Method of preventing genitalia prolapse in women of reproductive period

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to gynecology and can be used for prevention of genitalia prolapse in women of reproductive period. For this purpose exercises strengthening muscles of pelvic floor are done. In patient content of C-end telopeptides is determined, hormonal status is analysed, for which purpose content of estradiole, free testosterone, 170Hprogesterone is determined in first phase of menstrual cycle. If level of free testosterone is normal, level of estradiole is normal or lower, content of 170Hprogesterone is higher, patients, who are not planning pregnancy, are administered Diane-35 or Jeanine in accordance with contraceptive scheme for six months. Patients, who are planning pregnancy, are administered dexamethasone daily in the evening for three months. If content of 170Hprogesterone is 3.1 - 4.4 nmol/l, daily dose of dexamethasone equals 0.125 mg, if content of 170Hprogesterone is 4.5-7.0 nmol/l - 0.25 mg of dexamethasone, if content of 170Hprogesterone is higher than 7.0 nmol/l - 0.5 mg of dexamethasone; if content of C-end telopeptides is higher than 0.6 ng/ml additionally administered is ascorbic acid in dose 500 mg 3 times per day, magnerot in dose 500 mg 3 times per day for three months.

EFFECT: method ensures increase of efficiency of prevention of genitalia prolapse due to differentiated approach depending on hormonal status state and collagen metabolism in women of reproductive period by normalisation of hormonal status and correction of collagen-forming processes.

5 ex

The invention relates to medicine, namely to the gynecologist can be used for the prevention of genital prolapse in women of reproductive age. The method can be used in specialized gynecological care.

Among the possible medical benefits in the presence of perineal disorders include: correction of hormonal depending on medical indications and patient age (combined oral contraceptives among women of reproductive age, drugs estriol (locally and systemically), hormone replacement therapy in patients perimenopausal and postmenopausal age (Dobrokhotova WE Menopausal syndrome. 2005; 2-24).

However, data about the purpose of drug therapy in the prevention of genital prolapse is not revealed.

As prevention of genital prolapse is usually considered training the pelvic floor muscles.

Exercising the pelvic floor muscles helps to increase muscle mass muscles of the pelvic floor, strengthening reflex contraction of these muscles during stressful situations, such as sudden sharp rise in abdominal pressure (Radzinsky VE Perineology. 2006; 14-96). Goals of physical therapy are strengthening the pelvic floor, improve blood flow and trophic bodies of small taday method is selected as a prototype. It is generally accepted that well-known prototype method is not effective for the prevention of genital prolapse.

It is known that sex steroids have a direct effect on connective tissue, testosterone induces the proliferation of fibroblasts, estrogens increase the intracellular water content, and its deficiency leads to reduced formation of collagen in connective tissue (Kulakov V.I. Barren marriage. Moscow: GEOTAR-Media 2005. 214-231; the Facilities J. Hormonal and nonhormonal interventions for menopausal symptoms. Maturitas. 1996. 23. 159-168).

It is established that patients with adrenal hyperandrogenism Genesis belong to the risk group on the possible development of insolvency of the pelvic floor muscles are already at a young age, as they are in a state of chronic collagenoobrazovanie (Ilyina YOU, Umina S. C., Zhdanov M.S. the Influence of hormones on the metabolism of collagen in women with connective tissue dysplasia and without it. Bulletin of PFUR. 2009. No. 5. 207-216).

Tasked to develop effective way to prevent the development of genital prolapse, based as hormonal status of the woman, and metabolism of collagen.

Technical result achieved in the implementation of the proposed method is to improve the prevention of genital prolapse through the implementation of a graded approach depending on SOS the sustainability of hormonal status and metabolism of collagen in women of reproductive age by normalizing hormonal status and correction processes collagenopathy.

The invention consists in the following.

Patients of reproductive age prescribed exercises that strengthen the pelvic floor muscles. Patients of reproductive age determine the content of the C-terminal telopeptides, investigate the hormonal status, which determine the content of estradiol, free testosterone, onproduction in the first phase of the menstrual cycle.

The normal level of free testosterone, normal or low levels of estradiol, with increased content onproduction appoint women not planning pregnancy within six months Diana-35 or Janine on contraceptive scheme in addition to gymnastics, aimed at strengthening the pelvic floor muscles.

Patients planning to become pregnant, in addition to gymnastics, aimed at strengthening the pelvic floor muscles, prescribe dexamethasone daily in the evening for three months, and when the content onproduction of 3.1-4.4 nmol/l 0.125 mg; when the content onproduction of 4.5-7.0 nmol/l 0.25 mg, when the content onproduction more to 7.0 nmol/l to 0.5 mg

When the content of C-terminal telopeptides more than 0.6 ng/ml appoint ascorbic acid 500 mg 3 times a day, magnerot 500 mg 3 times a day. Treatment within three months.

