Complex rehabilitation therapy of genital endometriosis in women with endometriosis associated infertility

I.K. Orischak, О.М. Makarchuk, M.I. Rymarchuk, O.M. Ostrovska
In: HEALTH OF WOMAN · 2019 · pp. 84–86 · doi:10.15574/hw.2019.142.84 · W4285064620
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This study evaluated a complex rehabilitation therapy combining progestogens, indole-3-carbinol, and epigallocatechin-3-galate in women with endometriosis-associated infertility and found it effective for pain and fertility.

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This paper studied the effectiveness of complex treatment for bacterial vaginosis in 56 reproductive-age women, comparing conventional antibiotic-based regimens with intravaginal formulations including Feminum intima and probiotics (Laktostar Plus), using four groups with different combinations and sequencing of therapies. Outcomes were assessed through changes in complaints and pH measurements over time, along with vaginal microbiological assessment using Femoflor 16 at 7 and 21 days, and recurrence was evaluated clinically after 60 days. The authors reported that clinical and microbiological efficacy was observed in all women in groups 1 and 3, in 90% of group 2, and in 83% of group 4, with relapse at 60 days occurring in 7% overall (two cases in group 4). A major limitation acknowledged by the design is that this is a small, group-based comparative study focused on bacterial vaginosis treatment outcomes without broader mechanistic or longer-term follow-up. The paper does not explicitly discuss endometriosis or adenomyosis; it was included in the corpus via a keyword match in the upstream search index.

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Abstract

The most relevant and least investigated questions are the relationships between genital endometriosis and disorders of the fertile function. It is precisely the lack of a clear algorithm for early detection of genital endometriosis and the choice of adequate treatment to further develop these issues, both for improving the quality of life in this category of women and for improving reproductive capacity. The objective: to increase the effectiveness of rehabilitation therapy in patients with genital endometriosis and defection of fertility based on evaluation of individual factors and immunological mechanisms of interaction and optimizing ways to overcome these negative influences. Materials and methods. To achieve this goal, 68 patients with endometriosis associated infertility were examined, which assessed the nature of the hormonal imbalance, violations of individual immune defense units in relation to the level fluctuations of individual tumor markers. In order to evaluate the effectiveness of the proposed program, a group of patients with endometriosis associated infertility was divided into two groups: the main group (38 women) and the comparison group (30 patients). The features of the proposed treatment program were the use after surgical manipulation of complex therapy with the use of progestogens (didrogesterone in contraceptive mode) and the antiproliferative complex: indole-3-carbinol and epigallocatechin-3-galate. Results. Characteristic features of adenomyosis are an increase in this category of patients with levels of LH (2.67 times) and FSH (1.98 times), mainly in the II phase of the menstrual cycle, as well as an increase in estradiol levels, especially in the follicular phase of the menstrual cycle (2, 13 times). In patients with internal endometriosis, in 30.9% of cases (according to ultrasound scan) and in 41.1% of cases (according to histological examination), there are manifestations of hyperplastic processes of endometrium. Increasing the serum CA-125 level (according to our data, 3.1-fold) in women with external genital endometriosis is an effective diagnostic marker to confirm the presence of this pathology. Conclusions. Thus, it should be noted that the proposed rehabilitation therapy for genital endometriosis in the postoperative period is effective in the treatment of pain syndrome and increasing fertility for endometriosis-associated infertility. Key words: genital endometriosis, infertility, hormonal imbalance, tumor markers, rehabilitation therapy.
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Materials

and methods. Under the supervision were 56 women of reproductive age with a diagnosis of bacterial vaginosis. Patients were divided into 4 groups. The first group included 10 women who previously received antibiotic therapy on extragenital diseases. Women are administered clindamycin vaginal cream of miconazole and followed by intravaginal drug use Feminum intima and probiotic system Laktostar Plus. The second group consisted of 10 women who have previously received antibiotic therapy on extragenital diseases. Patients administered the drug Feminum intima and Laktostar Plus without using antibiotics. The third group is formed of 23 women who did not receive pre-antibiotic therapy. Prescribed combination therapy that, in addition to antibacterial cream included intravaginal drug Feminum intima and probiotic system Laktostar Plus. 23 women fourth group administered antibacterial cream and then using the drug Feminum intima. Monitoring the effectiveness of the treatment was carried out by clinical and laboratory course of the disease based on the dynamic changes of complaints of patients, assessment data pH measuring (7, 21 and 60 day observation of treatment), assessment of the ecological community conducted a test system Femoflor 16 at 7 and 21 days of early treatment. Results. In general, clinical and microbiological efficacy after completion of BV treatment in the 1-st and 3rd groups was noted in all patients, in the 2-nd group – in 90%, in the 4-th group – in 83% of women. Clinical efficacy (complaint regression and objective data normalization) averaged 4.4 days in group 1, 5.8 days in group 2, 4.2 days in groups 3 and 4, 4 days – in the 4-th group. An examination after 60 days showed that clinically relapsed BV occurred in 4 (7%) patients, 2 of whom were in the 4th observation group. Conclusion. The results showed that the combined treatment of bacterial vaginosis with the use of antibacterial vaginal gel Feminum intima and probiotic Laktostar Plus effectively and quickly restores the vaginal environment helps eliminate dysbiosis system and the rapid return of the normal microflora vaginally, reduces the number of recurrences of bacterial vaginosis. Key words: bacterial vaginosis, treatment, intravaginal forms, probiotics.

References

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