Treatment Of Abnormal Uterine Bleeding Research Articles

A comparison of the effects of oral dydrogesterone and levonorgestrel-releasing intrauterine device on quality of life and sexual function in patients with abnormal uterine bleeding.

The purpose of this study is to compare the effects of cyclic oral dydrogesterone treatment and levonorgestrel-releasing intrauterine device (LNG_IUD) on quality of life (QoL) and sexual function in patients diagnosed with abnormal uterine bleeding (AUB). The study was conducted at the University of Health Sciences Turkey Health Istanbul Kanuni Sultan Süleyman Training and Research Hospital, on 171 sexually active patients, aged 18-45, who were under a minimum of 6months of treatment for AUB. 85 patients were treated with oral cyclic dydrogesterone, and 86 patients received LNG-IUD. Following a minimum of 6 months of treatment, these patients were recruited to the study and were asked to complete a 36-Item Short Form Survey (SF-36) and the Female Sexual Function Index (FSFI). When the FSFI scores of the patients were compared, it was observed that the total FSFI score was significantly higher in the cyclic dydrogesterone group (p < 0.05). Likewise, it was observed that sexual desire, arousal, and lubrication domains were significantly higher in the cyclic dydrogesterone group (p < 0.05). No significant differences were found between the treatment groups in 7 out of the 8 dimensions of SF-36. The energy/vitality dimension was found to be significantly higher in the cyclic dydrogesterone group. Total FSFI score, as well as sexual desire, arousal, and lubrication scores, were significantly higher in the cyclic dydrogesterone group compared to the LNG-IUD group indicating that cyclic dydrogesterone has a more positive impact on sexual function when compared to LNG-IUD.

Therapeutic Carbohydrate Restriction as a Metabolic Modality for the Prevention and Treatment of Abnormal Uterine Bleeding.

Therapeutic carbohydrate restriction diets have been becoming increasingly popular over the years, resulting in dramatic weight loss and an improvement in metabolic disorders. Obesity, insulin resistance, and diabetes are the risk factors for many gynecologic morbidities such as uterine leiomyoma, endometrial polyps, and polycystic ovarian syndrome. There is evidence suggesting that the pathogenesis of cardiovascular disease is similar to that seen in many causes of abnormal uterine bleeding. We aim to explain how cardiovascular disease risk factor reduction with the use of therapeutic carbohydrate restriction may prevent and potentially treat these gynecologic disorders.

Phyto-progestins for the treatment of abnormal uterine bleeding without organic cause in women at high risk for breast cancer and breast cancer survivors: a prospective, pilot study

Objectives Some plants, such as Dioscorea Villosa (DV), Vitex Agnus Castus (VAC) and Turnera diffusa (D) have some ‘progesterone-like’ properties. We have investigated their simultaneous administration in breast cancer (BC) survivors or carriers of specific genetic mutations that can increase the risk of developing BC suffering from abnormal uterine bleeding without organic cause. Methods Women with irregular cycles in terms of length (interval between ≤ 24 or ≥ 38 days) without a uterine organic disease (polyps, adenomyosis, fibroids, hyperplasia/malignancy) were included. A daily diary of bleeding, questionnaires about health-related quality of life (Short Form 36) and menstrual psychophysical well-being (PGWB-1) and the Greene Climacteric Scale (GCS) (in women older than 40 years old) questionnaire were used. The presence of some premenstrual syndrome (PMS) symptoms was also evaluated. Results In the analyzed group of women (n = 15), all experienced a regularization of the menstrual cycles, with a mean duration in the three months of use of 27.1 ± 3.2 days, with a significant reduction of menstrual pain (p = 0.02) and flow (p = 0.02) intensity. Women with PMS (7/15) reported an impovement in depression, headache and abdominal pain scores (p < 0.05). No specific deterioration of different questionnaires evaluated during treatment were observed. General satisfaction with the treatment was 6.8 ± 0.3/10 on a 10 point. Conclusions A combination of DV, VAC and D could be a promising candidate to treat menstrual irregularities without an organic cause, with a significant reduction of menstrual pain and flow intensity and possible additional benefits in PMS symptoms treatment in women at genetic risk for BC and BC survivors.

