Faculty of Medicine
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Item type:Publication, THE IMPACT OF SUBCLINICAL HYPOTHYROIDISM ON THE LIPID PROFILE IN PERIMENOPAUSAL AND POSTMENOPAUSAL WOMEN(Македонска асоцијација на гинеколози и опстетричари = MACEDONIAN ASSSOCIATION OF GYNECOLOGISTS AND OBSTETRICIANS, 2025); - Some of the metrics are blocked by yourconsent settings
Item type:Publication, РИЗИК ФАКТОРИ ЗА ПАТОЛОШКИ ПРОМЕНИ НА ЕНДОМЕТРИУМОТ И НИВНА АСОЦИЈАЦИЈА СО ЕНДОКРИНИТЕ НАРУШУВАЊА, МЕТАБОЛИЧЕН СИНДРОМ И ОСТЕОПОРОЗА(2022)Introduction: The International Federation of Gynecology and Obstetrics (FIGO) has defined a classification system for abnormal uterine bleeding, called PALM-COEIN (polyp, adenomyosis, leiomyoma, malignancy and hyperplasia, coagulopathy, ovulatory disfunction, endometrial dysfunction, iatrogenic causes, unclassified reasons). Dysfunctional uterine bleeding is often during the menopausal transition as a result of hormonal changes during this period. In postmenopause there should be no uterine bleeding, the thickness of the endometrium should be less than 5 mm, and if it is above 5mm, the presence of polyp, hyperplasia or cancer is possible. Postmenopausal bleeding occurs in approximately 90% of patients with endometrial cancer, but only 9% of women with postmenopausal bleeding have endometrial cancer. Endometrial hyperplasia and endometrial polyps are associated with development of endometrial cancer and therefore these changes can be called premalignant. Atypical endometrial hyperplasia is a preneoplastic condition that precedes the most common malignant tumor of the uterus, endometrioid adenocarcinoma. Risk factors such as obesity, chronic anovulation, nulliparousness, late menopause, unopposed estrogen (without progesterone), hypertension and diabetes, all increase the risk of endometrial hyperplasia and endometrial cancer. Objectives: To determine the histopathological changes of the endometrium that occur during the period of perimenopause and postmenopause; to determine their association with the presence of diabetes, hypertension, metabolic syndrome, thyroid disorders, glycosylated hemoglobin levels, Vitamin D levels, and to determine the dynamics of bone markers in the peri and postmenopausal period. Material and methods: The study was a prospective observational cohort, involving a total of 160 respondents. The study group consisted of 120 patients who underwent fractionated explorative curettage due to a medical indication (abnormal bleeding or ultrasound-diagnosed endometrial abnormality). They were divided into two subgroups: perimenopausal and postmenopausal. The control group consisted of 40 healthy women without fractionated explorative curettage. Anamnestic data were taken from all respondents. Blood pressure, body weight, height, waist circumference, anteroposterior diameter of the uterus and endometrial thickness were measured. This laboratory analyses were performed: Glycemia, glycosylated hemoglobin (HbA1c), Hormonal Status - FSH, LH, Estradiol, Serum insulin, Thyroxine (fT4), Parathormon (PTH), lipid status, ionized calcium, serum iron, bone markers (Osteocalcin, β-Cross Laps), vitamin D (25-Hydroxyvitamin D). Results: The most common pathological change of the endometrium was an endometrial polyp, and it was present in 45% of the respondents. Endometrial hyperplasia without atypia was present in 23.3% of perimenopausal and 15% of postmenopausal women. Endometrial adenocarcinoma was present in 3% of perimenopausal and in 5% of postmenopausal women. Patients with endometrial pathology were older than healthy women and had significantly more frequently: greater endometrial thickness, higher blood pressure, body mass index, waist circumference, glycemia, triglycerides, serum insulin and metabolic syndrome. Vitamin D levels were lower in women with explorative curettage than in healthy women, and significantly lower in those with organic changes compared with those with functional pathological changes of the endometrium. Women with organic changes of the endometrium, compared with those with functional changes, had significantly higher: body mass index, waist circumference and endometrial thickness. Perimenopausal women, compared with those in postmenopause, had significantly longer duration and intensity of bleeding, larger anteroposterior diameter of the uterus and thickness of the endometrium. Postmenopausal women had higher body mass index, waist circumference, blood pressure, glucose, HbA1c, serum iron and bone markers (osteocalcin and β Cross Laps), than those in perimenopause. Postmenopausal duration in patients with explorative curettage was significantly positively correlated with serum values of bone markers osteocalcin and β Cross Laps. Conclusions: Fractionated explorative curettage is an effective method for timely and effective diagnosis of pathological changes of the endometrium in women with abnormal uterine bleeding or ultrasound-diagnosed abnormal endometrial findings. In the period of perimenopause and postmenopause, there are changes in the genital organs, but also there are internal disorders (obesity, metabolic syndrome, diabetes, thyroid disorders, cardiovascular disease, osteoporosis), which should be timely prevented, diagnosed and treated. According to our study, some of them are related to the occurrence of changes in the endometrium and the need for fractionated explorative curettage for timely diagnosis, especially of premalignant and malignant changes. