Kurichova N. The specific of pathogenesis, diagnostics and treatment of uterine bleedings in perimenopausal period.

The dissertation is devoted to the actual scientific and a practical topic ? clarification of features of pathogenesis, diagnostics and treatment of uterine bleeding in perimenopausal period. In the pathogenesis of endometrial hyperplasia the principal place is given an absolute or relative hyperestrohenemia and the complex neuroendocrine, metabolic and immune disorders. The study of molecular determinants of endometrial proliferative process in perimenopausal period will contribute the diagnostics and treatment among this category of patients and will improve the quality and duration of women's lives. Based on the complex of immunohistochemical studies for the first time we studied the structural and functional mechanisms of uterine bleedings in the endometrial hyperplastic process among perimenopausal women. We made the assesment of the intensity of proliferative activity and endometrial nuclear cells ploidy in the pathomorphological material among patients with different clinical and morphological variants of endometrial hyperplasia with uterine bleedings. It was defined first the possible pathogenic determinants of the origin and development of uterine bleedings with hyperplastic endometrial process among women in perimenopausal period. On the basis of markers apoptosis activity and proliferative activity (р27 and p53), receptors of nuclear cells and stroma we tried to deepen new pathogenic understanding of the development of uterine bleedings among perimenopausal patients with hyperplastic endometrial process. It was shown that the decreasing of apoptosis factors and increasing of proliferative factors among patients with nontypical endometrial hyperplasia were connected with the decreasing of receptors on estrogen and progesterone. The complex of morphological and immunohistochemical studies so as the identification of the proliferative activity and endometrial nuclear cells ploidy allowed to develop new medical diagnostic algorithm of treatment of uterine bleedings among perimenopausal patients with hyperplastic endometrial process based on the developed differential choice of treatment.