RU2327462C1 - Method of puberty metrorrhagia treatment - Google Patents

Abstract

FIELD: medicine; gynaecology.

SUBSTANCE: hormonal haemostasis is performed using complex oral contraceptive (COC) in dosage 1/2 tablet COC every 4-6 hours until metrorrhagia stops, and as well as during 1^st day after. Further daily dose is reduced by 1/2 tablet every for next day. Whereas dosage 1 tablet a day is achieved, COC introduction is prolonged for another 21 days. After that within 3 months cerebrum compositum combined with coenzyme compositum dosed 2.2 ml is intramuscularly injected. Introduction of these agents is alternated with mixed cerebrum compositum and ubiquinone compositum injections dosed 2.2 ml. this therapy is combined with peroral introduction of lymphomyosote and nux vomyka-homaccord in dosage 10 drops 3 times a day, as well as hepel and neurohel dosed 1 tablet a day.

EFFECT: eliminated possibility of syndrome intravascular coagulation and disease relapse; reduced development of hormonal therapy by-effects; provided menstrual cycle normalisation for this contingent of patients.

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Description

The present invention relates to the gynecology of children and adolescents and may find application in the treatment of uterine bleeding in the puberty period.

The health status of modern girls is characterized by a twofold increase in the level of disability, impaired formation of the reproductive system, an increase in the share of diseases with a chronic and recurrent course, and the presence of deviations in psychosomatic health.

The frequency of uterine bleeding in the puberty period (MKPP) in the structure of gynecological diseases in children and adolescents ranges from 10 to 37.3%. Over 50% of all teenage girl visits to the gynecologist are uterine bleeding of the puberty period. Almost 95% of all vaginal bleeding is caused by manual transmission. Most often, uterine bleeding in adolescent girls occurs during the first three years after menarche. Most menstrual irregularities in adolescents are of functional origin. According to modern concepts, their pathogenesis is associated with disturbances in cyclic activity in the hypothalamus-pituitary-ovary-uterus system, which is accompanied by changes in estrogenic activity.

Known surgical treatment of manual transmission, consisting in separate curettage of the mucous membrane of the body and neck of the uterus under the control of hysteroscopy, indications for which are acute profuse bleeding that does not stop against the background of drug therapy, the lack of effect of conservative complex therapy, the presence of clinical and ultrasonic signs of organic changes in the endometrium (polyps of the endometrium and / or cervical canal), recurrent bleeding (Uvarova E.V., Bogdanova E.A., Predtechenskaya O.A. “The use of hysteroscopy in girls with juvenile uterine bleeding.” The All-Russian Conference on Pediatric and Adolescent Gynecology “Modern preventive, diagnostic and therapeutic technologies in the clinic of pediatric gynecology”, M., 2000, p. 74).

The specified method is used in girls extremely rarely due to its invasiveness.

There is a method of treating manual transmission, where at the first stage, plasminogen-to-plasmin inhibitors (tranexamic or epsilonaminocaproic acid) are used orally for 4-5 g during the first hour of therapy, then 1 g every hour until the bleeding stops completely (total dose should not exceed 30 g) or intravenously 4-5 g for 1 hour, then drip 1 g per hour for 8 hours and in the second stage - combined oral contraceptives up to 4 tablets per day.

The disadvantage of this method is the risk of developing intravascular coagulation syndrome at the first stage of treatment and side effects from high doses of COCs due to their hormonal nature, in particular anemia, a high relapse rate, which is possibly due to the lack of effect on the regulation of hypothalamic-pituitary dysfunction.

The objective of the invention is a method of treating manual transmission, in which the possibility of developing intravascular coagulation syndrome is excluded and side effects of hormonal therapy and the possibility of relapse of the disease are reduced.

The problem is solved by the method consisting in the fact that at the first stage 1/2 tablet of combined oral contraceptive (COC) is administered every 4-6 hours until the bleeding stops and during the first day after the bleeding stops, then the daily dose of COC is reduced by 1/2 tablets on each subsequent day, upon reaching a dose of 1 tablet per day, continue the administration of COCs for another 21 days, then for 3 months intramuscularly, Cerebrum compositum with coenzyme compositum of 2.2 ml is administered, alternating with the introduction after 3 days - Cerebrum composite m ubiquinone kompozitum of 2.2 ml, and orally administered limfomiozot and Nux vomica Homaccord 10 drops 3 times a day, and Hepel nervohel 1 tablet 3 times daily.

