What hormonal pills are prescribed for fibroids. Effective medications for the treatment of uterine fibroids. Rules for taking contraceptive drugs

About a third of gynecological pathologies occur, which are found mainly in 35-50-year-old patients. They provoke changes in hormonal status, which most often consist of excess estrogen.

Although uterine fibroids are a pathology of benign origin, they can lead to the loss of the patient’s reproductive functions. Therefore, the disease requires mandatory medical supervision and specific treatment.

Based on a conservative approach, it is considered a higher priority by doctors and patients, because any, even the most, has certain risks.

Is it always necessary to treat a disease?

It is absolutely impossible to leave fibroids unattended, ignoring the changes that are taking place.

If the fibroid is detected at the initial stage of node formation, and it does not have a tendency to increase in size and progress, then treatment will consist of a systematic visit to the gynecologist, who will monitor the behavior of the tumor. Observation tactics can be chosen only if fibroids do not show any signs and do not cause discomfort.

The doctor will periodically refer the patient for ultrasound examinations to assess the size of the formation. Such actions are necessary to take timely necessary measures in case education begins to grow rapidly.

Most fibroids dissolve on their own after the onset of menopause or simply become very small.

When is conservative treatment indicated?

Conservative therapy is used for small fibroid nodes (less than 6 cm or 12 weeks of pregnancy).

The goal of conservative therapy is to prevent further growth of the tumor, activate the reduction of its size and prevent possible myomatous complications.

Typically, indications for conservative antimyoma therapy are the following factors:

• Small node sizes;
• Absence of pronounced clinical manifestations such as unpreventable bleeding or unbearable pain;
• If there are contraindications to surgical treatment.

In addition, conservative therapy is quite appropriate if the fibroid does not exert compression on adjacent urinary or intestinal structures and does not interfere with conception.

Medicines for uterine fibroids

Conservative treatment for fibroids is based on taking the following groups of medications:

1. Medications that help reduce the severity of clinical manifestations. These include hormonal drugs, anti-inflammatory and fortified drugs, intrauterine device;
2. Medicines that help reduce tumor size, which include Ulipristal, GnRH agonists, Fribristal, etc.

This approach to treatment helps to cope with pain, reduce bleeding and compensate for large blood losses by curing anemia, inducing artificial menopause and avoiding total removal of the uterine body.

But when choosing such therapy, it is worth considering that when the medication is finished, the original clinical picture will gradually return.

Anti-inflammatory

Treatment of fibroids with the use of anti-inflammatory non-steroidal drugs is additional.

Drugs like Wobenzym, Ibuprofen, Nimesil and the like help eliminate cramps and pain, and reduce the amount of intermenstrual and menstrual bleeding.

Such remedies are not a panacea and provide only temporary relief.

Hormone therapy

Since the fundamental etiological factor of uterine fibroids is hormonal imbalance, conservative treatment is based on hormone therapy, in which medications are prescribed that suppress the production of pituitary gonadotropic hormones.

In general, during antimyoma hormone therapy, COCs, antiprostagens and GnRH agonists, antigonadotropins, gestagens, etc. are prescribed.

Combined oral contraceptives

Drugs from the COC group are represented by various drugs produced on a hormonal basis.

Typically, the following combinations of hormonal substances are used to treat fibroids:

1. Desogestrel + Ethinyl estradiol. A similar combination occurs in drugs like Marvelon, Novinet or Mercilon;
2. Norgestrel + Ethinyl estradiol. The combination of these hormones is present in Regenidon and Ovidon;
3. Gestodenom + Ethinyl estradiol. These hormones are contained in Lindinet and Logest.

Taking these drugs helps stop uterine bleeding and pain in the lower abdomen. As for the reduction of nodes, in practice it is possible to achieve a similar effect with the help of combined oral contraceptives only in cases where the size of the formations does not exceed 15 mm.

Therefore, this group of medications is not a priority in the treatment of fibroids.

GnRH agonists

Drugs from the group of gonadotropin-releasing hormone agonists cause an artificial onset of menopause, which is achieved by inhibiting the production of gonadotropin hormones. The amenorrhea that occurs in this case is reversible, because it is temporary and ceases after discontinuation of therapy with GnRH agonists.

Among the drugs in this group, hormone-based drugs such as:

1. Triptorelin (drugs Decapeptyl, Diferelin and Decapeptyl-depot). The drugs are administered subcutaneously once a day for a month;
2. Goserelin (found in Zoladex). The drugs are injected subcutaneously or deeply intramuscularly into areas of the body such as the abdomen, buttocks or shoulders;
3. Nafarelin (endonasal spray Sinarel);
4. Buserelina. The drug is available in the form of a nasal spray;
5. Leuprorelin. The substance is present in the base of the drug Lucrin-depot. This medication is produced in powder form for the preparation of an injection suspension.

When treated with drugs of this group, patients experience adverse reactions caused by estrogen deficiency, such as hot flashes and decreased libido, demineralization of bone tissue, lability and frequent depressive disorders. To eliminate side effects, experts often recommend using various therapeutic tactics such as interval, add-back, drop-back, on-off.

In general, GnRH agonists are considered effective in the treatment of fibroid processes. In case of large formations, they help to reduce the nodes, which facilitates surgical treatment, allowing for organ-sparing surgery.

Antiprogestogens

Among the drugs in this group, Mifepristone is especially famous.

This medication is usually used to perform a medical abortion if the pregnancy is less than 9 weeks.

The use of this drug in myomatous processes provokes short-term tumor regression and relieves the symptomatic picture.

Therefore, antiprogestogen therapy is often used for the preoperative stage of treatment.

Antigonadotropins

This group of drugs is usually used in cases where other drugs are useless.

The main representatives of this group are products based on active ingredients such as:

1. Danazol. Based on it, drugs like Danogen, Danol, Verodanazol or Danazol are produced;
2. Gestrinone (drug Nemestran).

These medications are used quite rarely, since they only smooth out the clinical manifestations of fibroids, however, they do not in any way affect the size of the nodes. Side effects of antigonadotropic therapy include changes in voice tone, increased hair growth, or excessive acne.

Gestagens

This group of medications is considered effective and affordable, because the cost of such drugs is relatively low. The action of progestin drugs is aimed at blocking the production of estrogen hormones by the ovaries. But compared to GnRH antagonists, the severity of the effect of inhibition of hormonal activity is much lower.

Among the most common drugs are:

1. Norkolut;
2. Duphaston;
3. 17-OPK.

Of course, the use of gestagens does not fully justify the treatment, and in some patients, even after such therapy, a deterioration in their condition was observed with increased growth of nodes.

HRT-hormone replacement therapy

Such treatment helps alleviate menopausal symptoms, reduces the likelihood of heart pathologies, and prevents destructive changes in bones and atrophy of vaginal tissue.

The use of hormonal drugs in replacement therapy does not always make sense if the patient is in menopause. Usually at this time, tumor growth stops on its own without the use of any drugs. And if you take hormone-containing drugs, the reaction can become unpredictable.

Therefore, for menopausal patients, progestogens that have an antiproliferative effect, for example, Cliogest or Trisequence, are recommended as hormone replacement therapy.

Hormonal drugs

The use of hormonal therapy in the treatment of uterine fibroids is considered one of the frequently used therapeutic techniques.

Since the development of the tumor is based on estrogen excess and reduced progesterone activity, corrective hormonal therapy, which helps normalize hormonal status, ensures the reverse development of myomatous nodes.

Such treatment helps to reduce tumors, the main thing is that the therapy is selected individually, taking into account the characteristics of the patient’s condition.

