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SPECIFICITY OF HORMONAL ANALYSIS AND ULTRASOUND EXAMINATIONS OF GIRLS DURING THE MENSTRUAL CYCLE
G. Sh. Mavlonova, J. Ya.Toxirov
Bukhara State Medical Institute named after Abu Ali ibn Sino
ABSTRACT
The provides information about the hormonal function of the ovaries in girls aged 12-16 years and the size of the uterne ovary and endometrium on ultrasound.
Key words: ME, hormone
Today, measures are being taken in our country to improve the quality of medical care provided to the population, early diagnosis of juvenile diseases and reduce their complications. In accordance with the Action Strategy for the five priority areas of development of the Republic of Uzbekistan in 2017-2021, raising the level of medical services to a new level "... strengthening family health, protection of motherhood and childhood, expanding access to quality health care for mothers and children,to provide them with specialized and high-tech medical care, to implement comprehensive measures to reduce child mortality ... ».
Decree of the President of the Republic of Uzbekistan No. PF-4947 of February 7, 2017, No. PP-2650 of February 7, 2017, "On measures to further improve the system of protection of motherhood and childhood in Uzbekistan in 2016-2020" Resolution of the Government of the Republic of Uzbekistan dated June 20, 2017 No. PP-3071 "On measures to further develop the provision of specialized medical care to the population of the Republic of Uzbekistan in 2017-2021" and other regulations related to this activity. serves.
The purpose of the study: To study the hormonal background of the organism in the development of abnormal uterine bleeding in girls and adolescents.
Research objectives: To study the anamnestic and anthropometric parameters of physically healthy and adolescent girls complicated by abnormal uterine bleeding;
In accordance with the goals and objectives, this research was carried out at the Romitan District Central Polyclinic and Gynecology Department in 2012-2022.
Essential and toxic micronutrients, as well as the state of the pituitary-ovarian hormones, uterus, ovaries, endometrial layer were studied in 170 adolescent girls aged 12-16 years with abnormal bleeding from the uterus who applied to the Romitan District Central Polyclinic. The main group included 115 adolescent girls with abnormal uterine bleeding, and 55 physically healthy adolescent girls. In accordance with the goals and
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objectives, the following research program was developed: clinical and statistical analysis; clinical research methods (general analysis of blood, Ht, platelets); biochemical examination methods.
Adolescent girls involved in the study were divided into the following age categories: 31 (18.2%) girls at the age of 12, 32 (18.8%) at the age of 13, 14 - 35 (20.5%), 15 - 37 (21.7) %), 16 - 34 (20.0%). It should be noted that no significant age difference was found in the compared groups (R> 0.05). Thus, in the group of healthy girls at the age of 12 there were 10 (18.1%), at the age of 13 - 10 (18.1%), at the age of 14 - 12 (21.8%), at the age of 15 - 12 (21.8%), 16 years - 11 (20.0%). In the group of girls with juvenile hemorrhage, the distribution was as follows: 21 (18.2%), 22 (19.1%), 23 (20.0), 25 (21.7%), 23 (20.0%), that is, no significant difference was detected (R> 0.05). In the study groups, the age of the study participants was independent of place of residence (urban / rural) (R> 0.05).
The following hormones were detected by the enzyme-linked immunosorbent assay using the HumarderSingle (Germany, 2005) analyzer at the Bukhara Regional Diagnostic Center: (LG, FSG, estradiol, prolactin, progesterone). Hormonal studies were performed in the 7th follicular phase of the ovarian cycle, in the 14th ovulation phase, and in the 21st luteal phase. Blood for analysis was taken from the cubital vein between 8 and 10 a.m. from the girls involved in the study.
Ultrasound examinations were performed on an anatomical M-mode I BF (Sonomed, Spectromed-400, firm Acer, Russia, 2005, Sono Scape 551-600, China) model using a S 2.5 MGTs sector sensor.
During the obstetric and gynecological examination of the girls involved in the study, the indicators of the menstrual cycle were also studied. Indicators of menstrual function were assessed by the formation of a regular menstrual cycle, the specificity of its course. No statistically significant difference was observed compared with the women in the control groups
The structure of gynecological and somatic diseases in the examined girls was also analyzed. According to the results of the analysis, it can be seen that 76.7% of adolescent girls complicated by abnormal uterine bleeding at the juvenile age had infectious diseases, with frequent recurrence of complications with diarrhea. Anemia accounted for 70 (60.9%), thyroid disease for 59 (51.3%), chronic kidney disease for 11.3% of adolescent girls complicated by abnormal uterine bleeding at the juvenile age, and 5.5% for physically healthy girls.
