Heavy Uterine Bleeding Research Articles

Epidemiology of endometriosis in Ukraine: results a multicenter study (2019-2021).

Aim: To estimate the prevalence and incidence of endometriosis, and to evaluate risk factors associated with endometriosis in Ukraine. Materials and Methods: The multicenter cohort study was performed partly as a cross-sectional study to estimate occurrence of endometriosis, partly as a case-control study to look for factors associated with endometriosis. The study was carried out during the period from January 1st, 2019 to December 31st, 2021.This study included adolescent girls and adult women from 15 Ukrainian regions. Results: Among 15,458 patients, 4,397 (28.4%) endometriosis were observed. Of all endometriosis cases, 48.5% were peritoneal/superf i cial endometriosis (SPE), 34.6% were ovarian endometriotic cyst/endometrioma (OMA), and 16.9% were deep inf i ltrating endometriosis (DIE). The prevalence of the three types of endometriosis was: SPE, 13.8%; OMA, 9.8%; and DIE, 4.8%. The factors associated with an increased risk for endometriosis include age 23-32 years, parity (small number of births), age of fi rst sexual intercourse <20 years, history of healthcare-associated infection after gynecological surgery (pelvic abscess or cellulitis, salpingitis and oophoritis), history of infertility, early menarche (before the age of 11), dysmenorrhea, dyspareunia, pelvic pain, intermenstrual bleeding, heavy uterine bleeding and dysmenorrhea, and heavy uterine bleeding. Conclusions: Endometriosis is a common gynecological disease in Ukraine and the relative frequency of dif f erent types of endometriosis: the most common were ovarian and peritoneal endometriosis. Healthcare services and public health strategies need to be strengthened to ensure timely endometriosis diagnosis in adolescent girls and adult women and treatment.

The effect of adjuvant mitotane therapy of the adrenocortical carcinoma on the endometrium and its clinical consequences in menstruating women. Literature review and authors' own experiences.

Adrenocortical carcinoma (ACC) is a malignant tumour that originates from the adrenal cortex. It is a highly aggressive cancer characterised by a poor prognosis with an annual incidence estimated to be up to 2 cases per million. In the adult population, ACC is diagnosed typically between 40 and 50 years of age, more often in women. Complete surgical resection of the tumour is the primary treatment method for ACC. Unfortunately, despite properly performed adrenalectomy, regional recurrences or distant metastases are detected in up to 90% of the patients. For that reason, adjuvant therapy is recommended. Mitotane is the most effective adrenal-specific agent used in adjuvant and palliative therapy. Two menstruating patients, after adrenalectomy due to ACC, during adjuvant mitotane therapy, have been included in the study. The study aimed to assess the effect of mitotane therapy on the endometrium and its clinical consequences, based on the analysis of these two cases and a review of the literature. It seems that menorrhagia may be expected during adjuvant mitotane therapy of ACC in menstruating women. Heavy uterine bleeding during menstruation may appear several months after the beginning of therapy. The likely mechanism for heavy menstrual bleeding is complex. Menorrhagia can occur due to the toxic effect of mitotane in the form of a haemorrhagic diathesis, while long-term treatment (over ten months) can lead to relative hypoestrogenism resulting in endometrial hyperplasia. Clinical signs of hypoestrogenism during mitotane treatment, have been described (including pre-puberty girls) and should be considered as a side-effect of the therapy. Menorrhagia may lead to severe anaemia, so this should be considered when planning mitotane treatment. Continuous gestagen therapy is helpful in the treatment of the above disorders. After over 60 years of experience with mitotane usage, knowledge about it is still insufficient, and further studies are required.

From Elegance to Complexity: The Intricate Dance of Myometrial Stem Cells Transforming into Leiomyoma Stem Cells: Unraveling the Symphony of Genetic and Epigenetic Refinement

Uterine leiomyomas (LM), commonly referred to as uterine fibroids (UFs), pelvic tumor in women of reproductive age globally and are main indicators of hysterectomies if become symptomatic. The progression of uterine LM involves a complex interplay of hormones, stem cells, growth factors, and genetic/epigenetic irregularities. Both endometrial and myometrial stem/progenitor cells play pivotal roles in the uterus’ response to hormonal stimuli and return to its basal state. LM, arising from a single stem cell of smooth muscle cells with acquired mutations, exhibit diverse cellular transcriptomic patterns influenced by genotype. Affecting over 70% of women at some point in their lives, with significant clinical symptoms, such as pelvic pain, infertility, and heavy uterine bleeding. Recent literature underscores the potential importance of LM stem cells and their paracrine interactions with specialized cells, connecting the gap between medications targeting leiomyoma expansion and potential eradication strategies. Keeping these points in view, this review discusses the current understanding of the involvement of myometrial stem/progenitor cells and the genetic and epigenetic changes occurring in these cells during the pathogenesis of uterine LM.

