During the course of their lives, almost all women face pathological changes in the vulvovaginal area caused by various causes: dysplasia of connective tissue, excessive physical activity, childbirth, reduction of sex hormones, etc. Vulvovaginal symptoms have no significant impact on life expectancy and have a significant impact on the quality of life. In this regard, the modern possibilities of correction of these conditions, especially the minimally invasive ones, become especially important. The article discusses the methods of treatment and prophylaxis of age-associated pathological changes in the vulvovaginal area using a CO2-laser. Mechanisms of laser radiation influence on tissues are considered when using different modes. The advantages of microablative CO2-fraction laser photothermolysis in vaginal and vulva tissue rejuvenation programs are shown. The analysis of clinical studies on the use of lasers in the treatment of vulvovaginal diseases has been carried out, and tasks have been set for the development and implementation of highly effective and safe technologies in the practice of gynaecologists that affect the mucous membranes of the vagina and vulva, as well as a reliable assessment of their effectiveness.

The leading role of ovarian steroid hormones in the pathogenesis of uterine fibroids is confirmed by epidemiological, clinical and experimental studies. The new approaches to the treatment of this disease may be developed on the basis of the biological and genetic mechanisms underlying the occurrence and development of leiomyomas. The use of ulipristal acetate in patients with uterine leiomyoma may be a promising method for preparing them to the surgical procedures, but also for avoiding surgical treatment and related hypoestrogenic conditions, which results in the improvement of the women’s quality of life.

Therapy resistance of endometrial pathology is one of the significant issues for gynaecologists facing this problem. The features of chronic endometritis include high prevalence of infertility and recurrent endomentrial process, due to adhesive process in the uterus. This task requires an integrated approach, including the use of modern anti-adhesive barrier containing hyaluronic acid and carboxymethylcellulose.

Pelvic pain is one of the common causes for visiting a doctor, which can be the main symptom of gynecological diseases and an independent pathological condition. Acute pelvic pain is most often caused by an infection that affects the organs of a woman’s reproductive system. Non-infectious causes of pain are also associated with inflammation, and estrogens support pain and inflammation in women, which increases the risk of chronic pelvic pain (CPP). The urgency of the pelvic pain problem is considered not only in connection with an adequate diagnosis of its causes, but also from the perspective of managing the pain symptoms themselves. The anaesthesia strategy significantly improves the quality of life and prevents the development of chronic inflammatory diseases and CPP syndrome. Nonsteroidal anti-inflammatory drugs (NSAIDs) are widely used in pain therapy, and their effect consists in reducing the synthesis of prostaglandins and is pathogenetically substantiated both in the complex treatment of acute pelvic infections and in the treatment of idiopathic menstrual pain. The article presents clinical observations of the use of NSAIDs with the specified purpose.

If abnormal cytology test results are identified in the users of hormonal methods of contraception, including a vaginal ring, they should adhere to diagnostic algorithms aimed at identifying and treating HPV-associated cervical diseases. NovaRing vaginal ring is an effective, reliable and safe method of hormonal contraception, including for women who have previously undergone surgical treatment of HSIL.

Taking into account that the frequency of abortions in Russia today remains quite high, the strategy of fertility regulation through the provision of contraceptive advice to women of various ages comes to the fore. It has been proven that combined oral contraceptives are the most effective method of preventing unwanted pregnancies. An innovative combination of oral contraceptives containing estradiol valerate (EV) and dienogest (DNG) dynamically provides effective inhibition of ovulation and sufficient cycle control. DNG/EV has high efficacy, acceptability and tolerability and can be successfully used in sexually active women in need of contraception, regardless of their age. Like any modern contraceptive, this drug possesses a whole arsenal of pronounced therapeutic possibilities, which can be used in real clinical practice. In addition, the combination of EV and DNG is highly effective in the therapy of menorrhagia. The percentage of patients who had successful treatment and resulted in a decrease in menstrual blood loss was high. The effectiveness of the drug is confirmed by the bleeding of withdrawal at the end of the first treatment cycle and continues to increase gradually with further administration.

Clinical manifestations of hyperandrogenism can be an important diagnostic symptom of polycystic ovary syndrome, and in most cases allow establishing this diagnosis in a timely manner. The article discusses the problem of acne not only in adolescence, but also in adult women, and the problem of hirsutism in detail. It shows the role of combined oral contraceptives (COCs) as an effective therapy for acne and hirsutism in women, as well as the first-line therapy for polycystic ovary syndrome, according to the international and national clinical guidelines. The data summarize the effectiveness of the use of COCs containing drospirenone as a gestagenic component and levomefolate calcium in order to compensate for folate deficiency and, accordingly, reduce the level of homocysteine, which is often elevated in women with hyperandrogenism.

