COMPARATIVE ANALYSIS OF TREATMENT REGIMENS FOR UTERINE FIBROIDS IN INDIA AND RUSSIA

Relevance. A fibroids (myomas) is a benign, monoclonal tumor of the smooth muscle of the myometrium which contains large aggregates of collagen, elastin, fibronectin, and proteoglycans. The main causes of fibroids are estrogen Fibroid growth is primarily concentrated in the reproductive age group of 30-40 years. It is unusual for a fibroid to develop after menopause. In women going through menopause, fibroid size increases, indicating malignancy. PCO-affected women are more likely to experience fibroids [4].

Over 30 percent of women are estimated to have fibroid tumors. There are around 50 percent of them who remain asymptomatic (50%) In outpatient settings in hospitals, three percent of patients present with symptoms of fibroid. The following are some factors that lower the risk of fibroids: smoking inhibits aromatose, thus decreasing estrogen, physical exercise, pregnancy (absence of ovulation), multiparity,  breast-feeding. It is more common in patients with early menarche, nulliparous women and african american females. First-degree relatives of women with fibroids have a 2.5 times increased risk of developing fibroids. Monozygous twins are reportedly hospitalized for treatment of fibroids more often than heterozygous twins, but these findings may be the result of reporting bias. It is estimated that 5-20% of women of reproductive age suffer from fibroids or myomas, which are benign uterine neoplasms. As opposed than ovarian tumours, they grow slowly and take 3-5 years to become clinically palpable. There is a wide range of prevalence of fibroids based on study populations and diagnostic methods. Approximately 25% of women in reproductive age experience clinically significant symptoms due to fibroids [5, 7].

The impact of oral contraceptives (OCP) and pregnancy on uterine fibroids. The use of OCP has no effect on size of fibroid. The more the female becomes pregnant, more the anovulation and that is a protective factor. Patient with fibroid getting pregnant has no effect in on size of fibroid [2].

A fibroid’s hormonal effects. The formation of fibroids seems to be influenced by estrogen and progesterone. Before puberty, fibroids are uncommon, are more common during the reproductive years, and regress after menopause. Obesity and early menarche, which increase lifetime estrogen exposure, are two factors that raise the disease’s occurrence. Smoking, exercise, and parity all reduce estrogen exposure in a protective way [1, 6].

Fibroids come in two different varieties: extrauterine fibroid and uterine fibroid. The uterine fibroid is the most common type of fibroid occur in women, they are further distinguished Intramural or interstitial, submucosal and subserosal. The extrauterine fibroid is cervical or broad ligament fibroid. This further can be divided in two types- true broad ligament fibroid and psuedo broadligament fibroid [1, 3].

Objective: the main objective of this research paper is comparative analysis of treatment regimens for uterine fibroids in women living in India and Russia.

Research objectives:

1. Evaluate treatment regimens for uterine fibroids in women living in India.

2. Evaluate treatment regimens for uterine fibroids in women living in Russia.

3. Conduct a comparative analysis of treatment regimens for uterine fibroids in women living in India and Russia.

Materials and methods.

An analysis was made of 12 case histories of women treated in the gynecological department of the Kursk Perinatal Center. The following diagnostic methods were analyzed: history taking and analysis, general clinical and gynecological examination, including bacteriological examination of the vaginal microflora and cytological examination of the cervical canal of the cervix, laboratory and ultrasound methods. Considered and analyzed the treatment regimens of patients in each case.

Results of the study.

According to the studies discussed above, Indian and Russian treatment is provided for pre-menopausal, post-menopausal, and asymptomatic women. In our opinion for asymptomatic women also we should give treatment, giving Ulipristal Acetate 5mg is prescribed to patients for three months. By providing her in this stage we can save her from getting heavy menstrual bleeding and anemic syndrome. Both countries follow same algorithm of treatment but they give medical treatment once the size increases or woman is symptomatic.

There are multiple options available but as our first management should be to decrease blood loss during periods. So we can give mefenamic acids, tranexemic acid acids, low dose oral contraceptives during periods. I can also start with progestrone therapy, this can be oral or MIRENA. All of these are potential options to decrease the bood loss during periods. The best drug in market is available is Ulipristal acetate or Mifeprestone to shrink the fibroid.

For women, who has a severe fibroid with increase in fibroid, we should do hysterectomy or laparoscopic myomectomy. Uterine artery embolization is performed where second line of treatment doesn’t work, this treatment is much safer than surgery.

