Viral pandemics have shown that infected pregnant women are at risk of adverse pregnancy outcomes. Current evidence suggests that a pregnant woman’s immune system undergoes a transformation necessary to maintain pregnancy and fetal growth. The prevalence of human papillomavirus (PVI) is high, and its role in adverse pregnancy outcomes and reproductive loss is highly controversial. About 90% of cases of persistent human papillomavirus infection (PVI) are eliminated within one to two years. The role of the immune system in the elimination and persistence of PVI has been proven; however, there is no clear understanding of the mechanisms whereby PVI infected cells escape immune surveillance up to the present day. In addition, the immune mechanisms underlying the PVI persistence constitute a pathogenetic basis for the development of mechanisms of infertility, miscarriage and pregnancy pathology. Genetic polymorphism of the mother and the developing fetus, persistent PVI types and microbial landscape are modulating factors with an unexplained contribution in the transformation of quantity of introduced influences into the qualitative change in the biological state. The foreign and Russian research results analysed by the authors show that timely and adequate therapy of PVI may contribute to the preservation of reproductive potential and prevention of obstetric losses. The modern approach to the treatment of persistent PVI suggests the use of antiviral and immunomodulatory therapy. Due to its immunomodulatory and antiviral properties, inosine pranobex is used to treat viral diseases such as PVI, herpes simplex viruses, cytomegalovirus, Epstein-Barr virus and influenza.

Oxidative stress is one of the leading causes of sperm dysfunction. Excessive amounts of reactive oxygen species can damage sperm membranes and disrupt their DNA integrity, which affects not only the likelihood of getting pregnant naturally, but also the clinical outcomes of assisted reproductive technologies and the risk of miscarriage. Sperm cells are extremely vulnerable to oxidative stress, given the limited functional reserve of their antioxidant systems and the DNA repair apparatus. Lifestyle factors, most of which are modifiable, often trigger generation of reactive oxygen species.  Both the lifestyle modification and use of antioxidant dietary supplements are adequate and compatible ways to combat male oxidative stress-associated infertility. The search for other internal and external sources of reactive oxygen species, the identification of the etiology of oxidative stress and treatment of respective diseases are necessary for the successful regulation of redox processes in the male reproductive system in clinical practice, which is required not only to overcome infertility, but also to prevent induced epigenetic disorders in subsequent generations. The article presents the analysis of the molecular mechanisms of male idiopathic infertility. The authors provide an overview of how to prevent oxidative stress as one of the causes of subfebrile fever. The article provides an overview of modern therapeutics, as well as the options for eliminating the consequences of the effect of reactive oxygen species on spermatogenesis and male reproductive system in general.

The issue of fertility preservation in patients with cervical cancer is getting more and more common considering the improved effectiveness of early diagnosis and treatment of cancer. There is a number of evidence-based tactics available to the patients with diagnosed cervical cancer. These tactics have been proved effective and include methods such as ovarian transposition; oocyte, embryo and ovarian tissue cryopreservation. Nonetheless, there are no existing medical algorithms to define the priority of actions that should be taken in such cases of restricted time. The objective of this clinical case report is to highlight an existing concern towards the decision-making process regarding fertility preservation in patients with cervical cancer.

In this paper we report a clinical case of fertility preservation tactics in a patient undergone ovarian transposition. We pay attention to particular features of the controlled ovarian stimulation (COS) and oocyte retrieval process typical for such patients. The article discusses the subject of COS and oocyte retrieval effectiveness compared to patients who did not undergo ovarian transposition. The 35-year old patient presented 9 month after ovarian transposition to perform oocyte cryopreservation. As a result of COS 3 oocytes were aspirated, compared to 20 oocytes in another patient of comparable age and medical history, but with no ovarian transposition performed.

Regarding particular conditions constraining ovarian stimulation and oocyte retrieval after ovarian transposition, we recommend to consider the possibility of performing oocyte/embryo cryopreservation before ovarian transposition in patients with cervical cancer. Prioritizing oocyte and embryo cryopreservation in case of having sufficient time before treatment could significantly improve possibilities of achieving genetically related offspring in a long-term perspective.

