INDIVIDUALIZATION OF MANAGEMENT OF PATIENTSWITH ENDOMETRIOSIS OF THE UTERUS BASED ON THE USEOF LEVONORGESTREL-CONTAINING INTRAUTERINE SYSTEMAND HYSTERORESECTOSCOPIC ENDOMETRIAL ABLATION

Т. С. Дивакова, A. S. Podgornaya
In: Health and Ecology Issues · 2017 · pp. 22–27 · doi:10.51523/2708-6011.2017-14-4-4 · W3217630457
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⚙ AI-generated summary by gemini-2.5-flash-lite, 2026-06-13 ⓘ

This study evaluated the effectiveness of individualized treatment strategies using levonorgestrel intrauterine systems, hysteroresectoscopic endometrial ablation, or their combination for uterine endometriosis and bleeding.

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The paper discusses individualized management for patients with uterine endometriosis by using a levonorgestrel-containing intrauterine system and hysteroresectoscopic endometrial ablation, aiming to tailor treatment to patient characteristics. At a high level, it frames management options in the context of hormonal and procedural approaches, citing relevant literature and discussing considerations drawn from prior work, including results previously reported by the same authors regarding adenomyosis. A major caveat is that the provided text includes only the title, metadata, and references/annotation without the full study design, sample, outcomes, or explicit limitations. This paper is centrally about endometriosis — it focuses on uterine (endometriosis of the uterus) management using a levonorgestrel IUS and hysteroresectoscopic endometrial ablation.

