Prescribing combined hormonal contraceptives for the treatment of endometriosis may be the therapy of choice for patients with chronic pelvic pain and menstrual dysfunction.

The frequency and severity of side effects induced by the use of combined oral contraceptives (COCs) are the most common causes of withdrawal (64.4%). Better adherence can be achieved through adequate counselling on the choice of contraception and use of extended-regimen low-dose COCs with estrogen component and natural hormones containing novel selective progestins (dienogest, drospirenone) with minimum side effects. The choice of vitamin and mineral supplements based on the relevant micronutrient disbalance in women using COCs and "quick starting" could also contribute to compliance with the chosen method of oral contraception.

The article tells about the use of a combined contraceptive preparation containing the novel progestogen - dienogest - in conservative antirecurrent treatment of endometriosis. According to current concepts, endometriosis is a chronical dishormonal, immunodependent, multifactorial, genetically determined disease which manifests itself in the growth and presence of endometrioid heterotopias in the uterus. While accurate diagnosis and ablation of heterotopias require surgery, for subsequent treatment, doctor's toolkit offers a multitude of medicines the effects of which are on the whole described by the following: fight against manifestations of endometriosis, inhibition of the progression of the process, reduction of the disease recurrence, and improving the quality of life of patients. Pharmacotherapy of endometriosis should be effective and safe. Dienogest demonstrated properties comparable to those of gonadotropin-releasing hormone agonists, especially for early clinical manifestations of endometriosis. The combined contraceptive containing ethinylestradiol and dienogest is best suited for long-term (several months) treatment of endometriosis under a cyclic or continuous regimen.

Hemorrhoids is one of the most common diseases during pregnancy and in the postpartum period. It can be acute and chronic, and manifests itself in the form of thrombosis, inflammation or bleeding. The course of the disease can be either chronic or acute. Acute hemorrhoids is a complication of the chronic process and is further subdivided into forms according to the severity of inflammation and thrombosis. The classification reflects the pathogenesis of hemorrhoids; it is convenient and practical allowing for an unbiased approach in outlining indications and selecting the desired method of treatment depending on the stage of the disease and its severity. Conservative treatment of acute and chronic hemorrhoids is aimed at relief of symptoms of acute hemorrhoids, preventing complications as well as exacerbations of the chronic disease. Medications used in the treatment have anti-inflammatory, analgesic, hemostatic effects, improve blood flow and blood circulation in cavernous formations. The article tells about the drug of choice in the treatment of hemorrhoids in pregnant and postpartum women.

Damage of the central nervous system of the fetus is one of crucial issues in the modern healthcare as it represents a severe congenital disease with a poor prognosis accompanied by fetal death or severe disability of the newborn. Administration of folic acid or multivitamins during the periconceptual period is an effective method for primary prevention of neural tube malformation.

Traditionally, the problem of osteoporosis (OP) and osteopenia (OPe) in women is associated with the period of menopause. Increased bone fragility and osteoporotic fractures in pregnant, postpartum and breast-feeding women is less expected but the socio-economic burden can be significant. Neither the existing classification of OP nor the International Classification of Diseases separate OP associated with pregnancy, childbirth and lactation [1].

Iron deficiency anemia is a common disease. According to various reports, it is found in the majority of women of childbearing age, pregnant and postpartum women. This is due to the high requirement of iron during gestation and increased consumption in the postpartum period. Choosing the most effective iron replacement drug the effect of which is realized within the minimum period of time could be the best solution of the problem and contribute to favorable outcomes.

The efficacy and safety of the only existing corifollitropin alpha drug was compared with recombinant follicle stimulating hormone (rFSH) preparations administered for the purpose of stimulating multi-follicular growth under in vitro fertilization/intracytoplasmic sperm injection programmes. According to numerous sources, the efficacy in terms of live birth rates, clinical and ongoing pregnancy among female patients receiving corifollitropin alpha and those receiving rFSH during the first 7 days of stimulation was comparable. There were no statistical differences between the corifollitropin alfa and rFSH groups in terms of the incidence of ectopic and multiple pregnancy, risk of OHSS, embryonal/fetal malformations. The rate of antibody formation to corifollitropinu alpha was not clinically relevant. There were statistical differences in ovarian response between the groups of patients receiving corifollitropin alpha and patients taking rFSH reflected in a higher number of cumulus oocyte complexes in the corifollitropin alpha group. Patients demonstrated higher satisfaction after receiving corifollitropin alpha compared to rFSH due to a lower number of injections required.