Candida vulvovaginitis is an infectious lesion of the vulvar and vaginal mucosa caused by Candida yeast fungi. Vaginal candidiasis during pregnancy is associated with spontaneous miscarriages, premature rupture of the fetal membranes, premature birth, and low birth weight babies. Considering the potential risk of premature delivery at fungal invasion at the level of the lower reproductive tract of a pregnant woman, the search for a complex of preventive measures and timely treatment of сandida vulvovaginitis during gestation is of particular interest. The article presents the results of the use of the drug Zalain in 36 pregnant women, with a gestation period of 28 weeks or more with acute candidal vulvaginitis. In the course of the work, the results of local therapy with Zalain were evaluated and its clinical efficacy in the prevention of preterm labor was confirmed. The results of treatment contribute to a significant reduction in the frequency of initiation of preterm labor, as well as a persistent effect for 2-4 weeks after completion of the course in the postpartum period and the absence of early and distant manifestations of candidiasis in newborns.

The cohort prospective comparative study showed improvement of the management of patients with various forms of purulentseptic diseases (PSD). The study included 276 women with PSD admitted to the gynecological hospital from January 1, 2014 to December 31, 2016. The patients were divided into two cohorts depending on the clinical course, management, and outcomes, which corresponded to the clinical forms of PSD: uncomplicated and complicated. The parameters that were evaluated in patients in both groups included complaints, pregnancy course and childbirth, duration of manifestations of the disease, the clinical picture, laboratory parameters. The study resulted in the development of an algorithm for management of patients with PSD including lavage of the site of infection, adequate antibiotic therapy depending on the type of pathogen, infusion and anticoagulant therapy, and treatment of vaginitis. The developed algorithm for management of patients with various forms of postpartum PSD allowed all 276 (100%) participants to preserve reproductive function and avoid early postoperative complications.

The article presents a discussion of the issue of management of patients after spontaneous abortion to prevent inflammatory complications. The condition of 165 patients distributed randomly in two groups is analyzed. Attention was paid to a full-fledged microbiological examination, including bacterioscopy and modern methods of PCR-diagnostics: «Inbioflor(4+MHC)» and «Femoflor-16». Patients of the first group (85 people) were prescribed antibacterial therapy (doxycycline, metronidazole, povidoniodine), as well as modern methods of physiotherapy: magnetoinfrared laser and ozone therapy. The second group (80 people) received similar antibacterial therapy, without physiotherapy. The study showed that the best effect can be achieved with complex therapy, including antibacterial drugs and modern methods of physiotherapy.

Iron deficiency anemia (IDA) is one of the most common diseases in the world, characterized by hemoglobin synthesis disorder due to iron deficiency and manifested by anemia. According to WHO, the rate of IDA in pregnant women in different countries ranges from 21 to 80%, judging by the level of hemoglobin, and from 49 to 99% - by serum iron. Lack of treatment of iron-deficient pregnant women with varying degrees of iron deficiency leads to an increase in the frequency of complicated pregnancy, such as the threat of termination of pregnancy, placental insufficiency, delay in intrauterine development and hypoxia of the fetus, premature delivery, poor uterine contraction strength, pathological bleeding, infectious complications. Aim of the study: study of the efficacy of the drug containing iron sulfate (Ferrous sulfate) and ascorbic acid in pregnant women with latent and manifest forms of iron deficiency. Patients and methods: 66 pregnant women were examined. Group 1 consisted of 36 pregnant women with latent iron deficiency, Group 2–30 pregnant women with manifest iron deficiency and moderate anemia. Pregnant women in the 1st group were prescribed the drug only for 1 month due to the fact that there were no manifestations of anemia in this category of patients. Blood parameters were monitored dynamically after 1 month of treatment and after 2 months, which means after 1 month of absence of the drug intake. Patients of the 2nd group received treatment during 2 months, dynamic treatment after laboratory parameters was carried out after 1 and 2 months of treatment. Results of the study. Analyzing the data obtained, it was found that all laboratory parameters differ significantly from those before treatment. Pregnant women of the 1st group have no reliable changes between the parameters after 1 and 2 months of observations, as during this period the patients did not receive iron medication. And even a slight decrease in some indicators is noted, but when compared with laboratory data before treatment, the results differ significantly. Conclusion: Ferrous sulfate and ascorbic acid can be recommended to compensate iron deficiency in pregnant women with LID to prevent the development of anemia, in patients with MID to treat anemia and prevent the development of possible complications in pregnant women associated with this condition. Thus, earlier detection and elimination of LID leads to prevention of anemia later on.