Regulon, Marvelon (30 μg of ethinyl estradiol (EE) and 150 μg of desogestrel), Merilson, Novinet (20 μg of EE and 150 μg of desogestrel), femoden can be used as combined monophasic estrogen-progestogen contraceptives. (30 μg EE and 75 μg gestodene).

“Cerebrum compositum N” and other indicated drugs are among the anti-homotoxic drugs (Reckewig “Homeopathic anti-homotoxicology. Index of symptoms and modalities” Smolensk, 1996).

“Cerebrum Compositum N” is a complex homeopathic medicine containing 27 components of plant and animal origin, as well as minerals. The action of the drug: a marked improvement in the function of structures of the diencephalic level, as well as intrahemispheric indicators, which indicates an increase in cortical-subcortical interaction, a decrease in the severity of paroxysmal activity, and normalization of cortical rhythm. The drug enhances the catabolism of catecholamines, which explains its psycho-activating effect, has a cholinolytic effect, which regulates the effect on monoamine metabolism. The drug is closest to the group of neurometabolic or nootropic drugs. It has anti-asthenic, sedative and psychostimulating effects, and also affects mental retardation, improves memory, attention, and ability to concentrate. It can be the drug of choice in the treatment of various mental disorders in both childhood and old age, severe neurological diseases.

“Lymphomyozot” is considered in antihomotoxic therapy as one of the main drainage drugs used in the first stage of treatment of many chronic diseases. First of all, it is indicated in the treatment of diseases of hollow (tubular) organs, which are abundantly equipped with lymphatic vessels and nodes (nasopharynx, trachea, bronchi, gastrointestinal tract, genitourinary tract, uterus, fallopian tubes, vagina) and, of course, diseases of the lymphatic system itself. By activating the lymphatic system of the intestine, it enhances the local immunity of the intestinal mucosa and is therefore effective in the complex therapy of dysbiosis. Lymphomyozot is effective in case of asthenic state, asthenoneurotic syndrome, somatic disorders, mental development disorders that have developed as a result of various intoxications of the body.

"Coenzyme compositum" has a detoxification, metabolic, antioxidant effect. The components that make up the drug have a therapeutic effect on blocked or inactive enzyme systems. The tissue respiration and redox processes in the body are activated (Krebs cycle).

The ubiquinone compositum is intended to compensate for cellular lesions caused by chronic degenerative diseases.

Hepel is designed to normalize various disorders of the liver, with cholangitis and cholecystitis, liver diseases, flatulence, and all chronic degenerative diseases.

Nux Vomica Homaccord is the most commonly used drug. The drug itself and its alkaloid act on the whole body, but most of all on the nervous system, digestive tract and circulatory system.

"Nervohel" is indicated for increased nervous excitability, exogenous depression, psychosomatic disorders, insomnia.

The following examples illustrate the method of the invention.

Example 1

Patient D., 14.5 years old, was admitted to the Department of Gynecology for Children and Adolescents at the Scientific Center of the Obstetrics, Gynecology and Perinatology of the Russian Academy of Medical Sciences with complaints of prolonged spotting from the genital tract, headaches, dizziness, weakness, fatigue, irritability, tearfulness, impaired sleep From the anamnesis: maternal burden of gynecological diseases (uterine fibroids, endometriosis in the mother herself and uterine fibroids in the grandmother), cancer (stomach cancer in the great-grandmother and skin cancer in the grandmother).

She was born from the first pregnancy, proceeding with toxicosis of the first half of pregnancy from young parents. Delivery on time, without complications. Weight at birth was 2980 g, length - 54 cm. Breastfeeding up to 3 months.

The mother of menstruation from 13 years old, established immediately, regular, plentiful. The girl has congenital dysplasia of the hip joints. In childhood, she often had the flu, SARS (up to 11 years old), pyelonephritis at 3 years old, chicken pox at 5 years old.