Women who want to keep their uterus can choose to have a myomectomy. It might improve fertility and help with problems including heavy menstrual bleeding, pelvic pressure or pain, and reproductive problems. Russian populations have a thorough postrecovery management, which is not the case for Indian communities receiving treatment for fibroids. There is a follow-up every year, thus the follow-up management care is substantial. The etiological treatment seeks to stop any type of fibroids recurrence in addition to follow-up maintenance. The Indian treatment regimens do not include this crucial goal of the Russian therapy.

Another reason this option might be possible is India’s enormous population. Russia does not prescribe surgical interventional therapy such as uterine artery embolization, although India does. Any type of permanent contraception is discouraged in Russia, where having children is promoted, especially hysterectomy. The need for population management in India is demonstrated by the comparison of India’s billion-plus population (India population 1950–2022) and Russia’s hundred million population (Russia population (live)).

Conclusions. Asymptomatic women no treatment is given, but women has to come to hospital for follow-up after 36 months. After counselling and a discussion of all available treatments, the decision to start expecting management is taken along with the lady. Medical and surgical treatment options for fibroids should be considered and made available as an alternative to expectant care in situations when the uterus corresponds to or exceeds a gravid uterus at 14 weeks of gestation. In order to track changes in the size or quantity of fibroids, a plan of periodic annual evaluations is adhered along with expectant management. A Women who comes to hospital with symptoms like heavy or prolonged bleeding, pressure symptoms and reproductive infertility will be first examined for anemia and ultrasound is performed . In India, Ulipristal Acetate 5mg is prescribed to patients for three months together with an iron supplement as the first line of treatment for uterine fibroid. Since progestrone effects the endometrium, oral contraceptives are preferred, and Indian doctors prefer MIRENA IUD. The second line of treatment uses medications including leuprolide acetae (a gnrh agonist), eloglolix (a gnrh antagonist), mifepristone and Letrozes to reduce the size of the fibroid and stop bleeding. Surgery is not necessary if the patient is a postmenopausal woman because Intervention is typically not necessary because, in the absence of postmenopausal hormone therapy, postmenopausal women’s leiomyomas typically shrink and become asymptomatic. Women who aspire to start families submucous leiomyomas are best treated with hysteroscopic myomectomy. Abdominal or laparoscopic myomectomy is advised for the treatment of symptomatic intramural and subserosal leiomyomas in women who wish to preserve their ability to become pregnant and who do not have any significant contraindications to a surgical approach typically indicated due to the lack of information about the safety of pregnancy after other invasive procedures.

Russian treatment places a lot of emphasis on fibroid size. If the uterus is up to 12 weeks in length, they also don’t recommend medication for asymptomatic fibroid. Tranexamic acid is prescribed to symptomatic individuals to treat discomfort and excessive bleeding. For conservative therapy, they strongly advise progestrone therapy and analogs of gonadotropin-releasing hormone. In the event that the following therapy is unsuccessful, a hysterectomy is advised in the absence of any family intentions. It is advised that those who intend to have children in the future undertake an organ conservation surgery myomectomy.

Certain treatment options that are available in India are not included in the Russian treatment plan since the population of Russia and the population of India do not share the same characteristics. In Russia, treatment is not offered if the uterus is less than 12 weeks, in contrast to India, where medicine is not given to asymptomatic women with fibroid if the uterus is larger than 14. While russian doctors recommend tranexamic acid for symptomatic treatment, indian doctors recommend ulipristal acetate, an oral active synthetic SPRM. Both countries adhere to the same procedure for surgical treatment depending on the circumstances. The major surgery, total hysterectomy, is a component of the Indian uterine fibroid treatment regimen that is not seen as a practical choice for the Russian population. In India, hysterectomy is a significant treatment option for people with senile fibroids. To conclude, there are differences between the uterine fibroids treatment protocols used in India and Russia, but they also have a number of things in common that have been shown to work. Each distinction offers unique advantages or disadvantages for each nation. The purpose of the treatment is the same for both of these regimens, notwithstanding their variances. Insuring that uterine fibroids are effectively treated for their populations will result in the quickest recovery and almost minimal consequences, provided that the recommended treatment regimen is adhered to. It is challenging to establish which treatment plan is superior to the other because additional study must be done. Whatever the case, it is clear that each nation’s treatment strategy is the best one for the population in that nation.

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6. Scientific and Practical Council of the Ministry of Health of the Russian Federation, Clinical Recommendations of Uterine Fibroids. 2020
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