Prevention and treatment of inflammatory changes of genital organs in women with uterine leiomyoma

Vl.V. Podolsky, V.V. Podolsky

The goal is to present the results of the study of the microbiocenosis of the vagina in women with leiomyoma of the uterus and inflammatory diseases of the genital organs; to optimize the prevention and treatment of inflammatory changes of the genital organs in women of childbearing age with this pathology.

Patients and methods. 150 women of childbearing age were examined, who were divided into three groups:

I group — 50 women with uterine leiomyoma, who received the treatment and preventive measures proposed by us;
II group — 50 women with uterine leiomyoma who received traditional therapy;
III group — 50 healthy women. Bacteriological studies were conducted in order to assess the species and quantitative composition of the vaginal microflora in women after a course of treatment for vegetative disorders of the nervous system.

Microbiological analyses and recording of the results were carried out by the Order of the Ministry of Health of the USSR No. 535 dated 1985 and the Order of the Ministry of Health of Ukraine No. 234 dated May 10, 2007. For prevention and treatment of exacerbations of chronic inflammatory diseases of the genital organs and in comprehensive pre-gravid preparation for safe motherhood of women with uterine leiomyoma, vaginal suppositories "Api-Norm" were prescribed.

The results. The study of changes in the microbiocenosis of the genital tract in women with leiomyoma of the uterus, who received vaginal suppositories "Api-Norm" in complex anti-inflammatory therapy, after treatment shows a positive dynamics of indicators of insemination of the genital tract with both opportunistic pathogens and other infectious agents compared to women with leiomyoma of the uterus, which received traditional therapy.

After treatment and preventive measures, the biocenosis of the vagina of women with leiomyoma of the uterus, who received vaginal suppositories "Api-Norm" in complex anti-inflammatory therapy, approached the indicators of the biocenosis of the vagina of healthy women, and in women with leiomyoma of the uterus, who received traditional therapy, it changed after treatment less active and, according to some indicators, required a repeat course of treatment.

Conclusions. In women of childbearing age with uterine leiomyoma, there is an increase in the concentration of conditionally pathogenic microflora, which leads to the development of inflammatory processes in the genital organs. Increased contamination of the genitals by representatives of pathogenic and conditionally pathogenic microflora in the event of the appearance of inflammatory diseases requires complex treatment. The inclusion of "ApiiNorm" vaginal suppositories in the complex therapy of the treatment of inflammatory changes in the female genital organs and the subsequent prevention of the occurrence or exacerbation of inflammatory diseases indicates the high effectiveness of such suppositories.

Introduction

The reproductive health of the population of Ukraine needs close attention.

Issues of health care are a priority, since the health of the people is the greatest social and individual value, which largely affects the processes and results of the economic, social, and cultural development of the country, and therefore is a matter of national security and an important criterion for the social development and well-being of the country

Preservation of the health of the country's population is a medical and social problem, the solution of which requires optimal improvement of the socio-economic situation, preventive measures regarding health care, and the availability of medical care for all segments of the population

In modern conditions, the state of reproductive health is affected by various risk factors that lead to negative changes. In particular, in the state of reproductive health, such changes include both somatic and gynecological diseases.

Among somatic diseases in women, a significant number of diseases attract attention:

of the cardiovascular system (in urban and rural residents, respectively) — 35% and 31%,
digestive organs — 24% and 26%,
respiratory organs — 28% and 23%,
blood (anemia and other) — 15% and 18%,
allergic manifestations — 16% and 11%,
kidney diseases — 5% and 7%

The most frequent changes in reproductive health are (in urban and rural women):

chronic inflammatory diseases of the genital organs — 82% and 68%,
menstrual cycle disorders — 34% and 21%,
abortions — 65% and 77.6%,
sexual health disorders — 31% and 20%
precancerous and oncological diseases — 19% and 26% (including benign tumors of
the uterus — uterine leiomyoma),
perinatal disorders — 12% and 18%
infertility — 9% and 6%

