Nowadays fat tissue is considered as endocrine organ responsible for metabolism of sex hormones. Obesity is accompanied by a decrease in biosynthesis of 17β-estradiol (2-hydroxyestrone) inactive metabolites and increased production of aggressive metabolites (16-hydroxyestrone). This factor leads to hyperproliferative syndrome, which includes hormonal-dependent lesions of target organs: uterine leiomyomas, adenomyosis, hyperplasia of endometrium, tumor-like lesions of the ovaries, fibrocystic disease of the mammary glands, dysplasia of the cervical epithelium. Materials and methods. We observed 50 women of reproductive age (mean age 34.6±2.5 years) with adenomyosis, diffuse form of fibrocystic disease of the mammary gland and obesity. We studied complaints, anamnesis of diseases, made physical examination (BMI, waist/hip ratio), gynecological examination, ultrasound of small pelvis organs and mammary glands, laboratory tests (carbohydrate and lipid metabolism, HOMA-IR indexes). The main group consisted of 25 patients receiving dienogest (2.0 mg daily on continuous mode) and a combined drug (indole-3-carbinol - 200 mg and epigallocatechin-3-gallate - 45 mg) (two capsules twice a day). Comparative group took monotherapy with dienogest (2.0 mg per day in continuous mode). Duration of treatment was 6 months. All the examined patients complained of increased volume, sensitivity and soreness of the breasts in the second phase of the menstrual cycle. Aching pain of in the lower abdomen, which prevailed before menstruation disturbed 74.0% of investigated. Menstrual dysfunction was noted in 96.0% of women: dysmenorrhea in 64.0%, irregular menstrual cycle in 22.0%, and hyperpolymenorrhea in 78.2% patients, 64.0% of surveyed had a bloody discharge before/after menstruation. Waist circumference, as marker of excess visceral fat associated with the presence of insulin resistance, in all examined patients exceeded 85 cm. The presence of visceral obesity was associated with signs of dyslipidemia (hypercholesterolemia, increased levels of low density lipoprotein), and a carbohydrate metabolism disorder, which manifested in increased fasting glucose and the HOMA-IR levels. After the end of treatment sensitivity and pain in the mammary glands in the second phase of menstrual cycle were decreased in all patients. Normalization of menstrual function was noted by 82.0% of women. Also in main group, levels of total cholesterol and low density lipoproteins have decreased statistically significant. We also observed the improvement of carbohydrate metabolism, and a significant decline of the HOMA-IR index. Conclusions. Multi-target therapy (indole-3-carbinol-200 mg, epigallocatechin-3-gallate-45 mg) provides a complex effect, which manifests itself in inhibiting pathological hyperplastic processes in hormone-dependent organs and tissues of the female reproductive system on the background of obesity, as well as promotes the normalization of lipid and carbohydrate metabolism in these very patients.
18 - 21 May 2019
European Society of Endocrinology