Analysis of Clinical and Anamnestic Factors Affecting the Clinical Course of Genital Endometriosis in Patients with Thyroid Dysfunction

In this study, we conducted a comparative analysis of clinical and anamnestic factors in the development of external genital endometriosis (EGE) in women of reproductive age, with and without thyroid pathology (thyroidectomy), which is accompanied by hypothyroidism (HT). Material and methods. For this purpose, we examined 100 women with the pathology. We studied the following problems: the prevalence and localization of EGE; the main clinical forms of EGE and, on the basis of the obtained results, the factors influencing the clinical course of EGE on the fetus of HT. The diagnosis in all patients was confirmed during laparoscopy or laparotomy, as well as the results of mandatory histological examination. Results and discussion. We noticed that in 23.3% of clinical cases the ovaries were damaged without involvement in the uterus process. It was mostly observed in the age group of 20-29. Isolated damage to the endometriosis of the uterus was found in 26.7% of cases and in patients after 40 years, patients with combined forms of endometriosis accounted for 3.3%. When analyzing the clinical manifestations of EGE, it was found out that the main complaint of patients was a pain syndrome. Soreness in vaginal examination was found in 86.0% of patients, and dyspareunia was observed in 72.0% of the surveyed women. Complaints of chronic pelvic pain, not related to sexual activity and menstruation, were presented by 45.0% of women. Menstrual dysfunction was noted in 74.0%, reproductive disorders were less common, they were observed in 52.0% of patients, a factor of weighed heredity was found in 19.0% of cases. When studying the nature of menstrual flow, a rank-based method of their evaluation was applied depending on the severity of the clinical course and the concomitant pathology of the thyroid gland. In this case, a significant difference was found between the time of onset of menarche, the average duration of the menstrual cycle and the duration of menstrual bleeding in patients with a combination of EGE and HT (p <0.05). Violation of the reproductive function was more common in patients with a combination of EGE and HT (the main group) which comprised 62.5%, and less frequently it was seen in the comparison group – in 36.7% of women. According to the results of the survey, 67.5% of the patients of the main group had no history of pregnancy, more often primary infertility was diagnosed in 60.0% of the surveyed women in the main group. In the main group, 25.0% had observed pregnancies and 2, 5% did not live a regular sex life. Among examined contingent, there was a high frequency of spontaneous abortions (10.0%), which also attracted our attention. For the purpose of protection from pregnancy, 12.5% of the surveyed women of the main group used barrier means (condom, pharmatex) and interrupted sexual intercourse. Conclusion. The presented data show that preclinical manifestations of EGE with HT (the so called "Small forms") can be considered significantly higher rates of miscarriage in patients history with combined pathology. Analysis of clinical and anamnestic factors in the development of EGE on the background of thyroid dysfunction, accompanied by hypothyroidism of the thyroid gland showed the following prerequisites for promoting the development of common forms of EGE with HT: age over 30 years, absence of hormonal therapy for violations of the menstrual-ovarian cycle, using COC, diabetes mellitus, vegetative-vascular dystonia, infectious incendiary processes of the genital tract.