Evaluation of the Relationship between Obesity and Obesity Type and Endometrial Thickness-Endometrial Pathologies

Yıl 2020, , 253 - 259, 29.12.2020

Anıl Turhan Çakır , Sadun Sucu

https://doi.org/10.25048/tudod.771481

Öz

Aim: Obesity is associated with many problems, including gynecological diseases. It can cause anovulation, abnormal uterine bleeding,
endometrial polyp, endometrial hyperplasia and cancer by affecting various metabolic pathways and disrupting hormonal balance.
The main source of estrogen in the postmenopausal period is the peripheral aromatization of androgens in adipose tissue. Increasing
estrogen level with increased adipose tissue with obesity may affect the endometrial thickness measured by ultrasonography. In the
evaluation of obesity, measurements such as Body Mass Index (BMI), waist / hip ratio, waist circumference, waist / height ratio, neck circumference can be used. The aim of this study was to investigate the relationship between BMI and waist / hip ratio with endometrial
pathologies and endometrial thickness measured by ultrasonography in postmenopausal patients.
Material and Methods: Patients who were admitted to the gynecology outpatient clinic of Zonguldak Maternity and Children Hospital
between February 2020 and April 2020 due to abnormal uterine bleeding and planned for endometrial biopsy were included in the
study. Patient’s height, weight, waist and hip measurements were taken. BMI and waist / hip ratios of the patients were calculated from
the measurements obtained. Endometrial biopsy pathology results and endometrial thicknesses measured by ultrasonography during
the routine examination of patients in the postmenopausal period were recorded.
Results: There was no statistical difference between endometrial sampling results and waist / hip ratio (p = 0.091), BMI averages (p =
0.094) and BMI groups (p = 0.194, p = 0.121). No statistical difference was found between the endometrial thicknesses measured by
ultrasonography in the postmenopausal period and BMI groups and waist / hip ratio (p = 0.879 and p = 0.935).
Conclusion: In our study, no relation was found between BMI groups and waist / hip ratios, endometrial pathologies and endometrial
thickness measurements in the postmenopausal period. Different results can be obtained by using different methods in the evaluation
of obesity, adding biochemical parameters and increasing the number of patients.

Anahtar Kelimeler

Obesity,, Body mass index, Uterine bleeding, Endometrial diseases

Obezite ve Tipinin Endometrial Kalınlık ve Endometrial Patolojiler ile İlişkisinin Değerlendirilmesi

Öz

Amaç: Obezite jinekolojik hastalıklar da dâhil olmak üzere birçok sorun ile ilişkilidir. Çeşitli metabolik yolakları etkileyerek ve
hormonal dengeyi bozarak anovulasyon, anormal uterin kanama, endometrial polip, endometrial hiperplazi ve kansere sebep olabilir.
Postmenopozal dönemde ana östrojen kaynağı, yağ dokusunda androjenlerin periferik aromatizasyonudur. Obezite ile artmış yağ
dokusu ile birlikte artan östrojen düzeyi ultrasonografi ile ölçülen endometrial kalınlığa etki edebilir. Obezitenin değerlendirilmesinde
Beden Kitle İndeksi (BKİ), bel/kalça oranı, bel çevresi, bel/boy oranı, boyun çevresi gibi ölçümler kullanılabilir. Çalışmada BKİ ve
bel/kalça oranının endometrial patolojiler ve postmenopozal dönemdeki hastalarda ultrasonografi ile ölçülen endometrial kalınlık ile
ilişkisi incelenmesi amaçlandı.
Gereç ve Yöntemler: Şubat 2020-Nisan 2020 tarihleri arasında Zonguldak Kadın-Doğum ve Çocuk Hastalıkları Hastanesi jinekoloji
polikliniğine anormal uterin kanama nedeni ile başvuran ve endometrial biyopsi planlanan hastaların boy, kilo, bel ve kalça ölçüleri alındı.
Hastaların BKİ’leri ve bel/kalça oranları elde edilen ölçümlerden hesaplandı. Endometrial biyopsi patoloji tanıları ve postmenopozal
dönemdeki hastaların rutin muayene sırasında ultrasonografi ile ölçülen endometrial kalınlıkları kayıt altına alındı.
Bulgular: Hastaların endometrial patoloji tanıları ile bel/kalça oranı (p=0,091), BKİ değerleri (p=0,094) ve BKİ grupları (p=0,194,
p=0,121) arasında fark saptanmadı. Postmenopozal dönemdeki hastaların ultrasonografide ölçülen endometrial kalınlıkları arasında
BKİ grupları ve bel/kalça oranı açısından fark saptanmadı (sırasıyla p=0,879 ve p=0,935).
Sonuç: Çalışmamızda BKİ grupları ve bel/kalça oranları açısından endometrial patolojiler ve postmenopozal dönemdeki endometrial
kalınlık ölçümleri arasında fark bulunamamıştır. Obezitenin değerlendirilmesinde farklı yöntemlerin de kullanılması, biyokimyasal
parametrelerin eklenmesi ve hasta sayısının artırılması ile farklı sonuçlar elde edilebilir.

