HORMONAL THERAPY OF PROLIFERATIVE PROCESSES OF THE ENDOMYOMETRIUM AS A PREDICTOR OF METABOLIC DISORDERS IN THE LONG-TERM POSTOPERATIVE PERIOD

Abstract

Hysterectomy is one of the most common gynecological operations performed in the world. The aim of the study was to identify risk factors for the development of metabolic disorders in the postoperative period in patients who underwent hysterectomy without appendages, and to determine the role of hormone therapy as a predictor of metabolic syndrome.

Materials and methods. The study included 110 patients who were surgically treated for leiomyoma; 68 patients received hormonal therapy for symptoms of fibroids (menometrorrhagia) before surgery (group 1), and 42 patients whose main method of recovery was surgical intervention (hysterectomy without appendages).

Results. With increasing age, the proportion of nosological forms of proliferative processes of the endo-myometrium changes, namely, the frequency of leiomyoma with endometriosis decreases, and there is a tendency to increase the number of isolated forms of fibroids. The analysis of the initial data on the prevalence of somatic pathology revealed a high proportion of arterial hypertension and fat metabolism disorders, and hepatobiliary system diseases were 2 times more common among patients in group 1 (p<0.05). The formation of predictors of MS after surgical rehabilitation was noted up to 36 months in 64.7% of patients in group 1 versus 33.3% in group 2; persistent arterial hypertension was detected in 38.2% of observations, an increase in BMI (overweight and development of grade I-II obesity) was noted in more than half of cases, insulin resistance and hyperlipidemia, primarily due to the fraction of increased LDL cholesterol, were diagnosed in 67.6%. The change in the HOMA-IR index depended on the initial body weight and demonstrated a jump-like increase one year after the surgery with the preservation of consistently high values in the long-term period.

Conclusions. Predictors of the risk of metabolic syndrome in patients surgically treated for uterine leiomyoma are a hereditary history of pathology associated with metabolic syndrome, a combination of uterine leiomyoma with endometrial hyperplasia, fat metabolism disorders, pathology of the hepatobiliary tract, and to a lesser extent – arterial hypertension and vascular pathology. It has been established that long-term hormonal therapy of leiomyoma symptoms along with hysterectomy, even with preservation of ovarian tissue, is a factor in the increase in the proportion of clinical and laboratory criteria for metabolic syndrome, arterial hypertension, obesity, and disorders of fat and carbohydrate metabolism.