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PECULIARITIES OF THE PERIMENOPAUSE PERIOD IN WOMEN WITH
ENDOMETRIOSIS Ahmedova A.T.1, Agababyan L.R.2, Abdullaeva L.M.3 (Republic of Uzbekistan) Email: Ahmedova570@scientifictext.ru
'Ahmedova Aziza Tairovna—Assistant; 2Agababyan Larisa Rubenovna - Candidate of Medical Sciences, Associate Professor, DEPARTMENT OF OBSTETRICS AND GYNECOLOGY, FACULTY OF POSTGRADUATE EDUCATION, SAMARKAND STATE MEDICAL INSTITUTE, SAMARKAND;
3Abdullaeva Lola Mirzatullaevna - Doctor of Medical Sciences, DEPARTMENT OF OBSTETRICS AND GYNECOLOGY, TASHKENT MEDICAL ACADEMY, TASHKENT, REPUBLIC OF UZBEKISTAN
Abstract: despite the tremendous advances in the study of perimenopause, this problem continues to attract the attention of both scientists and practitioners, as well as the problem of managing patients with endometrioid disease. The possibility of reducing the symptoms of endometriosis after menopause depends on the individual case, since each woman's body functions differently and has its own individual characteristics. Although menopause can actually reduce the symptoms, it is not certain that they will definitely disappear as soon as you stop menstruating. Much also depends on the severity of the disease: in mild forms, the endometriosis symptoms in women disappear more quickly during menopause. Keywords: perimenopausal period, menopausal syndrome, endometriosis, vascular disorders.
ОСОБЕННОСТИ ПЕРИМЕНОПАУЗАЛЬНОГО ПЕРИОДА У ЖЕНЩИН С
ЭНДОМЕТРИОЗОМ Ахмедова А.Т.1, Агабабян Л.Р.2, Абдуллаева Л.М.3 (Республика Узбекистан)
'Ахмедова Азиза Таировна - ассистент; 2Агабабян Лариса Рубеновна - кандидат медицинских наук, доцент, кафедра акушерства и гинекологии, факультет последипломного образования, Самаркандский государственный медицинский институт, г. Самарканд;
3Абдуллаева Лола Мирзатуллаевна - доктор медицинских наук, кафедра акушерства и гинекологии, Ташкентская медицинская академия, г. Ташкент; Республика Узбекистан
Аннотация: несмотря на огромные достижения в изучении периода перименопаузы, эта проблема продолжает привлекать внимание как ученых, так и практиков, так же как и проблема ведения пациентов с эндометриоидной болезнью. Возможность снижения симптомов эндометриоза после климакса зависит от конкретного случая, поскольку у каждой женщины функционирует организм функционирует по-разному и имеет свои индивидуальные особенности. Несмотря на то, что на фоне менопаузы симптомы заболевания действительно могут сократиться, нельзя с уверенностью утверждать, что они обязательно исчезнут, как только у вас прекратится менструация. Многое также зависит и от степени тяжести заболевания: при легких формах симптомы эндометриоза у женщин при климаксе исчезают быстрее.
Ключевые слова: перименопаузальный период, менопаузальный синдром, эндометриоз, вегетососудистые нарушения.
DOI: ' 0.244' '/2542-0798-2020-' 7007
According to WHO's many demographic projections, a more dramatic increase in the number of older people is expected in the 21st century, which necessitates the establishment of national and international health systems for older women. The ultimate goal of these programs is to improve the quality of life of women [3, 4].
Introduction. According to the UN, by 2050 the number of elderly people will already be about 1.5 billion, that is 14.7% of the population, and today every 10th woman is in postmenopausal age. Every year their number increases by 25 million, and by 2020 this figure will be 47 million [1, 3, 5, 8].
Assessment of the sex ratio in the elderly population in different countries showed that in Uzbekistan at present the number of elderly people is 6.7%, and in 2030 this figure will reach -11.6%, in 2050 -19.4%. The number of women aged 45-54 years is 1 million 702 [stat.uz]. The life expectancy of women in Uzbekistan is about 4-5 years longer than that of men.
Recently, worldwide interest in studying the problems of perimenopause (PMP) has significantly increased [7, 8, 9].
Perimenopause - includes the period of the menopausal transition and 12 months after the last independent menstruation [4, 8, 9].
Currently, the mechanisms of the development of changes and the approximation of menopause, as well as the pathogenesis of pathological processes developing in the PMP, are not well understood.
The results of numerous studies indicate that in the PMP the basic algorithm of the reproductive system functioning is violated - the cyclic secretion of estradiol, progesterone, the internal ovarian proteins of Inhibin and Activin, as well as gonadotropic hormones [1, 3 ,6].