But hormonal therapy should be carried out over a long course, which can last for six months or even several years. Oral contraceptives like Zhanin or Urozhestan, which are classified as combination drugs, are considered popular among doctors for uterine fibroids. These drugs are usually prescribed for small nodules (>15 mm).

If the formation is larger, then COCs can provoke the progression of nodes.

In addition, the use of these drugs is justified only for subserous and intramural myomatous formations, which are considered the most amenable to the therapeutic effects of drugs. Also, fibroids should not grow quickly or compress nearby structures, disrupting their activity.

Phytoestrogens

Sometimes, in the complex conservative treatment of uterine fibroids, phytoestrogens are used - prohormones of plant origin. These drugs are taken for quite a long time until complete recovery occurs.

Unlike some medications, addiction does not form to phytohormones, because they are perceived by the patient’s body as food.

Phytoestrogens are present in many herbal preparations as well as in cultivated foods, for example:

• In hops;
• Linen;
• Lentil;
• Red clover;
• Cohosh, etc.

Phytoestrogens are often used as an alternative to HRT when the patient cannot take medications for some reason.

Mirena intrauterine device

Often, for uterine fibroids, an intrauterine device is used. It does not affect the development of the fibroid node in any way, however, it can eliminate some specific manifestations of the pathology.

The Mirena spiral has a local effect; it releases the hormone levonorgestrel in minimal dosages, which reduces the amount of menstrual bleeding and helps relieve pain.

The spiral is installed for 5 years, while the patient’s general condition does not change, since this hormone is secreted only within the uterine body and does not have access to the circulatory system. The Mirena IUD also protects against unwanted conception without affecting fertility in any way.

Homeopathy

Some experts consider homeopathy as an alternative method for treating uterine fibroids, although not all gynecologists agree with this, because homeopathic medicines can help women with early detected tumors, and with advanced fibroids, taking these drugs is often pointless.

Complex antimyoma therapy often includes homeopathic medicines such as:

1. Cyclima;
2. Clairs;
3. Byzanne;
4. Mastodinona, etc.

From a safety point of view, homeopathic medicines are considered the most harmless, because they are not capable of negatively affecting the female body. Such preparations are produced from natural ingredients of natural origin.

In addition to the above remedies, other drugs are used in homeopathic antimyoma therapy, for example, Witch hazel, Canadian goldenseal, Sepia, Potassium carbonate, Gold hydrochloride, etc.

Other medicines

Other drugs are also used in the treatment of fibroids. For example, in case of uterine bleeding, which is considered typical for a myomatous tumor, they often resort to the drug Dicinon, which has a beneficial effect on the mucous tissue of the uterine body, normalizing blood clotting.

With medium-sized fibroids, the drug Genistril, which is a hormonal drug that blocks progesterone activity, often helps to reduce them.

Particularly popular among women are local treatments for fibroids, such as tampons and suppositories for vaginal and rectal use. These are suppositories based on calendula, propolis, sea buckthorn, Fithoraxin suppositories containing celandine extract are also popular.

Vitamins

Myomatous processes in the uterine body are often accompanied by uterine bleeding, and quite profuse bleeding, as a result of which persistent iron deficiency anemia develops. Therefore, when treating fibroids, vitamin therapy is additionally prescribed.

A woman with fibroids needs vitamin K, which helps increase blood clotting. Since frequent bleeding provokes iron deficiency, it is necessary to take medications containing this trace element.

Equally important for a patient undergoing treatment for uterine fibroids is vitamin E (which significantly affects hormonal status), folic acid and B vitamins.

In addition, the use of the herbal preparation Estrovel, which contains phytohormones, plant extracts, amino acids and vitamins, is indicated. The drug helps normalize hormonal levels and the menstrual cycle, reduces blood loss and prevents the development of anemia.

Latest drug treatment research

In the spring of 2014, the Gedeon Richter company presented its newest drug, which many consider a breakthrough in the conservative treatment of myomatous processes in the uterus.

This medication is Esmya - an antigestagenic hormonal drug.

The duration of therapy with Esmya generally takes 8 months: 3 months - 1st course, then 2 months - break, then 3 months - 2nd course. The daily dosage is determined by the doctor.

The main substance of the drug is Ulipristal, a substance that inhibits progesterone receptors. The components of the drug suppress the division of myomatous cell structures, which leads to their destruction.

In addition, under the influence of the drug, the intensity of blood circulation in the uterine body decreases, and, therefore, blood loss due to uterine bleeding, which allows the use of Esmya in preoperative therapy.

Which method of contraception to choose if there are diseases of the woman’s genital area, such as fibroids, ovarian cysts or endometriosis. Condoms and spermicidal vaginal creams, tablets, suppositories are acceptable in such cases. What about the use of hormonal drugs?

Hormonal contraception and its mechanism of action in endometriosis

A disease in which the cells of the inner lining of the uterus, for various reasons, find themselves outside its cavity (uterine muscle, tubes, ovaries, cervix) is called endometriosis. Under the influence of hormones produced by the ovaries, the inner uterine layer changes periodically every menstrual cycle. For this, the uterus has all the conditions.
When such processes occur in other organs, pain appears. It is the main manifestation of endometriosis. Therefore, if you remove significant fluctuations in the level of ovarian hormones, the pain will go away. Hormonal contraceptives do just that.
They prevent the egg from maturing and reaching the surface of the ovary, which is when the most intense production of hormones occurs. Therefore, hormonal drugs, such as contraception for endometriosis, are not only not prohibited, but are also specifically prescribed to eliminate the symptoms of the disease. They do not eliminate endometriotic lesions, but with long-term use they do not allow them to develop again.

Types of hormonal contraceptives for endometriosis

Possible contraception with hormones for fibroids

Uterine fibroids, in which benign growth of its muscle layer occurs, have become significantly “younger.” The surgical method was previously one of the main methods in its treatment. According to the principle: no organ – no disease. The operation “for the company” also resolved issues of protection. When fibroids are detected in young, sexually active patients planning to give birth, removal of the uterus is not the best means of contraception.

The growth of myomatous nodes is stimulated by progesterone, and estrogens play a supporting role. You can stop the growth of fibroids if you bind the receptors intended for progesterone, similar in structure, but different in properties, to the progestogen contained in contraceptives. Contraception for fibroids using hormonal pills and the Mirena system is permitted. In addition to its protective properties, it has a number of therapeutic and prophylactic properties:

• stops the growth of myomatous nodes with a diameter of up to 1.5 cm,
• promotes the reverse development of nodes with a diameter of less than 1 cm,
• eliminates premenstrual pain,
• reduces the duration of menstruation and the amount of blood lost.

From a number of contraceptive pills used for fibroids, combined and monophasic are chosen. What this means was discussed earlier. The Mirena system should not be used if fibroid nodes grow into the uterine cavity. Tablets, like Mirena, do not cure fibroids, but can be used for this pathology. In many cases, they alleviate or eliminate the symptoms characteristic of the disease.

Copper-containing devices and intrauterine systems with progesterone are not indicated for patients with fibroids. For the purpose of protection, it is possible to use barrier methods. These include condoms, cervical caps, and vaginal diaphragms. Without restrictions, in the absence of allergies, spermicides are used.

What contraception is applicable for ovarian cysts

Hormonal medications to prevent pregnancy are not applicable for all types of ovarian cysts. But it is known for sure that functional cysts and birth control pills are compatible. Follicular and corpus luteum cysts are functional. The first ones grow if the vesicle in which the egg matures does not rupture in due time. And the latter are formed from the yellow body that appears after its rupture.

