Introduction. Endometriosis is a common gynecological disease that has important socio-economic significance for both sick women, their families, and society as a whole. It is often combined with other hyperplastic diseases of the uterus.

Aim. To analyze the involvement of GWAS-significant polymorphic loci of sex hormone genes in the development of combined proliferative diseases of the uterus in women with endometriosis. 

Materials and methods. The sample for the study included 395 women, including 103 patients with isolated endometriosis and 292 patients with endometriosis in combination with uterine fibroids and/or endometrial hyperplasia. All women underwent molecular genetic testing of seven GWAS-significant single-nucleotide polymorphic variants of sex hormone genes (rs34670419, rs11031005, rs11031002, rs148982377, rs112295236, rs1641549, rs117585797). The analysis of associations of polymorphic variants with the risk of developing combined proliferative diseases of the uterus in patients with endometriosis was carried out. To assess the functional effects of SNP associated with the formation of combined proliferative diseases of the uterus in women with endometriosis, the online programs HaploReg and Gtex Portal were used.

Results and discussion. Genetic variant A rs117585797 of the ANO2 gene is a risk factor for the development of combined proliferative diseases of the uterus in women with endometriosis (p = 0.05, рperm = 0.05, OR = 4.29). According to the data obtained in silico, the rs117585797 locus localized in the intron of the ANO2 gene affects the affinity of the regulatory DNA motif to the transcription factors Crx and Gsc.

Conclusions. Polymorphic locus rs117585797 of the ANO2 gene is associated with a high risk of the formation of combined proliferative diseases of the uterus in patients with endometriosis.

Introduction. Pregnancy planning is one of the leading areas in the population reproductive health care, in particular preventing and reducing the number of abortions.

Aim. To evaluate the uterine bleeding profile and other adverse events associated with the use of an etonogestrel subcutaneous contraceptive implant (Implanon NXT®). 

Materials and methods. We analysed medical records of female patients (n = 153) who used Implanon NXT® in the period from 2013 to 2023, records of adverse events, uterine bleeding, bleeding management techniques and reasons given by women for discontinuing the use of implants.

Results. The median duration of uterine bleeding episodes ranged from 7 to 13 days within a three-year period of use of Implanon NXT®. During the first 3 months, the proportion of women with prolonged bleeding was higher as compared to all other observation periods and gradually decreased during the first year of use of the drug from 41.2 to 15.8%. 40 patients with complaints of unsatisfactory uterine bleeding patterns required adjustment of drug dosages; 14 women continued to use Implanon NXT® after adjustment of drug dosages and repeated visits. 17.0% (n = 26) of patients required early removal of the implant. Due to pregnancy planning, the implant was removed early in 13% (n = 20) of patients. The most common adverse events included functional ovarian cysts, mastalgia, increased appetite, decreased libido, dizziness, acne; most of them were transient and did not require any management, and were not considered the reason for implant removal.

Conclusion. The number of uterine bleeding episodes in patients using the etonogestrel implant was comparable to the normal menstrual cycle. Some women had changes in the uterine bleeding patterns, such as amenorrhea, frequent and prolonged bleeding, which reduced the duration of use of this contraception method. At the same time, combined oral contraceptives were the most effective as compared to other drugs used in correction regimens.

Premature ovarian insufficiency (POI) directly affects the reproductive health of women all over the world. Currently, the study of this pathology is becoming an increasingly important issue due to the widespread prevalence of premature menopause in the female population. In addition to genetic predisposition, an important role in the development of premature menopause is played by the increasing number of ovarian surgeries due to the development of surgery, as well as radiation and chemotherapy for cancer, leading to premature depletion of the follicular reserve in the ovaries. An important component of treatment for women with POI is not only the management of undesirable symptoms of menopause, prevention of cardiovascular complications and fractures due to decreased bone mineral density, but also the possibility of realizing their reproductive function in the future. Therefore, other treatment options may be offered to women with POI in the absence of spontaneous pregnancy in the natural cycle. Oocyte donation may be recommended for such women, but this treatment option may not be suitable if the patient wishes to have genetically related children. In such a case, oogonal stem cell transplantation, ovarian cortex fragmentation or PRP therapy are possible. In women who will undergo chemotherapy and radiation therapy for cancer, reimplantation of ovarian cortical tissue is recommended to preserve fertility. If there is a risk of malignant cell transfer with this treatment modality, primordial follicles can be isolated from ovarian tissue, cultured and activated in vitro, fertilized, and transferred into the uterine cavity. IVF with surrogate embryo transfer may be an alternative choice for a woman with NPT, which allows her to realize her reproductive plans.