Inflammatory diseases of the genitals occurred in one in four girls, accounting for 34 (29.6%). In terms of age, inflammatory diseases were 3 (14.3%) at the age of 12, 2 (9.1%) at the age of 13, 9 (36.0%) at the age of 14 and 11 (47.8%) at the age of 15-16.
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Hormonal features of the pituitary-ovarian system in healthy girls with abnormal bleeding from the uterus at a juvenile age.
The aim of the study was to study the hormones of the pituitary-ovarian system in 22 healthy girls aged 12-16 years and 28 girls with IBD.
The study found that LG levels in the blood of girls in the control group varied significantly depending on age and the day of the menstrual cycle. Thus, in 12-year-old healthy girls, the LG level was 5.4 ± 0.34 ME / l in the first half of the cycle, while in the second half it decreased to 4.9 ± 0.31 ME / l (P> 0.05).
An increase in the concentration of this hormone was observed in 13-year-old girls, but depending on the stage of the cycle, it varied slightly: 5.8 ± 0.37 ME / l in the first stage of the menstrual cycle, 5.9 ± 0.37 ME / l in the second stage. (P> 0.05). In healthy 14-year-old girls, LG levels in the first phase of the cycle were 5.2 ± 0.22 ME / l, while in the second phase it increased to 7.8 ± 0.45 ME / l (P <0.001). At age 15, the LG concentration in the first phase of the cycle was 5.5 ± 0.29 ME / l, while in the second phase, it increased almost 5-fold to 19.0 ± 1.1 ME / l (P <0.001). The same dynamics was observed in 16-year-old girls: 5.6 ± 0.30 and 19.8 ±1.02 ME / l (P <0.001), respectively.
In girls with UBC, the LG index is much lower than in healthy indicators (P <0.050.01). However, the regularity of the oscillations of this hormone depending on the phase of the cycle is maintained. Thus, in 12-year-old girls, the LG concentration in the first phase of the cycle was 3.2 ± 0.15 ME / l, and in the second phase - 3.4 ± 0.14 ME / l (P> 0.05). However, in 13-year-old girls, hormone levels began to increase: 3.6 ± 0.16 ME / l in the first phase and 4.1 ± 0.18 ME / l in the second phase (P <0.05). The same dynamics is observed in girls aged 14, 15 and 16 years: 3.8 ± 0.16 in 14 -year-old girls and 5.3 ± 0.22 ME / l in the second phase of the cycle, 3.7 ± 0.16 and 5.6 ± 0 , 26 ME / l - 15 years, 4.5 ± 0.19 and 9.1 ± 0.42 ME / l (P <0.05-0.001).
FSG levels were significantly reduced among girls with YBQ in all age groups. Thus, in the first phase of the cycle, this figure was 2.8 ± 0.12 ME / l in 12-year-old girls, and in the second phase, 2.6 ± 0.11 ME / l. In 13-year-old girls, the concentration of this hormone increased to 3.1 ± 0.13 and 3.4 ± 0.15 ME / l (P> 0.05), respectively. However, FSG levels did not increase in 14- and 15-year-old girls: 2.8 ± 0.12 and 2.5 ± 0.11 ME / l in 14-year-old girls and -3.0 ± 0.13 and 2.8 ± 15 in 15-year-old girls, respectively. 0.12 ME / l (P> 0.05). FSG levels also increased significantly in 16-year-old girls: 3.5 ± 0.15 ME / l in the first stage and 3.8 ± 0.16 ME / l in the second stage of the menstrual cycle.
Girls with UBC have slightly lower prolactin levels than healthy girls. However, depending on the phase of the cycle, its total amount was preserved. In 12-year-old
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girls, the amount of prolactin in the blood was 159 ± 6.7 mME / l in the first stage of menstruation, 206 ± 8.8 mME / l in the second stage, 187 ± 8.0 and 224 ± 9.5 mME / l. -13 years, 240 ± 10.3 and 15 years 302 ± 12.8 mME / l, 228 ± 9.6 and 16 years 315 ± 13.8 mME / l - (P <0.001).
Thus, in healthy girls, the content of LG, FSG, estradiol, progesterone, and prolactin varied significantly depending on both age and the stage of the menstrual cycle. Thus, in girls aged 12-13 years, especially in the first stage of the cycle, a relative lack of LG, FSG, and estradiol concentrations indicates an anovulatory menstrual period (P = 0.51-0.76). In contrast, in older girls, the content of these hormones is significantly increased, and the onset of ovulation is exactly the second stage of the cycle, which contributes to a 4-10 increase in progesterone.