Risk factors of heavy uterine bleeding in patients with endometriosis and adenomyosis treated with dienogest

ObjectiveDienogest (DNG), a fourth-generation progestin, reduces pain associated with endometriosis and uterine adenomyosis; however, it is associated with irregular uterine bleeding that can cause anemia and poor quality of life. We investigated risk factors for heavy bleeding following DNG administration. Materials and methodsWe retrospectively investigated patients who received DNG for risk factors of heavy uterine bleeding, including clinical diagnosis, use of pretreatment gonadotropin-releasing hormone agonist, smoking, cancer antigen 125, and blood hormone levels. We additionally assessed the uterine area in patients with uterine adenomyosis, the major axis of the uterine body, the major axis of myometrial thickness, the site of tumor development, and the site of myoma development in patients with uterine fibroids. ResultsEighty Japanese patients were administered DNG. The median age was 41 (range: 24–51) years. The odds ratio (OR) for moderate-to-severe bleeding according to clinical diagnosis were 0.33 (P = 0.011) for endometrioma and 9.00 (P = 0.049) for uterine adenomyosis. Receiver operating characteristic curve analysis of the uterine area associated with uterine adenomyosis showed an area under the curve (AUC) of 0.909 between those with major and minor bleeding, with an optimal cut-off value of 7388.2 mm2. The uterine body major axis had an AUC of 0.946, with an optimal cut-off value of 78.3 mm. The major axis of myometrial thickness had an AUC of 0.855, with an optimal cut-off value of 46.8 mm. ConclusionPatients with endometrioma treated with DNG were less likely to experience heavy uterine bleeding. Uterine bleeding in patients with uterine adenomyosis and adenomyosis associated with uterine fibroids should be closely monitored while administering DNG.

Management of giant myoma – case report and literature review

IntroductionUterine myomas are one of the most frequently discussed issues in gynecology. Most of them are asymptomatic, however, severe pain in pelvis minor, heavy uterine bleeding or infertility may be reported by the patients and worsen quality of women’s daily life. Giant myomas are very rare and can be directly life-threatening.AimThe aim of this study was to present a clinical case of giant myoma, its management and highlight the potential impact on women’s health and well-being.Case studyA 70-years-old patient with a pain in lower part of abdomen, constipation and tiredness manifested difficulties in breathing. Abdominal examination revealed a huge, elastic abdominal mass extending from xiphoid process to the pubic bone. A total abdominal hysterectomy with right salpingo-oophorectomy was done.The patient was discharged from the hospital on the day 9 after the surgery and recovered without any incident.Results and discussionPatients with giant uterine myomas may develop respiratory failure and require intensive respiratory care. One of the highest priorities should be adequate ventilation and reduction the vena cava compression. Cleansing the intestines before surgery decreases the risk of contamination the peritoneal cavity by digestive tract content, in case of possible extension of the scope of surgery.ConclusionsIn the case of treatment of large uterine myomas, interdisciplinary cooperation of specialists in various fields is necessary in order to protect the patient’s vital parameters and prevent the occurrence of rare complications.

Comparative effects of treatment with ferric carboxymaltose versus ferric derisomaltose in a murine model of iron-deficiency anemia

