Ожирение у женщин: актуальные аспекты нарушений репродуктивного здоровья

В  последние десятилетия во  всем мире сформировалась устойчивая тенденция к  росту распространенности ожирения и избыточной массы тела, в том числе у женщин. Для лиц с ожирением характерна более высокая частота встречаемости болезней сердца и сосудов, инсульта, остеоартрита, диабета и репродуктивных нарушений. У тучных женщин, как правило, развивается дисфункция гипоталамо-гипофизарно-яичниковой оси, что проявляется расстройствами менструации, ановуляцией и бесплодием. Будучи эндокринным органом, жировая ткань высвобождает ряд биоактивных молекул, прежде всего адипокинов. Они по-разному взаимодействуют с  множеством молекулярных путей, способствуя развитию инсулинорезистентности, воспаления, артериальной гипертензии, повышению риска сердечно-сосудистых событий, нарушений свертывания крови, дифференцировки и созревания ооцитов. Кроме того, у женщин с ожирением и метаболическим синдромом чаще возникают проблемы с зачатием и вынашиванием беременности, связанные с дисфункцией эндометрия, у них значимо хуже результаты лечения при использовании вспомогательных репродуктивных технологий. Не менее важно пагубное влияние ожирения на эндометрий вне беременности, что повышает риски развития аномальных маточных кровотечений. Гормоны, синтезируемые жировой тканью, могут оказывать значительное влияние на функцию матки/эндометрия и, следовательно, влиять на количество менструальной кровопотери. Противоречивые результаты отмечаются у пациенток с эндометриозом. Корреляция индекса массы тела с риском возникновения эндометриоза не была доказана в клинических исследованиях, но отмечалась ассоциация между его значением и степенью тяжести заболевания. В обзоре показаны современные представления о патогенезе заболеваний органов репродуктивной системы и нарушений ее функций у пациенток с ожирением и избыточной массой тела.

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