Optimizing therapy for women with endometrial hyperplastic processes and hypothyroidism

Mkoyan G.Yu., Arutyunyan A.G., Airapetyan M.M.

1) Izmirlyan Medical Center, Erevan, Republic of Armenia; 2) Beglaryan Medical Center, Erevan, Republic of Armenia; 3) Polyclinic Eight, Erevan, Republic of Armenia
Objective. To determine the optimal drug therapy policy for endometrial hyperplastic processes (EHPs) in women with hypothyroidism.
Subject and methods. Examinations were made in 180 women with EHP; in 120 of whom, EHPs were associated with hypothyroidism. The investigators identified 2 groups: 1) 62 women who underwent only correction of thyroid dysfunction; 2) 58 patients who received combined therapy for hypothyroidism and EHP. A control group consisted of 60 female patients with EHP without thyroid disease.
Results. The efficiency of treatment for EHP was determined to be almost identical in both when prescribing only levothyroxine preparations and when using the latter in combination with gestagens and combined oral contraceptives.
Conclusion. Therapy for EHP in patients with hypothyroidism, first of all, should consist of correction of thyroid dysfunction.

Keywords

endometrial hyperplasia
endometrial hyperplastic processes
hypothyroidism
levonorgestrel-releasing intrauterine systems

References

  1. Завалко А.Ф., Котельникова Н.А. Гиперплазия эндометрия – патогенетические аспекты, классификация и распространенность патологии среди пациенток репродуктивного возраста. Вестник медицинского института «Реавиз»: реабилитация, врач и здоровье. 2016; 1: 22-7. [Zavalko A.F., Kotelnikova N.A. Endometrial hyperplasia: pathogenetic aspects, classification, and prevalence of the disease among reproductive-aged patients. Vestnik Meditsinskogo Instituta «Reaviz»: Reabilitatsiya, Vrach i Zdorovye (Bulletin of the Medical Institute «Reaviz»: Rehabilitation, Doctor. and Health). 2016; 1 (21): 22-7. (in Russian)].
  2. Михельсон А.Ф., Лебеденко Е.Ю., Лазарева И.П., Емельянова Т.А., Челах Т.Д., Грошилина Г.С., Богаченко С.М., Кутузова Е.А. Особенности вегетативной регуляции функций у женщин репродуктивного возраста с гиперпластическими процессами эндометрия. Главный врач Юга России. 2018; 3: 45-8. [Mikhelson A.F., Lebedenko E.Yu., Lazareva I.P. et al. Features of the autonomic regulation of functions in reproductive-aged women with endometrial hyperplastic processes. Glavnyi Vrach Yuga Rossii (Head Physician of the South of Russia). 2018; 3 (62): 45-8. (in Russian)].
  3. Амирасланов А.Т.О., Сафарова С.И.К. Факторы риска и прогностические показатели атипической гиперплазии эндометрия. Вестник современной клинической медицины. 2019; 12(2): 7-11. [Amiraslanov A.T.O., Safarova S.I.K. Risk factors and prognostic indicators of atypical endometrial hyperplasia. Vestnik Sovremennoi Klinicheskoi Meditsiny (Bulletin of Modern Clinical Medicine). 2019 12 (2): 7-11. (in Russian)].
  4. Binder P.S., Mutch D.G. Update on prognostic markers for endometrial cancer. Womens Health (Lond.). 2014; 10(3): 277-88. https://dx.doi.org/10.2217/whe.14.13.
  5. Паньшина М.В., Хадарцева К.А. Опыт профилактики патологии эндометрия. Вестник новых медицинских технологий. Электронное издание. 2018; 3: 61-5. [Panshina M.V., Khadartseva K.A. Experience in preventing endometrial diseases. Vestnik Novykh Meditsinskikh Tekhnologii (Bulletin of Novel Medical Technologies). 2018; 12 (3): 61-5.(in Russian)].
  6. Табакман Ю.Ю., Солопова А.Г., Биштави А.Х., Идрисова Л.Э. Гиперплазия эндометрия: спорные вопросы патогенеза и терапии. Акушерство, гинекология и репродукция. 2016; 10(3): 5-10. [Tabakman Yu.Yu., Solopova A.G., Bishtavi A.Kh., Idrisova L.E. Endometrial hyperplasia: controversial issues of pathogenesis and therapy. Akusherstvo, Ginekologiya, i Reproduktsiya (Obstetrics, Gynecology, and Reproduction). 2016; 10 (3): 5-10. (in Russian).]
  7. Юнусов А.А. Тиреоидный гомеостаз и дисгормональные нарушения репродуктивной системы у женщин. Международный эндокринологический журнал. 2014; 8: 100-6. [Yunusov A.A. Thyroid homeostasis and dyshormonal disorders of the female reproductive system. Mezhdunarodnyi Endokrinologicheskiy Zhurnal (International Endocrinology Journal). 2014; 8 (64): 100-6. (in Russian)].
  8. Суплотова Л.А., Макарова О.Б., Шарухо Г.В., Ковальжина Л.С. Роль питания в профилактике и коррекции йододефицитных состояний на эндемичной территории. Вопросы питания. 2018; 87(5): 27-36. [Suplotova L.A., Makarova O.B., Sharukho G.V., Kovalzhina L.S. The role of nutrition in the prevention and correction of iodine deficiency in an endemic area. Voprosy Pitaniya (Nutrition Problems). 2018; 87 (5): 27-36. (in Russian).]
  9. Нерсесян С.А., Тарламазян С.А., Крнатян Р.Н. Оценка некоторых клинико-диагностических показателей узловых образований в структуре заболеваний щитовидной железы. Медицинская наука Армении НАН РА. 2013; 53(4): 122-7. [Nersesyan S.A., Tarlamazyan S.A., Krnatyan R.N. Evaluation of some clinical and diagnostic indicators of nodules in the pattern of thyroid diseases. Meditsinskaya Nauka Armenii NAN RA (Medical Science of Armenia, NAS RA). 2013; LIII (4): 122-7. (in Russian)].
  10. UNICEF. Опыт Армении по выполнению программы всеобщего йодирования поваренной соли для профилактики йоддефицитных заболеваний. Доклад министерства здравоохранения РА, Н/Ц по контролю и профилактике заболеваний, 24-25 сентября. Алматы; 2015. [UNICEF. Armenia’s experience in implementing the universal salt iodization program for the prevention of iodine deficiency diseases. The report of the RA Ministry of Health, N/C on Disease Control and Prevention, Almaty, September 24-25, 2015. (in Russian)].