Intravenous (IV) iron preparations like ferric carboxymaltose (FCM) and ferric derisomaltose (FDI) are used to treat iron deficiency anemia (IDA) due to heavy uterine bleeding, inflammatory bowel disease, and chronic kidney disease. These preparations greatly differ in terms of their side-effect profiles (e.g, hypophosphatemia). However, studies that directly compare FCM and FDI are limited. The objective of this study was to compare the effects of FCM and FDI in a mouse model of IDA and investigate changes in blood parameters and mineral homeostasis. Female C57Bl/6J mice were fed iron-deficient diet for 5 weeks followed by IV bleeding (0.7% of body weight [b.w.]) for 3 consecutive days. On day 0 (last day of bleeding), baseline blood and urine were analyzed for hematocrit, CBC, P i and Ca 2+ . Mice were randomized to vehicle (saline, 2 μl/g b.w.; n=16), FCM (20 mg/kg; n=12), or FDI (20 mg/kg; n=12) treatment via retroorbital injection on day 0 and 7. On day 14, terminal blood, urine, spleen, and heart were collected. At baseline, compared with pre-bleeding, all mice had low hematocrit (22±1 vs 48±0.3%; P&lt;0.05) and microcytic hypochromic anemia. After 14 days, mice treated with FCM and FDI had higher hematocrit compared with vehicle (47±0.4 and 46±0.3 vs 25±1%; P&lt;0.05). WBC were similar on day 14 compared with day 0 for mice treated with FCM (8±1 vs 7±1 x10 9 /L; NS) or FDI (7±1 vs 7±1 x10 9 /L; NS); however, WBC were decreased in vehicle-treated mice (4±1 vs 6±1 x10 9 /L; P&lt;0.05). Thrombocytes were increased in vehicle-treated mice on day 14 compared with day 0 (1405±55 vs 795±23 x10 9 /L; P&lt;0.05); while there was no change in thrombocytes in mice treated with FDI (706±16 vs 831±29 x10 9 /L; NS), they were decreased in FCM-treated mice (583±41 vs 771±30 x10 9 /L; P&lt;0.05). Both FCM and FDI prevented splenomegaly that was seen in vehicle-treated mice (88±3 and 87±20 vs 263±40 mg; P&lt;0.05). Similarly, FCM and FDI prevented greater heart weight that was seen in vehicle-treated mice (0.43±0.01 and 0.45±0.01 vs 0.48±0.01 g/b.w. %; P&lt;0.05). After 14 days, mice treated with FCM and FDI had lower plasma P i compared with vehicle (1.9±0.1 and 2.1±0.1 vs 2.4±0.1 mmol; P&lt;0.05); although FCM-treated mice showed greater hypophosphatemia compared with FDI ( P&lt;0.05). There were no differences between groups for urinary P i . Plasma Ca 2+ was similar between groups on day 14; but compared with day 0, it was higher in vehicle (2.7±0.1 vs 2.5±0.1 mmol; P&lt;0.05) and FCM-treated mice (2.8±0.1 vs 2.5±0.1 mmol; P&lt;0.05). Urinary Ca 2+ /creatinine was higher in mice treated with vehicle compared with day 0 (0.4±0.04 vs 0.1±0.01 mmol/mmol; P&lt;0.05) but was lower with FCM (0.09±0.03 vs 0.14±0.04 mmol/mmol; P&lt;0.05) and FDI (0.08±0.01 vs 0.3±0.06 mmol/mmol; P&lt;0.05). In summary, our study shows that both iron preparations have similar effects on blood parameters, but mice were more hypophosphatemic when treated with FCM vs FDI. We speculate this may be due to variations in PTH and FGF23 levels. This work was supported by 1R01DK110621, VA Merit Award IBX004968A, NIDDK Diabetic Complications Consortium RRID:SCR_001415, DK076169 and DK115255 (all to TR). LT was supported by an AHA Postdoctoral Fellowship (828731). This is the full abstract presented at the American Physiology Summit 2023 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Clinical Predictive Factors of Failure of Hysteroscopic Endometrial Ablation: Retrospective Cohort Study at a Tertiary University Hospital

