CC BY
10
Khodjaeva Aziza Sagdullaevna, (Tashkent institute of improvement of doctors, chair "Obstetrics and gynecology") E-mail: t.mikhaylova@mail.ru
"MODERN OPPORTUNITIES IN TREATMENT OF TEENAGE GIRLS WITH RECURRENT UTERINE BLEEDINGS"
Abstract: in article there are considered questions of anti-recurrent therapy of uterine Bleedings at teenage girls. There were examined 60 patients - teenage girls - (middle age 14.2 ± 1.9). Risk factors of emergence and recurrence of uterine bleedings of pubertal period have been studied. There has been offered differentiated stage-by-stage approach to treatment of recurrent uterine bleedings at girls-teenagers.
Keywords: reproductive health of teenage girls, puberty, uterine bleedings of pubertal period, recurrence, vulvovaginitis, anemia, hypovitaminosis of B vitamins group.
A condition of reproductive health of modern popu- pedient. At the same time, numerous methods for treat-
lation of teenage girls is characterized by high prevalence of gynecologic diseases, and there is defined negative tendency of their augmentation [3; 8]. Pubertal period is critical in formation of female reproductive system. A immaturity hypophysial-pituitary and ovarian system and reception of target organs to hormonal influences -are triggers of various disturbances in menstrual function at teenage girls. Most often these disturbances are expressed by uterine bleedings of pubertal age, that has significant effect on reproductive health of woman in fertile age. According to researchers, frequency of UBT (Uterus bleedings in teenagers) fluctuates from 19% to 38% and doesn't tend to depression. A main reason for their emergence is age incompetence of reproductive system of teenage girl. Burdened premorbidal background in combination with lability of neuroendocrinal regulation of menstrual function are starting moment in a pathogenesis of MKPP [1; 2; 3; 6; 7].
Etiological factors promoting emergence of UBT are multifactorial Most ofresearchers emphasize a significant role in genesis of UBT of bacterial and viral infection, hypovitaminosis, disturbances in system of hemostasis. Influencing to organism of teenage girl during hormonal reorganization, these factors (separately taken or in common) as a result lead to disturbance in metabolism of estrogens, emergence of condition of relative and/or absolute hyperestrogenemia [2; 3; 5; 8].
Due to above stated, pathogenetically justified integrated multisystem approach to treatment of UBT is ex-
ment of teenage girls being available today with UBT are imperfect, that is confirmed with high frequency of their recurrence (up to 41%). Therefore search by clinicians of optimum methods of treatment of the teenage girls suffering from UB is continued [4; 7; 8].
An objective_of our research was optimization of tactics in maintaining teenage girls with recurrent UBT.
Material and methods of research. We have examined 60 girls - teenagers with UBT at the age of 13-16 years (middle age 14.2 ± 1.9) living in Tashkent city, not conducting sexual life during 2012-2016. For the first time disease (UBT) arose at 67% of examined teenage girls, in 33% cases there was noted a recurrence. According to that, examined teenage girls were divided into two comparative groups: 1st group - primary UBT (p = 40), 2nd group - UBT recurrence (p = 20).
As the important factor promoting emergence of UBT was somatic health of the child (rather its disturbance), we carried out an analysis of premorbidal background (PB) of the examined patients. The greatest burdening of premorbidal background gastrointestinal diseases is noted at 70% of examined patients, anemia of 1-2 degrees (59%), by pathology of a thyroid gland (54%), adenoid diseases and frequent ARD (acute respiratory disease) (36%), hypovitaminoses (especially group B vitamin) - 34%. At patients of the 1st PF group there was less burdened by above-mentioned somatopa-thies (to 30%) in comparison with patients of the 2nd group (54%).
Section 5. Medical science
Studying of a gynecologic case rate among examined patients has revealed inflammatory diseases of genitalias (vulvovaginitis, adnexitis) in 68% at patients of the 2nd group, 34% - at patients of the 1st group. Bacteriological studying of vaginal discharges defined mono causative agent only in 16%, in other 84% cases association of microorganisms with prevalence of Chlamydia and fungi and coccal (aerobic-anaerobic) flora is found. Biochemistry of a blood reflects anemia of 1-2 degrees at 59% of examined patients.
Heredity was burdened by various gynecologic diseases of mothers (myomas, cysts, DMK, sterility) also mainly at patients of the 2nd group (62%) while at patients the 1st group this indicator made 18%.
