Treatment of diffuse myometrial changes

There are many theories that consider possible causes of diffuse changes in the myometrium and endometrium of the uterus, but none of them has a sufficient evidence base. When choosing methods of treating pathology, doctors still rely only on assumptions and the assertion that hormonal imbalance plays a leading role in such disorders.

And the disruption of hormone production, as well as inflammatory processes provoked by diffuse changes in the tissues of the uterus, can be treated only by means of hormonal therapy. The task of doctors in this case is to reduce the production of estrogens in the female body as much as possible. And this can be achieved only with the help of drugs that suppress the synthesis of estrogen by the ovaries.

It is clear that many women are extremely negative about hormonal therapy, which has a lot of side effects, and weight gain is not the worst of them. Therefore, they are at a loss and do not know what to do with diffuse enlargement of the uterus.

If a woman is on the threshold of menopause, she can do without hormonal therapy by taking herbal tablets that support women's health, for example, "Women's Comfort 1". With the onset of menopause, the problem usually resolves itself, but in the pre-menopausal period, a woman will still have to regularly visit a gynecologist once every six months so as not to miss the initial stage of oncology, if the patient has such a predisposition, or undergo a course of anti-inflammatory therapy if the inflammatory process intensifies and causes severe discomfort.

But what about young women who still dream of becoming a mother of a smiling baby? Despite all their reluctance, they will still have to undergo a course of hormonal therapy, and often more than one, since there are no medications that would allow them to forget about adenomyosis or endometritis forever. These are diseases with a high probability of relapse.

Surgical treatment

Another option for treating the above pathologies is surgery. But surgical treatment is usually associated with a high risk that a woman will no longer be able to have children, so it is resorted to extremely rarely if drug therapy does not bring results and the proliferation of uterine tissue progresses.

What are the indications for surgical treatment? Surgery to remove the focus of diffuse changes is prescribed for:

• severe endometriosis of the uterus with pronounced diffuse changes in organ tissue and severe pain during and outside of menstruation (we are talking about stages 3 and 4 of the disease),
• severe degree of cervical adenomyosis,
• pronounced diffuse nodular and focal changes in the myometrium with multiple small foci,
• the spread of diffuse changes to the area of the ovaries, peritoneum, bladder, rectum,
• impossibility of effective hormonal therapy (in the presence of contraindications),
• lack of effect from hormone treatment,
• when there is a risk of a benign process becoming malignant.

Surgery may also be prescribed if, in addition to diffuse changes in the myometrium and endometrium, a woman has tumor processes (benign and malignant tumors in the uterus, uterine polyposis, ovarian cysts, etc.).

Depending on the severity and localization of the process, different types of surgery are prescribed:

• Gentle with minimal tissue trauma and organ preservation (endoscopic (usually laparoscopic) operations to cauterize or remove lesions using laser radiation, electric current, ultrasound waves, freezing, etc.). Cauterization and other gentle methods are appropriate for focal and nodular forms with a small number of endometriosis lesions, endometrial hyperplasia, purulent and adhesive processes.
• Radical, after which a woman is no longer able to have children: removal of the body of the uterus (supravaginal amputation of the organ), removal of the entire uterus (hysterectomy), removal of the uterus, fallopian tubes and appendages (panhysterectomy). They are carried out in the widespread diffuse form with damage to all tissues of the uterus and the presence of a large number of small lesions, the risk of oncology, the progression of adenomyosis and endometriosis in women after 40 years, the lack of a good effect from gentle operations.

It should be said that even sparing operations give good results and the foci of hyperplasia disappear for a while. However, during the first year after the operation they reappear in 20% of patients. After removal of the uterus and related organs, there is no risk of relapse, as well as any possibility of becoming pregnant.

But let's return to drug therapy, which can be carried out both independently and in combination with surgical treatment, providing for the preservation of the uterus and its functions. The main drugs in this case are hormonal drugs that regulate the level of estrogens in the woman's body and relieve inflammation. If the patient suffers from severe pain, it is possible to prescribe painkillers from the category of analgesics, antispasmodics or complex drugs that combine both of these actions. As an option that allows you to relieve pain and inflammation, drugs from the NSAID group are prescribed.

Since diffuse changes in the myometrium in moderate and severe form are often accompanied by bleeding (heavy menstrual and minor non-menstrual), they are often accompanied by the development of anemia. In this case, along with hormonal therapy for anedomyosis or endometriosis, it is necessary to combat the concomitant disease with the help of complexes containing vitamins and minerals necessary for the body, focusing on preparations with a high content of iron and folic acid, necessary for its complete absorption.