The article discusses the specific psycho-emotional status, autonomic regulation and pain phenomena of young women and women in the middle of the childbearing period who suffer from premenstrual syndrome. The study involved 72 women aged from 16 to 25 years and 51 between the ages of 30 and 38 years. The identified clinical features could be applied for further research on the development of pathogenetic methods to treat the disease in women in different age groups.

Puerperium pyoinflammatory diseases (PID) represent the most crucial problem in obstetrics. Among the PID pathologies, the leading place belongs to postpartum endometritis, most commonly occurring after surgical and pathological childbirth. Given the fact that in the pathogenesis of postpartum PID the significant role belongs to changes in the immunological status characterized either by the combined inhibition of T- and B-systems of immunity or, primarily, by damage to T-lymphocytes, the inclusion of immunomodulatory drugs in the complex therapy of postpartum endometritis contributes to a more rapid achievement of clinical effect and allows to obtain favorable outcomes.

The article tells about the key problems of diagnosis and treatment of patients with vulvovaginal candidiasis (VVC). Candida albicans causes 75--80% of candidiasis cases. Clinical forms of VVC include: Candida-carrying, acute VVC, chronic (recurrent) vulvovaginal candidiasis (CRVVC). The main diagnostic approaches to the treatment and prevention of recurrence of the disease are described. The authors presented data on the efficacy of the antifungal medication Diflucan in the fight against VVC.

Melatonin is one of the most underestimated agents of the endocrine system. While remaining undeservedly in the shadow of clinical science, it adjusts the body to the systemic changes of the external and internal environment. The periods of perimenopause and menopause are characterized by high levels of stress and reduced quality of life. In recent years, there is a growing understanding that melatonin as adaptogenic hormone supports the female body in this particularly vulnerable period of life. We assessed secretion of melatonin in women with climacteric syndrome (CS) and the effect of melatonin therapy on menopausal symptoms and quality of sleep. The study involved 31 women (mean age 53.5 ± 4,1 years) with mild CS (average age of menopause 52 ± 3 years). Melatonin secretion was evaluated by the concentration of its metabolite (urinary 6-hydroxy-melatonin-sulfate) using enzyme immunoassay. All patients received melatonin 3 mg/day orally at bedtime for 3 months. The results of the treatment were clinically assessed using the modified menopausal index (MMI) and the Pittsburgh Sleep Quality Index (PSQI). We found that baseline 6-hydroxy-melatonin-sulfate levels were very low in the evening urine: 1.88 ng/ml (1.08 to 5.34); at night and in the early morning they moderately increased (up to 6.36 ng/ml [from 2,34 to 16,04] and 25.71 ng/ml [15.51 to 32.03], respectively). After 1 month of treatment, MMI in the subjects decreased from 24,9 ± 8,1 points to 16,6 ± 8,8 (P = 0.013) and further to 13,2 ± 6,3 points after 3 months (P = 0.001). The MMI demonstrated a significant decrease of neuro-vegetative symptoms. The median PSQI decreased from 9 to 2 points (p = 0,027). Our findings suggest that melatonin is able to inhibit mild CS and the associated sleep disturbances.

Estrogen deficiency is the main cause of menopausal symptoms of varying intensity. Administration of vitamin and mineral supplements is a part of nonhormonal drug therapy and an etiopathologically substantiated method of therapy. Improving energy supply in cells and increasing the level of cyclic adenosine monophosphate (cAMP) can alter receptor sensitivity and amplify expression of estrogen effects without increasing their synthesis. Vitamins A and D affect gene transcription resulting in changes in synthesis of proteins which realize various biological potentials. The vast majority of women surveyed (70-80%) in the territory of the Russian Federation suffer from poly-hypovitaminoses, no matter their age, season, place of residence or professional affiliation. Additional supplementation with micronutrients has a positive effect on the body's defense system by stimulating non-specific resistance reactions, and that is key for the prevention of various diseases in the period of waning reproductive function.

