Due to the complexity of the diagnosis and treatment of polycystic ovary syndrome (PCOS) in adolescents, studies are currently underway to select targeted therapy to normalize the metabolic and reproductive status of girls, including those at risk for PCOS. There are a  lot of  researches, that evaluate the  effectiveness of  inositol therapy in  PCOS, ovarian dysfunction, insulin resistance (IR), ovarian hyperandrogenism in both adolescents and adult women, including those in IVF cycles. Currently, the choice of determining the ratio of myo-inositol (MI) and d-chiro-inositol (DCI) for the treatment of PCOS often leads to the physiological proportion of inositols in plasma (40:1), since research results are insufficient to unambiguously confirm it. In this connection, there is a large number of pharmaceuticals without or with a low dosage of DCI, that can’t bypass the defective epimerase activity and achieve an adequate level of DCI in the ovaries. Determination of a fair assessment and dosage of MI/DCI is required for long-term correction of metabolic, endocrinological and clinical manifestations of various PCOS phenotypes. Inositols are promising and safe treatment of hyperandrogenism, obesity, insulin resistance in women of various age groups and can also effectively complement a therapeutic effect of metformin and combined oral contraceptives. 

Female sexual behavior is under the complex influence of psycho-emotional, neuroendocrine and social factors. The realization of normal sexual activity in women is possible if many conditions are met and, first of all, ensuring a positive psycho-emotional background, safety, a satisfactory state of health, as well as comfortable interpersonal relationships for most women. In addition to significant psychological and social impact, accumulated modern scientific data confirm the important role of neuro-hormonal regulation of sexual behavior and suggest the potential effectiveness of pharmacological therapy. Unfortunately, however, medical strategies for correcting female sexual disorders are limited. Currently, in some countries, several drugs that increase female sexual activity are allowed for use, however, all of them are not registered and are not approved for use on the territory of the Russian Federation. The article briefly describes the neural mechanisms of the main areas of the central nervous system underlying receptivity and sexual attraction, namely the olfactory and limbic systems, the neocortex. The main attention is paid to the function of neurotransmitters and hormones that are critically involved in the modulation of emotions and sexual behavior, including the inhibitory mediator of gamma aminobutyric acid (GABA), estrogens, testosterone, and the excitatory mediator glutamate. The stages of development, the results of experimental and clinical studies to assess the effectiveness and safety of the unique Russian neuropeptide drug Desirex, which is a stimulant of sexual behavior due to the mechanism of reversible suppression of the GABAergic system, nonspecific stimulation of the dopaminergic system of motivation and reinforcement of positive emotions and disinhibition of the controlling function of the neocortex, are presented in detail. 

Introduction. Accuracy of  transvaginal sonography  (TVS) is substantial as the  first-line approach of  intrauterine pathology diagnostics. However, TVS has some limitations and factors that reduce its accuracy have not been definitively determined.

Aim. To evaluate the diagnostic accuracy of echography in intrauterine pathology and identify factors affecting it. Materials and methods. The study included 250  women who underwent hysteroscopy with endometrial biopsy: 128  with endometrial polyps  (EP), 33  with endometrial hyperplasia  (EH), 28  with chronic endometritis  (CE) and 60  women without endometrial pathology.

Results. The sensitivity and specificity of ultrasound in diagnosis of EP was 64.8% and 77.9%, respectively, EH – 64.7% and 89.8%, CE – 39.3% and 90.1%. Cumulative intrauterine pathology’s sensitivity reached 94.7%, and the specificity – 15.0%, which indicates a significant amount of false positive results. The lowest accuracy was in CE, EP less than 0.6 cm and in the absence of abnormal uterine bleeding.

Conclusions. TVS has limitations in verifying a specific diagnosis and characterized by both hyper- and hypodiagnosis. The clinician should take into account the size of the EP and the presence of symptoms for choosing optimal management. 