  11. Costales A.B., Schmeler K.M., Broaddus R., Soliman P.T., Westin S.N., Ramirez P.T., Frumovitz M. Clinically significant endometrial cancer risk following a diagnosis of complex atypical hyperplasia. Gynecol. Oncol. 2014; 135(3): 451-4. https://dx.doi.org/10.1016/j.ygyno.2014.10.008.
  12. Silva J.F., Ocarino N.M., Serakides R. Thyroid hormones and female reproduction. Biol. Reprod. 2018; 99(5): 907-21. https://dx.doi.org/10.1093/biolre/ioy115.
  13. Rodríguez-Castelán J., Anaya-Hernández A., Méndez-Tepepa M., Martínez-Gómez M., Castelán F., Cuevas-Romero E. Distribution of thyroid hormone and thyrotropinreceptors in reproductive tissues of adult female rabbits. Endocr. Res. 2017; 42(1): 59-70. https://dx.doi.org/10.1080/07435800.2016.1182185.
  14. Wang Y., Zhou R., Wang J. Relationship between hypothyroidism and endometrial cancer. Aging Dis. 2019; 10(1): 190-6. https://dx.doi.org/10.14336/AD.2018.0224.
  15. Wang Y., Nisenblat V., Tao L., Zhang X.Y., Li H., Ma C. Combined estrogen-progestin pill is a safe and effective option for endometrial hyperplasia without atypia: a three-year single center experience. J. Gynecol. Oncol. 2019; 30(3): e49. https://dx.doi.org/ 10.3802/jgo.2019.30.e49.
  16. Коваленко Е.П. Взаимосвязь гиперплазии эндометрия и эндокринных нарушений у женщин раннего и позднего репродуктивного возраста. Таврический медико-биологический вестник. 2014; 17(3): 35-8. [Kovalenko E.P. The relationship between endometrial hyperplasia and endocrine disorders in women of early and late reproductive ages. Tavricheskiy Mediko-Biologicheskiy Vestnik. Nauchno-Prakticheskiy Zhurnal (Tauride Biomedical Bulletin. Scientific and Practical Journal). 2014; 17 (3): 35-8. (in Russian)].
  17. Чехоева А.Н., Габараев Г.М., Бароева М.Д. Клинико-диагностические аспекты и лечебная тактика гиперпластических процессов эндометрия с современных позиций. Вестник новых медицинских технологий. Электронное издание. 2019; 4: 41-9. [Chekhoeva A.N., Gabaraev G.M., Baroeva M.D. Clinical and diagnostic aspects of and therapeutic policy for endometrial hyperplastic processes from contemporary perspectives. Vestnik Novykh Meditsinskikh Technologii. Elektronnoe Izdanie. (Bulletin of Novel Medical Technologies. Electronic Edition). 2019; 13 (4): 41-9. (in Russian)].
  18. Ткаченко Л.В., Свиридова Н.И., Исаева Л. В. Профилактика рецидивов гиперплазии эндометрия в перименопаузе. Вестник Волгоградского государственного медицинского университета. 2017; 4: 25-8. [Tkachenko L.V., Sviridova N.I., Isaeva L.V. Prevention of recurrent endometrial hyperplasia in perimenopause. Vestnik Volgogradskogo Gosudarstvennogo Meditsinskogo Universiteta ((Bulletin of the Volgograd State Medical University). 2017; 4 (64): 25-8. (in Russian)].
  19. Рустамова М.С., Бадалова М.Х., Сафарова С.М., Икромова З.М., Курбанова, М.Х., Хушвахтова, Э.Х. Соматический и гинекологический статус больных женщин с гиперпластическим синдромом. Sciences of Europe. 2016; 6-2: 68-71. [Rustamova M.S., Badalova M.Kh., Safarova S.M.et al. The somatic and gynecological status of female patients with hyperplastic syndrome. Sciences of Europe. 2016; 6-2 (6): 68-71.(in Russian)].
  20. Calsolaro V., Niccolai F., Pasqualetti G., Tognini S., Magno S., Riccioni T. et al. Hypothyroidism in the elderly: Who should be treated and how? J. Endocr. Soc. 2018; 3(1): 146-58.
  21. Reyes H.D., Carlson M.J., Devor E.J., Zhang Y., Thiel K.W., Samuelson M.I. et al. Downregulation of FOXO1 mRNA levels predicts treatment failure in patients with endometrial pathology conservatively managed with progestin-containing intrauterine devices. Gynecol. Oncol. 2016; 140(1): 152-60. https://dx.doi.org/10.1016/j.ygyno.2015.10.023.
  22. Чернуха Г.Е., Думановская М.Р. Современные представления о гиперплазии эндометрия. Акушерство и гинекология. 2013; 3: 26-32. [Chernukha G.E., Dumanovskaya M.R. Modern views on endometrial hyperplasia. Akusherstvo i Ginekologiya (Obstetrics and Gynecology). 2013; 3: 26–32. (in Russian)].
  23. Sletten E.T., Arnes M., Vereide A.B., Ørbo A. Low-dose LNG-IUS as therapy for endometrial hyperplasia. A prospective cohort pilot study. Anticancer Res. 2018; 38(5): 2883-9. https://dx.doi.org/10.21873/anticanres.12534.
  24. Goncharenko V.M., Beniuk V.A., Kalenska O.V., Demchenko O.M., Spivak M.Y., Bubnov R.V. Predictive diagnosis of endometrial hyperplasia and personalized therapeutic strategy in women of fertile age. EPMA J. 2013; 4(1): 24. https://dx.doi.org/10.1186/1878-5085-4-24.
  25. Масякина А.В., Кудрина Е.А. Диагностика и лечение доброкачественных гиперпластических заболеваний матки у женщин с эндрокринно-обменными нарушениями. Архив акушерства и гинекологии им. В.Ф. Снегирева. 2015; 2(3): 20-4. [Masyakina A.V., Kudrina E.A. Diagnosis and treatment of benign uterine hyperplastic diseases in women with endocrine and metabolic disorders. Arkhiv Akusherstva i Ginekologii im. V.F. Snegireva (V.F. Snegirev Archive of Obstetrics and Gynecology). 2015; 2 (3): 20-4. (in Russian)].
  26. Слюсарева О.А. Доказано или нет? Современные представления о лечении гиперплазии эндометрия (обзор литературы). Вестник новых медицинских технологий. 2013; 20(2): 338-43. [Slyusareva O.A. Proven or not? Modern views on the treatment of endometrial hyperplasia (a literature review). Vestnik Novykh Meditsinskikh Technologii (Bulletin of Novel Medical Technologies). 2013; XX (2): 338-43. (in Russian)].
  27. Inuwa I.M., Williams M.A. A morphometric study on the endometrium of rat uterus in hypothyroid and thyroxine treated hypothyroid rats. Ups. J. Med. Sci. 2006; 111(2): 215-25. https://dx.doi.org/10.3109/2000-1967-042.

