RU2188675C2 - Method for treating patients with amenorrhea of central genesis - Google Patents

Abstract

FIELD: medicine, gynecology. SUBSTANCE: the method deals with 10-15 seances of endonasal electrophoresis with dalargin at 0.3-0.5 mA current power for 10-20 min. It should be simultaneously prescribed 25 daily intramuscular injections of actovegin per 2 ml and intravenous injections of sodium thiosulfate. EFFECT: higher efficiency of therapy.

Description

 The invention relates to medicine, namely to endocrine gynecology, and can be used to treat women with menstrual dysfunction according to the type of primary and secondary amenorrhea of central (hypothalamic) origin.

 There are various methods of treating amenorrhea of central (hypothalamic) origin: psychotherapy, tranquilizers, nootropics, diuretics, exposure to synthetic progestins, stimulation of ovulation with antiestrogens, the use of gonadoliberin analogues, surgical treatment in the form of various interventions on the ovaries (V.N.Serov et al., 1995, I.I. Kadintseva, 1999, Yu.A. Gurkin, 1999).

 The disadvantages of these methods are their low efficiency, unstable effect, side effects in the form of aggravation of metabolic disorders, cephalalgia, weight gain, allergization, cholestasis, autonomic disorders, high cost, low availability (analogues of gonadoliberins), symptomatology (synthetic progestins) and others.

 The closest analogue of the proposed method is the use of bitemporal inductothermy in combination with infusions of sodium thiosulfate, injections of cerebrolysin, therapeutic fasting for 10-14 days and intravenous infusions of potassium chloride solution daily or every other day, carried out from the fifth or sixth day of fasting and in the recovery period ( patent for the invention of the Russian Federation 2141361 dated November 20, 1999).

 Its disadvantages are poor tolerance to starvation, exacerbation of the hypothalamic syndrome in response to starvation, since hunger is a stress factor. In addition, starvation is contraindicated in gallstone and urolithiasis, in case of peptic ulcer of the stomach and duodenum, which are often found in patients with hypothalamic amenorrhea. It is important that a thermal effect on the hypothalamus is impossible if there was a history of traumatic brain injury.

 The invention is aimed at solving the problem - improving the treatment of patients with central amenorrhea, the prevention of complications and adverse reactions.

The essential features of the proposed method
Restrictive signs - the use of intravenous infusions of sodium thiosulfate solution.

 Distinctive features are the use of dalargin, administered by endonasal electrophoresis daily with a course of 10-15 procedures, and daily intramuscular injections of Actovegin in an amount of 25.

 It is known that with hypothalamic disorders there are numerous systemic disorders: psycho-vegetative, endocrine, metabolic, immune and others. “Sex” in the reproductive system, which manifests itself as a lack of menstruation, is only a reflection of global dysregulation. Therefore, methods aimed at improving blood supply and trophism of the hypothalamic region should be used for treatment. Actovegin activates cellular metabolism by increasing the transport and accumulation of glucose and oxygen, enhancing their intracellular utilization. These processes lead to an acceleration of ATP metabolism and an increase in cell energy resources. The secondary effect is increased blood supply. Dalargin, which is a synthetic analogue of enkephalins, has antistress, immunomodulatory, cyto- and angioprotective, disaggregation effects and, in fact, is an adaptogen, increasing the functional reserves of adaptation mechanisms.

 The drug has high electrophoretic mobility. Given the anatomical and physiological connections between the nasal mucosa and the hypothalamus, in case of menstrual dysfunction of the central genesis, it is advisable to administer it in the form of endonasal electrophoresis, since this allows you to overcome the blood-brain barrier for dalargin. In addition, the use of direct current even without a medicinal substance has a positive effect in cases of dysregulatory menstrual dysfunction.

 The method is as follows.

 Dalargin intranasal electrophoresis is carried out for 10-15 procedures daily. For one procedure, use one ampoule of dry matter (1 mg of the drug), which is dissolved in 3 ml of distilled water. Turundas are moistened with this solution and they are injected into both nasal passages to a depth of 1-2 cm, the medicine is injected from the anode, a second electrode with an area of 80-100 cm is placed on the lower cervical vertebrae and connected to the negative pole. The current strength is from 0.3 to 0.5 mA, the duration of the procedure is from 10 to 15-20 minutes. At the same time, actovegin is prescribed in 2 ml intramuscularly daily 25 and 30% sodium thiosulfate solution in 10 ml intravenously slowly every other day. 10. The courses are repeated at intervals of 6 months.

Case Studies
Example 1. Patient K., 16 years old, was admitted with complaints of a lack of menstruation for 9 months, weight gain of 10 kg in 1 year, headaches. Monthly from 13 years old for six months regular, 6-7 days, 30 days later, then bleeding occurred, for which hormonal hemostasis was performed, after which menstruation became rare (after 83-102 days). A year later, repeated bleeding was stopped by rigevidone, after the cancellation of rigevidone, menorrhagia occurred, then persistent amenorrhea. Neurotropic treatment (nootropil, cinnarizine, veroshpiron) and vitamin therapy failed.

