Introduction. This article discusses modern therapeutic problems and previously published data on iron deficiency correction using ferrous sulfate (FS) and ferric carboxymaltose (FCM). The data obtained are analyzed and compared based on the age of the study, the clinical entity of anemia, sample size, types of research and dosages of the drugs used.
Aim. To conduct a systematic comparative analysis of the efficacy and safety of FS versus FCM for the correction of iron deficiency in various nosological forms of anemia.
Materials and methods. A systematic literature search was performed in the PubMed database for the period from January 1, 2008, to February 1, 2026. Inclusion criteria were direct comparative studies or meta-analyses comparing FCM with FS in adult patients with anemia. Primary outcomes were efficacy (increase in hemoglobin level) and safety (incidence of adverse events).
Results. Fourteen publications were included in the analysis. A key data discrepancy was identified: all four meta-analyses indicated a statistically significant superiority of FS over FCM in both efficacy (e.g., greater Hb increase by 4.9–8.5 g/L; p < 0.05) and safety profile. However, in three direct comparative randomized controlled trials meeting the criteria, the results for efficacy and tolerability were comparable. The vast majority of studies (19 mentions) were focused not on classic iron deficiency anemia (IDA), but on anemia of chronic disease (primarily in pregnant women), while true IDA was represented in only two works.
Conclusion. The existing evidence demonstrates a significant discrepancy between the results of meta-analyses and direct comparisons of FS and FCM. The available data do not allow for a definitive conclusion about the superiority of one drug over the other, especially for the population with classic IDA, and highlight the need for targeted comparative studies in this area.

Introduction. Asherman’s syndrome (AS) is an acquired condition characterized by the formation of intrauterine adhesions, leading to impaired reproductive function. The high recurrence rate following hysteroscopic adhesiolysis necessitates the development of effective methods for secondary prevention.
Aim. To evaluate the clinical efficacy of a combined method, comprising hysteroscopic adhesiolysis followed by a course of non-contact ultrasonic cavitation (NUC) with solutions of an antiseptic and an enzymatic agent, in comparison with standard surgical treatment.
Materials and methods. A prospective comparative study was conducted, involving 47 reproductive-age patients with verified AS. The main group (n = 22) received a course of 15 NUC procedures with sequential application of 0.05% chlorhexidine digluconate solution and Longidaza (3000 IU) after hysteroscopy. The control group (n = 25) received only standard surgical treatment. Efficacy was assessed after 3 months via control hysteroscopy with evaluation of the uterine cavity status according to the modified American Fertility Society (AFS) classification, ultrasound examination, and assessment of menstrual function using a pictogram.
Results. In Group 1, complete restoration of the normal uterine cavity (AFS score 0) was achieved in 19 patients (86.4%) vs 13 patients (52.0%) in Group 2. The patients showed an increase in endometrial thickness during the proliferative phase (6.8 ± 0.9 mm in Group 1 and 5.1 ± 1.2 mm in Group 2). The recurrence rate of adhesions was 13.6% in Group 1 vs 48.0% in Group 2.
Conclusion. The proposed comprehensive treatment regimen utilizing NUC demonstrates significant superiority over isolated hysteroscopic adhesiolysis in preventing AS recurrence, promoting effective restoration of the morpho-functional state of the endometrium.

Currently, pelvic inflammatory diseases (PID) are one of the most common gynecological problems in the world, with more than 448 million new cases reported annually (up to 60% of the total number of gynecological diseases). The peak of the disease (4–12%) occurs at the age of 17–28, which is associated with sexual activity and a low frequency of using barrier methods of contraception. PID represent a serious health problem that has a significant impact on the health of women of reproductive age. This group of diseases occupies a leading position in the structure of gynecological morbidity and is the most common cause of hospitalization in women. The aim of this article is to provide a comprehensive review of the issue of PID in women of reproductive age from an interdisciplinary perspective. This article presents a clinical case of a patient diagnosed with PID and bilateral salpingoophoritis. The patient had previously received antibiotic therapy in the hospital, where she sought medical help due to acute symptoms (pulling pain in the lower abdomen, yellow vaginal discharge). The symptoms appeared after unprotected sex. As during hospital treatment, potential etiological factors contributing to the onset of PID in the patient such as exposure to chlamydia and mycoplasma were not taken into account, empirical therapy with doxycycline monohydrate (100 mg twice daily for 14 days) was prescribed at patient’s follow-up visit before the results from the PCR test were available. By the end of the second day of prescribed therapy, the patient noted that her well-being was improved: discomfort and pulling pain in the lower abdomen disappeared. Periods were regular, pain-free, with moderate menstrual flow. The treatment efficacy was evaluated 21 days after completion of a 14-day course of Doxycycline EXPRESS, which showed that the patient achieved clinical and microbiological cure.