Received 11.10.2019

Accepted 29.11.2019

About the Authors

Gayane Yu. Mkoyan, Doctor Obstetrician-gynecologist, «Izmirlyan» Medical Center, Yerevan. Tel.: +374-77-55-33-77; +374-10-24-40-10.
E-mail: izmirlianmedicalcenter@gmail.com.
6 Aharonyan str., Yerevan, 0069, Republic of Armenia.
Armine G. Harutyunyan, MD, Associate Professor of Department of Obstetrics and Gyneacology of № 1 of YSMU named after M. Heratsi, «Beglaryan» Medical Center, Yerevan. Tel.: +374-91-41-50-49. E-mail: armineharutyunyan@ymail.com.
56 Abovyan str., Yerevan, 0069, Republic of Armenia.
Marine M. Hayrapetyan, Doctor- Endocrinologist of Polyclinic № 8, Yerevan. Tel.: +374 91 41-50-49. E-mail: pol.8@mail.ru.
51 A Baghramyan str., Yerevan, 0033, Republic of Armenia.

For reference: Mkoyan G.Yu., Arutyunyan A.G., Airapetyan M.M. Optimizing therapy for women with endometrial hyperplastic processes and hypothyroidism.
Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2020; 5: 144-49 (In Russian).
https://dx.doi.org/10.18565/aig.2020.5.144-49

Similar Articles

By continuing to use our site, you consent to the processing of cookies that ensure the proper functioning of the site.