Disturbances in the functioning of the ovaries, leading to improper production of hormones, cause the growth of such cysts. They can go away on their own, but if this does not happen within 2-3 cycles, then you should take birth control pills. They are scientifically called COCs (combined oral contraceptives). If such contraception is used for 3 or more months for an ovarian cyst, which is functional, then the process of its resorption is accelerated.

The use of COCs treats existing cysts and prevents the appearance of new cysts, as it normalizes and equalizes hormonal levels. The use of tablets for other types of cysts should be discussed with your doctor, making sure that they are not malignant. And, of course, they should not be large in diameter.

Barrier contraception has no restrictions for cysts. Spirals containing copper, the Mirena system, can be used, but after clarifying the nature of the cyst and medical approval.

Restrictions and prohibitions for the use of hormonal contraceptives

No matter how many advantages of hormonal drugs are listed, contraception for nodular fibroids, endometriosis and ovarian cysts involves certain contraindications:

• smoking after 35 years of age
• arterial hypertension
• bleeding from the uterus for unknown reasons
• liver diseases in the acute phase
• cases of blood clots in deep veins
• severe diabetes mellitus
• malignant neoplasms

For ovarian cysts, fibroids, and enometriosis, emergency oral contraception is contraindicated due to the high content of hormones in this pharmacological group of drugs.

With age, the risk of developing uterine fibroids increases. They are often identified after forty years. But this does not mean that it cannot develop in young women. Therefore, regular observation by a gynecologist is a very important component of disease prevention. Therapy for timely identified uterine pathology is reduced to treating fibroids with hormonal contraceptives.

Uterine fibroids (also known as fibroids or leiomyomas) are benign neoplasms that arise inside the muscular layer of the uterus - the myometrium. It is considered one of the most common female pathologies. The frequency of occurrence reaches a quarter of all cases of identified gynecological diseases.

The highest risk of developing fibroids is observed in women in the late reproductive and premenopausal periods. We can say that this is a group of women over the age of 45.

A myomatous node is a cluster of smooth muscle fibers that are closely intertwined. It looks like a round formation. In most cases, it reaches a size of no more than a couple of centimeters, however, in some cases, it can grow profusely and weigh more than a kilogram.

Science knows of a case when a knot reached sixty kilograms in weight.

Doctors distinguish the following types of uterine fibroids:

1. Submucosal;
2. Subserous;
3. Intramural.

Oral contraceptives

This group of medications is also called oral contraceptives because they are taken orally, that is, they need to be drunk. They are the most convenient drugs to use.

Today, modern medical products of this class are presented in the form of combined oral contraceptives (COCs) and single-component drugs.

They contain certain female sex hormones that can have different effects on a woman’s body.

Mechanism of action

Their action is reduced to suppressing the secretion of gonadotropic hormones by the pituitary gland, inhibiting folliculogenesis (the process of follicle formation) and suppressing ovulation. Thus, they prevent the development and release of the egg.

Due to the presence of negative feedback from the entry of progestin into the body, there is a suppression of the frequency of release of a hormone such as GnRH, which is produced by the hypothalamus.

Thus, the use of oral contraceptives leads to a decrease in the production of follicle-stimulating and luteinizing hormones by the adenohypophysis. In this regard, there is a decrease in the production of estradiol, and this leads to a disruption in the formation of follicles.

The presence of progestin negative feedback and the absence of positive feedback from the production of luteinizing hormone (LH) leads to suppression of the peak production of LH in the middle of the ovulatory cycle. The combination of these components leads to the suppression of follicle formation and blocks the ovulation process.

In addition to providing protection for sexual intercourse, these products are used as emergency postcoital contraceptives and abortifacients.

What other methods are there to prevent pregnancy?

For girls and even women, it is imperative to provide information about the availability of all possible methods of contraception. Today such protection methods are:

• combined oral contraceptives;
• contraceptive injections for women;
• sterilization;
• intrauterine contraceptives (for example, intrauterine devices);
• hormonal patches;
• barrier means (they are the most well-known non-hormonal contraceptives for the population) - condoms, diaphragms, caps, sponges;
• calendar methods;
• method of interrupted coitus.

Before using contraceptives, you should consult a gynecologist. An incorrectly selected drug can significantly harm your health.

How to protect yourself and which method to choose depends on the woman’s desire.

Hormonal contraceptive pills for uterine fibroids

Hormonal birth control pills not only help protect against unwanted pregnancy, but are also directly used to treat tumors.

The use of drugs in the treatment of fibroids began in the 60s. Contraceptives for women contain hormones identical to natural hormones.

There are monophasic and polyphasic agents.

Hormonal substances entering the body lead to the fact that the production of its own hormones becomes unclaimed. When the medications are discontinued, a cascade of hormonal reactions is restarted and everything falls into place.

Hormonal drugs are good ways to normalize the ovulatory cycle and influence a woman’s health. At the same time, contraceptive pills are used for nulliparous women with the same frequency as for women who have given birth. They are often prescribed to stimulate reproductive function or restore it.

The use of drugs from the group of contraceptives for uterine fibroids allows you to stop its growth in the early stages and completely eliminate it. Such drugs are also called drugs that resolve fibroids.

In addition, these drugs are indicated to be taken after removal of fibroids.

Which birth control pills are best to take for uterine fibroids?

The situation with hormonal contraceptives is the same as, for example, with technology: the newer the drug, the better the effect. If the drugs that existed before gave a good effect, but led to specific negative consequences (and this is not only obesity), then the new generation of drugs does not lead to this. Yes, yes, they don’t make you fat!

As already mentioned, there are two groups of hormonal contraceptives. The first is drugs from the group of combined oral contraceptives (COCs). The second includes monocomponent drugs, also known as “mini pills”.

Based on the name, it becomes clear that the first group contains two hormones, and the second group contains one.

Here are the most common remedies from each group.

Combined contraceptives include:

• Janine (a combination of Ethinyl estradiol and Dienogest);
• Median (combining Drospirenone and Ethinyl estradiol);
• Novinet (Ethinyl estradiol and Desogestrel);
• Rigevidon (a combination of Ethinyl estradiol and Levonorgestrel);
• Silhouette (Dienogest and Ethinylestradiol are combined) and others.

Monophasic drugs include:

• Charosetta;
• Micronor;
• Continuin and others.

Separation of COCs by dosage

This group of drugs, depending on the dose of the active substance they contain, is divided into three groups:

• microdosed;
• low-dose;
• highly dosed.

But there are cases when, depending on the dose, one drug may belong to different groups, for example Mifepristone 50 mg, 200 mg, 10 mg. It is the dosage of 50 mg that is used in the treatment of uterine fibroids.

Birth control pills for uterine fibroids after 40

At this age, a woman’s reproductive function begins to fade. She begins to have problems with the ovulatory cycle, menstruation becomes irregular, hot flashes, sweating and other symptoms characteristic of menopause occur. This indicates the imminent onset of menopause.

It turns out that there is no point in taking contraceptives for such women? Not at all. Their use, on the contrary, is recommended by many doctors. In this way, a woman not only protects herself from pregnancy, but also significantly improves her health.

The use of such drugs allows:

1. Reduce the likelihood of tumors;
2. Normalize the menstrual cycle;
3. Get rid of the symptoms of premenstrual syndrome;
4. Reduce pain during menstruation.

The age of entering menopause is highly individual, but most often it occurs after forty-five years. Smoking, alcohol abuse, the influence of negative environmental factors, unhealthy lifestyle, and genetic factors can “rejuvenate” menopausal age.

