L.V.POKUL

Peoples’ Friendship University of Russia, 6 Miklukho Maklay St., Moscow, Russian Federation, 117198 

Pokul L.V. ― D. Med. Sc., Professor of the Department of Obstetrics and Gynecology with the course of Perinatology of the University of Peoples’ Friendship of Russia, physician of the Regional Clinical Oncology Center №1 of the Ministry of Health of the Krasnodar Territory, tel. (8612) 33-8026, e-mail: liliana_v_@mail.ru 

The objective. Assessment of a pathogenetic effect of the homoeopatic remedy Mastopol on the mammary glands in patients of reproductive age after total oophorectomy and X-ray ovarian suppression against the background of administration of oestrogen and combined hormone replacement therapy (HRT).

Patients and methods. A prospective cohort study was undertaken that included 137 women of reproductive age after total hystero-oophorectomy and chemical and X-ray ovarian suppression, the mean age of patients was 38.78±0.85 years. In the process of study, 4 groups were formed. Group 1 comprised of 34 patients with a history of surgical treatment (simple, radical hystero-oophorectomy). Group 2 was formed of 45 women treated by combined methods (operative treatment in combination with radiation (CRT) and polychemotherapy (PCT). Group 3 comprised of 32 patients, who received combined radiotherapy, group 4 (control group) – 26 women with benign diseases of the internal genitalia, who received surgical treatment in the form of simple total hystero-oophorectomy. Methods: clinical investigation (examination, medical history), detection of the levels of 2a- and 16a-hydroxy oestrogen metabolites (16a-ОНЕ1) in urine and ultrasound scanning of the mammary glands.

Results. In patients with gynaecological cancer (groups 1-3), the levels of 2a-ОНЕ1 and 16a-ОНЕ1 before the beginning of HRT administration exceeded the values of patients from group 4 with benign diseases of the internal genitalia by 1.3 and 1.9 times, respectively. However, no significant differences in changes of the values of the 2a-ОН-Е1:16a-ОН-Е1 ratio in patients in the basic groups (1-3) were observed. Three months after, active growth of concentrations of hydoxymetabolites was found in patients against the background of oral administration of combined HRT. In particular, 2a-ОН-Е1 grew in groups by 1.5 to 1.9 times, 16a-ОНЕ1 – by 1.4 times. Analysis of the effectiveness of using Mastopol showed stabilization of the «protective» 2a-ОН-Е1 against the background of a significant decrease of mitogenic 16a-ОН-Е1. It is noteworthy that differences in concentrations of 2a-ОН-Е1 and 16a-ОН-Е1 metabolites in the participating groups (U=6,4; p<0.0001) were highly significant. The level of decrease of 16a-ОНЕ1 excretion by 1.6 to 2.2 times was noted in all patients. Against the background of HRT administration, widening of mammary ducts and thickening of the glandular component due to the influence of the steroid component were found. Three months after the beginning of intake of Mastopol a significant improvement of the values of breast sonography was noted. In all groups, a decrease of the glandular component and a decrease of the duct component by 2 times was observed.

Conclusion. Hyperexpression of 2a-ОНЕ1 and 16a-ОНЕ1 is found in patients with gynecological cancer after special methods of treatment in the state of total oophorectomy and X-ray ovarian suppression, with the highest expression of carcinogenic 16a-ОНЕ1 metabolite. The presence of high concentrations of urinary estrogen metabolites is also possible in patients with benign diseases of the internal genitalia based on dysfunction of steroidogenesis. Change of mammary gland density is characteristic for all women suffering oncopathology. Assessment of mammary glands in patients with benign diseases of the internal genitalia has also found mammary gland hyperplasia having insignificantly lower values. Against the background of therapy with the homoeopathic remedy Mastopol that contains a broad spectrum of biologically active vegetative ingredients, a marked decrease of hydroxy metabolites expression to the reference values of healthy women was noted, as well as a decrease of mammary gland  density.

Key words: oestrogen hydroxy metabolites: 2a-ОН-Е1, 16a-ОН-Е1, gynaecological cancer, hormone replacement therapy, Mastopol, mammary glands, post-oophorectomy syndrome, breast ultrasound investigation.

 

 

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