It is established that differentiated approaches the d to the prevention of genital prolapse using hormonal, metabolic therapy enables effective prevention of this disease, which is characterized by a complex pathogenesis, by correcting hormonal disorders and metabolism of collagen according to the developed scheme.

Identifying signs of increased collagenoobrazovanie by biochemical determination of C-terminal telopeptides, indicating an increased breakdown of collagen; identification of hormonal imbalance, leading to increased collagenoobrazovanie, allows to carry out an adequate prevention, aimed at the improvement of the metabolism of collagen, which helps prevent the early development of genital prolapse.

The method is as follows.

In women of reproductive age determine the content of the C-terminal telopeptides, investigate the hormonal status, which determine the content of estradiol, free testosterone, onproduction in the first phase of the menstrual cycle.

When determining levels of C-terminal telopeptides and hormones can be used in various diagnostic system, such as system Architect, ABBOT, USA, chemiluminescent immunoassay automatic analyzer "Architect"; diagnostic systems DSL, USA, enzyme-linked immunosorbent assay; automatic analyzer "Immulait 2000", SIEMENS d is I the determination of hormones and enzyme analyzer Stat Fax 2100 for the determination of C-terminal telopeptides.

Normative parameters of the studied hormones in the first phase of the menstrual cycle and C-terminal telopeptides (V. M. Sidelnikov Usual loss of pregnancy. 2005), (Caurina TI, Gorbunova V., Gorbunov. Connective tissue dysplasia. 2009):

Estradiol - 68-1269 pmol/l,

Onproduction - 1,21-3,09 nmol/l,

St. testosterone - 1,2-6,6 PG/ml,

C-terminal telopeptide - 0,112-0,738 ng/ml.

Patients of reproductive age prescribed exercises that strengthen the pelvic floor muscles.

The normal level of free testosterone, normal or low levels of estradiol, with increased content onproduction patients, not planning to become pregnant, prescribed Diane-35 or Janine on contraceptive scheme for 6 months in addition to gymnastics, aimed at strengthening the pelvic muscles of the pelvis.

Patients planning pregnancy in addition to gymnastics, aimed at strengthening the pelvic muscles of the pelvis, prescribe dexamethasone daily in the evening, and when the content onproduction of 3.1-4.4 nmol/l 0.125 mg; when the content onproduction of 4.5-7.0 nmol/l 0.25 mg, when the content onproduction more to 7.0 nmol/l to 0.5 mg

When the content of C-terminal telopeptides more than 0.6 ng/ml appoint ascorbic acid 500 mg 3 times a day, magnerot 500 mg 3 times a day. Treatment for for the three months.

The possibility of implementing the stated purpose and achievement of the technical result is confirmed by the following data.

The proposed method was used in 72 women. The follow-up period was 2 years. The development of genital prolapse in this category of women at follow-up were observed. The obtained data were compared with the results obtained from 130 patients who had a prevention method-prototype - only through exercises that strengthen the pelvic floor muscles. The genital prolapse was observed in 14.7% of cases.

Thus, normalization of hormonal status, as well as in the correction processes collagenopathy, including the appointment of metabolic therapy, can prevent the development of genital prolapse in women of reproductive age.

Examples.

Example 1.

Patient S., born in 1980, he complained of discomfort in the vagina, irregular menstruation over the last few months. The patient planning to conceive.

History: the period of 15 years, 3-5 days, 30-60 days, irregular, painless, moderate in number. Childbearing: 2 pregnancy and 1 spontaneous birth in the period, with episiotomies - raffia. Gynecological diseases: cervical ectopia. Contraception: what about the delivery took a long time Arino. Comorbidities: atopic dermatitis, nephroptosis, hemorrhoids.

When viewed noteworthy asthenic body type, hirsutism 2 degrees. During the inspection of the genital organs distance from the rear spikes to anal holes 2 cm scar on the perineum normal qualities, there is dilatation of the urethra, hemorrhoids, standing legs levatores at an obtuse angle, the cervix into the genital slit is not visible (either alone or with natureway). At vaginal examination the tone of the perineum when natureway weakly increases, the minimum position on the feeling tone of the perineum 1 finger.

Conducted clinical laboratory and instrumental examination: estradiol - 419 pmol/l, onproduction - 3.6 nmol/l free testosterone - 5.8 PG/ml, C-terminal telopeptide - 1,057 ng/ml.

When conducting a comprehensive urodynamic studies: during cystometry in standing position filling speed of 50 ml/min, normal bladder sensation, the first urge to urinate occurred when the filling volume of 180 ml, feeling the usual urge arose when the volume 217 ml, feeling a strong urge for a volume of 270 ml, maximum sistematicheskaya capacity of 270 ml, when the stress profile be pressure-volume filling of the bladder 270 ml, signs of leakage, no urine. Conclusion: the pathology it is not revealed.