This literature review focuses on the use of corifollitropin alfa for ovarian stimulation in assisted reproductive technology (ART) programmes in different groups of patients. Corifollitropin alfa is a gonadotropin drug with prolonged FSH activity. The main difference between corifollitropin alfa and other gonadotropins is the higher level of peak FSH, which leads to the recruitment of more follicles. Another feature is the inability to adjust the gonadotropin dose during the first days of ovarian stimulation. In contrast to traditional indications/contraindications for gonadotropins, the use of cortifollitropin is not recommended in combination with GnRH agonists or in patients with polycystic ovary syndrome.

Evidence for the feasibility and efficacy of using corifollitropin alfa in patients with various ovarian response variants in ART programmes has been analysed. Most researchers agree that the use of corifollitropin alfa can be recommended for patients with a presumed poor or normal ovarian response. The use of corifollitropin alfa in patients with a presumed excessive response to ovarian timulation is possible when embryo transfer is not expected: in oocyte donation/oocyte vitrification cycles or in "freeze-all" cycles.

A significant advantage of using corifollitropin alfa for oocyte donor patients is the single administration of the drug, which can be done in a medical facility, which reduces the risk of prescription non-compliance.

The use of corifollitropin alfa in protocols with GnRH agonists requires further research: firstly, corifollitropin alfa has no LH component and secondly, there is no possibility of ovulation trigger replacement in this protocol if there is a high risk of early ovarian hyperstimulation syndrome.

Introduction. About 30 to 50% of women with endometriosis complain of infertility. The incidence of infertility in all localizations of endometriosis is about 3-4 times higher than that in the general population.

Objective of the study: estimate the hormonal profile of patients with deep infiltrative endometriosis (DIE) based on the study of the level of AMH, FSH, LH, progesterone, estradiol, prolactin in the serum of peripheral blood, conduct a comparative analysis of the level of these hormones between groups of patients with DIE and tuboperitoneal infertility.

Materials and methods: the main study group consisted of 99 patients of reproductive age (from 18 to 40 years) with DIE, the comparison group consisted of 18 patients with tuboperitoneal infertility. The patients of the main group were divided into 2 subgroups: subgroup IA - DIE with colorectal endometriosis (n = 63), subgroup IB - DIE without colorectal endometriosis (n = 36). AH patients underwent determination of the level of AMH, LH, FSH, progesterone, estradiol, prolactin in the serum of peripheral blood before surgery.

Results and discussion: a significant decrease in AMH level was revealed in patients with DIE. The level of AMH in the main and comparison groups was 1.80 and 3.28 ng/ml, respectively (p = 0.01). At the same time, subgroup IA has a more decreased AMH level (1.37 ng/ml) than in the comparison group (p = 0.003). In subgroup IB (the median AMH level - 2.50 ng/ml) were no significant differences with the comparison group (p = 0.14). It was also noted that in the group of patients with colorectal endometriosis (subgroup IA) the percentage of patients with reduced ovarian reserve (AMH 0.01 - 1.0 ng / ml) was significantly higher than in the comparison group (30.2% versus 5, 6%, p = 0.03), there were no significant differences between the subgroups. There were no significant differences in the level of LH, FSH, E2, prolactin in serum between the groups (p> 0.05).

Assessment of the level of anti-mullerian hormone, as the most accurate marker of ovarian reserve, revealed a significant decrease in AMH levels in patients with DIE, more decreased in the group of patients with colorectal endometriosis. Every 3rd patient with DIE had an AMH level of less than 1, which is a risk factor for a “poor” response to ovarian stimulation according to the Bologna criteria.

Conclusion. A significant decrease in the level of serum AMH, along with a high percentage of previous surgeries for endometriosis, including ovarian resections, may be one of the factors in a decrease in the reproductive potential of patients with DIE.