Background: Endometrial ablation is a safe and effective minimally invasive surgical procedure. Despite the high success rate of endometrial ablation for heavy uterine bleeding management, some patients experience persistent symptoms after the procedure, necessitating a hysterectomy. The aim of this study is to determine the pre-operative clinical predictive factors of failure of endometrial ablation in the management of uterine bleeding. Methods: Retrospective cohort study of endometrial ablation procedures performed for treating heavy uterine bleeding. Results: Ninety five patients were included in the study. The failure rate was 24.2%. There was a statistically significant association between ablation failure and fluid deficit (p = 0.002) and intra-operative blood loss (p = 0.047). There was a statistically significant moderate association between adenomyosis (p = 0.003, φ = 0.37) and failed endometrial ablation. However, the age, body mass index (BMI), parity, number of miscarriages, number of cesarean sections, uterine length, endometrial thickness and procedure duration had no significant association with endometrial ablation. There was no significant relationship between the uterine abnormalities in general and the outcome of the endometrial ablation (p = 0.637). However, patients with combined adenomyosis and dysmenorrhea had a statistically significant association with outcome of the endometrial ablation (p = 0.016, φ = 0.28) and were more likely to have a failed endometrial ablation (crude odds ratio (COR) = 4.67, 95% confidence interval (CI), 1.35–16.09). Logistic regression to adjust for related factors revealed that the adenomyosis (adjusted odds ratio (AOR) = 50.83, 95% CI, 3.64–706.75, p = 0.003) and fluid deficit (AOR = 1.003, 95% CI, 1.000–1.006, p = 0.044) had a higher likelihood of an unsuccessful outcome. Hysterectomy was performed in 47.8% of patients who had failure of the ablation. Conclusions: Among pre-operative factors, adenomyosis, fluid deficit and combined adenomyosis and dysmenorrhea were found to predict failure of hysteroscopic endometrial ablation. Clinical Trial Registration: It was registered in https://www.clinicaltrials.gov database with Identifier: NCT05483348.

073 Management of heavy uterine bleeding in girls with Von Willebrand Disease — An 8-year retrospective analysis

Objective: Von Willebrand Disease (VWD) is the bleeding disorder most commonly associated with heavy uterine bleeding in women of any age, with an overall prevalence of 0,6–1,3% [1]. It can go unnoticed until menarche, when heavy menses become the first manifestation of the disease [2]. Symptom severity can vary [3,4], and several management strategies are available [3,5]. Our aim is to study the clinical presentation and management of adolescents with VWD presenting with heavy uterine bleeding at a tertiary referral hospital.

Effects of ferric carboxymaltose on phosphate and calcium homeostasis in a murine model of iron‐deficiency anemia

Iron deficiency anemia (IDA) can be caused by heavy uterine bleeding, inflammatory bowel disease, or chronic kidney disease. Ferric carboxymaltose (FCM) is an intravenous form of iron replacement therapy that has been shown clinically to induce severe hypophosphatemia. However, the mechanism by which this occurs is poorly understood. The objective of this study was to develop and characterize a mouse model that would allow investigating the effects of FCM on phosphate (Pi) and calcium (Ca2+) homeostasis. Female C57Bl/6J mice (n=40; 10/group) were randomized to either iron deficient (ID) diet (4 ppm iron) or control diet (48 ppm iron) for 4 weeks followed by intravenous bleeding (0.7% of body weight) 4 and 2 days prior to starting the study. Baseline blood and urine was collected for hematocrit, complete blood count, and serum and urine Pi and Ca2+ levels. Subsequently, mice were treated with a single IV injection of either vehicle (saline) or FCM (20 mg/kg) via retroorbital injection. One week later, terminal blood, urine, feces, liver, and spleen were collected. At baseline, compared with controls, ID mice had lower hematocrit (35±1% vs 39±1%; P&lt;0.05) and microcytic hypochromic anemia. After 7 days, FCM‐treated ID mice had significantly higher hematocrit compared with vehicle‐treated ID mice (43±1% vs 30±1%; P&lt;0.05). FCM treatment also significantly increased iron content in liver and spleen in control mice (18±1 vs 6±1 μmol/g and 36±2 vs 27±3 μmol/g, respectively; P&lt;0.05) and ID mice (16±1 vs 1±0.1 μmol/g and 21±2 vs 6±1 μmol/g, respectively; P&lt;0.05). At baseline, urinary Pi/creatinine ratios were significantly lower in ID mice compared with controls (30±5 vs 58±7 mmol/mmol; P&lt;0.05); however, FCM treatment in ID mice did not affect urinary Pi/creatinine ratios after 7 days (31±6 vs 18±5 mmol/mmol; not significant). There were no differences between groups for serum Pi, erythrocyte Pi, or fecal Pi. Under baseline conditions, no differences in plasma Ca2+ or urinary Ca2+/creatinine ratios were observed between groups; however, FCM‐treated ID mice had significantly lower plasma Ca2+ levels after 7 days compared with ID mice at baseline (2.3±0.1 vs 2.6±0.1 mmol; P&lt;0.05) and lower urinary Ca2+/creatinine ratios (0.1±0.1 vs 1.3±0.2 mmol/mmol; P&lt;0.05). We speculate this may be due to increased PTH and FGF23 levels in FCM‐treated ID mice. In summary, our study demonstrates for the first time that FCM affects Pi and Ca2+ homeostasis in a murine model of IDA. Further studies are needed to better understand the mechanisms of FCM on mineral homeostasis as well as the driving factors for species differences.

