Duryagin I.V., Ivanov I.I.

SI “Crimea State Medical University named after S. I. Georgievsky”

Chair of Obstetrics and Gynecology №2

(Department head – professor, Doctor of Medicine Ivanov I.I)

Simferopol

Hyperplastic processes in endometrium and their interconnection on blood sex hormones level in fertile and predecidual age women

Problems connected with hyperplastic processes in uterus are relevant for today because of its frequency and danger. A lot of women of fertile and predecidual age have hyperplastic processes in endometrium with the big risk of malignization (10-50%), that’s why this pathology is referred not only as the medical pathology but also as a big social problem. We should mention that endometrial hyperplasia is one of the main reasons of abnormal uterine bleedings which compose 10-25% of all gynecologists’ appointments.

As the main target of our investigation we select the relation of blood sex hormones level and frequency of hyperplastic processes in endometrium and also we should determine sensitivity of sex hormone receptors. For all of this we use biochemical analyses, ultrasound investigation of small pelvis, hysteroscopy with endometrial tissues target biopsy and morphological investigation of scrapes.

We’ve inspected 116 women divided in 2 age groups: women of fertile (22-41 years) and premenopausal (42-52 years) age. The first group consisted of 54 primary group women and 20 control group women, the second group consisted of 32 primary group women and 10 women of control group. At the moment of admittion to hospital all women complained on meno- or metrorrhagia, agenesis and dysmenorrhoea.

As the result of complaints analyses we found that in first group 26 (48,1%) women suffered from meno- or metrorrhagia and 5 of them (9,4%) complained on up to 7-days long menorrhagia, 22 women (40,7%) complained on longer than 7 days spotting, in the second group 9 of them (28,1%) complained on up to 7-days long menorrhagia, 6 women (18,7%) complained on longer than 7 days spotting, 18 women in first group (33,3%) and 9 women in second group (28,1%) suffered from dysmenorrhoea, 9 women from first group (16,6%) and 8 women from second group (25%) complained on longer than 2 months amenorrhea.

By the type of hyperplastic process women also were divided on 2 groups – patients with simple endometrial hyperplasia (SEH) and patients with endometrial fibrous polyp (EFP). Each group was divided in 2 subgroups depending on the age of patients - women of fertile (22-41 years) and premenopausal (42-52 years) age. In the first group were 28 (51,8%) cases of EFP and 17 (53,1%) cases in second group. 26 women (48,2%) suffered from endometrial hyperplasia in first group and 15 women (46,9%) in second group.

Also speculum and bimanual examinations were performed on each patient. The coexisting illness in this women was represented with uterine fibroid in 4 cases (7,3%) in women suffering from SHE and in 2 cases (6,2%) in women suffering from EFP.

Also we performed clinical-biochemical blood and urine analyze with consistent methods in all the patients. Each women was performed the ultrasound investigation of small pelvis. Endometrial polyps were represented as the anechoic pedunculated formations of different size, mainly localized on uterine fundus and salpinx orifice. It is remarkable that during the investigation we found that endometrium thickness in women with hyperplastic processes is more than in women with endometrial fibrous polyps. It follows from this that there are no excessive proliferation of endometrium in women with fibrous polyps but it is present in women with simple hyperplasia which leads in consequence to impairment of ovarian-menstrual cycle.

Hyperplasia hysteroscopy in our investigations was represented as the irregular-shaped high semitransparent polypous bulges. In the case of hyperplasia scrape is plethorical, in the case of polyps it’s scanty.

The dependence of endometrium thickness from the type of hyperplastic process is represented in the table 1.

Table 1.

Endometrium thickness	7-10 mm		13-16 mm
	first group	second group	first group	second group
Endometrial fibrous polyp	26 (57,8%)	16 (35,6%)	2 (4,4%)	1 (2,2%)
Endometrial hyperplasia	2 (4,8%)	5 (12,1%)	16 (39,3%)	6 (14,6%)
Control group	12 (60%)		8(40%)

The level of blood steroid hormones in women with hyperplastic processes is represented in the table 2.

Table 2.

Hormone	Progesterone average rate		Estradiol average rate
	first group	second group	first group	second group
EFP	82,1±23,81 nmol/l p<0,05	85,1±6,79 nmol/l p>0,05	93,4±5,68 nmol/l p<0,05	88,4±6,34 nmol/l p>0,05
SHE	12,2±3,72 nmol/l p<0,05	15,4±2,69 nmol/l p>0,05	192,3±13,34 nmol/l p<0,05	170,1±13,9 nmol/l p>0,05
Control group	12,5±2,79 nmol/l p<0,05		86,5±6,91 nmol/l p<0,05

As we can see in the table in the process of simple endometrial hyperplasia the level of progesterone in blood is increased and the level of estrogens is increased more than in 10 times.

As the result of this investigation we found that in the case of endometrial polyps the level of progesterone is increased in 6,5 times and the case of hyperplasia it is increased in 2,2 times that gives us the possibility of pathogenetically grounded therapy after the steroid hormones level measurement.