The history of the discovery of vitamin D (VD) has crossed 100 years. Initially, VD deficiency was limitedly associated with the development of rickets in children. Later, on the basis of a number of studies, it was found that VD deficiency is a risk factor for osteoporosis in men and women. However, the traditional concept of VD as the main regulator of calcium-phosphorus metabolism has undergone dramatic changes over the past two decades. A prerequisite for revising the role of VD and the spectrum of its biological properties was the identification of the distribution of its specific receptors in the body. VD receptors are expressed in the intestine, thyroid and parathyroid glands, kidneys, ovaries, uterus, placenta, hypothalamus, pituitary gland and play a vital function not only in calcium homeostasis. Accordingly, the list of target organs for VD action has been modified. VD deficiency, calculated on a pandemic scale, is a factor that increases the risk of developing not only osteoporosis, but also a number of other diseases. Observational and epidemiological studies have shown that reproductive system disorders are very often combined with VD insufficiency / deficiency. Subsequent scientific research aimed at establishing the role of VD in the formation of a particular pathology of the reproductive system has shown very ambiguous results. VD is recognized as an essential component of maintaining a woman’s reproductive health. Of course, the presence of an established association is not evidence of a causal relationship. There is a need for additional testing. This review focuses on the effect of VD on ovarian function and the formation of various dysfunctional conditions.

Folic acid (vitamin B9) is a water-soluble vitamin, essential for the growth and development of the blood and immune systems. Its deficiency is a significant risk factor for fetal neural tube defects. The widespread implementation of drugs and food supplements containing folic acid in preparation for pregnancy and in its first trimester has significantly reduced the incidence of fetal neural tube defects.

According to current recommendations, taking 0.4 mg of folic acid per day is indicated within 6 months before conception and in the first trimester of pregnancy. Taking folic acid at a dosage of 4 mg is indicated for patients with a history of a fetal neural tube defect.

There are also other risk factors for developing fetal neural tube defects. These include family history, obesity, malabsorption syndrome, folate cycle gene polymorphisms, smoking, drug use, diabetes mellitus (pre-gestational), and other chronic diseases. Determination of the required dosage of folic acid in these categories of patients still requires discussion and clinical trials. Also, folic acid intake is associated with a decreased risk of esophageal atresia, conotruncal heart disease, cleft palate, urinary tract malformations, and omphalocele, reduces the incidence of some behavioral anomalies, in particular, hyperactivity, the need for planning a pregnancy.

The article presents data on the clinical and pathogenetic variants of fetal growth restriction (FGR). FGR is one of the typical clinical manifestations of large obstetric syndromes, is associated with a high perinatal morbidity and has a significant impact on the quality and duration of human life. The emphasis is made on the differences in pathogenesis, the features of prediction, diagnosis, obstetric management and the assessment of perinatal outcomes in the early and late phenotype of the FGR. The review includes materials from domestic and foreign scientific literature that found in eLibrary and PubMed on this topic and published for the last 10 years. This article discusses the role of the formation of the embryo(feto)placental system under the influence of existing periconceptional risk factors in the implementation of various phenotypes of FGR. An analysis of the literature shows that the fetal growth potential, which genetically and epigenetically determined, changes during pregnancy

depending on maternal, placental and fetal factors, which ultimately determine the final weight-growth parameters of the newborn. The issues of informativeness of clinical, laboratory and instrumental predictors, diagnostic criteria, the choice of rational obstetric management in case of FGR of various periods of manifestation are discussed in this article. Convincing data on the perinatal and long-term consequences of intrauterine growth restriction are presented. The pathogenetic variant of FGR determines the features of the functioning of the immune system, has a significant impact on the programming of metabolic and endocrine processes, the formation of fetal brain structures. Identification of pregnant women at risk for the development of FGR of various periods of manifestation, timely diagnosis, selection of the timing and method of delivery should correspond to the main directions of the "4P-model" of modern medicine and represent an integral predictive, preventive and personalized system of examination and observation based on evidence-based medicine data and the requirements of practical obstetrics and perinatology.

This review focuses on the causes and consequences of nutritional deficiencies in the pregnant woman’s diet, as well as on the possibilities of its supplementation. It has been shown that inadequate intake of vitamins and minerals during pregnancy is accompanied by a lack of nutrient supply to the fetus, which can cause growth retardation, low birth weight and other obstetric and perinatal complications.

According to the analysed guidelines and recommendations, the body’s need for vitamins and minerals increases at least twice as much during pregnancy. Adverse effects of the environment, a number of gastrointestinal and liver diseases, chronic diseases, antibiotic therapy, etc. increase this need.

