Multidisciplinary approach in the treatment of uterine fibroids

Abstract

Introduction. The efficacy of preoperative therapy with Gynestril in the treatment of symptomatic uterine fibroids and anaemia of various degrees of severity was studied in the prospective, comparative cohort study.Aim. To evaluate the efficacy of preoperative therapy with mifepristone in patients with uterine fibroids and chronic iron deficiency anaemia of various degrees of severity.Materials and methods. The study included 70 women who were scheduled to undergo the organ-preserving surgical treatment due to symptomatic uterine fibroids from January 1, 2017 to December 31, 2022. 50 patients received Gynestril at a dose of 50 mg/day (1 tablet) from day 1 of the menstrual cycle for 3 consecutive months. Due to contraindications to its use, 20 patients refused to administer the drug in the preoperative period and received symptomatic haemostatic therapy, and were included in the control groups. The patients of both groups received anti-anaemic therapy with iron(III)-hydroxide polymaltose tablets, 250– 300 mg/ day orally. 40 patients underwent the organ-preserving surgery depending on the size, number, type and localization of uterine fibroids according to the FIGO 2011 classification and patients’ motivation to preserve their reproductive function.Results. The analysis of changes in the laboratory test results revealed that hemoglobin levels in the groups after Gynestril therapy reached reference ranges in all women, averaging 123.4 ± 8.2 g/l as compared to the baseline value 84.3 ± 6.7 g/l, p < 0.05. It was also noted that ferritin levels increased significantly, averaging 12.2 ± 1.9 µg/l compared to the pre-treatment level 8.8 ± 0.8 µg/l, serum iron levels reached 12.8 ± 1.0 compared to the pre-treatment level 8.0 ± 0.8, and TIBC level reduced to 72.1 ± 3.5 compared to the pre-treatment level 96.7 ± 4.8 (p < 0.05).Conclusions. A comprehensive multidisciplinary approach to the treatment of uterine fibroids, including preoperative therapy with Gynestril, myomectomy using occlusive and X-ray endovascular techniques preserved the reproductive function in 50 patients with symptomatic uterine fibroids and anaemia of various degrees of severity.