Overweight and obesity are diseases of the 21st century, in which quantitative and qualitative changes in adipose tissue contribute to adverse metabolic, somatic, and psychosocial consequences. The impact of obesity on reproductive health is multifaceted and ranges from fertility problems to the development of hyperplastic and neoplastic processes in the reproductive organs. However, with the advent of a new class of pharmacological agents (glucagon-like peptide-1 receptor agonists, GLP-1RAs), significant weight loss can be achieved, optimal reproductive function can be maintained, and associated cancer and cardiometabolic risks can be reduced. Experts believe their use should be considered during preliminary consultation. Currently, tirzepatide, which has competitive advantages over GLP-1RAs, has been developed for effective weight loss. It is a dual agonist of the GLP-1 receptor and a long-acting glucose-dependent insulinotropic polypeptide (GIP) receptor. Tirzepatide reduces body weight by increasing insulin secretion and tissue sensitivity, reducing glucagon secretion, delaying gastric emptying, promoting lipogenesis, and influencing eating behavior. Before the advent of GLP-1 agonists and tirzepatide, bariatric surgery was considered the most effective weight loss method, capable of achieving significant weight loss. Given the inherent risks of surgery and the potential for vitamin and mineral deficiencies, bariatric surgery should not be considered a first-line treatment for obesity. This article will present the key benefits of tirzepatide, which can be effectively used to treat obesity in women with various reproductive health conditions.

Combined hormonal contraceptives (CHCs) is the most common method of reversible contraception worldwide. Despite their high efficacy, the problem of tolerability and safety remains a key factor that determines compliance: up to 42% of users discontinue the OC within one year of initiation, primarily due to different adverse effects. The most important aspect of CHCs is their systemic action, which can be associated with both expected beneficial effects and undesirable pharmacological risks, raising the need for strict personalized prescribing and, above all, a thorough initial assessment of the patient’s comorbidities in accordance with the medical eligibility criteria for contraceptive use. The choice of CHCs should not only be guided by its main contraceptive effect, but also by its potential non-contraceptive, in particular, therapeutic effects. Therefore, it is worth paying special attention to the past medical history data, laboratory and instrumental examination findings, clinical manifestations in the patient who visited a practitioner to receive advice about choosing a drug (for example, symptoms of hyperandrogenism, a burdened oncological anamnesis (including ovarian cancer, breast cancer, colorectal cancer), arterial hypertension, smoking, etc.). This review aims to systematize evidence base regarding the tolerability and safety of CHCs in reproductive-age women. It describes advantages and limitations of CHC use, criteria for personalised approach to their choice, and provides an analysis of innovator product E4/DRSP characteristics with the consideration of its promising pleiotropic non-contraceptive effects. Data from the international databases PubMed, Google Scholar, and MEDLINE (with priority given to systematic reviews, metaanalyses, and original multicenter studies) for the period 2022–2026 were reviewed. The unique combination of E4/DRSP has been shown to be a reasonable first-choice contraceptive option for women who start COC use in dysmenorrhea, PMS, acne, and for patients with moderate cardiovascular risk factors in the absence of absolute contraindications to CHCs.