However, adequate nutritional support of the fetus is the result of several steps. These include the frequency of maternal food intake, the availability of nutrients in the food and the ability of the placenta to transport substrates effectively to the fetus.

The most recommended vitamin for consumption in pregnancy is folic acid, alone or in combination with other B vitamins, as its deficiency leads to birth defects in the child.

The authors of this review have reviewed a number of large studies conducted over the past decade that recommend iron and folic acid for pregnant women, regardless of dietary intake, as they have proven beneficial effects on the course and outcome of pregnancy. Folic acid, according to current recommendations, must be prescribed to every pregnant woman in the form of 400 mcg tablets daily regardless of her diet. Other most important and necessary vitamins for pregnant women are: vitamins A, C, D, E, K, B1, B2, B6, B12, PP, pantothenic acid, biotin.

Functional constipation is a common problem in pregnancy and postpartum period and is now considered not just a medical problem but also a factor influencing the quality of life. The frequency of defecation differs in people. Recent years specialists prefer personalized evaluation of the frequency of defecation for exact diagnostics of the condition, but not the classic definition. Functional constipation in pregnancy is caused by functional and anatomy changes of gastrointestinal tract and also by hormonal changes in pregnancy. Early diagnosis and correction of this pathology is one of the main objectives when managing normal pregnancy. This review covers current information on the theme, contains recommendations about the lifestyle during pregnancy and postpartum period and treatment options. Some foreign and Russian authors note the effectiveness of sodium picosulfate which accelerates the passage of the feces in a short time. It can be used during II and III trimesters of pregnancy as well as in the postpartum period and breastfeeding. Thus, complex correction of factors causing functional constipation decreases the risk of colon diseases as well as of all gastrointestinal tract in pregnant women and in the puerperium.

Introduction. Preterm birth (PR), complicated by premature rupture of the fetal membranes (PRPO), continues to be the focus of attention of obstetricians-gynecologists and neonatologists, due to high rates of perinatal morbidity and mortality.

The purpose of the study: to identify the features of the course of puerperium in preterm birth with a long anhydrous interval.

Material and methods. A single-stage cohort comparative study of the course and outcomes of PR complicated by PRPO and an anhydrous interval of more than 12 hours (group 1: n = 153) and spontaneous PR with an anhydrous interval of less than 12 hours (group 2: n = 408) has been conducted. Anamnestic data, peculiarities of pregnancy, childbirth, postpartum period, complications of puerperium and morbidity of newborns have been studied in detail.

Results and discussion. Pregnancy in group 1 was significantly more likely to occur against the background of acute respiratory diseases (ARVI - 2 times), colpitis (2.6 times), more often complicated by threatening termination (1.3 times), the development of isthmic-cervical insufficiency (1.3 times) and chorioamnionitis (5.7 times). It has been found that in the group of patients with a long anhydrous interval, the risk of hyperthermia (2 times - up to 49.7%), subinvolution of the uterus (1.5 times - up to 25.5%), late hypotonic bleeding (13 times - up to 6.5%), endometritis (4 times - up to 3.9%) increased significantly in the postpartum period, increasing the probability of generalization of infection and hysterectomy to 1.3%.

Conclusion. The results of the study once again have confirmed the negative impact of a long anhydrous interval on the incidence of newborns with PR. In addition, data have been obtained on an increased risk of purulent-septic infection in the puerperal period after PR, complicated by PRPO and a long anhydrous interval. All of the above indicates the need for further research in this area to develop a set of diagnostic and therapeutic measures to predict and prevent complications of puerperium during prolonged pregnancy complicated by PRPO.