Introduction. A woman’s unwillingness to enter pregnancy due to social and somatic factors is associated with a high risk of its termination and concomitant complications. A personalized selection of a method of contraception is necessary, which best meets the needs of a woman, including in achieving non-contraceptive effects.

Aim. To evaluate the effectiveness, safety and compliance indicators when using a combined drug (3 mg of drospirenone + 20 mcg of ethinyl estradiol) in women in the early and mature reproductive period.

Materials and methods. A study involving 68 women (polycystic ovary syndrome (PCOS), n = 31, adenomyosis, n = 20, uterine fibroids, n = 7, a combination of 2 or more diagnoses) was conducted on the basis of the Scientific polyclinic Department of the V.I. Kulakov National Research Medical Center of the Ministry of Health of the Russian Federation) of reproductive age (18–34 years) who took a combined contraceptive drug for 6 months or more. The control of the results was carried out on the basis of monitoring in the form of a survey.

Results. The average time of use of the drug was 9 (Q₁–Q₃: 8–11) months. After 3 and 6 months, 77.8% (21/27) and 100% of the observed patients, respectively, noted a decrease in the severity of PMS symptoms. 91.7% (n = 11/12) of patients noted a subjective decrease in the severity of acne and/or hirsutism after 6 months. 91.3% (n = 21/23) of women with copious painful menstruation noted normalization of the bleeding profile (volume of menstrual blood loss). 95.6% (65 patients out of 68) noted 100% compliance in the use of the drug.

Conclusions. The drug Dimia has a favorable profile of clinical and pharmacological safety and efficacy, along with the complete reversibility of contraceptive action when actualizing the issue of the realization of reproductive function. The advantages of the drug are to achieve well-studied non-contraceptive effects, in which patients with PCOS, internal endometriosis and uterine fibroids are interested, in the form of relieving manifestations of PMS and reducing the severity of dysmenorrhea, as well as cosmetic skin imperfections (acne-type rashes, hirsutism). Thus, the drug can be recommended to women of reproductive age as a reliable contraceptive, as well as to achieve non-contraceptive effects.

Introduction. Uterine fibroids are the most common disease of the female reproductive system. If indicated, the main organpreserving method of treatment is myomectomy. However, according to many researchers, women who have undergone conservative myomectomy are at a higher risk of developing complications during pregnancy such as placenta previa, placental disorders, and uterine scar failure.

Aim. To identify the features of the course of pregnancy, childbirth and perinatal outcome in women with a uterine scar after conservative myomectomy who received pregravid preparation.

Materials and methods. A retrospective study included an analysis of 159 outpatient histories of women planning pregnancy after conservative myomectomy, including the birth histories of 109 pregnant women aged 29–40 years who delivered at the Perinatal Center of the Regional Clinical Hospital in Khanty-Mansiysk from 2011 to 2021 in order to study the characteristics of the course of pregnancy in women with a scar on the uterus after conservative myomectomy.

Results. When analyzing the data, the following statistically significant differences between the groups were revealed: the first trimester of pregnancy in women with a uterine scar compared with the control group was more often complicated by chorion presentation, threatened miscarriage, urinary tract infection and early toxicosis (p < 0.05); in the second trimester of pregnancy in group 1, there were more often threatening preterm labor and placental disorders (p < 0.05), the majority of women with a scar on the uterus after myomectomy (77.8%) were delivered by caesarean section, in contrast to the control group (9.7%) (p < 0.05).

Conclusion. The data we obtained on the course of pregnancy, childbirth and perinatal outcomes after myomectomy reflected the need and effectiveness of preconception preparation in this contingent of women.

