The prevention of recurrence of uterine fibroids after conservative myomectomy

Abstract

The objective: to conduct a comparative analysis of the efficacy and tolerability of antigestagens (mifepristone) and gonadotropin-releasing hormone agonists (aGnRH) as part of adjuvant therapy for the prevention of the recurrence of uterine fibroids after conservative myomectomy in women of reproductive age.Materials and methods. The study included 99 patients of reproductive age (19–42 years old) with uterine myoma. The women were divided into three groups (n=33 each), which were balanced by age and the number of myomatous nodes. From the 8th day after surgical treatment, the patients of the 1st group were prescribed the antigestagen mifepristone at a dose of 50 mg daily for 4 months, the 2nd group – aGnRH (triptorelin) 3.75 mg intramuscularly once every 28 days for 6 months. The third, control group included women who had contraindications to adjuvant therapy or refused to take hormonal drugs. The effect of treatment on the uterus size was studied by ultrasound examination on the 8th day and in 1 and 4 months after surgery, the control of the recurrence was performed every 3 months for 3 years after surgery. The fact of myoma recurrence was established when at least one myomatous node more than 1 cm in diameter appeared.Results. From the second month of the therapy, 78.8% of patients in the 2d group had estrogen-deficient symptoms. In patients in the 1st group, minor side effects were registered only in 15.1%, in the 3rd group – 3–6% (p<0.05). After the completion of the therapy, the menstrual cycle restored in 3.3±1.5 weeks in the 1st and 6.2±1 weeks in the 2nd group of patients. All women in the control group had regular menstruations every month. In 1 month after surgical treatment, compared with the 8th day after operation, the volume of the uterus decreased by 14±2% in women in all three groups, in 4 months a further decrease was observed only in the 1st and 2nd groups, in the control group the indicators remained at the same level as in the first month after surgery. There was no recurrence of myoma during the first year after conservative myomectomy in patients of the 1st and 2nd groups, the further the cumulative risk was almost the same and after 24 months it was 12.5±5.2% and 13.7±8%, respectively. The cumulative recurrence rate in the 3d group was 9.1±5.6% after 6 months, 33±8.1% after 12 months, and 41.6±9.2% – 24 months. The pregnancy occurred mostly in the interval from 1 to 1.5 years after the operation, the average interval between the operation and fertilization was 13.7±5 months.Conclusions. Adjuvant therapy with mifepristone or aGnRH after conservative myomectomy leads to an equal reduction in the risk of myoma recurrence – in 4.25 times. The cumulative incidence of fibroid recurrence in 3 years after surgery is the lowest in the group of women taking mifepristone, and is the highest one in patients without adjuvant therapy. With a similar efficacy to GnRH agonists, the antiprogestins have less side effects and good tolerance, faster recovery of the menstrual function, reverse of hormonal parameters and a decrease in uterine volume. Therefore, in order to restore reproductive function and prevent early recurrence of uterine fibroids, women after conservative myomectomy can be recommended to take the adjuvant therapy with antiprogestins or GnRH agonists, the choice of which should be differentiated and individual.