It has been established that with age, along with the depletion of follicles, the number of receptors for gonadotropins decreases, which contributes to a decrease in the sensitivity of the ovaries to their own gonadotropin stimuli and a decrease in the frequency of ovulatory cycles [8].
As the perimenopause approaches, the number of anovulatory cycles increases, follicular shortening and insufficiency of the luteal phases of the cycle are observed, which is inevitably accompanied by clinical changes in menstrual function [8, 9].
It has been proven that an early marker of upcoming perimenopause is an increase in FSH levels due to the presence of feedback between inhibin and FSH [1, 4, 6].
Since LH secretion is not associated with inhibin, an increase in its content occurs later. In a number of scientific papers, it was noted that an increased level of FSH causes a rapid development of follicles, which is the reason for shortening cycles, which may be the first clinical manifestation of an approaching menopause [8].
It was found that the gonadotropic function of the pituitary gland, as well as the function of the ovaries in the PMF, is characterized by a wide variability of hormone levels - from regular cycles containing gonadotropic and ovarian hormones characteristic of the reproductive period to episodic spontaneous cycles with fluctuations from low levels of gonadotropins to high concentrations of FSH and LH, characteristic of postmenopause, while at the same time high concentrations of estrogen in the blood [3, 5, 7].
At present, the pathogenetic mechanisms of follicular persistence, leading to hyperestrogenism in the PMF, are still not fully understood. According to some researchers, hyperestrogenemia observed in the PMF is not a pathological deviation, but its normal component. [1, 4, 6, 8]. Along with this, the frequency of endometrial hyperplastic processes (GGE) increases.
In PMP, it creates significant difficulties in choosing treatment methods. This can explain the lack of unified recommendations on the choice of a drug, the dose and the optimal duration of its use, which is often inadequate, and therefore, relapses of GE occur.
The quality of life of patients with endometrioid disease in the period of perimenopause is significantly affected [4, 5, 7]. Frequent changes in mood, depression, and anxiety often interfere with everyday work, despite the fact that the components of physical health remain at an average level [1, 4, 6, 8].
Thus, despite the successes achieved in the study of etiopathogenesis, new methods of diagnosis and therapy, the problem of treatment and management tactics for women with endometriosis in the period of perimenopause remains far from being resolved.
All this dictates the need to optimize the management of patients with endometriosis in primary care, which should be aimed not only at creating adequate integrated approaches for predicting the development and recurrence of various gynecological and somatic diseases, but also developing common protocols for managing patients with this pathology.
Based on a patent search, registration number No. 001947, dated October 30, 2019, conducted by the State Scientific Medical Library under the Ministry of Health of the Republic of Uzbekistan, the problem "Features of the course of the perimenopause period in women with endometriosis" and its effect on the quality of life have not been studied.
Methods. An increase in the number of women with endometriosis suffering from menopausal syndrome requires the development of a new approach to the treatment of this category of women and is one of the urgent problems of modern gynecology, which served as the basis for our study.
To study the clinical course of menopausal syndrome in women with endometriosis based on the study of quality of life, hormonal status and treatment methods used.
We examined 87 women in the period of perimenopause with endometriosis from the age of 45 to 55 years, who contacted a gynecologist about complaints related to the manifestations of menopausal syndrome. A survey was conducted on the questionnaire of quality of life. The severity of klmakterisy syndrome in the period of perimenopause was evaluated using a modified menopausal index (MMI) -Kupperman index.
Symptoms inherent in menopause are associated with a decrease in estrogen levels in a woman's body. Because of this, organs controlled by female sex hormones cease to function properly, women with hypoestrogenia exhibit a violation of vasomotor function, flushing, dysphoria, depressive states, decreased libido and osteoporosis, which significantly reduces the quality of life. We conducted a survey on the questionnaire of quality of life SF 36 (table № 1 and 2).
