Strategy for prevention of uterine leiomyoma recurrence in combination with adenomiosis after organ-conserving operations in reproductive aged women

the study included 76 women of reproductive age who underwent organ-preserving surgical treatment for LM. Women were divided into two groups depending on the adenomyosis presence. Group I included 35 women with isolated LM, group II included 41 women with LM in combination with adenomyosis. Groups I and II were divided into 4 subgroups: in Ia and IIa subgroups during preparation for surgery patients received one of the agonists of gonadotropin releasing hormone (GnRH) for 3 months. In Ib and IIb subgroups suppressive therapy was not performed prior to surgical treatment. After a myomectomy women of I and II groups received one of the GnRH agonists for the first three months, followed by the low-dose combined oral contraceptive. The choice of funds was justified on the results of an immunohistochemical study of the Ki-67 antigen expression (proliferation marker), estrogen and progesterone receptors, and cyclooxygenase-2 (COX-2). Group IIb women were additionally prescribed non-hormonal therapy with fibrinolytic (streptokinase) and proteolytic (streptodornase) enzymes, as well as herbal antiproliferative agent containing indole-3-carbinol and epigallocatechin-3-gallate.

of the study: an immunohistochemical study showed that in women who did not receive suppressive therapy before surgery (Ib and IIb groups) Kі-67 antigen expression in the tumor nodes was significantly increased. Almost 2 times greater was the difference between the Ki-67 antigen expressions in the LM nodes with the adenomyosis combination. GnRH agonists did not inhibit the expression of estrogen and progesterone receptors. COX-2 expression was significantly higher than in intact myometrium. In women with combined uterine pathology the number of cells with a positive immunohistochemical reaction to COX-2 was 6.4 times higher than with isolated LM. Conclusions: myomectomy surgery only partially solves the problems of reproductive health restoration in women with combined uterine pathology. The proposed long-term suppressive therapy made it possible to reduce the tumor relapses number by almost 2.6 times after surgical organ-preserving treatment and to improve reproductive function in almost every third woman.

