PROGNOSTIC RISK PREDICTORS OF HYPERPLASTIC ENDOMETRIAL PROCESSES IN WOMEN WITH REDUCED REPRODUCTIVE POTENTIAL

Abstract

In the structure of female infertility, the uterine factor ranges from 25.20% to 42.30%. Inthe structure of gynecological diseases, endometrium hyperplastic processes (EHP) are15-40%, and in women of the reproductive age – 24.0-62.0%.The aim of the research – to examine the risk predictors of the developing benignhyperproliferative pathology of the endometrium in women of the reproductive age toimprove preventive approaches of management of this group of patients.Material and Methods. The results of analytical processing of medical documentationof 860 patients with uterine factor of subfertility, selected by the method of continuoussampling, were presented. For comparison, 100 forms of medical records of somaticallyhealthy patients were analyzed.Results. Dominating infl uences are the following clinical nosologies: endometrialpolyposis and hyperplastic processes (44.19%), adenomyosis (22.33%), multiple uterine fi broids (10.47%), uterine synechia (14.19%). The uterine factor was the main factor interms of reproductive losses and subfertility (38.68%), the incidence of the primary formof infertility was 17.63%, the secondary form (43.68%), the incidence in IVF programswas 119 cases (31.32%), in addition to that 21,85% had poor attempts. Patients rangedin age from 20 to 45 years, and endometrial hyperplasia processes (EHP) were morepronounced in late reproductive age (60.00%) (p <0.05). The risks of EHP developmentin relation to such factors as chronic pelvic infl ammatory disease, adenomyosis andexternal genital endometriosis, hysteromyoma, benign tumors and retention of ovarieshave been determined.Conclusions. The results obtained show an increase in the risk of endometrial hyperplasiaand polyps with age by 2.3 times. There is a high proportion of long-term use of intrauterinesystems, as well as low use of hormonal and barrier methods of contraception, thatcontributed to the chronicity of infl ammatory diseases of the reproductive system. Therisks of EHP development concerning such factors as chronic pelvic infl ammatorydisease, adenomyosis and external genital endometriosis, hysteromyoma, benign tumorsand retention of ovaries were presented. In the analysis of the structure of somaticmorbidity, high share of cardiovascular diseases, thyroid disease and disorders of lipidexchange was revealed. In the group of patients with endometrial hyperplastic processes,a low proportion of pregnancies was noted, along with a high percentage of miscarriages,missed abortions and recurrent miscarriages. The obtained results allow to supplementthe pathogenetic concept of the development of endometrial hyperplastic processes.