Introduction. Achieving pregnancy and live birth in assisted reproductive technology (ART) programs in the cohort of women of advanced reproductive age represents a complex clinical challenge due to the implementation of irreversible processes of biological and ovarian aging. The development and introduction of additional integrative indicators of ovarian stimulation into clinical practice are of great importance for the objective assessment of reproductive potential and optimization of IVF protocols.
Aim. To evaluate the indices FORT, FOI, and OSI as predictors of successful ART outcomes in patients of advanced reproductive age.
Materials and methods. The study included 256 married couples with women aged 40–42 years who underwent infertility treatment using standard IVF programs. An analysis of the clinical and anamnestic characteristics of the patients included in the study was performed. To assess the prognostic significance of follicular output rate (FORT), follicle-to-oocyte index (FOI), and ovarian sensitivity index (OSI), ROC analysis was conducted.
Results. According to the ROC analysis, none of the ovarian stimulation parameters demonstrated sufficient accuracy for practical application in predicting clinical pregnancy in women of advanced reproductive age. To determine the prognostic significance of the studied ovarian stimulation parameters for live birth, ROC analysis was also performed, which demonstrated high significance for the number of preovulatory follicles (AUC 0.73 (95% CI 0.62–0.85)) and the FORT index (AUC 0.84 (95% CI 0.72–0.96)). The remaining parameters did not show high value in predicting live birth.
Conclusions. In the present study, a good prognostic value of the FORT index in predicting live birth was demonstrated, indicating potential applicability in clinical practice in the cohort of women of advanced reproductive age. Further studies on larger samples are required for the wider implementation of this index into clinical practice.

Pelvic inflammatory disease (PID) can be defined as one of the primary and complex issues of vital importance in modern gynecology. Vulvovaginal infections can act as a provocative factor for both PID with its potential complications in the future, and those of the concomitant course. This descriptive review evaluates data on the efficacy of Miramistin in the treatment of pelvic inflammatory diseases. The analysis of the outcomes of comprehensive therapy of PID using antiseptic agent benzyldimethyl[3-(myristoylamino)propyl]ammonium chloride monohydrate (Miramistin®) in the dosage form of vaginal suppositories is provided. Topical combination therapy regimens for infectious and inflammatory GT diseases including Miramistin® vaginal suppositories has demonstrated high clinical efficacy in women with a wide range of PID associated with a wide variety of cervicovaginal flora. This article aims to identify and characterize current trends within PID therapy. The research into the review topic to prepare and write the paper involved various search queries to select publications subject to analysis. A literature review was conducted using English-language databases MEDLINE and PubMed with the keywords: sexually transmitted infections, cervical-vaginal infections, mixed infections, pelvic inflammatory diseases, PID, antiseptic, benzyldimethyl-myristoilamino-propylammonium, and miramistin. From articles retrieved, clinical trials with large sample sizes, systematic reviews, and meta-analyses were prioritized, yielding 47 articles on the subject matter to prepare the paper, and 41 articles for screening (cited reference lists). These reference links included important data: results of RCTs, clinical and cohort studies, as well as the theoretical background to substantiate the efficacy of this medication.

Introduction. Preterm birth remains one of the unresolved medical and social problems, with about 70% of cases occurring as late preterm births between 34 and 36 weeks and 6 days of gestation. Infectious factors play a significant role in preterm birth, but their role in the late preterm birth pathogenesis has been insufficiently studied.
Aim. To determine the significance of infectious and inflammatory risk factors in the pathogenesis of late spontaneous preterm birth.
Materials and methods. A retrospective single-center cohort comparative study was conducted. We analysed data from the medical records of 300 women with singleton pregnancies, including 150 with spontaneous late preterm birth (group 1) and 150 who delivered at 37–41 gestation weeks (group 2). Statistical data were processed using MedCalc Version 18.2.1 software (license Z2367-F3DD4-83E2E8-A6963-ED902) with nonparametric statistical methods. The critical level of statistical significance was set at p ≤ 0.05.
Results. Age, medical, social history and obstetric parity in patients of the comparison groups were comparable. Infectious and inflammation risk factors for spontaneous late preterm birth are vaginal infections during pregnancy (OR = 3.59; 95% CI 2.09–6.2; p < 0.0001), acute somatic bacterial infections (OR = 2.1; 95% CI 1.14–3.87; p = 0.018) and acute respiratory viral diseases (OR = 3.15; 95% CI 1.74–5.69; p = 0.0001). In the presence of two or more episodes of acute infection diseases during gestation, the late preterm birth probability increases up to 4 times (OR = 4.19; 95% CI 2.25–7.78; p < 0.0001).
Conclusion. Acute inflammatory diseases during pregnancy (both genital and somatic) are the most important among the factors for spontaneous late premature birth risk, which dictates the need for the treatment on infection foci at the pregnancy planning stages.

