The objective: to evaluate the effectiveness of the correction of climacteric syndrome (CS) with the use the method of sequential prevention and treatment of CS in women with uterine leiomyoma (UL) and endometrial hyperplasia (EH) based on studies of indicators of the immune system. Materials and methods. On the basis of prognosis using a mathematical model some groups of women with UL and EH in the period of before and after menopause, with the risk of development of disorders in menopause were chosen and the state of the immune system before and after the correction of climacteric syndrome with the use the method of sequential prevention and treatment of CS were evaluated. The prevention of CS was carried out in 184 women aged 40 to 53 years with the presence of signs of UL and EH, in which after menstruation was delayed for 3–6 months, uterine bleeding and symptoms of CS were observed. These women underwent CS prevention for one year with the use of a contraceptive containing of the natural estrogen estradiol valerate and gestagen dienogest. The women were divided into groups depending on the presence or absence of signs of CS, UL and EH: women with UL and CS (n=60), women with UL without CS (n=37), women with EH and CS (n=37), women with EH without CS (n=25), women with CS without UL and EH (n = 25). Women with UL and CS who constituted the main group (n=60), additionally used an immunomodulator that contains meglumine acridonacetate and suppositories containing recombinant alpha interferon 2. The control group consisted 50 women of the same age category without the presence of CS, UL and EH After the prevention in 24 women of the main group (n=60), the menstrual function was recovered and the symptoms of CS disappeared. In remaining 36 women the menopause was developed and they amounted to 1 treatment-and-prophylactic (1-T-P) group of women who were prescribed the treatment complex developed and proposed by us. In these women we investigated the effectiveness of the correction of climacteric syndrome with the use the method of sequential prevention and treatment of symptoms of CS. The treatment of CS, which included a complex of drugs: a combined herbal preparation containing cimicifuga, a preparation from the microalgae Spirulina platensis, pectin and a drug with the active substance mebicar, was carried out for one year in 193 women aged 48 to 60 years. These women consisted of women with UL and CS after prophylaxis – 1 treatment-and-prophylactic (1-T-P) group (n=36), of women without prior prevention: women with UL, CS and natural menopause – 1-treatment (1-T) group (n=31), women of 2 – treatment (2-T) group with UL without CS (n=40), women of 3 – treatment (3-T) group with EH and CS (n=25), women of 4 – treatment (4-T) group with EH without CS (n=27), women of 5 – treatment (5-T) group with CS without UL and EH (n=34). The control group consisted of 35 women of the same age category without the presence of UL, EH and CS. The signs of uterine leiomyoma (UL) and endometrial hyperplasia (EH) were determined according to ultrasound examination of the uterine and the results of histological investigations of the endometrium. The intensity of the symptoms of CS was evaluated using a modified Cooperman index (MCI). To assess the effectiveness of correction of CS in women with UL and EH by an enzyme immunoassay, the level of Ig A, G, M, interleukins 1 and 2 (IL-1, IL-2) of tumor necrosis factor (TNF) was studied before and after the use of prevention and treatment of CS. Group comparisons were performed using the angular Fischer transform. Parametric indicators at normal distribution were compared using Student’s t criterion. In the work, their quantitative values are given in the form of arithmetic mean and its error. Results. After the treatment in women with EH and CS (n=25) in women with CS without UL and EH (n=34) indicators of humoral immunity IgA, IgM, IgG, IL-1, IL-2 and TNF did not significantly differ from those in healthy women in the menopause (р>0,05). In women after consistent prevention and treatment of CS of 1 T-P group (n=36), we observed the increase of the level of IgA for 29%, IgM for 25%, decrease the level of IL-1 to 1,3 times, and TNF level – to 1,8 times. In women without prophylaxis of CS of 1-T group (n=31) we observed the increase of the level of IgA for 25%, IgM for 19%, compared with the indicators before the treatment (р<0.05), and the IgG and TNF level after the treatment does not differ from the indicators in healthy women in the menopause (р>0.05), the level of the IL-1 remained to 1,6 times higher compared with healthy women (р<0.05). The consistent use of prevention and treatment by our worked out method allows to reduce the intensity of CS in women with UL and CS after prevention (n=36) according to the MCI data by 1,26 times in comparison with women in the group with CS, UL and natural menopause (n=31), by 1,28 times in comparison with women in the group with EH and CS (n=25), by 1,39 times in comparison with women in the group with CS without UL and EH (n=25) after treatment according to our method, without previous prevention. Conclusions. The application of the correction of CS with the use of the method of consistent prevention and treatment of CS allows to reduce the intensity of symptoms of CS in women with UL and CS according to the MCI data by 1.26–1.39 times, recover the indicators of humoral link of immune system and prevent the exhaustion of antitumor protection factors. Keywords: climacteric syndrome, prevention, treatment, uterine leiomyoma, endometrial hyperplasia, immune system.
Transcriptome analysis of eutopic endometrium in adenomyosis after GnRH agonist treatment
