The objective: improving the efficiency of diagnosis and treatment of pathology and implantation ability of the endometrium in women of reproductive age who took part in hostilities and received concussions. Materials and methods. The study of endometrial pinopodia was carried out in 35 women of reproductive age who took part in hostilities and received concussions, who on the 21st day of the MC underwent operative laparoscopy and hysteroscopy with endometrial sampling for histological examination and scanning electron microscopy. Of these women, 22 patients – a comparison group – of reproductive age with a history of trauma without post-concussion syndrome and 13 in the main group, women of reproductive age, have the consequences of contusion in the form of post-concussion syndrome. Served as control 10 samples of endometrium from civilian women of reproductive age. The average age of the surveyed was 27.08±4.23 years. The period of stay in the combat zone was 29.34±9.21 months, the time from the moment of receiving a slight traumatic brain injury (contusion) was 18.8±9.2 months. Results. In combatant-women with contusion in history, there are disturbances in the receptivity of the endometrium, manifested by abnormalities in the development of pinopodia and their microvilli during the implantation window: areas without pinopodia in 47.50% of cases (p<0.006), pinopodia of sizes – in 77.50% (p<0.01) and abundant microvilli – in 37.50% (p<0.02); a decrease in the frequency of the presence of developed pinopodia by 2.12 times (p<0.01), large pinopodia by 2.29 (p<0.01), and a small number of microvilli by 4.00 (p<0.0001), an increase in the occurrence of medium-sized pinopodia by 3.00 (p<0.02) times, and a moderate number of microvilli by 4.00 (p<0.0001). A characteristic feature of endometrial pinopodia in the above patients is the presence of mosaicism of their shape (65.00%) and size (67.50%). Conclusions. Women in the military who have been injured in combat are diagnosed with reproductive health problems caused by both the traumatic brain injury itself and the stressors associated with military service. Keywords: reproductive health, female veterans, post-contusion syndrome, receptive endometrial enlargement, office hysteroscopy.
Despite the high level of development of modern surgery and pharmacology, none of the surgical techniques (hysterectomy / myometectomy or embolization of the uterine arteries) or drug therapy is not a guarantee of the absence of a future recurrence of uterine fibroids and endometriosis. However, there are methods of effective pharmacotherapy for their manifestations. In particular, selective progesterone receptor modulators (SMPR) demonstrate high efficacy in respect of the symptoms of myoma and the size of the nodes, which allows them to be considered as a complete alternative to the surgical treatment of uterine fibroids. The objective: evaluation of the effectiveness of the use of SMPR in the treatment of combined gynecological diseases. Patients and methods. The study included materials for the observation of 40 women 20–52 years old with uterine myoma against the background of combined gynecological pathology (endometriosis, infertility), which carried out the enucleation of myomatous nodes by laparotomy, laparoscopic or transcervical access. Patients were divided into two groups. In the main group (n=20), women received SMPR – ulipristal acetate (UPA) 5 mg daily for 3 months. The UIA's bioavailability is 70%. The optimal therapeutic single dose for the analyzed pathology is 5 mg. After 3 months, the first assessment of the effectiveness of the drug with combined gynecological pathology was conducted, then 14 women were exposed to surgical treatment, and 6 of 20 patients continued conservative treatment for another 1–4 months. After the operation to prevent the recurrence of uterine fibroids and endometriosis, 8 patients continued treatment of UPA for 4 months. In the comparison group (n=20), women underwent surgical treatment at similar rates, but the SMPR was not assigned to surgery. Results. Of the studies indicate that the use of such a selective modulator of progesterone receptors, like vandalite acetate, in the treatment of uterine myomas in combination with endometriosis is safe and well tolerated, leads to rapid persistent coping of uterine bleeding, a significant decrease in the size of nodes and foci of endometriosis, and the achieved The therapeutic effect is maintained even after the abolition of therapy. Conclusion. Thus, the use of the drug ulipristal acetate in the treatment of uterine fibroate on the background of combined gynecologic pathology is highly effective and promising as an independent and integrated treatment method of this category of patients. Key words: uterine myoma, endometriosis, selective modulators of progesterone receptors, viperpatel acetate, combined oral contraceptives.
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