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Abstract

Objective: to increase the efficiency of the treatment of uterine endometriosis complicated by uterine bleeding, based on the differential application of hysteroresectoscopic endometrial ablation, a levonorgestrel-containing intrauterine system, and gonadotropin-releasing hormone agonists. Material and methods: The study included 93 patients with uterine endometriosis complicated by uterine bleedings who were treated using the levonorgestrel-containing intrauterine system (31 patients), hysteroresectoscopic endometrial ablation (29 patients), and the combination of these methods (33 patients). The control group consisted of 23 patients without genital pathology. The treatment outcomes for the subgroups were analyzed based on studying clinical, anthropometric, sonographic, laboratory, immune-enzyme, endoscopic, immunohistochemical, morphological, and morphometrical parameters. Results. The levonorgestrel-containing intrauterine system is efficient (in 87.1% cases) for the treatment of patients with adenomyosis in cases when the size of the uterus does not exceed 250000 mm 3 , and possesses the main local and minimal systemic effect. It is comparable to hysteroresectoscopic endometrial ablation, whose efficiency in the elimination of uterine bleedings is 82.76 %. If the size of the uterus ranges from 150000 to 250000 mm 3 , the combined treatment strategy should be preferred (hysteroresectoscopic endometrial ablation, and the levonorgestrel-containing intrauterine system), which had 100 % efficiency in the corresponding group, and gonadotropin-releasing hormone agonists should be used. In the long-term follow-up study (1-5.3 years), the efficiency of the treatment with the use of the levonorgestrel-containing intrauterine system was 80.65 %, in the combined treatment - 100 %, in hysteroresectoscopic endometrial ablation - 72.41 %. Conclusion. The individualized use of the levonorgestrel-containing intrauterine system, hysteroresectoscopic endometrial ablation, the combination of these two treatment options as well as the application gonadotropin-releasing hormone agonists in the treatment of adenomyosis complicated by menorrhagia and other proliferative diseases of the endometrium and myometrium showed their high efficiency and reasonability.
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ИНДИВИДУАЛИЗАЦИЯ ВЕДЕНИЯ ПАЦИЕНТОК С ЭНДОМЕТРИОЗОМ МАТКИ НА ОСНОВЕ ИСПОЛЬЗОВАНИЯ ЛЕВОНОРГЕСТРЕЛСОДЕРЖАЩЕЙ ВНУТРИМАТОЧНОЙ СИСТЕМЫ И ГИСТЕРОРЕЗЕКТОСКОПИЧЕСКОЙ АБЛАЦИИ ЭНДОМЕТРИЯ https://doi.org/10.51523/2708-6011.2017-14-4-4 Аннотация Ключевые слова Об авторах Т. С. ДиваковаБеларусь А. С. Подгорная Беларусь Список литературы 1. Taylor, M.M. Endometriosis - a missed malady / M.M. Taylor // AORN J. - 2003. - Vol. 77, № 2. - P. 297-313. 2. Mueck, O.A. Dienogest: an oral progestogen for the treatment ofendometriosis / O.A. Mueck // Expert Rev. Obstet. Gynecol. - 2011. - Vol. 6, №1. - P. 5-15. 3. Developing symptom-based predictive models of endometriosis as a clinical screening tool: results from a multicenter study / K.E. Nnoaham [et al.] // Fertil. Steril. - 2012. - Vol. 98, № 3. - P. 692-701. 4. Frackiewicz, E.J. Diagnosis and treatment of endometriosis / E.J. Frackiewicz, V. Zarotsky // Expert Opin. Pharmacother. - 2003. - Vol. 4, № 1. - P. 67-82. 5. Дамиров, М.М. Клинико-морфологическое сравнение ультразвуковых критериев аденомиоза / M.М. Дамиров // Акушерство и гинекология. - 1994. - № 2. - С. 40-43. 6. Баскаков, В.П. Эндометриоидная болезнь / В. П. Баскаков, Ю. В. Цвелев, Е. Ф. Кира. - СПб., 2002. - 452 с. 7. Железнов, Б.И. Генитальный эндометриоз / Б. И. Железнов, А. Н. Стрижаков. - М., 1985. - 160 с. 8. Стрижаков, А.Н. Эндометриоз. Клинические и теоритические аспекты / А. Н. Стрижаков, А.И. Давыдов. - М.: Медицина, 1996. - 330 с. 9. Barbieri, R.L. Comparison of the pharmacology of nafarelin and danazol / R. L. Barbieri // Amer. J. Obstet. Gynecol. - 1990. - Vol. 162, № 2. - P. 581-585. 10. Adenomyosis: a systematic review of medical treatment / А. Pontis [et al.] // Gynecol. Endocrinol. - 2016. - Vol. 32, № 9. - P. 696-700. 11. Sexual Function in women with deep endometriosis: correlation with quality of life, intensity of pain, depression, anxiety and body image / I. Melis [et al.] // Intern. J. Sex. Health. - 2015. - Vol. 27. - P. 175-185. 12. Подгорная, А. С. Эффективность левоноргестрелсодержащей внутриматочной системы и гистерорезектоскопической аблации эндометрия в лечении аденомиоза / А.С. Подгорная // Медико-биологические проблемы жизнедеятельности. - 2017. - №1 (17). - С. 154-162. Рецензия Для цитирования: Дивакова Т.С., Подгорная А.С. ИНДИВИДУАЛИЗАЦИЯ ВЕДЕНИЯ ПАЦИЕНТОК С ЭНДОМЕТРИОЗОМ МАТКИ НА ОСНОВЕ ИСПОЛЬЗОВАНИЯ ЛЕВОНОРГЕСТРЕЛСОДЕРЖАЩЕЙ ВНУТРИМАТОЧНОЙ СИСТЕМЫ И ГИСТЕРОРЕЗЕКТОСКОПИЧЕСКОЙ АБЛАЦИИ ЭНДОМЕТРИЯ. Проблемы здоровья и экологии. 2017;(4):22-27. https://doi.org/10.51523/2708-6011.2017-14-4-4 For citation: Divakova T.S., Podgornaya A.S. INDIVIDUALIZATION OF MANAGEMENT OF PATIENTSWITH ENDOMETRIOSIS OF THE UTERUS BASED ON THE USEOF LEVONORGESTREL-CONTAINING INTRAUTERINE SYSTEMAND HYSTERORESECTOSCOPIC ENDOMETRIAL ABLATION. Health and Ecology Issues. 2017;(4):22-27. (In Russ.) https://doi.org/10.51523/2708-6011.2017-14-4-4 JATS XML

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