ClINICAl AND EPIDEMIOlOGICAl CHARACTERISTICS OF FERTIlE AGED WOMEN WITH UTERINE lEIOMYOMA , RESIDENTS OF INDUSTRIAl REGION OF UKRAINE

contacts: podolskyi Volodymyr IpoG of the namS of ukraine, department of Health problems of Fertile aged women 8 maiborody str., laboratory building 04050, Kyiv, ukraine сell: +38 (067) 447 57 99 tel. +38 (044) 484 40 64 e-mail: podolskyivv@gmail.com INTRODUCTION Healthcare issues are in priority because people's health is the greatest social and individual value, as the health of the population largely influences on the processes and results of the economic, social and cultural development. Therefore they are issues of national security and an important criterion for social development and well-being of the country [1–3, 10]. An important parameter characterizing reproductive health of woman is gynecological diseases, their frequency is increasing every year [1, 2, 10]. Among gynecological morbidity in fertile aged women more often appears hyperplasic processes among which the greatest impact on reproductive health has uterine leiomyoma [4–6].


INTRODUCTION
Healthcare issues are in priority because people's health is the greatest social and individual value, as the health of the population largely influences on the processes and results of the economic, social and cultural development.Therefore they are issues of national security and an important criterion for social development and well-being of the country [1][2][3]10].
An important parameter characterizing reproductive health of woman is gynecological diseases, their frequency is increasing every year [1,2,10].Among gynecological morbidity in fertile aged women more often appears hyperplasic processes among which the greatest impact on reproductive health has uterine leiomyoma [4][5][6].

ANAlYSIS OF lITERARY DATA AND AIM OF THE STUDY
Leiomyoma is one of the most frequent uterine pathologies.Uterine leiomyoma clinically manifested in 20-30% of women, in 80% cases fibroids are removed with following histological examination.Appearances of symptoms of the disease usually increase with age.In the USA, fibroids are the main cause for hysterectomy in women 40 years old and above, the total number ranged in about 30% of all cases, in Caucasians more than 50% cases.In women of black race adjusted relative risk of developing uterine fibroids compared to the 3.25 rate of white women in a large prospective cohort [4,5,7].
It is known about close relationship of steroid metabolism with autonomic nervous system, which provides mechanisms for homeostasis in the body.Violations in steroid metabolism or autonomic homeostasis can lead to development of pathological processes [8,9].
The aim of study is to provide clinical and epidemiological characteristics of fertile aged women with uterine leiomyoma residents of the industrial region of Ukraine.

MATERIAlS AND METHODS
Clinical and epidemiological studies have been provided in a population of fertile aged women to determine the frequency and structure of violations of reproductive health.Research has been done in the Dniprovskyi district of Kyiv, which was chosen as the one that corresponds to the typical industrial region of Ukraine.We examined 1000 fertile aged women, residents of Dniprovskyi district of Kyiv.For the clinical and epidemiological program a special questionnaire "Study of reproductive health of fertile aged women" was created -brochure contains 3 sections: "Basic questionnaire", "Your family" and "Medical interview".Questionnaires were distributed among fertile aged women.After completing 2 sections of questionnaire: "Basic questionnaire" and "Your family" women were invited to the doctor, where part "Medical interview" was filled together with medical examination and special examinations.
Clinical and epidemiological studies were population-based, cohort prospective studies.Determination of the population of fertile aged women and individual work with each woman held according to existing methods of clinical epidemiology and the principles of bioethics.
All information was inputted in paper media, were introduced later in the computer memory, thereby a computer database of surveyed women fertile aged women was created and provided further analysis of research results.
Statistical analysis was performed using applications MS Excel 2003, and SigmaPlot® 13.0.The reliability of data for independent samples calculated using the Student t-test.Confidence intervals were calculated by a Wald normal distribution.

STUDY RESUlTS AND DISCUSSION
The results of clinical and epidemiological studies have shown that the incidence of uterine leiomyoma in 1000 fertile aged women in the study area is 53.0 (5.3%).
According to official statistics the frequency of uterine leiomyoma in fertile aged women (1000 women) in the Dniprovskyi district of Kyiv on average for 5 years was 5.1, and differs from the overall frequency in the Kyiv, which is 4.4.The lowest rate in the Dniprovskyi district was in 2010 and amounted to 4.6 against the highest in 2013 -5.6.Also, the trend of increasing frequency of uterine leiomyoma observed in the whole city, where these rates in 2009 were minimal and increased in 2011 (respectively 3.9 and 4.6).
Annually, the clinical supervision on uterine leiomyoma in medical institutions in the Dniprovskyi district in average for 5 years was done for 4802 women, and 22092 women in all Kyiv.Thus, every year clinical supervision on uterine leiomyoma adds in average 779 women, and overall in Kyiv 5287 women; withdrawn from clinical supervision in the Dniprovskyi district 854 and 5248 women in Kiev.Thus, due to the recovery on leiomyoma in the Dniprovskyi district 15.3% of women, and overall in Kyiv 18.7% of women were removed from clinical supervision.The difference is almost 3% is reserve for more effective treatment of uterine leiomyoma in the Dniprovskyi district.