The article considers the first transdermal contraceptive patch developed in the 1980s and adapted for use in 2002. The transdermal contraceptive drug contains the progestin norelgestromin and the estrogen ethinyl estradiol. The contraceptive patch is a thin laminated matrix-like system consisting of 4 layers: an outer protective layer of polyester, a layer with drug substances, a permeable membrane and a clear polyester release liner that is removed before patch application. The patch is applied once a week for 3 consecutive weeks (21 days), followed by 1 patch-free week per cycle. Comparative clinical studies have shown that the efficacy and safety of the contraceptive system is comparable to those of combined oral contraceptives, mild to moderate local reactions are uncommon. The overall satisfaction with the transdermal system was 88%, most patients note the convenience and ease of use of the patch, the absence of the need for daily monitoring. The advantage of the transdermal system is that it is free from shortcomings of the oral dosage form: the use of Evra patch has no first-pass effect which occurs when the drug enters the liver and the active substances are not metabolized in the gastrointestinal tract, which increases their bioavailability. The increased sweating during physical activities, as well as humid and hot climate conditions do not affect the patch adhesion. Thus, the transdermal patch is free from the shortcomings that may occur while taking combined oral contraceptives, and is comparable to them in terms of cycle control efficacy, safety and side effects. The transdermal system compliance is high due to the ease of its use. 

Introduction. Latent iron deficiency, which has a high prevalence among women of childbearing age, most often, in the absence of therapy, progresses in pregnant women into manifest iron deficiency, manifested by clinical symptoms of anemia and associated with a complicated course of pregnancy, childbirth, the postpartum period, unfavorable outcomes of newborns. The above justifies the need for correction of iron deficiency at the preconception period.

Aim. To evaluate the effectiveness of therapy latent iron deficiency at the stage of preconception period.

Materials and methods. The study included 32 women at the stage of pregnancy planning with latent iron deficiency. All women taking the drug Ferretab 1 pill per day for 1 month. The level of blood parameters was assessed at 3 months before the intended conception, in the I, II and III trimesters of pregnancy, in the 3rd day after delivery. In newborns, the indicators of a clinical blood test were evaluated on the 2nd day after birth. We evaluated such indicators as the level of hemoglobin, erythrocytes, hematocrit, the average content of hemoglobin in erythrocytes, serum ferritin, serum iron, transferrin.

Results. Evaluation of laboratory data in the course of the study confirmed the effectiveness of the use the complex drug Ferretab. Patients already at the first visit to the doctor during pregnancy had a positive trend and a significant increase in the level of hematological parameters.

Conclusions. Oral administration of the complex drug Ferretab showed high efficiency in the treatment of latent iron deficiency at the stage of preconception period, significantly increasing the levels of hematological parameters, good tolerance and a small number of side effects, contribute to the high adherence of patients to therapy, which allows achieving significant clinical results. 

Introduction. The issues of dispensary check-ups for women with benign breast diseases (BBD) still remain an urgent challenge. What stands out are delayed visits to the doctor, irregular examinations and failure to follow prescribed therapy. Women’s health schools equipped with state-of-the -art information and communication technologies contribute to improving motivation for regular check-ups, timely examinations and adherence to treatment.

Aim. To study the impact of training on adherence to regular visits, examination and treatment provided to a dispensary group of women with BBD at the Prevention School.

Materials and methods. A total of 486 women with BBD who attended the Women’s Health Prevention School were observed. A professional medical advice included a gynaecological screening and consultation with an oncologist, breast ultrasound imaging for women of all age groups and mammography for women aged 40 years and older; once diffuse benign changes to breast tissues were detected, the women were prescribed Mastodynon (Bionorica SE) for 3 months.

Results. After training, the rates of visits to a doctor increased from 69.3% to 94.2%, the examination rates increased from 66.8% to 88.6%, adherence to regular therapy increased from 43.6% to 82.9%. 82.9% of women reported health improvements after therapy with the herbal medicine, 7.6% – absence of changes, 4.3% – deterioration in the condition, of which 2.6% – menstrual disorders, 5.2% women discontinued therapy (due to poor tolerance – 3.6%, skin reactions – 1.0%, family reasons – 0.6%).