It is well known that corpus luteum normal functioning is crucial for the luteal phase, which determines the embryo implantation and the progression of pregnancy. Luteal phase deficiency (LPD), associated with impaired progesterone secretion by the corpus luteum, is considered as a significant factor of infertility and early pregnancy loss, both in the natural cycle and in assisted reproductive technology (ART) programs. The LPD formation is associated with hypothalamic-pituitary-ovarian axis dysregulation, which leads to abnormal secretion of FSH, LH, ovulation and luteinization disorders, premature luteolysis. The most significant problem in the study of LPD is the lack of reliable and reproducible methods of its verification. This review summarizes the available data on the methods and issues of LPD diagnosing, including the duration of the luteal phase, the level of progesterone secretion, and endometrial biopsy. LPD is an important factor in reproductive failures during IVF, which is caused by suppression of the physiological FSH, LH secretion and requires mandatory progesterone support in the luteal phase of the cycle. It’s hard to define the contribution of LPD to miscarriage, however, empirical progestogen therapy may increase the live births rate in women with recurrent pregnancy loss. Currently, there is no evidence of the LPD role and progesterone support effectiveness in infertility management, so the diagnosis and therapy of LPD among these patients should not be considered.

All variants of thrombotic microangiopathy (TMA) in obstetric practice develop in an avalanche-like manner and require a rapid decision on the choice of treatment tactics. Although all these diseases have similar features, typical of the TMA syndrome as a whole, they are separate diseases with differing etiology and pathogenesis. Because the manifestations of TMA are almost identical in the different diseases, they may all imitate pre-eclampsia and the therapeutic approaches differ, a differential diagnosis is essential and often determines the prognosis.

The differential diagnostic search between the different TMA variants that can develop in pregnancy is described, as the prognosis of life often depends on the correct diagnosis. The main differences between pre-eclampsia/HELLP syndrome and life-threatening conditions such as atypical hemolytic-uremic syndrome, thrombotic thrombocytopenic purpura and catastrophic antiphospholipid syndrome are considered. Algorithms of diagnostic search are proposed. Attention is drawn to the fact that existing algorithms for the diagnosis of severe TMA prior to ADAMTS 13 results, based on the severity of thrombocytopenia and azotemia as well as scoring during pregnancy can serve as a guide, but not as a defining feature of the diagnosis.

The key to the differential diagnosis is the effect of delivery on the regression of TMA: if hemolysis and thrombocytopenia decrease after delivery, one can speak of ‘pure’ pre-eclampsia (PE) or HELLP-syndrome. If persistent or increasing, thrombotic thrombocytopenic purpura (TTP) and aHUS should be considered. With an ADAMTS 13 level of less than 10%, a diagnosis of TTP is made. With ADAMTS 13 over 10-20%, the patient falls into the «grey zone» and a repeat enzyme test is required. If there are signs of fulminant multiple organ failure, especially in a patient with initial suspicion of APS, CAPS can be suspected. To confirm it, high titres of APA are required. In addition, TMA may cause: sepsis and various urgent obstetric conditions complicated by the development of DIC.

Introduction. Research in recent years has shown that sexual dysfunction is now common in post-menopausal women and that it has a significant impact on their quality of life.

Aim: to identify the major causes of sexual dysfunction in postmenopausal women and their treatment options, by analysing different literature sources.

Materials and methods. During the study of this problem, 25 sources of literature, both Russian and foreign, dating from 2007 to 2020 were analysed.

Results and discussion. The main etiological aspects of sexual dysfunction in postmenopausal women, such as disorders of sexual desire, sexual pain disorders, orgasmic disorders are considered in this article. The role of physiological processes occurring in a woman’s organism during this age period in the formation of sexual dysfunction is presented, namely, the influence of insufficiency of sex hormones (In particular, estrogens) and genitourinary syndrome on disorders of the sexual sphere.

The main methods of treatment are described, including hormone replacement therapy, the use of non-invasive laser technology, and surgical correction of the dysfunction and atrophy of the pelvic floor muscles. Particular attention is paid to the use of the synthetic steroid tibolone and flibanserin, a drug used to treat hypoactive sexual desire disorder, and the data concerning their high efficacy are presented.

Conclusions. The predominant manifestation of sexual dysfunction are disorders of sexual desire and sexual pain disorders. Thus it is important to pay attention to this problem and to treat sexual dysfunction by treating its causes.

Conclusion. The treatment of sexual dysfunction must address the causes. In many cases, psychotherapy is necessary. MHT has a positive effect on the sexual function of patients. Testosterone therapy is justified in this case, but is rarely used, as it has a number of side effects and contraindications. Synthetic steroids (Tibolone) have shown good results in the treatment of sexual dysfunction.