Ultrasound of the uterus and ovaries in healthy girls with abnormal bleeding from the uterus at a juvenile age.
To determine the functional status of the ovarian and uterine cycle, we conducted a genital ultrasound examination of 36 girls with UBC. Thirty-two healthy girls were also examined to compare the results obtained. Studies have shown that there is no significant difference in the size of the left and right ovaries, so generalized data are provided.
In the first phase, in 12-year-old conditionally healthy girls, the ovary was 2.4 ± 0.17 cm long and 1.5 ± 0.08 cm wide, and in the second phase of the menstrual cycle, the size of the ovary did not differ significantly: 2.5 ± 0.2 and 1, respectively. , 6 ± 0.07 cm (P> 0.05). In 13-year-old girls, the ovaries enlarge: in the first phase they enlarge to 3.5 ± 0.23 and 2.5 ± 0.13 cm, respectively, and in the second phase they enlarge to 3.6 ± 0.2 and 3.0 ± 0.21 cm. Approximately the same results were obtained in girls aged 14, 15, and 16 years. In the first stage, in 14-year-old girls, the ovary was 3.4 ± 0.26 cm long and 2.4 ± 0.18 cm wide.
In the second phase of the cycle, these values increased significantly: 3.6 ± 0.27 and 3.5 ± 0.2 cm, respectively, in the first phase, the values studied at the age of 15 were 3.3 ± 0.21 and 2.6 ± 0.23, respectively. teng. cm, in the second - 3.8 ± 0.19 and 3.2 0.28 cm, in the first phase at the age of 16 - 3.8 ± 0.3 and 2.4 ± 0.18 cm, in the second phase - 3.8 ± 0 , 24 and 2.6 ± 0.17 cm.
The parameter that receives information about the uterus on ultrasound is its size and length, on the basis of which other dimensions are determined and, accordingly, the pathology of this or that organ is determined. In the girls we examined, there was no difference in uterine size depending on the phases of the ovarian cycle (P> 0.05). The length of the uterus in girls with UBC is slightly shorter than in healthy girls in general. However, the regularity of this magnitude increase does not change with age
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Interesting results were obtained when analyzing the endometrial layer in the subjects examined. In healthy girls, endometrial thickness is characterized by an increase in the second phase of the cycle. Thus, in the first stage of the menstrual cycle, the thickness of the endometrium in healthy 12-year-old girls was 0.9 ± 0.07 cm, in the second 1.1 ± 0.09 cm, and in 13-year-old girls 0.8 ± 0, 07 and 1.2 ± 0, 1 cm (P <0.01). The same situation persists in healthy girls at the age of 14, 15 and 16 years: 14 years, 0.9 ± 0.06 and 1.2 ± 0.07 cm, respectively, at the age of 15, 1.0 ± 0.09 and 1.4 ± 0.09 cm, 1.1 ± 0.1 and 1.0 ± 0.15 cm at 16 years of age.
In girls with UBC, a significant increase in endometrial thickness was observed in the second phase of the cycle, which may indicate follicular atresia. Thus, in girls with UBC at the age of 12, the thickness of the endometrium in the first phase of the menstrual cycle was 0.8 ± 0.08 cm, and in the second 1.2 ± 0.1 cm (P <0.01). In 13 -year-old girls, the thickness of the endometrium was 0.7 ± 0.09 in the first part of the menstrual cycle, 1.5 ± 0.16 cm in the second stage (P <0.01), and 0.7 ± 0, 05, and 1.6 ± 14 in the 14-year-old. 0.09 cm, 1.4 ± 0.09 and 1.6 ± 0.12 cm at 15 years of age, 1.0 ± 0.15 and 1.8 ± 0.17 cm at 16 years of age (P <0.05-0.001) ).
Thus, the ultrasound examination revealed regular changes specific to girls with healthy and UBC. Active growth of the ovaries was observed from the age of 13 years. In general, the size of the ovaries increased during the second stage of the cycle, which was especially noticeable in healthy girls aged 13, 14, and 15 years. In contrast, 16-year-old girls have an ovulation cycle of relatively similar size at both stages of the menstrual cycle. Unlike healthy girls, girls of all ages have an anovulatory type of menstrual cycle (P <0.05-0.001)
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CENTRAL ASIAN ACADEMIC JOURNAL ISSN: 2181-2489
OF SCIENTIFIC RESEARCH VOLUME 2 I ISSUE 5 I 2022
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