Clinical features of endometriosis in patients with type 1 diabetes mellitus
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Résumé
BACKGROUND: Endometriosis affects 5–10% of women of reproductive age worldwide. Despite the high prevalence of the disease, its diagnosis is usually delayed for several years and misdiagnosis is common, leading to delay in effective pathogen-based treatment. Early diagnosis and timely treatment of endometriosis are particularly important in patients with type 1 diabetes mellitus, as the longer the disease lasts, the greater the risk of vascular complications and the lower ovarian reserve, thus decreasing the reproductive capacity. AIM: The aim of this study was to analyze the clinical features of endometriosis in patients with type 1 diabetes mellitus allowing for a timely and accurate diagnosis. METHODS: This clinical study included women with endometriosis, type 1 diabetes mellitus, and a combination of the two. The control group consisted of healthy women of reproductive age. The diagnosis of endometriosis was confirmed by laparoscopic surgery and verified by histological examination. Serum anti-Müllerian hormone levels were determined using the immunochemiluminescence method from days 2 to 5 of the menstrual cycle. Glycated hemoglobin levels were measured in patients with type 1 diabetes mellitus. RESULTS: The study included 51 patients with endometriosis, 209 patients with type 1 diabetes mellitus, 79 patients with a combination of these diseases, and 31 conditionally healthy women. In patients with endometriosis combined with type 1 diabetes mellitus, the frequency of abnormal uterine bleeding was 31%, which is higher than in patients with only type 1 diabetes mellitus (11%), but lower than in those with only endometriosis (71%). Dysmenorrhea according to the McGill visual analogue pain scale in patients with endometriosis combined with type 1 diabetes mellitus was 3.9 ± 1.48 points, with endometriosis 7.06 ± 1.27 points, and with type 1 diabetes mellitus 1.2 ± 0.7 points. In patients with endometriosis combined with type 1 diabetes mellitus, there was a decrease in the number of antral follicles (8 ± 3) and anti-Müllerian hormone level (3.12 ± 1.78 ng/ml) compared to patients with type 1 diabetes mellitus (12 ± 4, 3.52 ± 2.0 ng/ml, respectively). The most pronounced decrease in the number of antral follicles (4 ± 2) and anti-Müllerian hormone level (0.94 ± 0.4 ng/ml) was found in patients with endometriosis. The incidence of deep infiltrative endometriosis was higher in patients without diabetes mellitus, occurring in 71% of cases. In patients with endometriosis combined with type 1 diabetes mellitus, it only occurred in 42% of cases. Endometrioid cysts were found in 42% of patients without type 1 diabetes mellitus and in 22% of those with the disease. Repeat surgical interventions were performed in 25% of patients with endometriosis without type 1 diabetes mellitus, compared to only 10% of women with endometriosis combined with type 1 diabetes mellitus. CONCLUSION: Late diagnosis and delayed treatment of endometriosis, which is often asymptomatic when combined with type 1 diabetes mellitus, can lead to a decrease in ovarian reserve and infertility. In patients with type 1 diabetes mellitus, endometriosis should be suspected in the presence of mild pain, abnormal uterine bleeding, decreased anti-Müllerian hormone levels and antral follicle count, and infertility to ensure timely diagnosis and selection of treatment strategies. Diabetic patients require a long period of pre-pregnancy planning in order to compensate for their disease.
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|---|---|---|
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