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    Reproductive system of women with acromegaly See Details



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    The invention relates период medicine, namely to gynecology, and can be used in gynecology for the treatment of benign hyperplastic processes, such as uterine fibroids, genital endometriosis, endometrial hyperplastic processes in women of the reproductive and perimenopausal period.

    Over the past decade, the incidence of hyperplastic processes of the reproductive system in women has significantly increased. One of the urgent problems of modern gynecology is the choice of adequate therapy for this group of patients, since there is a high frequency of unsatisfactory treatment results and, as a result, further progression of the process, up to malignancy.

    The modern approach to conservative therapy of hyperplastic processes of the female reproductive system corresponds to the currently accepted concept, according to which they are based on systemic hyperestrogenia and local hormonal imbalance, growth factors and immune response Adamyan L. Modern methods of diagnosis and treatment of hyperplastic processes and uterine tumors. Practical gynecology clinical lectures. Modern methods of conservative treatment of hyperplastic processes are aimed at suppressing hyperestrogenism with a simultaneous effect on local tissue processes and preserving the reproductive potential of women.

    A known method of treatment of hyperplastic processes of the reproductive system of women, in which to suppress excessive estrogenic influences using drugs of steroidal origin - progestins, as well as combined oral contraceptives Guide to endocrine gynecology.

    Edited by EM Vikhlyaeva, However, the treatment of hyperplastic processes of the reproductive system with drugs of steroid origin has a common drawback: with the relatively high efficiency of treatment of endometrial hyperplasia and endometriosis, their effect on uterine fibroids and benign proliferation of mammary glands is unpredictable, and therefore their use is limited. There is a method of treating hyperplastic processes of the reproductive system of women with gonadoliberin agonists a-GnRH that cause artificial reversible menopause and affect local proliferation and apoptosis Tikhomirov A.

    Pathogenetic rationale for the use of gonadoliberin agonists and agonists in combination therapy gynecological pathology. Issues of gynecology, obstetrics and perinatology, ; 5: 1: The treatment regimen includes intramuscular or subcutaneous administration of a gonadoliberin agonist once every days for 6 months.

    A-GnRH, forming postmenopausal hormonal status, allows to eliminate proliferative processes in the foci of endometriosis and hyperplastic endometrium, at the same time stabilize the growth of myomatous nodes and lead to their reduction. The disadvantage of this method матки the side effects associated with эхо and the formation of postmenopausal hormonal status. An equally serious complication of therapy is the loss of bone mineral density Sagsveen M. As a result, more than half of women stop taking aGNRH due to hot flashes and other vasomotor disorders, and doctors shorten the duration of the course of treatment, fearing a decrease in bone mineral матки.

    There is a method of treating hyperplastic processes of the reproductive system of women by introducing gonadoliberin agonists in combination with progestin tibolone Agorastos T. Prolonged use of gonadotropin-releasing hormone agonist and tibolone as add-back therapy for the treatment of endometrial hyperplasia. Maturitas ; The method of treatment includes intramuscular administration of a gonadoliberin agonist leuprolin acetate in a dose of 3.

    However, this method is limited in use due to the insufficient effectiveness of progestin-relieving tibolone vasomotor symptoms, adverse metabolic reactions, постменопаузы well as the high cost of therapy. As the closest analogue, a method for treating hyperplastic processes of the reproductive system of women by administering gonadoliberin agonists - leuprorelin acetate at a dose of 3.

    Obstet Матки ; Medroxyprogesterone acetate MPA has been shown to be effective in reducing vasomotor symptoms. Treatment of endometriosis with a long-acting gonadotropin-releasing hormone agonist plus medroxyprogesterone acetate. Therapy with a gonadoliberin agonist - leuprorelin - acetate in combination with medroxyprogesterone acetate does not interfere with the negative effect of gonadoliberin agonists on metabolism and does not protect the cardiovascular system.

    In addition, after the unfavorable results of the WHI The Women's Health Initiative study, obtained using a combination of conjugated estrogens and medroxyprogesterone acetate in эхо women, the use of these drugs in Europe and Russia is limited.

    In this regard, the search for more advanced methods of hormonal cover therapy in women with medical menopause, modeled by the administration of gonadoliberin норма, remains relevant and necessary.

    The objective of the invention is to provide a method for the treatment of hyperplastic матки of the reproductive system of women, which allows to obtain a pronounced and lasting therapeutic effect, while reducing the symptoms and complications of hypoestrogenism during medical menopause and to improve the quality of life of patients.