Conclusion. Raising women’s awareness about breast cancer and a set of measures increase the early detection of breast diseases and women’s cancer alertness. 

Introduction. One of the ways to increase adherence to contraceptives is to switch to prolonged contraceptives that do not require daily use.

Objective. Identify barriers to the use of Implanon by doctors and patients.

Materials and methods. At the first stage, we analyzed the results of using LARC with etonogestrel with 44 patients in the period from 2016–2019. Then, using Google-Forms, we conducted an online survey of 36 women of reproductive age (18–49 years old). At the third stage, we evaluated the results of a survey of 27 obstetricians and gynecologists who were trained in the “Clinical training program for  the introduction and removal of  a  subcutaneous contraceptive implant  (radiopaque implant, 68  mg of etonogestrel)” in Yekaterinburg. Microsoft Office Exel 2016 application software packages were used for statistical data processing.

Results. The majority of women – 80% (32) – wished to use implant with etonogestrel repeatedly. Women lack complete and real information about a subcutaneous implant with etonogestrel, which reduces the possibility of its use as a highly effective method of contraception. After the Implanon insertion/removal training, only 2 doctors (7.4%) voiced concerns about self-administration of the drug, and 25 (92.6%) cadets were ready for the introduction of a subcutaneous implant in practice and did not experience anxiety and fears before manipulation.

Conclusions. The main barrier in choosing an implant with etonogestrel n among women was low awareness of the mechanism of action, benefits and possible side effects of an implant with etonogestrel. Preliminary training-training of obstetricians and gynecologists with the possibility of self-administration of the drug on a dummy in conditions close to real, significantly increases the commitment of specialists to the use of the drug. 

Introduction. The efficacy of preoperative therapy with Gynestril in the treatment of symptomatic uterine fibroids and anaemia of various degrees of severity was studied in the prospective, comparative cohort study.

Aim. To evaluate the efficacy of preoperative therapy with mifepristone in patients with uterine fibroids and chronic iron deficiency anaemia of various degrees of severity.

Materials and methods. The study included 70 women who were scheduled to undergo the organ-preserving surgical treatment due to symptomatic uterine fibroids from January 1, 2017 to December 31, 2022. 50 patients received Gynestril at a dose of 50 mg/day (1 tablet) from day 1 of the menstrual cycle for 3 consecutive months. Due to contraindications to its use, 20 patients refused to administer the drug in the preoperative period and received symptomatic haemostatic therapy, and were included in the control groups. The patients of both groups received anti-anaemic therapy with iron(III)-hydroxide polymaltose tablets, 250– 300 mg/ day orally. 40 patients underwent the organ-preserving surgery depending on the size, number, type and localization of uterine fibroids according to the FIGO 2011 classification and patients’ motivation to preserve their reproductive function.

Results. The analysis of changes in the laboratory test results revealed that hemoglobin levels in the groups after Gynestril therapy reached reference ranges in all women, averaging 123.4 ± 8.2 g/l as compared to the baseline value 84.3 ± 6.7 g/l, p < 0.05. It was also noted that ferritin levels increased significantly, averaging 12.2 ± 1.9 µg/l compared to the pre-treatment level 8.8 ±  0.8 µg/l, serum iron levels reached 12.8 ± 1.0 compared to the pre-treatment level 8.0 ± 0.8, and TIBC level reduced to 72.1 ± 3.5 compared to the pre-treatment level 96.7 ± 4.8 (p < 0.05).

Conclusions. A comprehensive multidisciplinary approach to the treatment of uterine fibroids, including preoperative therapy with Gynestril, myomectomy using occlusive and X-ray endovascular techniques preserved the reproductive function in 50 patients with symptomatic uterine fibroids and anaemia of various degrees of severity. 

