Introduction. A woman’s reproductive system is embedded in a complex structure of neuro-endocrine and metabolic relationships. Melatonin is considered one of the key factors of paracrine regulation, participates in the regulation of basal metabolism and reproduction through selective interaction with natural ligands, membrane and cellular receptors.

Аim. To summarize modern scientifically proven information about the effect of melatonin on the body and the female reproductive system.

Materials and methods. The following databases were used to prepare the review: PubMed, Medline, eLIBRARY.RU, cyberleninka.ru, as well as the websites of Springer and Elsevier publishers.

Results. During the day, the body produces about 30 micrograms of melatonin, of which 80% is synthesized at night. It was found that there is a system of clock genes (Period and Timeless) and proteins encoded by them, depending on the duration of the light and dark period of the day, determining chronobiological changes in the entire organism. The main synthesis of melatonin does not have photoperiodicity and is constantly carried out in all peripheral tissues of the body. Melatonin has many isoforms, which ensures the selectivity of its interaction with natural ligands, differences in the regulation of receptor expression, both in individual tissues and in the process of development and aging of the body.

Currently known genes determining the pathways of melatonin synthesis are AA-NAT (arylalkylamine-N-acetyltransferase), DDC (AADC), ASMT, MTNR1A, MTNR1 (MT receptors 1A and 1B) and GPR50 (G protein-coupled receptor 50) encoding both synthesizing enzymes and the three main melatonin receptors. Genetic mutations of melatonin synthesis lead to a decrease in its level and activate the enzyme 5-hydroxytryptophanhydroxylase, which results in a decrease in the synthesis of serotonin and dopamine. The ratio and number of neurotransmitters determine the neuropsychic state of a person and affect all axes regulating metabolism and reproduction.

Conclusion. In the reproductive system, melatonin is involved in the development and aging of the reproductive system, the pathogenesis of endometriosis, polycystic ovary syndrome, infertility, folliculogenesis, fertilization, implantation, gestational diabetes mellitus, obesity, the development of premenstrual and menopausal syndrome.

Introduction. Postcoital cystitis (PCC) is not placed in a separate form of the disease, but rather considered as an isolated case of chronic (recurrent) cystitis; there are no sound recommendations for its treatment.

Aim. To determine the comparative efficacy of Furazidin and the combination of D-mannose and cranberry extract (Cystenium II supplement) in preventing recurrent PCC.

Materials and methods. We observed 60 female patients with chronic recurrent cystitis, aged 18 to 50 years (mean age 31.2 ± 4.9 years). All female patients had at least two recurrences within the previous 6 months, experiencing at least every second episode of cystitis occurring within 2–24 hours after sexual intercourse. The patients were randomized into two groups of 30 patients each: a treatment group (TG) and a comparator group (CG). The TG patients received Cystenium II at a dose of one lozenge 30–120 minutes before sexual intercourse and 8–12 hours after intercourse. In the CG, patients received Furazidin at a dose of 50 mg 2 hours before or within 2 hours after sexual intercourse.

Results. Both groups showed improvements during the therapy, but the severity of changes varied considerably. Upon completion of the treatment, the number of recurrences in the Cystenium Group was 9.5 times lower than in the Furazidin Group, while the number of sexual intercourses in the TG, in contrast, increased 1.5 times as compared to the CG. The proportion of sexual intercourses which resulted in PCC significantly reduced in both groups: from 63.6% to 2.8% in the TG and from 62.8% to 38% in the CG. The difference between the groups was statistically significant.

Conclusion. The results of this study clearly showed that Cystenium II supplement taken twice daily was more effective and better tolerated than Furazidin at a single paracoital dose of 50 mg to prevent recurrent PCC.

Introduction. Evaluation of the effect of dysprolactinemia during lactation in women on the course of extrasystolic arrhythmia seems important for cardiology and obstetrics. Proarrhythmic effect of prolactin was noted in studies on mice. However, the effect of prolactin on cardiac repolarization, as well as thyroid function in women during lactation, is currently insufficiently studied.

Aim. To study the effect of dysprolactinemia during lactation in women on thyroid hormones, electrocardiographic, hemodynamic parameters of the heart and the number of extrasystoles.