ClINICAl AND EPIDEMIOlOGICAl CHARACTERISTICS OF FERTIlE AGED WOMEN WITH UTERINE lEIOMYOMA, RESIDENTS OF INDUSTRIAl REGION OF UKRAINE
It should be noted that in average over five years rates of clinical supervision withdrawal due to recovery of symptomatic uterine leiomyoma is 25.32%, and in Kyiv is 43.76%.The data of effective treatment and removal of clinical supervision women with uterine leiomyoma shows that treatment for women with symptomatic uterine leiomyoma is done much better.
Fertile aged women that had uterine leiomyoma were in the age group of 30-40 years at most (Tab.1).Rate of uterine fibroids in the age of 26-30 years was 22.6%, in women aged 31-35 uterine leiomyoma was diagnosed in 28.3% and in the age 36-40 years in 18.9% of women.
Most women with uterine leiomyoma had well-being families -62.3% (Tab.2), but 26.4% of women had incomplete family.
More than half of women with uterine leiomyoma had higher education -52.8% and by social status were employees -49.0%(Tab.3,4).
The development of uterine leiomyoma in fertile aged women took place on a background of pelvic inflammatory diseases (Tab.6), which manifested in 64.2% of women and in 22.6% of women with cervical erosion.Many women with uterine leiomyoma (71.7%) underwent artificial abortion, and had a history of spontaneous abortions (22.6%) and benign ovarian cysts (16.9%).A significant number of pelvic inflammatory diseases, artificial abortion certainly led to violations of the balance of sex hormones, which is causing the growth of benign ovarian cysts and uterine leiomyoma (Tab.7).Some women underwent surgical treatment of uterine leiomyoma (7.5%), but had a recurrence of tumor growth.
Disease duration of more than one year had 35.8% of fertile aged women two years -52.9% and three years -13.2%.
For the location of benign tumors (Tab.10) frequently observed in the lower segment of the uterus (32.1%), in the uterus (24.5%) and on the left or right wall of the uterus (18.9%).
Almost half of women (41.9%) had not a large leiomyoma (Tab.11), uterus size corresponded to 12 weeks of pregnancy, others had size from 13 to 16 weeks (49.1%).
By the number of nodes in the uterus (Tab.12) one node had 64.0%women, two to three nodes -had 26.4% and more than three nodes had 13.2% women.
Regarding uterine leiomyoma women underwent a sufficient number of diagnostic methods (Tab.13).All women had pelvic ultrasound.Half of the women (50.9%) were provided colposcopic examination of the cervix, only 37.8% of women were provided histological study of the endometrium, endometrial cells for examination in 20.8% cases were obtained through dilation and curettage, in 3.8% via hysteroscopy, while 13.2% using pipelle biopsy.Vaginal swabs were provided in 13.2% of women, and hormonal testing in 15.1%.Doppler ultrasound of vessels of internal genital organs of women with uterine leiomyoma provided only in 9.4% of patients.After the diagnostic manipulations non-surgical and non-hormonal treatment had 39.6% of women, 22.6% of women agreed to have a hormonal treatment.Surgical treatment of leiomyoma had 7.5% of women.

Location uterine leiomyoma
The number of fertile aged women with uterine leiomyoma n* % (range) In the uterus 13 24.5 (12.9 -36.1) In the lower segment 17 32.1 (19.5 -44.6) In the left or right uterine wall 10 18.9 (8.Taking to account that uterine leiomyoma may lead to infertility we paid special attention to characteristics of reproductive function in women with this benign tumor (Tab.14).one delivery before diagnosed uterine leiomyoma had 32.1% of women, and two deliveries had 22.6%.number of deliveries with diagnosed uterine leiomyoma in surveyed women was insignificant (one delivery had only 3.8% women).number of deliveries in women after treatment of uterine leiomyoma with non-surgical methods in this group of women has increased almost twice and amounted 7.5%, and after surgical treatment (conservative myomectomy) 1.9%.
Unfortunately, a significant number of fertile aged women with uterine leiomyoma had bad habits (Tab.16), the most frequently occurring was smoking (43.4%) and excessive alcohol consumption (9.4%).
It should be noted that women with uterine leiomyoma actively used methods of contraception (Tab.17).Most often women with uterine leiomyoma were using oral hormonal contraceptives (32.1%), barrier methods (26.4%) and intrauterine device (22.6%), 18.9% of women were not using contraceptives.

CONClUSIONS
1.The problem of uterine leiomyoma is important for fertile aged women residents of Dniprovskyi district and for Kyiv overall, with the incidence of uterine leiomyoma in fertile aged women was 5.1% per 1000 women, which is slightly higher than the average according to the official statistics (4.4% per 1000 women).
2. gynecological diseases and conditions that can be considered as risk factors of uterine leiomyoma revealed in high rates of examined fertile aged women.Among them, chronic pelvic inflammatory diseases had 64.2% women; polycystic ovary syndrome had 32.0%; cervical erosion 22.6%; artificial abortions had 71.7% women with uterine leiomyoma.
3. In fertile aged women residents of the industrial region of Ukraine with uterine leiomyoma among social factors noteworthy is young age (30 to 40 years), by marital status women had well-being families (62.9%), mostly they had higher education (52.8%) and by social status were workers (20.8%) and employees (49.0%).
4. In women with uterine leiomyoma frequently observed clinical manifestations violations of autonomic homeostasis such as somatoform dysfunction of the autonomic nervous system (66.0%).

TABLE 1 .
RATES oF UTERInE FIBRoIDS In FERTILE AgED WoMEn BY AgE

TABLE 3 .
RATES oF UTERInE FIBRoIDS In FERTILE AgED WoMEn BY LEVEL oF EDUCATIon

TABLE 7 .
RATES oF UTERInE FIBRoIDS In FERTILE AgED WoMEn THAT HAD gYnECoLogICAL SURgERY

TABLE 9 .
RATES oF UTERInE FIBRoIDS In FERTILE AgED WoMEn BY LoCALIzATIon

TABLE 10 .
RATES oF UTERInE FIBRoIDS In FERTILE AgED WoMEn BY LoCATIon

TABLE 13 .
METHoDS oF DIAgnoSIS AnD TREATMEnT oF UTERInE FIBRoIDS In FERTILE AgED WoMEn

Bad habits The number of fertile aged women with uterine leiomyoma
* p = 0.00151