Intrauterine adhesions (IUDs) are one of the unresolved and unsolved problems of modern reproductive medicine worldwide. Adhesive lesions lead to partial or complete obliteration of the uterine cavity and/or cervical canal. The main clinical manifestations of IUDs are menstrual irregularities, cyclical pain, infertility and other various reproductive disorders. Reproductive outcomes in women with IUDs remain poorly understood and difficult to verify. At the same time, there is currently no understanding of the basic mechanisms of IUD development, including the processes explaining the failures of the above complications. The problem of overcoming IUD recurrences after adhesiolysis remains far from being finally resolved. The gold-standard treatment for IUD is hysteroscopic adhesiolysis, which, however, is associated with a high frequency of complications and relapses, highlighting the need for preventive approaches to the management of IUD. The drugs with enzymatic activity inhibiting abnormal connective tissue include bovhyaluronidase azoximer created by the Russian developers back in 2005. The drug consists of two components – hyaluronidase and azoximer bromide. The former is an enzyme, and the latter is a stabilizer that prolongs the action of hyaluronidase. Several studies have shown that bovhyaluronidase azoximer causes the destruction of intrauterine adhesions and restores the endometrium status in inflammatory pelvic diseases. Due to prolonged antifibrotic effect of bovhyaluronidase, azoximer can be used to treat women with IUDs to reduce the risk of the subsequent development of adhesive process in the uterine cavity.

The prevalence of  chronic endometritis  (CE) in  the general population ranges from 14.1  to 24.4% and is 2–3  times higher in patients with impaired reproductive function. The treatment of CE presents certain difficulties due to different approaches and conflicting information about the effectiveness of the methods used. According to studies, the cure rate of CE with antibiotics (AB) is 82.6–87.9% with a live birth rate of 56–62.4%. In ART programs in patients who have undergone a course of AB-therapy, there is a 5-fold increase in the frequency of live births. The need to reach a consensus on the diagnostic criteria for CE was noted to exclude the influence of study heterogeneity on treatment outcomes. In recent years, the need to restore immune protection in CE has been widely discussed. Of the immunomodulators available in the Russian Federation with proven efficacy is a complex of exogenous natural cytokines and chemokines, the use of which in combination with AB allows to achieve elimination of pathogens in 86% of patients with CE of viral and bacterial aetiology (56% in the treatment of AB alone) and achieve pregnancy, ended in childbirth, in 60% of cases (29% without cytokines). Immune function can be improved by addressing micronutrient deficiencies, in particular the vitamin and mineral complex Pregnoton, which can contribute to increased resistance to infection, faster recovery, and improved reproductive function. Treatment of CE should include broad-spectrum antibiotic therapy and antiviral therapy aimed at reducing the activity of viruses. The complex of exogenous natural cytokines and chemokines for topical application helps to increase the rates of pregnancy and live births. Biologically active supplements, including the Pregnoton vitaminmineral complex, can be used as additional means to improve the functions of innate and acquired immunity. 

Insulin resistance is the main pathogenetic component of many metabolic diseases, including obesity, type 2 diabetes mellitus, gestational diabetes mellitus, and polycystic ovary syndrome (PCOS). Despite the fact that to date the mechanisms of insulin resistance formation have not been established, one of the promising directions at present is the search for potential therapeutic strategies for its correction, due to the fact that this also improves the course of the concomitant underlying disease. Insulin sensitizers are a generally recognized method of PCOS therapy due to their safety and effectiveness in normalizing the metabolic and endocrine profile of patients with polycystic ovary syndrome. The leading position in this direction is occupied by the combination of myo-inositol (MI) with D-chiro-inositol (DHI) in a ratio of 40:1, which, according to the conducted studies, is comparable to the concentration of inositols in the blood plasma of healthy women. This ratio of MI/DHI is effective both for normalization of the metabolic profile, and for regulation of the menstrual cycle and overcoming anovulatory infertility. An analysis of the literature has shown that a number of biologically active substances, such as folic acid, vitamin D and alpha-lipoic acid, in combination with insulin sensitizers, have additional advantages, which gives grounds for continuing research on their significance as components of combined treatment, as well as in the search for the optimal dose and duration of such therapy. 

Introduction. Preeclampsia (PE) is a serious complication of pregnancy that occurs in 3-8% of pregnant women and is the leading cause of maternal and perinatal morbidity and mortality.