Materials and methods. The study included 33 lactating women with normal prolactin levels and euthyroidism, 34 with hyperprolactinemia and subclinical hypothyroidism, 28 with hyperprolactinemia and overt hypothyroidism, 32 with hypoprolactinemia and subclinical thyrotoxicosis, and 25 with hypoprolactinemia and overt thyrotoxicosis. The study methods included: electrocardiography (ECG) recording, electrophysiological study (EPS) of the heart, echocardiography (EchoCG), 24-hour Holter ECG monitoring (HM ECG), determination of prolactin, thyroid-stimulating hormone (TSH), and free thyroxine (free T4).

Results. Correlation analysis showed that during lactation, an increase and decrease in prolactin levels are accompanied by an increase in the number of extrasystoles (r = 0.975, p < 0.001; r = 0.973, p < 0.001). Regression analysis revealed that during lactation, an increase in prolactin levels over 57.19 ng/ml is accompanied by an increase in the number of extrasystoles. The sensitivity of the method was 66.7%, specificity – 92.9%, AUC = 0.837.

Conclusions. During lactation, women were found to have a relationship between prolactin, TSH and the number of extrasystoles. An increase and decrease in prolactin levels are accompanied by an increase in the number of extrasystoles. Hyperprolactinemia and hypoprolactinemia affect the clinical course of extrasystole and the rate of excitation conduction through the conduction structures of the heart.

Endometriosis is currently regarded as one of the most prevalent pathologies of the female reproductive system, exerting a significant impact on women’s quality of life and reproductive health, and frequently serving as a major cause of female infertility. Despite extensive research, the etiology of the disease remains incompletely understood. Primary umbilical ring endometriosis represents an exceptionally rare variant of extragenital endometriosis, with an estimated prevalence of approximately 0.5–1% in the female population. The clinical presentation typically includes a painful nodular mass in the umbilical region and cyclic pain syndrome correlated with menstrual phases. Due to its rarity, this pathology may present diagnostic challenges and lead to delays in management. Furthermore, its manifestations may mimic other umbilical masses, thereby necessitating thorough differential diagnosis. Histopathological examination remains the gold standard for definitive diagnosis, allowing for reliable identification of endometrial tissue. The treatment of choice is surgical excision, with the extent of resection determined by individual patient characteristics, medical history, clinical findings, and future reproductive plans. In cases where surgical intervention is contraindicated or not feasible, medical management may be employed to control symptoms, most commonly continuous progestin therapy. Herein, we present a clinical case of a rare coexistence of primary umbilical ring endometriosis with uterine endometriosis (adenomyosis) in a reproductive-age patient, underscoring the diagnostic complexity of this condition and highlighting the importance of a personalized approach to its management.

Introduction. Patients with infertility often require the help of assisted reproductive technologies to solve their problem. Two thirds of failures in ART cycles are associated with insufficient endometrial receptivity.

Aim. To evaluate the effectiveness of using estradiol valerate 2 mg (Progynova®) in women with thin endometrium in ART cycles.

Materials and methods. The study included patients with a thin endometrium ≤ 7.0 mm according to the ultrasound examination (US) of the pelvic organs on the 10–14th day of the menstrual cycle (peak of luteinizing hormone (LH) in the blood or on the day of progesterone administration in the hormone replacement therapy cycle). Patients with a thin endometrium (n = 74) were divided into two groups: the first group (n = 43) – patients with chronic endometritis established by histological examination and immunohistochemistry (IHC); group 2 (n=31) – patients with a thin endometrium without chronic endometritis. All patients received estradiol valerate according to one of the following regimens: 4 mg estradiol valerate in a natural cycle from the moment the dominant follicle reached a diameter of 13 mm or 4 mg estradiol valerate from day 3 of the menstrual cycle.

Results. Administration of estradiol valerate statistically significantly increased the endometrial thickness in women with thin endometrium (p < 0.05). The increase in endometrial thickness in patients of group 1 averaged 1.9279 mm, in patients of group 2 – 2.09 mm. The average endometrial thickness before treatment with estradiol valerate was 6.315 (4.7; 7.0) mm, after treatment – 8.311 (5.6; 11.0). 70 of 74 (94.6%) patients had an endometrial thickness of > 7 mm. Pregnancy in an IVF or PE cycle occurred in 44 patients with thin endometrium (62.5%) after treatment with estradiol valerate.

