Гинекология (Jul 2020)
Algorithm for management of patients of the period of menopausal transition with recurrence of anomalous uterine bleeding associated with beneficial proliferative changes of endometry
Abstract
Aim. To compile an algorithm for managing patients during the menopausal transition with a relapse of abnormal uterine bleeding associated with benign proliferative changes in the endometrium and evaluate its outcomes. Materials and methods. The observation of 150 patients aged 4555 years who had recurrence of abnormal uterine bleeding due to benign proliferative changes of the endometrium. All patients underwent hysteroresectoscopic ablation of the endometrium according to the monopolar coagulation-vaporization technique using Olympus equipment (Japan). The patients were divided into two groups. One group was formed by 98 women who, before hysteroscopic ablation of the endometrium, received hormonal preparations for 14 months, with the help of which suppressive changes in the uterine mucosa up to 34 mm were achieved. The other group consisted of 52 patients of the menopausal transition who did not receive preoperative drug therapy, and the thinning of the endometrium before hysterectomy was performed instrumentally. After hysteroresectoscopy, the period of clinical and instrumental observation was 2 years. Results. Based on the results of the study, an algorithm has been compiled for the treatment of women during the menopausal transition with abnormal uterine bleeding, including at the first stage a clinical, laboratory and instrumental examination with the selection of a group of patients to be treated by endometrial ablation, and at the second stage, measures for the preoperative thinning of the uterine mucosa, at the third stage performing hysteroresectoscopic ablation of the endometrium; and at the fourth stage dynamic monitoring during ie 2 years. The preoperatively achieved medical atrophy of the endometrium, followed by hysteroresectoscopy, contributes to an improvement of 20.3% in the results of treatment of patients in comparison with mechanical thinning of the endometrium before hysteroresectoscopy. In general, the developed algorithm increases the effectiveness of anti-relapse treatment to 92.8%. Conclusion. In practical health care, the proposed algorithm should be used, including successive steps. Following the algorithm, a differentiated approach to the choice of therapeutic tactics is carried out, taking into account not only morphological changes in the endometrium, but also the associated gynecological and somatic pathology of the patient, as well as justifying the conduct of preoperative preparation for hysteroresectoscopic ablation of the endometrium and determining the order of subsequent dynamic observation.
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