Organ-Preserving Approach in Treatment of Uterine Leiomyoma

Uterine leiomyoma is one of the most common benign hyperproliferative diseases of the female reproductive organs. According to the literature, its prevalence among women of reproductive age is estimated to be approximately 20?40%. Moreover, it is diagnosed more often (up to 75-85%) when carrying out morphological investigations of macro specimens after hysterectomy. In recent years the proportion of young patients with this pathology has increased. For a long period of time radical hysterectomy has been the most common method used to treat the disease. During the past decades the possibilities of organ-preserving treatment of the disease expanded due to the achievements of modern pharmaceutical industry and implementation of new technologies. As a result, surgical interventions themselves changed and the proportion of surgeries such as conservative myomectomy, uterine artery embolization, hysteroscopic resection of submucous fibroid increased. The data on surgical interventions allowed us to eradicate the symptoms of uterine leiomyoma preserving fertility in many patients, however, the risk of tumor recurrence and growth is still present. The recurrence rate after organ-preserving surgeries remains high and, according to the results of various studies, accounts for 2-50% of cases. Considering the above-mentioned data prevention of tumor recurrence is of great relevance. Based on the results of diagnostic program including endocrinologic, immunological and morphological investigations there was found that in women with isolated uterine leiomyoma dyshormonal disease, inflammatory processes of the genital organs, chronic endometritis, pathology of the receptor apparatus of uterine tissues occur more often; hyperprolactinemia, relative or absolute hyperestrogenemia and increased production of antibodies are more often diagnosed in women with uterine leiomyoma and co-existent dyshormonal pathology of the mammary and thyroid gland. According to the literature, in isolated uterine leiomyoma therapy aimed at correcting local factors including anti-inflammatory therapy, local hormone therapy or uterine artery embolization is recommended. In comorbidity correction of systemic metabolic disorders, namely anti-stress therapy, systemic hormone therapy, immune system correction, treatment of co-existent somatic pathology which may include local use of hormones and organ-preserving surgical interventions should be performed first of all. Thus, modern medicine has in its arsenal various organ-preserving, conservative, surgical including minimally invasive methods of treatment implementation of which allows us to improve quality of life in such patients as well as to enhance fertility and reproductive health of women.