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A NEW APPROACH TO THE TREATMENT OF WOMEN OF REPRODUCTIVE
AGE WITH ADENOMYOSIS
Kobiljonova Sabina Komilovna
Resident of the Master's program.
Askarova Zebo Zafarjonovna
Dsc, Samarkand State Medical University, Samarkand, Uzbekistan.
https://doi.org/10.5281/zenodo.15512755
Object of the Study:
Adenomyosis is a chronic gynecological condition characterized by the presence of
ectopic endometrial tissue within the myometrium, which often affects women of reproductive
age. It presents with symptoms such as dysmenorrhea, menorrhagia, chronic pelvic pain, and
infertility. Traditional treatments have focused on hormonal therapy or surgery; however, these
may be insufficient or inappropriate for women wishing to preserve their fertility. Therefore,
this research aims to explore the effectiveness of a novel, minimally invasive, integrative
therapeutic approach that combines intrauterine hormonal delivery, phytotherapy, and platelet-
rich plasma (PRP) therapy to offer better outcomes in terms of symptom relief, quality of life,
and reproductive function.
The study population consisted of 90 women aged 25–40 years who had been diagnosed
with adenomyosis at the Republican Specialized Scientific-Practical Medical Center of
Obstetrics and Gynecology between 2022 and 2024. All participants had symptomatic disease
confirmed via imaging and clinical evaluation. Patients were randomly divided into three
treatment groups:
Group 1 (Control group): Treated with standard hormonal therapy using combined oral
contraceptives or progestins (n=30).
Group 2 (Experimental group): Treated with an innovative combined approach
including Levonorgestrel-releasing intrauterine system (LNG-IUS), phytotherapy (Vitex
agnus-castus extract), and PRP intrauterine injections (n=30).
Group 3 (Surgical group): Treated with conservative hysteroscopic resection of
adenomyotic foci (n=30).
Methods and Materials:
Inclusion Criteria:
a.
Women aged 25–40 years
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b.
Confirmed diagnosis of adenomyosis through TVUS and MRI
c.
Symptomatic presentation (pain, heavy menstrual bleeding, or infertility)
d.
Desire to preserve fertility
Diagnostic Tools and Assessments Used:
a.
Clinical Examination: Detailed gynecologic history, symptom score evaluation using a
Visual Analog Scale (VAS) for pain, and menstrual cycle characteristics.
b.
Ultrasound Imaging (TVUS with Doppler): For evaluation of uterine structure, presence,
and depth of adenomyotic lesions.
c.
Magnetic Resonance Imaging (MRI): Used in selected patients to confirm diagnosis and
stage the disease.
d.
Laboratory Investigations: Serum CA-125 levels, hormonal profiling (FSH, LH,
estradiol, progesterone).
e.
Quality of Life (QoL) Assessment: Using validated questionnaires such as SF-36 and
WHOQOL-BREF.
Therapeutic Interventions:
a.
Group 1: Received standard hormone therapy for 12 months.
b.
Group 2: Received the novel treatment protocol:
c.
LNG-IUS (Mirena): For continuous local release of levonorgestrel to suppress ectopic
endometrial growth.
d.
Phytotherapy: Herbal supplementation with Vitex agnus-castus, known for hormonal
balancing effects.
e.
PRP Therapy: Platelet-rich plasma injections administered intrauterinely once every 3
months to promote endometrial repair and immune modulation.
f.
Group 3: Underwent hysteroscopic resection of adenomyotic tissue using bipolar
electrosurgical technique.
Follow-up and Monitoring
:
Patients were followed over 12 months, with assessments at baseline, 3, 6, 9, and 12
months.
Parameters monitored included symptom scores, uterine volume, lesion size,
hemoglobin levels, and pregnancy outcomes (for those attempting conception).
Results
:
Group 1 (Standard Hormonal Therapy):
63.3% of patients reported partial symptom relief, primarily in p
ain and bleeding.
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a.
36.7% experienced symptom recurrence within 6 months of treatment cessation.
b.
No significant reduction in uterine size or adenomyotic lesion depth was observed.
c.
CA-125 levels decreased modestly.
Group 2 (Novel Treatment):
a.
86.7% of patients experienced complete resolution of dysmenorrhea and menorrhagia.
b.
Uterine volume reduced by 20–30% on average as confirmed by ultrasound and MRI.
c.
Significant improvement in QoL scores.
d.
CA-125 levels normalized in 80% of cases.
e.
PRP appeared to contribute to improved endometrial receptivity; 6 spontaneous
pregnancies were reported.
f.
No systemic side effects were observed.
Group 3 (Surgical Group):
1.
93.3% of patients had resolution of pain symptoms.
2.
Surgical complications were minimal (adhesions in 10%, transient amenorrhea in 6.7%).
3.
Uterine integrity compromised in some patients, reducing chances of successful
pregnancy.
4.
No pregnancies occurred in this group during follow-up.
Discussion
:
This study highlights the potential of a multimodal, fertility-preserving strategy in the
management of adenomyosis in reproductive-age women. The combination of LNG-IUS,
phytotherapy, and PRP therapy demonstrated superior clinical outcomes compared to standard
hormonal therapy and surgical intervention. The local delivery of levonorgestrel significantly
reduced estrogenic stimulation of adenomyotic tissues, while phytotherapy provided additional
hormonal modulation without systemic side effects. PRP therapy played a pivotal role in
reducing inflammation, promoting tissue repair, and potentially enhancing fertility.
While standard hormone therapy remains effective for symptom control, it lacks
sustainability after discontinuation. Surgical treatment, although effective in symptom relief,
may not be suitable for patients desiring future pregnancies due to the risk of uterine scarring
and adhesion formation. In contrast, the novel treatment protocol appears to balance efficacy,
safety, and reproductive potential.
Conclusion
:
The novel approach comprising LNG-IUS, phytotherapy, and PRP intrauterine therapy
provides a highly effective, minimally invasive, and fertility-preserving treatment for women
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with adenomyosis. This combination significantly reduces pelvic pain and menstrual bleeding,
decreases uterine size and adenomyotic lesion depth, and improves the quality of life without
serious adverse effects. Moreover, the favorable impact on endometrial healing and restoration
of fertility underscores its potential as a first-line therapy for reproductive-age women. Further
large-scale, multicenter studies are warranted to validate these findings and integrate this
strategy into clinical guidelines.
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