Body Mass Index as an Indicator for Endometrial Biopsy in Premenopausal Women with Heavy Menstrual Bleeding

Background: Although Obesity is a risk factor of endometrial hyperplasia/ carcinoma, there is no consensus on using the BMI as a predictor for endometrial biopsy screening in patients with heavy menstrual bleeding in pre-menopausal women. Therefore, it’s clinically important to identify BMI cutoff values as a predictor for endometrial hyperplasia/ carcinoma in premenopausal women with heavy menstrual bleeding.Aim of the Study: To determine the feasibility of using Body Mass Index (BMI) as an indicator to perform endometrial biopsy in premenopausal women presented with heavy menstrual bleeding.Patients &amp; Methods: This is a cross-sectional study that was conducted in Obstetrics and Gynecology Clinic /Al-Emamain Al-Kadhemein teaching medical city in Baghdad where women 150 women who are 40-50 years old with heavy menstrual bleeding where sent for endometrial biopsy. 100 women had abnormal endometrial biopsy results, histopathological results of the abnormal endometrial samples were classified into following groups: hyperplasia without atypia, hyperplasia with atypia, and hyperplasia with atypia and cancer. Statistical analysis conducted to correlate The Body Mass Index (BMI) with the status of endometrial biopsy.Results: 42% of the women with BMI≥30 kg/m2 have hyperplasia with atypia or carcinoma compared to 10% of women who BMI&lt;30 kg/m2 (p&lt;0.001). from 54 women who had hyperplasia with atypia in endometrial sample results; 77.7% of such patients were BMI≥30 kg/m2. Receiver operating characteristic analysis shows that using BMI ≥30 kg/m2 as a predictor of hyperplasia with atypia or carcinoma carries a sensitivity of 80.77 % and specify of 86.00% with area under the curve (AUC) value of 0.83 (CI. 0.75-0.92) and (p&lt;0.001). women with BMI≥30 kg/m2 has a relative risk (RR) of 3.98 of developing endometrial hyperplasia (without atypia or with atypia+carcinoma) and a relative risk (RR) of 4.11 of developing hyperplasia with atypia or carcinoma (p&lt;0.001).Conclusion: Our results indicate that BMI regardless of the age is the highest risk factor for abnormal endometrial hyperplasia premenopausal women. Also, BMI≥30 kg/m2 has highest risk for developing endometrial hyperplasia with atypia or carcinoma. BMI≥30 kg/m2 can be used as predictor of endometrial hyperplasia in premenopausal women with heavy uterine bleeding.

Selective Progesterone Receptor Modulators (SPRMs) and Androgen Receptor Modulators (SARMs) as Treatment for Benign Gynecologic Diseases.

Common benign gynecologic conditions such as uterine fibroids and endometriosis are linked to chronic pelvic pain, abnormal and heavy uterine bleeding, and infertility. Effective medical management of these diseases is an unmet need. The steroid hormones progesterone (P4), estrogen (E2), and testosterone play a major role in reproductive physiology and uterine pathologies. Notably, selective progesterone receptor modulators have shown considerable promise as treatment options for some hormone-dependent conditions. More limited data are available regarding the safety and efficacy of selective androgen receptor modulators. In this report we review current evidence for selective progesterone receptor modulators and selective androgen receptor modulators as treatment options for benign gynecologic conditions.