Contraceptives for uterine fibroids and endometriosis

Endometriosis is the abnormal growth of the endometrium, both in the organs of the reproductive system and beyond.

The main cause of the development of endometriosis, as well as uterine fibroids, is an imbalance of female sex hormones. This suggests that using hormonal contraceptives for these pathologies is not only possible, but necessary.

The selection of necessary medications is carried out by a gynecologist individually for each woman. Before this, you must undergo a gynecological examination and pass the tests necessary to determine your hormonal status.

Patients who have been prescribed such medications need to take them systematically and be regularly monitored by a gynecologist.

Contraindications for use

Taking hormonal contraceptives is prohibited if you have:

• venous thrombosis or the risk of its development;
• coronary heart disease;
• diseases of the blood coagulation system;
• severe hypertension;
• pathologies of heart valves;
• cardiac conduction disorders;
• diabetes mellitus;
• liver diseases;
• lactation in the postpartum period.

In fact, the list of contraindications is much wider. The article shows only the main ones. To obtain detailed information about contraindications to the use of oral contraceptives, you should contact your gynecologist.

Important! Alcohol and oral contraceptives are incompatible things. The same as smoking when using hormonal methods of contraception.

Hormonal contraception has entered human life relatively recently. Despite this, they quickly proved their effectiveness. Today they are used as one of the main methods of preventing unwanted pregnancy.

However, do not forget that there are also contraceptives for men.

Hormonal contraceptives are widely used in the treatment of uterine fibroids. Moreover, they are the main and safest modern method of treating them.

Kiev City Center for Reproductive and Prenatal Medicine

Vinnytsia National Medical University named after. N.I. Pirogov

Summary. The paper examines the possibility of using combined oral contraceptives Novinet and Regulon, containing desogestrel, for uterine fibroids in combination with endometrial hyperplastic processes.

It is emphasized that the fundamental mechanism of the therapeutic effect of COCs on uterine fibroids and hyperplastic processes, as well as the prevention of this disease, is based on etiopathogenetic theories of the occurrence of uterine fibroids. Of course, there is interest in drugs that, in minimal doses, can have a beneficial effect on the endometrium and have pronounced antiproliferative effects. It has been shown that the drugs Novinet and Regulon can be used not only as contraceptives, but also as agents that have a pronounced therapeutic and preventive effect on fibroids and hyperplastic processes in the endometrium.

Key words: uterine fibroids, endometrial hyperplastic processes, therapy, combined oral contraceptives, Novinet, Regulon.

Introduction

Very often, endometrial hyperplastic processes are combined with uterine fibroids. This is due, first of all, to the fact that hormonal disorders play an important role in the pathogenesis of uterine fibroids and precancerous conditions of the endometrium. The traditional opinion about the leading role of estrogens in the pathogenesis of uterine fibroids is confirmed by data from many researchers. Estrogens are considered to be the main stimulators of leiomyoma growth.

In recent years, the progesterone theory has gained many supporters, according to which progesterone plays a key role in initiating a cascade of molecular genetic disorders that occur during tumor development, and, together with E2, is a physiological regulator of this process. During the follicular phase, estrogens increase the expression of genes that are normally active in the myometrium during pregnancy. An increase in myometrial mass can occur both due to hyperplasia of smooth muscle cells (SMC), which is initiated by estrogens, and due to the hypertrophy of these cells. However, the process of hypertrophy of SMCs, similar to the process of their hypertrophy during pregnancy, can occur with the combined effect of relatively high concentrations of estradiol and progesterone. In the luteal phase, progesterone increases the mitotic activity of fibroids, especially in young women.

It is generally accepted that hyperplastic changes in the endometrium arise as a result of a violation of neuroendocrine regulation, as a result of which the ratio of gonadotropic and sex hormones changes dramatically. The formation of endometrial hyperplasia is based on a violation of ovulation, which occurs as persistence of follicles or their atresia.

Endometrial hyperplasia and fibroids develop in women of a certain type, who experience long periods of hyperestrogenism throughout their lives due to disruption of the hypothalamic-pituitary regulation. Some authors identify a variant of glandular endometrial hyperplasia, which occurs against the background of low levels of estrogenic hormones, but with prolonged exposure to the endometrium. In this case, proliferative processes in the glands and stroma are weakly expressed.

To carry out effective treatment, it is necessary to study in detail the dynamics of the hyperplastic process and uterine fibroids. Among the numerous existing methods for diagnosing endometrial pathology, the most reliable and objective is histological examination of scrapings of the mucous membrane of the cervical canal and uterine cavity obtained during separate diagnostic curettage.

Examination of women with this pathology is carried out according to the clinical protocol for obstetric and gynecological care (order No. 676). The main method of screening and monitoring the condition before fractional diagnostic curettage of the endometrium is transvaginal ultrasound examination (Clinical protocols for obstetric and gynecological care, order No. 676). This method allows you to assess the thickness of the endometrium, its structure, the topography of the uterine cavity, the presence of concomitant pathology of the myometrium, the anatomical features of the uterine appendages, and calculate the index of the ratio of endometrial thickness to the anterior-posterior size of the uterus.

Cytomorphological, histochemical, endoscopic, ultrasound, X-ray and radioisotope research methods make it possible to determine early signs of endometrial malignancy even before the appearance of pathomorphological changes and clinical symptoms of the disease. These methods have great diagnostic value and make it possible to determine the effectiveness of the treatment.

When choosing treatment methods, the clinician is primarily guided by the data of histological examination of endometrial scraping. Fractional curettage is of great importance during subsequent hormone therapy, and also helps remove pathologically altered mucosa. This method is most valuable in combination with hysteroscopy.

The introduction of hormonal drugs into clinical practice has opened up new possibilities for the prevention and treatment of patients with uterine pathology. Treatment tactics depend on the size and location of the nodes, the results of histological examination, the characteristics of histogenesis (simple or proliferating fibroids), symptoms, age, reproductive plans, well-being of the patient and is individual in nature.

Traditionally, conservative treatment was based on temporary inhibition of ovarian function, that is, reproduction of drug-induced menopause and/or induction of hypoestrogenism. Drugs used as conservative therapy for fibroids and hyperplastic processes of the uterus are antigonadotropins and gonadotropic releasing hormone agonists (GnRH), androgen derivatives and gestagens. Based on the progesterone theory of the development of uterine fibroids, treatment with only pogesterone derivatives may not always be effective. Good results have been obtained with the use of GnRH agonists, however, this group of drugs has a number of contraindications (for example, osteoporosis), which limits their use in general or over time (3–6 months), since their use for more than 6 months is inappropriate due to the appearance of significant side effects. It has been proven that in women of reproductive age, fibroid growth resumes 3–12 months after the end of therapy. After GnRH therapy, there is a need to stabilize the achieved therapeutic effect and prevent relapses in the growth of uterine fibroids and hyperplastic processes.

According to a number of studies, long-term use of low and micro-dose combined oral contraceptives (COCs) not only has a stabilizing effect on the development of fibroids after therapy with basic drugs, but also exhibits a significant preventive effect on relapses of uterine fibroid growth.

The fundamental mechanism of the therapeutic effect of COCs on uterine fibroids, endometrial hyperplastic processes and the prevention of these conditions is based on etiopathogenetic theories of their occurrence. With proper use of oral contraceptives, a woman is guaranteed not to experience such a phenomenon as abortion. In this way, another pathogenetic factor in the development and growth of uterine fibroids and the development of hyperplastic processes is removed. There is also ample evidence that COCs reduce the risk of developing endometrial cancer, hyperplastic processes, uterine fibroids and ovarian cancer.