Conclusions. The use of estradiol valerate in IVF and ET cycles increases the thickness of the endometrium and increases the frequency of pregnancy and live birth in patients with a thin endometrium.

Endometriosis is a chronic estrogen-dependent disease characterized by ectopic implantation of functional tissue lining the uterus (endometrial glands and stroma) outside its cavity. The term “endometriosis” comes from the Greek words endo – “inside”, metra – “uterus”, and the suffix osis – “disease”. Most often, endometrial tissue is found in the ovaries, which leads to the formation of “chocolate” cysts. Endometrioid heterotopias can be found in the fallopian tubes, uterosacral ligaments, gastrointestinal tract and, less commonly, in the pleura, pericardium or central nervous system. Endometriosis is a common gynecological disease (10% of women of reproductive age) and is accompanied by the development of dyspareunia, dysmenorrhea and infertility. The complexity of the molecular and cellular mechanisms of the disease development makes it difficult to fully understand it and develop effective therapeutic strategies. Although hormones are recommended as first-line therapy, their efficacy and side effects vary significantly in the populations studied. Modern hormonal drugs correct the activity of endometriosis mainly by suppressing the production of estrogens and their systemic effects. The effect of hormonal substances directly on endometrioid heterotopias has not yet been fully established. Data on the activation of transcriptional coregulators, the expression of hormonal receptors in pathological foci and their ability to respond to appropriate stimuli are contradictory and form differentiated therapeutic outcomes in patients. Determining the optimally effective therapeutic tactics remains the main goal in endometriosis research. Gonadotropin-releasing hormone agonists (GnRH agonists) are widely used to treat hormone-dependent gynecological diseases. The multifaceted effect of GnRH agonists on the pathogenetic links of endometriosis (reduced estrogen synthesis, suppression of abnormal proliferation, active neoangiogenesis and inflammation) allows to stop the progression of the disease and quickly block the pain symptom, and the long-term preservation of the effect after the end of treatment helps to reduce the frequency of recurrence of endometrioid lesions. A sufficient evidence base has been accumulated, allowing for the confident use of GnRH agonist therapy to correct the activity of endometriosis. However, periodic updating of this database is a mandatory practice, since the results of new studies may change the conclusions of previous ones. This article presents a review of current data on the efficacy of buserelin acetate (Buserelin-depo, 3.75 mg).

There is a significant increase in the incidence of nonspecific vaginitis and cervicitis caused by non-classical pathogens in current gynecological practice. This trend is accompanied by an expansion of the infectious agent spectrum, including gram-negative aerobes, non-clostridial anaerobes, and mycoplasmas, which results in the increased incidence of mixed diseases. Despite the diversity of therapeutic strategies, particular attention of researchers was directed to the development of effective treatments for mixed nonspecific vaginitis and cervicitis, due to insufficient efficacy of the current treatment regimens contributing to the recurrence of the pathological process. Microbial associations produce virulence factors that promote infectivity of each microorganism and improve their resistance to external effects, including drug therapy. This article presents the results of our study demonstrating a significant increase in the prevalence of nonspecific vaginal infections among women in the Krasnodar Krai. We have analysed clinical case reports and features of the therapy of mixed nonspecific vaginitis and cervicitis with due account for the sensitivity of vaginal microbiota to etiotropic therapy. Clinical cases include the use of modern etiotropic therapy aimed at the rational elimination of pathogens using mixed-activity drugs, preferably bacteriostatic, which are best known for their minimal effect on the normal vaginal microbiota and high patient compliance. The active introduction of drugs with proven efficacy and safety into clinical practice helps improve the patients' ability to adhere to prescribed therapies, reduce the risk of non-specific vaginal infection recurrence, and minimize complications involving reproductive disorders. The experience with Vilpramycin SAR® has demonstrated its high clinical efficacy, low resistance of microorganisms and high tolerability, owing to its orodispersible dosage form, which makes it a universal remedy for the treatment of mixed infections in the female lower genital tract.