Evolution of laparoscopic myomectomy and description of two hemostatic techniques in a large teaching gynecological center

ObjectiveTo provide a description of laparoscopic myomectomy and the two hemostatic techniques performed over the last 11 years in a single reference center for gynecology and obstetrics and to evaluate the factors associated with favorable surgical outcomes. Study DesignWe retrospectively analyzed 625 who underwent laparoscopic myomectomy from January 2009 to December 2019. ResultsOf 625 patients, 437 (69.8%) were symptomatic. The most common symptoms were heavy uterine bleeding (33.2%). 188 patients (30.1%) were asymptomatic but were operated in 77 cases (12.3%) for rapid fibroid growth, 32 (5.1%) for uterine cavity distortion and, in 45 cases (8.6%), the myomectomy was indicated during a surgery for other medical reason due to its accessibility. In 173 cases (27.9%) intramyometrial adrenaline was injected and in 246 cases (39.7%) a temporary blockage of the uterus blood supply was performed.Only 35 (5.6%) patients presented complications, of which, 14 (40%) were hemorrhagic. These hemorrhagic complications were more frequent when intramyometrial adrenaline was used (5,8%) than after the temporary clipping of the uterine arteries and infundibulopelvic ligaments (0,8%; p < 0,001).In the multivariate logistic regression model, the only factor statistically associated with favorable surgical outcome was the use of temporary clipping of the uterine arteries at their origin and infundibulopelvic ligaments as hemostatic technique during the surgery. ConclusionLaparoscopic myomectomy was generally safe with a high level of favorable outcomes. The temporary clipping of uterine arteries and infundibulopelvic ligaments presented fewer intraoperative bleedings compared with injecting intramyometrial adrenaline.

The Role of Atorvastatin in Suppressing Fibroid Related Symptom and Fibroid Size in Perimenopausal Women

Background: Uterine fibroids are the most common benign gynecologic tumors, with a lifetime incidence of approximately 70%. They are associated with multiple symptoms, including heavy uterine bleeding and pelvic pain. Currently used treatments include contraceptive steroids, Gonadotropin-releasing hormone agonist (GnRHa), progesterone modulators, uterine artery embolization (UAE), magnetic resonance imaging-guided focused ultrasound surgery (MRgFUS), and radiofrequency ablation (RFA). Objective: To evaluate the effect of atorvastatin on decreasing fibroid related symptoms and fibroid size, endometrial thickness and cholesterol level in perimenopausal women. Patients and methods: Prospective randomized controlled trial that was conducted over a period of 12 months during 2019 and 2021 on 105 patients with symptomatic uterine fibroid in perimenopausal age, admitted to emergency unit and gynecology outpatient clinic at Mansoura University Hospital and after obtaining acceptance from institutional research board faculty of medicine then patients were prospectively recruited and randomized by computer program. Results: All groups at presentation demonstrated insignificant differences concerning demographic characteristics, gravidity and symptoms of uterine fibroid. Uterine fibroid demonstrated significant reduction in size as well as significant changes following the atorvastatin treatment after 6 months in a dose dependent manner, while endometrial thickness demonstrated insignificant differences as measured by transvaginal ultrasound (TVS). Cholesterol level demonstrated highly statistically significant decrease following atorvastatin treatment in a dose dependent manner. Conclusion: The current study demonstrated that atorvastatin has promising effects in cases with uterine fibroids as it was associated with a reduction of fibroid size with reduction of fibroid related symptom (menorrhagia, dysmenorrhea).

Peranan Resveratrol terhadap Progresivitas Uterine Fibroid

Uterine fibroids or leiomyomas are benign neoplasms that occur in the uterus and still become a health problem among women of reproductive age. Predominantly, uterine fibroids are found at productive age but some cases are found after menopause. Based on previous studies, there were 145 cases of uterine fibroids in 2014 and 69.7% were found in women over 40 years. Patients with uterine fibroids show a decreased quality of life with symptoms such as heavy uterine bleeding, pelvic pain, and loss of pregnancy. The pathogenesis of uterine fibroids is still unknown, but genetic factors, cytokines, growth factors, and steroid hormones are weak and play an important role in the development of uterine fibroids. Several studies have shown the effect of resveratrol that can be obtained from grape skins. Resveratrol can reduce extracellular matrix deposition and uterine fibroid cell proliferation. Looking at the induced events then resveratrol is effective in preventing the progression of uterine fibroids.