The type of progestin included in the preparations is also important. It is known that all progestins are capable of binding to progesterone receptors to one degree or another, and there are a number of differences between them (for example, affinity for progesterone receptors and the value of the antiproliferative index - the direct effect of progestins on the endometrium). Of course, there is interest in drugs that, in minimal doses, can have a beneficial effect on the endometrium, having pronounced antiproliferative properties.

As can be seen from the data in table. 1, the minimum doses required to suppress endometrial transformation are characteristic of desogestrel, which has been confirmed by numerous clinical studies.

Desogestrel is the latest generation progestin, which is included in COCs such as Novinet and Regulon. Desogestrel, a derivative of levonorgestrel, is metabolized into the active component 3 ketodesogestrel, which has unique selectivity for progesterone receptors with high progesterone activity, blockade of androgen receptors (antiandrogenic effect) and gonadotropins.

These properties explain the effectiveness of using Novinet and Regulon for fibroids and hyperplastic processes (in the absence of contraindications). It has been proven that the administration of the drugs Novinet and Regulon for therapeutic and prophylactic purposes is more effective in the early reproductive age for simple fibroids and the initial size of the nodes is not more than 2 cm. In addition, while taking these drugs, the rudiments of fibroid growth, determined by ultrasound, do not develop.

Immunohistochemical studies have confirmed that the drugs Novinet and Regulon are capable of regulating processes in the hypothalamic-pituitary system and target organs (uterus, ovaries), normalizing the ratio of FSH/LH, estradiol and progesterone (the central mechanism of action), and directly blocking progesterone receptors in the myomatous node. It is also necessary to take into account the correlation between the dose that suppresses transformation and the degree of affinity of different progestins for progesterone receptors in the uterine cavity (Tables 1, 2). Thus, for the metabolite of desogestrel (3 ketodesogestrel), the dose of endometrial transformation is 2 mg/cycle at 130% degree of affinity for progesterone receptors (for levonorgestrel - 120%), for dienogest the dose of endometrial transformation is 6 mg/cycle at 5% affinity, and for drospirenone - 50 mg/cycle.

We examined 57 patients with uterine fibroids (node ​​sizes up to 2 cm), which were combined with hyperplastic processes. The age of the patients ranged from 30 to 38 years (average - 36±0.5 years).

Along with clinical and anamnestic research methods, the complex of diagnostic measures included echographic examination, Doppler ultrasound, color Doppler mapping (CDC) of the pelvic organs; separate diagnostic curettage of the walls of the uterine cavity, study of gonadotropic (LH, FSH), steroid (E2, P) hormones.

An echographic examination in combination with color Dopplerography and pulsed Doppler ultrasound was carried out using Radmirultima ultrasound machines.

Ultrasound examination was carried out in the second phase with a preserved menstrual cycle using transabdominal access with a convex probe with a frequency of 3.5–5 MHz and using transvaginal access with a convex probe with a frequency of 2–7 MHz. The size of the uterus, size, structure, number and location of nodes, the condition of the endometrium and ovaries were assessed.

CDC was performed in the area of ​​the vascular bundles of the uterus on both sides, the state of the myometrium was also examined, the nature of the blood flow (arterial or venous), the localization of intratumoral blood flow (central or peripheral), the resistance index in the myomatous nodes, and the maximum velocity of arterial and venous blood flow were determined.

All patients, after excluding contraindications, underwent complex conservative treatment of uterine fibroids and endometrial hyperplasia with GnRH agonists for 3 months. Considering the risk of developing osteoporosis and symptoms characteristic of “medication-induced menopause,” further treatment to prevent relapses of hyperplastic processes was carried out using COCs.

Myomatous nodes (single or multiple) had intramural or intramural-subserous localization and sizes from 1 to 2 cm in diameter, which was determined by echography.

Taking into account the CDC data, a group of patients of 40 (70.18%) women with simple uterine fibroids and a group of patients of 17 (29.82%) people with proliferating uterine fibroids were identified. The subjects were identified with myomatous nodes (single or multiple), which had an intramural or intramural subserous localization and dimensions of 1–2 cm in diameter,

which was determined echographically.

During CDK in patients with a simple form of fibroids, a different number of color signals were noted along the periphery of the myomatous node, along the circumflex vessels, with no or single signals in the center.

In this case, the average maximum systolic velocity of arterial blood flow in the circumflex vessels was 17.1±1.4 cm/s, and the average resistance index in the myomatous nodes was 0.70±0.04. In patients with proliferating uterine fibroids, intense intratumoral blood flow was recorded. The maximum systolic velocity of arterial blood flow was 26.9±3.4 cm/s, the maximum velocity of venous blood flow in the nodes was 11.7±1.3 cm/s, the resistance index in the myomatous nodes was 0.47±0.04.

In all patients, to assess the functional state of the GGJ and hormonal homeostasis, the concentrations of FSH, LH, estradiol and progesterone were studied before treatment and after 6 months. after its completion (Table 3).

The data presented indicate that patients with uterine fibroids and endometrial hyperplasia before treatment had manifestations of hyperestrogenism against the background of a progesterone deficiency state, caused by an increase in FSH content and a decrease in the LH/FSH ratio.

In a morphological study of the endometrium, the proliferation phase was observed in 7 women, glandular hyperplasia - in 21, and glandular-cystic hyperplasia - in 29.

All 57 women underwent diagnostic curettage of the uterine cavity or hysteroscopy followed by morphological examination of the material. Subsequently (after using GnRH), in the absence of contraindications and taking into account the need of women to choose a method of contraception, patients were prescribed Novinet and Regulon. These drugs were prescribed with the aim of stabilizing myomatous nodes up to 2 cm in diameter, normalizing the ovariomenstrual cycle in hyperpolymenorrhea, and achieving therapeutic and preventive effects on the endometrium within 1 year.

During the study, the tolerability of Novinet and Regulon was assessed as good. Clinical manifestations before taking the drugs in the form of polymenorrhea were observed in 34 patients.

During the course of therapy using Novinet or Regulon, all patients noted a decrease in the number of menstrual days (up to 3) and, accordingly, blood loss decreased by 62%, for which a visual assessment of bleeding was used, proposed by Jansen (filling out visual tables with counting the number of used tampons and pads on different days of menstruation). After 6 months the average duration of menstrual days was 2.12±0.42.

The size of myomatous nodes was monitored every 6 months of treatment. The average number of nodes at the beginning of treatment reached 3.7±1.2 formations, and the average size was 1.6±0.6 cm. After 3 months from the start of treatment, the average number of myomatous nodes did not change, but their average size decreased to 1. 4±0.5 cm (p>

fetalmedic.com

Medicine. Treatment. Health. MedExpert

The use of combined oral contraceptives for endometrial hyperplastic processes and uterine fibroids

Date: 2010/9/28 | Section: Women's health

A.A. Protsepko, Yu.N. Melnik, D.G. Konkov

Summary. The paper examines the possibility of using combined oral contraceptives Novinet and Regulon, containing desogestrel, for uterine fibroids in combination with endometrial hyperplastic processes. It is emphasized that the fundamental mechanism of the therapeutic effect of COCs on uterine fibroids and hyperplastic processes, as well as the prevention of this disease, is based on etiopathogenetic theories of the occurrence of uterine fibroids. Of course, there is interest in drugs that, in minimal doses, can have a beneficial effect on the endometrium and have pronounced antiproliferative effects. It has been shown that the drugs Novinet and Regulon can be used not only as contraceptives, but also as agents that have a pronounced therapeutic and preventive effect on fibroids and hyperplastic processes in the endometrium.

