Characteristics of fibroid nodes in dynamics when using multiphasic and monophasic combined hormonal contraceptives

BACKGROUND: The increasing prevalence of uterine fibroids at the age of 20–35 years and late fertility intentions are modern trends in women’s lives. Combined hormonal contraceptives level out cyclic fluctuations of sex steroids in the natural menstrual cycle; can be used by patients with fibroid nodes for contraception; and have a protective effect on uterine fibroids. The literature does not provide comparative data on the use of multi- and monophasic combined hormonal contraceptives with ethinyl estradiol by patients with uterine fibroids.

AIM: The aim of this study was to assess the characteristics of fibroid nodes in dynamics in women using multiphasic and monophasic combined hormonal contraceptives.

MATERIALS AND METHODS: This study included 554 women. Prospective part of the research involved 118 patients with uterine fibroids without indications for surgical treatment: 54 patients used multiphasic (ethinyl estradiol and desogestrel) and monophasic (ethinyl estradiol and various gestagens) combined hormonal contraceptives, and 64 patients did not. Who underwent pelvic ultrasound examination three times over 12 months. Retrospective part of the research included analysis of in-person instrumental-clinical-anamnestic data obtained from 436 women (45 patients with fibroid nodes and 391 healthy individuals). Out of the 391 healthy participants, 297 ones used various combined hormonal contraceptives with ethinyl estradiol for 1–30 years, while the other 94 did not.

RESULTS: In women with uterine fibroids using various combined hormonal contraceptives with ethinyl estradiol (n = 94), no changes in the sizes of classification of International Federation of Gynaecology and Obstetrics (FIGO) types 3 to 6 fibroid nodes were observed (n = 124; 21.7 ± 2.8 vs. 21.5 ± 3.2 mm; p > 0.05). In patients with FIGO type 4 fibroid nodes using multiphasic combined hormonal contraceptives (n = 20), a decrease in the size of the nodes was registered after 12 months (n = 14; 15.7 ± 3.4 vs. 14.1 ± 2.7 mm; p < 0.05). In 17 (5.7%) healthy participants using combined hormonal contraceptives and in 15 (16.0%) patients without fibroid nodes who did not use these drugs, uterine fibroids were first diagnosed in the reproductive period.

CONCLUSIONS: The use of various combined hormonal contraceptives by patients with uterine fibroids did not lead to an increase in the size of FIGO types 3 to 6 fibroid nodes with an initial diameter of up to 22 mm. After 12 months, we noted a decrease in the size of F4 type fibroid nodes with an initial diameter of up to 16 mm for the women with uterine fibroids, who took multiphasic combined hormonal contraceptives. In women of reproductive age who used combined hormonal contraceptives for 1–30 years, uterine fibroids were first diagnosed 2.8 times less often than in patients who did not use these drugs.