Endometrial hyperplasia is the main form of hyperproliferative diseases of the uterine mucosa, which has a long, recurrent course, the absence of specific, pathognomonic symptoms, the complexity of diagnosis and the risk of malignancy. The work presented at the modern methodological level provides a new solution to the current task of gynecology to improve the effectiveness of treatment of nonatypical endometrial hyperplasia (NEH) in women with infertility and with excess body weight. The purpose of the study was to increase the frequency of restoration of reproductive function in infertile women with atypical hyperplasia of the endometrium and excess body weight on the basis of obtaining new scientific data on the peculiarities of hormonal, carbohydrate and adipokine metabolism, the morphofunctional state of the endometrium and the development of a combined complex method of treatment of this pathology. To solve the set goal, the following research tasks were solved: 1. Based on a retrospective analysis, establish the risk factors of complex atypical endometrial hyperplasia in overweight women and evaluate the effectiveness of its treatment with various pharmacotherapeutic approaches. 2. To determine the peculiarities of hormonal, carbohydrate and adipokine homeostasis in patients with infertility against the background of atypical hyperplasia of the endometrium and excessive body weight. 3. To determine the differences in the formation of foam pods in the endometrium in women with infertility against the background of atypical hyperplasia of the endometrium and excessive body weight. 4. To reveal the peculiarities of the expression of steroid receptors and implantation molecules in women with infertility against the background of atypical hyperplasia of the endometrium and excessive body weight. 5. To study the distinguishing features of indicators of immune reactivity in the endometrium in patients with infertility against the background of atypical hyperplasia of the endometrium and excessive body weight. 6. To investigate the indicators of proliferative and apoptotic reactivity in the endometrium in patients with infertility against the background of atypical hyperplasia of the endometrium and the presence of excessive body weight. 12 7. At the first stage, a retrospective analysis of 96 outpatient cards and medical histories of women of the P group with infertility, excess body weight and complex NEH and 87 outpatient cards of fertile healthy women of the K1 group with excess body weight was carried out to identify risk factors for the development of complex NEH in overweight women body and evaluation of the effectiveness of NEH treatment and restoration of reproductive function in this pathology, depending on the used hormonal agent - progestogens or aHnRH. At the second stage, 118 infertile women with complex NEH of the NEH group and 30 conditionally gynecologically and somatically healthy women of the K2 group were comprehensively examined. In the NGE group, 74 women of group A had excess body weight and 44 people of group B had a normal BMI. At the third stage, a pathogenetically justified method of combined staged treatment of NEH in infertile women with excessive body weight, which preserves fertility, with hysteroscopy, and complex postoperative staged use of aGnRH, LNGIUS, drugs indole-3-carbinol, myo-inositol was developed and applied metformin and agonists of PPARα and PPARγ receptors. At the fourth stage of the study, the results of the application of the developed method of treatment of complex NEH in patients with infertility and excess body weight were evaluated compared to the use of only aGnRH, dydrogesterone and folic acid preparations as drug therapy. 13 The following research methods were used in the work: general clinical, bacteriological, instrumental (ultrasound examination, hysteroscopy, paypel endometrial biopsy, hysterosalpingography), immunochemical, morphological, immunohistochemical, scanning electron microscopy, statistical. It was determined that among women of active reproductive age with excessive body weight, the risk factors for NEH are: menarche age 10-11 years (OR 13.39 [3.05-58.73]); duration of menstrual bleeding ≥ 6 days (OR 36.35 [14.15-93.38]); heavy menstruation (OR 3.42 [1.69-6.90]); dysmenorrhea (OR 3.73 [1.82-7.64]); irregular menstruation (OR 38.55 [2.28- 651.17]); transferred urogenital infections (SS 142.29 [8.58-2360]); chronic salpingo-oophoritis (OR 84.16 [5.06-1400]); leiomyoma of the uterus (SS 38.52 [2.28-651]); genital endometriosis (OR 30.76 [1.81-524]); PCOS (SS 33.82 [1.96- 565]). Treatment is ineffective in 17.71% of cases, among which 8.17 times more often when treated with oral or injectable progestogens compared to GnRH agonists (OR 3.31 [1.17-9.41]). Over the course of a year, relapse of the disease after treatment with GnRH agonists is 2.56 times less frequent (OR 0.11 [0.02-053]), and pregnancy occurs 2.56 times.