Aim. To evaluate the role of vascular homeostasis gene polymorphism in the formation of preeclampsia.

Materials and methods. The sample for this study included 250 women with preeclampsia and 209 women with normal gestation (control group). Five polymorphic loci of vascular homeostasis genes were selected for analysis: α-adducin (G460W ADD1), β2-adrenoceptor (+46G/A ADRB2), endothelin-1 (Lys198Asn EDN1) encoding the β3 G protein subunit (G/A GNB3), cytochrome 3A5 (+6986G/A CYP3A5). The molecular genetic study of all SNPs was carried out by polymerase chain reaction.

Results. It was found that genetic variants determine the  risk of  developing preeclampsia. The allelic variant 198Lys EDN1  (84.80%) occurs in  women with a  clinical diagnosis of  PE significantly more often than in  women of  the control group (79.67%) (p = 0.05; OR = 1.43; 95%CI 1.01–2.03). At the same time, among pregnant women without PE, combinations of 198Asn EDN1 x +46 A ADRB2 (23.65%) and 198Asn EDN1 x 460 ADD1 x +46 A ADRB2 (23.65%) are registered 1.6–1.7 times more often than among women with PE (14.46 and 13.65%, respectively, р_perm = 0.032). Conclusion. The risk factor for the formation of preeclampsia is the 198Lys EDN1 allele (OR = 1.43), and combinations of genetic variants 198Asn EDN1 х +46 A ADRB2 (OR = 0.55) and 198Asn EDN1 х +46 A ADRB2 х 460G ADD1 (OR = 0.51) have a protective value. 

Introduction. The problem of iron deficiency anemia by pregnant women remains relevant due to the wide spread of this complication (up to 40%) and requires the search for effective drugs with a minimum number of side effects.

Aim. To improve perinatal outcomes in patients with iron deficiency anemia.

Materials and methods. A retrospective analysis was done for 2020 of the medical records of patients, including an exchange card and birth histories. The patients were selected by a continuous sampling method. The study was conducted at the clinical base of the Department of Obstetrics and Gynecology with the course of perinatology of the Peoples’ Friendship University of Russia (Head of the Department, Corresponding Member of the Russian Academy of Sciences, Professor V.E. Radzinsky). All the patients (n = 114) were divided into three groups: the first group (n = 54) – a study group, which included pregnant women who had iron deficiency anemia in the II or III trimesters and received antianemic treatment; the second group (n = 30) – pregnant women with iron deficiency anemia (diagnosed in the 2nd trimester) who did not take iron supplements, the third group (n = 30) – a control group of women with normal hemoglobin levels during pregnancy and delivery.

Results. The use of ferrous sulfate (Sorbifer durules) at a dose of 200 mg per day by pregnant women with IDA led to the fact that the weight-height parameters in newborns did not differ from those of children from healthy puerperas. At the same time, the volume of blood loss was greater in patients with IDA, however, there were no massive bleedings and moderate IDA in the postpartum period. The level of hemoglobin was significantly higher in women in labor who received ferrous sulfate (Sorbifer Durules) from the II trimester compared with pregnant women who had IDA in the III trimester. Thus, further research and the search for optimal dosages are required, as well as determining the most effective period for the use of iron supplements.

Conclusions. Good tolerability and high efficacy of Sorbifer Durules in relation to a significant increase in hemoglobin and the absence of severe complications of pregnancy and childbirth associated with anemia allow us to recommend it for the treatment of IDA in pregnant women and puerperas. 