Therefore, an important parameter characterizing a woman's reproductive health is gynecological morbidity, the frequency of which is increasing every year. Among gynecological diseases in women of childbearing age, hyperplastic processes occur more and more often, among which leiomyoma of the uterus has the greatest impact on reproductive health

Leiomyoma is one of the most common benign tumors of the uterus. The frequency of this benign tumor, according to various authors, is from 15% to 35% in the structure of the general morbidity of women over the age of 35, and the frequency of surgical interventions for this pathology can be up to 50%

Often, leiomyoma of the uterus is accompanied by an inflammatory state of the genital organs, and the factor of the presence of infectious factors that caused the inflammatory process can be a stimulator of the growth of this benign tumor.

The purpose of the study is to optimize the prevention and treatment of inflammatory changes in the genital organs in women of childbearing age with uterine leiomyoma.

Research materials and methods

150 women of childbearing age were examined, who were divided into three groups:

I group — 50 women with uterine leiomyoma, who received the treatment and preventive measures proposed by us;
II group — 50 women with uterine leiomyoma who received traditional therapy;
III group — 50 healthy women.

Bacteriological studies were conducted to assess the species and quantitative composition of the vaginal microflora in women after a course of treatment for vegetative disorders of the nervous system.

Microbiological analyses and recording of the results were carried out by the Order of the Ministry of Health of the USSR No. 535 of 1985 and the Order of the Ministry of Health of Ukraine No. 234 of May 10, 2007.

The following differential diagnostic media were used for mucus culture: blood agar, yolk-salt agar, Endo, Saburo media, and MRS media for lactobacilli.

Sowing was carried out by the method of sector sowing on dense nutrient media, which makes it possible to determine the degree of microbial insemination and reveal the maximum possible spectrum of aerobic and facultatively anaerobic microflora.

The taxonomic position of microorganisms is determined according to "Bergey's Bacteria Identifier". Microorganisms were identified by their cultural and morphological characteristics

Determination of the number of lactic acid bacteria was carried out after 24–48 hours. incubation at a temperature of 37±1°С. In smears that were stained by Gram, lactobacilli had the appearance of gram-positive rods

To determine staphylococci, yolk-salt agar was used, on which staphylococci grew in the form of yellow or white convex colonies. The pigmentation of the colonies and the presence of lecithinase activity were taken into account during the study.

Identification of detected microorganisms was carried out on an automatic microbiological analyzer BD BBL Crystal (USA).

Sabouraud's medium was used to identify yeast-like fungi. Cups with sieves were incubated in a thermostat at a temperature of 37 ± 1°C for 3 days, then colonies with characteristic morphology — dense, opaque, milky color — were microscopically examined in a 40% solution of caustic soda. In smears, yeast-like fungi have the appearance of large oval gram-positive cells located singly, in clusters, or chains.

Depending on the obtained results of the state of microbiocenosis of the urogenital organs in women of childbearing age (group I) with uterine leiomyoma who had chronic inflammatory diseases of the genital organs, at the first stage basic treatment was prescribed, which was developed for women with this pathology and the effectiveness of which has already been proven. For prevention and treatment of exacerbations of chronic inflammatory diseases of the genital organs and in the complex pre-gravid preparation for safe motherhood of women with uterine leiomyoma in the second stage, the drug "Api-Norm" was prescribed 1 suppository intravaginally at night 1 time a day for 10 days, and then 2 times a week with a total course of 15 suppositories. This drug in the form of rectal suppositories was also prescribed to sexual partners of women with uterine leiomyoma, 1 suppository rectally at night, once a day for 10 days, and then 2 times a week for a total course of 15 suppositories.

"Api-Norm" vaginal suppositories contain a balanced multicomponent composition based on beekeeping products and plant components. This drug has a combined anti-inflammatory, antispasmodic, adaptogenic, anti-infective, antioxidant, and wound-healing effect; prevents the development of complications and possible relapses in diseases of the internal organs of the pelvis; activates, modulates, and supports the body's protective mechanisms, including cellular immunity; penetrates deep into tissues, saturates them with natural components, trace elements and vitamins; compatible with many other preventive and therapeutic drugs.