Perimenopausal abnormal uterine bleeding

Abnormal uterine bleeding is a very frequent symptom in the perimenopause. The causes are numerous ranging from physiological reactions due to decreasing/instable ovarian function to premalignant and malignant conditions. Benign findings such as endometrial polyps and myomas are increasing with age, leading to more abnormal uterine bleeding in the perimenopause. Cervical and vaginal causes of abnormal uterine bleeding should also be excluded by speculum examination. Sexually transmitted diseases should be ruled out in the perimenopausal women in new relationships. Measurement of hemoglobine, human chorion gonadotropine and thyreoid hormones are relevant in selected cases. Transvaginal ultrasound is the primary diagnostic tool in perimenopausal abnormal uterine bleeding. Saline or gel contrast sonohysterography improves the diagnostic accuracy. Based on the findings by ultrasound, more invasive procedures such as blind endometrial biopsy or hysteroscopy can be planned. Once premalignant and malignant causes are excluded, the necessity for treatment can be evaluated in collaboration with the individual woman. Severe heavy menstrual bleeding causing anaemia will need immediate treatment. In less severe cases and in intermenstrual bleeding expectant management can be considered. Hormonal medical treatment e.g., progestins or insertion of levonorgestrel-releasing intrauterine system (LNG-IUS) is a possibility in case of anovulatory bleeding interfering with the quality of life. The amount of bleeding can be reduced both by antifibrinolytic and non-steroidal anti-inflammatory drugs and LNG-IUS. In case of focal intrauterine lesions, such as endometrial polyps or submucous myomas, operative hysteroscopic procedures are warranted in the treatment of abnormal uterine bleeding. Other minimally invasive procedures, such as endometrial ablation or endometrial resection, is a good choice in selected cases, but some women will need a hysterectomy as a definite treatment of abnormal uterine bleeding in perimenopause.

PREMENOPAUSAL PERIOD AND ABNORMAL UTERINE BLEEDING

The article describes the analysis of abnormal uterine bleeding in premenopausal women, studies the causes and methods of treatment. The study was conducted in the gynecological department of the 1st clinic of the Samarkand State Medical University for 2021-2022. The study used general medical, clinical laboratory and instrumental diagnostic methods. The study investigated the causes and treatments for abnormal uterine bleeding and recommendations for improving treatment methods are given.

Endometrial ablation by trichloroacetic acid in abnormal uterine bleeding: A prospective interventional study

To evaluate the effectiveness of 50% Tricolored acetic acid (TCA) instillation in uterine cavity for the treatment of Abnormal uterine bleeding (AUB). In this study, 40 patients with the complaints of Abnormal menstrual bleeding, without any organic cause after ruling out malignancy were taken into consideration. After individually calculating the volume of TCA, it was instilled into the uterine cavity for chemically ablation of the endometrium. After a follow-up of 3 months, out of 40 patients, 53% reported hypo menorrhea and 27% reported amenorrhoea in contrast to 20% patients who had persistent symptoms. The study suggested that endometrial ablation with TCA is simple, cost effective, does not require longer hospital stay,can be done as an OPD procedure,do not require any sophisticated instrumentation and can be easily performed at primary health care centres after proper evaluation. However, to be used on regular basis, this method requires more randomised controlled trials.

Treatment of abnormal uterine bleeding using levonorgestrel-releasing intrauterine devices: experience from a Turkish tertiary hospital.

