OBJECTIVE: Metabolic study on plasmatic levels of homocysteine (Hcy) in 30 women post ovarectomy suffering from benign diseases. Based on previous pilot study by 6 women patients after ovarectomy the Hcy level increase has been supposed. Further objective was to detect possible change of homocysteinemia after application of estrogen replacement therapy (ERT). Hyperhomocysteinemia (HHC)--increased level of free amino acid homocysteine in blood--is considered on lipids independent risk factor in early development of cardiovascular diseases. The deficiency of 5,10-methylatetetrahydrofolate reductase (mutation C677T) is suspected as the main reason for decreased remethylation of Hcy. The group of women heterozygous for MTHFR mutation was compared with group of women patients without this mutation during the 8 weeks--monitoring after application of foliculostimulating hormone (FSH), estradiol (E2) for folate, vitamin B12 and Hcy in plasma. DESIGN: Basic study to get our own data about HHC in population of operated women before and after ovarectomy and after ERT. SETTING: Department of Obstetrics and Gynaecology, 1st Faculty of Medicine, Charles University, Prague. METHODS: Total homocysteine in plasma was estimated by chromatographic method with use of fluorescence detection. The level of hormones in plasma was estimated by RIA test of DCL company. The mutation of gen for 5,10-MTHFR was estimated by genetic examination. Six blood taking were performed within 8 weeks. The 1st before ovarectomy, further 1., 3., 7., 28. and 56. day after operation. Since the 28th day 50 micrograms of 17-beta estradiol have been substituted by weekly transdermal system. RESULTS: No homozygote for 5,10-MTHFR has been found in the group of operated women, only 5 heterozygotes and 25 healthy homozygotes were found. Hcy values were similar in both groups. The patients were distributed into 2 groups according to their FSM level in the plasma (40 UI/I was stipulated as the limit). After ovarectomy the Hcy increased by both groups and after hormonal treatment the Hcy decreased. The folate level in both groups corresponded with Hcy level, in B12 vitamin concentration no dependence has been proved (P < 0.0001). CONCLUSION: Significant increase of Hcy levels after overactomy and subsequent decrease after substitutive treatment by estradiol. This correlation was followed by folate levels. No difference or correlation in monitored parameters was observed between heterozygotes for MTHFR and healthy homozygotes.

Gynekologicko porodnická klinika 1 LF UK a VFN Praha