Characteristics of Uterine Hyperplastic Processes in Women with Obesity

О.М. Makarchuk, Abdulrakhman Abdulbaset Moslem
In: Galician Medical Journal · 2016 · vol. 23(3) · doi:10.21802/gmj.2016.3.42 · W2523060450
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This study identifies obesity and associated metabolic disorders as significant risk factors for uterine leiomyoma, adenomyosis, and endometrial hyperplasia in women of reproductive age.

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This study evaluated the characteristics of uterine hyperplastic processes in 60 women of reproductive age with leiomyoma and obesity, comparing them against a control group of healthy women. The researchers identified that factors such as prior instrumental uterine interventions, chronic genital inflammation, hormonal imbalances, and liver dysfunction significantly contributed to fibroid development in this population. A key finding was that metabolic disorders associated with obesity increased the prevalence of combined hyperplastic conditions, including endometrial polyps and adenomyosis, by nearly double compared to non-obese counterparts. Relevance to endometriosis: listed as one indication for GnRH antagonists, though the paper's main focus is uterine fibroids.

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Abstract

Introduction. Analysis of uterine leiomyoma incidence indicates not only its growth but also the increase in the number of women of early reproductive age. However, the problem of trigger mechanisms for its development is still uncertain and actual.The objective of the research was to assess the characteristic features of hyperplastic processes in uterus on the background of dishormonal and metabolic disorders.Materials and methods. 60 women of reproductive age with uterine leiomyoma participated in the clinical trial. They gave their informed written consent. The control group consisted of 20 healthy women of reproductive age. Statistical analysis was conducted using material package “STATISTICA for Windows®-6.0” and methods of odds ratio (OR) calculating and its 95% Confidential Interval (95% CI).Results and their discussion. According to the results of the research the main factors contributing to uterine fibroid development in women with obesity were determined. They included: the age of 30-45 years, instrumental intervention in the womb (abortion, diagnostic curettage, etc. (OR = 8.2; 95% CI: 5.1-13.5)); chronic inflammatory diseases of genitalia (OR = 7.9; 2.9-21.9); hormonal imbalances (fibro-cystic breast disease, thyroid disorders (OR = 8.61; 3.1-23.8), liver and gastrointestinal tract disorders (OR = 5.8; 2.1-15.9) sexual disorders and stress inductive factors (OR = 2.6; 1.4-7.1) (usually fibroids occur in 1-2 years after severe stress). There is a significant percentage of adenomyosis and endometrial hyperplastic processes. Growth of tumors in women with obesity increases to 35-40 years of age, and is associated not only with a progressive decrease in the functional activity of the ovaries, their sensitivity to gonadotrophic stimulation, but also with chronic functional exertion of regulation systems on the background of metabolic disorders of hemostasis and homeostasis in this category of women.Conclusions. One of the most significant risk factors for hyperplastic processes of the reproductive organs is obesity and associated metabolic disorders. In case of metabolic disorders activity and hepatocytes on the background of obesity the number of combined forms of hyperplastic processes in the uterus increases by 1.9 times. The main risk factor for fibroids in obese women is hepatocytes dysfunction on the background of a high percentage of hepatobiliary pathology, endocrine pathology – 68.3% (thyroid dysfunction, fibro-cystic breast changes). Morphological and histological structure of endometrium in obese women leads to the growth of endometrial polyps (36.66%).
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Abstract

Introduction. Analysis of uterine leiomyoma incidence indicates not only its growth but also the increase in the number of women of early reproductive age. However, the problem of trigger mechanisms for its development is still uncertain and actual. The objective of the research was to assess the characteristic features of hyperplastic processes in uterus on the background of dishormonal and metabolic disorders.

Materials

and methods. 60 women of reproductive age with uterine leiomyoma participated in the clinical trial. They gave their informed written consent. The control group consisted of 20 healthy women of reproductive age. Statistical analysis was conducted using material package “STATISTICA for Windows®-6.0” and methods of odds ratio (OR) calculating and its 95% Confidential Interval (95% CI).

Results

and their discussion. According to the results of the research the main factors contributing to uterine fibroid development in women with obesity were determined. They included: the age of 30-45 years, instrumental intervention in the womb (abortion, diagnostic curettage, etc. (OR = 8.2; 95% CI: 5.1-13.5)); chronic inflammatory diseases of genitalia (OR = 7.9; 2.9-21.9); hormonal imbalances (fibro-cystic breast disease, thyroid disorders (OR = 8.61; 3.1-23.8), liver and gastrointestinal tract disorders (OR = 5.8; 2.1-15.9) sexual disorders and stress inductive factors (OR = 2.6; 1.4-7.1) (usually fibroids occur in 1-2 years after severe stress). There is a significant percentage of adenomyosis and endometrial hyperplastic processes. Growth of tumors in women with obesity increases to 35-40 years of age, and is associated not only with a progressive decrease in the functional activity of the ovaries, their sensitivity to gonadotrophic stimulation, but also with chronic functional exertion of regulation systems on the background of metabolic disorders of hemostasis and homeostasis in this category of women. Conclusions. One of the most significant risk factors for hyperplastic processes of the reproductive organs is obesity and associated metabolic disorders. In case of metabolic disorders activity and hepatocytes on the background of obesity the number of combined forms of hyperplastic processes in the uterus increases by 1.9 times. The main risk factor for fibroids in obese women is hepatocytes dysfunction on the background of a high percentage of hepatobiliary pathology, endocrine pathology – 68.3% (thyroid dysfunction, fibro-cystic breast changes). Morphological and histological structure of endometrium in obese women leads to the growth of endometrial polyps (36.66%).

References

Kosei NV. Optimization of organ-preserving treatment of uterine leiomyoma with levonorgestel-releasing system implementation. Daidzest profesiinoi medychnoi informatsii “Zrostai maliuk”. 2010; 25: 20-26. Мelnichenko GA. Obesity in endocrinologist’s practice. Russkii meditsinskii zhurnal. 2001; 2 (9): 82-87. Tatarchuk TF, Kosei NV, Mogilevsky DM, Sukhorebraya EI, Shakalo IN. Modern aspects of organ-preserving treatment of uterine. Reproduktivnoe zdorovie zhenshchiny. 2006; 1 (25): 123-129. Tatarchuk TF, Shevchuk TV. Functional liver diseases in gynaecological practice. Zdorovie zhenshchiny. 2006; 3 (27): 250-260. Garry R, Shett S, Sutton C. Which hysterectomy? A detailed comparison of laparoscopic, vaginal and abdominal hysterectomy. Menorrhagia. Iss Medical Media Ltd. 1999; 239-252. Sabry M. Innovative Oral Treatments of Uterine leiomyoma. Obstetrics Gynecology International. 2012; 1-10. http://dx.doi.org/10.1155/2012/943635 This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. Copyright (c) 2017 O. M. Makarchuk, Abdulrakhman Abdulbaset Moslem

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