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DIAGNOSIS BASED ON VITAMIN D LEVELS IN MENOPAUSAL WOME
¹Nuftilloyeva Marjona Jabbor qizi
Amanova Madina Furkatovna
²Scientific advisor:
¹Samarkand State Medical University
²1st year clinical resident, Department of Obstetrics and Gynecology No. 3
Assistant at the Department of Obstetrics and Gynecology No. 1, Samarkand State Medical
University
https://doi.org/10.5281/zenodo.14836392
Objective:
Climacteric syndrome (CS) is a pathological condition characteristic of most
women during the period of physiological decline in ovarian function. The most common early
symptoms of menopause include vasomotor symptoms, including hot flashes and night sweats,
and emotional disturbances (depressive states, sleep disorders, etc.), which are observed in
approximately 75% of perimenopausal women and can last for 10 years or more [1-5].
It is currently believed that immune dysregulation, particularly changes in cytokine
balance, may play an important role in the pathogenesis of early menopause [6, 7]. Vitamin D
metabolism disorders may also be involved in the pathogenesis of KS. Thus, a link between
25(OH)D deficiency and vasomotor symptoms has been identified [8].
Research methods and materials:
Inclusion criteria for the study: female gender,
postmenopause lasting up to 5 years, written voluntary consent to participate. Exclusion criteria:
taking hormonal drugs and immunosuppressants; autoimmune, endocrine diseases, as well as the
presence of chronic inflammatory, oncological, hematological and mental diseases, metabolic
diseases, chronic kidney and liver diseases.
The first phase of the study assessed clinical signs and symptoms of VD and cytokine
profiles in women with CS (n = 229). Control data were the results of a study of women of similar
age but without symptoms of CS (control group, n = 73).
In the second phase, the dynamics of clinical and immunological indicators were studied
in two groups of women with CS, randomly selected and not differing in age, clinical and
laboratory parameters. The first group (comparison group, n = 57) consisted of patients who
received therapy with a phytoestrogen preparation for 6 months. The second group (main, n = 57)
included women who, in addition to a similar 6-month course of phytoestrogens, were prescribed
cholecalciferol using saturation schemes determined by the initial level of 25 (OH) D in the blood
serum [13].
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Results:
There was no significant difference in 25(OH)D levels between CS patients and
control participants, but nevertheless, an additional analysis was conducted to assess the frequency
of CS detection at different 25(OH)D levels ( Table 2 ). All patients were divided into four groups:
normal 25(OH)D content (n = 32; 10.6%), its deficiency (n = 95; 31.5%), moderate (n = 132;
43.7%) and severe (n = 43; 14.2%). The results of multiple comparisons of the results obtained in
the four groups did not show significant differences (p = 0.085).
However, when comparing patients in two combined groups with 25(OH)D values of 20.0
ng/mL or more in one group and <20.0 ng/mL in the other ( Figure 1 ), significant differences were
found (p = 0.018). Early postmenopausal women with CS symptoms showed increased production
of the pro-inflammatory cytokines IL-6 and IL-8 (p < 0.05). Patients with 25(OH)D levels less
than 20.0 ng/mL were also shown to have a significantly higher incidence of CS, consistent with
VD deficiency (p < 0.05).
We found that the association between CS and VD deficiency, as well as the decrease in
25(OH)D during CS in the majority of women examined (89.4%), served as the basis for standard
correction of this vitamin deficiency. The combination of phytoestrogens and cholecalciferol
provided a significant reduction in the severity of clinical manifestations of CS and normalization
of IL-8 levels due to a decrease in cytokine production during treatment (p <0.001).
Conclusion
: Our findings regarding the high frequency of VD deficiency and deficiency
in postmenopausal women are consistent with the results of a study by H. Vázquez-Lorente et al.
[14]. VD deficiency may be one of the factors in the development of clinical symptoms of CS [15]
and normalization of 25 (OH) D levels may help reduce the intensity of the symptoms of the
syndrome [16].
To date, there are isolated studies, the conclusions of which confirm the role of changes in
the cytokine balance in the development of CS. An increase in the level of some pro-inflammatory
cytokines, in particular, TNF-α and IL-8, has been detected in CS [18]. A significant correlation
between increased circulating IL-8 concentrations and the presence and severity of hot flashes was
shown by A. Malutan et al. [19]. A connection between systemic inflammation and depression as
one of the manifestations of CS in peri- and postmenopause has been shown [7, 20]. A significant
increase in the level of IL-6 and TNF-α in the serum of perimenopausal women was also found
against the background of depression [6].
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