• І. О. Yurchenko Shupyk National Medical Academy of Postgraduate Education, Department of obstetrics, gynecology and perinatology, Kyiv, Ukraine
Ключові слова: hyperprolactinemia; puberty; menstrual disorders; prolactin.


Objective: to optimize the management of patients with menstrual disorders on the background of hyperprolactinemia during puberty, taking into account the main etiopathogenetic factors of hyperprolactinemia.

Materials and methods. The research covered 94 adolescent girls during the period of menstrual function. Participants were selected randomly. According to the management tactics the girls were divided into clinical groups: I (main) group - girls with menstrual disorders on the background of hyperprolactinemia, cured using our proposed differentiated approach (n = 33); II (comparison) group - girls with menstrual disorders on the background of hyperprolactinemia, cured with the conventional method (n = 31); III (control) group - healthy girls (n = 30). Organic pituitary pathology was excluded from all patients.

Results of the research. During examination, the average age of patients was 14.0 ± 1.5 years. Having determined the role of the main damaging factors, concomitant pathology, possible causes and degree of influence of hyperprolactinemia on the development of menstrual disorders during sexual development, treatment was differentiated depending on the type of menstrual disorders, age, body mass index, level of psychoemotional stress, level of hyperprolactinemia, using a unified complex that affects hormonal regulation, including prolactin levels and developed an algorithm for a differentiated approach to the treatment of menstrual disorders depending on body mass index and anxiety levels.

For girls with severe body weight deficit, we recommended additional high-calorie, balanced, protein-enhanced diet and psychotherapy; with insufficient body weight - high-calorie, balanced, protein-enhanced diet; with normal and overweight - physical training. When high levels of personal and situational anxiety were detected, we recommended comprehensive anti-stress therapy.

Thus, prolactin levels of girls with hyperprolactinemia before treatment were twice as high as prolactin levels in healthy girls, and 34.4% higher than the upper limit of normal indicators in group I and group II by 30.8%. After our treatment, the level of prolactin of girls of the first group decreased by 49.4% and reached normal values, while in the second group the level of prolactin decreased on average by only 20.5% and its level for some patients remained slightly above the upper limit of normal indicators. Along with the normalization of prolactin levels, we were able to achieve a stable normalization of menstrual function in patients who were treated with our proposed differentiated approach. In contrast to the first group in the second group, the dynamics of change was slower: after six months, the deviation of prolactin levels was about fifty percent of its level in healthy girls, which required a longer course of treatment and normalization and disappearance of clinical symptoms was achieved one year after start treatment.

Conclusions. Given all the obtained data, we can conclude that complex multidirectional therapy aimed at eliminating the etiologically contributing factors that caused hyperprolactinemia, such as a pathology of hypothalamic-pituitary structures, is considered by us to be the main pathogenetic link in treatment and the basis of a differentiated approach. All of the above helps to restore hormonal homeostasis and menstrual function, reduces the duration of treatment, and prevents reproductive dysfunction of adult women in the future.

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