The study is devoted to improve 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 of this pathology. The results of the retrospective and clinical studies showed that the patients of the perimenopausal period (mean age - 50,9±4,6 years) make up 53,4±1,9 % of all patients with pathology of endo- and myometrium, aimed to the diagnostic curettage of the uterine cavity. In this case, the frequency of endometrial hyperplasia and adenomyosis combination is 46,6 % (216 cases). It is advisable to include such patients in the risk group of endometrial cancer, since more than a third of them (33,0±5,8 %) exhibit complicated atypical forms of hyperplasia (endometrial adenomatosis) and 65.6±1.8 % of cases of EP. In the presence of a clinical diagnosis of "leiomyoma of the uterus with hemorrhagic syndrome" in the period of perimenopause there is a high coefficient of diagnostic loading, as well as high frequency of detection of severe forms of atypical hyperplasia (AEH - 38,6±0,3 %) and EP - 71,3±0,3 %. It was found that among somatic diseases in perimenopausal patients with extragenital pathology and diseases of endo- and myometrium prevails: varicose veins of the lower extremities - 61 (61,0 %), arterial hypertension of 2-3 stages - 46 (46,0 %); coronary heart disease, angina pectoris - 8 (8,0 %); obesity - 43 (43,0 %), diseases of liver, gallbladder and pancreas - 52 (52,0 %). In 78,0 % of patients, somatic pathology was presented by two or more diagnoses. The author determines that the perimenopausal patients with pathology of endo- and myometrium and extragenital diseases has a maximum voltage of the hemostasis system, and the unstable equilibrium of hemostasis system parameters is inherent in the first phase (hypercoagulation) of the DIC syndrome. Disturbances in the system of vascular-thrombocyte linkage, which manifests itself in a significant decrease in platelet count to 159,5±12,7 109 / l and an increase in their aggregation capacity to 42,3±4,4 %. Changes in the fibrinolysis system are detected: a significant increase in plasma lysis (p<0,05) - from 154,3±9,1 sec in control to 213,9±11,2 seconds in patients, a decrease in AT-III (from 71,3±2,2 to 57,3±3,3 %), and, compared to healthy women, an increase of 3 times the soluble fibrin (+) - 3,9±0,4 (p<0,05), a positive reaction in the ethanol test is noted in 97,3 % of patients, which is significantly different from that of healthy women - 30,7 %. The results of immunohistochemical studies showed that the expression of steroid receptors in the endometrium is most active in the functional layer and decreases in the basal regions, the positive coloration around the centers of adenomyosis takes place in 70-80 % of cells on ER (the intensity of expression was 2+ and 3+) and up to 70 % cells in PR and 30 % in AR. According to the index of proliferation (Ki-67) it was determined that proliferative processes in myometrium around adenomyosis areas are significantly more developed than in submucous zones of myometrium.