The descriptive review presents modern strategies for the prevention of sexually transmitted infections (STIs) in the context of increasing resistance of microorganisms to antibiotics at present. WHO materials, recommendations of leading professional communities, and clinical studies were used for the analysis. The main measures to combat STIs in the world and in Russia include organizational activities, raising public awareness, and increasing the use of personal protective equipment. The article presents established facts about the resistance of STI pathogens to antimicrobial drugs and measures to limit the spread of resistant microorganisms. In the context of restrictions associated with antibiotic resistance for treatment, the issue of STI prevention is especially acute. Approaches to primary and secondary prevention of STIs are described. The main attention is paid to post-exposure prophylaxis (doxycycline, antimicrobial agents), information is provided on their effectiveness and limitations. The rationale for the use of Miramistin® for post-exposure prophylaxis is given. Conducted studies of the antimicrobial activity and clinical effectiveness of Miramistin® convince us that this drug has high potential in the fight against STIs, both bacterial and viral.

Introduction. An important step in the development of the theory of netotic transformation of leukocytes was the emergence of facts about the ability to extrude DNA not only in neutrophils, but also in other cells of the innate immune system.

Aim. To quantitatively assess the release of intracellular DNA (extracellular traps) for neutrophils, eosinophils and basophils of peripheral blood at different stages of gestation during normal pregnancy and in pregnant women with placental disorders associated with thrombophilia.

Materials and methods. The study included 85 pregnant women aged 19 to 42 years (45 pregnant women with thrombophilia (protein S deficiency and protein C deficiency) and placental disorders (Group 1), 40 women with normal pregnancy (Group 2). Group 3 (control) consisted of 20 non-pregnant women. In dynamics (I, II and III trimesters), an analysis of the quantitative and qualitative composition of the peripheral blood leukocyte population was performed, the level of DNA traps for neutrophils (NETs), eosinophils (EETs) and basophils (BETs) was assessed.

Results. In pregnant women in Group 1, during the second and third trimesters, the total number of leukocytes increased in relation to the initial data by 1.4 and 1.8 times, respectively, mainly due to an increase in the neutrophil population. The absolute number of eosinophils by the second trimester increased by 25%, and by the third – by 50%. The level of basophils in the peripheral blood by the second trimester increased 2-fold, maintaining these values at 35–37 weeks.

Conclusions. Further studies of the features of the formation of NETs, EETs and BETs and the identification of correlations between the level of ethosis and the clinical picture are needed, which will contribute to understanding the mechanism of pathological tissue damage and the progression of immunothrombosis, and will determine potential therapeutic targets for the development of promising therapeutic strategies.

Primary hyperparathyroidism (PHPT) is a rare endocrine disease, but it is the most common cause of hypercalcemia in non-pregnant women. In the scientific literature and clinical practice of an obstetrician-gynecologist and endocrinologist, planning, pregnancy and the birth of a healthy child in a woman with PHPT are presented in rare cases and undoubtedly arouse scientific and practical interest. A clinical case from the practice of a gynecologist and endocrinologist of a patient who became pregnant against the background of hyperparathyroidism is presented. The history and clinical picture of the disease, the data of hormonal and instrumental methods of examination, and the treatment are described. A patient with hyperparathyroidism and pregnancy was observed by an endocrinologist and a gynecologist throughout the entire gestational period, the necessary laboratory and instrumental methods of examination, constant monitoring of the clinical condition, and correction of drug therapy were carried out in dynamics. Currently, there is no consensus on the treatment of PHPT during pregnancy, and an individualized approach to therapy is required for pregnant women with PHPT. The management of pregnancy in women with PHPT depends on the severity of symptoms, gestational age at the time of manifestation, age, concomitant diseases and complications. In women of childbearing potential with PHPT detected before pregnancy, it is essential to provide preconception counseling and radical surgery based on the underlying etiology of PHPT before conception. For optimal maternal and fetal outcomes, a multidisciplinary approach is recommended with close collaboration between an endocrinologist, obstetrician, and pediatrician. Special cases (parathyroid cancer, syndromic forms) should be accompanied by an individual treatment plan in a specialized endocrine department. The management of PHPT during pregnancy should be based on gestational age, severity of hypercalcemia, and the balance of risk and benefit to the mother and fetus.