EXPERIENCE OF LONG-TERM USE OF DIENOGEST FOR THE TREATMENT OF ADENOMYOSIS

Endometriosis refers to a chronic, often recurrent disease that requires the appointment of a long-term management plan and the patient with the appointment of therapy that effectively affects the clinic of this disease, at the same time having good tolerability, ensuring the patient's adherence to this method of treatment. This dictates the need for careful selection of a drug that meets such requirements. Moreover, studies of drug therapy for endometriosis should also be prolonged. In this case, they allow you to qualitatively assess the effectiveness of a particular type of treatment in the context of routine clinical practice. The main clinical manifestations of endometriosis of the uterine body-adenomyosis are pain syndrome, manifested by various types of pain (dysmenorrhea, dyspareunia, dyschesia, chronic pelvic pain) and the presence of abundant uterine bleeding. The presented clinical case demonstrates the effectiveness of long-term (for 36 months) use of dienogest at a dosage of 2 mg per day (the drug Vizanna) in a continuous mode in the treatment of a patient with adenomyosis. By the 4th month of therapy, the pain syndrome, manifested by dysmenorrhea and dyspareunia, which is the leading clinical manifestation of this pathology in the patient, was completely stopped. The proposed type of therapy has also demonstrated its effectiveness in relation to another clinical manifestation of the disease - heavy uterine bleeding. By the 6th month of therapy, the patient had developed persistent amenorrhea. Good tolerability and the absence of side effects, along with a pronounced clinical effect, led to a high adherence of the patient to this type of drug therapy and allowed her to continue it in the future with dynamic monitoring.

DIAGNOSTIC CRITERIA EARLY DIAGNOSIS ENDOMETRIOSIS

The purpose of this study is to study a clinical case of late diagnosis of endometriosis of the uterine body (adenomyosis), despite the presence of such typical clinical manifestations as heavy uterine bleeding, leading to the formation of chronic post – hemorrhagic iron deficiency anemia and the development of sideropenic syndrome, accompanied by weakness, dizziness, rapid fatigue, brittle hair and nails. Also, the data of the family history (endometriosis in the mother) and the patient's history indicating the presence of pollinosis and bronchial asthma were not taken into account.

INFERTILITY ASSOCIATED WITH ADENOMYOSIS

The aim of the study was to study a clinical case of infertility in a patient due to endometriosis of the uterine body (adenomyosis) and to choose management tactics. This clinical case demonstrates the need to identify this pathology as one of the causes of infertility and prescribe therapy to overcome infertility. Diagnostic criteria for detecting this pathology were complaints of heavy uterine bleeding, dysmenorrhea, as well as data from gynecological examination and ultrasound examination of the pelvic organs.

Systemic thromboembolism including multiple cerebral infarctions with middle cerebral artery occlusion caused by the progression of adenomyosis with benign gynecological tumor: a case report

BackgroundAdenomyosis, a benign gynecological disease, causes cerebral infarction. Similar to Trousseau’s syndrome, it elevates cancer antigen 125 (CA125) and D-dimer levels; causes hypercoagulability; and results in cerebral infarction. However, no case of adenomyosis causing major cerebral artery occlusion and requiring endovascular thrombectomy has yet been reported. We report on a woman with middle cerebral artery occlusion caused by adenomyosis progression with a benign gynecological tumor and recurrent cerebral infarction. She was successfully treated by endovascular thrombectomy and hysterectomy.Case presentationA 48-year-old woman with heavy uterine bleeding was transported by ambulance to our hospital. Upon arrival, she presented with impaired consciousness. Laboratory test results revealed decreased hemoglobin (8.2 g/dL) and elevated D-dimer (79.3 µg/mL) levels. Radiological imaging revealed adenomyosis, a left ovarian tumor, multiple uterine myomas, and old and new bilateral renal infarctions. She experienced repeated episodes of excessive menstruation caused by adenomyosis and was scheduled for hysterectomy in 2 months at another hospital. After hospital admission, uterine bleeding stopped. However, 5 days after initial bleeding, she had another episode of heavy uterine bleeding and developed left hemiparesis and dysarthria 20 min later. Brain magnetic resonance imaging revealed bilateral multiple cerebral infarctions indicating right middle cerebral artery occlusion. Thus, endovascular thrombectomy was performed, and anticoagulant therapy was administered. Laboratory test results after thrombectomy revealed elevated CA125 (3536 U/mL) and CA19-9 (892 U/mL) levels. She was at a risk of recurrent heavy uterine bleeding leading to repeated cerebral infarction because of anticoagulant treatment. Therefore, we performed hysterectomy and ovariectomy 11 days after initial bleeding. Histopathological assessment revealed no malignancy. Although she developed asymptomatic pulmonary thromboembolism 14 days after initial bleeding, D-dimer and tumor marker levels returned to normal soon after gynecological surgery. At 15 months post-surgery, she had not experienced further ischemic events.ConclusionsAdenomyosis with benign gynecological tumors may be associated with elevated D-dimer and tumor marker levels; excessive menstruation; and anemia. It may cause systemic thromboembolism, including cerebral infarction. To our knowledge, no other study has reported that adenomyosis causes major cerebral artery occlusion requiring endovascular thrombectomy. Hysterectomy may be an effective radical treatment of this condition.

