Individualized approach in the management of women with female sexual dysfunction, external genital endometriosis and hyperhomocysteinemia

The problem of treatment of endometriosis in women of reproductive age remains an urgent task for obstetricians and gynecologists, as it has a direct impact on women’s ability to conceive. Overcoming the demographic crisis in Ukraine requires doctors to find new methods and techniques in a personalized approach to the treatment of women with endometriosis. The presence of comorbid pathology in endometriosis, in particular hyperhomocysteinemia (HHC) and female sexual dysfunction (FSD), necessitates individualization of the management of such patients. Objective — to determine the effect of surgical treatment of women with external‑intraoral endometriosis and female sexual dysfunction and hyperhomocysteinemia on the characteristics of their hormonal homeostasis and indicators of FSD. Materials and methods. The study included 19 patients with external‑intrinsic endometriosis and female sexual dysfunction and hyperhomocysteinemia with homozygous form of MTRF gene polymorphism. Surgical intervention in the form of laparoscopic cystectomy was performed in 12 patients (group I). 7 patients refused to undergo surgery (group II). Surgical intervention was performed 6 months after the start of treatment. The hormonal status and parameters of the FSD were studied according to the results of a questionnaire at the time of treatment, 6 months after the start of conservative therapy, and 3 months after surgery. Results. At 3 months after surgery, the values of vitamin D, FSH, LH, estradiol, progesterone, free T, DHEA‑S and 17‑OH were statistically significantly higher in women of group I compared with patients who did not undergo surgery — II (p<0.05), and the levels of homocysteine, TSH, prolactin were lower (p<0.05). In patients of group I, a statistically significant increase in questionnaire scores was noted after surgery compared with patients who did not undergo surgery at a significance level of p<0.001. Against the background of the total duration of treatment (6 months of conservative therapy + 3 months of combined treatment — conservative therapy + surgery) in patients of group I with a homozygous mutation, it was possible to achieve normalization of the FSD in all 12 (100.0%) patients. In patients who did not undergo surgery, no normalization of FSD was observed. Conclusions. The treatment of women with FSD and external genital endometriosis should be individualized, taking into account the entire clinical problem, including the impact of the disease and the impact of its treatment on the quality of life. Pregravidar preparation of women with LBP and BPH and hypoandrogenism in homozygous carriage of MTRF polymorphism genes should include surgical removal of ovarian endometrioma to improve LBP and hormonal background for pregnancy.