Thanks to the special technology of obtaining the constituent components and their activation, the drug "Api-Norm" differs from other drugs of similar orientation in its high activity and increased bioavailability of active substances. Due to the well-chosen components, the properties of the components of the drug reduce the likelihood of side effects and allergic reactions.

Plant components and beekeeping products included in "Api-Norm" have a high level of effectiveness and safety from the point of view of evidence-based medicine.

We chose this drug because the components of multicomponent vaginal suppositories have a positive effect on the condition of women's reproductive organs. Suppositories include:

sea buckthorn oil, which has anti-inflammatory, pain-relieving, antibacterial (especially against staphylococci and proteus) effects. Promotes epithelization and granulation of tissues, and accelerates wound healing. Normalizes degenerative changes of mucous membranes. Contains a complex of vitamins;

marigold extract (calendula) has regenerating, antibacterial, antiviral, analgesic, anti-inflammatory, and bacteriostatic (especially against streptococci and staphylococci) effects. Suppresses the migration of leukocytes in places of inflammation. It is used for disorders of the menstrual cycle, ulcers, and erosions, white hair

propolis extract has antioxidant, antiviral, antibacterial, anti-inflammatory, wound-healing, antispasmodic, and antiseptic effects. Its composition includes more than 50 biologically active substances, a significant amount of vitamins, and trace elements. Increases the number of immunoglobulins (increases specific immunity). Enhances the effect of natural and synthetic antibiotics and antimycotics. Stabilizes cell membranes. Delays the growth of cancer and pathological cells.

St. John's wort extract has an antibacterial, antiseptic, pain-relieving effect, and also enhances the regenerative capacity of tissues. Reduces spasms and fragility of blood vessels. The important active substances of St. John's wort are essential oils, flavonoids (rutin, quercitrin, hyperoside), and hypericin.

natural beeswax has an anti-inflammatory, antiseptic, and softening effect, and is a source of vitamin A and trace elements important for cellular immunity. Increases the biological activity of the constituent plant extracts.

sea buckthorn oil, which has anti-inflammatory, pain-relieving, antibacterial (especially against staphylococci and proteus) effects. Promotes epithelization and granulation of tissues, and accelerates wound healing. Normalizes degenerative changes of mucous membranes. Contains a complex of vitamins;
Marigold extract (calendula) has regenerating, antibacterial, antiviral, analgesic, anti-inflammatory, and bacteriostatic (especially against streptococci and staphylococci) effects. Suppresses the migration of leukocytes in places of inflammation. It is used for disorders of the menstrual cycle, ulcers, erosions, white hair;
propolis extract has antioxidant, antiviral, antibacterial, anti-inflammatory, wound-healing, antispasmodic and antiseptic effects. Its composition includes more than 50 biologically active substances, a significant amount of vitamins, and trace elements. Increases the number of immunoglobulins (increases specific immunity). Enhances the effect of natural and synthetic antibiotics and antimycotics. Stabilizes cell membranes. Delays the growth of cancer and pathological cells.
St. John's wort extract has an antibacterial, antiseptic, pain-relieving effect, and also enhances the regenerative capacity of tissues. Reduces spasms and fragility of blood vessels. The important active substances of St. John's wort are essential oils, flavonoids (rutin, quercitrin, hyperoside), and hypericin.
natural beeswax has an anti-inflammatory, antiseptic, and softening effect, and is a source of vitamin A and trace elements important for cellular immunity. Increases the biological activity of the constituent plant extracts.

