Dinnik V. Pubertal uterine bleeding: clinical aspect, pathogenesis, treatment, and prognosis.

The thesis dwells upon preserving reproductive health in adolescent girls and presents a new solution of the scientific problem of uterine bleeding (UB) mechanisms development in puberty, which is considered to be a prerequisite for employing new pathogenetic treatment methods. A study of peculiarities in the central mechanisms of menstrual function regulation was performed in adolescent girls with pubertal uterine bleeding (PUB), as dependent on changes in the pituitary-ovaries system with subsequent comparison of the revealed hormonal changes with the peculiarities in their clinical manifestations. On the basis of an integrated examination of the patients there was proved the availability of PUB clinical polymorphism and substantiated the expediency of distinguishing 3 variants of the disease clinical course. The thesis provides an original scientific substantiation of catecholamines, serotonin, PG, oxytocin, and PRL regulatory role in formation of PUB different variants. For each clinical group of the patients there were worked out models of hypothalamus-hypophysis-gonads interrelations which testified to different mechanisms of PUB development in pubertal patients. The fundamental investigations revealed some peculiarities in formation of different clinical variants in PUB course and made it possible to improve nonhormonal methods for UB treatment at puberty, having incresed their effectiveness significantly. There were determined the most informative clinico-anamhestic hormonal and biochemical criteria correlated with the effectiveness of the prescribed nonhormonal therapy. It was proved that nonhormonal therapy employment at puberty was most physiological and was accompanied by positive changes in hormonal status. On the basis of catamnestic observations there was confirmed the necessity to give preference to nonhormonal therapy at puberty. There was singled out a combination of clinico-hormonal sings which became prognostic criteria as regards PUB consequences. An algorithm for prognosticating the risk of recurrent bleeding was worked out, which was very important for determining the regularity of medical observation already at early stages of the disease onset.