Introduction. The high incidence of abnormal uterine bleeding (AUB) (over 30%) among patients of reproductive age is accompanied by the development of iron deficiency anaemia (IDA), which, in turn, is a social problem among global burden diseases throughout the world.

Aim. To evaluate the clinical efficacy and compliance with the Vojea complex regimen to prevent IDA in women with abnormal uterine bleeding.

Materials and methods. A multicentre clinical observational study was conducted in 6 health care facilities and women’s health clinics in Yekaterinburg and Moscow. The study included 52 patients with latent iron deficiency (serum ferritin level < 15 ng/ml) who were diagnosed with abnormal uterine bleeding (AUB) due to ovulatory dysfunction. All patients received Vojea complex at a dose of 1 tablet QD for 3 months while taking pharmaceutical therapy for AUB. The clinical and laboratory efficacy and medication compliance were assessed at 30, 60 and 90 days after initiation of treatment.

Results. Starting from the 1st month of treatment with the study complex, positive trends in clinical and laboratory findings were observed in both groups. After the three-month therapy with Vojea, ferritin levels increased 5.4 times (a clinically significant growth was reported after the two-month intake), plasma folate levels increased 4.9 times and red blood cell folate concentrations increased by 45%. The complex therapy helped reach and maintain the average red blood cell folate concentration >400 ng/ml (906 nmol/l). Side effects included isolated events of gastrointestinal dyspepsia and individual intolerance. All patients reported good and excellent tolerance of the complex, which ensured high compliance with the drug regimen (92%).

Conclusion. The three-month therapy with Vojea complex as part of the combination approach to the treatment of AUB in women with latent iron deficiency showed high clinical and laboratory efficacy, as well as good compliance with the drug regimen.

Urinary tract infections (UTIs) are the most common pathology among pregnant women and are associated with maternal and foetal complications. According to some authors, the incidence of UTIs increased 4 times in the last decades of the 20th century. Escherichia coli is the most predominant pathogen causing up to 80% of UTIs, Klebsiella is ranked second causing up to 8% of UTIs, and pathogenic staphylococcus and mixed microflora are ranked third. To diagnose UTIs, laboratory, physical and radiological diagnostic methods are applied. According to most authors, informative value yielded by lab tests is more than 90%. The prescription of antibacterial chemotherapy should be based on the results of urine culture and sensitivity testing. Before the test results are obtained, broad-spectrum antibacterial drugs (ABs) are usually prescribed. The most commonly used therapy regimens are third-generation cephalosporins with dose adjustments, as may be necessary, after sensitivity is determined. Some authors recommend to continue treatment with urinary tract antiseptics after AB therapy is completed. The impaired urine output should be restored before AB therapy is prescribed. This review presents an analysis of the literature that was found in the databases PubMed (the National Library of Medicine), The Cochrane Library, as well as in the research citation databases (Scopus, Web of Science). The etiological factors and features of the pathogenesis of UTIs in pregnant women, as well as diagnostic standards, are described. The current guidelines for the treatment and prevention of UTIs in pregnant women are considered and antibacterial therapy regimens with current dosage forms are presented. The benefits of using cefixime dispersible forms are described in detail.

The relevance of diseases accompanied by pathological secretions from the genital tract is undeniable. This is the leading reason for women to go to a gynecologist. Despite the routine nature of diseases associated with pathological secretions from the genital tract – bacterial vaginosis, aerobic vaginitis, candidiasis vulvovaginitis, mixed vaginitis – the issues of their diagnosis and treatment remain unresolved. In the treatment of vaginosis and vaginitis, we are increasingly faced with the formation of biofilms and, accordingly, a refractory response to treatment or a relapse of the disease. Research shows that refractory response and relapse of the disease are different conditions that require different therapeutic and preventive approaches, but in both cases their cause is often the formation of biofilm. Biofilm vaginitis is a problem of the new century. Biofilms are a difficult task in the treatment of bacterial infections and are one of the main causes of infection persistence. Currently, more than 80% of bacterial infections are caused by the formation of bacterial biofilms. Due to the biofilm, increased tolerance to antimicrobials is maintained for a number of reasons. The article discusses available methods of overcoming antibiotic resistance in bacterial vaginosis and vaginitis, the possibility of avoiding recurrence of the disease without causing significant harm to the vaginal microbiota. Special attention is paid to such an antiseptic as dequalinium chloride. Unlike antibiotics, dequalinium chloride is less toxic to lactobacilli and does not increase the risk of developing candidiasis vulvovaginitis. It works well both on the causes of bacterial vaginosis and on flora unrelated to bacterial vaginosis, which makes it a potentially effective drug for aerobic and mixed vaginitis.