Anemia and diffuse changes in uterine tissues in themselves, occurring in a chronic form, are fertile ground for various infections, because they contribute to a decrease in the body's protective functions. To prevent the development of infectious pathologies, patients are prescribed immunostimulants.

If the inflammation intensifies and purulent discharge appears, which indicates the addition of a bacterial infection, the woman is prescribed a course of antibiotic therapy. And to reduce its negative consequences in the form of a violation of the body's microflora, probiotics are additionally indicated.

Thus, drug treatment of moderate and severe diffuse changes in the myometrium and endometrium includes: hormonal, vitamin and immunostimulating therapy. Moreover, hormonal treatment remains the main one.

But what about young women who want to experience the joy of motherhood, for whom such treatment is contraindicated, and gentle surgical measures are unacceptable or do not bring results? Here, physiotherapy comes to the rescue, which allows slowing down tissue growth and preventing possible complications. Thus, physiotherapy is considered an effective and safe prevention of the adhesion process (including such a possibility after surgery) and helps reduce pain.

There are many methods of physiotherapy treatment of diffuse enlargement of the uterus, but their selection should be done by a specialist doctor. What procedures can he prescribe:

• electrophoresis with painkillers and sedatives, which stops the production of estrogens and relieves pain,
• magnetic therapy, which eliminates inflammation and swelling of the uterine tissue, reduces the likelihood of spasms and pain, normalizes blood circulation and nutrition of the tissues of the diseased organ, improves metabolism in them, stimulating regenerative processes, calms the nervous system (this is also important in the postoperative period),
• balneotherapy (hydrotherapy) involves radon and iodine-bromine baths; such treatment helps relieve pain, calm the nervous system, reduce inflammation and high blood pressure, and normalize the thyroid gland (microclysters and vaginal treatment with radon-enriched water may also be prescribed),
• hydrotherapy – treatment using baths with medicinal fillers, such as bischofite or pine extract, which have a calming effect, relieving pain and spasms,
• laser therapy helps fight infection, reduces pain, improves microcirculation and metabolism in tissues (especially effective in the postoperative period),
• UV treatment promotes rapid healing of postoperative wounds when the endometriosis site has already been removed,

The appointment of physical procedures for diffuse changes in the myometrium is carried out taking into account that thermal exposure will only intensify pathological processes. Therefore, the choice should be made on those procedures that do not lead to tissue heating. And even therapeutic baths are carried out with caution, ensuring that the water temperature is slightly warm (within 33-36 degrees).

Drug therapy

Surgical treatment is always a trauma for the body. Therefore, doctors are in no hurry to resort to such drastic measures, especially considering the fact that removal of the uterus puts an end to a woman's dream of becoming a mother, and gentle methods have a high probability of recurrence of adenomyosis or endometriosis already in the first year after surgery, not to mention the following years.

Before resorting to surgical intervention, the gynecologist tries to defeat the disease with the help of medications, the purpose of which is to alleviate the symptoms of the disease, put it into remission and prevent exacerbations. Hormonal treatment and vitamin therapy improve the patient's quality of life and give hope for a desired pregnancy.

What hormonal drugs help a woman overcome such an unpleasant disease:

• Combined contraceptives, which are classified as estrogen-gestagen agents. Among such drugs, the most frequently prescribed are drugs with female names "Yarina", "Diane 35", "Zhanin", "Jess", as well as contraceptives "Demulen", "Marvelon", "Non-ovlon", which suppress ovulation and estrogen production.
• Progestogens are steroid female sex hormones that ensure the possibility of pregnancy onset and maintenance. They inhibit cell proliferation and transfer the endometrium to the secretory phase, preventing its further growth into the uterus and myometrium. Such drugs include: Duphaston, Progesterone, Dydrogesterone, Utrozhestan, Norgestrel, Gestoden, Norkolut, Exluton, etc.
• Antigonadotropic drugs that act on the pituitary gland to suppress the production of sex hormones in the ovaries (Decapeptyl-depot, Danoval, Dipherelin, Buserelin-depot, Danol, Danogen, etc.).

As we have already said, many women are afraid to take hormonal drugs, but if there is no other way to get pregnant with diffuse changes in the myometrium, then potential procreators should at least know what they may encounter while taking contraceptives and other medications.

Let's look at one drug from each group of drugs. Let's start with contraceptives.

"Yarina" is a drug based on ethinyl estradiol and drospirenone, which is often prescribed as part of a combination therapy for diseases caused by inflammatory and dysplastic processes in the uterus and ovaries. The contraceptive is able to normalize the menstrual cycle and the condition of the uterine mucosa. A useful side effect of the drug is considered to be a decrease in pain syndrome during menstruation.

