ULTRASOUND PARAMETERS AND THE STATE OF UTERINE HEMODYNAMICS IN WOMEN WITH MENSTRUAL DYSFUNCTION IN PUBERTY

Abstract

The study of hemodynamic features of the pelvic organs in women is of great clinical importance, since it allows assessing the degree of recovery of endometrial regeneration after menstruation, the possibility of implantating a fertilized egg and placental development. Women who have had menstrual dysfunction in puberty, the determination of qualitative and quantitative parameters of uterine hemodynamics can be useful while choosing treatment tactics, evaluating its effectiveness, and will also provide significant assistance in predicting the prospects for their reproductive health. The purpose of the study. To examine the hemodynamics of uterus and assess the ability of endometrium to implant in women with menstrual dysfunction in puberty with the help of ultrasound and dopplerometry.Materials and methods. To achieve the set goals, 120 women of reproductive age from 19 to 32 years old were examined. By the nature of the disorders, the main group of women (n = 90) with menstrual dysfunction in puberty were divided into 3 subgroups (n = 30): the first group - women with primary oligomenorrhea, the second one - with late menarche, the third one - with pubertal bleeding. The control group consisted of women (n = 30) with the correct rhythm of menstruation in puberty. Results. On the basis of a comparative analysis of the echographic parameters of the size of the uterus in women with menstrual dysfunctions in puberty (main group) and women with the correct rhythm of menstruation (control group), it was found that, on the average stage of endometrial secretion, the volume of the uterus is 1, 2 times smaller in women of the main group (p˂0.05) due to the width of the body of the uterus (p˂0.001). The ratio between the length of the body and cervix in the examined groups did not differ significantly. The thickness of the anterior wall of the uterus is less than the control values in women with late menarche (p˂0.05) and pubertal bleeding (p˂0.01), which was a predictor of the absence of combined uterine pathology. Echographic examination of the thickness of the endometrium at a late stage of the proliferation phase in the examined women did not reveal significant differences with the control group. In the middle stage of the secretion phase, the thickness of the endometrium was less in women, who had menstrual dysfunction in puberty - 9.50 ± 0.27 mm versus 11.38 ± 0.48 mm in the group with the correct menstruation rhythm (p <0.001), but remained within the reference values. Dopplerometry of uterine arteries was performed to assess the functional activity and the possibility of sectorial transformation of the endometrium, which did not reveal significant differences in women of the main and control groups. Conclusions. An analysis of the ratio between the body length and the cervix of the uterus proves the absence of signs of genital infantilism in patients with menstrual dysfunctions in puberty. Doppler studies of hemodynamics in the arteries of uterus in this group of women in different phases of the menstrual cycle indicate an adequate blood supply to the uterus. Although the inferior phase of proliferation of endometrial thickness in its middle stages remained insufficient secretion (9,52 ± 0,42 mm; p <0.01), however, the normal blood flow in the radial and basal uterine arteries contributed to the successful implantation of the blastocyst.