Introduction. Urinary tract infections are the second most common type of bacterial infections worldwide. Treatment of patients with chronic (recurrent) cystitis remains challenging and requires an individual approach.

Aim. To assess the efficacy of combined therapy for exacerbation of chronic cystitis.

Materials and methods. A total of 65 women aged 18–48 years were enrolled in an open comparative bidirectional study. All participants received antibacterial therapy for exacerbation of chronic cystitis in accordance with the clinical guidelines for the treatment of cystitis in women. After the therapy was completed, the comparison group (35 patients) did not receive any drugs, whereas 30 patients from the treatment group were prescribed Cystenium II biologically active dietary supplement at a dose of 1 orally disintegrating tablet twice daily for 2 weeks. The examination included a measurement of the severity of complaints using the Acute Cystitis Symptom Score (ACSS), a clinical urinalysis and urine culture + sensitivity test. The efficacy of treatment was assessed following completion of antibiotic therapy and two weeks after the therapy.

Results. After finishing antibiotic treatment, no patient has achieved full recovery (improvement of urinalyses, no growth of pathogenic microbial flora, no complaints). Both groups showed statistically significant decreases in ACSS scores on Visit 2. Over the following two weeks, the symptoms in the comparison group did not change (p > 0.05), and in the treatment group the sum of scores continued to decrease, reaching an average of 3.62 ± 0.42, which is 5.5 times less than the baseline level and almost 3 times less than the sum of scores following completion of antibacterial therapy (p < 0.05). The positive changes in leukocyturia and bacteriuria were also more pronounced in the treatment group.

Conclusion. After completion of antibiotic therapy for relapse of chronic (recurrent) cystitis, the patients usually have residual effects that cannot be regarded as presentations of an active disease, but they disturb patients. A two-week course of pathogenetic therapy with a combination drug containing A-type Vaccinium macrocarpon proanthocyanidins, vitamin C and D-mannose to be received as the second step can increase the efficacy of treatment.

Increasing evidence indicates that adversities in utero and early childhood can have long-lasting effects on physiological and mental health not only in childhood but also in adulthood. Micronutrient deficiency, and in particular iron deficiency, is one of the most significant factors. Based on literature data, to determine the effect of iron deficiency in pregnant women on the neuropsychological development of infants, as well as to determine a cohort of pregnant women who need iron supplements. The search was conducted in MEDLINE (from PubMed), EMBASE (from OVID), Cochrane Library and ClinicalTrials.gov from 2010 to December 2023 without language restrictions. Data were extracted. Primary outcomes included iron deficiency, serum ferritin less than 15 μg/L in pregnant women, perinatal outcomes, and development of children in infancy. The data of serum ferritin in umbilical cord blood in newborns were compared with the serum ferritin of mothers. Data on iron supplementation and its effect on perinatal outcomes were assessed. Daily oral iron supplementation during pregnancy in women without IDA or ID reduces the incidence of iron deficiency anemia at the woman’s due date, reduces the incidence of iron deficiency in fullterm neonates, and reduces the incidence of morbidity in low-birth-weight infants. Iron supplementation during pregnancy and the postpartum period is a strategy for timely replenishment of ID and prevention of IDA to reduce cerebral iron deficiency in the fetus and newborn. The absence of side effects and high bioavailability, enhanced by ascorbic acid, allow us to recommend SunActive®Fe Bonoferlat as a daily supplement for pregnant and lactating women, according to WHO recommendations.