We evaluated the efficacy of the levonorgestrel-releasing intrauterine device in treating menorrhagia using a pictorial blood assessment chart. We retrospectively examined 822 patients treated with a levonorgestrel-releasing intrauterine device for abnormal uterine bleeding between January 1, 2017, and December 31, 2020, at a Turkish tertiary hospital. A pictorial blood assessment chart was used to determine each patient's blood loss amount, which involves the use of an objective scoring system to determine the amount of bleeding in towels, pads, or tampons. Descriptive statistical values were presented as mean and standard deviation, and paired sample t-tests were used for within-group comparisons of normally distributed parameters. Moreover, in the part of the descriptive statistical analysis, the mean and median values for the non-normally distributed tests were not close to each other, indicating that the data obtained and analyzed in this study had a non-normal distribution. Of 822 patients, 751 (91.4%) exhibited a significant reduction in menstrual bleeding after device insertion. Moreover, a significant decrease was observed in the pictorial blood assessment chart scores 6 months postoperatively (p < 0.05). This study revealed that the levonorgestrel-releasing intrauterine device is an easy-to-insert, safe, and effective treatment option for abnormal uterine bleeding (AUB). Furthermore, the pictorial blood assessment chart is a simple and reliable tool for evaluating menstrual blood loss in women before and after the insertion of levonorgestrel-releasing intrauterine devices.

Value and influencing factors of preoperative MRI evaluation for previous cesarean scar defect associated abnormal uterine bleeding in patients undergoing laparoscopic surgery.

As the cesarean section rate increases year by year, the treatment of previous cesarean scar defects (PCSD) poses a significant challenge. This study aims to evaluate the clinical value of preoperative magnetic resonance imaging (MRI) technology and analyze relevant influencing factors for patients with abnormal uterine bleeding (AUB) associated with cesarean scar defects who underwent laparoscopic surgery. A retrospective cohort analysis was performed on women who underwent laparoscopic surgery for PCSD-related AUB at the Department of Gynecology, the Third Xiangya Hospital of Central South University from 2018 to 2022. A total of 57 patients who underwent laparoscopic surgery for the treatment of AUB associated with PCSD were divided into 2 groups based on their postoperative clinical cure status: The clinically-cured group (n=28, 49.1%) and the non-clinically-cured group (n=29, 50.9%). After a postoperative follow-up period of 3 months for all participants, logistic regression analysis was conducted to explore the correlation between the clinical cure rate of AUB associated with cesarean scar defects treated by laparoscopic surgery and various factors. These factors included patient age, clinical symptoms, obstetric history, history of cesarean section, basic clinical information, preoperative MRI parameters, and postoperative menstrual conditions. There were no significant differences in many aspects, including the patient's age at the time of previous cesarean section, number of pregnancy, time since the previous cesarean section, the uterus position assessed by preoperative T2 signal MRI, defect length, defect width, residual muscle layer thickness, adjacent uterine muscle layer thickness, and distance from the defect to the external cervical os between the 2 groups (all P>0.05). However, the time of onset of AUB symptoms (P=0.036, OR=1.019, 95% CI 1.002 to 1.038) and the depth of the defect on the preoperative MRI (P=0.010, OR=5.793, 95% CI 1.635 to 25.210) were identified as risk factors affecting the clinical cure rate. The time of onset of AUB symptoms and the depth of the defect on preoperative MRI are risk factors that influence the clinical cure rate of laparoscopic surgery for the treatment of AUB associated with PCSD, which could be helpful for evaluating the prognosis of disease.

Treatment of Abnormal Uterine Bleeding Due to a Leiomyoma in a Bicornuate Uterus with Uterine Artery Embolization: The First Case in the Literature

Treatment of Abnormal Uterine Bleeding Due to a Leiomyoma in a Bicornuate Uterus with Uterine Artery Embolization: The First Case in the Literature

8771 The Impact of Social Determinants of Health Delaying Treatment for Women That Undergo Hysterectomy for Abnormal Uterine Bleeding

