Misyura A. Prevention of Metabolic Disorders in Women after Hysterectomy by Means of Individual Hormonal Therapy

The work is devoted to the grounding of differentiated prevention of metabolic disorders in women after hysterectomy depending of evidences and predictors of metabolic menopausal syndrome. The analysis of frequency and forms of metabolic disorders and predictors of metabolic syndrome has been carried out on the basis of examination of 180 patients with surgical menopause in premenopausal periods. Data concerning dynamics of development of metabolic menopausal syndrome have been extended. The role of availability of android obesity, impaired glucose tolerance, early changes of bone metabolism as predictors of metabolic syndrome in women after hysterectomy has been determined. Interconnection of bone metabolism dynamics depending on levels of sex steroid hormones, indices of glucose and lipid profile in women after hysterectomy has been specified. It has been established that there are signs of predictors of metabolic syndrome in 41.7 %, full form of MMS in 5.0 %, incomplete form of MMS - in 22.9 % of patients with benign tumour diseases of genital organs in premenopausal period. The main reasons of risk of menopausal metabolic syndrome development after hysterectomy are obesity, especially android one, arterial hypertension, menstrual disorder from the premenopausal period, burdened hereditary history, combination with physical pathology (hypertensive disease, kidney diseases, diabetes mellitus). The most prognostically unfavourable factors of deterioration of metabolic endocrine processes after hysterectomy are BMI exceeding 30kg per m2, visceral abdominal obesity and insulin resistance. Against the background of incomplete form of metabolic syndrome the level of intensity of further metabolic disorders after hysterectomy is determined by the nature of predictors, their duration, age of operative intervention carried out and its scope. It has been proved that total hysterectomy, with menopausal metabolic syndrome, provokes apparent and early changes of structural and functional state of bone tissue, which is confirmed by rapid increase of osteocalcin level in blood serum. With initial BMI over 30kg per m2, metabolic disorders are deepening within the first month of post-operational period (increase of glycaemia on an empty stomach and postprandial glycaemia, hypercholesterolemia, and dislipidemia development). Prognostic criteria and the most significant factors as to the development and progress of metabolic structural and functional disorders of bone tissue has been determined, which allows to qualitatively estimate the level of prognosticated risk, as well as resolve the issue of the necessity, term, and scope of preventive measures. The efficiency of methods of ultrasound densitometry and bone metabolism markers research when observing patients has been estimated; and the expediency of estrogen-gestagen therapy and phytoestrogens has been determined. Differentiated ways of correction, individual programs of prevention and treatment of menopausal metabolic disorders aimed at liquidation of hormonal dysfunction and delayed metabolic endocrine disorders have been developed on the basis of complex study of clinical hormonal peculiarities of surgical menopause in women with metabolic disorders. Individual regimen of prevention and therapy of metabolic disorders in women after hysterectomy in post-operational period has been developed and applied, which allowed improving the course of early and late post-operational period, quality of women's life. The efficiency of application of estrogen-gestagen therapy with metabolically neutral progestin and phytoestrogens from early terms of post-operational period has been proved. Early prescription of metabolically neutral estrogen-gestagen medicines (on 1-2 day) after total hysterectomy prevents progression or development of metabolic disorders and improves processes of bone tissue remodelling. Differentiated approaches to prevention and therapy of menopausal metabolic syndrome allow to achieve positive clinical effect in 91.2 % of cases.