Introduction. The choice of medications for the treatment of iron deficiency anemia (IDA) in a pregnant woman is based on therapeutic efficacy and safety, forming a high patient compliance to long-term therapy

Aim. To evaluate the therapeutic efficacy, clinical tolerance and safety of using a medication based on iron sulfate and ascorbic acid in the treatment of iron deficiency anemia in pregnant women

Materials and methods. The study included 155 women diagnosed with IDA: twenty-four pregnant women in the first trimester (group 1), forty-five pregnant women in the second trimester (group 2), and eighty-six patients in the third trimester (group 3).

Antianemic therapy was administered to all pregnant women with Sorbifer Durules (iron sulfate 100 mg of iron sulfate and 60 mg of ascorbic acid) 100 mg two times per day for a long time until normalization of hematological parameters and improvement of the clinical symptoms with a transition to 100 mg per day until delivery for the purpose of preventing IDA.

Results. The gestational age included in the observation were 10.6 (1.6), 20.2 (2.6) and 30.9 (2.6) weeks. When analyzing hematological parameters changes in 1 month after the start of therapy, there was positive dynamic which revealed the increase in hemoglobin levels by 5.4 g/l and 7.2 g/l in patients of groups 1 and 2, respectively (p < 0.05), with a continuing tendency to increase at 37.1 ± 1.1 weeks by 10.3 g/l and 9.7 g/l (p < 0.05). It was noted that there was a decrease in the number of patients with IDA in group 1to 20.8%, which is 1.5 and 2.1 times lower compared to groups 2 and 3 (p = 0.03). Adverse reactions when taking Sorbifer Durules were registered in 3.2% of pregnant women, there were no clinical situations requiring discontinuation of the medication.

Conclusion. The combination of iron sulfate and ascorbic acid in a prolonged release formula (Sorbifer Durules) is a well-tolerated and effective treatment option of IDA at any stage of pregnancy.

Chlamydia infection is one of the most common sexually transmitted infections. It is caused by the obligate intracellular bacterium Chlamydia trachomatis, which affects both men and women, but in most cases it is asymptomatic, making timely diagnosis and treatment difficult. The clinical manifestations of chlamydia infection are caused by the pathogen’s tropism for the cylindrical epithelium and its ability to infect the mucous membranes of the urethra, cervical canal, fallopian tubes, endometrium, rectum, oropharynx, and conjunctiva. In women, this condition often leads to cervicitis and urethritis, as well as inflammatory pelvic diseases that can result in tubal-peritoneal infertility. Chlamydia infection is particularly dangerous during pregnancy. It increases the risk of premature birth, amniotic rupture, intrauterine infection, and underweight children. The above substantiates the importance of diagnosing and timely treating chlamydia infection during pregnancy, and the choice of an effective and safe drug during gestation is an urgent issue. The article presents clinical cases of successful use of the antibacterial drug Josafen in obstetric practice in patients with chlamydia infection during pregnancy. This drug has proven to be safe during gestation, well-tolerated, and effective against the pathogen.

Conclusion. Josafen showed high activity against Chlamydia trachomatis, which makes it an effective treatment for urogenital chlamydia during pregnancy, as evidenced by the absence of complications in the anteand postnatal periods.

Folates (vitamin B9) are essential for one-carbon metabolism, nucleotide synthesis, and DNA methylation, playing a central role in embryonic and placental development. Folate deficiency is associated with neural tube defects, pregnancy complications, and mental health disorders, including perinatal depression. Several studies have shown that inadequate dietary intake of folate may disrupt this pathway and reduce DNA methylation, a major epigenetic factor influencing gene activities. DNA methylation during fetal development plays a critical role in regulating fundamental biological processes such as imprinting, X-chromosome inactivation, differentiation, and pluripotency. Objective – to summarize recent evidence (2023–2025) on the role of folates during pregnancy, with a focus on epigenetic mechanisms, the Developmental Origins of Health and Disease (DOHaD) concept, offspring cognitive outcomes, and opportunities for personalized nutritional support. The review highlights experimental and clinical findings on the impact of folates on epigenetic regulation, placental function, and longterm offspring health. Supplementation is shown to reduce the risk of neural tube defects, preeclampsia, and intrauterine growth restriction. Associations between maternal folate status, child cognitive development, and perinatal depression are discussed. Special attention is given to monitoring biomarkers (red blood cell folate, homocysteine, vitamin B12) and genetic predictors (MTHFR polymorphisms) to justify a personalized approach. Adequate folate intake in the periconceptional period and throughout pregnancy is crucial for preventing obstetric and psychiatric complications and shaping favorable long-term offspring outcomes. Personalized supplementation strategies based on biomarkers and genetic data represent a promising avenue for clinical practice.

