ASSESSMENT OF THE MICROBIOTA STATE OF THE REPRODUCTIVE TRACT IN PATIENTS WITH HYPERPLASTIC PROCESSES OF THE ENDOMETRIUM
Authors: Orishchak I. K. , Кusa O. M. , Henyk N. I. , Makarchuk O. M. , Hodlevska N. A. 
Published: January 2023

Hyperplastic processes of the endometrium, in the structure of gynecological pathology, occupy from 15.0% to 50.0% in women of reproductive age, disrupting the reproductive function, manifested by infertility, miscarriage, long, irregular, painful menstruation, high frequency of chronic adnexitis (73.9 %), uterine leiomyomas (45.8%), genital endometriosis (17.7%), cervical erosion (26.0-34%). The development of the disease is associated both with inadequate treatment of the acute altering process and with the primary chronicity of inflammation with a violation of local mechanisms of anti-infective protection. We cannot ignore the important role of inflammatory diseases of the pelvic organs, which causes the increase in the fate of chronic endometritis to 70.0%, and the chronicity of the process, inadequate therapeutic options and resistance to medical measures cause a change in women's field, which, undoubtedly affects the implantation processes.

The question of the role of an infectious factor in endometrial hyperplasia remains incompletely elucidated and understudied, which preserves the expediency of detailing the pathogenetic mechanisms of endometrial hyperplastic processes.

The aim of the study: to evaluate the microbiocenosis of the vaginal mucosa in patients with hyperplastic processes of endometrium.

Materials and methods. A comprehensive clinical and laboratory examination of 80 patients of reproductive age with endometrial hyperplastic processes was performed: 40 patients with endometrial hyperplasia without atypia (group 1), 40 patients with endometrial polyps (group 2). The control group consisted of 30 healthy women without gynecological pathology.

All patients underwent diagnostic and therapeutic hysteroscopy followed by morphological and immunohistochemical examination. Bacterioscopic and investigation of biomaterial of the reproductive tract was carried out using the "Femoflor" test system in real time. The TORСH-group pathogens were verified by the DNA-PCR method.

Research results. A significant proportion of menstrual cycle disorders (AUB - 55.0 %, algodismenorrhea - 41.3 %), generative function (infertility - 36.9 %, spontaneous abortions - 18.8 %, missed abortion- 8.8%) and also transferred inflammatory processes of the genitals (dysbiosis, PID, exo-endocervicitis - 75.0%).

Based on the results of DNA-PCR data evaluation, the following were found: Chlamydia trachomatis — in 24 (30.0%) cases, Mycoplasma genitalium — in 21 (26.3%), Ureaplasma urealyticum — in 17 (21.3%), Candida albicans — in 18 (22.5%), in 37 (46.3%) cases – genital herpes (HSV) types 1 and 2, cytomegalovirus (CMV) and human papillomavirus type 16.18 (HPV) in 23 (28.8%) ), as well as viral (32.5%) and viral-bacterial associations (51.3%). According to the results of the evaluation of the microbiocenosis of the vagina in the examined women with impaired reproductive function against the background of endometrial hyperplasia and endometrial polyps, pronounced dysbiosis prevailed (47.5% and 62.5%, respectively).

Conclusions. The obtained results confirm the scientific position regarding the important role of an infectious factor in the development of hyperplastic processes of endometrium, and the normalization of the microbiocenosis of the genital tract contributes to the effectiveness of treatment and the prevention of possible relapses.