<h3>Study Objective</h3> 1) Identify the social determinants of health that contribute to delayed treatment for abnormal uterine bleeding (AUB), defined as women presenting with large uteruses at the time of hysterectomy, and patterns of healthcare utilization over a 3-year period and 2) Assess health-related outcomes in women with delayed hysterectomy for AUB. <h3>Design</h3> Retrospective cohort study. <h3>Setting</h3> Single hospital system. <h3>Patients or Participants</h3> 1,361 women who underwent hysterectomy for benign causes of abnormal uterine bleeding over a 3-year period between January 1, 2014, to December 31, 2017. <h3>Interventions</h3> N/A. <h3>Measurements and Main Results</h3> Women with enlarged uteri ≥ 500 g at time of hysterectomy were more likely to present to the emergency department (10.9% vs. 7.0%, p=0.034) and subspecialty care visits (34.2% vs. 28.0%, p=0.047). There were no differences in generalist gynecological visits among the two groups. Black women disproportionately composed those with enlarged uteri (59.9% vs. 36.1%, p=<0.001). There were no differences identified in age, BMI, socioeconomic status, ethnicity or insurance type. Women who delayed treatment for AUB were more likely to undergo mini-laparotomy (2.7% vs. 0.8%, p=0.01) or laparotomy (68.9% vs. 24.2%, p=<0.001) compared to minimally invasive approaches, demonstrated lower pre-operative hemoglobin levels (11.5 vs. 12.3, p=<0.001), lower hemoglobin levels in a 3-year period leading up to hysterectomy (10.0 vs. 11.3, p=<0.001), increased estimated blood loss (373.3mL vs. 178.7mL, p=<0.001), procedure time (171.9 min vs. 145.1min, p=<0.001) and length of hospital stay (1.4 days vs. 0.6 days, p=<0.001). <h3>Conclusion</h3> Delayed treatment for women who ultimately underwent hysterectomy for abnormal uterine bleeding was associated with increased emergency department and subspecialty care visits, and this population was disproportionately composed of Black woman. Perioperatively, delayed treatment was associated with more open surgeries, increased blood loss, increased operative time, and longer hospital stays.

Robotic hysterectomy for the treatment of refractory menometrorrhagia and squamous endometrial morules: A case report

Introduction: Abnormal uterine bleeding (AUB) is a common presentation in the field of gynecology. Proper diagnosis and management of this condition can be difficult and permanent treatment options, including robotic hysterectomy, may be necessary. In patients with a history of previous abdominal surgery, pelvic adhesions may present obstacles to this surgical approach. Case Report: In this case report, a 41-year-old woman desired permanent treatment for AUB. The patient underwent endometrial biopsy which revealed inexplicit squamous morules. She opted for permanent treatment via robotic hysterectomy. Her operation was complicated by the presence of dense pelvic adhesions caused by previous surgeries. Conclusion: This report aims to detail the potential difficulties in the clinical management of inconclusive biopsy results and in using a robotic approach to hysterectomy in the setting of pelvic adhesions. Authors encourage ongoing clinical investigation to determine the optimal methods for diagnosing and treating AUB.

Clinical Update on Uses for Mifepristone in Obstetrics and Gynecology.

Mifepristone (RU-486) is a selective progesterone receptor modulator that has antagonist properties on the uterus and cervix. Mifepristone is an effective abortifacient, prompting limitations on its use in many countries. Mifepristone has many uses outside of induced abortion, but these are less well known and underutilized by clinicians because of challenges in accessing and prescribing this medication. To provide clinicians with a history of the development of mifepristone and mechanism of action and safety profile, as well as detail current research on uses of mifepristone in both obstetrics and gynecology. A PubMed search of mifepristone and gynecologic and obstetric conditions was conducted between January 2018 and December 2021. Other resources were also searched, including guidelines from the American College of Obstetricians and Gynecologists and the Society of Family Planning. Mifepristone is approved by the Food and Drug Administration for first-trimester medication abortion but has other off-label uses in both obstetrics and gynecology. Obstetric uses that have been investigated include management of early pregnancy loss, intrauterine fetal demise, treatment of ectopic pregnancy, and labor induction. Gynecologic uses that have been investigated include contraception, treatment of abnormal uterine bleeding, and as an adjunct in treatment of gynecologic cancers. Mifepristone is a safe and effective medication both for its approved use in first-trimester medication abortion and other off-label uses. Because of its primary use as an abortifacient, mifepristone is underutilized by clinicians. Providers should consider mifepristone for other indications as clinically appropriate.