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, THE CORRELATION BETWEEN HIGH BLOOD PRESSURE AND RISK OF ENDOMETRIAL MALIGNANCY IN POSTMENOPAUSAL WOMEN(Македонско лекарско друштво = Macedonian medical association/De Gruyter, 2022); ; ; Introduction. Postmenopause is a period that starts one year after the last menstruation. Late menopause, after 70 years, is called senile. Aim. To examine the correlation between high blood pressure and the risk of endometrial malignancy in postmenopause. Methods. A prospective clinical study was conducted involving 120 postmenopausal patients treated at the University Clinic for Gynecology and Obstetrics in Skopje, divided into two groups: control and examined. The control group included 40 postmenopausal patients, hospitalized and operated due to urogenital pathology. The examined group consisted of 80 patients. A detailed history of patients was taken and blood pressure was measured, intervention was taken from both groups, and the material obtained was sent for histopathological analysis to determine eventual malignancy. Results. In our study women with high blood pressure were 15.724 [p=0.010, 95% CI=1.932-27.952] times more likely to have endometrial cancer compared to women with normal blood pressure. Conclusion. In postmenopausal patients, the likelihood of endometrial cancer significantly increases with high blood pressure. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, HETEROGENEITY OF ENDOMETRIUM – AN INCREASED RISK FACTOR FOR ENDOMETRIAL MALIGNANCY(Македонско лекарско друштво = Macedonian Medical Association, 2021-03); ; ; Introduction. The normal postmenopausal endometrium should appear thin, homogeneous and echogenic. Endometrial cancer causes the endometrium to thicken, appear heterogeneous, have irregular or poorly defined margins, and show increased color Doppler signals. Aim. To examine the correlation between endometrial echogenicity and the risk of endometrial malignancy in postmenopausal women. Methods. This was a prospective clinical study involving 120 postmenopausal patients treated at the University Clinic for Gynecology and Obstetrics-Skopje, divided into two groups: control and examined. The coнtrol group included 40 postmenopausal patients, hospitalized and operated on due to urogenital pathology. The examined group consisted of 80 patients divided into two subgroups – a group with uterine bleeding and the other one without uterine bleeding. According to the ultrasound verified thickness of the endometrium, the two subgroups were divided according to endometrial thickness into: the first group with endometrial thick ness from 5-8 mm; the second from > 8-11mm and the third group above 11 mm. We made ultrasound examination by measuring the echogenicity of the endometrium in both groups of patients as well as in sub groups, which were also divided into other subgroups according to endometrial thickness. Results. The probability of endometrial malignancy was significantly increased by 4,938 in heterogenous endometrium. Conclusion. There are many examples of intratumor heterogeneity in endometrial malignancy, either at the morphologic or the molecular level. Attention should be paid so as not to miss minor subpopulations of tumor cells with diagnostic and prognostic relevance. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Hormonal changes in women with abnormal endometrial bleeding in peri and postmenopause(European Society of Endocrinology, 2022-05); ; - Some of the metrics are blocked by yourconsent settings
Item type:Publication, BONE MARKERS IN PERIMENOPAUSAL AND POSTMENOPAUSAL WOMEN WITH ABNORMAL UTERINE BLEEDING(International Osteoporosis Foundation, 2022-03-24); ; - Some of the metrics are blocked by yourconsent settings
Item type:Publication, CORRELATION BETWEEN ENDOMETRIAL NEOVASCULARIZATION AND RISK OF ENDOMETRIAL MALIGNANCY IN POSTMENOPAUSAL WOMEN(Македонско лекарско друштво = Macedonian medical association, 2020); ; ; Introduction. The period that starts one year after the last menstruation is called menopause and it is divided into early and late menopause. Aim. To examine the correlation between endometrial neovascularization and the risk of endometrial malig-nancy in postmenopausal women. Methods. This is a prospective clinical study invol-ving 120 postmenopausal patients treated at the Univer-sity Clinic for Gynecology and Obstetrics-Skopje, di¬vi-ded into two groups: control and examination. The control group included 40 postmenopausal patients, hospitalized and operated due to urogenital pathology. The examined group consisted of 80 patients divided into two subgroups –the group with uterine bleeding and the other one without uterine bleeding. According to the ultrasound verified thickness of the endomet-rium, the two subgroups were divided according to endometrial thickness into: the first group with endo-metrial thickness from 5-8 mm; the second from >8-11 mm and the third group above 11 mm. We made ul¬tra-sound examination by measuring the resistant index (Ri) of the endometrium in both groups of patients as well as in subgroups, which were also divided into other subgroups according to endometrial thickness. Results. The probability of endometrial malignancy was significantly increased by 0.097 times in postme-no¬pausal patients. Conclusion. Doppler examination of endovascular neo-vas¬cularization (Ri) is a significant predictor of endo-met¬rial malignancy (p<0.05). Women with endometrial Doppler Ri>0.42 were 0.097 [p=0.029, 95% CI=0.012- 0.787] times less likely to have endometrial cancer than women with endometrial Doppler Ri≤0.42.