Gestational diabetes mellitus (GDM) is one of the most common diseases during pregnancy and increases risks of shortand long-term complications to both mothers and their children. Timely treatment of GDM significantly reduces the specified risks. The development of insulin resistance in pregnancy is associated with increased secretion of maternal and fetoplacental hormones (placental lactogen, estrogens and progesterone, cortisol and prolactin) with increasing gestational age. Thus, GDM develops during pregnancy in patients with insufficient pancreatic function due to progressive hyperglycemia and insulin resistance. Oral glucose tolerance test (OGTT) is the most commonly used test in world practice to establish a diagnosis. In Russia, OGTT is carried out at a gestational age of 24–28 weeks using 75 g of glucose and assessing venous plasma glycemia values at three points: before and 30, 60, and 120 minutes after drinking the glucose solution. However, refusal of patients to complete the test is one of the problems associated with the OGTT. Nausea and vomiting are the most commonly reason for not completing the OGTT. In some cases, patients cannot complete the test due to severe tolerance to a hyperosmolar glucose solution. In such cases, a number of solutions are discussed in the literature, one of which is the possible use of glucose-based compositions comprising flavouring additives, which are allowed for use during pregnancy to improve the tolerability of the OGTT. Improving the tolerability and compliance with the procedure is one of the most important conditions for successful and timely diagnosis.

Introduction. Impact of iron deficiency on pregnancy outcomes appears an urgent issue despite generally accepted standards of therapy. Iron needs increase during pregnancy and manifestations of its deficiency reduce QoL in pregnant women and worsen newborn health. Ferric carboxymaltose helps overcome iron deficiency in a quick and efficient manner from the 2^nd trimester.

Aim. To analyse the results of ferric carboxymaltose therapy of iron deficiency conditions in pregnant women.

Materials and methods. In this article we presented our own experience in providing ferric carboxymaltose therapy to treat iron deficiency in 152 pregnant women from the 2^nd trimester.

Results and discussion. Correction of anaemic syndrome was observed in more than 73.3% (up to 93.3% depending on the severity of primary anaemia) as early as the first week after administration of ferric carboxymaltose. Haemoglobin and ferritin levels at 3 week post-infusion were significantly higher than pre-infusion levels (p < 0.001). Improvement of haemoglobin levels at 6 weeks after initiation of therapy was achieved in all women with mild anaemia and in 98.5% of women with severe anaemia. No definite severe hypersensitivity reactions were detected. The overall incidence of side effects was 10.5%, with headache being the most frequently reported type (7.9%). All pregnancies resulted in a live birth without malformations; the rate of preterm birth was 9.5%.

Conclusion. Ferric carboxymaltose is an effective drug to quickly correct iron deficiency in pregnant women with a minimum number of adverse reactions and without negative impact on newborn health.

Introduction. Presently, preinduction and induction of labour is one of the approaches to improve maternal and perinatal outcomes. In this regard, the rate of labour induction is steadily increasing.

Aim. To determine the efficacy and safety of dinoprostone vaginal insert for cervical ripening and labor induction.

Materials and methods. The study included 81 women with a singleton pregnancy of 37 weeks. and more, cephalic presentation of the fetus, with the birth canal not ready and the presence of indications for induction of labor. Dinoprostone vaginal insert was placed for 24 hours or till onset of labor. After removal of the dinoprostone vaginal insert patient was undergoing cervical assessment by digital Bishop Score immediately. If labor didn’t start spontaneously, additional cervical ripening procedures may be considered or labor induction.

Result. The Bishop score increased on average by 2 points after cervical ripening with dinoprostone vaginal insert. 77.78% of patients went into labor before dinoprostone vaginal insert removing. 71.6% of the women had the vaginal birth. The cesarean section rate was 29.6%. Failed labor induction was observed in 2.47% cases. All the children were born alive. The average weight of newborns corresponded to the general population. No infectious complications or significant side effects were recorded in the study.

Conclusion. The use of dinoprostone vaginal insert is an effective method for cervical ripening (increase in Bishop score by an average of 2 points, p < 0.05) and labor induction (onset of labor before removal of SVT in 78% of cases) with a good safety profile (there were no serious adverse or side effects).

Introduction. Statistics show that about 13 to 15 in 100 pregnancies end in early miscarriage. This represents both a medical and social issue, as such outcome may be associated with maternal depression and anxiety, which inevitably affects women’s activities, performance efficiency and social inclusion. Restoration of normobiocenosis and lactobacilli pool dominance is one of the key challenges for women planning pregnancy.

