RISK FACTORS FOR GENITAL PROLAPSE IN PERIMENOPAUSAL WOMEN WITH CONNECTIVE TISSUE DYSPLASIA AND THEIR CORRECTION

Shcherbina N., Alaya Lamia

CLINICAL AND EXPERIMENTAL MEDICINE

Scentific article

The genital prolapse, as part of the gynecological pathology, occurs in 1.7 to 28% women one to the composition, according to different authors, from 1.7 to 28%, particularly among women older than 40 years this figure rises to 34.7%. In 85.5% of patients with genital prolapse the following symptoms occur: urinary incontinence in 70% of patients, defecation disorders in 36.5% and dyspareunia in 53.3% patients. Until today there is no consensus about the etiology and pathogenesis of the genital prolapse. However, most researchers agree that the main factor in the development of prolapse is a violation of the state of the pelvic floor. According to modern research, the leading cause of prolapse is the dyspalsia of the systemic connective tissue dysplasia (CTD). According to the literature, CTD is common in 48% cases among women with genital prolapse. CTD is a multisystem pathology with a progressive course, which is characterised by the defects in the protein synthesis or catabolic multyfunction of the components of the extracellular matrix of the connective tissue. Matrix metalloproteinases (MMPs) play a critical role in regulating the homeostasis of the extracellular matrix. MMPs are proteolytic enzymes involved in the degradation and remodeling of the connective tissue. The aim of the study was to investigate the risk factors associated with the genital prolapse in menopausal women with connective tissue dysplasia. We examined 65 women in perimenopause with genital prolapse of 1-2 stages. The patients were divided into two groups according to age and the presence of phenotypic signs of CTD and the applied treatment. Clinical characteristics and the estradiol concentration of the matrix metalloproteinase 9 (MMP-9) activity in serum were determined. Women in both groups with clinical signs of genital prolapse showed a significant (p <0,05) decrease in the estradiol concentrations compared to the physiological norm. Thus, in the group of patients with CTD symptoms the average estradiol level was 0.13 ± 0.014 nmol / L and in Group 2 - 0.27 ± 0.035 nmol / l. The elevated levels of MMP-9 were detected in the group CTD symptoms (215,11 ± 17,3 ng / ml) compared to the norm value determined among women in perimenopaus (100,0 ± 6,1 ng / ml) which confirms pathogenic role of metalloproteinases in the restructuring on the connective tissue. Patients with genital prolapse and connective tissue dysplasia show increase collagen destruction with the low levels of estradiol. The data obtained in this study allows us to consider the hyperestrogenic levels and MMP-9 activity dysfunction hypoestrogeniya violation of MMP9 activity as the risk factors for this disease in perimenopausal women. Promt response to the hormonal disorders together with the metabolic therapy significantly increases the effect of preventative and therapeutic interventions for genital prolapse.

genital prolapse, connective tissue dysplasia, the activity of matrix metalloproteinases, estrogens, complex metabolic therapy

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«Bulletin of problems biology and medicine» Issue 2 part 1 (128), 2016 year, 135-139 pages, index UDK [618.13/.15-007.4 +616.62-222/.223]-08:618.173-018.2-007.17