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Study on endometrial pathological structure and muscle strength in patients with perimenopausal abnormal uterine bleeding

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https://www.eduzhai.net American Journal of Medicine and Medical Sciences 2021, 11(4): 286-289 DOI: 10.5923/j.ajmms.20211104.06 Results of Studying the Structure of Endometric Pathology and Myometry in Women with Abnormal Uterine Bleeding during Perimenopause Askarova Zebo Zafarjonovna1, Alieva Dilfuza Abdullaevna2 1Samarkand Medical Institute, Samarkand, Uzbekistan 2Professor, Doctor of Medical Sciences, Republican Specialized Obstetrics and Gynecology Scientific-Practical Medical Center, Tashkent, Uzbekistan Abstract Purpose study of the structure of the endometrium in women with abnormal uterine bleeding during perimenopause. We analyzed the case histories of 125 patients with abnormal uterine bleeding who received inpatient treatment in the gynecological department of the 1st clinic of SamMI from January 2019 to May 2020. According to the histological study of group I, 32 (37.6 ± 5.2%) were diagnosed with glandular hyperplasia of the endometrium, 3 (3.5 ± 2.0%) of patients, glandular hyperplasia of the endometrium was combined with a submucous myomatous node, in 9 (10.6 ± 3.3%) - glandular-cystic hyperplasia of the endometrium, endometrial polyps - in 41 (48.2 ± 5.4%) patients. According to the histological examination of group II scraping, 5 (19.2 ± 7.7%) were diagnosed with glandular hyperplasia of the endometrium, 2 (7.6 ± 5.2%) had glandular cystic hyperplasia, polyps were diagnosed in 10 (38.4 ± 9, 5%), 2 (7.6 ± 5.2%) patients with glandular hyperplasia of the endometrium revealed a submucous myomatous node, atypical endometrial hyperplasia in 6 (23.0 ± 8.2%) and endometrial cancer in 1 (3.8 ± 3.7%) patient. Thus, during histological examination of endometrial scraping in patients with abnormal uterine bleeding in the group with recurrent AMC, atypical endometrial hyperplasia was verified 6 (23.0 ± 8.2%) and endometrial cancer was detected in one patient, while patients of group I had atypical endometrial hyperplasia and no endometrial cancer was detected. Keywords Coagulopathic, Oncological alertness, Precancer, Adenomyosis, Submucous myomatous, Endometrial glandular 1. Introduction Abnormal uterine bleeding (AMB) is one of the most common reasons for visiting a gynecologist and performing intrauterine interventions. The term AMB covers severe uterine bleeding, which can be caused by anatomical pathology of the reproductive system and women with normal anatomy in whom AMK can be caused by ovulatory dysfunction, coagulopathic and iatrogenic causes [11,13]. Endometrial hyperplastic processes are a common pathology, the frequency of which increases towards the period of age-related hormonal changes in perimenopause. Endometrial hyperplastic processes in most cases are manifested by abnormal uterine bleeding [12]. The most frequent morphological substrate of abnormal uterine bleeding (AMB) during perimenopause in women is endometrial hyperplastic processes [2,5]. As you know, the causes of AMB are chronic anovulation, which is characteristic of this age period of life due to age-related Received: Mar. 3, 2021; Accepted: Mar. 22, 2021; Published: Mar. 28, 2021 Published online at https://www.eduzhai.net hormonal changes [5]. Endometrial hyperplasia (EH) is one of the main forms of pathological proliferative changes in the uterine mucosa, characterized by excessive proliferation of the predominantly glandular and, to a lesser extent, its stromal component. However, one should not forget about oncological alertness. According to a number of authors, in 70% of cases of uterine cancer during perimenopause, hyperplastic processes of the endometrium precede, and in 30-79% of cases within 1-3 years, atypical endometrial hyperplasia turns into cancer [1,5]. So, in the studies of Barbieri R.L. et al. the risk of transformation of simple hyperplasia into atypical hyperplasia was about 10.5%, and into endometrial cancer 2% [7,4]. Endometrial polyps, glandular and glandular-cystic hyperplasia of the endometrium refer to background processes and only atypical hyperplasia is a true endometrial precancer. Glandular hyperplasia during perimenopause in 0.4-1% of cases turn into atypical hyperplasia and endometrial cancer. Atypical hyperplasia turns into American Journal of Medicine and Medical Sciences 2021, 11(4): 286-289 287 endometrial cancer in 40% of cases [1]. Precancerous EH transforms into endometrial cancer in 10% of patients (according to different authors, from 2 to 50%) [8,9,10]. As