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Abstract
The aim. Minimization of the frequency of recurrence of endometrial hyperplasia (EH) in women of reproductive age with overweight (OW) depending on the tactics of treatment.
 Materials and methods. 90 women of reproductive age with endometrial hyperplasia and OW were selected. They, in turn, were divided into three groups: group 1 – 30 women who took a gonadotropin-releasing hormone agonist (GnRH agonist), namely at a dose of 3.75 mg intramuscularly once every 28 days; group 2 – 30 women who used progestin (norethisterone) at a dose of 10 mg per day from day 16 to 25 of the cycle, group 3 – 30 women who took combined oral contraception (COC) (30 mcg ethinyl estradiol and 150 mcg desogestrel) in a cyclic mode 21/7.
 Evaluation of the effectiveness of therapy included a clinical picture of the disease 6 months after the start of treatment, assessment of the variability of the average values of endometrial thickness and uterine size on ultrasound (US) of the pelvis 6 months after treatment. Also analyzed the effectiveness of therapy based on the results of morphological examination of the endometrium in a biopsy of the uterine mucosa, performed 6 months after the start of treatment. In addition, a general analysis of the frequency of EH recurrence was performed 6–24 months after treatment.
 Results. The results showed that in the group in which women were prescribed GnRH agonist, there was a significantly higher effectiveness of treatment, in particular the absence of uterine bleeding and menstrual disorders (MD). At the same time, in the other norethisterone group, 53.3 % (16) of women had intermenstrual uterine bleeding. In patients in the group in which women received COC, uterine bleeding was observed in 30.0 % (i.e. 9) of patients (p <0.05).
 Immediately after treatment, the average values of endometrial thickness in patients of group 1, according to ultrasound, was 3.59±0.47 mm, which was significantly less than in women of groups 2 and 3 – 6.81±0.59 mm (p<0.001) and 7.58±0.69 mm (p<0.001).
 In addition, patients in group 1 at 3, 6, 12, 24 months after the end of hormone therapy were registered significantly lower average values of endometrial thickness, compared with patients receiving norethisterone and estrogen-progestogen drugs.
 Conclusions. In a comparative evaluation of the effectiveness of treatment of endometrial hyperplastic processes in overweight women, it was found that the recurrence rate after 6–24 months occurs in 6.7 % (i.e. 2) of patients after GnRH agonist therapy, in 33.3 % (i.e. in 10) patients receiving norethisterone (p<0.001), and in 50 % (i.e. 15) of women treated with COC (p<0.001).
Highlights
Endometrial hyperplasia is considered to be the most common pathology of the uterine mucosa
The effectiveness of the therapy was evaluated on the basis of the clinical picture of the disease 6 months after treatment, assessment of variability in mean endometrial thickness and uterine size on ultrasound of the pelvis 6 months after treatment, as well as on the analysis of morphological examination of the endometrium in biopsy of the uterine mucosa, performed 6 months after treatment
The effectiveness of the therapy was evaluated on the basis of the clinical picture, namely the presence of intermenstrual uterine bleeding, the nature of menstrual cycles, based on the assessment of variability of uterine size and endometrial thickness in control ultrasound of the pelvis, and on the analysis of endometrial morphological changes mucous membrane of the uterus, which is carried out 6 months after treatment
Summary
Endometrial hyperplasia is considered to be the most common pathology of the uterine mucosa. A number of publications of the authors indicate the possibility of spontaneous regression of endometrial hyperplasia, which is from 15.0–28.0 % to 48.9–70.0 %. Hyperplastic processes in the endometrium belong to the proliferative processes, which in the long run without treatment could serve as a background for the development of malignant lesions of the uterine mucosa [1, 2]. The leading theory of its development is hyperestrogenism: absolute – in polycystic ovary syndrome, obesity (increased peripheral conversion from androstenedione to estrone, and to (2021), «EUREKA: Health Sciences» Number 5 estradiol) and relative – a decrease in the production of hormones that neutralize the effects of estrogen, especially anus, prone luteal phase, luft syndrome. The duration of estrogen action on the mucous membrane of the uterine cavity plays a significant role [3, 4]
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