- Vovk, I.B., Kondratiuk, V.K., Chubei, G.V., Zakharenko, N.F. “Treatment of genital endometriosis – from evolution to revolution (literature review).” Women’s Health 4 (2009): 40–3. - Vovk, I.B., Khomynska, Z.B., Zakharenko, N.F., et al. “Characteristics of hormonal status in women with endometriosis.” Women’s Health 10.56 (2010): 162–4. - Grek, L.P. “Features of systemic disorders in patients with genital endometriosis in combination with benign genital diseases and chronic pelvic pain syndrome.” Medical perspectives Vol. XXII-4 (2017): 62-7. - Guriev, T.D., Sidorova, I.S., Unanyan, A.L. The combination of uterine fibroids and adenomyosis. Moscow. MIA Ltd (2012): 256 p. - Damirov, M.M. Current management for patient with adenomyosis. Moscow. BINOM (2015). - Zakharenko, N.F. “Clinical and anamnestic characteristics of women with different forms of endometriosis.” Pediatrics, Obstetrics and Gynecology: Scientific and Practical Journal 72.5 (2010): 97–104. - Zakharenko, N.F., Kovbasii, V.P., Kovalenko, N.V. “Characteristics of psychological personality types in benign hyperproliferative diseases of the female reproductive system.” Women’s Health 2.48 (2010): 133–6. - Kudinova, N.N., Frolov, M.V., Naumov, N.V., Shurshukov, Y.Y. “Medical and social characteristics of women with uterine myoma in combination with adenomyosis.” Electronic journal “Postgraduate doctor”. Available from: [http://vrach-aspirant.ru/article/ gynecology/13525], last accessed Oct 22, 2019. - Patent for useful model № 54872 Ukraine.Method for postoperative rehabilitation and pregrevidas preparation after conservative myomectomy / Potapov, V.O., Medvedev, M.V., Polschikov, P.I., Stepanova, D.Y., Finkova, O.P., No. u 2010 06592; appl. 31.05.2010, pub. 25.11.2010, bull. No. 22. - Patent for useful model № 85891 Ukraine. Method of treatment of hyperproliferative states of the pelvic organs / Potapov, V.O., Hryschenko, O.V., Medvedev, M.V., et al., No. u 2013 04798; appl. 15.04.2013, pub. 10.12.2013, bul. No. 23. - Potapov, V.A., Мedvedev, М.V., Ivakh, V.I. “Strategies for the therapy of endometriosis disease in combination with the uterine body leiomyoma.” Journal of Obstetrics and Women's Diseases Vol. LХI special edition (2012): 26–7. - Strizhakov, A.N., Davydov, A.I., Pashkov, V.M., Lebedev, V.A. Benign uterine diseases. Moscow. GEOTAR-Media (2012): 288 p. - Tatarchuk, T.F., Zakharenko, N.F., Tutchenko, T.N. “New approaches to the problematic issues of treatment of genital endometriosis.” Reproductive Endocrinology 3 (2013): 36–45. - Tatarchuk, T.F., Zakharenko, N.F., Manoliak, I.P., Kovbasii, V.P. “Improving medical tactics in women with endometriosis.” Reproductive Endocrinology 4.18 (2014): 24–7. - Tatarchuk, T.F.., Zakharenko, N.F.., Manoliak, I.P., et al. “Features of climacteric syndrome in women with endometriosis and possible ways of its correction.” Scientific journal of the MOH of Ukraine 2 (2014): 71–8. - Fadeeva, N.I., Yavorskaya, S.D., Dolina, O.V., et al. “Adenomyosis: new therapeutic options.” Medical news 5 (2017): 13–15. - Adamson, G.D., Pasta, D.J. “Endometriosis fertility index: the new, validated endometriosis staging system.” Fertil Steril 94 (2010): 1609–15. - Bayoglu, T.Y., Dilbaz, B., Altinbas, S.K., Dilbaz, S. “Postoperative medical treatment of chronic pelvic pain related to severe endometriosis: levonorgestrel-releasing intrauterine system versus gonadotropin-releasing hormone analogue.” Fertil Steril 95 (2011): 492–6. - Brosens, I., Brosens, J.J., Fusi, L., et al. “Risks of adverse pregnancy outcome in endometriosis.” Fertil Steril 98 (2012): 30–5. - Brown, J., Pan, A., Hart, R.J. “Gonadotrophin-releasing hormone analogues for pain associated with endometriosis.” Cochrane Database Syst Rev 12 (2010): CD008475. - de Ziegler, D., Gayet, V., Aubriot, F.X., et al. “Use of oral contraceptives in women with endometriosis before assisted reproduction treatment improves outcomes.” Fertil Steril 94 (2010): 2796–9. - Fagervold, B., Jenssen, M., Hummelshoj, L., Moen, M.H. “Life after a diagnosis with endometriosis – a 15 years follow-up study.” Acta Obstet Gynecol Scand 88 (2009): 914–9. - Giudice, L.C. “Clinical practice: endometriosis.” N Engl J Med 362 (2010): 2389–98. - Guo, S.W. “Recurrence of endometriosis and its control.” Hum Reprod Update 15 (2009): 441–61. - Laschke, M.W., Menger, M.D. “Anti-angiogenetic treatment strategies for the therapy of endometriosis.” Hum Reprod Update 18 (2012): 682–702. - Shakiba, K., Bena, J.F., McGill, K.M., et al. “Surgical treatment of endometriosis: a 7-year follow-up on the requirement for further surgery.” Obstet Gynecol 111 (2008): 1285–92. - Stratton, P., Berkley, K.J. “Chronic pelvic pain and endometriosis: translational evidence of the relationship and implications.” Hum Reprod Update 17 (2011): 327–46. 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