-W classification the submucous node assigned to group II, which required preliminary reducing its size prior to surgery. Ulipristal acetate 5 mg as a preparation of selective progesterone receptor modulators was administrated. For the post-hemorrhagic treatment of iron deficiency anemia drug iron hydroxide (III) complex polymaltose (maltofer) was used. This combination of drugs is not only possible to quickly eliminate clinical symptoms, as well as to create conditions for the organ-surgical treatment of uterine fibroids, increase the safety and efficiency of operations, to avoid complications in the postoperative period.
Evaluation of the endometrium 6 months after hysteroscopic resection of myoma node after administration these drugs showed conformity with the phase of the menstrual cycle, a good blood supply, the absence of inflammation markers and a slight decrease of estrogen and progesterone receptors expression.
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Copyright (c) 2016 Т. Ф Татарчук, Н. В. Косей, Н. А. Редько, Н. В. Яроцкая, В. А. Джупин
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