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Recently, there has been a trend towards a significant increase in uterine tumors, in particular fibroids, in women of reproductive age. Manifestations of uterine fibroids during pregnancy depend on the location and size of the fibroids. Prevention before pregnancy consists of timely treatment of uterine fibroids using organ-preserving medical technologies at the stage of preconception preparation. With the onset of pregnancy, in such patients, the content of sex steroid hormones in the local bloodstream of the uterus changes, the volume of nodes increases due to cellular hyperplasia and hypertrophy, cellular hyperplasia in myomatous nodes is blocked, and the death of myocytes in the central zone of the nodes is accelerated. Up to 75 % of pregnant women with uterine fibroids undergo surgical treatment, including conservative myomectomy. In this category of pregnant women, the frequency of spontaneous abortions and premature births is higher. There have been cases of spontaneous uterine rupture during pregnancy after embolization of the uterine arteries.

The quality of life European Quality of Life Questionnaire EQ-5D-3L and the level of pain on the NRS scale in the postoperative period in women after laparoscopic conservative myomectomy were assessed. The data obtained confirm the low level of postoperative pain and the rapid recovery of quality of life indicators in patients after laparoscopic conservative myomectomy.

Recently, there has been a trend towards a significant increase in uterine tumors, in particular fibroids in women of reproductive and perimenopausal age. Up to 75 % of patients with uterine fibroids undergo surgical treatment. Cervical fibroids develop in 5-8 % of cases. Such an arrangement of nodes, regardless of their size, leads to functional disorders of the urinary system with the rapid development of organic pathology of the kidneys and ureters, as well as venous congestion in the pelvis and lower extremities. Surgical treatment of patients with atypical location of uterine fibroids is classified as traumatic, technically complex and has a high risk of intra- and postoperative complications.

The review article presents the results of the published works, concerning the studies of therapy of symptomatic uterine fibroids. As known, uterine fibroids takes the second place in the structure of gynecological pathology without downtrend. Conducted investigations demonstrate ambiguous results in the use of surgical and minimal invasive methods of treatment. Part of the authors lean toward the election of myomectomy as a method with the minimal influence on fertility and excluding the disease recurrence. The group of investigators, adherents of more sparing approaches to the organ-preserving tactics substantiate and prove the expediency of making the embolization of uterine arteries, taking into consideration the individual approach and risk assessment of long-term results. Discussability of the questions of choosing the methods of treatment of symptomatic uterine fibroids, taking into the consideration a long-term exodus and perspective of the realization the reproductive function determine the necessity of conducting further perspective investigations.

The aim of the research – clinical and morphological assessment of the effectiveness of the ambulatory hysteroscopic myomectomy with diode laser radiation in the pulsed mode in case of submucous uterine myoma. Materials and methods. A comparative analysis of the specific features of the surgery course, post-surgery period, endometrium status and reproductive function has been performed in 171 patients (1st group) who underwent surgery with the use of the diode laser in the pulsed mode and 31 patients (2nd group) who were treated with the use of the bipolar electric energy. Results. Surgeries performed with the use of the diode laser energy in the pulsed mode are characterized by less blood loss in case of single-step and in performing the 1st step of the two-step myomectomy, by complete removal of the uterine myoma in statistically significantly greater number of patients with the uterine myoma of the G2 type (85.96 %) and G1 type with the diameter 7-20 mm (88.89 %), and by absence of the intra- and post-operative complications. Statistically significantly greater number of patients treated with the use of the laser energy show absence of morphological signs of the endometritis (46.78 %) in 2 months after the myomectomy, and of the manifestations of perivascular fibrosis in the endometrium in 5 months (72.0 %). Patients who have underwent surgery with the use of the laser energy in contrast to the women who have been treated with the bipolar electric energy, are characterized by a shorter lapse of time between the surgery event and conception – 7.82 ± 1.42 and 13.13 ± 4.97 months respectively; the frequency of the pregnancy occurrence is 60.78 % and 59.26 %, delivery at term – 95.45 % and 92.31 %. Conclusion. Hysteroscopic myomectomy with the use of diode laser energy in the pulsed mode is effective and safe approach to the removal of the submucous uterine myoma and could be used in ambulatory setting.

Myoma of the uterus is one of the most common diseases of the female genital organs. Carrying out myomectomy allows you to preserve the reproductive potential of women. Today, gynecologists are faced with the task of optimizing the examination, selection of patients and the choice of access for a successful low-traumatic myomectomy operation.