Kovalenko E. Clinico-pathogenetic basis of approaches to the treatment of women with endometrial hyperplasia.

The dissertation is devoted to the substantiation of approach to optimize the diagnosis and treatment of severe forms of endometrial hyperplasia by studying changes in the morphofunctional state of the endometrium, local and systemic hormonal homeostasis, components of the protease-inhibitor system and proinflammatory cytokines. It is shown that inflammation plays an important role in the development of severe forms of endometrial hyperplasia and therefore the results can be interpreted such as formation of inflammation associated with endometrial hyperplasia. The nature and severity of inflammatory changes can be investigated by the level of CD45+ expression during the immunohistochemical study, by the level of proinflammatory cytokines, nonspecific proteinases and their inhibitors in uterine washings, the determination of which was proposed as additional criteria for minimally invasive diagnosis and prognosis of endometrial pathology. Based on the inflammatory changes it was shown that the use of systemic and intrauterine methods of hormonal therapy in patients with complex endometrial hyperplasia lead to reduce levels of cytokines, the activity of proteases and normalization of hormonal levels. The level of the normalization of local markers allowed to recommended the use of GnRH agonists and combined oral contraceptives for the treatment severe forms of endometrial hyperplasia. Treatment of women with complex endometrial hyperplasia by using of this complex showed a decrease of the recurrence on 21,4% within 12 months compared with the use of progestogens.