Uterine leiomyoma occurs in women over 35 years of age in 25–30% and in pregnant women in about 3–12%. However, in 10% of pregnant women, it turns out to be an accidental finding and is detected by ultrasound examination in the first trimester of pregnancy Approximately 10–30% of pregnant women with uterine leiomyoma have complications during pregnancy, childbirth and the postpartum period. The article demonstrates a case of successful delivery in a patient with uterine myoma at full-term pregnancy with preservation of reproductive function in a maternity hospital of the 3^rd level. In the period of 38–39 weeks, the patient was hospitalized in the maternity hospital. By the decision of the council, the pregnant woman was prepared for a planned operative delivery. A lower median laparotomy was performed for adequate access. Performed caesarean section in the lower segment according to Defler. During the operation, a live, full-term girl weighing 3600 g and height 53 cm, 7/8 points on the Apgar scale was extracted. On the left, along the anterior surface of the uterus in the bottom area, a subserous myomatous node on a pedicle is determined, measuring 300*220*150 mm. Blunt and sharp dissection of adhesions was performed, followed by removal of a myomatous node weighing more than 1 kg. The postoperative period was uneventful. The patient was discharged on the 5^th day. In our clinical case, a successful myomectomy was performed during a planned caesarean section. This type of surgery can be considered a safe option in carefully selected cases and a cost-effective method. However, this method should be performed by experienced surgeons who are skilled in the technique and take into account the size and location of the myomatous node.

Introduction. All thrombotic microangiopathy (TMA) variants in obstetric practice have a diverse clinical presentation and can manifest as various system and organ damage, which often makes it difficult or interfere with the diagnostic assessment, thus slowing down initiation of the necessary therapy.

Aim. To study the clinical presentations of various TMA variants in obstetric practice.

Materials and methods. A total of 313 pregnant women were enrolled in the study, of which atypical hemolytic uremic syndrome (aHUS) was diagnosed in 71 women, “HELLP syndrome” in 124 women, and “PE” with varied severity in 70 women. A group of patients with more rare causes of TMA was also identified: TTP and sepsis in 13 patients, and 35 patients without signs of TMA were included in the control group. We assessed and compared the main clinical, laboratory and instrumental findings.

Results. The study identified damage to various systems and organs in various TMA types in obstetric practice. The damage to kidneys, liver, nervous system, visual organs was observed in patients with aHUS, HELLP syndrome, TTP, septic TMA and PE, while the damage to skin, cardiovascular system and lungs was detected in patients from all groups except for PE. Small and large vessel thrombotic complications were detected in patients from the former three groups. The patients with aHUS showed the maximum multisystemic presentation severity.

Conclusions. The thrombotic microangiopathy in obstetrics is generalized in nature, and various symptoms of organ dysfunction require a multidisciplinary approach to such patients. 

Introduction. Preterm premature rupture of the membranes (PPROM) is one of the most common pregnancy complications. PPROM as а cause of infectious complications poses the greatest danger with increasing duration of period without amniotic fluid (i.e., watchful waiting) in full-term pregnancy.

Aim. Comparative evaluation of  test systems for  the diagnosis of  premature rupture of  the membranes  (PROM) based on the determination of the pH of the vaginal contents, the detection of placental alpha macroglobulin-1 (PAMG) or insulin-like growth factor-binding protein 1 (IGFBP-1).

Materials and methods. The study included 52 patients at 22–41 weeks of gestation in whom, according to the clinical examination, it is impossible to exclude/confirm PROM. All women were examined for the detection of PROM using test systems: nitrazine pH test, immunochromatographic test for the detection of IGFBP-1 or PAMG-1. The sensitivity, specificity, accuracy, predictive value of positive and negative results were calculated.

Results. As a result of the study, premature rupture of the membranes was confirmed in 25 cases, and this diagnosis was excluded in 27 cases. In three observations, additional observation and examination were required due to the questionable interpretation of  the result due to a  test error. Sensitivity and specificity were 64.0  and 66.7% for  the nitrazine test, 95.8  and 92.3% for IGFBP-1, and 95.8 and 96.3% for PAMG-1.

Conclusion. The nitrazine test has low sensitivity and specificity, therefore, for the diagnosis of PROM, test systems based on the determination of PAMG-1 and IGFBP-1 should be used, which improves the quality of diagnosis, reduces the risk of complications and ensures the timely start of a set of measures appropriate to the clinical situation. A negative test result avoids unnecessary hospitalization and unnecessary interventions, which is important both from a medical and economic point of view. 