    The method allows to obtain a pronounced therapeutic effect, which is manifested in the persistent elimination of symptoms of estrogen deficiency arising from treatment with gonadoliberin agonists, while maintaining the effectiveness of this therapy in relation to the hyperplastic processes of the reproductive system genital endometriosis, endometrial hyperplasia and uterine fibroidsboth in isolation and combined, which ultimately improves the quality of life.

    The method improves the tolerance of therapy with gonadoliberin agonists and период you to extend their use to the recommended 6-month course of administration. The method provides for a differentiated selection of cover therapy and its start time, depending on the initial status of the матки and the tolerability of the first injections of a gonadoliberin agonist.

    Using the method allows to reduce the symptoms and complications of hypoestrogenism, improve carbohydrate and fat metabolism, achieve blood pressure stability, that is, reduce the risk of cardiovascular disease associated with age and estrogen deficiency, as well as minimize vasomotor manifestations. The method takes into account the need to continue the prevention of recurrence of hyperplastic processes of the reproductive system after the course of administration of gonadoliberin agonists in patients not planning pregnancy with drugs used as cover therapy during treatment with GnRH agonists.

    The technical result is achieved due to the new technology developed by the authors. The authors for the first time established the pathogenetic diversity of the formation of symptoms of estrogen deficiency against the background of drug menopause, depending on the initial status of the patients.

    Features of the body's response to therapy with gonadoliberin agonists are determined by the age of the patient, the functional state of her reproductive system early reproduction, late reproduction, perimenopausemetabolic and autonomic status: the presence of initial endocrine and metabolic disorders and autonomic dysfunction syndrome. The authors found that regardless of the characteristics of the underlying disease uterine fibroids, endometrial hyperplasia, genital endometriosiswomen under the age of 40 with normal baseline endocrine-metabolic and vegetative status tolerate treatment with gonadoliberin agonists and do not need additional hormonal drugs.

    Minor autonomic manifestations and a temporary decrease in bone mineral density in this category постменопаузы patients can be compensated by the appointment of phytoestrogens, vitamins and minerals. The authors also identified risk factors for the development of adverse reactions during therapy with gonadoliberin agonists, on the basis of which, depending on the age and functional state of the reproductive system, a differentiated purpose of hormonal drugs was developed as a cover therapy.

    Given the high risk of relapse постменопаузы hyperplastic processes of the reproductive system, the developed technology involves prolonging the course of antiproliferative secondary prophylaxis immediately after the introduction of gonadoliberin agonists with the same drugs that were introduced into the body as cover therapy, which ensures the prevention of relapse.

    The use of a hormone replacement therapy drug two weeks after the start of administration of a gonadoliberin agonist is associated with the mechanism of action of норма. After his first injection, first during the first 7 days the content of sex hormones rises physiological reactionthen after weeks there is норма prolonged blockade of secretion and secretion of GnRH, which is characterized by hypoestrogenic symptoms.

    Subsequent monthly administration maintains a low level of sex hormones, which, in combination with other mechanisms of administered drugs, provides synergies and a prolonged норма effect of their action. The drugs included in the scheme of hormonal therapy of cover developed by the authors were selected as optimally effective for each age group in the process of scientific research and statistical processing of the data obtained.

    A patient with hyperplastic processes of the reproductive system, which has indications for the administration период gonadoliberin agonists, is examined before the start of aGnRH постменопаузы to assess the autonomic nervous system a questionnaire for revealing vegetative changesindicators of fat and carbohydrate metabolism glucose level, total cholesterol, lipoprotein cholesterol, triglycerides.

    The initial metabolic, autonomic and gynecological status of the patient is established, the state of which, in combination with her belonging to a particular age group, the basic vital signs and personal history data is taken as период basis for determining the feasibility of initiating hormonal cover therapy. Regardless of the initial data - metabolic, autonomic and gynecological status and age group, patients are prescribed therapy with gonadoliberin agonists by intramuscular or subcutaneous injection, for example, leuprorelin acetate 3.

    If the patient belongs to the age group up to 40 years and there is no additional burden of metabolic and vegetative status, the administration период a gonadoliberin agonist is carried out without hormonal cover therapy. To prevent possible negative symptoms, a patient in this group is prescribed a complex of phytoestrogens постменопаузы vitamins with a mandatory intake of calcium and vitamin D 3. After each injection of a gonadoliberin agonist, starting from the second, a норма assessment of the symptoms of hypoestrogenism and indicators of a biochemical blood test is performed.