Table 1. Quality of life SF 36
All the time Most of the time Often Sometimes Rarely Never
a. Did you feel awake? 1 2 3 4 5 6
b. Are you very nervous? 1 2 3 4 5 6
c. you felt calm (oops) and pacified (oops)? 1 2 3 4 5 6
d . You felt so depressed that nothing could cheer you up? 1 2 3 4 5 6
e. Did you feel full of strength and energy? 1 2 3 4 5 6
f. Did you feel sad and sad (s)? 1 2 3 4 5 6
g. Did you feel exhausted? 1 2 3 4 5 6
h. Did you feel happy? 1 2 3 4 5 6
I. Did you feel tired? 1 2 3 4 5 6
Table 2. Quality of life SF 36
Definitely true Mostly right I don't know Mostly wrong Definitely wrong
But it seems to me that I'm more prone to disease, than others 1 2 3 4 5
My health is not worse than that of most of my friends in. 1 2 3 4 5
I expect my health to decline 1 2 3 4 5
Umen excellent health 1 2 3 4 5
The chosen method of contraception has had a very positive effect on my general health 1 2 3 4 5
Non-hormonal correction of vegetative-vascular and psychoemotional disorders was studied in 88 women during the period of perimenopause. Patients were divided into 2 groups: group I consisted of 40 women (operated on for endometriosis), group II consisted of 47 women (not operated on for endometriosis). The control group consisted of 50 women aged 45-55 years without gynecological pathology.
Results and Discussion.
Complaints of patients before treatment are presented in table № 3.
Table 3.Condition of women examined before treatment
Symptoms Number of Patients of the main group Number of Patients eontrol Group
№ % № %
Hot flashes 87 100.0 8 16
Profuse sweating 35 40,2 10 20
Sleep disturbance 27 31,03 12 24
Fatigability 53 60,9 14 28
Anxiety state 31 35,6 0 0
Depression 33 37,9 0 0
Irritability 25 28,7 4 8
Decreased libido 29 33,3 9 18
Headaches 23 26,4 13 26
Palpitations 46 52,8 15 30
A / D boost 19 21,8 9 18
A weak severity of menopausal syndrome according to the Kupperman index was noted in the main group -20.3% of patients, medium-66% and severe-32%, Fig. 1.
Fig. 1. The dynamics of the development of symptoms in the main group
In the control group, the severity of menopausal syndrome according to the Kupperman index: a weak degree in 18, an average degree in 14%, severe in 5%. Correction of psychoemotional and vegetovascular disorders was carried out with the drug Prosulpine (active substance, sulpiride) 200 mg, the drug was prescribed 2 times a day, 100 mg until 4 p.m. Control was carried out after 1, 3, 6 weeks.
According to the data obtained, at 1 week of therapy there were positive trends in the emotional sphere in group I in 90% of women, in group II 93%, in the control group by 96%, by the end of the third or sixth week, the number of hot flashes and their severity significantly decreased, sweating decreased, B/ P fluctuations, tachycardia, anxiety, depression, emotional lability, headaches, increased performance in group I -92%, in group II 94%, in the control group 97% (table № 4).
Symptoms after 1 week after 3-6 weeks
n-40 n-47 n-50 n-40 n-47 n-50
Hot flashes 5 3 3 3 2 2
Profuse sweating 4 3 2 2 3 2
Sleep disturbance 6 5 2 4 4 1
Fatigability 6 5 3 - - -
Anxiety state - 1 - - - -
Depression - - - - - -
Irritability 6 3 - 4 5 1
Decreased libido 4 3 - 3 4 2
Headaches 4 5 2 - - -
Palpitations 6 4 3 2 4 2
blood pressure boost 4 3 3 4 3 2
According to the quality of life questionnaire -SF36, in women with endometriosis during the period of perimenopause before treatment, a decrease in the quality of life was noted, in the main group - 56%, in the control group - 72%.
After the treatment, a significant improvement in the psychoemotional state and an increase in the quality of life of patients were noted both in the main group 89% and in the control -96%. Conclusions.
This study allowed us to determine the quality of life in the period of perimenopause in women with endometriosis (operated and not operated), to analyze the somatic. Also, improve non-hormonal methods of treating menopausal syndrome in women with endometriosis.
Thus, the literature review and our own research indicate the feasibility of treating patients with endometriosis during the perimenopause period with psychoemotional and vegetative vascular disorders with atypical small antipsychotic drugs, which allows to increase the clinical effectiveness of complex treatment and improve the quality of life of perimenopausal women.
The results obtained will expand understanding of the period of perimenopause in women with endometriosis, the use of non-hormonal drugs in order to improve the quality of life of women with endometriosis in the period of perimenopause.
The results of the study were introduced into the work of women's clinics, district and city polyclinics No. 8 and No. 12, in the educational process of the Department of Obstetrics and Gynecology for clinical residents and masters of SamM.
References / Список литературы
1. Agababyan L.R., Nasirova Z.A., Makhmudova S.E. Social aspects of reproductive health and contraceptive behavior of women who have undergone caesarean section «Dostizheniya vuzovskoy nauki», 2019.
2. Agababyan L.R., Akhmedova A.T. Possibilities of correction of menopausal disorders in women with contraindications to hormone replacement therapy / Problemy Reproduktsii, 2017. Т. 23. № 3.
