Chernukha L. Optimization of pre-gravid training of women with menstrual cycle disorders against the background of hypoandrogenism

The dissertation work is devoted to increasing the effectiveness of pre-gravid preparation of women of reproductive age with hypoandrogenic provision of the hormonal background of the reproductive system by evaluating changes in clinicalinstrumental and hormonal researches, as well as improving the management of this category of patients. The following tasks were defined in order to solve the set goal: to study the reasons for the unsatisfactory results of the existing methods of pre-gravid preparation of women of reproductive age with a violation of the menstrual cycle; to find out the role of functional hypogonadism in the formation of a hypoandrogenic background of hormonal support in women with a violation of the menstrual cycle; to determine the features of the receptor potential of the lower part of the reproductive tract of women with hypoandrogynism; to improve and show the effectiveness of the algorithm of diagnostic and treatment-prophylactic measures in women of reproductive age with a violation of the menstrual cycle against the background of hypoandrogenism. The object of research is hypoandrogenism and menstrual cycle disorders. The subject of the research is ovulation, female sexual dysfunction, effectiveness and timing of pre-gravid measures. Research methods are clinical, biochemical, cytological, microbiological, morphological and statistical. The main links of the pathogenesis of menstrual cycle disorders and miscarriage in women with hypoandrogenism have been established, which consist in the negative impact of pituitary dysfunction with a decrease in LH levels and suppression of DHEA-S and free testosterone indicators, which are accompanied by ovulation disorders, the formation of female sexual dysfunction (FSD) (hypolubrication) and early gestational losses. The proof of such an influence was revealed by a direct, highly strong correlation between the DHEA-S index, a violation of the menstrual cycle (anovulation) (r = 0.79, p<0.001) and a negative correlation between pregnancy and FSD (r = -0.35, p<0.05), as well as between menstrual cycle disorder and FSD (r = +0.39, p<0.05). It has been shown that functional hypoandrogenemia is the result of a combination of comorbid diseases of the endocrine and immune systems, avitaminosis (deficiency/insufficiency of vitamin D) and hyperhomocysteinemia. Based on the obtained data, it was possible to improve the management algorithm of women with hypoandrogenism due to the appointment of personalized drug therapy. The most significant clinical, instrumental and microbiological markers for monitoring the effectiveness of the proposed algorithm were established. The clinical and anamnestic characteristics of women with hypoandrogenism were studied and the leading risk factors of the gestational process were established. All studies were planned and conducted for the period from 2021 to 2024. The author conducted a retrospective analysis of early pregnancy loss (stage I) in 69 women with early pregnancy loss and female sexual dysfunction, the control group consisted of 32 women with a history of early pregnancy loss, without female sexual dysfunction. At the II stage (prospective), a clinical, laboratory and functional examination of 120 women was carried out, of which 90 were biochemically diagnosed with hypoandrogenism: of these, 45 women received the therapy recommended by the author, 45 received traditional prepregnancy therapy; the control group was 30 healthy women. The author independently collected and prepared biological material. The author wrote all sections of the dissertation, formulated conclusions, improved the algorithm of treatment and preventive measures. The author carried out statistical processing of the obtained results. The materials of the dissertation are presented in scientific works published independently, in a co-authored publication, the contribution of the dissertation was decisive, as well as in the part of introductory acts related to scientific and practical novelty.