Новые аспекты в лечении лейомиомы матки, ассоциированной с эндометриозом

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Despite the high level of development of modern surgery and pharmacology, none of the surgical techniques (hysterectomy / myometectomy or embolization of the uterine arteries) or drug therapy is not a guarantee of the absence of a future recurrence of uterine fibroids and endometriosis. However, there are methods of effective pharmacotherapy for their manifestations. In particular, selective progesterone receptor modulators (SMPR) demonstrate high efficacy in respect of the symptoms of myoma and the size of the nodes, which allows them to be considered as a complete alternative to the surgical treatment of uterine fibroids. The objective: evaluation of the effectiveness of the use of SMPR in the treatment of combined gynecological diseases. Patients and methods. The study included materials for the observation of 40 women 20–52 years old with uterine myoma against the background of combined gynecological pathology (endometriosis, infertility), which carried out the enucleation of myomatous nodes by laparotomy, laparoscopic or transcervical access. Patients were divided into two groups. In the main group (n=20), women received SMPR – ulipristal acetate (UPA) 5 mg daily for 3 months. The UIA's bioavailability is 70%. The optimal therapeutic single dose for the analyzed pathology is 5 mg. After 3 months, the first assessment of the effectiveness of the drug with combined gynecological pathology was conducted, then 14 women were exposed to surgical treatment, and 6 of 20 patients continued conservative treatment for another 1–4 months. After the operation to prevent the recurrence of uterine fibroids and endometriosis, 8 patients continued treatment of UPA for 4 months. In the comparison group (n=20), women underwent surgical treatment at similar rates, but the SMPR was not assigned to surgery. Results. Of the studies indicate that the use of such a selective modulator of progesterone receptors, like vandalite acetate, in the treatment of uterine myomas in combination with endometriosis is safe and well tolerated, leads to rapid persistent coping of uterine bleeding, a significant decrease in the size of nodes and foci of endometriosis, and the achieved The therapeutic effect is maintained even after the abolition of therapy. Conclusion. Thus, the use of the drug ulipristal acetate in the treatment of uterine fibroate on the background of combined gynecologic pathology is highly effective and promising as an independent and integrated treatment method of this category of patients. Key words: uterine myoma, endometriosis, selective modulators of progesterone receptors, viperpatel acetate, combined oral contraceptives.