Treatment of diffuse changes in myometrium

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. Choosing methods of treating pathology, doctors are still based only on the assumptions and the assertion that the leading role in such violations is played by hormonal imbalance.

A violation of hormone production, as well as inflammatory processes, provoked by diffuse changes in the tissues of the uterus, can be treated only through hormonal therapy. The task of doctors in this case is to minimize the production of estrogen in the female body. 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 most terrible of them. Therefore, they are lost and do not know what to do with a diffuse increase in the uterus.

If a woman is on the threshold of menopause, you can do without hormone therapy, drinking plant pills that support women's health, for example, "Female Comfort 1". With the onset of menopause, the problem is usually resolved by itself, but in the pre-menopause the woman will still have to visit the gynecologist on a regular basis once every six months to not overlook the initial stage of oncology if the patient has such a predisposition or undergo anti-inflammatory therapy if the inflammatory process increases and will be very discomforting.

But what about young women who still dream of becoming the mother of a smiling little girl? They, despite all their reluctance, still have to undergo a course of hormone therapy, and often not one, because there are no such drugs that would allow forever to forget about adenomyosis or endometrium. It is a disease with a high probability of relapse.

Surgery

Another option for treating the above pathologies is surgery. But surgical treatment is usually associated with a greater risk that a woman will no longer be able to have children, so it is rarely used if medication is not working and the proliferation of uterine tissues is progressing.

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

• a severe degree of endometriosis of the uterus with pronounced diffuse changes in the tissues of organs and a strong pain syndrome during and outside menstruation (we are talking about stages 3 and 4 of the disease);
• severe degree of cervical adenomyosis,
• expressed diffuse nodular and focal changes in myometrium with multiple small-size foci,
• the diffusion of diffuse changes in the ovarian, scapular, bladder, rectum,
• the impossibility of the behavior of effective hormonal therapy (in the presence of contraindications),
• no effect of hormone treatment,
• with the threat of the transition of a benign process to a malignant one.

The operation can 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, polyposis of the uterus, ovarian cyst, etc.).

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

• Gentlemen with minimal traumatization of tissues and organ preservation (endoscopic (usually laparoscopic) operations for cauterization or removal of lesions by laser radiation, electric current, ultrasonic waves, freezing, etc.). Cauterization and other gentle methods are suitable for focal and nodular forms with a small number of endometriosis foci, endometrial hyperplasia, purulent and adhesive processes.
• Radical, after which the woman does not have the opportunity to have children: removal of the uterus body (supravaginal amputation of the organ), removal of the entire uterus (hysterectomy), removal of the uterus, fallopian tubes and appendages (pangysterectomy). Conducted in the diffuse form with a defeat of 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 good effect from sparing operations.

I must say that even sparing operations give a good result and the foci of hyperplasia disappear for a while. However, during the first year after the operation they appear again in 20% of patients. After the removal of the uterus and associated organs, the risk of recurrence is absent, as is any opportunity to become pregnant.

But back to the drug therapy, which can be carried out alone or in combination with surgical treatment, which provides for the preservation of the uterus and its functions. The main drugs in this case are hormonal drugs that regulate the level of estrogen in the body of a woman and remove inflammation. If the patient is suffering severe pain, it is possible to prescribe analgesics from the category of analgesics, antispasmodics or complex drugs that combine both of these actions. As an option, which allows to stop pain and inflammation, prescribe drugs from the NSAID group.

Since  diffuse changes in myometrium  in moderate and severe form are often accompanied by bleeding (abundant menstrual and minor outside of menstruation), they are often accompanied by the development of anemia. In this case, along with hormonal therapy of anemia or endometriosis, one must fight 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 full assimilation.

Anemia and in itself diffuse changes in uterine tissues that occur in a chronic form are fertile soil for various infections, because they contribute to a decrease in the protective functions of the body. To prevent the development of infectious pathologies, patients are prescribed the use of immunostimulants.

If the inflammation increases and there is a purulent discharge that indicates the attachment of a bacterial infection, a woman is prescribed a course of antibiotic therapy. And to reduce its negative consequences in the form of a violation of the microflora of the body, the reception of probiotics is additionally shown.

So, drug treatment of moderate and pronounced diffuse changes in myometrium and endometrium includes: hormonal, vitamin and immunostimulating therapy. And the main thing is hormonal treatment.

But how to be young women who want to experience the joy of motherhood, to whom such treatment is contraindicated, while sparing operational measures are unacceptable or do not bring results. Here, physiotherapeutic treatment comes to the rescue, which allows to slow the growth of tissues and prevent possible complications. So physiotherapy is considered effective and safe prevention of adhesions (including such a probability after the operation) and helps reduce the pain syndrome.