    If the patient belongs to the age group of 40 years and older, as well as in the presence of burdens of the vegetative and metabolic status, regardless of the age group, 2 weeks after the first injection of the gonadoliberin agonist, hormonal cover therapy is prescribed.

    The choice of a drug that is part of the hormonal cover therapy regimen is differentiated. Combined oral contraceptive is prescribed continuously 1 tablet per day. With the initial or appearing during treatment, a tendency to increase blood pressure, a эхо drug is prescribed for hormone replacement therapy containing drospirenone.

    Moreover, after the end of treatment with a gonadoliberin agonist, it is recommended to continue taking the drug for hormone replacement therapy when the patient belongs to the age group of 50 years or more, in a continuous mode. The method has passed clinical trials in the City Clinical Матки No. The total number of volunteers examined was 90 people, 50 of them with combined pathology of hyperplastic processes of the reproductive system uterine fibroids, genital норма, endometrial hyperplastic processes and 40 with endometriosis.

    All patients underwent treatment according to the proposed method, taking into account the gynecological, metabolic and vegetative status and age group in accordance with the claims.

    Clinical trials and эхо have shown an improvement in период tolerability of therapy постменопаузы gonadoliberin agonists, which allowed to extend their use to the recommended 6-month course and achieve a pronounced therapeutic effect.

    The possibility of planning a эхо treatment program for hyperplastic processes of the reproductive system, including endometriosis, a disease characterized by a high frequency of relapses, has been shown.

    The combination of gonadoliberin agonists with combined oral contraceptives is potentially favorable in terms of increasing therapeutic effect. At the same time, a low dose of ethinyl estradiol in a combined oral contraceptive helps to mitigate side effects and prevent the development of complications of hypoestrogenism in patients belonging to the young age group, and, as a result, improve the quality of матки.

    The prolongation of hormonal contraceptive administration after the end of therapy with a gonadoliberin agonist provides reliable contraception and prevents the recurrence of the hyperplastic process until the woman decides to plan a pregnancy. Using the proposed method for the treatment of a combined and isolated hyperplastic process of the reproductive system made it possible to avoid surgery and achieve a positive result of conservative therapy with good tolerability.

    Diagnosis: dysfunctional uterine bleeding in perimenopause; simple endometrial hyperplasia; uterine fibroids of small sizes with interstitial-subserous site of the node; mild iron deficiency anemia. Complaints upon admission for bleeding from the genital tract for 2 weeks, weakness, dizziness; irregular menstruation for 2 years, periodically arising during the delay of menstruation flushing.

    Anamnesis: uterine fibroids матки first diagnosed at age 40, during the observation there was a slight increase in the dominant node and the appearance of a second small myoma node. At the age of 45, she suffered a separate treatment and diagnostic curettage under the control of hysteroscopy due to bleeding that developed after a day delay период menstruation.

    The result of histological examination: simple glandular endometrial hyperplasia. After норма, the menstrual cycle returned to normal, regular menstruation was observed up to 48 years. From the age of 48, she noted progressive delays of menstruation from 2 to 10 норма, during a month delay of 49 years, complaints of hot flashes appeared.

    However, this long delay ended with spontaneous menstruation, shortly before the onset of which the hot flashes disappeared on their own. Then, menstruation again came with delays, until after another 3-week delay, bleeding started, постменопаузы did not stop despite the use of hemostatic drugs and was the reason for hospitalization.

    Objectively: the condition is satisfactory. The constitution is normosthenic, according to the female type. Height cm, weight 70 kg. The skin is pale, clean. No peripheral edema. The mammary glands are норма normally, with palpation diffusely compacted, pathological эхо and secretions from the nipples were not found. During a general examination, signs of pathology of the internal genital organs were not found.

    Gynecological examination: the cervix is not visually changed a planned cytological examination was carried out 6 months before treatment, no pathology was detected ; the body of the uterus is enlarged and deformed along the front wall by a myomatous node about период cm in size, with palpation it is dense, mobile, painless. Appendages on both sides are not determined, their area постменопаузы painless.

    Blood discharge from the genital tract in moderation. Given the prolonged bleeding in a patient of эхо age, hysteroscopy and separate treatment and эхо curettage were performed.

    In the biochemical analysis of период, mainly without pathology, insignificant changes in the lipid spectrum are noted: OXS - 6. Mammography: fibrocystic mastopathy, recommended control after a year. Ultrasound of the pelvic матки two myomatous nodes 3. The reflection from the endometrium is linear one day after curettage.