Introduction. No standard of care therapy is currently available for patients with radiation-induced cystitis. Several approaches to symptomatic treatments are considered.
Aim. To evaluate histological, immunochemical, and electron microscopic findings on bladder ultrastructure in patients with late onset radiation cystitis (LRC).
Materials and methods. The study included 136 patients aged 30–68 years with late onset radiation cystitis, which developed as a complication of the concurrent radiation therapy due to cervical cancer. In addition to routine examinations, 48 patients underwent plain urethrocystoscopy with bladder wall biopsies taken from the most conspicuous lesions, followed by morphological and immunohistochemical examination of the biopsy specimens. Patients were randomized into a comparison group (CG, n = 104), which received standard symptomatic drug therapy, and a treatment group (TG, n = 32), which received identical symptomatic therapy and instillations with a viscoelastic protector of urinary bladder mucosa containing 50 ml of hyaluronic acid solution, which were administered twice weekly for two months. Immediate treatment outcomes were evaluated at the end of the two-month course, and the long-term outcomes were evaluated a year after the combination therapy.
Results. We found a highly statistically significant (p < 0.001) improvements in symptoms (relief of pain, urgency, hematuria) of LRC after the therapy. Cystoscopy also confirmed the statistically significant superiority of treatment outcomes in the TG patients: they demonstrated significantly lower rates of hyperemia, mucosal edema, angioectasias, and urothelial erosions. Unlike the CG, the patients receiving instillations with the viscoelastic protector of urinary bladder mucosa showed no mucosal ulcers after a two-month course of therapy.
Conclusions. The standard symptomatic treatment supplemented by bladder instillations with the viscoelastic hyaluronic acid protector of urinary bladder mucosa eliminates clinical and laboratory manifestations of bladder inflammation and reduces the frequency of relapses by 1.5 times in women with late onset radiation cystitis during the 1-year follow-up period.

Introduction. Female regular blood donors are at high risk for developing iron deficiency (ID) and iron deficiency anemia (IDA).
Aim. To evaluate the efficacy and safety of the dietary supplement Iron Elemental AСMOFER ® in the prevention and treatment of ID in female blood donors.
Materials and methods. The study included 47 female regular blood and blood component donors with a donation history of 2 to 14 years. The average age was 43.4 ± 10.7 years (range: 25 to 48 years). Inclusion criteria: donor age over 18 years; weight over 50 kg; serum iron less than 10 μmol/L, serum ferritin less than 30 μg/L; signed informed consent form. These female blood donors with diagnosed ID were prescribed the dietary supplement Iron Elemental AСMOFER ® one capsule once daily for 8 weeks (1 capsule contains elemental iron – 20 mg; ascorbic acid – 50 mg).
Results. A study of 47 female blood donors revealed decreased ferritin and serum iron levels, indicating ID. During therapy with the dietary supplement Iron Elemental AСMOFER®, women with ID and IDA experienced a significant increase (p < 0.05) in hemoglobin concentration, red blood cell count, and hematocrit. The highest concentration of hemoglobin was noted after 8 weeks of taking the drug: initially, the concentration of hemoglobin in the blood was on average 122.5 ± 11.9 g/L, and after 8 weeks of taking it – up to 132.4 ± 10.8 g/L (p < 0.05); the number of erythrocytes also increased from 4.48 ± 0.36 × 10¹²/L initially and after 8 weeks of taking it – up to 4.66 ± 0.55 × 10¹²/L.
Conclusion. The use of the Iron Elemental AСMOFER® dietary supplement in female donors with ID and IDA resulted in a rapid increase in hematological parameters (hemoglobin, red blood cell count, hematocrit) and ferrokinetic parameters (ferritin and serum iron) in 93.6% of women.

