Vitamin D Effect on the Severity of Chronic Pelvic Pain in Patients with Ovarian Endometriosis Combined with Pelvic Inflammatory Diseases

Abstract

Numerous publications in recent years indicate the impact of vitamin D deficiency on the course and severity of a number of gynecological diseases, including endometrial disease. As this transmitter is associated with immune disorders, its involvement in local immunosuppression in the progression of the systemic inflammatory response in the case of endometrial disease is not excluded. Considering the pathogenetic links between vitamin D metabolism and the severity of pelvic pain, it became appropriate to study the relationship between this parameter and the intensity of pelvic pain in patients with ovarian endometriomas associated with chronic pelvic inflammatory diseases, which was the objective of this research. Materials and methods of research. The study included 90 patients with ovarian endometriosis aged 20 to 41 years. The main group consisted of 44 patients with endometrioma combined with pelvic inflammatory diseases; the comparison group consisted of 46 patients with isolated ovarian endometrioma. The control group included 30 relatively healthy women without gynecological and somatic pathology. At the initial stage, the level of 25-hydroxyvitamin-D3 (25 (OH) D) was determined in patients of the three groups by mass spectrometry using standard methods. Analysis and discussion of research results. Patients with ovarian endometrial cysts on the background of pelvic inflammatory disease were statistically significantly older compared with the group of isolated endometriomas; more than half of the observations were patients aged 36-40 years (p<0.05). Laparoscopic diagnostic and therapeutic techniques allowed to present objective signs of combination of ovarian endometrioma with manifestations of external genital endometriosis: severe manifestations of external genital endometriosis were diagnosed in 31.8% vs. 15.21% in the comparison group. Depending on the severity of the pain syndrome according to VAS, patients of the main group were stratified as follows: 22.7% noted pelvic pain of low intensity, 40.9% – moderate pain, 25.0% – severe pain; in the comparison group there were no manifestations of severe pelvic pain. The combination of pelvic inflammatory disease with ovarian endometriosis was accompanied by an increase in the share of vitamin D deficiency – in 38.64% and the share of severe pain – in 25.0%.
 Conclusion. A significantly moderate inverse correlation was found between the verification of the manifestations of external genital endometriosis and the level of vitamin D in the blood serum. The obtained data dictated the need to assess the therapeutic potential of vitamin D in combination with nonsteroidal anti-inflammatory drugs to enhance the analgesic effect and reduce the drug load.