Diagnosis: N is the consistency of the pelvic floor muscles. Hyperandrogenism.

Were assigned to the treatment: dexamethasone 0.125 mg daily in the evening for 3 months, ascorbic acid 500 mg 3 times a day, magnerot 500 mg 3 times a day for 3 months. The patient has exercises that strengthen the pelvic floor muscles.

After 3 months the results of clinical and laboratory studies were as follows: onproduction - 2.1 nmol/l, C-terminal telopeptide - 0.7 ng/ml after 1 year of treatment, onproduction 2.3 nmol/l, C-terminal telopeptide - 0.58 ng/ml.

Thus, during the time of observation on treatment indicators were normalized hormone levels, were also conducted correction processes collagenopathy, as evidenced by the decrease in the number of C-terminal telopeptides.

Data gynecological examination after 2 years of observation: data still, genital prolapse no.

Example 2.

Patient D., born 1974, has complained of a feeling of periodic heaviness in the abdomen, lack of satisfaction during sexual intercourse. Accurately be called the beginning of these complaints may not, as they appeared gradually, and began to pay attention to them last 1.5-2 years. The patient planning to conceive.

History: the period of 15 years, 2-4 days 35-45 days, irregular, painless, moderate in number. Childbearing: 1 pregnancy, 1 birth in the period, with episiotomies - raffia. ginekologicheski history: trubodetaley infertility, 3 IVF attempts, VDCN, ectopia of the cervix. Pregnancy occurred in a spontaneous cycle 1 year after the last IVF. In the childhood has transferred varicella.

When viewed draws asthenic body type, hirsutism step 2. During the inspection of the genital organs distance from the rear spikes to anal 1.8 cm scar on the perineum normal qualities, standing legs levatores at an obtuse angle, the cervix into the genital slit is not visible (either alone or with natureway). At vaginal examination thinned crotch, the tone of the perineum when natureway weakly increases, the minimum position on the feeling tone of the perineum 1 finger.

Conducted clinical laboratory and instrumental examination: estradiol - 118 nmol/l, onproduction - 7.8 nmol/l free testosterone with 5.2 PG/ml, C-terminal telopeptide - of 0.79 ng/ml.

When conducting ultrasound pelvic pathology was not detected.

Diagnosis: the failure of the pelvic floor, hyperandrogenism.

Were assigned to the treatment: dexamethasone 0.5 mg daily in the evening for 3 months, ascorbic acid 500 mg 3 times a day, magnerot 500 mg 3 times a day for 3 months. The patient has exercises that strengthen the pelvic floor muscles.

After 3 months the results of clinical and laboratory studies were as follows: onproduction - 4.1 nmol/l, C-terminal telopeptide - 0,68 is g/ml, after 1 year of treatment, onproduction 3.9 nmol/l, C-terminal telopeptide to 0.6 ng/ml

Thus, increased levels of the hormone on the background of therapy is normalized, we also observed a decrease in the amount of collapse of the collagen, which was assessed by the level of C-terminal telopeptides.

Gynecological examination after 2 years data from earlier, prolapse genital not.

Example 3.

Patient I., born in 1971, has complained of irregular menstrual cycle, discomfort in the vagina, periodic nagging pains in the lower abdomen.

History: menstruation of 14, 4-5 days after 35-50 days, irregular, painful, moderate in number. Childbearing: 3 pregnancies, 1 birth in term 2 the effect. the abortion. Gynecological history: chronic bilateral salpingo-oophoritis. In the childhood was ill with a rubella, SARS.

The examination normostenichesky body type, hirsutism 1 degree. During the inspection of the genital organs distance from the rear spikes to anal 2,1, standing legs levatores at an acute angle, the cervix into the genital slit is not visible (either alone or with natureway). At vaginal examination crotch without pathology, the tone of the perineum when natureway normal.

Conducted clinical laboratory and instrumental examination: estradiol - 203 nmol/l, onproduction 4.4 nmol/l, free testosterone was 5.2 PG/ml, C-terminal telopeptide - to 0.72 ng/ml.

When conducting ultrasound pelvic pathology was not detected.

Diagnosis: VDCN (congenital dysfunction of the adrenal cortex), hyperandrogenism.

Treatment the patient refused.

After 3 months the results of clinical and laboratory studies were as follows: onproduction of 3.1 nmol/l, C-terminal telopeptide was 0.68 ng/ml after 1 year of treatment, onproduction 3.2 nmol/l, C-terminal telopeptide - 0.7 ng/ml

Gynecological examination after 2 years - gender gap gaping, prolapse of vaginal walls, cervix into the genital slit is not visible (either alone or with natureway). The tone of the perineum when natureway weakly increases, the minimum position on the feeling tone of the perineum 2 fingers.

