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Purpose of the study: to examine the morphological and immunohistochemical features of the endometrium in postmenopausal women with uterine bleeding, depending on body weight and metabolic syndrome.Materials and methods. The study included 114 women with postmenopausal uterine bleeding. Women were divided into 3 groups. Group I included 41 patients with overweight and obesity class I–II, group II – 43 women with metabolic syndrome, group III (control) consisted of 30 patients with normal body weight. Hysteroscopy with morphological analysis of biopsied material was performed for all patients of groups I and III and 41 patients of group II. Pathohistological and immunohistochemical analysis were used to diagnose endometrial pathology. The level of cell proliferation in the endometrium was assessed by immunohistochemical analysis using monoclonal antibodies for Ki-67 expression; antiapoptotic activity was determined by the Bcl-2 and COX-2 expression.Results. Endometrial pathology was diagnosed in 94.74% of women. Endometrial polyps in the structure of the identified pathologyprevailed in group I and control group III (82.93% and 83.33%, respectively), while endometrial polyps were detected in 25.59% of women in the group II. Endometrial hyperplasia was diagnosed in the vast majority (69.76%) in group II, hyperplasia without atypia was detected in 51.16% and endometrial hyperplasia with atypia in 18.60%.Conclusions. Endometrial hyperplasia value was higher in postmenopausal women with metabolic syndrome compared to patients with normal weight, overweight and obesity. There was an increase of Ki-67, Bcl-2 and COX-2 expression in the endometrial glands in women with metabolic syndrome in comparison to patients with normal weight and obesity, for which only increased Bcl-2 expression in the stroma was observed. This confirms the existing data on the predominance of the apoptosis inhibition over proliferation in the formation of endometrial diseases in the postmenopausal period and confirms the combination of hyperproliferative processes and apoptosis inhibition if there is metabolic syndrome.
Purpose of the study: to examine the morphological and immunohistochemical features of the endometrium in postmenopausal women with uterine bleeding, depending on body weight and metabolic syndrome.Materials and methods. The study included 114 women with postmenopausal uterine bleeding. Women were divided into 3 groups. Group I included 41 patients with overweight and obesity class I–II, group II – 43 women with metabolic syndrome, group III (control) consisted of 30 patients with normal body weight. Hysteroscopy with morphological analysis of biopsied material was performed for all patients of groups I and III and 41 patients of group II. Pathohistological and immunohistochemical analysis were used to diagnose endometrial pathology. The level of cell proliferation in the endometrium was assessed by immunohistochemical analysis using monoclonal antibodies for Ki-67 expression; antiapoptotic activity was determined by the Bcl-2 and COX-2 expression.Results. Endometrial pathology was diagnosed in 94.74% of women. Endometrial polyps in the structure of the identified pathologyprevailed in group I and control group III (82.93% and 83.33%, respectively), while endometrial polyps were detected in 25.59% of women in the group II. Endometrial hyperplasia was diagnosed in the vast majority (69.76%) in group II, hyperplasia without atypia was detected in 51.16% and endometrial hyperplasia with atypia in 18.60%.Conclusions. Endometrial hyperplasia value was higher in postmenopausal women with metabolic syndrome compared to patients with normal weight, overweight and obesity. There was an increase of Ki-67, Bcl-2 and COX-2 expression in the endometrial glands in women with metabolic syndrome in comparison to patients with normal weight and obesity, for which only increased Bcl-2 expression in the stroma was observed. This confirms the existing data on the predominance of the apoptosis inhibition over proliferation in the formation of endometrial diseases in the postmenopausal period and confirms the combination of hyperproliferative processes and apoptosis inhibition if there is metabolic syndrome.
The article presents data from guidelines, consensus and literature sources on the modern point of view regarding to the pathogenesis, diagnosis and principles of treatment of women with polycystic ovary syndrome. It is a systemic pathology that occurs in women of any age, from puberty to menopause, involving almost all systems of the body in the process. The work focuses on the variability of the clinical manifestations of this syndrome, which is characterized by menstrual irregularities, infertility, polycystic changes in the ovaries according to ultrasound, dermatopathies and metabolic disorders. The main purpose of diagnosing the syndrome is to determine the severity of clinical manifestations, the sources and pathogenesis of androgen hyperproduction, the impact on reproductive function, as well as the assessment of metabolic and cardiovascular risks. Given the multifaceted clinical manifestations, the management of women with polycystic ovary syndrome requires a multidisciplinary approach, and pathogenetic therapy should include normalization of the hormonal profile and menstrual function, treatment of dermatopathies, correction of metabolic disorders, treatment of infertility (if pregnancy is relevant), etc.
The objective: on the basis of a comprehensive examination of women of reproductive age to establish the frequency of phenotypes (clinical variants) of polycystic ovary syndrome (PCOS).Materials and methods. 34 patients (main group) who complained of menstrual disorders and/or dermatopathies by recommendation of a dermatologist were examined. The control group is represented by 30 women without gynecological and somatic pathology. The mean age of women in the main group was 26,4±0,9 years and 29,1±0,9 years in the control group (p>0,05). The age of women in the study groups ranged from 18 to 35 years. Patients underwent a comprehensive examination to assess the severity of hirsutism and the severity of acne, as well as the body mass index was determined. All women underwent ultrasound examination in the dynamics and quantitative assessment of the concentration of hormones in the blood plasma, namely cortisol, thyroid-stimulating hormone, prolactin, free testosterone and its index, androstenedione, dehydroepiandrosterone sulfate, 17-α-OH-progesterone, sex hormone binding globulin. Variation-statistical processing of the results was carried out using the program «STATISTICA 13».Results. The results of the conducted research show that 73,5% had menstrual irregularities, and 52,9% – infertility. Acne and hirsutism in every 3rd woman were combined and were diagnosed in 47,1% and 41,2% of women, respectively. Ultrasound signs of polycystic ovaries were found in 94,1% of patients according to the criteria for the diagnosis of PCOS, and in 88,2% – anovulation. According to the laboratory examination, hyperadrogenism was found in 55,9%, which is confirmed by statistically significant (p<0,05) predominance in the main group compared with the control group of androstenedione, free testosterone and its index. In addition, it should be noted statistically significant (p<0,05) higher levels of 17-α-OH-progesterone and prolactin in the main group, but their indicators were within the reference values of the norm. Analyzing the frequency of phenotypes (clinical variants) of PCOS, it was found that phenotype A (classical) occurred in 32,4%. Phenotype B (incomplete classical) was diagnosed in 14,7%, and phenotype C (ovulatory) – only 8,8%. The most often, namely in 15 (44,1%) women with PCOS, the phenotype D (non-androgenic) was established.Conclusions. The results of the conducted research show that in women with PCOS clinical symptoms are characterized by menstrual dysfunction (73,5%), infertility (52,9%) and dermatopathies, namely acne (47,1%) and hirsutism (41,2%). According to the laboratory exanination, hyperadrogenism was found in 55,9%, which is confirmed by statistically significant (p<0,05) predominance in the main group compared with the control group of androstenedione, free testosterone and its index. Among the clinical variants of PCOS, the non-androgenic phenotype (phenotype D) was the most often diagnosed, the frequency of it was 44,1%. Classical (phenotype A) and incomplete classical (phenotype B) were found in 32,4% and 14,7%, respectively. It should be noted that only 8,8% of women with PCOS are diagnosed with phenotype C (ovulatory).
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