In order to increase the efficiency and reduce the frequency of complications after the treatment of endo- and myometrium combined pathology in late-reproductive patients due to optimization of approaches and conducting organ-saved intrauterine cryosurgery based on the results of clinical-laboratory, hardware and morphological studies, 150 patients were examined and treated. Research methods, which were used: clinical-anamnestic, microscopic, pathomorphological, immunohistochemical, immuno-enzymatic, microbiological, hemostasis, hardware, statistical. Based on the results of a retrospective analysis of clinical, ultrasound and pathomorphological research of histological material from 1259 patients with pathology of endo- and myometrium, it was determined that 46.94 % of patients in late reproductive period constituted 36.9 % of all subjects. In this case, the presence of a combination of hyperplastic processes of endometrium and adenomyosis in patients of late reproductive age was established in 216 (46.6 %) cases. These results served as the basis for the choice of study subjects. It has been determined that anemia, diseases of the gastrointestinal tract, heart disease and hypertension, varicose of the lower extremities veins, endocrine pathology (obesity, diffuse euthyroid goiter) predominate among somatic diseases in patients with pre-tumor diseases of the endometrium and adenomyosis. Features of the reproductive history of such patients are: early menarche, a large number of pregnancies, most of which ended in induced abortions, the presence of leiomyomas of the uterus. It has been shown that thrombofilically significant risk factors for thromboembolic complications in women with endometrial hyperplasia and adenomyosis include: age over 40, smoking, taking hormonal medicaments, leiomyoma and uterine adenomyosis, cardiovascular disease (hypertension, varicose veins), and another severe extragenital pathology. Detection of these factors in combination with disorders in the hemostasis system (vascular-thrombocytal link, plasma hemostasis and the system of fibrinolysis) indicates an average and high risk of thromboembolic complications and requires thromboprophylaxis. The estimation of blood flow velocities in the uterine and internal iliac arteries showed a decrease in both systolic and diastolic blood flow velocity and increase of peripheral resistance rate. In the subendometrial arteries, the picture is directly opposite: a decrease in peripheral resistance and an increase in systolic and diastolic velocity of blood flow. 17 The combined pathology of endo- and myometrium is accompanied by a high level of infection with aerobic (Echerichia coli, Staphylococcus epidermidis, Corinebacterium species, Staphylococcus aureus) and anaerobic (Gardnerella vaginalis, Bacteroides species, Bacteroides Melaninosenicus, and Peptococcus species) pathogens of UGI. There is a high frequency of microbial associations (up to 66.0 %). In the pathogenesis of clinical manifestations of endometrial patology and adenomyosis, mollikuts and obligate intracellular parasites are important because in this pathology, a high incidence of Ureaplasma ur. (23.0 %), Micoplasma vag. (17.0 %), Chlamidia tr. (14.0 %) and Trichamonas vag. (9.0 %) is observed. Immunohistochemical studies (determination of receptors for estrogen (ER), progesterone (PR), androgen (AR), proliferative process activity (Ki-67) in myometrium) revealed a positive coloration of 70-80 % of cells on ER in the vicinity of the centers of adenomyosis (expression intensity was 2 + and 3+), up to 70 % of cells in PR and 30 % in AR. At the same time, according to the index of proliferation (Ki-67) it was determined that proliferative processes in myometrium around the areas of adenomyosis are significantly more developed than in the submucous zones of myometrium. The immune-enzyme (determination of CA-125) showed a significant increase (p <0,05) in the concentration of CA-125 in the case of adenomatosis with adenomyosis. The obtained results indicate the need for more radical treatment (cryosurgery) in the indicated patients, followed by careful observation after surgery. The analysis of the results of clinical, laboratory, instrumental, bacteriological and immunohistochemical studies, determination of the state of the hemostasis system before and after 1, 3 and 6 months after endocryosurgical treatment of endometrial pathology in combination with adenomyosis showed that the method of treatment and prevention of thromboembolic and inflammatory complications in the that patients are highly effective. The criteria for effectiveness are: the absence of complaints, which characterise the precancerous diseases of the endometrium and adenomyosis (pain, hemorrhagic syndrome, etc.), the absence of complaints during the bimanual examination, the reduction of the size of the uterus according to the palpation data and ultrasound, the thickness of the endometrium 3-4 mm, negative results of the pathomorphological investigation of the uterine cavity aspirates. After 6 months, the efficacy of treatment, according to clinical data and ultrasound results was 85.0 %, prevention of thromboembolic and inflammatory complications - 100 % of cases
