Pathomorphological features of endometrium in abnormal uterine bleeding in obese patients of reproductive age

• Yulia S. Artemenko
• Marina B. Khamoshina
• Natalia V. Petrenko
• Olga A. Demina

Abstract

The aim of the study was to identify the pathomorphological features of the endometrium in abnormal uterine bleeding (AUB) in patients of reproductive age with obesity.

Material and methods. 99 patients aged 19–49 with AUB were examined. Women were stratified depending on the presence of obesity: 1^st group (n=46) – obese patients (BMI ≥30 kg/m²), 2^nd group II (n=53) – non-obese patients (BMI= 18.5–27.7 kg/m²). All women underwent a standard pathomorphological study of endometrial biopsy specimens. Statistica 8.0 and IBM SPSS Statistics v.26 (developed by IBM Corporation) were used for statistical data analysis. Quantitative indicators having an abnormal distribution were described using the median (Me), the interquartile range (IQR%) was calculated. Comparison of groups on a categorical basis in the analysis of four-field conjugacy tables was performed using the exact Fisher criterion or the Pearson criterion χ². The differences were considered statistically significant at p<0.05. The odds ratio indicator (OR) was calculated with 95% CI boundaries, border indicators greater than one indicated the presence of significant differences. The strength of the relationship between the signs was assessed using the values of Kramer’s V (at V<0.1 – insignificant, V – 0.1…<0.2 – weak; V – 0.2…<0.4 – average; V – 0.4…<0.6 – relatively strong; V – 0.6…<0.8 – strong; V – 0.8–1.0 – very strong).

Results. It was found that in women of reproductive age with obesity, AUB significantly more often occur against the background of the desquamation phase (21.7 vs 5.7% in patients without obesity, p=0.034). On the contrary, AUB against the background of the secretion phase in this group of patients occurred 4.4 times less often (4.3 vs 18.9%, p=0.033). The chance of detecting endometrium in the desquamation phase during pathomorphological examination in patients with AUB and obesity is 4.6 times higher than in normal patients (OR=4.63; 95% CI 1.19–18.03, p<0.05), and the relationship between the signs of «endometrium in the desquamation phase» and «obesity» has an average strength (V=0.237).

Conclusion. The obtained results indicate the need to search for the pathogenetic relationship between obesity and endometrial dysfunction as one of the causes of AUB in the reproductive period of life. Genetic and immunohistochemical markers of inflammation, angiogenesis and hypoxia deserve special attention in this aspect, which can be considered as promising for the development of prognostic and therapeutic technologies aimed at managing the risks of relapse.

Keywords:abnormal uterine bleeding; obesity; pathomorphological examination

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