Utility of the Levonorgestrel-Releasing Intrauterine System in the Treatment of Abnormal Uterine Bleeding and Dysmenorrhea: A Narrative Review.

Introduction: We undertook a literature review of the use of levonorgestrel-releasing intrauterine devices when utilized for heavy menstrual bleeding and/or dysmenorrhea. Methods: A narrative review of articles in the Scopus and Medline databases was conducted. Results: A number of options exist for the management of both abnormal uterine bleeding (AUB) and dysmenorrhea, and evidence is accumulating that the insertion of a levonorgestrel-releasing intrauterine system (LNG-IUS) represents a useful option for their long-term treatment. The idea of using a progestogen released in utero was initially conceived to achieve long-term contraception, but it was quickly found that these systems could be utilized for a number of therapeutic applications. The first device to be made commercially available, Progestasert, was withdrawn from the market because, in the event of contraceptive failure, it caused a disproportionate percentage of extrauterine pregnancies. On the other hand, the LNG-IUS continues to be successfully utilized in its various variants, releasing 20, 13, or 8 μg/day. These devices have a respective duration of action of 7 (possibly 8), 5, and 3 years, and there exist versions of frameless systems affixed to the myometrium of the uterine fundus. In the present review, following a brief description of the major causes of AUB and dysmenorrhea, the molecular bases for the use of the LNG-IUS are summarized. This is followed by a compendium of its use in AUB and dysmenorrhea, concluding that the insertion of the system improves the quality of life, reduces menstrual blood loss better than other medical therapies, and decreases the extent of dysmenorrhea and pelvic pain. In addition, there is no evidence of a significant difference in these outcomes when the use of the LNG-IUS was compared with improvements offered by endometrial ablation or hysterectomy. Possibly, the most important mechanism of action of the system consists of its ability to induce amenorrhea, which effectively eliminates heavy bleeding and dysmenorrhea. However, no method is ideal for every woman, and, in the case of the LNG-IUS, younger age and severe dysmenorrhea seem to be associated with a higher risk of discontinuation. Conclusion: The higher-dose LNG-IUS is a useful tool for HMB and dysmenorrhea in women of all ages. The low cost and ease of use make the LNG-IUS an attractive option, especially when contraception is also desired.

Efficacy of Qiancao () and Haipiaoxiao (), a traditional Chinese herb pair, on abnormal uterine bleeding in rats with incomplete abortion.

To investigate the most effective weight ratio of Qiancao () and Haipiaoxiao () used to produce decoction for the treatment of abnormal uterine bleeding (AUB) in rats with incomplete abortion, and to study the possible mechanism. The models of AUB were established by incomplete drug abortion with mifepristone and misoprostol in pregnant rats. The therapeutic effects of decoctions made by eight different weight ratios of Qiancao () and Haipiaoxiao () were observed. Statistical analysis revealed that the most effective weight ratio of Qiancao () and Haipiaoxiao () to treat AUB in this study was 2∶1. The insights gained from this study would improve understanding of the mechanisms involved in the effect of Qiancao () and Haipiaoxiao () on AUB.

A comprehensive review of Rubia cordifolia L.: Traditional uses, phytochemistry, pharmacological activities, and clinical applications.