Aim. To evaluate the effectiveness of probiotics at the pregravid preparation stage in women with a history of early pregnancy loss and bacterial vaginosis (BV).

Materials and methods. We selected 46 patients of reproductive age (24–39 years) who applied for early pregnancy loss, with complaints of vaginal discharge with an unpleasant odour, pruritus, burning, and dyspareunia, using databases of 5 medical clinics in Moscow, Tyumen and Stavropol. To treat bacterial vaginosis, two-stage therapy aimed at eliminating the increased number of anaerobic microorganisms and restoring the vaginal microbiocenosis was used.

Results. The effectiveness of combination therapy was assessed at 1 month. All patients on therapy experienced clinical improvement, normalization of vaginal microbiocenosis parameters based on Femoflor-16 test findings after the end of treatment. Physiological microbiocenosis of Lactobacillus spp. > 107 was detected in 43 (94.5%). In all patients, the average vaginal pH after two-stage therapy was 4.3 ± 0.7. The safety of Acilact Duo therapy was assessed in all study participants. No negative trends were recorded.

Conclusion. Superlimflife (Acilact Duo), acidophilus bacteria + vitamin-mineral protein-peptide complex, quickly restores optimal vaginal acidity (pH), stimulates the growth of lactobacilli, and reduces the incidence of BV relapses.

Introduction. Obstetric haemorrhage remains the number one cause of maternal death globally. Today, the frequency of hypotonic postpartum hemorrhage (PPH) reaches 80% in the obstetric hemorrhage profile.

Objective. To evaluate the long-term outcomes of uterine artery embolization (UAE) for the treatment of early hypotonic postpartum hemorrhage (PPH).

Material and methods. 136 patients were examined 2–8 years after UAE performed for early hypotonic postpartum hemorrhage. A survey was conducted for everyone. Ultrasound of the pelvic organs on the 5th–7th day of the menstrual cycle with an assessment of endometrial thickness, ovarian volume, number of antral follicles, and also Dopplerography were performed in 34 patients. Hormonal status was studied in 34 patients, that were examined in the first phase of the menstrual cycle, with an assessment of serum levels of anti-Mullerian hormone (AMH), follicle-stimulating (FSH) and luteinizing (LH) hormones.

Results. 19.1% (26/136) of patients planned pregnancy. Pregnancy occurred in 61.5% (16/26). Term delivery occurred in 38.5% (10/26), PPH recurrence occurred in 30% (3/10), placenta accretion was not detected. 23.1% (6/26) patients were pregnant at the time of the survey. Neither morphological nor functional changes of the ovaries were detected in patients 2–8 years after UAE.

Conclusions. Uterine artery embolization is a safe method of therapy of early hypotonic postpartum hemorrhage.

Introduction. Chronic kidney disease (CKD) in pregnancy poses certain risks of both gestational complications and adverse perinatal outcomes, which increase with the decline of renal function.

Aim to access pregnancy outcomes in patients who underwent nephrotransplantation.

Materials and methods. Retrospective study of pregnant women who gave birth at Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology in the period from 2005 to 2021: 102 pregnancies in 97 patients were analyzed: five recipients had two successful pregnancies.

Results. The average age of pregnant women was 31 ± 4.03 years. In equal proportions, patients underwent related or cadaveric kidney transplantation – 52% (n = 53) and 48% (n = 49) of cases, respectively. The average delivery time was 35.5 ± 2.7 weeks. The average weight of newborns was 2545 ± 655 grams. Premature birth (PB) occurred in 47.1%, the average period of birth was 33.4 ± 2.87 weeks, of which early birth (<32 weeks) was 22.5%. The average period of pregnancy after transplantation was 5 ± 3.31 (1–18) years, this period was not associated with obstetric complications or deterioration of graft function. A significant increase in the following parameters was noted during pregnancy: serum creatinine level (p = 0.006), proteinuria (p = 0.003). The glomerular filtration rate also decreased significantly by the end of pregnancy (p = 0.011). Preeclampsia was the leading cause of decreased graft function during pregnancy (32.4%).