Diagnosis: VDCN (congenital dysfunction of the adrenal cortex), prolapse of vaginal walls.

According to clinical and laboratory examination the patient was shown holding the correction of hormonal disorders and appointment of metabolic therapy aimed at improving processes collagenopathy. But the woman from the treatment refused. During the observation, the patient was diagnosed genital prolapse.

Example 4.

Patient K., born in 1985, has complained of irregular menstrual cycles in the past year. The patient has no plans shall beremennosti.

History: the period from the age of 16, 2-4 days, 30-60 days, irregular, painless, moderate in number. Childbearing: pregnancy was not. Gynecological history: ectopia of the cervix. In the childhood was ill acute respiratory infections, atopic dermatitis.

When viewed normostenichesky body type, hirsutism step 2. During the inspection of the genital organs distance from the rear spikes to anal 2.8 cm, standing legs levatores at an acute angle, the cervix into the genital slit is not visible (either alone or with natureway). At vaginal examination crotch without pathology, the tone of the perineum when natureway normal.

Conducted clinical laboratory and instrumental examination: estradiol - 250 nmol/l, onproduction - 4.7 nmol/l, C-terminal telopeptide - 0.7 ng/ml

When conducting ultrasound pelvic pathology was not detected.

Diagnosis: VDCN (congenital dysfunction of the adrenal cortex).

Were assigned to the treatment: Diane-35 contraceptive diagram 6 months, ascorbic acid 500 mg 3 times a day, magnerot 500 mg 3 times a day for 3 months. The patient has exercises that strengthen the pelvic floor muscles.

After 3 months the results of clinical and laboratory studies were as follows: onproduction - 2.8 nmol/l, C-terminal telopeptide - to 0.62 ng/ml after 1 year of treatment, onproduction 2.5 nmol/l, C-terminal t is ropeptide - 0,6 ng/ml.

Thus, increased levels of the hormone on the background of therapy normalized decreased amount of decomposition of collagen, which is measured at the level of the C-terminal telopeptides.

Gynecological examination after 2 years data from earlier, prolapse genital not.

Example 5.

Patient K., born in 1983, has complained of irregular menstrual cycles in the past year. The patient has no plans for pregnancy.

History: the period of 15 years, 3-4 days, 30-60 days, irregular, painless, moderate in number. Childbearing: pregnancy was not. Gynecological history: ectopia of the cervix. In the childhood was ill ARD.

When viewed normostenichesky body type, hirsutism step 2. During the inspection of the genital organs distance from the rear spikes to the anal hole of 2.5 cm, standing legs levatores at an acute angle, the cervix into the genital slit is not visible (either alone or with natureway). At vaginal examination crotch without pathology, the tone of the perineum when natureway normal.

Conducted clinical laboratory and instrumental examination: estradiol - 210 nmol/l, onproduction - 4.1 nmol/l, C-terminal telopeptide was 0.68 ng/ml.

When conducting ultrasound pelvic pathology was not detected.

Diagnosis: VDCN (congenital dysfunction cor the adrenal glands).

Were assigned to the treatment: Janine on contraceptive diagram 6 months, ascorbic acid 500 mg 3 times a day, magnerot 500 mg 3 times a day for 3 months. The patient was engaged in physical therapy, including exercises designed to strengthen the pelvic floor muscles.

After 6 months the results of clinical and laboratory studies were as follows: onproduction - 2.7 nmol/l, C-terminal telopeptide - 0.61 ng/ml after 1 year of treatment, onproduction 2.5 nmol/l, C-terminal telopeptide - 0.59 ng/ml.

Thus, increased levels of the hormone on the background of therapy normalized decreased amount of decomposition of collagen, which is measured at the level of the C-terminal telopeptides.

Gynecological examination after 2 years data from earlier, prolapse genital not.

Method of prevention of genital prolapse in women of reproductive age, including exercises, which strengthen the pelvic floor muscles, characterized in that the patient determine the content of the C-terminal telopeptides, investigate the hormonal status, which determine the content of estradiol, free testosterone, onproduction in the first phase of the menstrual cycle and during normal levels of free testosterone, normal or low levels of estradiol, increased content onproduction administered to patients, n is planning to become pregnant, within six months of Diana-35 or Janine on contraceptive scheme, patients planning pregnancy, dexamethasone daily in the evening for three months, while when the content onproduction of 3.1-4.4 nmol/l daily dose of dexamethasone is equal to 0.125 mg, when the content onproduction of 4.5-7.0 nmol/l 0.25 mg of dexamethasone, when the content onproduction more to 7.0 nmol/l 0.5 mg of dexamethasone; when the content of C-terminal telopeptides more than 0.6 ng/ml appoint ascorbic acid 500 mg 3 times a day, magnerot 500 mg 3 times a day for three months.