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Individualized correction of sex steroid deficiency in early postmenopausal women with uterine leiomyoma

https://doi.org/10.17749/2313-7347/ob.gyn.rep.2020.161

Abstract

Aim: to develop individualized options for correcting sex steroid deficiency in early postmenopausal patients with uterine leiomyoma.

Materials and Methods. 180 postmenopausal patients with uterine leiomyoma were examined. To correct menopausal manifestations, patients were prescribed: Group 1 (n = 60) – low-dose drug estradiol 1 mg/drospirenone 2 mg, Group 2 (n = 60) – ultra-low-dose drug estradiol 0.5 mg/drospirenone 0.25 mg, Group 3 (n = 60) – patients refused to take menopausal hormone therapy (MHT). Clinical and anamnestic, laboratory and instrumental examination was carried out by assessing vasomotor and genitourinary symptoms. Special attention was paid to ultrasound examination of the pelvic organs with Dopplerometry of the intratumoral vessels.

Results. The vasomotor manifestations of menopausal syndrome in postmenopausal patients with uterine leiomyoma were effectively relieved with drug containing 17β-estradiol/drospirenone, regardless of component dosage (RR = 0.25). The size of nodes in uterine leiomyoma type 2–6 according to classification of The International Federation of Obstetricians and Gynecologists (FIGO) as well as Dopplerometry data in the uterine artery in postmenopausal women showed no changes after 9-month use of 17β-estradiol/drospirenone. In Group 1, increased vascularization intensity (RR = 1.4) and decreased peripheral vascular resistance in intranodular vessels were revealed in 6 % patients.

Conclusion. The use of MHT drugs at varying component doses did not enlarge size of leiomyoma nodes nor affected hemodynamic parameters in the uterine arteries during 6-month-treatment. However, while prolonging MHT duration, it increased vascularization of myoma nodes assessed by measuring intranodular blood flow, increased vascularization and decreased resistance index after administering low-dose vs. ultra-low-dose MHT therapy that should be taken into account upon planning therapeutic regimen and its timeframe.

About the Authors

M. V. Koval
Ural State Medical University, Ekaterinburg, Health Ministry of Russian Federation
Russian Federation

Marina V. Koval – MD, PhD, Assistant, Department of Obstetrics and Gynecology,

3 Repina Str., Ekaterinburg 620014, Russia



T. A. Oboskalova
Ural State Medical University, Ekaterinburg, Health Ministry of Russian Federation
Russian Federation

Tatyana A. Oboskalova – MD, Dr Sci Med, Professor, Head of the Department of Obstetrics and Gynecology

3 Repina Str., Ekaterinburg 620014, Russia



References

1. Kovalyova L.A. Additional options for climacteric syndrome treatment. [Dopolnitel'nye vozmozhnosti terapii klimaktericheskogo sindroma]. Medicinskij alfavit. 2017;3(23):42–5. (In Russ.).

2. Stuenkel C.A., Davis S.R., Gompel A. et al. Treatment of symptoms of the menopause: an Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2015;100(11):2015–236. https://doi.org/10.1210/jc.2015-2236.

3. Gass М.L., Bachmann G.A., Goldstein S.R. et al. Management of symptomatic vulvovaginal atrophy: 2013 position statement of The North American Menopause Society. Menopause. 2013;(9):888–902. https://doi.org/10.1097/gme.0b013e3182a122c2.

4. Glazunova A.V. Clinical and pathogenetic justification of postmenopausal women management with vaginal atrophy with considering the peculiarities of vaginal microbiocenosis and individual links of local immunity. [Kliniko-patogeneticheskoe obosnovanie vedeniya zhenshchin s vaginal'noj atrofiej v postmenopauze s uchetom osobennostej mikrobiocenoza vlagalishcha i otdel'nyh zven'ev lokal'nogo immuniteta]. Avtoref. dis. kand. med. nauk. Moskva, 2017. 26 s. (In Russ.).

5. Sinha A., Ewies A. Non-hormonal topical treatment of vulvovaginal atrophy: an up-to-date overview. Climacteric. 2013;16(3):305–17. https://doi.org/10.3109/13697137.2012.756466.

6. Menopausal hormone therapy and preservation of women's health in adulthood. Clinical guidelines (Treatment protocol). [Menopauzal'naya gormonoterapiya i sohranenie zdorov'ya zhenshchin v zrelom vozraste. Klinicheskie rekomendacii (Protokol lecheniya)]. Moskva, 2015. 54 s. (In Russ.). Available at:http://www.minzdravrb.ru/download/0517/protokolmenopause.pdf. [Accessed: 20.06.2020].

7. Baber R., Panay N., Fenton S. IMS recommendations on menopausal hormone therapy and preventive strategies for midlife health. Climacteric. 2016;19(2):109–50. https://doi.org/10.3109/13697137.2015.1129166.

8. Villiers T.J., Hall J.E., Pinkerton J.V. Revised Global Consensus Statement on Menopausal Hormone Therapy. Maturitas. 2016;91(2):153–5. https://doi.org/10.3109/13697137.2013.771520.

