Prognostic risk predictors of hyperplastic endometrial processes in women with reduced reproductive potential
Keywords:infertility, endometrial hyperplasia, chronic pelvic inflammatory disease, metabolic imbalance, risk factors
In the structure of female infertility, the uterine factor occupies one of the leading places and ranges from 25.20% to 42.30%, and in women with repeated unsuccessful attempts at in vitro fertilization, intrauterine pathology is detected in 45% of cases. In the structure of gynecological diseases, hyperplastic processes of the endometrium are 15–40%, and in women of reproductive
age – 24.0–62.0%.
The objective: to examine the risk predictors of the developing benign hyperproliferative pathology of the endometrium in women of reproductive age to improve preventive approaches of management of this group of patients.
Materials and methods. The results of analytical processing of medical documentation of 860 patients with uterine factor of subfertility (pregnant woman’s card (form 111 / y), ambulatory card (form 025 / y-04)), witch were selected by the method of continuous sampling, were presented. This allowed to establish the structure and frequency of endometrial hyperplastic processes
in women of reproductive age, to assess the features of reproductive health parameters in this category of patients and to determine prognostic predictors of endometrial hyperplastic processes. For comparison, we analyzed 100 forms of medical records of patients who were routinely preventively examined in these medical institutions.
Results. Dominating influences are such clinical nosologies: endometrial polyposis and hyperplastic processes (44.19%), adenomyosis (22.33%), multiple uterine fibroids (10.47%), including submucous myomas (7.79%), uterine synechia (14.19%), uterine retinas and anomalies in the development of the uterus were rarely inserted (2.09% and 1.28% respectively). The uterine factor was the main factor in terms of reproductive losses and subfertility (38.68%), the incidence of the primary form of infertility was 17.63%, the secondary form (43.68%), the incidence in IVF programs was 119 cases (31.32%), including one in five failed IVF attempts
(21.85%). Patients ranged in age from 20 to 45 years, and endometrial hyperplasia and polyposis were more pronounced in late reproductive age (60.00%) versus (40.00%) in early reproductive age, respectively (p<0.05).
The performed statistical calculations allowed to present the risks of developing hyperplastic processes of the endometrium in relation to such factors as chronic pelvic inflammatory disease (OR = 6.16; 95% CI: 3.52–10.78), adenomyosis and external genital endometriosis (OR=10,59; 95%: 4.21–26.67), uterine fibroids (OR=3.07; 95%: 1.19–7.92), benign tumors and retention of ovaries (OR=4.98; 95%: 1.96–1.67).
It should be noted that the share of somatic disorders and their comorbidity increased with age by 1.7 times in cases of hypertension, metabolic disorders, thyroid pathology and diseases of the urinary system (p<0.05). Assessing the reproductive function in women with endometrial hyperplastic processes, it should be noted the low reproductive potential in this category of patients.
Conclusions. The results show an increase in the risk of endometrial hyperplasia and polyps with age by 2.3 times. There is a high proportion of long-term use of intrauterine systems, as well as a low use of hormonal and barrier methods of contraception, which, no doubt, can contribute to the chronicity of inflammatory diseases of the reproductive system. The statistical calculations allowed to present the risks of developing hyperplastic endometrial processes for such factors as chronic pelvic inflammatory disease, adenomyosis and external genital endometriosis, uterine fibroids, benign tumors and retention of ovaries. In the analysis
of the structure of somatic morbidity, the share of cardiovascular diseases, thyroid disease and disorders of fat metabolism is high. In the group of patients with endometrial hyperplastic processes, a low proportion of pregnancies was noted, along with a high percentage of miscarriages, missed abortions and recurrent miscarriages. The obtained results allow to supplement the pathogenetic concept of the development of endometrial hyperplastic processes.
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