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OPTIMIZATION BY THE METHOD OF PCOS TREATMENT IN WOMEN WITH CHRONIC IODINE DEFICIENCY Ahmedova N.M.1, Abdullajonova S.A.2 Email: Ahmedova17162@scientifictext.ru
1Ahmedova Nilufar Mahmudovna - Candidate of Medical Sciences, Associate Professor;
DEPARTMENT OF OBSTETRICS AND GYNECOLOGY № 1; 2Abdullajonova Sayyora Azimjonovna - Master's degree, DIRECTION: OBSTETRICS AND GYNECOLOGY, ANDIJAN STATE MEDICAL INSTITUTE, ANDIJAN, REPUBLIC OF UZBEKISTAN
Abstract: polycystic ovary syndrome is one of the most common endocrinopathies in women of reproductive age. The incidence of PCOS is about 30% among patients of gynecologists-endocrinologists, and in the structure of endocrine infertility it reaches 75%. Up to 95% of cases of hirsutism in women are associated with polycystic ovary syndrome. Diagnostic methods are extensive and are not limited only to the reproductive sphere. The article presents the main diagnostic methods and treatment strategies for patients with PCOS. Among patients with endocrine infertility, PCOS occurs in 30-40% of cases. Keywords: polycystic ovary syndrome, infertility, ovaries, iodine deficiency, ovulation.
ОПТИМИЗАЦИЯ МЕТОДОВ ЛЕЧЕНИЯ СПКЯ У ЖЕНЩИН С ХРОНИЧЕСКИМ ЙОДОДЕФИЦИТОМ Ахмедова Н.М.1, Абдуллажонова С.А.2
1Ахмедова Нилуфар Махмудовна - кандидат медицинских наук, доцент, кафедра акушерства и гинекологии № 1;
2Абдуллажонова Сайёра Азимжоновна - магистр, направление: акушерство и гинекология, Андижанский государственный медицинский институт, г. Андижан, Республика Узбекистан
Аннотация: синдром поликистозных яичников является одной из самых частых эндокринопатий у женщин репродуктивного возраста. Частота СПКЯ составляет около 30% среди пациенток гинекологов-эндокринологов, а в структуре эндокринного бесплодия достигает 75%. До 95% случаев гирсутизма у женщин связано с синдромом поликистозных яичников. Методы диагностики обширны и не ограничиваются только репродуктивной сферой. В статье представлены основные методы диагностики и стратегия лечения пациентов с СПКЯ. Среди пациентов с эндокринным бесплодием СПКЯ встречается в 30-40% случаев.
Ключевые слова: синдром поликистозных яичников, бесплодие, яичники, йододефицит, овуляция.
UDC 618.11-006.31-07-08
Relevance. In recent years, a concept has been put forward, which has received universal approval, that the clinical manifestations of polycystic ovary syndrome (PCOS) should be treated as a syndrome, and not as a disease, and retain the most common name "polycystic ovary syndrome". A feature of this syndrome is the great variability of clinical manifestations and laboratory data [4, 6, 11].
Among patients with endocrine infertility, PCOS occurs in 30-40% of cases.
The frequency of restoration of regular ovulatory cycles in the treatment of PCOS reaches 80-90%, but the restoration of fertility in this disease is a big problem due to the relatively low efficiency of both conservative and modern endoscopic methods of treatment,
which does not exceed, according to E.M. Vikhlyaeva (1980), T.G. Gadiati (2000) and others, 50% -60%. Moreover, even the use of assisted reproductive technologies in patients with PCOS is less effective than in other forms of infertility [2, 5, 8, 10].
The unresolved problem of infertility against the background of PCOS prompted the study of the morphofunctional state of the endometrium in this disease, which plays an important role in the processes of implantation and the development of pregnancy [1, 3, 7, 9].
Purpose of the study. Optimization of therapy for patients with polycystic ovary syndrome with different clinical phenotypes.
Materials and research methods. On the basis of the Regional Perinatal Center in Andijan (OPC), for the period from 2019-2021, a comprehensive examination of 100 patients who first applied for infertility with PCOS was carried out, which made up the I (main) group.
