Клінічний випадок консервативного лікування вузлової форми аденоміозу

Clinical case report: сonservative treatment of nodular adenomyosis DOI: https://doi.org/10.18370/2309-4117.2018.40.44-48Keywords: adenomyosis, dysmenorrhea, endometriosis, adolescent period, Visanne, dienogestAbstract The article describes the clinical case of the nodular form of adenomyosis, first detected in a patient at the age of 16 years after another appeal to a gynecologist in connection with pronounced prolonged dysmenorrhea with ultrasound of a small pelvis. After the diagnosis of “Nodular form of adenomyosis”, the patient received 6 injections of triptorelin acetate 3.62 mg, resulting in an adenomyosis node decreased in size from 72 x 68 mm to 31 x 29 mm. Taking into account the developed side effects (aches in bones, hot flushes, weakness, tachycardia), therapy with triptorelin was discontinued. Clinical efficacy persisted for 6 months, after which painful menstruation resumed. Two years later, the patient was urgently transferred to the gynecological department of the Kyiv City Clinical Hospital No. 9 with severe manifestations of dysmenorrhea. With ultrasound of the pelvic organs, an endometrioid node in the uterus measuring 50 x 46 mm was found. The patient was recommended receiving Visanne (dienogest) in a dose of 2 mg, which she took 1 year and 10 months, being under constant supervision of the clinic’s specialists. The unauthorized break in treatment, which the patient explained with good health, provoked the resumption of painful symptoms. Visanne was continued for 2 years, as a result of which the endometrioid node decreased to 21.0 x 16.7 mm. In April 2017, in connection with the patient’s marriage and the desire to become pregnant, the reception of the dienogest was canceled. It is proposed to take a plant complex of antiproliferative action containing indole-3-carbinol 200 mg and green tea extract 82 mg. After 8 months, the patient was diagnosed with a pregnancy at 4 weeks, against which the adenomyosis node decreased to 18.1 x 11.1 mm. The results of the first two ultrasound screenings of the fetus in the gestation period of 13 and 18 weeks are described. There were no deviations in fetal development, and the endometriosis focus in the uterus was not clearly visualized at the first screening. The importance of the problem of secondary dysmenorrhea on the background of endometriosis, the establishment of a timely diagnosis and the choice of the right treatment tactics on which the future reproductive health of a teenage girl directly depends. References - Vovk, I.B., Zakharenko, N.F., Radysh, T.V. “Status of activation of blood lymphocytes and serum levels of inflammatory mediators in different forms of endometriosis.” Pediatrics, obstetrics and gynecology 1.76 (2013): 77–81. - Zakharenko, N.F., Zadorozhna, T.D., Kalugina, L.V. “Indol-3-carbinol in the treatment of adenomyosis.” Drugs of Ukraine plus 2.15 (2013): 22–4. - Zakharenko, N.F., Tatarchuk, T.F., Kovalenko, N.V. “The role of oxidative stress in the genesis of endometriosis.” Reproductive endocrinology 4.18 (2014): 13–16. - Tatarchuk, T.F., Kalugina, L.V. “Issue of prevention and treatment of hormone-depended hyperproliferative diseases in women.” Women’s Health 7 (2013): 51–7. - European Society of Human Reproduction and Embryology. Management of endometriosis. Guideline (2013). - Dunselman, G.A., Vermeulen, N., Becker, C., et al. “ESHRE guideline: management of women with endometriosis.” Hum Reprod 29.3 (2014): 400–12. - Johnson, N.P., Hummelshoj, L.; World Endometriosis Society Montpellier Consortium. Consensus on current management of endometriosis. Hum Reprod, 28(6)(2013):1552 - 1568. - Zotova, O.A., Artymuk, N.V. “Adenomyosis: clinic, risk factors and problems of diagnosis and treatment.” Gynecology 6 (2013): 31–4. - Stilley, J.A., Birt, J.A., Sharpe-Timms, K.L. “Cellular and molecular basis for endometriosis-associated infertility.” Cell Tissue Res 349.3 (2012): 849–62. Downloads Published How to Cite Issue Section License Copyright (c) 2018 Н. Ф. Захаренко, Н. В. Коваленко, И. П. Маноляк This work is licensed under a Creative Commons Attribution 4.0 International License. Authors who publish with this journal agree to the following terms: - Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal. - Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.