The package of the drug contains 21 tablets, which must be taken strictly according to a specific schedule. The tablets are numbered by days of the week. It is advisable to take them at the same time, starting from the first day of menstruation. After finishing the package, take a break for 7 days, during which menstrual bleeding begins. The next package is started immediately after the end of the week-long break, regardless of when menstruation began.

If you fail to take a pill at the appointed time, you should take it later and take the next one at the right time.

An effective contraceptive drug has multiple contraindications for use. It is not prescribed in case of high probability of venous thromboembolism caused by anticoagulation therapy, predisposition (both hereditary and acquired), surgical interventions after which the patient was limited in movement for a long time, etc. The situation is identical with a high probability of arterial thromboembolism. The risk of arterial thromboembolism exists in case of myocardial infarction and angina pectoris, cerebrovascular accidents, vascular complications of diabetes mellitus, severe arterial hypertension. In this case, episodes of thromboembolism in the patient's medical history and the pathology that is currently present are taken into account.

Taking Yarina against the background of severe liver diseases may be dangerous. If the organ's indicators have returned to normal, the contraceptive is prescribed with caution and regular laboratory monitoring of liver function. If a benign or malignant tumor is detected in the liver (including such episodes in the patient's history), taking hormonal contraceptives is dangerous due to the likelihood of relapse.

Contraindications include any hormone-dependent tumors, regardless of their location (most often, such neoplasms are found in the area of the genitals and mammary glands).

In case of acute and severe chronic renal failure, unexplained vaginal bleeding, pregnancy and hypersensitivity to the components of COCs, taking the drug is prohibited.

Side effects of the drug that may accompany its use are usually expressed in the form of worsening mood, headaches and migraines, nausea, soreness of the mammary glands, the appearance of intermenstrual bleeding and spotting from the genitals, the development of vaginal candidiasis (thrush). Less often, patients note an increase or decrease in sexual desire, fluctuations in blood pressure, the appearance of diarrhea and vomiting, itching and rashes on the skin (in the form of acne or eczema), hair loss, enlargement of the mammary glands, genital infections, fluid retention in the body, manifested by edema syndrome, a change in body weight in one direction or another.

Doctors also report alarming changes in blood tests that disappear after discontinuing COCs. The instructions note isolated cases of thromboembolism and erythema, discharge from the mammary glands and angioedema (Quincke's edema).

"Duphaston" is a drug based on a synthetic analogue of progesterone - dydrogesterone. This is a relatively safe representative of progestins, which does not have an estrogenic or androgenic effect. It has nothing in common with steroid drugs, does not change thermogenesis, and does not have a negative effect on metabolism. Dydrogesterone stimulates the secretory function of the endometrium and reduces its proliferation.

The drug does not inhibit ovulation and does not prevent conception. It can be taken both outside and during pregnancy, preventing the threat of miscarriage and premature birth.

For the treatment of various forms of endometriosis, the drug is prescribed in a single dose of 10 mg (1 tablet). The frequency of taking the drug is 2 or 3 times a day. Treatment usually begins on the 5th day of the menstrual cycle and continues for 20 days.

Planning a pregnancy with diffuse changes in the myometrium should be done in advance, starting to take the drug on the 11th day and stopping on the 25th day of the menstrual cycle. The hormonal drug should be taken twice a day, 1 tablet at a time. After conception, a dose reduction is possible no earlier than the 20th week of taking it.

If the patient has managed to become pregnant, but there is a risk of miscarriage before 20 weeks of pregnancy, she is first given 4 tablets of Duphaston as a starting dose, and then she will have to take 1 tablet of the drug every 8 hours for 7 days, after which the frequency of taking the drug is reduced.

There are few contraindications for the drug "Duphaston". It is not prescribed for hypersensitivity of the body to the components of the drug and hereditary Rotor and Dubin-Johnson syndromes, which manifest themselves in the development of jaundice. The drug is indicated during pregnancy if there is a risk of miscarriage, but it cannot be taken during breastfeeding, since it can penetrate into the mother's milk. Hormonal therapy can cause irreparable harm to the child's body, so the baby will need to be transferred to artificial feeding for the duration of treatment.

The instructions for the drug contain very little information about side effects regarding the female reproductive system, because it does not affect ovulation in any way. There is information only about possible breakthrough bleeding and rare episodes of pain in the mammary glands. Other undesirable effects of the drug are headaches, itching and rash on the skin, as well as liver dysfunction, manifested by yellowing of the skin and whites of the eyes, general malaise, vague abdominal pain. Symptoms such as the development of hemolytic anemia, severe allergic reactions (Quincke's edema) and manifestations of hypersensitivity, edema syndrome are observed in rare cases.

