Dissertation for the degree of Doctor of Philosophy in the field of knowledge 22 "Health care" in the specialty 222 "Medicine" - State institution "Institute of Pediatrics, Obstetrics and Gynecology named after Academician O.M. Lukyanova National Academy of Sciences of Ukraine", Kyiv, 2024.
The results of clinical-statistical and sociological studies have found that 40% of active smoking women had been engaging in this harmful habit for a maximum of 3 years (40.0%).
Among women exposed to passive smoking, the largest proportion by duration of exposure to smoking were those affected for 1 month (26.6%) and 3 years (33.3%).
It was found that nearly half of the women active smokers (48.6%) smoke between five to ten or more cigarettes a day.
In these women: active smokers most commonly suffered from chronic inflammatory diseases of the reproductive organs (CIDRO) - 66.6%, in passive smokers - 33.3% of cases, and in women who quit smoking – 20.0% of cases; menstrual cycle (MC) disorders were observed in 53.3% of women, in 33.3% of women, and in 20.0% of women, respectively.
In active smoking women, the concentration of gram-positive staphylococci and streptococci was registered within the range of lg4.0 CFU/ml to lg4.5 CFU/ml, intestinal microflora - from lg3.9 CFU/ml to lg4.8 CFU/ml, fungi of the genus Candida - lg4.2 CFU/ml, bacterial vaginosis in 20%, chlamydia in 10%, ureaplasmosis in 15%. The genital herpes virus was present in 15% of women.
The study confirmed a significant increase in levels of immunoglobulins G, A, M, and lysozyme in women with inflammatory diseases against the background of smoking.
Analysis revealed MC disorders and changes in the levels of gonadotropic and sex hormones, particularly an increase in follicle-stimulating hormone, luteinizing hormone (LH), indicating a hormonal regulation imbalance of the reproductive system.
The concentration of LH in active smoking women in the first phase of the MC was significantly different from the indicators in passive smoking women.
An increase in stress-associated hormones prolactin and cortisol was noted in active smoking women. They exhibited significant psycho-emotional disorders, such as increased nervousness and emotional exhaustion.
An increased frequency of cervical pathologies in smokers with sexually transmitted infections (STIs) was observed.
A decrease in the concentration of malondialdehyde and hydroperoxides was found, indicating oxidative stress in smoking women with STIs.
Grounded diagnostic methods and optimized tactics of treatment and prevention of inflammatory diseases of the reproductive organs in women of fertile age (WFA) caused by STIs against the background of smoking were proven to be highly effective.
Scientific novelty of the research.
The comprehensive studies conducted allowed us to identify the modern etiological factors of CIDRO in WFA caused by STIs and to determine the main pathogenetic mechanisms of reproductive health disorders against the background of smoking. For the first time, based on clinical-statistical and sociological studies conducted in such women, the peculiarities of the course of CIDRO caused by STIs were defined.
Based on the assessment of the state of various organs and systems of the body in the examined women and the conducted general clinical, biochemical, microbiological, hormonal, psychological, morphological, and statistical studies, pathogenetic interrelations between CIDRO, the state of reproductive health, and smoking were determined.
Considering the obtained results, the methods of diagnostics, treatment, and prevention aimed at improving the reproductive health of such women were optimized.
Practical significance of the obtained results.
WFA with CIDRO caused by STIs against the background of smoking require regular screenings and monitoring of the urogenital microbiota, monitoring of immune status indicators, assessment of the hormonal state with the determination of pituitary gonadotropins, sex hormones, and stress-related hormones.
WFA with CIDRO caused by STIs against the background of smoking need regular psychological consultations and psycho-emotional relief to overcome stress-related changes.
The conducted studies have optimized the diagnosis, treatment, and prevention of inflammatory diseases of the reproductive organs in WFA caused by STIs against the background of smoking.
The dissertation research has been implemented in practical activities and the educational process of medical and educational institutions in Ukraine.
Validation of the dissertation results.
The main provisions of the work were reported and discussed at scientific conferences: 2022, Zaporizhzhia, 2022, Kyiv, 2022, Ternopil, 2022, Kyiv, 2023, Kyiv, 2023, Zaporizhzhia.
