Evaluation of the effectiveness of combination therapy using laser-mediated photodynamic therapy in patients with combined hormone-dependent pathology: endometrial hyperplasia and adenomyosis

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Abstract

Objective. To evaluate the effectiveness of photodynamic therapy (PDT) combined with traditional hormone therapy on reproductive outcomes, the frequency of clinical manifestations, and the recurrence rate in women of reproductive age with endometrial hyperplasia (EH) and adenomyosis.

Materials and methods. A retrospective single-center comparative study was carried out from 2021 to 2023. The sample was formed using a consecutive sampling method. The study included 48 women aged 25 – 45 years with the established diagnosis of adenomyosis based on clinical findings, ultrasound examination, and hysteroscopy, as well as non-atypical EH confirmed by histological examination. Two groups were formed: hormone therapy (n=21) and combination therapy using endometrial PDT (n=27). Assessment of reproductive outcomes included pregnancy rate, the time before getting pregnant, clinical symptoms before and after treatment, and the recurrence rate of EH based on follow-up histology of endometrial biopsy specimens. The follow-up period was up to 36 months.

Results. Combination therapy using PDT led to statistically significant increase in pregnancy rate (p=0.002), whereas the time before getting pregnant did not differ significantly between the groups (p=0.750). Reduced frequency of clinical manifestations after treatment was in both groups. Despite low frequency of abnormal uterine bleeding, heavy menstrual bleeding, and dysmenorrhea in the group of combination therapy using PDT, no statistically significant differences between the groups in these outcomes were observed. The recurrence of EH was less common in the group of women who were treated with combination therapy compared with the group of women who received traditional hormone therapy (3/18 [16.7%] vs 6/13 [46.2%]; RR=0.36; 95% CI 0.11–1.18; p=0.114).

Conclusion. In patients with EH and adenomyosis, combination therapy using PDT was associated with higher pregnancy rate compared with hormone therapy alone. It suggests that this approach is promising for treatment of combined hormone-dependent pathology. The trend was observed in favor of combination therapy with PDT regarding the recurrence rate of EH and persistence of clinical symptoms after treatment. However, no statistically significant intergroup differences were found for these indicators.

About the authors

Vladimir N. Serov

Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia

Email: v_serov@oparina4.ru
ORCID iD: 0000-0001-6640-1235

Academician of the Russian Academy of Sciences, Dr. Med. Sci., Professor, Chief Researcher

Russian Federation, Moscow

Natalia M. Pasman

Novosibirsk National Research State University; LLC “Clinic of Professor Pasman”

Email: nmpasman@gmail.com
ORCID iD: 0000-0002-6095-1954

Dr. Med. Sci., Professor, Head of the Department of Obstetrics and Gynecology, Institute of Medicine and Medical Technologies

Russian Federation, Novosibirsk; Novosibirsk

Nadezhda A. Selyunina

Novosibirsk National Research State University; LLC “Clinic of Professor Pasman”

Author for correspondence.
Email: nadezhda_silk@mail.ru
ORCID iD: 0009-0003-9958-6151
SPIN-code: 4273-7582

obstetrician-gynecologist, Teaching Assistant, Department of Obstetrics and Gynecology, Institute of Medicine and Medical Technologies

Russian Federation, Novosibirsk; Novosibirsk

Tatyana V. Veretelnikova

LLC “Clinic of Professor Pasman”

Email: nadezhda_silk@mail.ru
ORCID iD: 0009-0007-1022-6985

obstetrician-gynecologist of the highest category

Russian Federation, Novosibirsk

Elizaveta A. Zhdanova

Novosibirsk National Research State University

Email: e.zhdanova1@g.nsu.ru
ORCID iD: 0009-0001-9259-4840
SPIN-code: 8914-4911

student at the Department of Obstetrics and Gynecology, Institute of Medicine and Medical Technologies

Russian Federation, Novosibirsk

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