MODERN ASPECTS OF THE MANAGEMENT OF PATIENTS WITH ABNORMAL UTERINE BLEEDING

Abstract

The purpose of the research: to propose a modern algorithm for diagnostic and therapeutic measures for AUB in women of reproductive age for it prevention in the future.
Materials and methods. To achieve this goal, we examined 90 patients with AUB at the age of 25–40 years with menstrual irregularities in the form of prolonged bleeding (˃8 days) with excesseve blood loss (80 ml).
Results. Patients with chronic cyclic AUB predominated among women. In 57 (95%) women of the first group, chronic inflammatory diseases of the internal genital organs were detected: candida – 23 (38.3%), ureaplasma – 15 (25%), chlamydia – 12 (20%), mycoplasma – 7 (11.7%). %). The study of the hormonal status in the examined women of the first group revealed an increasing in the level of estradiol and a decreasing in the level of progesterone. Thus, we observed hyperestrogenia in 47 (78.3%) cases, hypoprogesteronemia – 45 (75%). Methods of treatment for women in the first group: prescribing combined oral contraceptives (COCs) containing dienogest + estradiol, using synthetic progestogens with microdoses of hormones, taking progesterone receptor modulators, using an intrauterine system with levonorgestrel, iron supplementation was included in the treatment to correct anemia, surgical methods – hysteroscopy, laparoscopy. In the second group, women underwent "blind" scraping of the walls of the uterine cavity, conventional examination methods. Recidive in the first group occurred only in 3 (5%) women. In women of the second group, recidive was observed in 23 (76.7%) cases.
Conclusions. Modern technologies for managing patients should include additional examination for sexually transmitted infections and hormonal status. The use of minimally invasive organ-preserving surgical techniques in the treatment should become a routine practice.