Rubia cordifolia (family: Rubiaceae) L (R. cordifolia) is a perennial botanical drug climbing vine. As the main part of the traditional Chinese medicine, the rhizome has a long history. A great number of literary studies have reported that it can be used for the improvement of blood circulation, hemostasis, activation of collaterals, etc. When it comes to the wide application of R. cordifolia in traditional medicine, we systematically review its traditional uses, phytochemistry and pharmacological effects. Literatures were systematically searched using several scientific databases, including China National Knowledge Infrastructure (CNKI), Baidu Scholar, PubMed, Web of Science, and other professional websites. Kew Botanical Garden and the iPlant were used for obtaining the scientific names and plant images of R. cordifolia. In addition, other information was also gathered from books including traditional Chinese herbal medicine, the Chinese Pharmacopoeia, and Chinese Materia Medica. So far, many prescriptions containing R. cordifolia have been widely used in the clinical treatment of abnormal uterine bleeding, primary dysmenorrhea and other gynecological diseases, allergic purpura, renal hemorrhage and other diseases. The phytochemistry studies have reported that more than 100 compounds are found in R. cordifolia, such as bicyclic peptides, terpenes, polysaccharides, trace elements, flavonoids, and quinones. Among them, quinones and peptides are the types of components with the highest contents in R. cordifolia. The modern pharmacological studies have revealed that R. cordifolia and its derived components have anti-tumor, anti-oxidative, anti-platelet aggregation, and anti-inflammatory effects. However, most studies are preclinical. The pharmacological mechanism of R. cordifolia has not been thoroughly studied. In addition, there are few pharmacokinetic and toxicity studies of R. cordifolia, therefore the clinical safety data for R. cordifolia is lacking. To sum up, this review for the first time summarizes a systemic and integrated traditional uses, chemical compositions, pharmacological actions and clinical applications of R. cordifolia, which provides the novel and full-scale insight for the drug development, medicinal value, and application of R. cordifolia in the future.

Uterine artery embolization

Uterine fibroids (UF) is an extremely common benign tumor of the female reproductive system. This pathology is often associated with symptoms that significantly impair the quality of life of a woman and her working capacity, and can also affect the ability to conceive and gestation. Today, we have in the arsenal of operational, drug and minimally invasive methods of UF treatment. One of the most researched and at the same time rather controversial methods of UF treatment is uterine artery embolization (UAE).Literary sources were reviewed using the MEDLINE, PubMed and Web of Science databases for the period 2011–2021. The data related to the history of the technique development, its implementation, indications and contraindications for UAE, its effect on the UF symptoms and on fertility were systematized and presented in this review.UAE as an independent method for the treatment of benign uterine tumors has 20 years of experience in the world and in Ukraine. The indications for UAE are symptomatic UF: profuse and/or prolonged menstruation, dysmenorrhea, compression of the pelvic organs, dyspareunia, frequent urination or urinary retention. Absolute contraindications for UAE are genital tract infections, pregnancy, doubts about the diagnosis, as well as contraindications to the use of X-ray contrast agents.The effectiveness of UAE is assessed by the manifestations of UF symptoms and by the degree of fibroids size reduction. The average node reduction in the diameter is 2.2 cm. The clinical efficacy index is 81–96, 70–100 and 46–100% respectively in the treatment of abnormal uterine bleeding, pelvic pain and symptoms of compression of adjacent organs. There is a decrease in the node volume by 25–60% within 3–6 months.Conclusions. UAE today is an effective and safe minimally invasive operation, which is a worthy alternative to hysterectomy and expands the possibilities of organ-preserving technologies if there is UF.

[Guideline on diagnosis and treatment of abnormal uterine bleeding: 2022 revisions].

由中华医学会妇产科学分会妇科内分泌学组制定的中国《异常子宫出血诊断与治疗指南》于2014年发布，对国内异常子宫出血（AUB）的规范化诊治起到了良好的指导作用。随着新的研究进展，国际妇产科联盟于2018年再次更新了育龄期AUB的定义与分类，中华医学会妇产科学分会妇科内分泌学组也根据国内外新的研究进展和结果，结合国内的临床实践以及其他学科和专业的发展和发现，针对AUB的定义、诊治流程、病因治疗进行了更新、补充，形成了中国《异常子宫出血诊断与治疗指南（2022更新版）》，以便与国际接轨，更好地指导临床实践和研究。.

