Conserving therapy for symptomatic uterine leiomyoma in patient of reproductive age

Authors

DOI:

https://doi.org/10.18370/2309-4117.2016.28.94-100

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

Abstract

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.

Author Biographies

Т. Ф Татарчук, Institute of Pediatrics, Obstetrics and Gynecology, NAMS of Ukraine

MD, professor, corresponding member. NAMS of Ukraine, Deputy Director for Research, Head of Endocrine Gynecology

Н. В. Косей, SI “Institute of Pediatrics, Obstetrics and Gynecology of the NAMS of Ukraine”

MD, chief researcher at the Endocrine Gynecology Department

Н. А. Редько, SI “Institute of Pediatrics, Obstetrics and Gynecology of the NAMS of Ukraine”

Researcher at the Endocrine Gynecology Department

Н. В. Яроцкая, SI “Institute of Pediatrics, Obstetrics and Gynecology of the NAMS of Ukraine”

Junior researcher at the Endocrine Gynecology Department

В. А. Джупин, SI “Institute of Pediatrics, Obstetrics and Gynecology of the NAMS of Ukraine”

Postgraduate student at the Endocrine Gynecology Department

References

  1. Endina, A.V., Gladilin, G.P. “Regulation of iron metabolism in women of reproductive age with benign uterine body pathology, complicated by bleeding.” Basic Research 7 (2013): 87–90.
  2. Zabolotnov, V.A., Rybalka, A.N., Shatila, V.Y., Kosolapova, N.V. “Modern classification of the uterus leiomyoma.” Women’s Health 1.97 (2015): 70–73.
  3. Kosei, N.V. Uterine leiomyoma (clinic, pathogenesis, diagnosis and treatment): dissertation thesis for a MD degree. Sciences specialty 14.01.01. Kyiv (2009): 36 p.
  4. Tatarchuk, T.F., Kosei, N.V. “New in the hormonal regulation of uterine fibroids.” Medical aspects of women’s health 7.93 (2015): 21–7.
  5. Tatarchuk, T.F., Kosei, N.V. “Modern principles of treatment of uterine leiomyoma.” Health of Ukraine, December thematic issue (2012): 10–13.
  6. Tatarchuk, T.F., Kosei, N.V. “Modern principles of diagnosis and treatment of uterine leiomyoma.” Family Medicine 4 (2005): 67–73.
  7. Cook, H., Ezzati, M., Segars, J.H., McCarthy, K. “The impact of uterine leiomyomas on reproductive outcomes.” Minerva Ginecologica 62.3 (2010): 225–36.
  8. Donnez, J., Tomaszewski, J., Vazquez, F., et al. PEARL II Study Group. “Ulipristal acetate versus leuprolide acetate foruterine fibroids.” N Engl J Med 366 (2012): 421–32.
  9. Lasmar, R.B., et al. “Hysteroscopic Myomectomy STEP-W Classification.” J Minim Invasive Gynecol 12.4 (2005): 308–11.
  10. Uterine myoma, myomectomy and minimally invasive treatments. Ed. by A. Tinelli, A. Malvasi. Springer International Publishing (2015): 281 p. DOI: 10.1007/978-3-319-10305-1

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Published

2016-04-21

How to Cite

Татарчук, Т. Ф., Косей, Н. В., Редько, Н. А., Яроцкая, Н. В., & Джупин, В. А. (2016). Conserving therapy for symptomatic uterine leiomyoma in patient of reproductive age. REPRODUCTIVE ENDOCRINOLOGY, (28), 94–100. https://doi.org/10.18370/2309-4117.2016.28.94-100

Issue

No. 28 (2016)

Section

Clinical case

License

Copyright (c) 2016 Т. Ф Татарчук, Н. В. Косей, Н. А. Редько, Н. В. Яроцкая, В. А. Джупин

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