Rectal suppositories "Api-Norm", prescribed to sexual partners of women with uterine leiomyoma, have a combined anti-inflammatory, antispasmodic, adaptogenic, anti-infective, antioxidant and wound-healing effect; have an antitumor effect, delay the development of hyperplasia, reduce the risk of cancer; prevent the development of complications and possible relapses in diseases of the prostate gland and other internal organs of the pelvis; activate, modulate and support the body's own protective mechanisms, including cellular immunity; penetrate deep into tissues, saturate them with trace elements and vitamins; compatible with many other preventive and therapeutic drugs. Treatment and prevention measures for sexual partners of women suffering from uterine leiomyoma are important because they ensure the effectiveness of treatment and prevention measures for these women.

Due to the special technology of obtaining constituent components and their activation, the drug "Api-Norm" differs from drugs of a similar orientation in high activity and increased bioavailability of active substances. Due to the well-chosen components, the properties of the components of the drug reduce the likelihood of side effects and allergic reactions

Plant components and beekeeping products included in "Api-Norm" have a high level of effectiveness and safety from the point of view of evidence-based medicine.

The composition of rectal suppositories is slightly different from those prescribed for women, and contains:

black poplar extract, which has antioxidant, anti-inflammatory, antifungal, antimicrobial effects; promotes epithelization and granulation of tissues. The content of populin glycoside determines the pain-relieving properties. The antihistamine properties of the extract reduce the risk of allergic reactions from other components;
comfrey extract has a regenerating, analgesic, anti-inflammatory, hemostatic and enveloping effect, and exhibits antitumor activity. Among its main active substances: allantoin, zinc, vitamin B12, triperthenes. Antioxidant properties prevent the development of malignant neoplasms;
propolis extract has antioxidant, antiviral, antibacterial, anti-inflammatory, wound-healing, antispasmodic and antiseptic effects. Its composition includes more than 50 biologically active substances, a significant amount of vitamins and trace elements. Increases the number of immunoglobulins (increases specific immunity). Enhances the effect of natural and synthetic antibiotics and antimycotics. Stabilizes cell membranes. Delays the growth of cancer and pathological cells;
St. John's wort extract has an antibacterial, antiseptic, pain-relieving effect, and also enhances the regenerative capacity of tissues. Reduces spasm and fragility of blood vessels. The important active substances of St. John's wort are essential oils, flavonoids (rutin, quercitrin, hyperoside) and hypericin;
natural beeswax has an anti-inflammatory, antiseptic and softening effect, is a source of vitamin A and trace elements important for cellular immunity. Increases the biological activity of the constituent plant extracts.
Ascorbic acid, which is part of "Api-Norm" (17 mg per 1 suppository), is an antioxidant, plays an active role in regulating redox processes, carbohydrate metabolism, blood coagulation, tissue regeneration; increases the body's resistance to infections, reduces vascular permeability, reduces the need for other vitamins such as: B1, B2, A, E, folic acid, pantothenic acid. Strengthens the activity and increases the bioavailability of flavonoids.

The research was carried out in accordance with the principles of the Declaration of Helsinki. The research protocol was approved by the Local Ethics Committee of all institutions mentioned in the work. Informed consent of the women was obtained for the research

The statistical processing of the obtained research results was carried out using the standard computer packages "Data Analysis" Microsoft Excel for Windows 2007. The value of the arithmetic mean was calculated - the value (M), the average error of the average value (m), the level of probability of discrepancies (p). The reliability of the obtained data was assessed by the generally accepted method using the Student's criterion. Reliability was considered established if its probability was equal to at least 95% (0.05).

Research results and their discussion

Bacteriological examination of vaginal secretions of examined women of fertile age proved that in women with uterine leiomyoma, in combination with inflammatory changes of the genital organs, there were changes in the state of microbiocenosis.

Examination of women with uterine leiomyoma showed that before treatment (I and II groups) gram-positive cocci with hemolytic properties were released with a higher frequency than in healthy women (III group). Thus, S. aureus was detected in 13%, S. epidermidis (hem.) — in 17%, S. agalactiae — in 12%; among enterobacteria: E. coli — in 18%, hemolytic E. coli — in 12% of women, Klebsiella — in 20%

The frequency of sowing Candida fungi was 25%. Representatives of normal microflora — lactobacilli were found in 72% of examined women. Deficiency of lactobacilli was observed in 51%, and their absence in 28% of patients. The concentration of lactic acid bacteria did not reach the indicators of healthy women and amounted to lg3.6 CFU/ml.

