Алгоритм лечения женщин фертильного возраста с миомой матки сочетанной с аденомиозом

Аннотация

Recently, a combination of uterine fibroids and adenomyosis in women of reproductive age has been increasingly diagnosed. Purpose of the study: to study the effectiveness of preparations dienogest and ulipristal acetate in combination in women with combined pathology of uterine fibroids and adenomyosis. Material and research methods: 165 women with uterine myoma and / or adenomyosis were examined and divided into 3 groups. All patients underwent ultrasound to determine the location and size of the nodes, determine the presence and degree of adenomyosis, Doppler study of blood flow in the uterine arteries and vessels around and inside the myomatous node with determination of the resistance index (IR). Research results. Analysis of the reproductive history of the patients showed that in all three groups the frequency of reproductive losses and infertility was high. With the severity of adenomyosis, dienogest was first prescribed, for 6 months in a continuous mode, then Ulipristal acetate. And with a combination of proliferating fibroids with adenomyosis, ulipristal acetate was first prescribed for 84 days, then dienogest was prescribed for 6 months in a continuous mode. Conclusions. To choose a method of treatment and the selection of drugs, it is important to clarify the clinical and morphological variant of myoma (simple or proliferating node), the features and nature of adenomyosis (focal or diffuse form), the severity of the vascularization process, as well as the presence of hyperplastic changes in the endometrium.