Gestational diabetes mellitus (GDM) is a disease characterized by hyperglycemia, first established during pregnancy, while the concentration of venous plasma glucose should not exceed 6.9 mmol/l. As a rule, after childbirth, the disease regresses, but it does not pass without a trace for either the mother or the child. The consequences of gestational diabetes include an increased risk of cardiovascular diseases in the mother and type 2 diabetes, as well as diabetic fetopathy of the fetus and complications during pregnancy and childbirth: the threat of termination of pregnancy, premature birth, preeclampsia, polyhydramnios, high frequency of operative delivery and birth trauma. There is also a long-term risk of developing obesity, diabetes and cardiovascular diseases in a child. Gestational diabetes affects approximately 16.5% of pregnant women worldwide, an increase in the incidence is predicted due to an increase in the percentage of obese women. Gestational diabetes mellitus is a complication of gestation that is not easily diagnosed and poorly predicted, and therefore potentially threatening to any pregnancy, requiring, given the list of perinatal and long – term consequences for mother and child, pre-gravidar prevention, thorough diagnosis and mandatory treatment with permanent control of glycemia levels, ketonuria and instrumental monitoring: cardiotcography and ultrasound. A competent approach to pregnancy planning, the implementation of a screening program for GDM and timely correction in case of its detection is the key to the health of a woman and her unborn child. 

The problems of planning, follow-up of pregnancy and childbirth in women with inherited extrapyramidal neurological disorders, including torsion dystonia, are represented by isolated cases and receive little literature coverage. Dystonia is a rare disease, the incidence of its various types is 300–400 patients per million (0.03%). Idiopathic torsion dystonia is a group of genetically determined hyperkinetic disorders, which refers to an extrapyramidal pathology of the central nervous system with a progressive course of the disease. This article presents the case follow-up of pregnancy and childbirth in a patient with torsion dystonia and chronic neurostimulation 1.5 years after implantation of the ActivaRC neurostimulation system without drug therapy. The patient has given birth via elective caesarean section while receiving neurostimulation via the ActivaRC system. This clinical observation shows that the physiological course of pregnancy in patients with this diagnosis is possible in case of its advance planning and correction of the DBS programming. A multidisciplinary approach to the management of a patient with generalized torsion dystonia and chronic neurostimulation made it possible to achieve a favourable pregnancy outcome for both mother and fetus. Follow-up of pregnancy in such patients requires a correction of the DBS programming and choosing the optimal timing and method for delivery. The routine follow-up clinical examination by a neurologist should be carried out both in the planning stage and throughout the entire period of pregnancy (end of the first trimester, weeks 21–23, 32–34), as well as in the postpartum period. 

Coronary artery disease and stroke make up the greater part of the pattern of cardiovascular diseases (CVD). Their prevalence is increasing primarily due to death rates decline and life expectancy increase. However, CVDs remain the leading cause of death in both high/middle and low income countries (WHO, 2008). The burden of coronary heart disease and stroke is determined both by a significant decrease in patients’ quality of life and the economic expenditures of healthcare aimed at treating these conditions and managing their complications. The overall CVD risk is more or less the same in men and women, but a detailed analysis shows a clear dependence on the patient age. The CVD risk in men is comparable to the CVD risk in women of younger age groups, i.e. CVD incidence rates in women are about ten years behind such rates in men. CVDs are of major concern for women who enter menopause. The changing endocrine profile predisposes to an increase in the cardiovascular event rates due to a combination of risk factors such as visceral obesity, atherogenic dyslipidemia, impaired glucose regulation, homeostasis disorders, and vascular dysfunction. However, an independent association between age-related degenerative changes in the ovaries and CVD risk has been established primarily in women with premature and early menopause (<40– 45 years). Menopause hormone therapy (MHT) significantly reduces most CVD risks. The effectiveness of the prevention of irreversible effects of oestrogen deficiency is ensured by the timely MHT start during the very first pathological changes in female health or in the late stage of the menopausal transition/early postmenopausal stage (><60 years or within ten years after the last menstrual period). The concept of prescribing MHT within the “window of therapeutic opportunity” produces a  favourable benefit-risk ratio for patients.>˂40– 45 years). Menopause hormone therapy (MHT) significantly reduces most CVD risks. The effectiveness of the prevention of irreversible effects of oestrogen deficiency is ensured by the timely MHT start during the very first pathological changes in female health or in the late stage of the menopausal transition/early postmenopausal stage (˂60 years or within ten years after the last menstrual period). The concept of prescribing MHT within the “window of therapeutic opportunity” produces a  favourable benefit-risk ratio for patients.