Chlamydia trachomatis is the most common bacterial sexually transmitted infection (STI) worldwide. In 2012, the prevalence of urogenital chlamydial infection (UGCI) among women was 4.2%. According to 2020 data released by the World Health Organization (WHO), approximately 129 million new C. trachomatis infections are reported annually worldwide. It should be noted that in the Russian Federation, in 2021, the incidence rate of UGCI was 17.8 per 100,000 population, which is 27.6 times lower than the official incidence rate in the United States (490.6 per 100,000 population) for the same period. Untreated UGHI can lead to pelvic inflammatory diseases (PID), as well as cervicitis and endometritis, which have a tendency for transformation into chronicity. UGHI is associated with spontaneous abortion, chorioamnionitis, premature rupture of membranes, ectopic pregnancy, preterm labor, and stillbirth. Furthermore, chlamydia increases the risk of infertility in both men and women. The authors note that the failure to screen women with complicated gynecological/obstetric anamnesis for sexually transmitted infections (STIs) at the pregravid preparation stage may subsequently cause the diagnosis of a perinatal infection with an unidentified pathogen. Pregnant women with UGCI are treated at any gestation stage using systemic antibacterial agents with due account for their effects on the fetus. Currently, azithromycin is the best option for the treatment of UGCI during pregnancy. This article reviews current clinical guidelines and other legal acts applicable to the diagnosis and treatment of chlamydial infection in women.

Introduction. Recurrent vulvovaginal candidiasis (RVVC) in pregnant women represents a clinical and obstetric challenge requiring the use of topical antifungal agents with a proven safety profile. Natamycin, a polyene antibiotic with minimal systemic absorption, is considered one of the drugs of choice in this patient population.
Aim. To evaluate the clinical and microbiological efficacy as well as the safety of intravaginal natamycin (100 mg) in pregnant women with RVVC during the second and third trimesters of gestation.
Material and methods. A prospective open-label randomized clinical trial was conducted. A total of 94 pregnant women (22–35 weeks of gestation) with confirmed RVVC were enrolled. The patients received natamycin 100 mg intravaginally once daily for 6 days. Treatment efficacy was assessed on day 2 and day 21 after completion of therapy using clinical, microscopic (native smear, Gram staining), and microbiological criteria. Adherence (Morisky–Green scale), adverse events, and pregnancy outcomes were evaluated.
Results. On day 2 after completion of therapy, clinical cure was achieved in 93.6% of patients (resolution of pathological discharge), and pruritus/burning was relieved in 97.9%. Microbiological eradication (absence of pseudohyphae in native smear) was observed in 90.4% of women. On day 21, the recurrence rate was 9.6% based on clinical manifestations and 11.7% based on microbiological findings. Satisfactory adherence (4 points on the Morisky–Green scale) was found in 94.7% of patients. No systemic adverse events were recorded; local burning was reported in 2.4%. The preterm birth rate was 8.5%, which does not exceed population-based rates.
Conclusion. Intravaginal administration of natamycin 100 mg in pregnant women with RVVC demonstrates high clinical and microbiological efficacy, a favorable safety profile, and good treatment adherence, supporting its recommendation as a first-line agent for topical treatment in this patient population.

Atypical hemolytic uremic syndrome (aHUS) is a life-threatening thrombotic microangiopathy (TMA) driven by dysregulation of the alternative complement pathway. Within obstetrics, its diagnosis is critically confounded by profound clinical mimicry of common obstetrical emergencies. Delayed diagnosis is invariably associated with the rapid progression of multi-organ dysfunction syndrome (MODS), culminating in unacceptably high maternal and perinatal mortality and irreversible disability. This article presents a rare clinical case of aHUS triggered by placental abruption at 27 weeks of gestation in a patient with a history of two uncomplicated term deliveries. The initial clinical presentation was dominated by hemorrhagic shock and disseminated intravascular coagulation (DIC) secondary to massive abruption, which effectively masked the classic TMA triad of microangiopathic hemolytic anemia, thrombocytopenia, and acute kidney injury. A systematic diagnostic workup including thromboelastography, schistocyte quantification, ADAMTS-13 activity assay, and renal biopsy was required to sequentially exclude other TMA subtypes and definitively establish the diagnosis. Despite a significant delay in initiating targeted therapy with the C5 complement inhibitor eculizumab and the development of severe acute kidney injury with cortical necrosis requiring prolonged renal replacement therapy (RRT), a favorable outcome was achieved. Eculizumab therapy facilitated gradual recovery of native renal function, culminating in the complete discontinuation of RRT. This case underscores placental abruption as a independent trigger for aHUS. It provides a compelling rationale for the inclusion of aHUS in the differential diagnosis of any complex obstetrical catastrophe and offers crucial clinical evidence supporting the potential for renal recovery following delayed initiation of complement blockade, even in the setting of severe, established parenchymal injury.