Results of researches: Analysis of etiological factors ofUBT showed a necessity of integrated stage-by-stage differentiated approach to treatment. Patients of the 1st group received traditionally sexual steroids of hormonetherapy (KOK) originally with haemostatic purpose, then in a cyclic regimen for normalization of menstrual cycle of 3-6 months (ethenyloestradiolum + dezogestret). Starting dose of hemostasis depended on intensity of bleeding and patient's weight, having made from 2 to 4 tablets, with subsequent transition to a cyclic regimen. However, reception of hormonal drugs was followed by giddiness (32%), nausea and vomiting practically at every second patient. In this connection, parents ofpatients refused continuation of treatment with KOK that led further to recurrence of UBT.
Patients of the 2nd group with haemostatic purpose received medicinal preparations, corrective fibrinolysis, i. e. anti-inflammatory effect as inflammatory diseases of genitalias had high specific gravity having anti-fibrinolitic activity, and also rendering (to 68%). It is about the drug Yunimef-T, combining these effects at the expense of components - traneksame and mefename acids. Traneksame acid, being a fibrinolis inhibitor, has systemic haemostatic effect at bleedings, Mefename acid possesses nonsteroid anti-inflammatory effect, also promotes decrease of du-
ration of bloody discharges at menstruation. Patients of 2nd group received drug on 2 tablets 3 times a day within 5 days. In none case there was noted a refusal of treatment due to bad tolerance of drug. Complex of treatment included also pathogenetically corrected purpose of drug of Normodoks as anemia and hypovitaminoses of vitamins of B group occurred at patients of the 2nd group in 59% and 34% respectively. Doksilamin succinate being a part of normodoks, blocks H1 - histaminic receptors, promoting to good acceptability of medicinal therapy, and pyri-doxine (second component) participates in a metabolism, in particular amino acids (glutamic, ziztein, methionine and others), stimulates formation of erythrocytes. Drug was prescribed w for 1 tablet in day, reception duration -1 month. Expressed positive effect is noted already with the following normal menstruation at 18 patients, lasting positive effect by 2-3 month of treatment. The post-treatment period at patients of the 1st group lasted 2-3 months while there was noted at patients of the 2nd group post-treatment to the following menstruation.
Conclusion. Uterine bleedings of pubertal period need to be considered as a multifactorial disease with predilection to a recurrence, therefore there is required differentiated and stage-by-stage approach to their treatment. Complex treatment of patients offered by us with UBT is pathogenetically justified as at the same time makes corrective impact on several etiological factors (inflammation, anemia, hypovitaminoses of vitamins of B group) that is pathogenetically justified and allows to optimize tactics of maintaining patients with UBT. Clinical laboratory researches have demonstrated that efficiency of UBT treatment offered by us made 82%, frequency ofrecurrence decreased twice, normalization ofmenstrual cycle is noted to the second month, lasting positive effect - also to the following menstruation that reduced treatment duration for twice. This pathogenetically justified treatment of UBT is not only anti-recurrence, but also keeping a regulation of reproductive system of teenage girl in the future.
References:
1. Gurkin Yu. A. Gynecology of teenagers / Tutorial for doctors. - SPb.: Foliant, - 2009. - 574 p.
2. Karakhalis L.Yu., Fedorovich O. K. Treatment of dysmenorrhea at women of early reproductive age // Consilium Medikum. - 2015. - No. 9 (6). - P. 13-16.
3. Karacus S. Kiran G. Ciralik H. Efficacy of micronized vaginal progesteron versus oral dydrogesterone in treatment of irregular dysfunctional uterine bleeding: A pilot randomized controlled trial Aust, N. Z. J. Obstet, Gynaecol. -2015. - Vol. 49. - P. 685-688.
4. Lapchenko M. L. Gynecologic diseases at little girls and girls. Gl.6. - M., - 2014. - P. 18-21.
5. Prilepskaya V. N., Yaglov V. V. Inflammatory diseases of small pelvis organs. - M.: GEOTAR. - Media, - 2016.
6. Pinkerton J. V. Pharmacological therapy for abnormal uterine bleeding // Menopause. - 2015. - Vol. 18 (4). -P. 453-446.
7. Uvarova E. B. Uterine bleedings of pubertal period. Clinical references "Obstetrics and gynecology", 4 prod. Under editorship ofAcademician of RSA - G. M. Savelyeva, V. N. Serov, G. T. Sukhikh. - M., - 2015. - P. 678-703.
8. Uvarova E. V. Pediatric and adolescent gynecology. - Moscow: Littera, - 2015. - 375 p. (in Russian).