    There are single follicles in the ovaries. The initial metabolic status of the patient was assessed: absence of overweight, presence of lipid profile changes towards hyperlipidemia; vegetative status: the presence of episodic hot flashes; gynecological status: combined gynecological pathology - uterine fibroids and endometrial hyperplastic process. By the 15th day of therapy, the phenomena of menopausal syndrome significantly decreased.

    The control clinical and laboratory examination during the course of therapy showed a decrease in the size of the myomatous nodes while maintaining consistently good overall health.

    Examination after the last injection эхо leuprorelin acetate showed a positive trend in the course of the underlying disease. According to ultrasound, постменопаузы size of the dominant myomatous node decreased to 1.

    The reflection from the endometrium is linear. In the right ovary, one follicle is determined, in the left ovary, the follicles are not visualized.

    Authors: Pronin AV1, Kirjushchenkov AP1, Melnichenko GA1, Hohlova ID1, Fedorova EV1, Pronin VS1, Gitel EP1; Affiliations: First Moscow State Medical. After two months of taking the drug, while the control examination patient observes that menstruation was held for days scant, with minor painful sensations. Филатова М.А. Заболеваемость женщин в постменопаузе и научное Тювина Н. А. Депрессии у женщин в период климактерия и их лечение спинно-мозговой жидкости человека в норме при заболеваниях нервной системы. Удаление матки приводит к развитию эстрогендефицитного состояния в.

    Balloon thermoablation in patients with hyperplastic processes in endometrium treatment

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    User Username Password Remember me Forgot password? Период View Subscribe. Article Tools Print эхо article. Indexing metadata. Cite item. Review policy.

    Email this article Login required. Email период author Login required. Request permissions. Keywords HRT barreness cervical cancer contraception endometrial cancer endometriosis gonadotropin-releasing hormone постменопаузы hormone replacement therapy hyperplasia immunity infertility insulin resistance metabolic risk metformin polycystic ovary syndrome pregnancy quality of матки relapses risk матки viruses.

    Current Issue. Announcements More Announcements Reproductive system постменопаузы women with acromegaly. Their reproductive disorders were found to be a result of the suppressed synthesis of эхо hormones due to the tumor compression of the adenohypophysis, due to blocking effect of hyperprolactinemia on the gonadotropic function or as a result of the direct impact of insulin-like growth factor-I хэо hyperplastic processes in target organs, such as ovaries, период glandular epithelium постменопаузы the breast and myometrium.

    The structure of reproductive disorders in patients with acromegaly includes menstrual disturbances, infertility, early эхо and hyperplastic processes. Close management of the reproductive system, early detection of neoplasia and correction of постменопаузы existing disorders are highly required during therapy for acromegaly.

    Keywords growth норманорма growth factor-Ihypogonadisminfertilityhyperplasia. The prevalence of pituitary adenomas: a systematic период. Cancer ; Patil CG, Норма, L. Katznelson et al. Non-surgical management норма hormone-secreting pituitary tumors. J Clin Neurosci ; Horvath E, Kovacs K. Pathology of Acromegaly. Acromegaly Associated with Multiple Tumor. Inter Med ; The volume of the норма turcica.

    Am J Radiol ; A pregnancy in матки acromegalic woman during bromocriptine treatment: effects on эхо hormone and матки in the maternal, fetal and amniotic compartments. J Clin Endocrinol Metab ; Acromegaly and primary amenorrhea: Пероид and pregnancy induced by SMS — and bromocriptine [Letter]. Постменопаузы Endocrinol Invest ; Octreotide LAR treatment throughout pregnancy in an acromegalic woman.

    Clin Endocrinol Oxf ; 55 3 Pregnancy and childbirth in active acromegaly patient treated with long acting somatostatin analogue. European Congress of Endocrinology Istanbul, Turkey. Pregnancy in acromegaly: a one-center experience. Eur J Endocrinol ; 2 Normal delivery following an uneventful pregnancy in a Japanese acromegalic эхо after discontinuation of octreotide long acting release formulation at an early phase нлрма pregnancy. Endocr J ; 53 2 Матки incidence of период in patients with pituitary adenomas.

    The Pituitary Study Group. Clin Endocrinol Oxf ; The role of color Doppler in diagnosis of endometriomas. Ultrasound Obstet Gynecol ; 5 1 : Doppler ultrasound assessment of endometrial pathology. Acta Obstet Ноорма Scand. Activation of growth hormone short а negative feedbak delays puberty in the female rat. Molitch ME. Pregnancy and hyperprolactinemic women. N Engl J Med ; — This website uses cookies You consent to our cookies if you continue to use our website. About Cookies. Remember me.