In this study, the diagnostic aspects of typical endometrial hyperplasia (benign endometrial hyperplasia) and atypical endometrial hyperplasia (endometrioid intraepithelial neoplasia) are reviewed. The article provides data on multidisciplinary and diverse selected diagnostic measures: ultrasound examination of the endometrium (data on the characteristics of the endometrial status in the absence of pathology and diagnostic criteria for the hyperplastic process occurring in the mucous component of the uterine anatomy), menogram (data on the nature of the menstrual cycle in the presence of a disease), hysteroscopy (information on the diagnostic role and comparison with the dilation and curettage (D&C) method), examination of the hormonal status (FSH, LH, thyroid hormones), and examination of the liver (due to the fact that the liver processes hormones). Thanks to modern diagnostic methods, and in this case, immunohistochemical examination (IHC), we can identify new aspects in the pathogenesis of atypical endometrial hyperplasia (AEH). IHC indicators of malignancy are: PR- and ER-receptor profile of the endometrium are in the position of “inverse proportion”, inactivation/loss of PTEN, PAX2, ARID1A, increase in expression of β-catenin (CTNNB1), mutations in the proto-oncogene KRAS, registration of MSI, as well as about the expression of LH/hCG receptors. Similar mutational aberrations of AEH and endometrial cancer are mentioned. The role of the endometrial microbiome in the development of pathology has been shown. In the preparation of this review, data was collected from the scientometric libraries PubMed, CyberLeninka, eLIBRARY.RU, using the keywords: endometrial hyperplasia, atypical endometrial hyperplasia, endometrioid intraepithelial neoplasia, immunohistochemistry, MSI, ultrasound, sexually transmitted infections, uterine microbiome, as well as from bibliographic sources. Time frame: 1997–2025.

Introduction. Up to 10% of pregnant women suffer from hypertensive disorders, but preeclampsia (PE) occupies a special place, complicating approximately 2–8% of gestations worldwide.
Aim. The pathogenesis of PE is not fully understood, but there is no doubt that it is closely related to angiogenic imbalance. Materials and methods. The study included 72 patients admitted to an obstetric hospital with suspected PE. Depending on the value of PLGF, the participants were divided into 3 groups: patients with a high risk of placental dysfunction (n = 37) (<12 pg/ ml), patients with a medium risk of placental dysfunction (n = 21) (12–100 pg/ml), and patients with a low risk of placental dysfunction (n = 14) (>100 pg/ml).
Results. In patients with a high risk of placental dysfunction, severe PE was statistically significantly more common, as was the shortest interval before premature delivery, as well as adverse maternal and neonatal outcomes. Based on the level of PLGF and proteinuria, a prognostic model was developed to determine the likelihood of developing severe PE, with a specificity and sensitivity of 94.0% and 81.8%, respectively.
Conclusions. The introduction of PLGF analysis into clinical practice can help predict severe PE, simplify risk stratification, and implement personalized treatment strategies and dynamic monitoring, which can improve maternal and perinatal outcomes.