3. Agababyan L.R. et al. Features of Pure Progestostin Contraception in Women with Preeclampsia/Eclapmia // Polls of Science and Education, 2019. № 26 (75).
4. Brown J., Farquhar C. Endometriosis: an overview of Cochrane Reviews. Cochrane Database Syst Rev., 2014. Mar 10;(3):CD009590. doi: 10.1002/14651858.CD009590.pub2. Review.
5. Gunawardane D.N., Allen P.W. Selected Case From the Arkadi M. Rywlin International Pathology Slide Club: Polypoid Endometriosis in the Pouch of Douglas in a Perimenopausal Woman. Adv Anat Pathol., 2015. Sep; 22 (5):331-4. doi: 10.1097/PAP.0000000000000081.
6. Makhmudova S.E., Agababyan L.R. The rehabilitation of patients, suffering vulvovaginal candidiasis (vvk), taking combined oral contraceptives (COCS) // Natsional'naya Assotsiatsiya Uchenykh, 2016. № 5. С. 32-32.
7. Makhmudova S.E., Agababyan L.R. Effectiveness and acceptability of the prolonged combined oral contraceptives in women with anemia // Novyy vektor razvitiya nauchnoy deyatel'nosti. Vyzovy i resheniya, 2016. P. 35-37.
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9. Takaesu Y., Nishi H., Kojima J., Sasaki T., Nagamitsu Y., Kato R., Isaka K. Dienogest compared with gonadotropin-releasing hormone agonist after conservativesurgery for endometriosis. J Obstet Gynaecol Res. 201.
FEATURES OF THE DIAGNOSIS OF ECHINOCOCCOSIS IN CHILDREN IN
SAMARKAND REGION Kudratova Z.E.1, Kuvandikov G.B.2, Nabiyeva F.S.3 (Republic of Uzbekistan) Email: Kudratova570@scientifictext.ru
'Kudratova Zebo Erkinovna — Assistant; 2Kuvandikov Golib Berdirasulovich — Assistant; 3Nabiyeva Farangiz Sadriddinovna—Assistant, DEPARTMENT OF CLINICAL LABORATORY DIAGNOSIS, SAMARKAND STATE MEDICAL INSTITUTE, SAMARKAND, REPUBLIC OF UZBEKISTAN
Abstract: the article presents the results of our own studies of 178 sick children with a diagnosis of liver echinococcosis. The examination includes a set of clinical, laboratory and instrumental methods or research. An important condition for the timely diagnosis of liver echinococcosis is a efficient algorithm for examining patients[1]. Correct interpretation of the results of laboratory and instrumental examination methods allows you to make a correct diagnosis in a timely manner, as well as identify asymptomatic developing complications [2].
Keywords: laboratory and instrumental examination methods, echinococcosis, complications, liver, diagnosis.
ОСОБЕННОСТИ ДИАГНОСТИКИ ЭХИНОКОККОЗА У ДЕТЕЙ В САМАРКАНДСКОЙ ОБЛАСТИ Кудратова З.Э.1, Кувандиков Г.Б.2, Набиева Ф.С.3 (Республика Узбекистан)
'Кудратова Зебо Эркиновна — ассистент; 2Кувандиков Голиб Бердирасулович — ассистент; 3Набиева Фарангиз Садриддиновна — ассистент, кафедра клинической лабораторной диагностики, Самаркандский государственный медицинский институт, г. Самарканд, Республика Узбекистан
Аннотация: в статье приведены результаты собственных исследований 178 больных детей с диагнозом «эхинококкоз печени». Обследование включает в себя комплекс клинических, лабораторных и инструментальных методов исследований. Важным условием своевременной диагностики эхинококкоза печени является рациональный алгоритм обследования больных [1]. Правильное толкование результатов лабораторных и инструментальных методов обследования позволяет своевременно поставить правильный диагноз, а также выявить бессимптомно развивающиеся осложнения [2].
Ключевые слова: лабораторные и инструментальные методы исследования, эхинококкоз, осложнения, печень, диагностика.
УДК: 616-093/-098
Актуальность. Эхинококкозы - актуальная проблема медицинской паразитологии, так как эхинококкоз относится к одним из тяжелых паразитарных эндемических заболеваний и остается медико-социальной проблемой в ряде стран мира, в том числе и в Узбекистане. В последние годы в Самаркандской области, отмечается увеличение числа больных с эхинококкозом печени и его осложненными формами [3, 4]. Важным условием своевременной диагностики эхинококкоза печени
