Markers of insulin resistance in perimenopausal women with endometrial pathology.

Objectives: To determine and compare the prevalence of insulin resistance and carbohydrate metabolism parameters in women with endometrial pathology

Material And Methods: 100 perimenopausal women with abnormal uterine bleeding and/or abnormal endometrium were included into the study. Hysteroscopy with biopsy was performed. The study population was divided into four groups according to histopathological results of the endometrium: non-atypical endometrial hyperplasia, endometrial polyp, endometrial cancer and controls. Fasting glucose and insulin levels and OGTT, IR indexes, occurrence of diabetes, pre-diabetic state, overweight, obesity and hypertension were assessed.

Results: Insulin resistance was diagnosed in 41.0% of the patients. The prevalence of markers of insulin resistance increased to 57.1% in cases with confirmed endometrial pathology compared to 31.8% in histologically normal endometrium (p<0.01). The frequency of insulin resistance was 52.6% (p=0.059) and 55.5% (p=0.04), respectively in women with non-atypical hyperplasia and patients with endometrial polyps when compared to the control group. Abnormal parameters of carbohydrate metabolism indicate little sensitivity and specificity in predicting endometrial hyperplastic lesions. The insulin levels at 120 minutes of OGTT correlate best with such changes (concentration >57 microU/ml in case of hyperplasia and >61 microU/ml in endometrial polyps).

Conclusion: Insulin resistance and carbohydrate metabolism disturbances are common in women with endometrial pathologies. In these patients there is clinical basis for recommending lifestyle modification (change of diet, more physical activity), or for introduction of pharmaceutical insulin-sensitizing agents.