Anahtar Kelimeler

Obezite, beden kitle indeksi, uterus kanaması, endometriyal hastalıklar

Kaynakça

• 1. Akyol A, Obezite ve Kadın üreme Sağlığı, Fırat Tıp Dergisi/Firat Med J 2018;23:Özel Sayı/Supp 48-53.
• 2. Sonmez A, Bayram F, Barcin C, et al. Waist circumference cut off points to predict obesity, metabolic syndrome, and cardiovascular risk in Turkish adults. Int J Endocrinol 2013;2013:767202.
• 3. Üstün Y, Köksal E, Obezite ve anestezi. J. Exp. Clin. Med., 2013;30:15-23.
• 4. Satman I, Omer B, Tutuncu Y, Kalaca S, Gedik S, Dinccag N, Karsidag K, Genc S, Telci A, Canbaz B, Turker F, Yilmaz T, Cakir B, Tuomilehto J; TURDEP-II Study Group. Twelve-year trends in the prevalence and risk factors of diabetes and prediabetes in Turkish adults. Eur J Epidemiol. 2013;28:169-80.
• 5. Altunkaynak, BZ, Özbek E. Obezite: nedenleri ve tedavi seçenekleri. Van Tıp Dergisi, 2006;13(4):138-142.
• 6. WHO: Obesity: Preventing and Managing the Global Epidemic. Report of a WHO Consultation. Geneva, WHO Technical Report Series 894, 2000.
• 7. Nelson-DeGrave VL, Wickenheisser JK, Hend-ricks KL, et al. Alterations in mitogen-activated protein kinase and extracellular regulated kinase signaling in theca cells contribute to excessive androgen production in polycystic ovary synd-rome. Mol Endocrinol 2005; 19: 379-90.
• 8. Günaldı O, Bozkurt SH, İlter E, Günaldı A, Çelik A, Ayan TM. Obezitenin kadın kanserleri üzerindeki etkileri: derleme makalesi. Maltepe Tıp Dergisi, 2019;11(3):88-97.
• 9. Wiseman M. The second World Cancer Research Fund/American Institute for Cancer Research expert report. Food, nutrition, physical activity, and the prevention of cancer: a global perspective. Proc Nutr Soc 2008;67:253-6.
• 10. Ward KK, Roncancio AM, Shah NR, Davis MA, Saenz CC, McHale MT, et al. The risk of uterine malignancy is linearly associated with body mass index in a cohort of US women. Am J Obstet Gynecol 2013;209:579.
• 11. Yang TY, Cairns BJ, Allen N, Sweetland S, Reeves GK, Beral V. Postmenopausal endometrial cancer risk and body size in early life and middle age: prospective cohort study. Br J Cancer 2012;107:169–175.
• 12. Jeong NH, Lee JM, Lee JK, Kim JW, Cho CH, KimSM, et al. Role of body mass index as a risk and prognostic factor of endometrioid uterine cancer in Korean women. Gynecol Oncol 2010;24–28.
• 13. 13. World Cancer Research Fund / American Institute for Cancer Research. Continuous Update Project Report. Food, Nutrition, Physical Activity, and the Prevention of Endometrial Cancer. 2013.
• 14. Mustaqeem M, Sadullah S, Waqar W, Farooq MZ,Khan A, Fraz TR. Obesity with irregular menstrual cycle in young girls. Mymensingh Med J. 2015 Jan;24(1):161-7.
• 15. Temür M, Çift T, Balcı UG, Güçlü, YA., Yılmaz Ö, Öngel, K. Kadın yaşamında obezitenin jinekolojik etkileri. SDÜ Tıp Fakültesi Dergisi, 2017;24(4):153-158.
• 16. Panidis D, Tziomalos K, Papadakis E, Chatzis P, Kandaraki EA, Tsourdi EA, Macut D, Bjekic-Macut J, Marthopoulos A, Katsikis I.Associations of menstrual cycle irregularities with age, obesity and phenotype in patients with polycystic ovary syndrome. Hormones (Athens). 2015 Jul-Sep;14(3):431-7.
• 17. Kaaks R, Lukanova A, Kurzer MS. Obesity, Endogenous Hormones, and Endometrial Cancer Risk: A Synthetic Review. Cancer Epidemiol Biomarkers Prev. 2002; 11: 1531-43.
• 18. Smith B, Porter R, Ahuja K, Craft I. Ultrasonic assesment of endometrial changes in stimulated cycles in an in vitro fertilization and embryo transfer program. J In Vitro Fertil Embryo Transfer 1984:1:233-8.
• 19. Fleisher AC, Pittaway DE, Beard LA, Thieme GA. Sonographic depiction of endometrial change occuring with ovulation induction. J ultrasound med 1984: 3:341-6.
• 20. Warming L, Ravn P, Christiansen C. Visceral fat is more important than peripheral fat for endometrial thickness and bone mass in healthy postmenopausal women. Am J Obstet Gynecol 2003; 188: 349-53.
• 21. Arıkan Iİ, Barut A, Arıkan D, Harma M, Harma Mİ, Bozkurt S. Comparison of serum androgens and endometrial thickness in obese and non-obese postmenopausal women. J Turk Ger Gynecol Assoc. 2010;11(3):149-151.
• 22. Nakamura H, Tsuda H, Hosoi M, Sato T, Inoue T, Nishimura S, et al. Endo-metrial thickness in Japanese women with hypertension or/and type 2 diabetes mellitus. Eur J Obstet Gynecol Reprod Biol 2006;129:174-7.
• 23. Yerebasmaz N, Gulkilik A, Effect of Body Mass Index on Endometrial Thickness in Asymptomatic Postmenopausal Women. Journal Of Clınıcal And Analytıcal Medıcıne, 2015;6:761-764.