In the age of broad medical options, women’s health has received sufficient attention. The different periods of a woman’s life are characterised by specific physiological changes, based on the age-related characteristics of the reproductive system. The onset of menopause can have a negative impact on health in varying degrees. Clinicians have a clear understanding of the effects of estrogen deficiency and the therapeutic options for managing it with menopausal hormone therapy (MHT) and alternative methods of treatment. However, to date, methods for optimising and individualising the correction of menopausal disorders continue to improve. The individualization of MHT is aimed at increasing the efficacy of menopausal management and minimizing possible adverse events. Individualization is based on the selection of a hormone drug taking into account age, menopausal status, somatic health of the woman and her main complaints against the background of estrogen deficiency. The next stage of transformation of MHT concerned the composition of the drugs and the doses of their components. The evolution of the estrogenic component began with the use of conjugated estrogens, whose metabolism is not fully clarified, and stopped at the production of bioidentical estrogens (17p-estradiol and estradiol valerate), which in their structure are as close as possible to ovarian estradiol. The type, dose and combination of estrogens and progestogens determine the severity and specificity of the effect of the hormone. This article will present a clinical case study of the low- and ultra-low-dose combination of 17p-estradiol and dydrogesterone (E/DG).

Introduction. Amidst a steady increase in hyperplastic processes in uterus and mammary glands, numerous studies have shown that women with dyshormonal pathology of mammary glands had a range of gynecological diseases: external or internal endometriosis, hyperplastic processes of the endometrium and myometrium, polyps, polycystic ovary syndrome (PCOS), etc.

Objective. To assess the mammary gland condition in premenopausal women with endometrial hyperplasia during indole-3-car-binol (I3C) therapy.

Materials and methods. A total of 42 premenopausal patients aged 45-52 years (48.54 ± 1.83) were enrolled in an open-label prospective study. All patients received I3C 400 mg a day for 12 months. The examination included clinical laboratory, ultrasound imaging and mammographic examination of the mammary glands, cytologic examination of a nipple discharge. The examinations were carried out at the baseline, 6 and 12 months after starting treatment. The study findings were evaluated using descriptive statistics. Differences were considered significant at p <0.05.

Results and discussion. All patients were diagnosed as having mastalgia before starting treatment. Mammary gland ultrasound imaging showed that the frequency of BI-RADS 2 was 9.5 times higher than that of BI-RADS 1 (90.5% and 9.5%, respectively, p <0.05). Mammography revealed that the frequency of BI-RADS 2 was 9.26 times higher than that of BI-RADS 1 (88% and 9.5%, respectively, p <0.05). After 6-month therapy, 59.5% of patients reported the disappearance of pain syndrome, the number of patients with ONE1/16a-ONE1 deviations decreased by 22%, 7.1% of patients showed improvement of ultrasound picture in BI-RADS. After 12-month therapy, the number of patients with ONE1 / 16a-ONE1 deviations decreased by 92.86% compared with the figures before starting treatment, ultrasound imaging showed improvement in the BI-RADS picture in 19% of patients, mammography findings - in 28.5% of patients. I3C is an effective and safe method to treat benign breast diseases in premenopausal women.

Conclusion. Indole-3-carbinol therapy can be assessed as the treatment having an influence on the general components of pathogenesis of endometrial hyperplasia and benign hyperplastic processes in mammary glands. It is advisable to consider the use of indole-3-carbinol combined with antioxidant resveratrol in clinical practice.

Iron deficiency anemia is a frequent companion in postmenopausal women and those who have reached adulthood. Anemia in mild form in elderly women often occurs almost asymptomatically. Over time, iron deficiency progresses: severe complications occur, the quality of life decreases significantly, and the prognosis for life becomes unfavorable. A cross-section of the literature data in recent years shows that iron, folate, vitamin B12 deficiency, gastrointestinal diseases, pathologies in the processes of erythropoiesis and other somatic diseases come to the fore in terms of the etiological factors of anemia in elderly women. An important role in the development of anemia in older women is played by an irrational diet throughout life, which causes a lack of iron and folate in food. That is why therapy with a complex drug, which includes iron (II) fumarate in combination with folic acid is a rational choice in comparison with iron monotherapy for the prevention and treatment of anemia in elderly women. The administration of oral iron preparations for the correction of iron deficiency and for the purpose of selecting an effective pathogenetic therapy for anemia solves the problem of complications and improves the quality of life of older women. Iron (II) fumarate + folic acid - a tablet form of iron preparation in combination with folic acid for oral use, which has good tolerability, quickly replenishes iron reserves in the body of elderly patients, reducing mortality in this age group.

