Prevention of recurrence of uterine leiomyoma and endometriosis with coexisting disease in women of reproductive age after surgical treatment

of the study: to evaluate the effectiveness of a medication containing a gonadotropin-releasing hormone antagonist, estradiol, and norethisterone (Rieko) in the postoperative period after surgical treatment of women of reproductive age with comorbidity of uterine leiomyoma and endometriosis in order to prevent recurrence of the disease.

and methods. The study included 49 women aged 26 to 45 years with a combination of uterine leiomyoma and endometriosis. 21 patients received the medication Rieko in the postoperative period starting from the first day of the menstrual cycle for the prevention of recurrence during three menstrual cycles (the main group). 28 patients in the postoperative period did not receive treatment with hormonal medications (comparison group). All patients underwent surgical laparoscopy or laparotomy via the Pfannenstiel approach under endotracheal anesthesia. Conservative myomectomy, removal of ovarian endometriomas, and/or vaporization or excision of endometrioid heterotopias on the pelvic organs were performed during laparoscopy or laparotomy. Results. Examination of patients after treatment showed that severe and moderate pain was observed only in 4.8% of women in the main group, which was almost three times less than in the comparison group and almost 19 times less than before surgical treatment. Dysmenorrhea was reported three times less frequently by patients in the main group. Abnormal uterine bleeding and significant blood loss ceased in the main group, in the comparison group they were observed in 17.9% of women (p < 0.05). Assessment of the psychoemotional state of the participants three months after treatment indicated an increase in the overall level of indicators in 95.2% of patients who received hormonal therapy. Conclusions. Timely administration of the medication Rieko in the postoperative period in women of reproductive age with comorbidity of uterine leiomyoma and endometriosis improves the psychoemotional state, reduces clinical manifestations of the disease, and prevents recurrence.