Summary. The possibility of using combined oral contraceptives Novinet and Regulon to replace desogestrel is being considered for uterine fibroids associated with hyperplastic endometrial processes. It is agreed that the principle mechanism of the therapeutic effect of COCs on uterine fibroids and hyperplastic processes, as well as the prevention of illness, is based on etiopathogenetic theories of the culprit of uterine fibroids. Of course, there is interest in drugs that, in minimal doses, have a positive effect on the endometrium, exhibiting a significant antiproliferative effect. It has been shown that the drugs Novinet and Regulon can be used only in the context of contraceptives, and also as a way to exhibit therapeutic and preventive effects in fibroids and hyperplastic processes in the endometrium.

Summary. In the work is considering the possibility of using combined oral contraceptives of Novinet and Regulon containing desogestrel, at uterine fibroids in combination with hyperplastic processes of endometrium. It is underlined that the principal mechanism of therapeutic effect of COC on uterine fibroids and hyperplastic processes, and also preventive maintenance of this disease, is based on etiopathogenetic theories of uterine fibroid occurrence. Certainly, attracts interest preparations which in the minimum doses are capable of rendering beneficial effects on endometrium, possessing expressed anti-proliferative actions. It is shown that applications Novinet and Regulon can be used not only as contraceptives, and as the agent, having expressed medical and phylactic effects at fibroids and hyperplastic processes in endometrium.

Introduction Very often, endometrial hyperplastic processes are combined with uterine fibroids. This is due, first of all, to the fact that hormonal disorders play an important role in the pathogenesis of uterine fibroids and precancerous conditions of the endometrium. The traditional opinion about the leading role of estrogens in the pathogenesis of uterine fibroids is confirmed by the data of many researchers. Estrogens are considered to be the main stimulators of leiomyoma growth. In recent years, the progesterone theory has gained many supporters, according to which progesterone plays a key role in initiating a cascade of molecular genetic disorders that occur during tumor development, and, together with E2, is a physiological regulator of this process. During the follicular phase, estrogens increase the expression of genes that are normally active in the myometrium during pregnancy. An increase in myometrial mass can occur both due to hyperplasia of smooth muscle cells (SMC), which is initiated by estrogens, and due to the hypertrophy of these cells. However, the process of hypertrophy of SMCs, similar to the process of their hypertrophy during pregnancy, can occur with the combined effect of relatively high concentrations of estradiol and progesterone. In the luteal phase, progesterone increases the mitotic activity of fibroids, especially in young women. It is generally accepted that hyperplastic changes in the endometrium arise as a result of a violation of neuroendocrine regulation, as a result of which the ratio of gonadotropic and sex hormones changes dramatically. The formation of endometrial hyperplasia is based on a violation of ovulation, which occurs as persistence of follicles or their atresia. Endometrial hyperplasia and fibroids develop in women of a certain type, who experience long periods of hyperestrogenism throughout their lives due to disruption of hypothalamic-pituitary regulation. Some authors identify a variant of glandular endometrial hyperplasia, which occurs against the background of low levels of estrogenic hormones, but with prolonged exposure to the endometrium. In this case, proliferative processes in the glands and stroma are weakly expressed. To carry out effective treatment, it is necessary to study in detail the dynamics of the hyperplastic process and uterine fibroids. Among the numerous existing methods for diagnosing endometrial pathology, the most reliable and objective is histological examination of scrapings of the mucous membrane of the cervical canal and uterine cavity obtained during separate diagnostic curettage. Examination of women with this pathology is carried out according to the clinical protocol for obstetric and gynecological care (order No. 676). The main method of screening and monitoring the condition before fractional diagnostic curettage of the endometrium is transvaginal ultrasound examination (Clinical protocols for obstetric and gynecological care, order No. 676). This method allows you to assess the thickness of the endometrium, its structure, the topography of the uterine cavity, the presence of concomitant pathology of the myometrium, the anatomical features of the uterine appendages, and calculate the index of the ratio of endometrial thickness to the anterior-posterior size of the uterus. Cytomorphological, histochemical, endoscopic, ultrasound, X-ray and radioisotope research methods make it possible to determine early signs of endometrial malignancy even before the appearance of pathomorphological changes and clinical symptoms of the disease. These methods have great diagnostic value and make it possible to determine the effectiveness of the treatment. When choosing treatment methods, the clinician is primarily guided by the data of histological examination of endometrial scraping. Fractional curettage is of great importance during subsequent hormone therapy, and also helps remove pathologically altered mucosa. This method is most valuable in combination with hysteroscopy. The introduction of hormonal drugs into clinical practice has opened up new possibilities for the prevention and treatment of patients with uterine pathology. Treatment tactics depend on the size and location of the nodes, the results of histological examination, the characteristics of histogenesis (simple or proliferating fibroids), symptoms, age, reproductive plans, well-being of the patient and is individual in nature. Traditionally, conservative treatment was based on temporary inhibition of ovarian function, that is, reproduction of drug-induced menopause and/or induction of hypoestrogenism. Drugs used as conservative therapy for fibroids and uterine hyperplastic processes are antigonadotropins and gonadotropin-releasing hormone agonists (GnRH), androgen derivatives and gestagens. Based on the progesterone theory of the development of uterine fibroids, treatment with only pogesterone derivatives may not always be effective. Good results have been obtained with the use of GnRH agonists, however, this group of drugs has a number of contraindications (for example, osteoporosis), which limits their use in general or over time (3–6 months). ), since taking them for more than 6 months is not advisable due to the appearance of significant side effects. It has been proven that in women of reproductive age, fibroid growth resumes 3–12 months after the end of therapy. After GnRH therapy, there is a need to stabilize the achieved therapeutic effect and prevent relapses in the growth of uterine fibroids and hyperplastic processes. According to a number of studies, long-term use of low- and micro-dose combined oral contraceptives (COCs) not only has a stabilizing effect on the development of fibroids after therapy with basic drugs, but also exhibits a significant preventive effect against relapses of uterine fibroid growth. The fundamental mechanism of the therapeutic effect of COCs on uterine fibroids, endometrial hyperplastic processes and the prevention of these conditions is based on etiopathogenetic theories of their occurrence. With proper use of oral contraceptives, a woman is guaranteed not to experience such a phenomenon as abortion. In this way, another pathogenetic factor in the development and growth of uterine fibroids and the development of hyperplastic processes is removed. There is also ample evidence that COCs reduce the risk of developing endometrial cancer, hyperplastic processes, uterine fibroids and ovarian cancer. The type of progestin included in the preparations is also important. It is known that all progestins are capable of binding to progesterone receptors to one degree or another, and there are a number of differences between them (for example, affinity for progesterone receptors and the value of the antiproliferative index - the direct effect of progestins on the endometrium). Of course, there is interest in drugs that, in minimal doses, can have a beneficial effect on the endometrium, having pronounced antiproliferative properties.