The postmenopausal period takes about a third of a woman’s life, which emphasizes the need to maintain health and quality of life against the background of pronounced hormonal changes. In peri- and postmenopausal women, estrogen deficiency and hormonal imbalance lead to systemic disorders, including morphofunctional changes in the skin, its appendages and mucous membranes. The skin, being not only a barrier, but also an endocrine organ, is sensitive to estrogens, androgens and cortisol. The lack of estrogens reduces its turgor, elasticity, slows down regeneration, promotes dryness, itching, the formation of wrinkles, as well as changes in hair structure and the development of androgenic alopecia, etc. These changes often remain underestimated and are difficult to correct with standard dermatological methods. Effective management of patients with menopausal symptoms, including changes in the skin and its appendages, requires an integrated approach. Optimal clinical results are achieved through interdisciplinary collaboration of specialists – a gynecologist and a dermatologist, and, if necessary, an endocrinologist, which ensures individualization of therapy and an improvement in the quality of life of peri- and postmenopausal women. Menopausal hormone therapy (MGT), although it has no direct indications for isolated skin manifestations, has proven to improve the biomechanical properties of the skin. The aesthetic effects of MGT are not the primary goal of therapy, but they significantly affect the quality of life and psychological state of patients. A search for the review was conducted using the following keywords: skin, perimenopause, postmenopause, menopausal hormone therapy, aging. Authors analysed 58 home and foreign research papers on the effects of hormone replacement therapy (HRT) on skin state, its elasticity, hydration, and hair growth, identified the main benefits of various types of combined HRT, and described them in this article.

Climacteric Syndrome (CS) is a complex condition that extends beyond vasomotor symptoms (VMS) to include psychoemotional disorders, sleep disturbances, metabolic dysfunctions, and increased risks of somatic pathology. These changes affect up to 97.5% of women during peri- and postmenopause, impairing quality of life and elevating the risks of cardiovascular, neurodegenerative, and oncological diseases. This review provides analysis of current data from international electronic bibliographic and scientific databases (PubMed, Scopus, Web of Science, eLIBRARY.RU), as well as Cochrane Library and peer-reviewed medical journals. It focuses on several insufficiently elucidated pathophysiological aspects of postmenopausal disturbances, including the mechanisms of narrowing the hypothalamic thermoneutral zone, dysfunction of the serotonergic and noradrenergic neurotransmitter systems, the role of oxidative stress and decreased antioxidant enzyme activity, DNA damage and carcinogenesis, and the development of dyslipidemia, insulin resistance, and endothelial dysfunction. The review provides a detailed argument for the necessity of implementing a comprehensive therapeutic approach to CS, aimed not at isolated symptom relief but at the simultaneous correction of key interconnected pathogenetic links. It presents a detailed analysis of modern fundamental and clinical data demonstrating the efficacy of various active molecules, including β-alanine, isoflavones, 5-hydroxytryptophan, and vitamins C, E, and B. Their effects are examined in terms of stabilizing the thermoregulation center in the hypothalamus, selective modulation of estrogen receptors, improving lipid profile and insulin sensitivity, as well as restoring serotonin levels, homocysteine balance, and suppressing oxidative stress. This multicomponent patient management strategy ensures not only effective symptomatic control of vasomotor and psychoemotional manifestations of CS but also long-term prevention of cardiovascular, metabolic, and neurodegenerative complications, aligning with the principles of women’s active longevity.

The modern world still faces a number of demographic challenges, one of which is the continued increase in number and percentage of older population. This phenomenon poses numerous challenges to the global healthcare system, which requires significant economic and organizational investments in the health care delivery. Genitourinary syndrome of menopause (GSM) is one of the most common and pressing age-associated disorders. Current epidemiological data point to the extremely high prevalence rates for this nosology, which increases progressively as female reproductive aging proceeds according to the STRAW+10 scale. The studies have shown that at least one in two women experiences urogenital atrophy during their lifetime. Generalized atrophic syndrome in the urogenital region triggers a combination of typical symptoms, including vulvovaginal, urological, and sexual ones. Regardless of the clinical phenotype, GSM is associated with a significant decrease in women’s QoL overall and social maladjustment. Furthermore, it has now been proven that GSM is a significant predictor of the development of various phenotypes of pelvic floor muscular incompetence up to pelvic organ prolapse. In this regard, timely diagnosis and targeted/proven therapy are crucial steps to improve quality of life and maintain female reproductive health over the long horizon. This article aims to review available research literature in the context of GSM mainstreaming (from epidemiology to clinical presentation), as well as to highlight current approaches to the management of GSM based on the national and international guidelines of the British Menopause Society (2025). A literature search was conducted in international databases such as PubMed, Google Scholar, and Elsevier. The search for papers was performed using the following keywords: genitourinary syndrome of menopause, vulvovaginal atrophy, clinical symptoms, and treatment of GSM. A total of 56 papers were selected for the narrative review, the most relevant of which