The article tells about the incidence and severity of menopausal symptoms in women during pre-, peri- and post-menopausal periods as well as the rationale for their treatment. It was found that the use of menopausal hormone therapy (MHT) should be individualized and should not be cancelled solely due to the woman's age. The results of numerous studies of women in the transition from pre- to peri- and further to postmenopause are demonstrated. Limitations in the duration of MHT therapy are considered, and the need to develop safer therapies for long-term treatment of hot flushes is substantiated. It is proved that ultra-low-dose medication is effective for the treatment of both moderate and severe vasomotor symptoms.

The article tells about major anticoagulant medications used in cancer patients taking into account the pathogenesis of hypercoagulation status in these patients: oral anticoagulants, heparin medications, selective factor Xa-inhibitors. The main advantages of low molecular weight heparins versus unfractionated heparin are described. Recommendations for the prevention of thrombotic complications in cancer patients are provided. Possible complications of heparin therapy are reviewed, and the prevention methods are suggested.

Clinical studies of medicine-based and surgical methods for the treatment of endometriosis are described. Although endometriosis was described as early as in the XIX century, the causes for its emergence and spread have not been fully investigated. Also, many questions regarding methods of treatment remain far from being solved. Due to the chronic and often relapsing nature of the disease, Practice Committee of the American Society for Reproductive Medicine (ASRM) has concluded the following: "endometriosis should be viewed as a chronic disease that requires a lifelong management plan with the goal of maximizing the use of medical treatment and avoiding repeated surgical procedures." Thus, treatment of endometriosis should not only be comprehensive but also adapted to the specifics of each woman's organism.

The review tells about inadequate frequency of use (less than 1%) and low awareness (58--59%) among Russian women of emergency contraception, novel recommended medications and their effectiveness (52--100%) and safety according to recent clinical trials. Enhancing awareness of doctors and potential consumers of high efficacy and safety of emergency contraception would increase its use whenever necessary.

The study demonstrated the need for topical use of Ovestin® in preoperative preparation of postmenopausal women with varying degrees of genital prolapse and stress urinary incontinence, as well as early start of administration in women during perimenopause to prevent estrogen-dependent complications and reduce the progression of the disease with minimum clinical manifestations.

The article presents the results of a study of 71 patients with adhesive process diagnosed with external genital endometriosis (EGE) confirmed by laparoscopy. In accordance with the specific serum immunoreactivity evaluation, all patients were divided into 3 groups: Group A (normal response type), Group B (hyper-response type) and group C (hypo-response type). The duration of infertility was on average 6,1 ± 1,3 years. After surgery patients underwent antigonadotropic therapy with 3.75 mg buserelin (a course of 4--6 injections). Against a background of the baseline therapy, all patients in groups B and C underwent correction of immunological disorders. Conclusion: Management of immunological disorders in patients with adhesive process associated with EGE enhances the effectiveness of recovery of the reproductive function

The objective was to determine the presence and severity of placental apoptosis in pre-eclampsia. The study included 31 patients. All patients were divided into 2 groups: group I (treatment) included 11 pregnant women with preeclampsia, group II (control) - 20 healthy patients. Gene expression was evaluated with qPCR assay, and placental apoptosis was assessed by the TUNEL method. It was found that the level of placental apoptosis in preeclampsia patients was significantly higher compared to that of apparently healthy females, and in some cases stem villi are destroyed due to programmed cell death in the villous stroma and syncytiotrophoblast. In preeclampsia, oxidative stress leads to increased levels of apoptosis in placental villi. Both trophoblast cells and, in certain cases, cells of the villous stroma are subject to apoptosis.