As can be seen from the data in table. 1, the minimum doses required to suppress endometrial transformation are characteristic of desogestrel, which has been confirmed by numerous clinical studies. Desogestrel is the latest generation progestin, which is included in COCs such as Novinet and Regulon. Desogestrel, a derivative of levonorgestrel, is metabolized into the active component 3-ketodesogestrel, which has unique selectivity for progesterone receptors with high progesterone activity, blockade of androgen receptors (antiandrogenic effect) and gonadotropins. These properties explain the effectiveness of using Novinet and Regulon for fibroids and hyperplastic processes (in the absence of contraindications). It has been proven that the use of the drugs Novinet and Regulon for therapeutic and prophylactic purposes is more effective in early reproductive age with simple fibroids and the initial size of the nodes is not more than 2 cm. In addition, while taking these drugs, the rudiments of fibroid growth, determined by ultrasound, do not develop. Immunohistochemical studies have confirmed that the drugs Novinet and Regulon are capable of regulating processes in the hypothalamic-pituitary system and target organs (uterus, ovaries), normalizing the ratio of FSH/LH, estradiol and progesterone (central mechanism of action), and directly blocking progesterone receptors in the myomatous node . It is also necessary to take into account the correlation between the dose that suppresses transformation and the degree of affinity of different progestins for progesterone receptors in the uterine cavity (Tables 1, 2). Thus, for the metabolite of desogestrel (3-ketodesogestrel), the dose of endometrial transformation is 2 mg/cycle at 130% degree of affinity for progesterone receptors (for levonorgestrel - 120%), for dienogest the dose of endometrial transformation is 6 mg/cycle at 5% - om affinity, and for drospirenone - 50 mg/cycle.

The purpose of the study is to study the effect of desogestrel-containing COCs (Novinet and Regulon) in the combination of uterine fibroids (with node sizes up to 2 cm) and hyperplastic processes.

Material and research methods

We examined 57 patients with uterine fibroids (node ​​sizes up to 2 cm), which were combined with hyperplastic processes. The age of the patients ranged from 30 to 38 years (average - 36±0.5 years). Along with clinical and anamnestic research methods, the complex of diagnostic measures included echographic examination, Doppler ultrasound, color Doppler mapping (CDC) of the pelvic organs; separate diagnostic curettage of the walls of the uterine cavity, study of gonadotropic (LH, FSH), steroid (E2, P) hormones. An echographic examination in combination with color Dopplerography and pulsed Doppler ultrasound was carried out using Radmirultima ultrasound machines. Ultrasound examination was carried out in the second phase with a preserved menstrual cycle using transabdominal access with a convex probe with a frequency of 3.5–5 MHz and using transvaginal access with a convex probe with a frequency of 2–7 MHz. The size of the uterus, size, structure, number and location of nodes, the condition of the endometrium and ovaries were assessed. CDC was performed in the area of ​​the vascular bundles of the uterus on both sides, the state of the myometrium was also examined, the nature of the blood flow (arterial or venous), the localization of intratumoral blood flow (central or peripheral), the resistance index in the myomatous nodes, and the maximum velocity of arterial and venous blood flow were determined. All patients, after excluding contraindications, underwent complex conservative treatment of uterine fibroids and endometrial hyperplasia with GnRH agonists for 3 months. Considering the risk of developing osteoporosis and symptoms characteristic of “medication-induced menopause,” further treatment to prevent relapses of hyperplastic processes was carried out using COCs.

Research results and discussion

Myomatous nodes (single or multiple) had intramural or intramural-subserous localization and sizes from 1 to 2 cm in diameter, which was determined by echography. Taking into account the CDC data, a group of patients of 40 (70.18%) women with simple uterine fibroids and a group of patients of 17 (29.82%) people with proliferating uterine fibroids were identified. The subjects were identified with myomatous nodes (single or multiple), which had an intramural or intramural-subserous localization and sizes of 1–2 cm in diameter, which was determined by echography. During CDK in patients with a simple form of fibroids, a different number of color signals were noted along the periphery of the myomatous node, along the circumflex vessels, with no or single signals in the center. In this case, the average maximum systolic velocity of arterial blood flow in the circumflex vessels was 17.1±1.4 cm/s, and the average resistance index in the myomatous nodes was 0.70±0.04. In patients with proliferating uterine fibroids, intense intratumoral blood flow was recorded. The maximum systolic velocity of arterial blood flow was 26.9±3.4 cm/s, the maximum velocity of venous blood flow in the nodes was 11.7±1.3 cm/s, the resistance index in the myomatous nodes was 0.47±0.04. In all patients, to assess the functional state of the GGJ and hormonal homeostasis, the concentrations of FSH, LH, estradiol and progesterone were studied before treatment and after 6 months. after its completion (Table 3).

The data presented indicate that patients with uterine fibroids and endometrial hyperplasia before treatment had manifestations of hyperestrogenism against the background of a progesterone deficiency state, caused by an increase in FSH content and a decrease in the LH/FSH ratio. During a morphological study of the endometrium, the proliferation phase was observed in 7 women, glandular hyperplasia in 21 and glandular cystic hyperplasia in 29. All 57 women underwent diagnostic curettage of the uterine cavity or hysteroscopy, followed by a morphological examination of the material. Subsequently (after using GnRH), in the absence of contraindications and taking into account the need of women to choose a method of contraception, patients were prescribed Novinet and Regulon. These drugs were prescribed with the aim of stabilizing myomatous nodes up to 2 cm in diameter, normalizing the ovariomenstrual cycle in hyperpolymenorrhea, and achieving therapeutic and preventive effects on the endometrium within 1 year. During the study, the tolerability of Novinet and Regulon was assessed as good. Clinical manifestations before taking the drugs in the form of polymenorrhea were observed in 34 patients. During the course of therapy using Novinet or Regulon, all patients noted a decrease in the number of menstrual days (up to 3) and, accordingly, blood loss decreased by 62%, for which a visual assessment of bleeding was used, proposed by Jansen (filling out visual tables with counting the number of used tampons and pads on different days of menstruation). After 6 months the average duration of menstrual days was 2.12±0.42. The size of myomatous nodes was monitored every 6 months of treatment. The average number of nodes at the beginning of treatment reached 3.7±1.2 formations, and the average size was 1.6±0.6 cm. After 3 months from the start of treatment, the average number of myomatous nodes did not change, but their average size decreased to 1. 4±0.5 cm (p>0.05), and after 6 months - up to 1.2±0.4 cm (p

medexpert.org.ua

Treatment of uterine fibroids without surgery

Uterine fibroids are a benign neoplasm that occurs in the myometrium of the uterus. Most often, fibroids develop in young women under 50 years of age and are accompanied by heavy menstrual flow, cycle disruption and minor pain. Treatment of uterine fibroids can be conservative or surgical. Let's look at methods of drug treatment for uterine fibroids.

1. Conservative treatment of uterine fibroids

1. Treatment with androgen derivatives (anazole, gestrinone) to reduce the production of steroid hormones by the ovaries. This helps reduce tumors (fibroids). The course of treatment is 8 months (without a break).

2. The use of gestagens (duphaston, norkolut, utrozhestan) to prevent the growth of fibroids and normalize the endometrium.

3. Installation of the Mirena hormonal device containing levonorgestrel (gestagen). The spiral is installed for 5 years. Thanks to the constant release of hormones into the uterine cavity, the pathological process stops.

4. Use of oral contraceptives. This method of treatment with contraceptives (Yarina, Regulon) is suitable for small uterine fibroids.

Hormonal therapy has a positive effect, reducing the size of fibroids, but after stopping treatment there is a risk that the tumor will begin to grow at an accelerated pace.

Treatment of uterine fibroids with traditional methods

Modern medicine is wary of any kind of treatment of tumor processes using traditional medicine. Drug treatment should be the main one, and traditional methods of getting rid of fibroids can be used as a reasonable addition to the main drug therapy.

