Submucosal leiomyoma of the uterus in combination with adenomyosis. Principles of target therapy in the reproductive period

A.I. Davydov, Вiталiй Пашков, М.N. Shakhlamova
In: Voprosy ginekologii, akušerstva i perinatologii · 2019 · vol. 18(3) , pp. 124–132 · doi:10.20953/1726-1678-2019-3-124-132 · W2966119063
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Operative hysteroscopy combined with ulipristal acetate and ethinylestradiol/dienogest effectively treats submucosal leiomyoma and adenomyosis in reproductive-aged women.

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This paper outlines therapeutic strategies for reproductive-age patients presenting with submucosal leiomyomas co-occurring with adenomyosis. The authors advocate for a combined approach involving operative hysteroscopy alongside preoperative hormonal preparation using ulipristal acetate and the combination drug Siluet. They report that ulipristal acetate significantly reduces tumor volume and facilitates conversion to lower types, while Siluet effectively prevents adenomyosis progression and inactivates residual lesions. This paper is centrally about adenomyosis — specifically as a comorbid condition requiring targeted hormonal and surgical management alongside submucosal fibroids.

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Gynecology, Obstetrics and Perinatology - Gynecology, Obstetrics and Perinatology - 2019 volume 18 issue 3 Submucosal leiomyoma of the uterus in combination with adenomyosis. Principles of target therapy in the reproductive period Authors / Institutions Aleksandr I. Davydov / Vladimir M. Pashkov / Marina N. Shakhlamova / The authors present a tactics of treating patients with submucosal leiomyoma of the uterus (SLM) in combination with adenomyosis, which is grounded on operative hysteroscopy (transcervical myomectomy, excision of adenomyotic foci) and hormonal therapy – pre-operative preparation with ulipristal acetate (UPA) 5 mg/day and Siluet (ethinylestradiol + dienogest). As is shown, in SLM types 1–2 UPA ensures not only reduction of the volume of submucosal uterine tumour (on average by 36%), but also its conversion to types 0–1, and also fast hemostasis under the conditions of severe iron deficiency. Siluet is notable for its high effectiveness with respect to prevention of the growth of adenomyosis and inactivation of unremoved heterotopias in combination with adequate compliance. Key words: adenomyosis, operative hysterectomy, ulipristal, submucosal leiomyoma, target therapy, ethinylestradiol + dienogest. For citation: Davydov A.I., Pashkov V.M., Shakhlamova M.N. Submucosal leiomyoma of the uterus in combination with adenomyosis. Principles of target therapy in the reproductive period. Vopr. ginekol. akus. perinatol. (Gynecology, Obstetrics and Perinatology). 2019; 18(3): 124–132. (In Russian). DOI: 10.20953/1726-1678-2019-3-124-132 by 36%), but also its conversion to types 0–1, and also fast hemostasis under the conditions of severe iron deficiency. Siluet is notable for its high effectiveness with respect to prevention of the growth of adenomyosis and inactivation of unremoved heterotopias in combination with adequate compliance. Key words: adenomyosis, operative hysterectomy, ulipristal, submucosal leiomyoma, target therapy, ethinylestradiol + dienogest. For citation: Davydov A.I., Pashkov V.M., Shakhlamova M.N. Submucosal leiomyoma of the uterus in combination with adenomyosis. Principles of target therapy in the reproductive period. Vopr. ginekol. akus. perinatol. (Gynecology, Obstetrics and Perinatology). 2019; 18(3): 124–132. (In Russian). DOI: 10.20953/1726-1678-2019-3-124-132

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