Features of the course of external genital endometriosis due to cervical pathology

Abstract

Background. In modern literature, there is a limited number of publications devoted to the characteristics of the course of endometriosis in patients with cervical diseases (CD), the choice of management tactics for cervical diseases and the prevention of relapses of these diseases.Objective. To analyze clinical, anamnestic and laboratory data in patients of reproductive age with a combination of benign cervical diseases and external genital endometriosis.Materials and methods. A retrospective cohort study was conducted that included 100 women of reproductive age with external genital endometriosis. The main group consisted of 56 patients with a combination of benign cervical diseases and external genital endometriosis. The comparison group consisted of 44 patients with external genital endometriosis without cervical cancer. An assessment was made of clinical and anamnestic data, the results of a cytological examination of a cervical smear, extended colposcopy and the level of hormones AMH, FSH, estradiol, performed by enzyme immunoassay on days 2-5 of the menstrual cycle. Statistical analysis was carried out using the SPSS Statistics 26.0 program.Results. External genital endometriosis in 56% of cases is associated with benign cervical diseases, in the structure of which non-inflammatory diseases predominate (63%). Inflammatory diseases of the cervix were observed in 16% of patients, and combined pathology of the cervix was observed in 21% of women with external genital endometriosis. The presence of concomitant cervical pathology in 83.3% of cases is accompanied by endometriosis-associated infertility, this is significantly more common than in patients with inflammatory (22.2%) and non-inflammatory (42.9%) cervical diseases, p < 0.05. Surgical treatment of endometriosis did not lead to pregnancy within one year after surgery in any planning patient with concomitant cervical pathology (0/11); this figure in women with non-inflammatory cervical diseases was 14.3% (4/32), whereas in 75.0% (3/4) with inflammatory diseases of the cervix, pregnancy occurred within a year after surgery, p<0.05. In turn, the presence of inflammatory cervical diseases was associated with a significantly lower level of AMH (1.4±0.5 ng/ml) compared to patients with non-inflammatory cervical diseases (3.0±0.4 ng/ml) and combined cervical cancer pathology (3.4±0.5 ng/ml), p<0.017. A significant decrease in ovarian reserve in the future can also lead to impaired fertility in this category of patients.Conclusion. The results of the study indicate the need for a comprehensive assessment of the condition of the cervix in patients with genital endometriosis, including a thorough history taking, cytological examination and extended colposcopy in combination with determination of HPV virus carriage. Timely measures for the diagnosis and treatment of cervical diseases in patients with endometriosis-associated infertility will improve fertility rates in this category of patients.