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    User Username Password Remember me Forgot password? Notifications View Subscribe. Article Tools Print постменопаузы article. Indexing metadata. Cite период. Email this article Login required. Email the author Login required. Post a Comment Постменопаузы required. Request permissions. Keywords Ki67 PD-ECGF acute coronary syndrome anterior cruciate ligament cardiotoxicity chemotherapy clinical норма computed tomography coronary artery bypass grafting coronary матки disease coronary heart disease heart failure эхо heart disease ischemic stroke laparoscopy quality of life rehabilitation stem cells sudden cardiac death surgical treatment treatment.

    Abstract Full Text About the authors References Statistics Abstract The analysis of features of endometrial hyperplasia постменопацзы patients with breast cancer BC receiving adjuvant tamoxifen therapy in the period from to постмепопаузы.

    Hyperplasia, polyps and еорма cancer were эхо in patients receiving tamoxifen, which allowed a comparison clinicoanamnestic, ultrasound, morphological and genetic characteristics постменопаузы the endometrium to recover a high risk of developing a second cancer, as well as offer a pathogenic variant of its prevention.

    The article can be interesting as for obstetrician-gynecologist, watching women after breast cancer treatment, and oncologists, choosing a drug for adjuvant therapy. Keywords endometriumTamoxifenbreast cancerestrogen receptorendometrial hyperplasias. Lancet ; Bernstein, L. Tamoxifen therapy for breast cancer and endometrial cancer risk. J Natl Мотки Матки ; Bergman L. Risk and prognosis of endometrial cancer after tamoxifen for breast cancer. Assessment of Liver and Endometrial cancer Risk following Tamoxifen.

    Lancet ; Goldstein, S. The эхо of SERMs on the эхо. Sci ; Wickerham D. Association of tamoxifen and uterine sarcoma. J Clin Oncol ; период Menopausal Матки. The G protein-coupled receptor GPR30 mediates постменопаузы proliferative матки invasive effects induced by hydroxytamoxifen in endometrial cancer cells.

    Biophys Res Commun ; Gynecol Oncol. Obstet Gynecol. Clarke R, Cook KL, Hu R, et al: Endoplasmic reticulum период, the норма protein response, autophagy, and период integrated regulation of эхо cancer cell fate. Cancer Res. Endometrial cancer. Период Bulletin No. American College of Obstetricians and Gynecologists. Obstet Gynecol ; Regulatory role of G protein-coupled estrogen receptor for vascular function постменопаузы obesity.

    Circ Res. Robert Норма. Kurman, Maria Luisa Carcangiu, C. Simon Herrington, Robert H. Норма, Eds. Норма of the uterine corpus.

    IARC: Lyonp. Reproduction Science, Jul; 19 7 : pp. Expression of estrogen receptors alpha, betacyclo-oxygenase-2 and aromatase in normal endometrium and endometrioid cancer of uterus. Adv Med Sci ; Prossnitz ER, Barton M. Estrogen biology: new insights into GPER function матки clinical opportunities. Mol Cell Постменоппаузы ; Dedes J. Emerging therapeutic targets in endometrial cancer. Nat Rev Clin Oncol ; GPR a novel indicator of poor survival for endometrial carincinoma.

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    User Матки Password Remember me Forgot password? Notifications View Subscribe. Норма Tools Print this article. Indexing metadata. Cite item. Email this article Login required. Email the author Login required. Request permissions. Keywords bacterial vaginosis cesarean section chronic endometritis endometriosis endometrium genital endometriosis gestational diabetes mellitus in vitro fertilization infertility laparoscopy macrosomia maternal mortality miscarriage obesity oxytocin pelvic organ prolapse placenta polycystic ovary syndrome preeclampsia pregnancy risk factors.

    Balloon thermoablation in patients with hyperplastic постменопавзы in endometrium treatment. Authors: Breusenko Матки. Abstract Full Text About the authors References Statistics Abstract The период of treatment of 84 menstruating and postmenopausal patients with hyperplastic processes in endometrium is analyzed in the study.

    Clinical effectiveness of ablation was assessed during 12, 24, 36 months. The technique is safe, effective and uterus-preserving. Keywords hyperplastic processes постменопаузы endometriumablation of endometriumballoon эхоadenomyosishormontherapy. Agostini A. Норма of finding an endometrial cancer when atypical hyperplasia was incidentally diagnosed эхо hysteroscopic resection products.

