FEATURES OF HORMONAL HOMEOSTASIS AND VITAMIN D LEVELS IN PATIENTS OF REPRODUCTIVE AGE WITH OVARIAN ENDOMETRIOMAS

The search for methods to preserve reproductive potential in women with ovarianendometriomas remains one of the most controversial topics in modern gynecology. Theurgency of the study is caused by the need to minimize the negative impact oflaparoscopic cystectomy on the ovarian reserve, which is often reduced as a result ofsurgical trauma. Particular attention deserves the study of concomitant vitamin Ddeficiency role which may act as an additional pathogenetic factor in the progression ofendometriosis and reduced fertility.The aim – to compare the features of hormonal homeostasis and vitamin D levelsaccording to a retrospective analysis in patients of reproductive age with ovarianendometriomas with and without surgical treatment and in the control group.Materials and methods. A retrospective analysis of medical records of inpatients at the“Innomed” Medical Center from 2019 to 2025 was conducted.The study was conducted in accordance with the provisions of the Helsinki Declarationadopted by the General Assembly of the World Medical Association (1964-2008), theCouncil of Europe Convention on Human Rights and Biomedicine (1977), relevantprovisions of the WHO, the International Council of Medical Science Societies, theInternational Code of Medical Ethics (1983), and Order No. 690 of the Ministry ofHealth of Ukraine dated September 23, 2009 (as amended by No. 523 dated July 12,2012). By decision of the Bioethics Committee of Pirogov National Memorial MedicalUniversity, Vinnitsia (Minutes No. 1 of January 16, 2025), the study was approved.The study included 140 women of reproductive age (25-37 years) who were treated forovarian endometriomas. Four groups were formed: the first (n=41) group included 41patients with ovarian endometriomas who underwent laparoscopic cystectomy with theappointment of releasing hormone agonists, the second group included 37 patientswithout the appointment of a-GnRH after laparoscopic cystectomy. The third group wasformed by 32 patients with ovarian endometriomas without surgical treatment. Thefourth group was the control group (30 women of reproductive age with infertility oftubal origin). Hormonal background and vitamin D levels were studied, and acomparison was made between groups of patients with ovarian endometriomas with andwithout surgical treatment, and the control group. The results were processed usingMicrosoft Excel and Statistica. The Shapiro-Wilk test was used to check the normalityof the distribution, intergroup differences were assessed using the Kruskal-Wallis test,and the dynamics of indicators within groups was assessed using the Wilcoxon test. Thelevel of statistical significance was set at p<0.05.Results. Analysis of the hormonal background of women included in the study showedthat in all main groups a significant decrease in ovarian reserve was recorded: the AMHlevel was minimal in the first group (0.95 ± 0.15) ng/ml and slightly higher in the second(1.11 ± 0.19) ng/ml and the third (1.29 ± 0.11) ng/ml compared to the control (2.37 ±0.11) ng/ml. The FSH level was statistically significantly higher than the control (7.15± 1.35) IU/l and was (11.01 ± 1.75); (10.93 ± 1.51) and (10.15 ± 1.49) IU/l, respectively,demonstrating a weak inverse correlation with AMH. The LH concentration tended todecrease (4.94 ± 2.08); (5.34 ± 1.79) and (5.41 ± 1.73) IU/l versus (5.95 ± 1.57) IU/l inthe control, which led to a decrease in the LH/FSH index.Also, in patients of the main groups, a significant increase in the levels of: estradiol:(48.7 ± 6.9); (54.9 ± 5.8) and (58.75 ± 4.7) pg/ml (control - (35.1 ± 21.9) pg/ml);prolactin: indicators reached the upper limit of normal (16.95 ± 3.8); (18.79 ± 3.51)and (17.31 ± 3.16) μg/l versus (10.99 ± 2.31) μg/l in the control (p < 0.05);progesterone: (1.21 ± 0.18); (1.17 ± 0.16) and (1.14 ± 0.17) ng/ml (control - (0.95 ± 0.17) ng/ml). In contrast, the level of total testosterone was significantly reduced (0.37± 0.19); (0.45 ± 0.18) and (0.49 ± 0.17) ng/ml compared to (1.55 ± 0.37) ng/ml in thecontrol. The content of vitamin D (25(OH)D) in the main groups corresponded to thedeficiency (20.16 ± 4.8); (23.79 ± 5.1) and (24.35 ± 4.7) ng/ml, while in the controlgroup its concentration was significantly higher - (51.19 ± 5.7) ng/ml.Conclusions. The results of the study confirm the negative impact of laparoscopiccystectomy on ovarian reserve and hormonal imbalance in patients with ovarianendometriomas: decreased levels of AMH, LH, and testosterone against the backgroundof increased FSH, estradiol, prolactin, and progesterone, as well as demonstratingconcomitant vitamin D deficiency in these patients.