The Use of A Uterine Balloon for the Treatment of Abnormal Uterine Bleeding

The Use of A Uterine Balloon for the Treatment of Abnormal Uterine Bleeding

The optimization of abnormal uterine bleeding treatment in women with chronic psychogenic stress

The objective: to assess the effectiveness of the complex optimized treatment approach to abnormal uterine bleeding (AUB) in women with chronic psychogenic stress on the quality of life.Materials and methods. We examined 100 women of reproductive age with AUB and chronic psychogenic stress, 50 patients of them consisted the I group and received the optimized treatment, and 50 persons (II group) received the standard AUB treatment. 30 women without AUB and chronic stress were included in the control group. The examination of all persons included: anamnesis, clinical and gynecological examinations, ultrasound examination, general blood test, blood ferritin, vitamin D in serum blood. The quality of life was determined according to the 36-Item Short Form Health Survey before treatment and after three months. The standard approach included diagnostic and therapeutic measures according to the recommendations of Order N 353 dated 13.04.2016 of the Ministry of Health of Ukraine. The optimized treatment additionally included recommendations for lifestyle changes, melatonin, the use of vitamin D depending on its level, the medicament correction of iron deficiency without anemia.Results. The results of the questionnaire 36-Item Survey scales indicate that in patients with AUB and chronic psychogenic stress there is a decrease in the scales relative to the values of healthy women, especially in psychological component. In the persons of the II group there was no significant dynamics of the scales “Bodily pain” and “Physical role functioning” relative to the indicators before treatment, while the scales “Physical function” (p&lt;0,001) and “General health perceptions” (p=0.01) increased significantly. The optimized treatment lead to a significant increase in all physical component scales compared till normal indices. In patients of the II group the indicators of psychological scales after treatment were significantly lower than the average values of healthy women. Thus, the value of the scale “Mental Health” was lower by 14,34% relative to the control group (p=0,18), “Emotional role functioning” – 18,38% (p=0,007), “Social role functioning” – 15,46% (p=0,003), “Vitality” – 23,27% (p=0,005). In the women of the I group there was a significant increase in the indicators of the psychological scales, which after treatment reached the values of healthy women.Conclusions. In women with AUB and chronic psychogenic stress, there is an insufficient positive dynamics in improving the quality of life after the standard treatment, especially the scales of the psychological component. The optimized treatment approach leads to the improvement of all parameters of quality of life of the patients.

In Vitro Investigation and Characterization of Silicone Matrix IVR Loaded with Levonorgestrel: A Propper Method for Hormon Replacement Therapy

Introduction: Among 3 to 30 percent of women of reproductive age, experience abnormal uterine bleeding (AUB). Vaginal rings are one of the systems of interest for the local delivery of hormones that due to their polymeric structure allow prolonged release of drug. In this study, the design and fabrication of matrix vaginal rings containing levonorgestrel (LNG) were investigated.&#x0D; Methods: In this experimental study, at first, two pieces of aluminum mold were designed, then base (A) and cross-linker parts (B) of polymer with LNG were mixed and 48 polymeric rings containing LNG were manufactured by injection molding method. To achieve the desired drug release values in a given time, the effect of temperature, rpm, release environment, different initial loading, cross-linker percentage and a mathematical model to predict release and swelling test were investigated.&#x0D; Results:  As a result of the experiments, it was revealed that with increasing drug loading, the release rate rises, while increasing the cross-linker percentage reduced the drug release. Finally, the ring A:B=100:9.5 with an initial loading of 0.2 % LNG relative to silicon was selected as an appropriate ring, and release experiments were performed at 37 °C, shaker speed of 80 rpm, and release medium containing 10 % ethanol. Drug release values were measured by spectrophotometer and analyzed by SPSS statistical software version 16.&#x0D; Conclusion: Based on the results, it can be deduced that matrix vaginal ring containing LNG is a suitable drug delivery system for prolonged release of LNG for treatment of AUB that depending on the drug initial loading and cross-linker percentage, the required diffusion coefficient, and release rate can be achieved in a certain time.