Shapoval Y. Optimization of diagnostics and treatment of combined pathology of the uterus and mammary glands in women of reproductive age

The work was carried out on the basis of the KNP «City Maternity Hospital No. 3» during 2016 – 2024. The study included 90 patients with hyperplastic processes of the endometrium and benign diseases of the mammary glands. The aim of the dissertation was to optimize and improve the diagnosis and treatment of patients with endometrial hyperplastic processes and to develop a comprehensive therapy for benign breast diseases. The study included 90 women aged 18 to 47 years. The main group (30 patients – 33,3% of the total number of patients) consisted of patients diagnosed with GPE and benign breast diseases. The comparison group consisted of patients diagnosed with GPE without concomitant breast pathology (30 patients – 33,3%). The control group included 30 healthy women. Differential diagnosis by age showed that endometrial hyperplasia without atypia is observed in women of early fertile age - 23.3% and late fertile age - 26.7%, while in patients of middle fertile age this indicator was 33.3%. Complaints of bloody vaginal discharge were equally observed both in the development of isolated endometrial hyperplasia and in the combined pathology of GPE with the development of mastopathy, but the intensity of these discharges was higher in patients with combined pathology (P<0,05). In addition, in women with combined endometrial hyperplasia and mastopathy, the number of spontaneous miscarriages increased and the frequency of pregnancies and childbirth decreased. Analysis of the microbiota in endometrial samples from patients with GPE and concomitant proliferative processes in the mammary glands showed dysbacterial disorders in the endometrium: a decrease in the concentration of lactobacilli was observed, an increase in the concentration of Enterobacteriaceae, Staphylococcus spp. and new species of microorganisms were detected - Prevotella spp., Mobiluncus spp. Scientific novelty of the results obtained. For the first time, it was clarified that the pathogenetic mechanisms of the development of HPE and mastopathy in women of reproductive age are associated with hormonal imbalance of the pituitary-ovarian system. A connection between the form of hyperplasia and the receptor phenotype of the endometrium was revealed. It was found that women with GPE and benign breast tumors have disturbances in immunological homeostasis, which was characterized by an imbalance in the subpopulation content of T cells, a decrease in the average values of the number of T lymphocytes (CD3+), T suppressors (CD8+), T helpers (CD4+), which was accompanied by a decrease in the CD4+/CD8+ ratio and indicates the formation of secondary immunodeficiency. It has been shown that when endometrial hyperplasia develops in a woman's body, an effective treatment regimen is the use of medroxyprogesterone and gonadotropin-releasing hormone analogues. In women in whose body benign breast tumors are diagnosed along with GPE, the use of Danazol is effective. Practical significance of the results obtained. The feasibility of determining reproductive and thyroid hormones, as well as estrogen and progesterone receptors for early diagnosis of combined pathologies is proposed and substantiated. Establishing the relationship between hormonal disorders and the state of cellular and humoral immunity will help to identify the type of endometrial hyperplasia and its relationship with the development of benign breast tumors, as well as the risk group for the course of these pathologies and the development of relapses. The use of the proposed treatment regimens will make it possible to further prevent relapses and modify the treatment program in order to preserve fertility.