Introduction. Postmenopausal women in a state of oestrogen deficiency often experience pelvic prolapse with underlying genitourinary menopausal syndrome, when the progression of atrophic processes in the vaginal mucosa comes to the forefront.

Aim. To evaluate the results of the use of topical hormonal therapy in the perioperative period to improve the vaginal epithelial surface appearance in postmenopausal women who need surgical treatment of pelvic prolapse.

Materials and methods. A comparative prospective randomized clinical trial included 60 postmenopausal patients aged 60 to 69 years with a postmenopausal period of 10 to 20 years, suffering from POP-Q stage II–IV pelvic prolapse (ICS, 1996). All patients were recommended surgical treatment using vaginal approach. The treatment group (Group 1) included 30 patients who received topical hormonal therapy with an estriol drug (Ovestin cream, 1 mg/g) within 1 month before reconstructive plastic surgery. The comparison group (Group 2) included 30 patients who did not receive hormonal treatment in the perioperative period.

Results. No complications were observed in the treatment group after reconstructive plastic surgery in the early and late postoperative periods. In the comparison group, natural urination was not achieved in 9 of 30 (35.0%) women on Day 2 after surgery, in 4 of 30 (13.3%) patients on Day 3. Also in that group, 4 of 30 (13.3%) patients experienced infectious and inflammatory complications in the postoperative period, the mucous membrane healing in 5/30 (16.6%) patients took a long time, over 1 month.

Conclusions. The use of topical hormonal therapy with an estriol drug in the perioperative period in patients who require surgical treatment of pelvic prolapse results in the relief of vulvovaginal atrophy symptoms and adequate regeneration of the vaginal mucosa, which helps reduce the likelihood of complications in both early and late postoperative periods. 

A woman’s health during the perimenopausal transition is not irrelevant because of the risk zone in which this category of women falls. Mature patients often have complaints associated with the menopausal syndrome. The increase in life expectancy of women, their active lifestyle that they want to maintain, which is not always possible due to the presence of a number of adverse factors such as the environment, stress factors, the presence of chronic diseases that tend to frequent exacerbations, all this aggravates the overall condition of women and primarily has a negative impact on their psycho-emotional health. The menopausal syndrome, which can debut during the perimenopausal transition, further complicates the woman’s condition. The job of a specialist gynaecologist is to help and manage these patients. It would seem that there is no question: the clinical guidelines and protocols are clearly prescribed algorithms for the management and therapy of such patients, where it is stated in black and white about the prescription of menopausal hormone therapy, which is pathogenetic and justified in the development of the menopausal syndrome and the complaints associated with it. But the prescription of this therapy is associated with a set of risks and side effects. Non-hormonal therapy is a good alternative in the treatment of menopausal disorders, given that hormonal treatment is contraindicated in a number of women. This article presents a cross-section of the literature data on the results of prescribing a dietary supplement MENSE® (Aquion JSC, Russia) in women with psycho-emotional tension during menopause. MENSE® complex contains an impressive range of components (β-alanine, 5-hydroxytryptophan, phytoestrogens – soy isoflavones, B vitamins, folic acid, vitamins E and C) favorably affecting the female body and improves the quality of her life during perimenopause. This complex can be recommended for patients with menopausal syndrome as an effective therapeutic agent for the period of selection of menopausal hormonal therapy or the presence of contraindications to it. MENSE® is an effective complex for improving the quality of life of perimenopausal women against the background of psycho-emotional conditions.