A personalized approach to managing patients with uterine fibroids
A change in the socialization of society, a tendency toward late pregnancy planning, and an increase in the incidence of uterine fibroids among reproductive-aged women determine the relevance of treatment for this disease and take on social significance.Levakov С.A., Budanov P.V., Zairatyants O.V., Movtaeva Kh.R., Azadova G.Ya., Levakova S.E.
Objective. To evaluate the comparative efficacy of mifepristone (Ginestril), a selective progesterone receptor modulator (SPRM) (Esmya), and a gonadotropin-releasing hormone GnRH agonist (Buserelin Depot) in the treatment of women with uterine fibroids and internal endometriosis.
Subjects and methods. A total of 150 women diagnosed with uterine fibroids and internal endometriosis of the corpus uteri were selected. The inclusion criteria were the presence of symptoms of uterine fibroids, refusal of surgical treatment, a desire to maintain reproductive function, and preparation for planned pregnancy. All the patients were randomly divided into three groups of 50 people each according to a prescribed drug (mifepristone, ulipristal acetate, GnRH agonist) and for the convenience of statistical analysis. Therapy was prescribed for 3 months. All the examinees were reproductive-aged.
Results. When mifepristone and ulipristal were used, there was the highest frequency of devascularization of myomatous nodules, as evidenced by Doppler study. Twenty-nine of 36 patients receiving mifepristone had myomas transformed from proliferating to simple. The ulipristal and GnRH-agonist groups had similar data (28/35 and 26/36, respectively). After 3 months of treatment, the largest number of cases without active peri- and intranodular blood flow in the area of a myomatous nodule were recorded in the mifepristone group (62%; n = 31). Six months after the start of the study (3 months after completion of therapy), the uterine volume was re-estimated. At this stage, 6 (4%) women who became pregnant were excluded from the study. The adverse reactions of Ginestril use included weight gain (by less than 3% of the baseline weight in one (2%) patient), headache, and weakness (in two (4%) patients). Patients with liver and kidney dysfunction were excluded before ulipristal acetate was administered. The use of Esmya was accompanied by reversible endometrial thickening by more than 16 mm (12%) after its treatment cessation, hot flashes (6%), psychoemotional disorders (12%), headache (12%), and acne (12%). The administration of Buserelin Depot resulted in headache, psychoemotional disorders (14%), decreased libido (12%), and insomnia (12%).
Conclusion. Drug therapy aimed at eliminating the symptoms of uterine fibroids is an effective tool for organ sparing, preparation for pregnancy, and surgical treatment. Mifepristone most actively converts the clinical variant of proliferating fibroids into a simple one. The highest safety profile and the possibility of dose adjustment is an important aspect of choosing mifepristone. The prescription of ulipristal requires mandatory additional examination. This drug is comparable to mifepristone in the degree and rate of a decrease in the size of myomatous nodules. The GnRH agonist more markedly reduces the size of the uterus in fibroids concurrent with internal endometriosis of the corpus uteri. The use of the GnRH agonist is associated with the higher incidence of side effects compared with ulipristal and mifepristone.
Keywords
uterine fibroids
drug treatment
mifepristone
ulipristal
GnRH agonist
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Received 11.11.2019
Accepted 29.11.2019
About the Authors
Levakov Sergey A., MD, Professor, head of the Department of obstetrics and gynecology, Institute of clinical medicine, Moscow State medical university. I. M. Sechenova Ministry of health of Russia (Sechenov University). E-mail: levakoff@yandex.ruAddress: 119991, Moscow, Trubetskaya str. 8, p. 2.
Pavel V. Budanov, MD, Professor, Department of obstetrics and gynecology, Institute of clinical medicine, Federal STATE Autonomous educational institution of First Moscow state medical University them. I. M. Sechenova Ministry of health of Russia (Sechenov University).
Address: 119991, Moscow, Trubetskaya str. 8, p. 2.
Oleg V. Zayratyants, MD, Professor head of the Department of pathological anatomy of the Moscow state medical University. A. I. Evdokimova “ Ministry of health of Russia, chief specialist-expert on pathological anatomy of Roszdravnadzor in the Central Federal district of the Russian Federation.
Address: 127473, Moscow, Delegatskaya St., 20, p. 1
Khadijat R. Movtaeva applicant of the Department of obstetrics and gynecology of the Institute of clinical medicine of the Moscow state university I. M. Sechenova Ministry of Health of Russia (Sechenov University).
Address: 119991, Moscow, Trubetskaya str. 8, p. 2
Gyallar Ya. Azadova, post-graduate student of the Department of obstetrics and gynecology Of the Institute of clinical medicine. I. M. Sechenova Ministry of Health Of Russia (Sechenov University).
Address: 119991, Moscow, Trubetskaya str. 8, p. 2
Svetlana E. Levakova, applicant of the Department of obstetrics and gynecology of the Institute of clinical medicine of the Moscow state University. I. M. Sechenova Ministry of Health Of Russia (Sechenov University).
Address: 119991, Moscow, Trubetskaya str. 8, p. 2
For citation: Levakov S.A., Budanov P.V., Zairatyants O.V., Movtaeva Kh.R., Azadova G.Ya., Levakova S.E. A personalized approach to managing patients with uterine fibroids.
Akusherstvo i Ginekologiya/ Obstetrics and gynecology. 2019; 12:174-82. (In Russian).
https://dx.doi.org/10.18565/aig.2019.12.174-182
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