Diffuse massive adenomyosis and infertility. Is it possible to treat this condition?

Background Severe forms of adenomyosis are a serious gynecological problem. In most cases, conservative treatment of this pathology is unsuccessful. Adenomyomectomy by Osada's approach seems to be the most promising solution. The present study evaluated the follow-up results of this type of surgery in patients with adenomyosis and infertility. Materials and methods The prospective study included 26 patients with severe forms of adenomyosis who underwent an adenomyomectomy using Osada's approach. In 18 patients (69%), infertility was the main indication for surgical treatment. The follow-up period lasted from July 2012 to January 2018. Results The median post-operative follow-up period was 18 months. For the first 12 months patients received hormonal therapy. In all postoperative patients, the menstrual cycle had normalized, and other symptoms of the disease had disappeared. Seven patients continue to receive postoperative hormonal treatment. Three individuals got spontaneously pregnant; two of them delivered full-term babies by cesarean section. Six patients are planning a pregnancy with assisted reproductive technology. Conclusion In the present study, the organ-preserving surgery of severe adenomyosis performed using Osada's method appeared to be a good alternative to hysterectomy. It stopped the development of pathological symptoms of the disease and restored the patient's reproductive function.

Successful prevention of preeclampsia in a high-risk pregnancy using progestogen dydrogesterone: a clinical case.

The presented clinical example convincingly demonstrates the efficacy of dydrogesterone (30 mg) in the prevention of severe preeclampsia in a high-risk patient (early development of preeclampsia and preterm Cesarean section in her first pregnancy, arterial hypertension). This case suggests using dydrogesterone as an option to prevent preeclampsia, as previously shown in a prospective randomized study.

The combined GnRH-agonist and intrauterine levonorgestrel-releasing system treatment of complicated atypical hyperplasia and endometrial cancer: a pilot study.

In this article, we present the results of organ-preserving treatment applied in 24 patients of reproductive age with atypical endometrial hyperplasia or early-stage endometrial cancer. All of them would like to preserve their reproductive potential. Thirteen women with atypical endometrial hyperplasia were treated with the combination of six intramuscular injections of 3.75 mg gonadotropin-releasing hormone agonist (GnRHa)--leuproreline acetate depot every 4 weeks. After the third injection of 3.75 mg of leuproreline acetate, the levonorgestrel intrauterine hormonal system containing 52 mg levonorgestrel (Mirena®, Bayer, Germany) was inserted for at least 6 months. In 11 women with stage IA well-differentiated endometrial adenocarcinoma, hormonal therapy included nine intramuscular injections of 3.75 mg of GnRHa every 4 weeks. After the third injection of 3.75 mg of GnRHa, we also inserted a GnRH-IUS (Mirena®) for at least 12 months. This type of therapy was effective for all these patients and may be offered to be used as an alternative to surgery in women with atypical endometrial hyperplasia or early stage 1A well-differentiated endometrial cancer in women of reproductive age. Three women with endometrial cancer became pregnant and two of them delivered at term and one has an ongoing pregnancy.