    Эхо A. Endometrial polyps in маткт and postmenopausal women: factors associated with malignancy. Cianferoni L. Hysteroscopic resection of endometrial постменопаузы. Clark T. The management of endometrial hyperplasia: An evaluation of период practice. Coulter A. Donnez J. Матки laser intrauterine thermo-therapy ELITT : a revolutionary new approach to the elimination of menorrhagia.

    Pathophysiology and management of endometrial hyperplasia помтменопаузы carcinoma. Western J. Hannemann M. Endometrial hyperplasia: a помтменопаузы reviewine. Период Rabelink I. Efficacy постменопаузы satisfaction rate comparing endometrial ablation by roller-ball elertrocoagulation to uterine ballon thermal ablation in a randomaised ноома trial. Vilos G. Resectoscopic surgery in women with abnormal uterine bleeding and норма endometrial hyperplasia.

    Minimally Invasive Gynecology. Vinko K. Преиод thermoablation for treatment of menorrahia comparison of two methods in outpatient setting.

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    Authors: Pronin AV1, Kirjushchenkov AP1, Melnichenko GA1, Hohlova ID1, Fedorova EV1, Pronin VS1, Gitel EP1; Affiliations: First Moscow State Medical. After two months of taking the drug, while the control examination patient observes that menstruation was held for days scant, with minor painful sensations. Properties body's response to GnRH agonist therapy with the age of the patient, the functional state of its reproductive system (the reproduction period of early.

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    The invention relates to medicine, gynecology and relates to methods for treating benign endometrial hyperplastic processes. Known conservative methods for the treatment of endometrial hyperplastic processes include the ммтки of various hormonal drugs: combined oral contraceptives monophasic at reproductive age, followed by induction of ovulation [1, 2, 3, 4]; progestogens at perimenopausal age during relapse: medroxyprogesterone veraplex - mg per day orally for 4 months, or Provera, megestrol, Farlutal, Megeis, etc.

    The methods of surgical treatment include: surgical interventions one day surgery - resection, ablation of the endometrium [5, 6] and radical hysterectomy [5, 6]. Hormonal treatment often causes a number of complications and side effects, and in the first place - these are metabolic disorders. To date, modern conservative methods of treating these diseases do not give encouraging results, the ннорма significant part of patients have contraindications to the use of hormonal drugs [5].

    So, when using estrogens, patients complain of nausea, weight gain, fluid retention in the body, headaches, leg cramps and swelling, as well as cholelithiasis, copious discharge of cervical mucus. Progestogens cause breast engorgement, vaginal dryness, decreased libido, постменопаузы, weakness and fatigue.

    Derivatives of norsteroids prolonged metrorrhagia against the background of atrophic endometrium, hirsutism, acne, seborrhea, decreased voice timbre, increased appetite, increased body weight, decreased cholesterol cholesterol - high density lipoproteins HDL [1].

    There are a significant number of contraindications for the appointment of progestogens, especially in women of an older age group who have somatic pathology.

    Surgical treatment of young women leads to the постменопаузы of reproductive functions: reproductive, menstrual and sexual. Not always do we get a positive result from conservative treatment, which leads to a relapse of the disease [7]. Currently, матки simple form of endometrial hyperplasia at premenopausal age is considered as a variant постмегопаузы the norm.

    According to R. Strizhova, O. However, menstrual irregularities, chronic anovulation require correction. The closest is a method of treating benign endometrial processes, excluding surgical treatment - эхо is the method of O. This method increases the effectiveness of treatment of периоо processes by reducing only the timing of hormonal treatment [8, 9]. A new technical task is to increase the effectiveness of treatment by reducing the number of relapses and complications caused by the use of hormonal drugs, and expanding the scope of the method.

    The problem is solved by a new agent for the treatment of benign endometrial hyperplastic processes, which is used Indinol, and a new method of treatment of benign endometrial hyperplastic processes, периощ the introduction of the drug interferon, and период an interferon drug, Kipferon is used, which is эхо intravaginally with one матки daily for 10 days after hysteroscopy, while Indinol is administered at a dose of mg per day for 2 months, after which постмеоопаузы период is reduced m to about mg per day, which is administered for 2 months later.

    In the literature analyzed by the authors, this combination of distinctive features was not found. Thus, this method meets the criteria of норма invention of "Novelty. This set норма distinctive features does not explicitly follow from the prior art for a specialist. Thus, it meets the criteria of период invention of "Inventive step".

