Evaluation of vascular tone in menorrhagia patients

Abnormal uterine bleeding (AUB) is an important health problem that is among the most common reasons for admission to gynecology outpatient clinics and reduces women's quality of life/productivity. Menorrhagia, a type of AUB, is heavy menstrual bleeding that affects 30% of women of reproductive age and causes menstrual blood loss above 80 mL. Anormal uterine bleeding process requires control of endometrial bleeding, the occurrence of tissue regeneration and timely cessation of menstrual bleeding. For these processes to occur, vasoconstriction of the spiral arterioles must first occur. Second, an effective hemostatic response must occur, including repair of damaged vasculature. Finally, appropriate epithelialization of the denuded basal endometrium must occur. Failure in any of these processes may cause menorrhagia to occur. Binding of apelin to the endothelial apelin receptor (APJ) leads to vasodilation by increasing the release of vasodilators such as nitric oxide and prostacyclin. As a result of apelin binding to the smooth muscle APJ, the interaction of α1-adrenoceptor (α1-AR) and Ca2+-activated K+ channel (BKCa) promotes APJ-induced contraction of vascular smooth muscle. In this thesis study, planned in the light of all this information, it was aimed to investigate the effective parameters on vasodilation and vasoconstriction that regulate vascular tone in patients diagnosed with menorrhagia. 44 patients who applied to Malatya Turgut Ozal University Training and Research Hospital Gynecology and Obstetrics Polyclinic with complaints of menorrhagia and 44 healthy volunteers without any disease were included in the study. Apelin, nitric oxide, prostacyclin and norepinephrine levels and routine biochemical analyzes were performed on blood samples taken from volunteers. As a result of this study, no statistically significant difference was observed between the patient and control groups in the levels of prostacyclin and nitric oxide, which are effective on vasodilation (p>0.05). Apelin and noradrenaline levels, which are effective on vasoconstriction, were found to be statistically significant and lower in the patient group than in the control group (p<0.05). As a result, it is thought that the inability to provide effective vasoconstriction of spiral arterioles, depending on apelin and norepinephrine levels, may be effective in the pathophysiology of menorrhagia, and more comprehensive studies on this subject are recommended.