There are many methods for physiotherapeutic treatment of diffuse uterine enlargement, but a specialist should be involved in their selection. What are the procedures he can appoint:

• electrophoresis with painkillers and sedatives, stopping the production of estrogen and stopping the pain syndrome,
• magnetotherapy, which eliminates inflammation and edema of the uterus, reduces the likelihood of spasms and pain, normalizes blood circulation and nutrition of the diseased organ tissues, improves metabolism in them, stimulates regenerative processes, calms the nervous system (this is also important in the postoperative period),
• Balneotherapy (hydrotherapy) means radon and iodide-bromine baths; such treatment allows you to calm down the pain, calm the nervous system, relieve inflammation and high blood pressure, normalize the thyroid gland (additionally microclysters and vaginal discharge can be administered with water enriched with radon).
• hydrotherapy - treatment with baths with medicinal fillers, such as bischofite or pine extract, acting soothing, relieving pain and spasms,
• Laser therapy helps fight infection, reduces pain, improves microcirculation and metabolism in tissues (especially effective in the postoperative period),
• treatment with UV radiation promotes rapid healing of postoperative wounds, when the focus of endometriosis has already been removed,

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

Medication Therapy

Surgical treatment is always a trauma to the body. Therefore, doctors are slow to resort to such drastic measures, especially considering that the removal of the uterus puts an end to the woman's dream of becoming a mother, and sparing methods have a high probability of recurrence of adenomyosis or endometriosis already in the first year after surgery, not to mention the next years .

Before resorting to surgical intervention, a gynecologist tries to defeat the disease with the help of medicines, whose goal is to alleviate the symptoms of the disease, transfer it to a state of remission and prevent exacerbations. Hormonal treatment and vitamin therapy contribute to improving the quality of life of the patient and gives hope for the desired pregnancy.

What kind of hormonal drugs help a woman to overcome such an unpleasant disease for her:

• Combined contraceptives, which are classified as estrogen-progestational agents. Among such drugs, the most commonly prescribed drugs are women's names "Yarina", "Diana 35", "Zhanin", "Jess", as well as contraceptives "Demulen", "Marvelon", "Non-ovolon", suppressing ovulation and estrogen production.
• Progestogens are steroid female sex hormones that provide the opportunity for the onset and retention of pregnancy. They inhibit the proliferation of cells and transfer the endometrium into the secretory phase, preventing its further growth inside the uterus and myometrium. These drugs include: Duphaston, Progesteron, Dydrogesteron, Utrozhestan, Norgestrel, Gestoden, Norkolut, Eksluton, and others.
• Antigonadotropic drugs that affect the pituitary gland to suppress the production of sex hormones in the ovaries (Decapeptil Depot, Danoval, Diferelin, Buserelin Depo, Danol, Danogen, etc.).

As we have already said, many women are afraid to take hormonal drugs, but if there is no other possibility to become pregnant with diffuse changes in the myometrium, the potential successors of the genus should at least know what they can face during the reception of contraceptives and other medications.

Consider 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 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 the reduction of pain during menstruation.

Packaging contains 21 tablets, which must be drunk strictly according to a certain scheme. Tablets are numbered by day of the week. Take them preferably at the same time, starting with the first day of menstruation. At the end of the package, take a break for 7 days, during which menstrual bleeding begins. The next package begins immediately after the end of the week break, regardless of when the menstruation began.

If the tablet failed to be taken at the appointed time, it should be done later, and the next one should be taken at the right time.

An effective contraceptive has multiple contraindications for use. It is not prescribed for a high probability of venous thromboembolism due to anticoagulation therapy, predisposition (both hereditary and acquired), surgical interventions after which the patient has been restricted for a long time in movement, etc. An identical situation and with a high probability of arterial thromboembolism. The risk of arterial thromboembolism exists with a history of myocardial infarction and angina, cerebral circulation disorders, vascular complications of diabetes mellitus, and severe arterial hypertension. This takes into account episodes of thromboembolism in the patient's anamnesis and the pathology that is taking place at the present time.

Danger may represent the reception of "Yarina" on the background of severe liver disease. If the body's parameters returned to normal, the contraceptive is prescribed with caution and regular laboratory monitoring of the liver. If a benign or malignant tumor is found in the liver (including such episodes in the patient's history), hormonal contraceptives are dangerous because of the likelihood of a relapse.

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

In acute and severe chronic renal failure, incomprehensible vaginal bleeding, pregnancy and hypersensitivity to components of COC, medication is prohibited.

Side effects of the drug that can accompany it, usually expressed in the form of mood worsening, headaches and migraines, nausea, tenderness of the mammary glands, the appearance of intermenstrual bleeding and spotting discharge from the genital organs, the development of vaginal candidiasis (thrush). Less frequently, patients notice an increase or decrease in sexual desire, fluctuations in blood pressure, the appearance of diarrhea and vomiting, pruritus and rashes on the skin (in the form of acne or eczema), hair loss, breast enlargement, genital infections, fluid retention, , change in body weight in one direction or another.

Doctors also report an alarming change in blood tests that disappear after COC has been withdrawn. In the instruction, isolated cases of development of thromboembolism and erythema, the appearance of secretions from the mammary glands and angioedema (Quincke's edema) are noted.

"Dyufaston" - a drug based on a synthetic analogue of progesterone - dydrogesterone. It is a relatively safe representative of progestins, which does not have estrogenic and androgenic effects. It has nothing to do with steroid drugs, does not change thermogenesis, 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 interfere with conception. It can be taken both outside and during pregnancy, preventing the threat of miscarriage and premature birth.

