Cervical dysplasia in perimenopausal: features of diagnostics and therapy
The aim of the study was to assess the significance of CIN risk factors in pre- and perimenopausal women with the development of an algorithm of management aimed at increasing the effectiveness of treatment, improving the quality of life of patients, preventing the progression of dysplasia. Materials and methods. At the first stage, a retrospective evaluation of treatment of 202 patients with dysplasia in the perimenopause was carried out, in the second stage, a step-by-step algorithm for the maintenance was developed, and in the third stage, the experimental group under this algorithm was treated. Results. One third of women with CIN to 45 years of age had a combination of HPV and HSV, 44.1 % over 45 years of age, no viral DNA fragments were found. A high incidence of combined gynecological pathology in this age group was noted, including up to 45 years in the form of hyperplastic endometrial processes and breast pathology; Over 45 years of age in the form of genitourinary syndrome, endometrial polyps and cervical canal and vulvar diseases. In a group with CIN III, in a number of cases, a combination of dysplasia with atypical endometrial hyperplasia and breast cancer was diagnosed. The study showed a higher efficiency of step-wise treatment of CIN in the perimenopause compared with the traditional management technique. The obtained results stipulate the need for an integrated approach to therapy with the extension of the diagnostic algorithm, stimulation of antiviral immunity, including the method of photodynamic therapy, the inclusion in the treatment of the rehabilitation phase, the use of hormonal and targeted therapy. Complex therapy has increased the effectiveness of treatment, accelerated repair of cervical tissue. Conclusions. Carrying out of stage complex therapy allowed to increase the effectiveness of therapy, to prevent the progression of CIN.