Characteristics of the reproductive mucosa microbiota in patients with endometrial hyperplasia in combination with chronic endometritis and an optimized program of rehabilitation therapy and preconception training
Keywords:endometrial hyperplasia, chronic endometritis, parameters of the microbiota of the reproductive tract mucosa, treatment, bacteriophage therapy, pregravid preparation
The etiology and pathogenesis of hyperplastic processes of the endometrium (HPE) are currently unclear, some aspects of the pathogenesis remain controversial and debatable.
The objective: was to evaluate the microbiota of the reproductive mucosa in patients with subfertility on the background of endometrial hyperplasia combined with chronic endometritis, and to develop an optimized treatment and rehabilitation program.
Materials and methods. A comprehensive clinical and laboratory examination of 54 patients of reproductive age with subfertility on the background of endometrial hyperplasia and chronic endometritis was performed.
Two groups were formed to evaluate the effectiveness: the main group - 30 patients who received an optimized program of treatment and rehabilitation options, the comparison group – 24 patients who received classic conventional therapy.
The endometrium of 20 gynecologically healthy women was used for control clinical-laboratory and morphological examinations.
The personalized program of postoperative support is offered: basic antibiotic therapy, supplemented with bacteriophage therapy, antiviral therapy, immunomodulatory, angioprotective and venotonizing agents, correction of ischemia, correction of metabolic disorders, restoration of morphofunctional potential of endometrial tissue with the use of individualized hormone therapy was proposed.
Results. HPE became the prerogative of all patients in the study group, and in 19 (35.2%) endometrial polyps were registered, in 35 (64.8%) a combination of hyperplasia and polyps.
The results of bacteriological research showed a significant proportion of abnormalities in vaginal biocinosis, which is manifested by a significant reduction in the frequency of secretions of major acid-forming lactobacilli compared with healthy patients.
After using the proposed treatment program to improve well-being, reduce pain and reduce hypersecretory abnormalities were noted by all patients, the results of control pipelle biopsy with microbiological examination of the endometrium 3 months after the end of treatment showed sterile cultures in 97% of samples.
During the year of observation, spontaneous pregnancy out of 30 people who received pre-pregnancy training in the main group occurred in 14 (46.7% of cases), and of the 16 women enrolled in the ART program, 7 (43.7%) became pregnant.
Conclusions. A comprehensive study of the microbiocenosis of the mucous membranes of the reproductive tract showed that in women with endometrial hyperplasia combined with CE, microbiological parameters are characterized by a high frequency of viral and viral-bacterial associations, a significant proportion of dysbiotic disorders. Carrying out pregravid preparation along with optimizing the antibacterial therapy program using rational antimicrobial agents, modern enzyme preparations to reduce the intensity of stroma fibrosis, individualized hormonal correction, agents that improve the effects of ischemia and changes in mucosal microbiota, allow to restore morphofunctional disorders in the endometrium.
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