"Decapeptyl-Depot" is an antigonadotropic agent with an antitumor effect based on triptorelin. The drug acts gradually and consistently. It stimulates the pituitary gland to produce follicle-stimulating and luteinizing hormones. When the concentration of the active substance in the blood reaches constant values, the pituitary gland becomes insensitive to the action of gonadotropin-releasing hormone produced in the body. This leads to a decrease in the concentration of gonadotropins in the blood, stimulating the production of specific hormones by the sex glands, including estrogen, to the level observed during menopause.

The drug is used to treat endometriosis, uterine fibroids, infertility in women and hormone-dependent prostate cancer in men. It is available as a powder for preparing an injection solution in a syringe, which is supplied with a syringe with a solvent. Using an adapter, connect the syringes together in order to thoroughly mix the lyophilisate and solvent (the drug is moved from syringe to syringe using a plunger at least 10 times until the suspension resembles milk in appearance).

The medicine is administered intramuscularly or subcutaneously in the abdominal area. Injections are given rarely, every 28 days, regularly changing the injection site. In case of endometriosis, treatment should be started from the 1st to the 5th day of the menstrual cycle. The course of treatment is from 3 months to six months. Further administration of the drug may disrupt bone density.

During treatment with Decapeptyl-Depot, hormonal contraceptives containing estrogen should not be taken. The drug is not prescribed during pregnancy (it should be excluded during a gynecological examination before prescribing the drug) and breastfeeding, despite the fact that the drug does not have teratogenic and mutagenic properties. The drug is also contraindicated for women with hypersensitivity to its components. It is not used in pediatrics.

Caution should be exercised when treating patients with osteoporosis, as well as those who are at high risk of developing this pathology, which consists of a decrease in bone strength.

The drug reduces the content of sex hormones in the blood and in connection with this the following symptoms described in the section "side effects" may be observed: mood swings, depressive states, decreased sexual desire, frequent migraines, sleep problems. In addition, women may complain of weight gain, the appearance of "hot flashes" typical for women during menopause, muscle and joint pain, dryness of the vaginal mucosa and uterine bleeding outside of menstruation. There is information about allergic reactions of varying severity, reversible liver dysfunction detected by laboratory methods, increased cholesterol in the blood, pain at the injection site.

Usually, the side effects of the drug "Decapeptyl-depot" disappear immediately after the end of the therapeutic course.

If you look closely at the drugs that affect the production of sex hormones, you will notice that they are really not that safe. But on the other hand, therapy with these drugs helps to stop the disease, which threatens a woman not only with infertility, but also with various life-threatening and health-threatening complications. And not every woman will decide to remove the uterus, which allows you to forget about the disease forever.

Since frequent and prolonged bleeding with diffuse changes in the myometrium often leads to the development of iron deficiency anemia, the patient may be prescribed iron preparations for its treatment (Heferol, Ferronat, Ferretab, Fenuls, Irradian, Tardiferon, etc.).

"Ferretab" is a drug that helps eliminate iron deficiency in the body. Iron salts (ferrous fumarate) in the drug are combined with folic acid, which improves the absorption of the microelement, stimulates the synthesis and maturation of normoblasts (rudiments of red blood cells - erythrocytes), the production of amino acids and nucleic acids, purines, etc.

The medicine is prescribed at 1 capsule per day, but if necessary, the dose can be increased to 2-3 capsules. Restoration of normal blood picture occurs within 2-3 months, after which it will be necessary to take the medicine for about 1 month for preventive purposes to obtain a normal hemoglobin level.

It is recommended to take the capsules on an empty stomach with a glass of water.

The drug is not prescribed in case of hypersensitivity to its components and pathologies in which iron accumulates in the body. Other contraindications to the use of the drug are considered to be impaired iron absorption in the body and vitamin B12 deficiency.

"Ferretab" is a drug for the treatment of iron deficiency anemia and is not used to treat other types of anemia (hemolytic, aplastic, lead, etc.).

Side effects of the drug include bloating and a feeling of fullness, discomfort in the epigastric region, nausea, and vomiting. Typically, such symptoms occur against the background of existing gastrointestinal tract inflammatory pathologies.

It is not advisable to take the drug simultaneously with antacids and tetracycline antibiotics, which impair iron absorption in the gastrointestinal tract. However, ascorbic acid, on the contrary, improves its absorption.

In case of endometriosis and other pathologies of the female reproductive system accompanied by menorrhagia, iron preparations are prescribed in a long course. Breaks in treatment are possible, but their duration should be short.