Gardnerellosis in women with uterine leiomyoma before treatment (I and II groups) was diagnosed in 38%, chlamydia — in 15%, ureaplasmosis — in 17%, herpes virus — in 28% of the examined.

Before treatment, 35% of patients in groups I and II had associative forms of bacterial insemination of the vagina. The associations most often included gram-positive cocci and enterobacteria (Klebsiella) or enterococcus and Candida fungi, as well as gardnerella and herpes virus

Quantitative indicators of seeding of gram-positive cocci in women with uterine leiomyoma were lg3.8–lg4.2 CFU/ml. Representatives of enterobacteria were found in concentrations of lg4.0–lg4.5 CFU/ml, fungi of the genus Candida — lg4.7 CFU/ml. These indicators exceeded the diagnostic value and were higher than in women of the III group.

Thus, the obtained data show that in women with uterine leiomyoma, opportunistic bacteria and pathogens of the "new generation" were detected with a higher frequency and in lower concentrations than in healthy women

The study of changes in the microbiocenosis of the genital tract in women of the I group after treatment indicated a positive trend in the indicators of insemination of the genital tract by both opportunistic microorganisms and other infectious agents compared to the women of the II group.

In women of the I group, the quantitative indicators of the sowing of various types of staphylococci that had pathogenic properties after treatment were within the range of lg2.0–lg3.5 CFU/ml. The level of enterobacteria seeding in patients of the 1st group after treatment decreased and did not exceed the normal values (lg2.0–lg2.8 CFU/ml). Contamination of the genital tract by fungi of the genus Candida (lg3.2 CFU/ml) and protective microflora (lg5.2 CFU/ml) corresponded to the normal indicators in women of the I group.

The frequency of diagnosis of chlamydia, ureaplasmosis, and gardnerellosis in women of the 1st group significantly decreased after treatment (table). Also, with a lower frequency than before treatment and compared to women of the II group, the frequency of contamination of the genital tract with associations of bacterial flora, viruses, infectious agents of the "new generation" and gardnerel (15%) was recorded

After the medical and preventive measures, the biocenosis of the vagina of women of the I group approached the indicators of the vaginal biocenosis of the III group; in women of the II group, it changed less actively after treatment and, according to some indicators, required a repeated course of treatment.

Qualitative and quantitative indicators of vaginal biocenosis of women of childbearing age with uterine leiomyoma before and after treatment (%), lgCFU/ml

* — statistically significant difference between the indicators of women with uterine fibroids (group I) before and after treatment (p>0.05);

** — the difference is statistically significant between the indicators of women with uterine leiomyoma of the I group and women with uterine leiomyoma (II group) (p>0.05);

*** — a statistically significant difference between the indicators of women with uterine leiomyoma of group I after treatment and healthy women (group III) (p>0.05)

Conclusions

In women of childbearing age with uterine leiomyoma, there is an increase in the concentration of conditionally pathogenic microflora, which leads to the development of inflammatory processes of the genital organs

Increased contamination of the genitals by representatives of pathogenic and conditionally pathogenic microflora in the event of the appearance of inflammatory diseases requires complex treatment.

The inclusion of "ApiiNorm" vaginal suppositories in the complex therapy of the treatment of inflammatory changes in the female genital organs and the subsequent prevention of the occurrence or exacerbation of inflammatory diseases indicates the high effectiveness of such suppositories.

Prospects for further research

A prospective study of the mechanisms of the development of inflammatory diseases of the genital organs in women of childbearing age with uterine leiomyoma is the study of the further state of their reproductive health and the catamnesis of the occurrence or exacerbation of inflammatory diseases.

The authors declare no conflict of interest.