Human papillomavirus infection in women and men causes benign, premalignant and malignant diseases of the anogenital area. Laboratory diagnosis plays a major role in early detection of HPV-associated diseases in women, but there are no approved screening modalities, which can detect HPV-associated diseases in men. Examination of the sexual partners of patients with anogenital HPV diseases is a substantiated and important link in a chain of cancer prevention methods.

The urinary tract infection continue to exert significant impact on millions of patients worldwide, most of whom are otherwise healthy reproductive women. Antibiotic therapy for acute cystitis does not prevent recurrences, which plague up to one fourth of women after an initial urinary tract infection. Rising antimicrobial resistance among uropathogenic bacteria further complicates therapeutic decisions, necessitating new approaches based on fundamental investigation.

The results of treatment of 204 patients with bacterial vaginosis with metronidazole, clindamycin and dequalinium chloride, as well as the efficacy of two-stage treatment with consistent use of etiotropic drug and lactobacillus drug are discussed.

Aim: evaluation of efficacy of Multi-Gyn® Actigel application in the complex therapy of bacterial vaginosis (BV) and prevention of its recurrence in pregnant women.

Patients and methods: 87 patients of reproductive age were examined and treated with the diagnosis of «bacterial vaginosis, chronic recurrent course». 41 of them from the main group were given Multi-Gyn® Actigel at the 1st stage of treatment, while 46 women of the comparison group were given 2% clindamycin cream In order to restore vaginal microbiocenosis, a probiotic containing Lactobacillus casei rhamnosus spp. LCR35 was used in both groups at the second stage Clinical laboratory methods were used.

Results: efficacy of Multi-Gyn® Actigel application in complex therapy of BV and prevention of its recurrences in non-pregnant women was proved. As a result of Multi-Gyn® Actigel prescription there were no complaints, pH level was normalized, almost complete absence of BV-associated microorganisms was achieved and lactobacillus pool preservation even in the distant period after treatment.

Conclusion: Multi-Gyn® Actigel is an effective remedy for treatment of BV and prevention of its recurrence in non-pregnant patients, especially in the chronic recurrent course of the disease. This effect is achieved not only by eliminating anaerobic microorganisms, but also due to the persistent preservation of the lactobacillus pool.

The cohort prospective comparative study investigated the efficacy of mifepristone use in patients after surgical treatment of uterine myoma. It was shown that the use of mifepristone at a dose of 50 mg/day in a continuous mode for 3 months after surgical treatment for proliferating uterine myoma led to the absence of recurrences of the disease for 2 years after the drug withdrawal. The use of mifepristone after embolization of uterine arteries allowed to significantly reduce the size of the node by 25% during 12 months and by 50% (p<0.05) after 24 months. Complex treatment of uterine myoma, including myomectomy and drug therapy with mifepristone, allowed to realize reproductive function in 46% of patients, and delivery through the natural birth canal occurred in 24% of patients.

The article emphasizes the role of magnesium in a woman’s body, the causes and symptoms of its deficiency. It also describes the role of estrogens, combined oral contraceptives and hormone replacement therapy in the development of magnesium-deficient states, and the relationship between these states and vitamin B6. The paper overviews multicenter studies on the treatment of magnesiumdeficient conditions from the standpoint of evidence-based medicine, which show the need to maintain an adequate level of magnesium  and pyridoxine in the treatment of estrogen-dependent diseases.

Many women equate the word menopause primarily with decline of life. On the one hand, the aesthetic component of the delicate age makes negative contributions to the dissatisfaction with this state; on the other hand, the growing pool of somatic health problems does not improve the quality of life in the best way. The woman’s path of life is unique and consists of chapters of beginnings and endings, losses and gains. A person, who develops harmoniously and consistently, reaches their creative climax by the age of 50. This is the age, when a person is able to plunge into their inner world more deeply, and the perception of what is happening in the outer world weakens. Mental maturity, accumulated experience, well established social connections allow a person to feel confidently in everyday reality. However, the physiological changes associated with menopause and the reproductive function failure affect the personal history of each of the fair sex in one way or another. Not a simple, but at the same time a very significant period begins after 50 years, when it is necessary to conquer new peaks and overcome new distances. Only a thoughtful and successful start of menopause can provide a sense of satisfaction and a cloudless horizon in physical well-being.

