Effects of androgen deficiency on the structure of endometrium in women of reproductive age

Abstract

Objective — to identify the features of the histological structure of the endometrium in women of reproductive age with hypoandrogenism, to optimize therapeutic tactics at the preconceptive stage.
 Materials and methods. Examination of patients with androgen deficiency revealed 48 patients with endometrial hypoplasia by ultrasound markers. After examination on CD 138 and detection of chronic endometritis, 9 patients were excluded from the study. At second stage, immunohistochemical testing for estrogen, progesterone and androgen receptors was performed. According to the results, patients were divided into 2 groups: the first group (24 patients) with a high level of expression of androgen receptors and the second group (15 patients) with a low level of expression of androgen receptors. Both groups of patients received hormonal therapy for 3 months: estradiol valerate 1 g per day continuously and 200 mg of micronized progesterone from the sixteenth to the twenty-fifth day of the menstrual cycle, patients of the first group received additional dehydroepiandrosterone (DHEA) in a dose of 25 mg per day in the form of sublingual spray.
 Results. According to the ultrasound study in the first group of patients, the endometrium was normal both during treatment and 1 and 3 months after stopping treatment. The endometrium of women in group 2 showed positive changes during treatment (control after 1 and 3 months of therapy), and the absence of these effects after discontinuation of hormone therapy, which coincided with the restoration of intermenstrual bleeding in these women.
 Conclusions. Optimization of the gravidar transformation of the endometrium of women with biochemically diagnosed hypoandrogenism and infertility requires study of the receptor potential of the endometrium. The established high levels of expression of androgen receptors at immunohistochemical examination of the endometrium can be considered as indication for the inclusion of DHEA spray forms in the complex of pre-pregnancy training. The combination of estrogen-progestogen therapy and androgens has a positive effect on the gestational potential of the endometrium in women of reproductive age with androgen deficiency.