Chumak Z. Microcirculatory-tissue, cellular and endocrine factors in the development of proliferative processes of the endometrium in the perimenopausal period

The thesis for a scientific degree of doctor of medical sciences by specialty 14.01.01 – Obstetrics and Gynecology. – The Odessa National Medical University of the Ministry of Health of Ukraine, Odessa, 2021. The thesis, on the basis of complex retrospective and prospective researches, gives a new concept of development and progression of hyperplastic processes of the endometrium according to age categories. The majority of pathological manifestations were detected in the perimenopausal period, which was for endometrial hyperplastic processes (EHP) – 15.31%, atypical endometrial hyperplasia (AEH) – 1.42% and the first episodes of detection of endometrial adenocarcinoma – 0.43% with increasing of age. Further study revealed an increase in the relationship between average duration of daylight hours and AEH (r=0.41). The manifestations of reproductive system disorders in patients, their relationship with the development of family history and the presence of comorbid pathology, which in combination leads to pathological conditions in the endometrial tissue. Examination of patients included morphological, immunohistochemical, molecular genetic, taking into account markers: age, endometrial tissue condition, ER, PR, Ki-67, p53, bcl-2, Hif-1α, VEGF, IGF-1, telomerase activity and telomere length. The importance of apoptotic processes in the development of EHP and AEH, and the influence of reduced tissue oxygenation are shown. The obtained results allow to expand the idea of cellular and tissue homeostasis in dyshormonal changes and use in the differential diagnosis of EHP and AEH. The distribution of these factors was introduced into a mathematical model that allows the calculation of recurrence and surgery for a particular patient in order to maintain the quality of life. Key words: endometrial hyperplasia, atypical endometrial hyperplasia, Ki-67, p53, bcl-2, Hif-1α, VEGF, IGF-1, telomere, telomerase.