Ferric Carboxymaltose Solution Versus Iron Sucrose Complex in Treating Iron-Deficiency Anemia Patients with Heavy Uterine Bleeding

BACKGROUND: Heavy uterine bleeding (HUB) affects 4.0%–51.6% of women and is responsible for the high prevalence of iron-deficiency anemia (IDA). Ferric carboxymaltose (FCM) is a novel Type I polynuclear iron (III)-hydroxide carbohydrate complex that is highly stable and requires short administration time. The current study estimated the budgetary impact of adopting FCM to treat IDA in HUB patients from the perspective of a tertiary care hospital in the Kingdom of Saudi Arabia (KSA). SUBJECTS AND METHODS: A budget impact model was adopted to compare the total annual costs of iron sucrose complex (ISC) versus FCM from a tertiary care hospital setting perspective in a 1-year time horizon. RESULTS: The total annual cost in ”ISC” scenario was higher than in ”FCM” scenario (Saudi Riyal [SAR] 1,079,535 vs. SAR 724,981), resulting in a cost saving of SAR 355,000 over a 1-year time horizon with FCM. Lower expenditure on health professionals and lower costs of disposables and overhead were the main drivers to the cost savings accounting for nearly 96% of the savings. Although the direct IV iron cost was higher in ”FCM” scenario, the increase in pharmaceutical drug cost was offset by the savings in the cost associated with disposables (−SAR 232,000) and resource utilization (−SAR 451,195). CONCLUSION: FCM was associated with cost savings as compared to ISC for the treatment of IDA in HUB patients from the tertiary care hospital perspective in the KSA.

MANAGEMENT OF ASRIGDARA WITH KUTAJASHTAKA AVALEHA AND YASHTIMADHU GHRITA MATRA BASTI - AN OPEN LABEL, DOUBLE ARM, RANDOMIZED CLINICAL TRIAL

Introduction: The word Asrigdara explains about prolonged, cyclic or acyclic excessive menstrual bleed-ing in Ayurveda. 9-14% of women in their reproductive age lose 80 ml of blood in each cycle. It is the most common cause of Anemia. Traditionally, Heavy Uterine Bleeding is managed with medical therapy and surgical intervention with associated side effects. But due to limitation of medical therapy as well as surgical interventions, it becomes the necessity of time to find out a permanent, easy, effective and less side effect producing care which can be easily administered and accepted by the patient. Objective: To evaluate the clinical efficacy of Kutajashtaka Avaleha orally and combination of Kutajashtaka Avaleha and Yashtimadhu Ghrita matra basti in combating the signs and symptoms of Asrigdara. Materials and Methods: 56 patients were selected from the Stri Roga and Prasuti Tantra OPD, All India Institute of Ayur-veda, New Delhi and randomly divided into 2 groups. Group A was administered with Kutajashtaka Ava-leha orally regularly for the period of 3 months with the doses of 5gm BD after meal with water, while in Group B, Combination of Yashtimadhu Ghrita Matra Basti (60 ml for 7 days in 3 consecutive cycles after meal through rectal route after 7th day of menses) for 3 months and Kutajashtaka Avaleha was given and the follow up period of 1 month without medication was same for both the groups. Results: Kutajashtaka Avaleha orally alone and Combination of Yashtimadhu Ghrita Matra Basti &amp; Kutajashtaka Avaleha oral both gave statistically highly Significant results (P&lt;0.001) but with better results when the treatment was combined and Markedly Improved (51-75% relief) the signs and symptoms. Conclusion: Combination of Yashtimadhu Ghrita Matra Basti &amp; Kutajashtaka Avaleha oral gave more statistically significant results than Kutajashtaka Avaleha orally alone. No adverse effects were reported during the entire trial period.