Menarche from 12.5 years for 5 days. Then menstruation is regular, after 28 days for 10-20 days. In January 2004, amid a stressful situation (moving to another school), menstruation that came on time went into bleeding.

On examination: the correct physique. Low power (BMI-17.5). Height - 165 cm, weight - 46 kg. There is severe scoliosis in the thoracic spine.

With a gynecological examination, the correct development of the external genital organs, juiciness of the vulva, and juicy fringed hymen are noted. With vaginoscopy, the vaginal mucosa is pink in color with well-defined folding. The cervix is cylindrical in shape, the discharge is plentiful, bloody with an admixture of mucus. During rectoabdominal examination, the uterus is palpated, mobile, painless. The right ovary is slightly enlarged.

An additional examination revealed: a clinical blood test: HB-126; er-4.2; reticulocytes-4; platelets-230; p-1; l-40; L-4,5; s-54; m-3; eos.-2; ESR-2.

Blood biochemistry: commonly. bilirubin-17.0; cholesterol-3.8; glucose 5.3; ЩФ-184; ASAT-13; ALAT-8; creatinine-40.1; sodium 141; calcium 2.39; potassium 4.4; magnesium 1.07; iron-20.1.

Hormonal status: LG-13; FSH-6.4; estradiol-230; prolactin-352; T-2.2; cortisol-518; progesterone 2.0; T3-1.7; T4 St.-15.3; TTG-2.6.

X-ray of the skull - without pathology. The x-ray of the hands-bone age is 1-2 years ahead of the calendar.

EEG: revealed dysfunction of the mesodiencephalic and stem structures of the brain. With hyperventilation, paroxysms are noted.

According to abdominal ultrasound revealed bilateral pyelectasia.

According to ultrasound of the pelvic organs: uterus 3.8 × 2.8 × 3.6 cm; the cervix is 2.6 cm; the endometrium is 1.2 cm. The left ovary: 3.2 × 2.5 × 3.3 cm with a small fluid inclusion of 1.6 cm in diameter. Right ovary: 3.9 × 2.7 × 3.6 cm with a maximum fluid inclusion of 1.5 cm in diameter. Both ovaries with small cystic inclusions.

In the study of coagulogram - isocoagulation.

Immunological research: a decrease in T-lymphocytes and T-suppressors with an increase in B-lymphocytes and normal immunoglobulins.

Consulted by a general practitioner. Conclusion: chronic pyelonephritis in remission. Consulted by a psychotherapist. Conclusion: a reaction to stress of a depressive nature. Gelarium therapy recommended.

As a result of the examination, the diagnosis was made: uterine bleeding of the puberty period. Bilateral pyelectasia. Chronic pyelonephritis in remission. Scoliosis. The reaction to stress is depressive.

The patient will prescribe marvelon 1/2 tablet every 4 hours until complete hemostasis (achieved on the 2nd day). In the following days carried lowering of the daily dose of _^half a tablet a day. Reducing the daily dose to 1 tablet, taking marvelon was continued for 21 days from the moment of complete hemostasis. After the abolition of marvelon, there was a regular menstrual-like reaction. At the second stage of bleeding treatment, complex homeopathic preparations were used: cerebrum compositum 2.2 ml with coenzyme compositum 2.2 ml in a single syringe / m, cerebrum compositum and ubiquinone compositum 2.2 ml after 3 days. In addition, the patient took: lymphomyozot and nux-vomica-homaccord 10 drops 3 times a day, hepel and nervohel 1 tablet. × 3 times a day.

At the end of 3-month therapy with complex antihomotoxicologic drugs, menstruation became regular, after 26 days for 5-6 days.

During the control study, indicators of hormonal status, ultrasound of the pelvic organs corresponded to regulatory parameters.

Example 2

Patient S., 13 years old, was admitted to the department with complaints of prolonged blood discharge from the genital tract, headaches, fatigue, distraction.

From the anamnesis: there is a burden of heredity in endocrine diseases (diabetes mellitus in the son of the husband’s brother in the father’s line and cancer of the pancreas in the grandmother’s in the mother’s side), in mental illness (schizophrenia in the grandmother in the mother’s side), in the mother’s (irregular menstruation).