you know, the gold standard for determining the background of AMK is morphological - the study of histological preparations of endometrial scrapings [3,9]. The aim of our study was to study the structure of the endometrium in women with abnormal uterine bleeding during the perimenopause. all patients underwent clinical and anamnesis examination, transvaginal ultrasound examination, and hysteroscopy. As you know, uterine bleeding is a syndrome diagnosis, which can be caused by a large number of different diseases. In the period of per menopause, which is a critical period in terms of the occurrence of various neoplasm’s, with abnormal uterine bleeding, along with ultrasound, a morphological examination of the uterine mucosa is mandatory. 2. Materials and Methods 3. Results We analyzed the case histories of 125 patients with abnormal uterine bleeding who received inpatient treatment in the gynecological department of the 1st clinic of SamMI from January 2019 to May 2020. The age of women varied from 43 to 51 years, on average 46.9 ± 1.6 years. According to generally accepted standards, All patients with endometrial hypertrophy 111 (88.8 ± 2.8%), we underwent a morphological examination of scrapings (Table 1). The exception was 14 (11.2 ± 2.8%) in whom the ultrasound diagnosed the thickness of the endometrium from 1 to 4 mm. Table 1. Histological structure of the endometrium in women with abnormal uterine bleeding during perimenopause Endometrial structure Endometrial glandular hyperplasia Glandular hyperplasia of the endometrium and submucous myomatous node Glandular cystic hyperplasia Endometrial polyps Atypical endometrial hyperplasia Endometrial cancer I group, n = 85 32(37,6±5,2%) 3(3,5±2,0%) 9(10,6±3,3%) 41(48,2±5,4%) - II group, n = 26 5(19,2±7,7%) * 2(7,6±5,2%) 2(7,6±5,2%) 10(38,4±9,5%) 6(23,0±8,2%) 1(3,8±3,7%) consolidated group, n = 111 37(33,3±4,5%) 5(4,5±1,9%) 11(9,9±2,8%) 51(45,9±4,7%) 6(5,4±2,1%) 1(0,9±0,9%) Note: * -p <0.05 reliability of differences between groups I and II According to the histological study of group I, 32 (37.6 ± 5.2%) were diagnosed with glandular hyperplasia of the endometrium, in 3 (3.5 ± 2.0%) patients, glandular hyperplasia of the endometrium was combined with a submucous myomatous node, in 9 (10, 6 ± 3.3%) glandular-cystic hyperplasia of the endometrium, endometrial polyps - in 41 (48.2 ± 5.4%) patients. According to the histological examination of group II scraping, 5 (19.2 ± 7.7%) were diagnosed with glandular hyperplasia of the endometrium, 2 (7.6 ± 5.2%) had glandular cystic hyperplasia, polyps were diagnosed in 10 (38.4 ± 9, 5%), in 2 (7.6 ± 5.2%) patients on the background of glandular hyperplasia of the endometrium, a submucous myomatous node, atypical endometrial hyperplasia in 6 (23.0 ± 8.2%) and endometrial cancer in 1 (3, 8 ± 3.7%) patient. Thus, during histological examination of endometrial scraping in patients with abnormal uterine bleeding in the group with recurrent AMC, atypical endometrial hyperplasia was verified 6 (23.0 ± 8.2%), and in one patient, endometrial cancer was detected, while in patients of group I, atypical hyperplasia endometrial and endometrial cancer were not identified. Analysis of the results of endometrial histology, depending on the data of the ultrasound structure of the myometrium in patients with AMB, showed a combination of glandular hyperplasia of the endometrium (GHPE) with endometrial myoma in 9 (7.2 ± 0.6%), with adenomyosis in 9 (7.2 ± 0.6%) %), a combination with adenomyosis and myoma 4 (3.2 ± 1.6%), VHGE without myometrial pathology 15 (12.0 ± 2.9%) and in 5 (4.0 ± 1.8%) patients with VHGE combined with a submucous myomatous node. Glandular cystic hyperplasia of the endometrium (GLCHP) was combined with myometrial pathologies in 11 (8.8 ± 2.5%) cases, of which 6 with uterine myoma (4.8 ± 1.9%), with adenomyosis in 2 (1,6 ± 1.9%), combination with myoma and adenomyosis in 3 (2.4 ± 1.4%) patients. Endometrial polyps (PE) were combined with myometrial pathology in 34 (27.2 ± 3.9) patients, of whom 19 (15.2 ± 3.2%) patients were associated with uterine myoma, in 13 (10.4 ± 2, 7%) with adenomyosis, in 2 (1.6 ± 1.9%) it was combined with uterine myoma and adenomyosis. Endometrial polyps without myometrial pathology were found in 17 (13.6 ± 0.8%) cases. Atypical endometrial hyperplasia (AGE) was combined with uterine myoma in 2 (1.6 ± 1.9%) cases, in 4 (3.2 ± 1.6%) patients, AGE was not combined with myometrial pathology. In patients who did not undergo curettage (14 (11.2 ± 2.8%)), uterine myoma was found in 4 (3.2 ± 1.6%) and adenomyosis in 10 (8.0 ± 2.4%). 