The diploma research was carried out with the aim of restoring of reproductive health in women with severe morbid obesity who require bariatric surgery by developing a complex of therapeutic and preventive measures based on the study of the relationship between the state of the central and autonomic nervous systems, lipid and carbohydrate metabolism, hormones of adipose tissue, hypothalamic-pituitary- ovarian and thyroid systems.
According to the results of the examination of 190 women of reproductive age (from 23 to 45 years old) with: morbid obesity, a high frequency of menstrual cycle disorders was found (73.33% against 13.33% of women of the control group with normal body weight), polycystic ovaries (28.46% against 6.667% of women of the control group) and hyperproliferative processes of the endometrium (33.84% against 10.0% of women of the control group). There was also a higher specific weight of uterine leiomyomas (23.84% vs. 6.67% of women in the control group), infertility (33.07% vs. 6.67% of women in the control group), and dyshormonal diseases of the mammary glands (74.61% vs. 28, 33% of women of the control group). Chronic inflammatory processes of the pelvic organs probably occurred more often in patients of the main observation group (48.46%) in contrast to women with normal body weight (10.0%).
A more detailed analysis of the reproductive history revealed a high frequency of miscarriage in patients with morbid obesity. At the same time, 44.61% of the patients of the main group had a history of pregnancy, childbirth - 27.69%, and 29.23% of abortions, against the patients of the control group, respectively, 78.33% had a history of pregnancy, 63.33% - childbirth and 10 .0% of abortions (p1-4, 2-5, 3-6 <0.05).
Analysis of the structure of somatic morbidity in the examined showed that women with morbid obesity have a statistically significantly higher frequency of autoimmune diseases (25.38% vs. 8.33% of women in the control group), thyroid dysfunction (31.53% vs. 11.67% of women in the control group), diseases of the digestive system (22.30% vs. 8.33% of women in the control group), as well as varicose veins of the lower extremities in women with morbid obesity compared to women in the control group (19.23% vs. 5.0%).
According to the results of ultrasound examination, the picture of multifollicular ovaries was almost 4 times more frequent in women of the main group than in women of the control group (28.46% vs. 6.67%). Among hyperproliferative processes of reproductive organs, endometrial hyperplasia (33.84% versus 10.0%), uterine leiomyomas (23.84% versus 6.67%), ovarian tumors (9.23% versus 3 .33%) and benign diseases of the mammary glands (36.92% vs. 8.33%), which may be a consequence of chronic hyperestrogeny on the background of obesity, as well as anovulation. The structure of dyshormonal diseases of the mammary glands was dominated by: diffuse fibrocystic disease and diffuse fibroadenomatosis, and nodular forms were found in 7% of cases.
Analysis of hormonal homeostasis indicators showed a higher serum concentration of LH in patients with morbid obesity compared to women of the control group (13.61±3.4 mIU/ml vs. 5.71±2.4 mIU/ml), FSH (8.4±3, 5 units/l versus 6.8+1.8 units/l), estradiol (.35±0.42 pg/ml versus 0.26±0.12 pg/ml). The analysis of the mean serum level of prolactin showed that in patients with morbid obesity, its high value was observed, in contrast to women in the control group (23.89±4.1 ng/ml vs. 10.27±4.6 ng/ml). During the study, a negative correlation was established between the levels of AMH, BMI and the content of adipose tissue in the main groups of the study (r=-0.78).
The average level of vitamin D was lower than the norm in all groups of examined women, including women in the control group. The results of the approbation of medical tactics based on the results of dynamic observation during 12 months showed that the dynamics of excess weight loss was typical for all patients after the bariatric surgery with a sharp decrease in weight in the first 3-4 months, regardless of the proposed treatment complex. Along with the normalization of the menstrual cycle and the presence of a dominant follicle in patients of groups 1 and 2, during 12 months, the stabilization of the levels of sex hormones was also noted, but it should be noted that these changes occurred faster in patients who received improved medical complex after bariatric surgery. A positive effect was also found on metabolic parameters in patients of the studied groups, which were more pronounced especially in patients who took improved medical complex.
