Chronic endometritis in patients of reproductive age: individualized treatment capabilities

Abstract

Introduction. Inflammatory diseases of the pelvic organs represent one of the lead causes affecting health status in women of childbearing age. The pathogenetic mechanisms of chronic endometritis (CE) have been extensively studied, but many issues remain debatable. This disease manifests in various clinical pictures, including relapsing course, so a need to conduct combination individualized treatment rises no doubts.Aim: to assess effectiveness of combination individualized therapy of CE.Materials and Methods. A comprehensive analysis of clinical data was performed in 107 patients with morphologically verified CE, examining microflora composition in the uterus, cervical canal, urinary tract, and intestine by using a wide range of laboratory research methods; assessing cell subset composition of peripheral blood lymphocytes by using immunocytochemistry (CD3+, CD4+, CD8+, CD19+, CD95+, CD3+CD4+, CD3+CD8+, CD3+CD95+), measuring level of serum cytokines – interleukin-1β, tumor necrosis factor-α, interleukin 8, and interleukin 10. For this, all patients were subdivided into 2 groups: 53 patients (group I, main received treatment according to the original protocol (antibiotics and bacteriophages, immune preparations, herbal medicines), 54 patients (group II, control) received conventional therapy (antibiotics, immunomodulatory drugs, hormones).Results. It was found that urogenital tract microbiota was profoundly altered in patients with CE, also featured with dysregulated immune system. In addition, associated changes in the leukocyte-lymphocytic arm of the immune system and features of clinical and anamnestic data were obtained, which is important in combination treatment of patients with this pathology. Composition microflora in the vagina, cervical canal and uterine cavity was markedly improved that was confirmed by bacteriology data, vaginal pH value and menstrual function were by 2-fold more often in group 1 vs. group 2. A 12-month follow-up revealed in group 1 no complaints of pelvic pain requiring pain killers, with pronouncedly lowered amount of doctor visits due to inflammatory pathology of the urinary tract additionally confirming effectiveness of individualized treatment.Conclusion. The data of the study evidence about a need to individualize diagnostic and therapeutic approaches while managing patients with CE. The treatment strategy for patients of childbearing age with CE should be based on minimizing drug aggression, taking into account concomitant pathologies, features of microbiota composition in the genitourinary organs and changes in the immune system. An combination and individualized therapeutic approach provides an opportunity to substantially better results after treatment of CE.