The girl was born from II pregnancy (I pregnancy - spontaneous miscarriage at 4 weeks), which proceeded with toxicosis and the threat of termination of pregnancy in the first half of pregnancy. Delivery on time, without complications. Birth weight - 3500 g, length - 52 cm. Born from young parents (mother was 23 years old, father is 25 years old). The mother has menstruation from 13 years old, irregular, after 1-2 months, 7 days before pregnancy.

The girl in childhood had frequent bronchitis.

Menarche from 13 years for 5 days, the 2nd menstruation turned into bleeding (within 1 month). During this period, there was a severe stressful situation (conflict with the teacher at school). In addition, mother often punished the girl with a belt for various offenses.

Objectively: proper physique, satisfactory nutrition.

Height - 158 cm; weight - 48 kg.

With a gynecological examination: the external genitalia are developed correctly. When vaginoscopy - a pale pink color of the mucosa, a moderately pronounced folding of the vagina. The discharge is bloody, moderate, without mucus. During rectal examination, the uterus is dense, mobile, painless. On the left, an enlarged, painless ovary is palpated. Right appendages without features.

Clinical blood test: HB - 139 g / l, er.-4.4, p-4; reticulocytes 5; platelets-316; lymph.-34; s-55; L-6; m-3; eos.-4; ESR-6.

Blood biochemistry: protein-86; cholesterol 4.4; sodium-142, 3; calcium 2.123; potassium 4.15; magnesium 0.5.

Coagulogram - slight hypercoagulation.

X-ray of the skull - without pathology. An x-ray of the hands of the bones is 1 year ahead of the calendar.

EEG: dysfunction of the mesodiencephalic structures of the brain.

Hormonal status: LG-17.2; FSH-8.5; E2-188 (2 phase of the cycle); T3-288; T3-2.09; T4 St. 13.7; TTG-1.3.

Ultrasound of the pelvic organs before admission to the department: the uterus is 4.8 × 3.5 × 5.3 cm, a small amount of free fluid in the adjacent space. The cervix is 2.6 cm. The endometrium is 1.2 cm. The left ovary is the formation of a cystic structure 4.6 × 2.9 × 0.6. Right ovary: 2.7 × 1.5 × 2.8 cm Conclusion. Endometrial hyperplasia. Yellow body cyst of the left ovary. After the examination, the diagnosis was made: uterine bleeding of the pubertal period. Endometrial hyperplasia. Yellow body cyst of the left ovary. Posthemorrhagic anemia. Chronic gastritis in remission.

Hemostasis was carried out with a regulon of 1/2 table every 4 hours until complete hemostasis (hemostasis on the 2nd day), with a decrease in the daily dose in the following days to 1 tablet per day. With a decrease in the daily dose of regulon to 1 table. per day, the drug was continued up to 21 days, counting from the first day from the beginning of hemostasis. Over the next 3 months, she received weekly antihomotoxic therapy: Cerebrum compositum and coenzyme compositum, 2.2 ml each, alternating with the first administration of 2.2 ml of ubiquinone compositum. For 3 months she took Hepel and Nervohel 1 tablet. 3 times a day, lymphomyozot and nuks-vomica-homaccord 10 drops 3 times a day. After the treatment, the menstrual cycle normalized (observation period 3 years).

The claimed method was treated 51 patients, the menstrual cycle was restored in 84.3% of girls. None of the observations showed side effects of hormone replacement therapy and relapse.

Claims (1)

A method of treating uterine bleeding puberty, hormonal hemostasis complex comprising oral contraceptive (COC), characterized in that the injected _^half COC tablets every 4-6 hours until hemostasis and during the first day after the bleeding stops, then the daily dose reduced by COC _^1/2 tablet every other day, when the dose of 1 tablet per day continue administering COC still for 21 days, then for 3 months intramuscularly administered tserebrum kompozitum with coenzyme kompozitum of 2.2 ml, with alternating administration m 3 days tserebrum kompozitum with ubiquinone kompozitum of 2.2 ml, and orally administered limfomiozot and Nux vomica-Homaccord 10 drops 3 times a day, and Hepel nervohel 1 tablet 3 times daily.