ASSESSMENT OF COMORBIDITY IN THE MANAGEMENT OF PATIENTS WITH A DISGORMONAL COMBINED PROLIFERATIVE PATHOLOGY OF REPRODUCTIVE ORGANS

The influence of comorbid pathology on the clinical manifestations, diagnosis, treatment and prognosis of many diseases is individual, but it is generally recognized that the interaction of diseases, age and pathomorphosis predetermines the pathogenetic features of the pathology of the reproductive system, troubles diagnosis, the choice of optimal medical technologies, negatively affects the quality of life of women.The aim of the study was to evaluate the prevalence of comorbid conditions in women with reproductive health disorders against the background of a dyshormonal combined pathology of the reproductive system.Materials and methods. The study involved 350 women aged 20 to 42 years. The examination included the study of complaints, personal and family history, anthropometric, physical, ultrasonographic, instrumental, clinical and laboratory examination with the definition of the hormonal profile, the function of thyroid gland, level 25 (OH) D. A combined dyshormonal benign proliferative pathology of the reproductive organs (genital endometriosis, adenomyosis / leiomyoma of the uterus in combination with endometrial hyperplasia and diffuse mastopathy) was diagnosed in 51.3% of the patient, 8.9% had PCOS, 15.1% had endometriosis disease, 16,3% - to the uterus leiomyoma. Absence of pathology at the time of examination was found in 14.3% of women.Results of the study and their discussion. Diffuse mastopathy (BI-RADS 2) occurred in 63.7% of women, and changes in BI-RADS 3 were detected in 11.1%. Structural and functional changes of the thyroid gland were found in 53.4% women, of the frequency of diffuse goiter I – II st. was did not differ between clinical groups (p> 0.05). At the same time, the prevalence of autoimmune thyroiditis was higher in patients with dyshormonal pathology of the reproductive system compared with women without gynecological pathology (p = 0.0001). Euthyroid status in patients with combined dyshormonal pathology occurred 1.5 to 1.9 times less frequently than in patients with endometriosis, uterine leiomyoma and PCOS (p≤0,0005). 27.7% of women had excess weight, obesity of the 1st degree - in 34.9%, obesity of the second degree in 9.7% of women, which in general accounted for 72.3% of the examined. The most often severe vitamin D deficiency (level 25 (OH) D on average 6.3 ± 1.5 ng / ml) among women with D deficiency was detected in 53.3% of cases with PCOS and in 70.5% of women with combined dyshormonal diseases of the reproductive organs (p <0.05) in the absence of severe deficit D in women without gynecological pathology, which is a convincing indicator of the importance of vitamin D for the normal functioning of the female reproductive system.Conclusions. Comorbidity is a serious problem for reproductive health and requires a change in the diagnostic and treatment approaches from disease-oriented recommendations to patient-centered approaches based on an integrated assessment of the patient.