medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/2079-701X-2018-13-40-44medsovet-2600Research ArticleКонтрацепцияContraceptionТерапевтическая тактика при нарушениях менструального цикла, вызванных овуляторной дисфункциейTherapeutic tactics with violations of the menstrual cycle caused by ovulative dysfunctionДиккеГ. Б.DikkeG. B.

чл.-корр. Российской Академии Естествознания, д.м.н., профессор кафедры акушерства, гинекологии и репродуктивной медицины факультета повышения квалификации медицинских работников,

Москва

Moscow

ФГАОУ ВО «Российский университет дружбы народов»РоссияPeoples’ Friendship University of RussiaRussian Federation2018220920180134044Copyright © Дикке Г.Б., 20182018Дикке Г.Б.Dikke G.B.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-sovet.pro/jour/article/view/2600Цель обзора

Цель обзора: представление современных данных о патогенезе нарушений менструального цикла (НМЦ), связанных с овуляторной дисфункцией, и эффективности их лечения медикаментозными средствами.

Основные положения

Основные положения. Показано, что НМЦ – результат нарушений циклического производства гонадотропных и половых гормонов. Среди гормональных средств для лечения НМЦ выгодно отличаются комбинированные эстроген-гестагенные оральные контрацептивы (КОК), в особенности имеющие в своем составе дроспиренон (ДРСП). Введение левомефолата кальция – биологически активной формы фолата – в состав КОК, содержащих 30 мкг этинилэстрадиола (ЭЭ) и ДРСП, оказывает потенцирующее действие, связанное с их неконтрацептивными эффектами, обусловленными антиандрогенной и  антиминералокортикоидной активностью. Показано, что левомефолат кальция, участвующий в обменных процессах организма человека, в составе КОК имеет протективное влияние на сердечно-сосудистую систему (за счет снижения уровня гомоцистеинемии) при синдроме поликистозных яичников, способствует снижению ожирения. 

Заключение

Заключение. Комбинация 30ЭЭ/ДРСП способствует нормализации менструального цикла и имеет неконтрацептивные эффекты, связанные с антиандрогенным и антиминералкортикоидным действием, а фортификация левомефолатом кальция, кроме того, способствует нормализации менструального цикла. Кроме того, данная комбинация оказывает положительное влияние на гормональный профиль и показатели липидного обмена, имеет протективное действие в отношении сердечно-сосудистых заболеваний у женщин с метаболическим синдромом при поликистозных яичниках и способствует нормализации веса. 

Purpose

Purpose: presentation of modern data on the pathogenesis of menstrual cycle disorders (NMCs) associated with ovulatory dysfunction, and the effectiveness of their treatment with medication.

Basic provisions

Basic provisions. It is shown that NMC is the result of violations of the cyclic production of gonadotropic and sex hormones. Among the hormonal drugs for the treatment of NMCs, combined estrogen-progestational oral contraceptives (COCs), especially those with drospirenone (DRSP), are advantageous. The introduction of calcium levomefolate - biologically active form of folatein the composition of COCs containing 30 μg of ethinylestradiol and DRSP has a potentiating effect associated with their noncontraceptive effects due to antiandrogenic and antimineralocorticoid activity. It was shown that calcium levomefolate, which participates in human body metabolism, as a component of COC, has a protective effect on the cardiovascular system (due to a decrease in the level of homocysteinemia) in the syndrome of polycystic ovaries, contributes to reducing obesity.

Conclusion

Conclusion. The combination of 30EE/DRSP promotes the normalization of the menstrual cycle and has non-contraceptive effects associated with antiandrogenic and antimineralcorticoid action, and fortification with calcium levomefolate also has a positive effect on the hormonal profile and lipid metabolism, has a protective effect on cardiovascular diseases in women with the metabolic syndrome in polycystic ovaries, contributes to the normalization of weight. 

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The authors declare that there are no conflicts of interest present.