To treat various forms of endometriosis, the drug is prescribed in a single dose of 10 mg (1 tablet). Multiplicity of the drug - 2 or 3 times a day. Usually, treatment is started on day 5 of the menstrual cycle and continues for 20 days.

Planning pregnancy with diffuse changes in the myometrium should be done in advance, starting to take the drug on day 11 and completing the reception on the 25th day of the menstrual cycle. Take a hormonal drug you need twice a day for 1 tablet. After conception, the dose reduction may not be earlier than at week 20 of admission.

If the patient managed to get pregnant, but there is a threat of miscarriage in the period up to 20 weeks of pregnancy, she is first given 4 tablets of Dufaston in the form of a starting dose, and then for 7 days every 8 hours she will have to take 1 tablet of the drug, after which the multiplicity drug intake is reduced.

Contraindications for the drug "Dyufaston" a little. It is not prescribed in cases of hypersensitivity to the components of the drug and the hereditary syndromes of Rotor and Dabin-Johnson that manifest themselves in the form of jaundice. The drug is indicated in pregnancy if there is a risk of miscarriage, but during breastfeeding it can not be taken, because it can penetrate into the mother's milk. To the organism of the child hormonal therapy can cause irreparable harm, so the baby will need to be transferred to artificial feeding for the time of treatment.

In the instructions to the drug, there is very little information about the side effects of the reproductive system of a woman, because on ovulation it does not affect in any way. There is information only about possible bleeding bleeding and rare episodes of pain in the mammary glands. Other undesirable effects of the medication are headaches, itching and rash on the skin, as well as violations of the liver, manifested by icterus of the skin and eye proteins, general malaise, undefined abdominal pain. Symptoms such as the development of hemolytic anemia, severe allergic reactions (Quincke's edema) and manifestations of hypersensitivity, edematous syndrome are observed in rare cases.

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

The drug is used in the treatment of endometriosis, uterine fibroids, infertility in women and hormone-dependent prostate carcinoma in the stronger sex. It is produced as a powder for the preparation of an injection solution in a syringe, to which a syringe with a solvent is attached. Using an adapter, the syringes are connected to each other in order to mix the lyophilate and the solvent well (the medicine is transferred from the syringe with a syringe into the syringe at least 10 times until the suspension looks like milk).

Enter the drug intramuscularly or subcutaneously into the abdomen. Injections are rarely performed at intervals of 28 days, regularly changing the place of administration of the drug. When endometriosis treatment should start from 1 to 5 days of the menstrual cycle. The course of treatment is from 3 months to 6 months. Further administration of the drug may impair bone density.

During treatment with the drug "Decapeptil Depot" hormonal contraceptives, estrogen-containing drugs can not be taken. The drug is not prescribed during pregnancy (before prescribing the medicine it must be excluded during gynecological examination) and breastfeeding, despite the fact that the drug does not possess teratogenic and mutagenic properties. The drug is also contraindicated for women with hypersensitivity to its components. Not applicable in pediatrics.

Caution should be observed in the treatment of patients with osteoporosis, as well as those who have a high risk of developing this pathology, which consists in reducing the strength of bones.

The drug reduces the content of sex hormones in the blood, and in this regard, such symptoms described in the section "side effects" can be observed: mood swings, depressive states, decreased sexual desire, frequent migraines, sleep problems. In addition, women can complain about weight gain, the appearance of "tides" characteristic of women during menopause, muscle and joint pain, dryness of the vaginal mucosa and bleeding from the uterus outside the menstrual period. There is information about allergic reactions of varying severity, reversible violations of the liver, detected by laboratory, increased cholesterol in the blood, soreness at the site of administration of the drug.

Usually the side effects of the drug "Decapeptil Depot" disappear immediately after the end of the therapeutic course.

Having looked closely at the drugs that affect the production of sex hormones, you can see that they are really not so 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 health complications. And to remove the uterus, which allows you to forget about the disease forever, not every woman decides to decide.

Since frequent and prolonged bleeding with diffuse changes in the myometrium often lead to the development of iron deficiency anemia, iron preparations can be prescribed to treat the patient (Heferol, Ferronat, Ferretab, Fenyuls, Irradian, Tardiferon, etc.) ).

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

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

Capsules are recommended for taking on an empty stomach. Drink them with a glass of water.

The drug is not prescribed for hypersensitivity to its components and pathologies, in which iron accumulates in the body. Other contraindications for the use of the drug are violations of iron digestibility in the body and vitamin B12 deficiency.

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

Side effects of the drug can be considered bloating and a feeling of overflow, discomfort in the epigastric region, nausea, attacks of vomiting. Usually, such symptoms occur against the background of the pathologies of the GIT of the inflammatory plan.

It is undesirable to take the drug simultaneously with antacids and antibiotics of the tetracycline series, worsening the absorption of iron in the digestive tract. But ascorbic acid, on the contrary, improves its absorption.

In endometriosis and other pathologies of the genital area in women accompanied by menorrhagia, iron preparations are prescribed by a course of long duration. Breaks in treatment are possible, but their duration should be small.