Dymarska O. Optimization of Management Strategies for Women of Reproductive age with ovarian endometriomas

This thesis is devoted to solving the urgent problem of increasing the efficiency of diagnostics and treatment of ovarian endometriomas in women of reproductive age by scientifically substantiating, creating and implementing an improved algorithm of modern diagnostic and therapeutic and preventive measures, built on a comprehensive analysis of the state of the ovarian reserve and its changes before and after surgery. The study proves the practical importance of a personalized approach to choosing the optimal tactics of managing patients with endometriomas, which involves an integrated interpretation of hormonal markers and ultrasound characteristics of the ovarian reserve. Endometriosis is one of the most actual problems of modern gynecology, which occupies a leading position in the structure of gynecological pathology and affecting up to 65.0% of women of reproductive age. Its significant prevalence, high percentage of infertility, chronic pelvic pain and pronounced impact on the life quality define endometriosis as an important medical and social problem. Endometriomas account for up to 35.0% of benign ovarian cysts and are observed in almost half of patients with endometriosis, causing a decrease in ovarian reserve both as a result of the pathology itself and after surgical treatment, in particular laparoscopic stripping, which remains the “gold standard”, but can lead to the loss of functional ovarian tissue. Preservation of ovarian reserve is a key task of modern gynecology, but the mechanisms of its reduction, optimal approaches to surgery and clear criteria for choosing treatment tactics remain poorly defined. There is an urgent need to improve methods for assessing ovarian reserve and clarify the capabilities of 3D transvaginal ultrasound with Doppler, taking into account indicators of hormonal homeostasis markers, for a comprehensive analysis of the functional state of the ovaries and ovarian reserve. Literature did not reveal any works on determining the level of endogenous intoxication in women with endometriomas depending on the type of energy used during surgical treatment. The presence of endotoxin aggression from the focus of the ovarian tumor against the background of surgical treatment causes the occurrence of a syndrome of mutual burden and is a powerful risk factor for the development of complications. At the same time, the lack of unified standards for sparing organpreserving surgical interventions worsens the prognosis of reproductive function. In this context, the development and implementation of an algorithm of modern diagnostic and therapeutic and preventive measures aimed at maximum preservation of ovarian reserve in women with endometriomas is scientifically and practically justified and is of great importance for increasing the effectiveness of treatment and reducing the frequency of resorting to assisted reproductive technologies. The purpose of the study: to increase the effectiveness of the treatment of ovarian endometriomas in women of reproductive age by developing and implementing an algorithm of modern diagnostic and therapeutic and preventive measures taking into account ovarian reserve indicators. Objectives of the research: 1. To analyze the clinical, epidemiological and medico-social characteristics of the course of endometrioid disease in women of reproductive age with ovarian endometriomas by conducting a structured medico-social audit. 2. To assess the morphofunctional characteristics of the follicular apparatus in patients with ovarian endometriomas using 3D transvaginal ultrasound in color and power Doppler modes before and after surgical treatment. 3. To study the state of hormonal homeostasis in women of reproductive age before and after surgical treatment of ovarian endometriomas depending on the hemostasis methods used. 4. To investigate ovarian reserve indicators in women of reproductive age before and after surgical treatment of ovarian endometriomas depending on the hemostasis methods and cystectomy techniques used. 5. To determine the levels of tissue destruction products in blood plasma after surgical treatment of ovarian endometriomas, taking into account the type of energy applied intraoperatively to achieve hemostasis. 6. To conduct a comparative analysis of pathomorphological changes in ovarian tissues and endometrioma capsule in relation to the technological parameters of surgical intervention. 7. Based on the results obtained, develop and implement an algorithm of modern diagnostic and therapeutic and preventive measures for patients of reproductive age with ovarian endometriomas and evaluate its effectiveness in terms of preserving reproductive potential.