The dissertation is devoted to the issues of restoration of reproductive function after
hysteroscopic myomectomy in view of the peculiarities of hormonal regulation and local
cervical immune status and the possibility of their correction.
Uterine leiomyoma is the most common benign tumor of the small pelvis in women,
affecting >60% of patients aged 30-44 years. According to Vilos G. (2015), among
women over 50 years of age, uterine leiomyomas are present in more than 70%, 20-50%
of whom have symptoms that cause severe medical, social and economic consequences.
Uterine leiomyomas are asymptomatic in a significant number of cases and can be
detected incidentally by transvaginal ultrasound or magnetic resonance imaging.
However, in approximately 30% of cases, uterine leiomyomas affect the quality of life
and health of the woman, with abnormal uterine bleeding and heavy menstrual bleeding
being the most common complaints, along with iron deficiency anemia. Medical
treatment of abnormal uterine bleeding associated with leiomyoma includes symptomatic
agents such as nonsteroidal anti-inflammatory drugs and tranexamic acid, and hormonal
therapy including combined oral contraceptives, gonadotropin-releasing hormone
agonists or antagonists, levonorgestrel intrauterine systems, selective progesterone
receptor modulators, and aromatase inhibitors (Vannuccini S. et al., 2024). Surgical
options include fertility-sparing treatments such as myomectomy or non-conservative
options such as hysterectomy, especially in perimenopausal women who do not respond
to any treatment. Radiological interventions are also available: uterine artery
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embolization, high-intensity focused ultrasound or magnetic resonance-guided focused
ultrasound, and radiofrequency ablation.
Despite the attitude to conservative myomectomy as a radical method of treating
uterine fibroids, the restoration of reproductive function after such an intervention
remains a relevant issue. Fluctuations in the concentration of reproductive hormones and
ovarian dysfunction both contribute to the recurrence of uterine fibroids and act as an
obstacle to the implementation of reproductive function (ElSokary H. et al., 2020). The
presence of a tumor formation and surgical intervention in the uterine cavity have a
powerful effect on the immune response. Local cervical immunity plays an important role
in both maintaining the normal state of the cervical epithelium and in the processes of
conception and pregnancy (Zahorodnya O.S. et al., 2023).
Based on the above, the proposed topic for research is the optimization of the
restoration of reproductive function after women with hysteroscopic surgery for
submucosal fibroids.
The aim of the study is to improve the restoration of reproductive function in women
after hysteroscopic myomectomy by studying their hormonal and local immune status
and developing an algorithm for their correction.
Material and methods of the study. To achieve this goal, a prospective cohort study
was conducted at the clinical base of the surgical center of the DNU "Scientific and
Practical Center of Preventive and Clinical Medicine" DUS (Kyiv) during 2020-2023. It
included 301 patients who applied to the Center for ultrasound-diagnosed submucosal
uterine fibroids. The inclusion criterion for the study was visualization during vaginal
scanning of a myomatous node of type O or I according to FIGO aged 19 to 45 years.
Hysteroscopic myomectomy was used to treat submucosal leiomyoma in all patients.
Depending on the tactics of further management, the patients were divided into 2 groups.
121 patients of the main group in the postoperative period received complex rehabilitation
therapy, 100 patients of the comparison group did not receive additional treatment after
surgery. 80 women who applied to the Center for a planned preventive examination
formed the control group. The proposed complex of rehabilitation therapy included: a
drug with antiproliferative action (indinol-3-carbinol) 200 mg per day in two doses from
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the 4th day after surgery for 3 months; anti-inflammatory and immunomodulatory action
(glutoxim) intramuscularly 1 ampoule (30 ml) per day, for 10 days from the 1st day after
surgery; NO - donor angioprotector (L-arginine) orally 1 sachet 3 g 2 times a day, 14 days
after surgery, for 1 month, then 1 sachet 1 time a day for 2 months.
At the first stage of the study, the structure of complaints of patients with submucosal
uterine fibroids was analyzed – abnormal uterine bleeding, algodysmenorrhea impaired
fertility, miscarriage. The frequency of these complaints in women of the control group
was studied by active questioning. The predominant localization of the myomatous node
(anterior, posterior or lateral wall of the uterus), the prevalence of other uterine pathology
among women of the main group and the comparison group were analyzed.