288 Askarova Zebo Zafarjonovna and Alieva Dilfuza Abdullaevna: Results of Studying the Structure of Endometric Pathology and Myometry in Women with Abnormal Uterine Bleeding during Perimenopause Thus, GHPE was detected in 15 (12.0 ± 2.9%) patients (3.2 ± 1, 6%) of patients without myometrial pathology and without myometrial pathologies, PE was detected in 17 (13.6 in 1 (0.8 ± 0.8%) patient with endometrial cancer, no ± 0.8%) patients without myometrial pathology, AHE in 4 myometrial pathology was detected by ultrasound data. Table 2. Analysis of the results of endometrial histology depending on the data of the ultrasound structure of the myometrium in patients with anamal uterine bleeding Structure endometrium n = 125 myometrium structure n = 125 Endometrial glandular hyperplasia Glandular hyperplasia of the endometrium and submucous myomatous node Glandular cystic hyperplasia Endometrial polyps Atypical endometrial hyperplasia Endometrial cancer Patients who have not undergone curettage Total myoma 9(7,2±0,6%) 5(4,0±1,8%) 6(4,8±1,9%) 19(15,2±3,2%) 2(1,6±1,9%) 4(3,2±1,6%) 45 adenomyosis 9(7,2±0,6%) 2(1,6±1,9%) 13(10,4±2,7%) 10(8,0±2,4%) 34 fibroids in combination with adenomyosis 4(3,2±1,6%) 3(2,4±1,4%) 2(1,6±1,9%) - 9 without myometrial pathology 15(12,0±2,9%) 17(13,6±0,8%) 4(3,2±1,6%) 1(0,8±0,8%) 37 Total 37(25,6±8,4%) 5(4±1,8%) 11(8,8±2,5%) 51(40,8±4,4) 6(4,8±1,9%) 1(0,8±0,8%) 14(11,2±2,8%) 125 The most informative method of examining women with AMC during perimenopause is diagnostic curettage of the uterine cavity, according to the conclusions of which a plan for the management of patients is developed. 4. Conclusions 1. Thus, during histological examination of endometrial scraping in patients with abnormal uterine bleeding in the group with recurrent AMC, atypical endometrial hyperplasia was verified 6 (23.0 ± 8.2%) and endometrial cancer was detected in one patient, while patients of group I had atypical endometrial hyperplasia and no endometrial cancer was detected. 2. Thus, GHPE was detected in 15 (12.0 ± 2.9%) patients without myometrial pathologies, PE was detected in 17 (13.6 ± 0.8%) patients without myometrial pathology, AHE in 4 (3.2 ± 1, 6%) of patients without myometrial pathology and in 1 (0.8 ± 0.8%) patient with endometrial cancer, no myometrial pathology was detected by ultrasound data. [3] Alieva D.A., Askarova Z.Z. Results of studying the structure of endometrial pathology in women with abnormal uterine bleeding during perimenopause // Tibbietda yangi kun. No. 4 (34) 2020. S. 69-72. [4] Ailamazyan E. K. Gynecology: from puberty to menopause. — M.: MEDpress, 2017.— 512 p. [5] Zaporozhan VN, Vikhlyaeva EM, Zheleznov BI Dysfunctional uterine bleeding // Guide to endocrine gynecology / Ed. E. M. Vikhlyaeva. - M.: Med. inform. agency, 2015.— 768 p. [6] Savelyeva G. M., Breusenko V. G., Kaplusheva L. M. Hysteroscopy. M.: GEOTAR, 1999. 176 p. [7] Topchieva OI, Pryanishnikova VA, Zhemkova ZP Endometrial biopsy. M.: Medicine, 1998. 232 p. [8] American College of Obstetrics and Gynecology. Practice Bulletin No. 128, Diagnosis of abnormal uterine bleeding in reproductive aged women. ObstetGynecol. 2012; 120: 197-206. [9] Askarova Z. Z., Saparbayeva N.R, Aliyeva D. A., Kurbaniyazova M.Z. Value of hysteroscopy and genetic research of women with abnormal uterine bleeding in perimenopause. // European journal of molecuiar & clinical medicine. Volume 8 Issue 1, P. 409-416. REFERENCES [1] Ablakulova V.S. On the risk of recurrence of endometrial polyps. Second honey journal. Uzbekistan. 1999; 1; 53-55p. [2] Askarova ZZ The frequency of pathomorphological changes in the endo- and myometrium in the development of AMC in perimenopausal women // Achievements of science and education №2 (56) 2020 pp. 113-115. [10] Barbieri RL. A new (to the US) first-line agent for heavy menstrual bleeding (Editorial). OBG Management. 2010; 22: 9-12. [11] Basila D, Yuan CS. Effects of dietary supplements on coagulation and platelet function. Thromb Res. 2015; 117: 49-53. [12] Bosteels J, Kasius J, Weyers S. Hysteroscopy for treating subfertility associated with suspected major uterine cavity American Journal of Medicine and Medical Sciences 2021, 11(4): 286-289 289 abnormalities. Cochrane Database Syst Rev. 2015; 2: CD009461. [13] Kurman, R.J. Endometrial hyperplasia and related cellular changes. / R.J. Kurman, H.J. Norris // Blaustein’s pathology of the female genital tract / ed. by R.J. Kurman – 5 th ed. – New York, 1995. – P. 411-437. Copyright © 2021 The Author(s). Published by Scientific & Academic Publishing This work is licensed under the Creative Commons Attribution International License (CC BY). http://creativecommons.org/licenses/by/4.0/

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