- Barnick C. Fibroids and endometriosis: what they are and common symptoms. [Internet]. Obstetrics&Gynaecology. 2023; 03. Available from: https://www.topdoctors.co.uk/medical-articles/fibroids-and-endometriosis-what-they-are-and-common-symptoms - Uimari O, Nazri H, Tapmeier T. Endometriosis and Uterine Fibroids (Leiomyomata): Comorbidity, Risks and Implications. Front Reprod Health. 2021 Oct 26;3:750018. DOI: 10.3389/frph.2021.750018. - Surrey ES, Soliman AM, Johnson SJ, Davis M, Castelli-Haley J, Snabes MC. Risk of Developing Comorbidities Among Women with Endometriosis: A Retrospective Matched Cohort Study. J Womens Health (Larchmt). 2018 Sep;27(9):1114-1123. DOI: 10.1089/jwh.2017.6432. - Choi EJ, Cho SB, Lee SR, Lim YM, Jeong K, Moon S, et al. Comorbidity of gynecological and non-gynecological diseases with adenomyosis and endometriosis. Obstet Gynecol Sci. 2017 Nov;60(6):579-586. DOI: 10.5468/ogs.2017.60.6.579 - Nezhat C, Li A, Abed S, Balassiano E, Soliemannjad R, Nezhat A, et al. Strong association between endometriosis and symptomatic leiomyomas. JSLS J Soc Laparoendosc Surg. 2016; 20:e2016. DOI: 10.4293/JSLS.2016.00053 - Lin KYH, Yang CY, Lam A, Chang CYY, Lin WC. Uterine leiomyoma is associated with the risk of developing endometriosis: A nationwide cohort study involving 156,195 women. PLoS ONE. 2021; 16:e0256772. DOI: 10.1371/journal.pone.0256772 - Zondervan KT, Becker CM, Missmer SA. Endometriosis. N Engl J Med.2020;382:1244-56. DOI: 10.1056/NEJMra1810764 - Gallagher CS, Mäkinen N, Harris HR, Rahmioglu N, Uimari O, Cook JP, et al. Genome-wide association and epidemiological analyses reveal common genetic origins between uterine leiomyomata and endometriosis. Nat Commun2019;10:4857. DOI: 10.1038/s41467-019-12536-4 - .Méar L, Herr M, Fauconnier A, Pineau C, Vialard F. Polymorphisms and endometriosis: a systematic review and meta-analyses. Hum Reprod Update2020;26:73–102. DOI: 10.1093/humupd/dmz034 - Mu F, Rich-Edwards J, Rimm EB, Spiegelman D, Missmer SA. Endometriosis and risk of coronary heart disease. Circ Cardiovasc Qual Outcomes2016;9:257–64. DOI: 10.1161/CIRCOUTCOMES.115.002224. - Haan YC, Diemer FS, Van Der Woude L, Van Montfrans GA, Oehlers GP, Brewster LM. The risk of hypertension and cardiovascular disease in women with uterine fibroids. J Clin Hypertens (Greenwich).2018;20:718–26. DOI: 10.1111/jch.13253. pmid:29569360. - Kvaskoff M, Mahamat-Saleh Y, Farland LV, Shigesi N, Terry KL, Harris HR, et al. Endometriosis and cancer: a systematic review and meta-analysis. Hum Reprod Update.2021;27:393–420. DOI: 10.1093/humupd/dmaa045 - Wang YX, Farland LV, Gaskins AJ, Wang S, Terry KL, Rexrode KM, et al. Endometriosis and uterine fibroids and risk of premature mortality: prospective cohort study. BMJ. 2024 Nov 20;387:e078797. DOI: 10.1136/bmj-2023-078797 - Kramer KJ, Ottum S, Gonullu D, Bell C, Ozbeki H, Berman JM, Recanati MA. Reoperation rates for recurrence of fibroids after abdominal myomectomy in women with large uterus. PLoS One. 2021 Dec 9;16(12):e0261085. DOI: 10.1371/journal.pone.0261085 - Stewart EA, Cookson CL, Gandolfo RA, Schulze-Rath R. Epidemiology of uterine fibroids: a systematic review. BJOG. 2017;124(10):1501–12. DOI: 10.1111/1471-0528.14640 - Kotani Y, Tobiume T, Fujishima R, Shigeta M, Takaya H, Nakai H, et al. Recurrence of uterine myoma after myomectomy: Open myomectomy versus laparoscopic myomectomy. J Obstet Gynaecol Res. 2018;44(2):298–302. DOI: 10.1111/jog.13519 - Meng T, Cheng S, Li X, Gao H, Li Y, Du M, Shi J. Analysis of risk factors for recurrence after laparoscopic myomectomy: A retrospective study. Medicine (Baltimore). 2025 Mar 14;104(11):e41697. DOI: 10.1097/MD.0000000000041697. - Holdsworth-Carson SJ, Chung J, Machalek DA, Li R, Jun BK, Griffiths MJ, et al. Predicting disease recurrence in patients with endometriosis: an observational study. BMC Med. 2024 Aug 7;22(1):320. DOI: 10.1186/s12916-024-03508-7 - Becker CM, Bokor A, Heikinheimo O, Horne A, Jansen F, Kiesel L, et al. ESHRE guideline: endometriosis. Hum Reprod 2022 Feb 26;2022(2):hoac009. DOI: 10.1093/hropen/hoac009oac009 - International Working Group of Aagl EE, Wes, Tomassetti C, Johnson NP, Petrozza J, Abrao MS, et al. An international terminology for endometriosis. Hum Reprod Open. 2021 Oct 22;2021(4):hoab029. DOI: 10.1093/hropen/hoab029 - Capezzuoli T, Vannuccini S, Mautone D, Sorbi F, Chen H, Reis FM, et al. Long-term hormonal treatment reduces repetitive surgery for endometriosis recurrence. Reprod Biomed Online. 2021;42(2):451–6. DOI: 10.1016/j.rbmo.2020.09.018 - Tapmeier TT, Nazri HM, Subramaniam KS, Manek S, Garbutt K, Flint EJ, et al. Protocol for a longitudinal, prospective cohort study investigating the biology of uterine fibroids and endometriosis, and patients’ quality of life: the FENOX study. BMJ Open. 2020;10:e032220. DOI: 10.1136/bmjopen-2019-032220 - Chiuve SE, Huisingh C, Petruski-Ivleva N, Owens C, Kuohung W, Wise LA. Uterine fibroids and incidence of depression, anxiety and self-directed violence: a cohort study. J Epidemiol Community Health. 2022; 76:92–9. DOI: 10.1136/jech-2020-214565 - Bourdel N, Chauvet P, Billone V, Douridas G, Fauconnier A, Gerbaud L, et al. Systematic review of quality of life measures in patients with endometriosis. PLoS One. 2019 Jan 10;14(1):e0208464. DOI: 10.1371/journal.pone.0208464. - Della Corte L, Di Filippo C, Gabrielli O, Reppuccia S, La Rosa VL, Ragusa R, et al. The Burden of Endometriosis on Women’s Lifespan: A Narrative Overview on Quality of Life and Psychosocial Wellbeing. Int J Environ Res Public Health. 2020 Jun 29;17(13):4683. DOI: 10.3390/ijerph17134683 - Neumann B, Singh B, Brennan J, Blanck J,∙Segars JH. The impact of fibroid treatments on quality of life and mental health: a systematic review. Fertility and sterility. VIEWS AND REVIEWS Volume 121, Issue 3P400-425 March 2024. DOI: 10.1136/jech-2020-214565 - Chaban OS, Haustova OO, editors. Practical psychosomatics: Diagnostic scales: A textbook. 3rd Ed. Kyiv: Medkniga; 2021. 199 p. - Rijeko. [Internet]. State Register of Medicinal Products of Ukraine, 2024. Available from: http://www.drlz.com.ua/ibp/ddsite.nsf/all/shlz1?opendocument&stype=57B1B85DE3ED56FBC2258 BD300515630 - Al-Hendy A, Lukes AS, Poindexter AN 3rd, Venturella R, Villarroel C, Critchley HOD, et al. Treatment of Uterine Fibroid Symptoms with Relugolix Combination Therapy. N Engl J Med. 2021 Feb 18;384(7):630–642. DOI: 10.1056/NEJMoa2008283. - Krewson C. Combination therapy for uterine fibroids and endometriosis. [Internet]. Contemporare OB/GYN. June 2, 2023. Available from: https://www.contemporaryobgyn.net/view/combination-therapy-for-uterine-fibroids-and-endometriosis - Arjona Ferreira JC, Migoya E. Development of relugolix combination therapy as a medical treatment option for women with uterine fibroids or endometriosis. F S Rep. 2022 Nov 21;4(2 Suppl):73-82. DOI: 10.1016/j.xfre.2022.11.010 Downloads Published How to Cite Issue Section License 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.