 Features of the anamnesis: she was born full-term, the mother during pregnancy has the flu, childbirth is rapid. Past diseases: frequent acute respiratory viral infections, tonsillitis, otitis media, appendectomy at age 6, purulent mastitis, provoked by the introduction of oxytocin. Objective status: normostenic constitution, height 164 cm, body weight 60 kg, BMI - 23. Skin is pale, no striae, acrohyperhidrosis. The thyroid gland is increased to I degree. The mammary glands are developed, soft, there is no discharge from the nipples. From the internal organs pathology is not detected. Genital status: the external genitalia are formed correctly, with an rectal examination, an unexpanded uterus is palpated, the appendages are not detected. Ultrasound of the small pelvis revealed a cystic change in the ovaries. Venous plethora was found on the fundus, signs of intracranial hypertension, and the syndrome of the "small Turkish saddle" were found on the craniogram. An endocrinologist has established a diffuse enlargement of the thyroid gland of the first degree, an ENT doctor - chronic compensated tonsillitis. Hormones: LH - 3.5 mIU / ml, FST - 8.5 mIU / ml, prolactin - 314 mIU / l. According to the lipid profile, gross dyslipidemia of type IV is established. Diagnosis: Amenorrhea II of dysregulatory genesis, autonomic dystonia syndrome, diffuse enlargement of the thyroid gland of I degree, chronic compensated tonsillitis. The treatment was carried out: endonasal electrophoresis of dalargin 10, actovegin 25 2 ml intramuscularly, sodium thiosulfate 10 10 ml intravenously every other day. Examined after 6 months, during this time menstruation passed three times, headaches disappeared, body weight decreased by 3 kg, the lipid spectrum of the blood returned to normal. Subsequently, menstrual function recovered.

 Example 2. Patient P., 18 years old, complained of a lack of menstruation for 8 months, overweight, and headaches. Monthly from 13 years to 5 days, after 32-34 days with delays of up to 50 days in the summer, from 17 years of delay monthly began to progress sharply. Sex life does not live. Overweight from 7-8 years old is gradually increasing, over the past year there has been a sharp increase in weight (by 8 kg).

 Features of the anamnesis: up to 3 years of very frequent infections: acute respiratory viral infections, mumps, salmonellosis and others, there are childhood and relevant psychogeny. Objective status: height 160 cm, body weight 98.5 kg, BMI - 38.5. Fat deposition is more pronounced in the body and especially in the shoulder girdle; there is a menopausal hump and an apron. White striae are expressed on the arms, mammary glands, hips, burgundy striae - on the stomach and legs. The mammary glands are hypoplastic, soft, there is no discharge from the nipples. The thyroid gland is not detected. HELL - 120/80. From the internal organs pathology is not detected. Gynecological examination revealed the underdevelopment of the lower third of the labia minora, the “inverted” perineum, the hymen, the uterus is small, mobile, painless, the appendages are not detected. Ultrasound of the small pelvis revealed uterine hypoplasia of the first degree, a small cystic change in the ovaries, the M-echo value of 2 mm. On the fundus is determined plethora of veins. Craniographically established syndrome of intracranial hypertension, frontal hyperostosis. Endocrinologist's conclusion: pubertal hypothalamic syndrome, exacerbation phase, obesity II degree. Consultation of an ENT doctor: chronic pharyngitis, chronic tonsillitis. Immunological data: secondary immunodeficiency syndrome with impaired functional activity of regulatory subpopulations of T-lymphocytes. Hormone levels: FSH 7.0 mIU / ml; prolactin 183.2 mIU / ml; TSH 1.1 mIU / L. From laboratory studies, platelet hyperaggregation is noteworthy. Diagnosis: Amenorrhea II of the central (hypothalamic) genesis. Metabolic syndrome. Obesity II degree. Syndrome of intracranial hypertension. Bacterial vaginosis. Chronic pharyngitis. Chronic tonsillitis. The treatment was carried out: endonasal electrophoresis of dalargin 15, 10 intravenous injections of 30% sodium thiosulfate solution of 10 ml every other day, 25 intramuscular injections of actovegin 2 ml daily. Examined after 5 months, during this time she lost 5 kg, her menstruation went twice, headaches stopped. Subsequently, the initial rhythm of menstruation was restored.

 The positive effect of the proposed method in the form of increasing treatment efficiency is that the function of the hypothalamus is optimized due to the dehydration effect of sodium thiosulfate on the brain, improvement of trophic structure of the brain under the influence of actovegin and intranasal galvanization with the simultaneous administration of dalargin.

 The advantage of the proposed method is that it does not cause complications and adverse reactions, has a multilateral beneficial effect on the body, helps to eliminate neuroendocrine-immune dysregulation, provides physiological "inclusion" of cyclic processes in the endometrium and ovaries.

 The method is simple, affordable, easily reproducible, does not require special equipment and high economic costs.

Claims (1)

 A method of treating central amenorrhea using intravenous infusions of sodium thiosulfate, characterized in that at the same time 10-15 sessions of dalargin endonasal electrophoresis with an amperage of 0.3 to 0.5 mA are additionally carried out, the procedure lasts 10-20 minutes, 25 intramuscular injections of actovegin 2 ml daily.