Abstract:
To date, there are several approaches to the treatment of endometrial hyperplasia, but
it is quite unclear which approach provides a higher clinical response with a lower recurrence
rate, in addition to preservation and restoration of fertility in infertile women with complex
non-atypical endometrial hyperplasia (NEH) and excess body weight. The purpose of the
study was to evaluate the effectiveness of the restoration of reproductive function in patients
with infertility, complex NEH and with excess body weight according to the proposed
method. Material and methods. 74 women of reproductive age with complex NEH,
infertility and excess body weight were under observation, of which 34 patients of the main
group after hysteroscopic resection of the lesion at the first stage of treatment, at the second
stage of treatment received gonadotropin-releasing hormone agonists (aGnRH) and adjuvant
therapy with drugs indole-3-carbinol, metformin, fenofibrate for three months, and then at the
third stage of treatment dydrogesterone, metformin, a vitamin-mineral complex that included
myo-inositol, banaba leaves, extract of 1% corosolic acid, vitamin D3, methylfolatequatrafolic, chromium for 6 months. 40 patients of the control group after hysteroscopic resection of the lesion at the first stage of treatment were prescribed aGnRH for 3 months in
the second stage of treatment, then methylfolate-mvatrafolic for 6 months. Anthropometric
data, echometric and morphofunctional characteristics of the endometrium during the
expected window of implantation, hormonal profile and levels of peripheral blood lipokines
in the dynamics of treatment were studied. Reproductive results were evaluated within a year
after the end of treatment. The results. Treatment of complex NEH in the main group led,
compared to the control group, to a decrease in body mass index, improvement in echometric
and morphofunctional characteristics of the endometrium, its receptivity during the expected
window of implantation, hormonal profile and lipokines level in peripheral blood, a decrease
in insulin resistance, and an increase in the frequency of pregnancy. Conclusion. The
proposed scheme for the treatment of complex NEH in infertile women with excess body
weight allowed to improve their reproductive results, is effective and can be recommended for
implementation in wide clinical practice.
