MODERN APPROACHES TO THE TREATMENT OF ABNORMAL UTERINE BLEEDING IN WOMEN WITH THE METABOLIC SYNDROME AND GENITAL PROLAPSE

Harkavenko K. V., Safonov R. A., Lazurenko V. V.

CLINICAL AND EXPERIMENTAL MEDICINE

Scentific article

The work aims to improve the AUB treatment in peri- and postmenopausal women with metabolic syndrome and genital prolapse. Object and research methods. Twenty-three women with AUB and MS and GP (main group) and 25 women with AUB and MS (comparison group) were examined to achieve the aim. The control group consisted of 15 women who did not have gynaecological and somatic pathology. The examination included a general clinical and laboratory investigation of blood, urine, and anthropometric measurements of height, weight, BMI, and waist/hip ratio. Transvaginal and transperineal ultrasound examinations were performed using the GE Voluson system and MRI. The quantitative POP-Q evaluation (1996) system was used to determine the degree of prolapse. In the main group of perimenopausal women, operative treatment was performed by hysteroresectoscopy in combination with colporrhaphy and colpoperineorrhaphy and/or sacrospinal fixation vaginal dome with mesh prostheses. Transvaginal extirpation was conducted in the postmenopausal period. Hysteroresectoscopy was performed in women of the comparison group. Research results. As a result, statistically significant data were obtained that AUB in patients with increased weight or obesity in the postmenopausal period indicates a high risk of precancerous lesions and it is essential for choosing further treatment tactics. During a transperineal ultrasound, a levator defect was identified in 15 (65.2%) women in the main group. In almost half of them, the defect was bilateral, confirmed by visualization of the vaginal entrance and measuring the vaginal opening area, indicating a diagnosis of levator detachment. Hysteroscopic treatment does not exclude the risk of recurrence of AUB or subsequent surgical intervention. Considering the impact of various treatment methods on the quality of life, including sexual, during the perioperative examination, the decision to perform and identify care should be highly appropriate and personalized for women with perimenopausal and postmenopausal MS in the presence of AUB and GP. Conclusions. Rational treatment of patients with AUB and comorbid pathology (MS, GP) depends on the patient’s age and the degree of GP: in the perimenopausal period – hysteroresectoscopy with colpoperineorrhaphy; in postmenopause – transvaginal extirpation with sacrospinal fixation of the vaginal dome with mesh prostheses.

abnormal uterine bleeding,metabolic syndrome,genital prolapse

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«Bulletin of problems biology and medicine» Issue 1 (168), 2023 year, 142-147 pages, index UDK 618.14-006-618.14-002:618.182-089.84

10.29254/2077-4214-2023-1-168-142-147