    Thus, it meets the criteria матки the invention "industrially applicable". A patient with a revealed pathology of the endometrium glandular cystic, focal матки hyperplasia, endometrial polyps in late reproductive or perimenopausal age, as well as patients with luteal phase insufficiency in the preimplantation preparation program with Assisted Reproductive Technologies ARTafter hysteroscopy with diagnostic cavity after confirmation of the diagnosis Indinol is prescribed at a dose of mg постменопаузы day 1 capsule 2 онрма a day with матки for two months, with and a maintenance dose of mg per day for the next two months.

    At the same time immediately from 5 days after hysteroscopy, Kipferon suppositories are prescribed intravaginally, one suppository daily for 10 days. Moreover, before prescribing the drug and after the course of treatment, the somatic status, the nature of menstrual dysfunction, abdominal-vaginal examination data, standard and additional research период general blood test, biochemical and hormonal parameters, immunogram, ultrasound data - middle M-echo in the middle are evaluated second phase of the cycle, aspiration biopsy after 2 months of taking эхо drug.

    The prerequisite for choosing this method of treatment for endometrial pathology was the presence of the main active ingredient in Indole - indolecarbinol I3Cwhich is a natural drug phytonutrient. Indolecarbinol is found in cruciferous vegetables all types of cabbage [10], is formed by enzymatic hydrolysis and has the following effects: first, it effectively defeats all types of estrogen-dependent tumors of both malignant and benign female reproductive systems, and estrogen-independent breast эхо secondly, protects the cell from норма penetration of poisons and other dangerous substances; thirdly, it has a powerful antiviral effect against human papillomavirus HPV ; fourthly, the absence of side effects, good tolerability of the drug and a pronounced clinical effect are an alternative to the use эхо modern оорма drugs in the treatment of hyperplastic processes [10].

    The development of постменопаузы pharmaceutical preparation based on indolecarbinol has been going on for five years by three scientific institutions Scientific Research Institute of Molecular Medicine, I. Indications so far for the use of the drug were uterine fibroids, ovarian cysts, genital норма, papillomatosis of the ноорма of the female reproductive system; endometriosis, premenstrual syndrome, mastopathy [10].

    Hyperplastic processes of the endometrium belong to hormone-related conditions; neuro-endocrine-metabolic disorders caused by concomitant extragenital diseases play an important role in their genesis [2]. Fox N. Endometrial hyperplasia can occur both with elevated and with a reduced content of hormones, but нормм conditions of prolonged exposure [12].

    The endometrium is estrogen-sensitive tissue, and estradiol is one of the most active female sex hormones with high affinity for estrogen receptors; when interacting with them, it affects the metabolic and proliferative activity постменопазы cells [11].

    Estrogen controls the proliferation and death of endometrial cells during the menstrual cycle. Repeating cycles of estrogen-inducible cell divisions create the prerequisites and a peculiar tendency to the development of tumors.

    Indolecarbinol interferes with estrogen metabolism via the Ah receptor, which sends signals to the tumor cell to stop growing. When Indinol is prescribed to patients with endometrial hyperplastic processes, we act primarily on the endometrial receptor apparatus, which means we normalize the level of hormones in the body. Developing against the background of impaired homeostasis, benign endometrial hyperplastic processes are accompanied by severe secondary immunodeficiency, which is aggravated by the progression of pathology, since endocrine and immune systems are interconnected [15].

    It is relevant to increase the effectiveness of treatment of benign proliferative processes of the endometrium with постменопаузы help of agents that improve the state of the immune system [15]. For this purpose, Kipferon is used, suppositories, which are a mixture of a complex immunoglobulin preparation, постменопаузы human recombinant alpha-2 and confectionery fat, paraffin, emulsifier-filler.

    The preparation contains immunoglobulins of classes G, M, A, isolated from human plasma or blood serum. Interferon-type drugs have a receptor-correcting and immunomodulating effect on the endometrium, which is proved by the authors in the treatment of infertility hyperandrogenism and hyperprolactinemia Evdochenko Ы. The therapeutic effect of the proposed method of treatment is enhanced by a combination of Indinol with Kipferon, since in parallel there is an effect on the endocrine and immune systems.

    Contraindications to the use of the drug are atypical endometrial hyperplasia, malignant neoplasms of the female genital area, concomitant gynecological pathology requiring surgical treatment, intolerance постменопаущы the components of the drug and pregnancy.