Conclusions. In general, pregnancy outcomes after nephrotransplantation are favorable, but there is an increased risk of preeclampsia, preterm birth, including operative delivery, urinary tract infection and anemia.

Female hypogonadism, as a result of natural or induced shutdown of ovarian function, is a multifaceted problem. A variety of clinical manifestations motivates women to consult doctors of various specialties and solve health problems without focusing on the underlying cause. The financial and economic component of the problem due to a violation of the quality of life of women and a sharp decrease in their ability to work requires the inclusion of the most effective method of treatment. There are a number of MHT regimens and combinations that allow differentiated selection of the drug, taking into account the woman’s health status and her concomitant diseases. The range of biological effects and risks depends on the type and dose of the hormonal drug, duration of use, route of administration, and time of initiation of MHT. As a component of MHT, bioidentical estrogens and gestagens are used, different in their vector of influence, pharmacodynamic and pharmacokinetic profile. The article is devoted to cyclic biphasic MHT using a combination of 17β-estradiol (2 mg) and levonorgestrel (0.15 mg). The experience of using the drug will be presented in the form of a review and our own clinical cases from everyday medical practice.

Increasing number of anovulatory cycles in the perimenopause, leading to relative hyperestrogenism, and persistent hypoestrogenism in postmenopause, increase the proliferative activity and change the endometrium morphology. That is associated with higher rates of intrauterine pathology. The prevalence of atypical hyperplasia and endometrial cancer in women of the peri- and postmenopausal periods reaches its maximum values. Therefore, one of the most important concepts of patient’s management is to exclude malignant and precancerous endometrial pathology. Significant hormonal changes leads to important confounders in diagnostic and therapeutic algorithms. It could lead to both hypo- and hyperdiagnosis. The review analyzes the main causes of abnormal uterine bleeding, the features of their clinical manifestation, taking into account probable iatrogenic causes, extrauterus and extragenital sources of spotting. This article reviews the principles of ultrasound examination, considering menstrual cycle phase, duration of menopause, hormone treatment, as well as indications for endometrial biopsy, in case of inconsistency of clinical presentation, ultrasound results, menopausal status and iatrogenic factors. We describe the relevant principles of medical correction, wait-and-see tactics and surgical treatment of abnormal uterine bleeding, both in the presence of organic pathology of the endometrium, and in its absence.

Introduction. Genitourinary syndrome of menopause (GSM) is a complex of symptoms resulting from changes to the vulvovaginal region, urethra and bladder due to estrogen and other sex steroid deficiency. Vulvovaginal atrophy is one of its manifestations, and vaginal dryness, dyspareunia, burning and itching are the most common symptoms.

Aim. To analyse 20 clinical cases of the use of innovative laser procedures combined with phytoestrogens in patients with vulvovaginal atrophy as a symptom of GSM vs the standard systemic protocol for menopausal hormone therapy.

Materials and methods. A clinical case-control study was conducted among 20 postmenopausal women. The age of the subjects ranged from 50 to 65 years with amenorrhea for at least 1 year, a follicle-stimulating hormone level of >30 IU/L and various presentations of GSM. The women were divided into two groups: group 1 (n = 10) received laser therapy combined with phytoestrogens, group 2 (n = 10) received systemic menopausal hormonal therapy. To evaluate the results, a survey with a specialized international vulvovaginal symptom questionnaire (VSQ) was carried out to determine the vaginal health index scores before and after treatment.

Results. After treatment, both groups showed significant improvement in the form of the reduction or disappearance of symptoms of vulvovaginal atrophy. The prescription of phytoestrogens provided an additional positive effect after 3 sessions of carbon dioxide laser treatment.

Conclusion. The carbon dioxide laser exposure resulted in the reduction or disappearance of the local symptoms of climacteric syndrome in the form of GSM, and the use of phytoestrogens as part of Mense BAA supplemented the treatment of psychoemotional and neurovegetative changes, which allowed us to make a conclusion about the feasibility, high efficiency and safety of the complex treatment for women, who do not wish to take menopausal hormone therapy and (or) have absolute contraindications. However, further research on the laser technologies and other non-hormonal techniques to treat GSM is required to carry out a more complete and accurate assessment of the effectiveness and safety of these treatments.