Placenta accreta is one of the most severe anomalies of attachment, due to the high risk of massive bleeding. At present, the paradigm of organ-preserving delivery is laid. The implementation of this tactic is possible in the context of the introduction into the obstetric practice of patient blood management (PBM).

Objective: to evaluate the effectiveness of blood preservation methods in the management and delivery of pregnant women with placenta placenta accrete.

Materials and methods: The study group consisted of 59 pregnant women with placenta accreta in age from 20 to 40 years old (32,43 ± 5,05), who were examined in «Scientific Medical Research Center of Obstetrics”. Clinical, special (ultrasound and magnetic pelvic magnetic resonance imaging) and laboratory methods were used. A program of preparation for delivery was developed using the principles of the PBM: treating anemia at the preoperative stage; a multidisciplinary operating team was prepared (two obstetricians, a surgeon, anesthesiologist and resuscitator, anesthetist, transfusionist, physician, who provides work for Cell Saver, laboratory assistant). Operational tactics included a bottom cesarean section using one of the methods of surgical prevention and arrest of bleeding - bilateral ligation of the internal iliac arteries (1st group) (19 women), temporary stop of blood flow in common iliac artery by means of vascular clamps Satinsky (18 patients – 2ndgroup); bilateral overlay of turnstile harnesses on the base of the wide ligaments and the cervical-neck area, supplemented by a controlled balloon tamponade of the uterus (22 patients – 3rd d group). The operation was carried out under conditions of intraoperative reinfusion of autoerythrocytes on the apparatus “Cell-Saver 5”, donor FFP and erythrocyte component, tranexam preparations, rFVIIa (KoagilVII) were administered. In 80% of women, operations were performed under combined spinal-epidural anesthesia.

Results: the lowest blood loss was detected in the 3rd group with compression complex hemostasis: 1286 ± 510 ml. Accordingly, the volumes of infusion and transfusion therapy were also the smallest in this group. The volume of reinfused autoerythrocytes ranged from 260 ml to 1420 ml and averaged 801,7 ± 414,18 ml with a hematocrit of 55-60%. Donor erythrocytes were transfused to only 27 patients in an average volume of 785,1 ± 134,2 ml. rFVIIa (Koagil) was administered to four patients: three from the first group and one from the second group: a significant decrease in the speed and volume of bleeding was noted, and he performed an organ-sparing operation. Hysterectomy was performed on five women (8,77%). In the postoperative period was carried out antianemic therapy. The hospital stay averaged 7,9 ± 1,8 days.

Conclusion: The special role in the management and delivery of pregnant with placenta accreta plays the use of various PBM techniques , which include rational therapy of preoperative and postoperative anemia with modern iron preparations, rational surgical tactics, red blood cell autotransfusion, use of modern hemostatic agents and blood substitutes. A comprehensive multidisciplinary approach to this problem allows reducing blood loss, minimizing the volume of donor blood components and implementing organ-preserving tactics in a significant number of women.

Aim: to evaluate the efficacy of Picoprep for colonoscopy preparation in women with pelvic pathology.

Patients and methods: during the period from January 2018 to December 2018 in the Federal State Budgetary Institution «National Medical Research Center of Obstetrics, Gynecology and Perinatology named after V.I.Kulakov’’ of the Ministry of Health of the Russian Federation, 873 diagnostic video-colonoscopies were performed on women of reproductive age (from 23 to 41 years of age) in the surgical department of the Department of Operational Gynecology and General Surgery. Macrogol and Picoprep were used in preparation for the study. 512 (58.7%) of the total number of performed colonoscopies were performed after colon preparation with Picoprep.

Results: quality of colon preparation with Picoprep: excellent – 168 (32.7%), good – 275 (53.7%), satisfactory – 66 (13%), unsatisfactory – 3 (0.6%).

Conclusion: The effectiveness of Picoprep does not differ from the quality of preparation with the use of alternative preparations of Macrogol, but significantly exceeds them in tolerability by patients.

The article considers the indications for the use of iron carboxymaltosate, peculiarities of its structure, efficiency and safety of its use in various gynecological diseases, proved on the basis of meta-analysis of randomized clinical studies