Flaksemberg M. Reproductive health of women with uterine leiomyoma (pathogenesis, molecular genetic mechanisms of development, treatment and rehabilitation).

This work is dedicated to improving the efficiency of diagnostics and treatment of reproductive age patients with uterine leiomyoma (UL) by optimizing the complex of diagnostic and treatment and prophylactic measures for the recovery of reproductive health, based on the study of genetic and molecular mechanisms of development, peculiarities of clinical course, hormonal and immune homeostasis, morphofunctional state of target organs and immunohistochemical markers of the pathological process. Uterine leiomyoma in the reproductive age group of women was found in 19.2 % of cases without a decreasing tendency. UL, which requires surgical intervention, is characterized by a younger age, the need for repeated hospitalizations, and more frequent coexistence with genital endometriosis and benign ovarian masses. The conservative group of women is characterized by a higher incidence of chronic inflammatory diseases of the pelvic organs (39.9 %), endometrial pathology (43.9 %), and cervical pathology (20.0 %). Infertility occurred in 40.6 % of women and depended on age, early manifestation of the disease and influence of a combination of factors. The presence of leiomatous nodules that deform the uterine cavity, over 30 mm in size, is critical for the viability of the pregnancy. The presence of concomitant inflammatory genital processes is one of the possible determinants of UL, favours 5 years earlier and more often leads to infertility (53.2 %). Women with reproductive uterine leiomyoma are characterized by cellular leiomyoma (56.7 %) and associated endometrial pathology (73.3 %) in morphological and immunohistochemical examinations of remote nodes, nerve damage to the receptors of estrogen (20-80 %) and progesterone (40-90 %), an increase in the distribution of Ki-67, TNF-α - in the proliferative phase of the cycle and a decrease in the secretory phase and the occurrence of p53 depending on the proliferative potential of the nodes and a significant presence of estrogen receptors.