Прогнозування виникнення клімактеричного синдрому тяжкого ступеня у жінок з ендометріозом у період менопаузи

Abstract

Every year, the number of women entering the menopause increases. This period is often complicated by the development of climacteric syndrome (CS). The frequency of this pathology, according to various authors, varies from 40 to 75%. The problem of CS is extremely relevant for patients with endometriosis, which account for about 50% of the female population in perimenopause. Climacteric disorders lead to temporary, and sometimes, full loss of ability to work, worsening the quality of life in the period of the highest social and professional activity. Taking into account the above-mentioned, the timely formation of high-risk groups of CS’ development and the creation of prognostic models, which will allow to determine in time the probability of occurrence of severe forms of CS in each individual case, to appoint differentiated prophylaxis and adequate therapy, in order to reduce the number of postmenopausal complications. The objective: high risk stratification of severe menopausal symptoms in women with endometriosis. Materials and methods. By the specially designed questionnaire were surveyed 128 women aged 39 to 55 years, of which 72 patients with endometriosis and severe climacteric syndrome and 56 women with endometriosis only. In order to check the reliability of the developed mathematical model for predicting the severe course of CS among women with endometriosis, 94 women were examined, of which 52 women with CS against the background of endometriosis and 42 women with endometriosis only. As a model, the method of stepwise discriminant analysis was used. To confirm the sensitivity of the created prognostic mathematical model, the relative risk (RR) of the severe CS’ development among women with endometriosis in perimenopause was calculated. The values of two discriminant functions (f1 and f2) were determined, the first of which showed the likelihood of an onset of a severe climacteric syndrome among women with endometriosis, and the second – denied such an opportunity. The received digital data were statistically processed using modern methods of variation statistics on the base of Microsoft Excel Office 2010 program with the application for absolute numbers – Student’s criterion, for the relative – the method of the angular transformation of Fisher. The difference between the compared values was considered probable at p<0.05, which corresponded to a probability of 95%. Results. As a result of data analysis were identified nine key factors that most influenced the risk of serious forms of CS among women with endometriosis: stress anamnesis, the presence of harmful production factors, alcohol consumption, smoking, type of personality accentuation, ecological living conditions, the presence of anxiety, extragenital disease and surgical treatment of endometriosis in the anamnesis. During analyzing the frequency of severe menopausal syndrome in this group of patients the sensitivity of the mathematical model was confirmed – 90.38%: from 52 patients with severe CS against the background of endometriosis of 47 could be expected with medium or high degree of probability (RR 6.5; CI: 2.32–9,98). This confirms the high predictive accuracy of this mathematical model. Match of actual results with theoretical expectations in the high risk observed in 93.11%, average – 76. 92% and in the group of women with a low probability of occurrence of this disease, was not forecasted occurrence of severe CS in 87.18% of cases. Conclusion. Taking into account the obtained data, it can be argued that the developed algorithm and the mathematical model for prediction are highly sensitive, and their use will help to prioritize groups of women with high risk of development of severe CS against endometriosis, which will allow to take prophylactic measures to prevent the development of this pathology in the future. Key words: climacteric syndrome, endometriosis, risk prediction, discriminant analysis.