Персонализированный подход к пациентам с обильными менструальными кровотечениями в репродуктивном возрасте

Abstract

The number of women suffering from heavy menstrual bleeding, according to various publications, is not decreasing and makes up about 20% of gynecological patients. Such patients, in the absence of predictive intervention by a gynecologist, are at risk of developing somatic diseases associated primarily with iron deficiency. At the same time, the correction of heavy menstrual bleeding requires a differential approach to the choice of treatment, considering the patient’s age and reproductive plans, the cause of bleeding, as well as an assessment of the benefit-risk ratio of the drug and its additional advantages. Objective. To study the efficacy of using a combined oral contraceptive (COC) containing 2 mg chlormadinone acetate / 0.03 mg ethinylestradiol in patients of reproductive age with idiopathic heavy menstrual bleeding leading to iron deficiency who need reliable contraception. Patients and methods. The study included 67 women of reproductive age between 18 and 45 years (mean age 27.2 ± 0.5 years) who visited a gynecologist with a complaint of heavy menstrual bleeding accompanied by latent iron deficiency. After considering the safety of COC according to the Medical Eligibility Criteria for Contraceptive Use (World Health Organization, 2015), all women were prescribed Belara (2 mg chlormadinone acetate / 0.03 mg ethinylestradiol) for 6 months with an assessment of efficacy, safety, and possible prolongation of its use. Results. The administration of Belara containing 2 mg chlormadinone acetate/0.03 mg ethinylestradiol demonstrated its efficacy as means of contraception and reducing menstrual blood loss, which contributes to the normalization of iron indices in women. Among 51 (76.1%) patients with latent iron deficiency, 49 (96%) had recovery of ferritin levels (>30 mg/dL) after taking Belara. Meanwhile, the frequency of adverse reactions did not exceed 15%. They were represented by scanty acyclic uterine bleeding (4.5%), increased sensitivity of the breasts (7.5%), nausea (1.5%), and headache (1.5%). All adverse reactions did not require additional therapy or drug withdrawal. Conclusion. Belara may be recommended for women of reproductive age with heavy menstrual bleeding accompanied by latent iron deficiency who need reliable contraception. Key words: heavy menstrual bleeding, latent iron deficiency, combined oral contraceptives, ethinylestradiol, chlormadinone acetate