Group II (comparison) consisted of 150 patients with PCOS who were treated for infertility in the period from 1998 to 2000, on the basis of their case histories, a retrospective analysis of the effectiveness of various methods of therapy was carried out.
Results of the study: The presence of clinical, metabolic and ultrasound differences in women with PCOS with different body weights makes it appropriate to distinguish two clinical and pathogenetic variants of this syndrome: obesity (65.25%) and type II polycystic ovaries with a peripheral location of follicles (71, 35%) and without obesity (34.75%) with type I polycystic ovaries with a diffuse arrangement of follicles (65.57%).
Typical hormonal disorders in both phenotypes of PCOS are: not only increased levels of free testosterone (82.89%), levels of luteinizing hormone (64.37%),. LH / FSH index> 2 (50.36%), dehydroepiandrosterone sulfate (24.51%) in the blood serum of patients, decreased levels of growth hormone (48.22%) and sex steroid-binding globulin (77.97%), as well as increased levels androstenedione (57.64%) and decreased glycodelin levels (78.95%).
In obese PCOS, hyperinsulinemia occurs 2 times more often (74.01%) than in non-obese patients (48.78%); impaired glucose tolerance in 43.01% of obese women; hyperC-peptidemia -in 44.74% of patients with visceral obesity and in 23.07% of patients with gluteofemoral obesity, and only with a BMI of more than 30 kg / m is a marker of the severity of metabolic disorders.
Violations of the lipid spectrum of blood (hypercholesterolemia, hypoalphalipoproteidemia and hypertriglyceridemia), revealed in 86.84% of patients with visceral obesity and in 74.36% -with gluteofemoral obesity, as well as in 51.22% - with normal body weight, indicate an increase in atherogenic potential of blood in patients with PCOS.
A high risk (40-80%) of developing coronary heart disease was detected only in patients with polycystic ovary syndrome and obesity (9.11%).
In patients with PCOS and obesity: visceral and gluteofemoral, there were higher levels of leptin (respectively: 52.76 ± 3.21 and 42.40 ± 2.87 ng / ml) than in patients with PCOS without obesity (14.99 ± 0.49 ng / ml). The value of the leptin / BMI index> 0.7, accompanied by a decrease in fertile function, was significantly higher in the group of patients with obesity (1.65 ± 0.11), compared with the group of patients with PCOS without obesity (0.68 ± 0.06 ), (p <0.001).
Therapy with metformin and pioglitazone leads to an improvement in metabolic and normalization of hormonal disorders in PCOS: a significant decrease in the levels of immunoreactive insulin, C-peptide, idexinsulin resistance, leptin, atherogenic coefficient, free testosterone and an increase in glycodelin levels by 20.8-56.5%, depending on of the listed parameters and phenotype of patients with PCOS.
Restoration of a regular menstrual cycle during therapy with metformin and pioglitazone was observed in 78.95% and 94.73% of obese patients; ovulatory cycle - in 21.05% of patients with visceral obesity; in 35% and 42.10% of women - with gluteofemoral obesity, respectively; the onset of pregnancy in 15.79% and 21.05% of patients with visceral obesity and in 25% with gluteofemoral obesity.
Output. Based on the study of hormonal and metabolic disorders, proposals were substantiated and formulated to optimize conservative methods of treating patients with
PCOS, including the improvement of methodological approaches to examining patients and the principles of their therapy.
The expediency of including in the complex of hormonal examination of patients with PCOS to determine the content of somatotropic hormone, free testosterone, androstenedione and glycodelin in the blood serum is shown.
The necessity of assessing the secretion of insulin, C-peptide, glucose tolerance and blood serum lipid parameters for the first detection of insulin resistance, hyperinsulinemia and dyslipoproteinemia not only in patients with PCOS and obesity, but also with normal body weight has been substantiated. The identification of these disorders, which form the basis of the metabolic syndrome, indicates a high likelihood of developing type 2 diabetes mellitus (DM) and coronary heart disease.
A differentiated approach to the management of patients with PCOS has been proposed. The high efficiency of adequate reduction of hyperinsulinemia in obese patients for the correction of hormonal and metabolic disorders has been shown.
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