FEATURES OF ETIOPATHOGENETICALLY CONDITIONED CORRECTION OF REPRODUCTIVE SYSTEM DISFUNCTIONS IN PATIENTS WITH HYPERANDROGENIA OF COMBINED GENESIS.

Abstract

There were examined 105 women with combined hyperandrogeny aged from 19 to 38 years. The studies show that the main causes of reproductive disorders of patients with hyperandrogeny is anovulation (47.1 %) and luteal phase deficiency (52.9 %). In anovulatory form of the reproductive system disorders there are characteristic clinical and laboratory signs of both ovarian and adrenal hyperandrogenism, but with a predominance of ovarian component. Violation of menstrual function mainly caused by opsomenorrhea - 60.6 % in 9.1 % of cases. Reproductive function of patients with hyperandrogenic anovulatory form affected with high frequency of primary infertility - 63.6 %. For patients with hyperandrogeny and luteal phase deficiency there are characteristic clinical and laboratory signs of both ovarian and adrenal hyperandrogenism, but with a predominance of adrenal component. Menstrual function characterized as opsomenorrhea in 27.0 % of patients. Reproductive function of patients with luteal phase defect is characterized by a high incidence of spontaneous abortion before 12 weeks - 24.4% and primary infertility - 35.1 %. Conducting individual hormonal correction of metabolism of androgens taking into account the identified violations of the reproductive system in patients with hyperandrogeny, reduces clinical manifestations of androgen dependent dermopathies, normalization of menstrual function and stable recovery of reproductive function, and the overall effectiveness of therapy is 68.0 % ( anovulatory form - 67.6 % and the luteal phase deficiency - 68.4 %). Laboratory criterias of anovulatory hyperandrogenism forms are: lack of dynamic changes of steroid profile during the menstrual cycle and significant increase in major androgens and their correlation with estradiol - total testosterone, free testosterone, androstenedione and moderate increase of dihydrotestosterone; increased ratio of LH / FSH> 2 and the prevalence rate of estrogen type anovulation - 75.6 %. In the luteal phase deficiency basic laboratory criteria considered: hypoestrogenic state on the 5th-7th day of menstrual cycle and a moderate increase in total and free testosterone, androstenedione and dihydrotestosterone significant increase; high level of correlations of total testosterone to estradiol, dihydrotestosterone and estradiol to the pronounced rise in the ratio of estradiol to free testosterone on the 21st-23rd day of menstrual cycle.