1. Infusion of celandine. The plant is poisonous, so it must be taken with caution.

Brew one tablespoon of celandine with a glass of boiling water. Infuse for two weeks in a darkened container. Use by dropping one drop into a glass of water in the morning, before eating. After three days of use, you can increase the dose by adding one drop daily until you reach 15 drops. Then drink in the reverse order (descending).

2. Potato juice. Take half a glass of fresh, just squeezed potato juice before breakfast. The course is about a month.

3. Apitherapy (treatment using bee products) has a positive effect. Women suffering from uterine fibroids are recommended to take royal and drone jelly - powerful biostimulants.

The article was written specifically for www.nasheditya.ru

nasheditya.ru

Treatment of fibroids: is it possible to take Regulon for fibroids?

The occurrence of such a female disease as fibroids is quite common among women who have had abortions, had difficult births, had genital surgery, or have experienced changes during menopause. The fibroid itself is a small benign formation that is located in different areas of the uterus, depending on the case. Most often, fibroids in women are diagnosed during a routine examination. This diagnosis is not considered terrible, so there is no need to panic when making it.

Most often, after diagnosing fibroids, doctors place the patient under observation and prescribe special medications. Treatment can be conservative, combined or surgical. Conservative involves inhibiting the growth of a benign tumor, as well as blocking complications with a decrease in fibroid size. In this case, doctors prescribe special antitumor drugs. The concerns of many women are related to the fact that these medications have hormonal components. Therefore, many people ask the question: is it possible to take Regulon for fibroids?

The answer to this question is, of course, yes. The fact is that the occurrence of the fibroid disease itself is associated with a hormonal imbalance. Therefore, without normalizing it, it will be difficult to solve the problem. The use of hormonal drugs makes it possible to reduce the tumor in volume and transfer it to a safer level, in which surgical intervention is not necessary. In addition, the contraceptive Regulon allows you to normalize the general condition of the female body and solve problems associated with premenstrual syndrome. The accompanying function of preventing pregnancy helps a woman cure the disease completely and prepare the body, because pregnancy is contraindicated during treatment.

If the disease occurs in a more dynamic phase, the doctor may prescribe a more intensive course of treatment. And it may involve surgery.

uliyanovsk.bezformata.ru

2018 Blog about women's health.

Birth control pills for uterine fibroids are often prescribed by gynecologists to prevent the progression of the pathological process. However, they are not suitable for a complete cure of the disease, just as other medications cannot provoke resorption of the myomatous node.

But the analogues of female sex hormones that make up such tablets significantly improve the functioning of the reproductive system of a patient suffering from uterine fibroids. A properly developed treatment regimen helps not only stop the growth of a pathological neoplasm, but also significantly improve a woman’s quality of life.

Types of PRT

Contraceptives that are used to stop the growth of a pathological node with uterine fibroids are divided into 2 groups:

1. COCs, or combined oral contraceptives. Such products contain synthetic estrogen substitutes, as well as the substance progestogen.
2. Monophasic hormonal drugs. These products differ from other contraceptives in that each tablet contains an equal amount of all active ingredients.

For the treatment of uterine fibroids, contraceptives of the first group are used mainly. They are highly effective, and not only in combating the progression of pathology or in preventing unwanted pregnancy. COCs have a beneficial effect on the psycho-emotional state of patients with myomatosis, and their positive effect on hormonal levels also cannot be denied.

Reception features

Treatment of fibroids with birth control pills must be carried out under the close supervision of a doctor. The dosage and frequency of doses of the drug are selected for each patient individually, and an overdose can have an extremely negative impact on health.

These tablets should be taken to treat uterine fibroids as follows:

• taking the medication must be started on the first day of menstruation;
• When treating fibroids, you must take birth control pills strictly within the dosage prescribed by your doctor;
• the course of therapy should not be interrupted, otherwise a re-outbreak of the disease may occur;
• It is advisable to take the prescribed medicine at the same time.

Sometimes, when taking birth control pills to treat uterine fibroids, you may notice bloody discharge from the vagina. There may also be a shift in the menstrual cycle. This is not a reason to panic, but a gynecologist monitoring the dynamics of treatment of uterine fibroids with the help of contraceptives must know about such changes.

The effectiveness of drugs in the treatment of fibroids

Contraceptives are prescribed only if the fibroids are small. In this case, with their help you can achieve:

• reducing the intensity of intermenstrual bleeding or stopping it completely;
• normalization of the menstrual cycle;
• stabilization of psycho-emotional state;
• normalization of hormonal levels.

The effectiveness of contraceptive drugs in the treatment of uterine fibroids is confirmed not only by doctors - positive dynamics are also noted by patients themselves. But hormonal therapy for myomatosis does not give immediate results, so it will have to be continued for several months (usually for six months).

Contraception for myomatosis after 40 years

Are birth control pills effective for uterine fibroids after 40 years of age? This group of drugs is often prescribed to women on the eve of menopause in order to prevent further growth of the myomatous node.

In patients over 40, the production of their own sex hormones decreases, which often leads to regression of the pathological process. But it also happens that the fibroid, on the contrary, begins to actively grow, and in order to stop its growth, the gynecologist prescribes birth control pills.

But, in addition to stopping the progression of the pathology, women over 40 can take such drugs for:

• elimination of menopausal manifestations (in particular, hot flashes);
• restoring the balance of sex hormones;
• establishing reproductive function, etc.

Birth control pills for uterine fibroids in women over 40 can only be taken if they have a strong immune system.

Against the background of weakened immunity, the absorption of drugs is significantly reduced. Consequently, this negatively affects their effectiveness in treating fibroids.

The most effective drugs

Uterine fibroids can be treated with the following contraceptive medications:

• Janine;
• Regulona;
• Silhouette;
• Microlute;
• Novineta;
• Marvelona et al.

Fibroids can be treated only with the drug prescribed by the gynecologist. Under no circumstances should you look for a replacement for contraceptives on your own - this can lead to serious side effects.

The fact is that the selection of a specific medicine is carried out taking into account the size and type of pathological node, as well as the presence of concomitant diseases (for example, endometriosis). In addition, not all women can treat fibroids with one or another remedy - sometimes doctors have to select analogs of birth control pills that are little known to patients with myomatosis.

Contraindications

Treatment of fibroids with contraceptive drugs is prohibited for women who:

• have bad habits;
• suffer from hypertension;
• have malignant neoplasms of various localizations;
• have untreated liver disease.

COCs also cannot be used to treat myomatosis in patients with deep vein thrombosis and uterine bleeding of unknown origin.

Contraception for endometriosis

With this group of drugs you can treat not only fibroids, but also endometriosis. This is a disease that can occur in both young girls and women after 40. Endometriosis is often treated using progesterone-containing products:

• Janine;
• Yarina;
• Utrozhestan;
• Duphaston;
• Byzanne;
• Danazol;
• Buserelina;
• Zoladexa et al.

These medications will be effective only at the first and second stages of the development of endometriosis, when the tissues of the uterine mucosa do not grow beyond the genital organ and do not form adhesions.

At this time, contraceptives stop the progression of the pathological process, eliminate pain, and reduce the intensity of intermenstrual discharge.

Treatment of fibroids and endometriosis with hormonal contraceptives has many positive aspects. One of these is the lack of need for additional contraceptives.

However, if the patient is advised to avoid pregnancy during the initial phase of therapy, a condom should be used during sexual intercourse. This is the only contraceptive that will protect against unwanted pregnancy and also prevent infection with sexually transmitted diseases. And they can only aggravate the course of myomatosis or endometriosis!