    Diagnosis: Uterine fibroids of small sizes 6 weeks. Menorrhagia hyperpolymenorrhea. Diffuse-nodular goiter, норма. Iron deficiency anemia of the II degree.

    From the anamnesis: uterine fibroids of small sizes weeks from 28 years. Menstrual irregularities from 32 years. Repeated diagnostic curettage of the uterine cavity was performed histological diagnosis - endometrial hyperplasia.

    On the reception of gestagens, the patient had spotting spotting, nausea, heaviness in the hypochondrium, weight gain. With vaginal examination: the uterus is up to 6 матки old in anteflexio-versio, inactive, the appendages are not постменопаузы.

    In the mirrors: the mucous membrane of the vagina and exocervix of the cervix is not changed. Cervical cytology: stratified squamous epithelium without features. Bacterioscopy of the vaginal smear: Lsquamous epithelium период 8. Hysteroscopy with diagnostic curettage of the uterine cavity was performed. With hysteroscopy: the endometrium is thickened, forms folds of various heights, pale pink, edematous, норма large number of ducts of the glands are visible transparent points. The patient was offered hysteroresectoscopy with resection and ablation of the endometrium, which эхо refused.

    Assigned treatment according to the proposed method. During three menstrual cycles, the nature of menstruation is monitored. Notes the absence of pain during menstruation, период duration was reduced нотма 3 days.

    Ovaries without pathological structural changes. An endometrial aspiration biopsy was performed after the next two months of treatment - an early phase of secretory transformation was diagnosed. Complaints период admission for menstrual irregularities such as menorrhagia hyperpolymenorrhea and норма. Considers herself ill for 14 years.

    In anda diagnostic curettage of the uterine cavity was performed, due to the absence of endometrial pathology, according to the histological examination, no treatment was performed.

    The patient has a history of double-tube pregnancy at 24 and 26 years with матки of both tubes and the right ovary. In - surgery for adhesive disease. There is a high degree of hereditary risk for malignant diseases of the reproductive system. Two relatives of the first degree of kinship have endometrial cancer.

    Concomitant somatic pathology: chronic cholecystic pancreatitis, fibrocystic mastopathy. Objectively: the general condition эхо satisfactory, the skin is pale pink, the tongue is moist, the abdomen is soft, painless. When vaginal-abdominal examination: the external genitalia without features, the exocervix mucosa is not changed. The spherical uterus is enlarged up to 7 weeks, shifted to the left and sharply anteriorly, limited in mobility.

    Appendages are not palpable due to норма pronounced adhesive process. Discharges from the genital tract are scarce, bloody. M-echo 18 mm with hyperechoic inclusions closer to the anterior wall. Conclusion: echoes of adenomyosis and endometrial pathology polyp. Cytology of the cervix uteri - I type of smear according to Pappanicolaou. With hysteroscopy: the length of the uterine cavity along the probe is 8. The length of the cervical canal is 3.

    The uterine cavity is medium in size, from the bottom and the left tubular angle, formation occurs on a wide stalk up to 1 cm in diameter, soft pink in color polyp - removed by a curette during curettage of the uterine cavity. The endometrium is high, unevenly located. Dianosis: endometrial polyp on the background of endometrial hyperplasia. After histological confirmation of the result of endometrial scraping fibrous polyp against the background of the active form of glandular cystic endometrial hyperplasiathe treatment is prescribed according to the proposed method: - a course of treatment with Indinol at a dose of mg per day постменопаузы 2 months in combination with the use of Kipferon suppositories intravaginally for 10 days 1 candle daily after hysteroscopy.

    Further, Indinol was continued to be taken with a матки reduction of up to mg per day for the next two months. After two months of taking the drug, during a follow-up examination, the patient notes that the past menstruation эхг not plentiful for days, with minor pain on the first day. M-echo 7 mm corresponds to phase 2 период the menstrual cycle. Ovaries without features. After 3 months: no complaints, menstruation for 3 days, the amount of menstrual blood is moderate, painless.

    An echoscopic examination of the pelvic organs revealed no пениод changes. With an endometrial пермод biopsy day 19 of the cyclethe endometrium corresponds to the phase of secretion. The proposed regimen of pharmacotherapy was selected as a result of the analysis of эхл, clinical observations of this category of patients.

    According пероид the proposed method, катки women were treated with various forms of menstrual irregularities 15 - late reproductive age g.

    And 7 perimenopausal эхо g. According to the proposed method.