Object of the study: the postovariectomic syndrome (POES) in female patients at the reproductive age. Purpose of the study: improvement of the methods for diagnosing metabolic-endocrine disturbances and elaboration of pathogenetic medical-prophylactic measures with respect to clinical manifestations and complications of POES in female patients at the reproductive age, who have undergone bilateral ovariectomy, as well as improvement of their life quality. Methods of the investigation: clinical; immunoenzyme; microbiological; instrumental – dopplerometry, uroflowmetry, digital roentgenological densitometry; statistical ones. Theoretical and practical results: as a result of the conducted study, an algorithm for examining women with POES was improved. This algorithm envisages a complex of clinical-laboratory and instrumental studies directed at the revealing of hormonal, lipid, immunological, microbiological, haemorheological, haemodynamic, urodynamic and osteopenic disturbances within different terms after bilateral ovariectomy and an assessment of the efficacy of their pharmacological correction. It is recommended that a scheme of examination of women with POES (especially during 6-12 months after the operation) should include determination of the concentration of the adrenocorticotropic hormone (ACTH), hydrocortisone and biogenic monoamines (adrenaline and serotonin) in order to timely diagnose hormonal-mediatory disturbances, which can cause secondary immunological insufficiency; but when the latter develops, it necessitates a profound immunological examination. The efficacy of using a tissue-selective regulator of estrogen activity as monotherapy only during the first year of POES was proved, when losses of the bone tissue are absent or moderate (from -1.0 to -2.5 SD), the concentration of total cholesterol is below 6.76 mM/l, that of cholesterol fraction in low density lipoproteins (LDL’s) < 2.6 mM/l and atherogenicity coefficient (AC) < 3.0. The efficacy of using an inhibitor of the endogenic synthesis of cholesterol (HMG-CoA reductase inhibitor), a bone tissue remodulator (the working base of the drug consists of the sodium salt (4-amino-oxybutidylen) of diphosphonic acid – sodium alendronate) and a drug which control calcium and phosphorus metabolism (it contains calcium carbonate and cholecalciferol) as additional therapy in female patients with the duration of POES over one year, as well as with densitometrical signs of a reduced mineral density of their bone tissue (2.5 SD and less), a tendency to hypercholesterolaemia with dyslipoproteinaemia and abundance of atherogenic substances (total cholesterol > 6.76 mM/l; LDL’s > 2.6 mM/l, AC > 3.0), therewith increasing the efficacy of dyslipidaemia correction by 45.4 % and the efficacy of the bone tissue remineralization by 48.8 %. Novelty: for the first time, an integral chronological assessment of the hormonal status state, lipid metabolism, haemostasis system, immunological reactivity and microbiocenosis in the urogenital tract, the circulation in the internal iliac arteries, urodynamics and mineral density of the bone tissue in women with POES was described. For the first time, it was revealed that the first six months following bilateral ovariectomy were characterized by the most critical reconstruction of the organism functions, when the natural adaptation increase in the level of gonadotropins (follicle-stimulating hormone and luteinizing hormone) was accompanied by a significant reduction in the content of ACTH with a resultant reliable increase of cortisone concentration (relative hypercorticism) with a tendency to a predominance of biogenic monoamines – stress reaction mediators. In his case, female patients with POES developed some inhibition of their cellular immunity with a tendency to an intensification of autoimmune processes and pathological biocenosis of the urogenital tract formed, it being characterized by the elimination of lactoflora, a high level of microbial contamination, polymicrobiosis with a prevalence of the anaerobic microflora component. Some intensification of the blood coagulation potential was revealed with a simultaneous decrease in the activity of antitrombin III, which causes a higher danger of the intravascular thrombogenesis. For the first time, it was found out that female patients with POES typically had urodynamical disturbances which, in combination with progressing atrophic processes in the urogenital tract against a background of secondary immunodeficiency, created favourable conditions for the infection persistence and serve as a basis for developing hyperreflex and/or stress incontinence, the latter significantly decreasing the woman’s life quality. In such cases, during the first postoperative year each fifth female patient developed osteopenia, and the rate of the bone mass loss could achieve 10 %. Degree of introduction: results of the research were introduced into the work of the Kharkiv Regional Hospital, the activity of female dispensaries of the municipal health care establishment (MHCE) “Maternity Home No. 1 of the Dzerzhinsky District” of the City of Kharkiv, MHCE Kharkiv City Polyclinic No. 3, MHCE “Kharkiv City Polyclinic No. 13”, MHCE “Kharkiv City Polyclinic No. 18”, municipal establishment “Zolochev Central District Hospital” and Dergachi Central District Hospital of the Kharkiv Region. Theoretical propositions and practical recommendations are used in the educational process of the Departments of Obstetrics and Gynaecology of Kharkiv National Medical University and Kharkiv Medical Academy of Postraduate Education, when studying relevant sections of obstetrics and gynaecology. Sphere of application: medicine, obstetrics and gynaecology.