9. Report about the meeting of the expert council dedicated an ultra-lowdose drug for menopausal hormone therapy (0.5 mg estradiol/0.25 mg drospirenone) entering the Russian market. [Otchet o zasedanii ekspertnogo soveta, posvyashchennogo vyhodu ul'tranizkodozirovannogo preparata dlya menopauzal'noj gormonal'noj terapii (0.5 mg estradiola/0.25 mg drospirenona) na rossijskij rynok]. Kankun, Meksika, 2014. (In Russ.). Available at: https://gynendo.ru/novosti/sobytiya/otchet-o-zasedanii-ekspertnogosoveta. [Accessed: 20.06.2020].

10. Archer D.F., Schmelter T.H., Schaefers M. et al. A randomized, doubleblind, placebo-controlled study of the lowest effective dose of drospirenone with 17 β-estradiol for moderate to severe vasomotor symptoms in postmenopausal women. Menopause. 2014;21(3):227–35. https://doi.org/10.1097/GME.0b013e31829c1431

11. Balan V.E., Amirova Zh.S., Kovaleva L.A. et al. Specific features of therapy for disordered urination in menopausal women. [Osobennosti terapii narushenij mocheispuskanij u zhenshchin v klimakterii]. Rossijskij vestnik akushena-ginekologa. 2015;15(3):29–34. (In Russ.).

12. Prilepskaya V.N., Ledina A.V. Estriol (local and systemic forms) in the treatment of atrophic vulvovaginitis. [Estriol (lokal'nye i sistemnye formy) v lechenii atroficheskogo vul'vovaginit]. Ginekologiya. 2015;17(1):66–8. (In Russ.). https://doi.org/10.26442/2079-5831_17.1.66-68.

13. Vilos G.A., Allaire C., Lefebvre G. et al. The management of uterine leiomyomas. J Obstet Gynaecol. 2015;37(2):157–78. https://doi.org/10.1016/S1701-2163(15)30338-8.

14. Douchi T., Ijuin M., Ijuin T. Relationship of ultrasonographic endometrial thickness and uterine size to bone mineral density in postmenopausal women. Maturitas. 2004;48(3):219–23. https://doi.org/10.1016/j.maturitas.2003.10.010.

15. Chang I., Hong G., Oh Y. Effects of menopausal hormone therapy on uterine myoma in menopausal women. J Menopausal Med. 2013;19(3):123–9. https://doi.org/10.6118/jmm.2013.19.3.123.

16. Gregoriou O., Koidaris S., Botsis D. Long-term effects of Tibolone on postmenopausal women with uterine myoma. Maturitas. 2001;40(1):95–9. https://doi.org/10.1016/S0378-5122(01)00234-1.

17. Polatty F., Viasso F., Colleoni R., Nappi R.E. Uterine myoma in postmenopause: a comparison between two therapeutic schedules of HRT. Maturitas. 2000;37(1):27–32. https://doi.org/10.1016/S0378-5122(00)00159-6.

18. Jaisamrarn U., Triratanachat S., Chaikittisilpa S. et al. Ultra-low-dose estriol and lactobacilli in the local treatment of postmenopausal vaginal atrophy. Climacteric. 2013;16(3):347–55. https://doi.org/10.3109/13697137.2013.769097.

19. Mozheyko L.F. Uterine fibroids: modern view on etiology and pathogenesis, classification, diagnosis and treatment. [Mioma matki: sovremennyj vzglyad na etiopatogenez, klassifikaciyu, diagnostiku i lechenie]. Reproduktivnoe zdorov'e. Vostochnaya Evropa. 2018;8(3):291–300. (In Russ.).

20. Bulun S.E. Uterine fibroids. N Engl J Med. 2013;369(14):1344–55. https://doi.org/10.1056/NEJMra1209993.

21. Horak P., Mara M., Dundr H. et al. Effect of a selective progesterone receptor modulator on induction of apoptosis in uterine fibroids in vivo. Int J Endocrinol. 2012;2012:436174. https://doi.org/10.1155/2012/436174.

22. Ceylan B., Ozerdoğan N. Menopausal symptoms and quality of life in Turkish women in the climacteric period. Climacteric. 2014;17(6):705–12. https://doi.org/10.3109/13697137.2014.929108.

23. Ozerskaya I.A. Echography in gynecology. Study guide. [Ekhografiya v ginekologii. Uchebnoe posobie]. Moskva: Vidar-M, 2013. 564 s. (In Russ.).

24. Oleinik N.S. Peculiar properties of dopplerometry in uterine myoma. [Osobennosti dopplerometrii pri miome matki]. Tavricheskij medikobiologicheskij vestnik. 2012;15(2):237–8. (In Russ.).

25. Bulanov M.N. Ultrasound gynecology: a course of lectures in three volumes. Volume 2. [Ul'trazvukovaya ginekologiya: kurs lekcij v trekh tomah. Tom 2]. Moskva: Vidar-M, 2010. 306 s. (In Russ.).


Review

For citations:


Koval M.V., Oboskalova T.A. Individualized correction of sex steroid deficiency in early postmenopausal women with uterine leiomyoma. Obstetrics, Gynecology and Reproduction. 2020;14(4):457-468. (In Russ.) https://doi.org/10.17749/2313-7347/ob.gyn.rep.2020.161

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ISSN 2313-7347 (Print)
ISSN 2500-3194 (Online)