The “gold” standard of treatment for women with menopausal syndrome (MS) is hormonal therapy, which, however, may not be acceptable in all cases, which determines the need to choose other methods.

Effective alternatives to the treatment of MS are tissue-selective modulators of estrogen receptors and phytoestrogens, which contribute to the reduction of both early (vegetative-vascular and psycho-emotional) and mid-term and late disorders (osteoporosis), in contrast to selective serotonin reuptake inhibitors and serotonin / norepinephrine, which affect only the vegetative-vascular and psychoemotional symptoms and bisforphonates, which prevent the loss of bone mineral density. Isoflavones of red clover at a dose of 40 mg when taken for 3 months lead to a reduction in hot flashes in 47-85% of patients, insomnia in 53%, anxiety and depression in 76-81%, and also has a positive effect on endocrine-metabolic disorders and bone mineral density with prolonged use. Their use has been shown to be safe for 3 years. Controlling stress through cognitive behavioral therapy (positive effects on psychological symptoms, stress and depression) and clinical hypnosis (reducing symptoms by 50%) may be helpful in relieving MS symptoms. Supplements with vitamins C, D, K and calcium can be recommended to maintain healthy bones, antioxidants (vitamins C and E) - to enhance the effects of pharmacotherapy. There is no evidence of benefits for vasomotor symptoms of yoga, breathing exercises, relaxation, herbal and homeopathic remedies, nutritional supplements.

The information accumulated to date on the efficacy and safety of phytoestrogens (red clover extract) makes it possible to recommend them as an alternative to MHT for the treatment of disorders associated with involutive changes in the female reproductive system during the peri- and postmenopausal period.

Incidence of reported cases of genital herpes in different countries has increased dramatically during the last years, which is essentially caused by spread of asymptomatic or atypical types of herpes. Frequent relapses of herpes infection are characterized by changes in the immunological status. The authors of presented article analysed the findings of foreign and domestic studies on the treatment of the disease, systematized information about the features of antiviral chemotherapy drugs used in the treat-

ment of genital herpes, identified criteria for the efficacy and duration of suppressive therapy, and the feasibility of its combination with courses of immunomodulatory drugs. The article summarizes the authors’ own experience in the treatment of genital herpes in 50 patients, who were randomly divided into 2 groups: (active treatment) group 1 consisted of 25 women who received antiviral (acyclovir and its analogues) and immunomodulatory therapy (aminodihydrophthalasindione sodium, suppositories), (comparison) group 2 consisted of 25 patients who received antiviral therapy only. The following were criteria for the inclusion of patients: genital herpes history, clinical presentation of genital herpes during the prodromal period or exacerbation, and no more than 48 hours after the rash occurred.

The results of evaluation of the treatment effectiveness showed that the vesicles disappeared and the crusts formed during aminodihydrophthalasindione sodium therapy in the active treatment group of patients as early as Day 2-5 after starting treatment, while the acute phase of local inflammation in the comparison group was reversed only by Day 4-5. Complete reepitheli-alization occurred in the active treatment and comparison groups by Day 6-7 of the treatment. At the same time, the PCR test did not detect HSV-2 in smears in 24 (96.0%) women in the active treatment group and in 25 (88.0%) women in the comparison group. No one had any fresh rashes in the course of treatment with the drug. In addition, the authors reported prolongation of clinical remission in the active treatment group up to 5 months (up to 55 days on average).

As can be seen from the above, the inclusion of immunomodulatory drugs in the combination specific antiviral therapy leads to faster achievement of the clinical effect, allows to reduce frequency of relapses and improves the patients’ quality of life.