Published August 31, 2020 | Version v1
Journal article Open

THE SUBSTANTIATION OF DIFFERENTIATED THERAPY OF THE COMBINED DISGORMONAL PATHOLOGY OF REPRODUCTIVE ORGANS IN WOMEN OF REPRODUCTIVE AGE WITH COMORBID CONDITIONS

Creators

  • 1. Lviv national medical University named Danylo Galitsky

Description

The objective: substantiation of the differentiated therapeutic approaches to the treatment of the combined dyshormonal pathology of the reproductive organs, taking into account the comorbidity of the patients.
Materials and methods. The study involved 300 women of reproductive age (20 - 42 years, an average of 29.9±5.6 years). The examination included ultrasonographic examination of the pelvic organs, mammary glands, thyroid gland, determination of the levels of pituitary tropic hormones and ovarian steroid hormones, thyroid hormones, antibodies to thyroperoxidase, serum levels 25 (OH) D.
Results. Obesity of varying degrees was observed in 31.0% of the patients examined. The prevalence of autoimmune thyroiditis in patients with a dyshormonal pathology of the reproductive system was 36.0%, and subclinical hypothyroidism was diagnosed in 21.3% of women, but among patients with autoimmune thyroiditis, the incidence of subclinical hypothyroidism was 59.3% with 3.7% of manifest hypothyroidism. Insufficiency of vitamin D was detected in 34.0% of patients with dyshormonal pathology, vitamin D deficiency in 44.3%, severe deficit in 21.7%. Сonclusions. The use of complex differentiated pharmacotherapy for treatment of combin dyshormonal pathology of reproductive organs with correction of comorbid states allows to achieve a higher efficacy in comparison with usual practice (normalization of MCs 97.2% at 73.3%, reduction of pain syndrome 94.7% at 60.6% and cyclic mastodynia – 93,9% at 43,9%, reduction of vegetative-vascular and non-specific symptoms – 94,8±3,9% at 24,3±16,7%), to reduce the frequency of relapses during 6 months of observation from 14, 5% to 4.1% (p=0.0128), to achieve the desired pregnancy without stimulants and the ART and ovulation in 64.1% of patients compared with 30.6% (p=0.0079) in case of usual practice.

Files

The substantiation of differentiated therapy of the combined disgormonal pathology of reproductive organs in women of reproductive age with comorbid conditions.pdf

Files (268.4 kB)

Additional details

References

  • Kiselev VI, Sidorova IS, Unanyan AL, Muizhnek EL. Hyperplastic processes of the organs of the female reproductive system: theory and practice. M.: Medpraktika-M, 2010: 468 p. (In Russ.).
  • Kryukova AA. Conservative treatment of the uterine hyperplastic processes against the background of thyroid pathology. Reproductive health of a woman. 2006; 2 (26): 93-96. (In Russ.).
  • Maruna P. Gynecological aspects of thyroid disorders. A review. Ceska Gynecol. 2006; 71 (4): 332–338.
  • Männistö T, Vääräsmäki M, Pouta A. et al. Thyroid dysfunction and autoantibodies during pregnancy as predictive factors of pregnancy complications and maternal morbidity in later life J. Clin. Endocrinol. Metab. 2010; 95(3): 1084-1094.
  • Chernukha GE, Dumanovskaya MR. Modern ideas about endometrial hyperplasia. Obstetrics and gynecology. 2013; 3: 26-32. (In Russ.).
  • Grigorenko AN. Hyperplasia of the endometrium: there are more questions than answers. Reproductive endocrinology. 2017; 3 (35): 31-43. (In Russ.).
  • Holick MF, Binkley NC, Bischoff-Ferrari HA, Gordon CM. et al. Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society clinical practice guideline. J. Clin. Endocrinol. Metab. 2011; 96 (7): 1911–30.
  • Holick MF, Chen TC. Vitamin D deficiency: a worldwide problem with health consequences. The American journal of clinical nutrition. 2008; 87 (4):1080S–1086S.
  • Mithal A, Wahl DA, Bonjour JP, et al. Global vitamin D status and determinants of hypovitaminosis D. Osteoporos Int. 2009; 20:1807–20.
  • Buggio L, Roncella E, Somigliana E, Vercellini P. Vitamin D and benign gynaecological diseases: A critical analysis of the current evidence. Gynecol Endocrinol. 2015;16:1-5.
  • Palacios С, Gonzalez L. Is vitamin D deficiency a major global public health problem? J Steroid Biochem Mol Biol. 2014;144.Pt A:138-145.
  • Radzinsky BE, Ordiyants IM, Maslennikova MN, Pavlova EA. Mammary glands and gynecological diseases: from the generality of pathogenetic views to practical solutions. Reproductive endocrinology. 2014; 2 (16): 72-80. (In Russ.).
  • Belyalov FI. Twelve theses of comorbidity. Clinical medicine. 2009; 12: 69-71. (In Russ.).
  • Gubanova GV, Belyaeva UN, Shemetova GN. Comorbid patient: stages of formation, risk factors and tactics of reference. Modern problems of science and education. 2015; 6: 10-13. (In Russ.).
  • van Weel C, Schellevis FG. Comorbidity and guidelines: conflicting interests. Lancet. 2006; 367: 550-551.
  • Shoelson SE, Herrero L, Naaz A. Obesity, inflammation, and insulin resistance. Gastroenterol. 2007;132:2169-2180.
  • Redmond GP. Thyroid dysfunction and women's reproductive health. Thyroid. 2004; 14 (1): 515.
  • Walsh JP, Bremner AP, Feddema P. et al. Thyrotropin and thyroid antibodies as predictors of hypothyroidism: a 13-year, longitudinal study of a community-based cohort using current immunoassay techniques J. Clin. Endocrinol. Metab. 2010; 95(3): 1095-1104.
  • Brabant РG, Duntas L, Monzani F et al. Management of Subclinical Hypothyroidism 2013 ETA Guideline. Eur. Thyroid. J. 2013; 2: 215-228.
  • Alexander EK, Pearce EN, Brent GA,. Brown RS, et al. 2017 Guidelines of the American Thyroid Association for the Diagnosis and Management of Thyroid Disease During Pregnancy and the Postpartum. Thyroid. 2017; 27 (3): 315-389. DOI: 10.1089/thy.2016.0457.
  • Food and Drug Administration, HHS, et al. Food Labeling: Revision of the Nutrition and Supplement Facts Labels. Final rule. Federal Register. 2016; 81 (103): 33-741. URL: https://www.federalregister.gov/documents/2016/05/27/2016-11867/food-labeling-revisionof-the-nutrition-and-supplement-facts-labels#h-127.
  • Hossein-Nezhad A., Holick M.F. Vitamin D for health: a global perspective. Mayo Clin Proc. 2013; 88 (7): 720–55.
  • Holick MF. Vitamin D is not as toxic as was once thought: a historical and an up to-date perspective. Mayo Clin. Proc. 2015; 90: 561–4.