Introduction. Rheumatoid arthritis (RA) is a disease characterized by epidemiological sexual dimorphism (affecting predominantly women). For many of women, the onset of the disease occurs around menopause, making it important to analyze the relationship between RA and estrogen deficiency.

Aim. To study the clinical features of RA in women depending on the age of menopause.

Materials and methods. A retrospective study of 246 postmenopausal women with an established diagnosis of RA in postmenopause was conducted. Patients were divided into subgroups depending on the age of menopause: early (before 45 years, n = 71) and timely menopause (≥45 years, n = 175), a comparison of quantitative and qualitative indicators was made between the subgroups. In the subgroup with early menopause, a division was made depending on the natural (n = 46) or surgical cause (n = 25) of its onset, followed by an intergroup comparison.

Results. Women with early menopause were comparable with the group with timely onset of menopause in terms of the main clinical and laboratory parameters characterizing RA. Women with natural early menopause, compared with early surgical menopause, were characterized by significantly higher levels of C-reactive protein (6.45 [3.35; 22.33] mg/L vs. 3.20 [1.70; 10.90] mg/L; p = 0.03) and ESR (28.50 [16.50; 58.00] mm/h vs. 16.00 [11.00; 29.00] mm/h; p = 0.021), as well as trends toward higher DAS28 activity (p = 0.06), more swollen joints (4.50 [2.25; 8.00] vs. 3.00 [1.00; 6.00]; p = 0.089), and a higher incidence of erosive arthritis (78.3% vs. 56.0%; p = 0.077). On the other hand, early surgical menopause was associated with a higher incidence of cardiovascular disease and hypertension (72.0% versus 34.8%; p = 0.003), as well as higher fasting glucose levels (5.49 [4.88; 5.79] mmol/l versus 5.00 [4.79; 5.40] mmol/l; p = 0.03) compared to women with early natural menopause.

Conclusions. The age of menopause in our sample did not have a significant effect on the clinical course of RA, but women with early natural menopause had higher rates reflecting the inflammatory activity of RA, and women with early surgical menopause more often suffered from metabolic disorders.

Vulvovaginal atrophy (VVA) is considered to be a consequence of estrogen-deficient conditions and disorders of the vaginal microbiocenosis. The disease is most often found in periand postmenopausal age. A large number of estrogen receptors are found in the mucous membrane of the vagina, vulva, urethra, bladder, muscles and ligaments of the pelvis; that is why against the background of hypoestrogenia, the tissues become atrophic, their extensibility and strength decrease. Symptoms of VVA are common, but underestimated by women and gynecologists worldwide due to the psychosocial determinant – the perception of VA symptoms as manifestations of inevitable aging process, not worthy of treatment. Most patients do not expect any medical help from a gynecologist, perceiving vaginal discomfort, such as vaginal dryness, dyspareunia, and vaginal itching as age-related and natural manifestations of aging. That is why during the routine examination of perimenopausal and postmenopausal patients, gynecologists should regularly inquire about the symptoms of genitourinary menopausal syndrome. Timely diagnosis and treatment can halt the progression of GUMS. Therapy with local estrogen forms is the gold standard for the treatment of GUMS; particularly, intravaginal estriol has no age restrictions, unlike menopausal hormone therapy, and can be prescribed to women over 60 years of age. Local estrogens relieve itching, and vaginal dryness, normalize vaginal microflora and low vaginal pH, helping to reduce the incidence of recurrent urogenital nonspecific infections in postmenopausal women. The article will present modern international and domestic guidelines for timely detection of genitourinary menopausal syndrome and its relevant safe treatment with topical use of ultra-low doses of estriol and acidophilic lactobacilli.