Estriol is an effective and safe drug to treat climacteric syndrome, genitourinary syndrome, in a complex therapy of genital organs prolapsed, atrophic processes at the menopause stage, hypoestrogenia, at cervical factor of infertility.

Menstrual irregularities are an eternal female problem, in the treatment of which ever new aspects are opening. One of the most common problems is pain in the abdomen during menstruation. This form of menstrual disorder requires special attention, since, according to different authors, menstrual cramps of various severity are registered by 30 to 75% of women. However, about 10% of women, along with sharp pain, speak about deterioration of the general condition to the extent of temporary disability. Moreover, it is known that pain affects the emotional sphere, mental and general condition of the woman, and as a consequence, the relations within the family, thus making it a relevant healthcare and social problem (Smetnik V.P., Tumilovich L.P., 1998).

The article describes the specific features of termination of progressive uterine pregnancy in the II trimester. It was found that the efficacy of medical abortion in the II trimester of pregnancy is 94–98%. High efficacy, low incidence of side effects or early and late complications and economic feasibility demonstrate that the method is promising and safe; therefore, it can be recommended as a priority when choosing a method for medical termination of pregnancy in the II trimester.

Anemia can be detected in women before pregnancy, during pregnancy, after childbirth, during lactation period, requiring the attention of doctors and clinical and laboratory monitoring. Iron deficiency anemia (IDA) is the most common anemia in pregnant women. Accurate diagnosis is needed, since there are other possible anemias (posthemorrhagic, folate deficiency, anemia of chronic diseases). Modern options of IDA treatment are include the use of oral iron preparations (in 90% of pregnant women), intravenous iron preparations (in 10% of pregnant women), erythropoiesis stimulating agents – ESA (in 2% of pregnant women), and red blood cell transfusions in severe cases (in 3% of pregnant women). The history of creation of intravenous iron complexes in the laboratory of C.F. Hausmann, as well as properties of various intravenous iron complex formulations in the historical aspect of their manufacturing process (ferric gluconate, iron dextran, iron sucrose, ferric carboxymaltose) and the negotiation of adverse events are described. Indications for the use of intravenous iron preparations are the following: severe IDA, ineffectiveness or intolerance of oral iron, the presence of gastric or duodenal ulcer or gastrointestinal surgery in the past, contraindications for red blood cell transfusions, use of ESA. The advantages of intravenous ferric carboxymaltose are the possibility to use the high dose of iron preparation (1000 mg, 1 time per week), no need for test dose, the possibility of intravenous administration in 15 minutes. High efficiency, good tolerability of ferric carboxymaltose in the treatment of IDA are shown. Pharmacoeconomic analysis showed the feasibility of administration of ferric carboxymaltose in comparison with the drug of previous generation (iron sucrose). The use of intravenous iron preparations in the treatment of IDA in pregnant women will allow to minimize red blood cell transfusions and to move to the stage of drug replacement therapy.

Menorrhagia is the pathological condition which is negatively affecting physical, emotional and social quality life of the woman. Medicines of the choice of therapy of uterine bleedings are the combined oral contraceptives (COC). The estradiol valerate/ dienogest (E2V/DNG), represents the combined oral contraceptive (COC) recommended for women as contraceptive. Gives to feature of influence of medicine on endometrium the chance of its application in case of uterine bleedings. The hormones which are a part suppress excessive proliferation of endometrium that leads to reduction of amount of menstrual allocations. Results of a research which confirm successful application of E2V/DNG in case of the menorrhagia at the women of reproductive age in clinical situations who aren’t requiring operational treatment are provided.

Chlormadinone acetate-containing combined contraceptives are well researched, they have a high degree of reliability during prolonged use in different modes. They have a protective anti-atherogenic properties and is offset by the risk for cardiovascular system, because the existing data indicate that the risk of thromboembolism against the background of chlormadinone preparation is minimal to date among all COCs and is comparable with the «first-generation» progestins, like levonorgestrel. The undeniable advantage of CMA-containing COC is a neutral impact on carbohydrate metabolism and blood coagulation system. CMA COCs have anti-atherogenic effect, which makes them “the drugs of choice” in patients with sclerocystic ovaries, metabolic syndrome and systemic diseases associated with hypercoagulability.

Russian scholars and Western specialists who studied the effect of CMA-containing combination drug, allow us to recommend COC Belara® to assign not only with the contraceptive purpose, but also as a product for the stability of the menstrual cycle, as the drug of choice in the hyperpolimenorrhea, al’go – and dysmenorrhea, hyperandrogenism, expressed in the form of acne, hirsutism, oily seborrhea, decrease in sexual activity because of dyspareunia, as well as to anxiolytic and sedative effect in PMS. 

Study objective. To study the efficacy of the drugs vitamin D at the stage of planning of pregnancy in women with infertility of various etiologies, according to domestic and foreign literature.

Materials and methods. We conducted a search of the literature sources by the keywords “vitamin D”, “infertility”, “pregravid preparation” in domestic and foreign databases: elibrary, Medline/PubMed, Embase, CINAHL. 23 sources were selected.

Study results. Vitamin D plays an important role in the regulation of the menstrual cycle and the reproductive health of women. The prevalence of vitamin D deficiency among women with infertility of various etiologies reaches 69%. It is vital to achieve an adequate level of vitamin D in a woman’s body and to prevent its deficiency.

Conclusion. For all women with infertility at the stage of preparation it is recommended to conduct assessment of adequacy of vitamin D by determination of 25(OH)D in serum and correction of its deficit to achieve levels of 25(OH)D more than 30 ng/ml. 

Study objective. To study the efficacy of folic acid drugs, in particular metafolin, at the stage of pregravid preparation and during pregnancy to prevent congenital malformations and complications of pregnancy.

Material and methods. We conducted a search of the literature sources by the keywords «folic acid», «folates», «metafolin», «pregnancy», «methyltetrahydrofolate» in domestic and foreign databases: elibrary, Medline/PubMed, Embase, CINAHL. 23 sources were selected.

Study results. One of the main challenges that the obstetrician faces is the prevention of pregnancy complications and congenital malformations of the fetus. In the literature there is considerable amount of evidence about the effectiveness of folic acid. However, the natural food folates and folic acid preparations may not be absorbed to a sufficient degree by the body in women with defects in folate-converting enzymes, the incidence rate of which reaches 50%.

Conclusion. All women at the stage of pregravid preparation and during pregnancy should take folates to prevent complications of pregnancy and congenital malformations in the fetus. Given the high prevalence of mutations in genes responsible for folateconverting enzymes, in clinical practice it is recommended to use folates able to be absorbed by the body regardless of genetic variants of the folate cycle enzymes. 

Objective: to study the combined use of first-trimester biochemical screening results and uterine artery pulsality index (PI) for inclusion in risk group for fetal growth restriction (FGR), improvement of pregnancy outcomes in women from the risk group for the development of FGR.

Material and methods. The work is based on the results of studies conducted from 2009 to 2014 in the maternity unit of Republican Clinical Hospital № 2 MoH in the Republic of Tatarstan which is the clinical facility for the Department of Obstetrics and Gynecology № 1 of the Continuing Medical Education Institution “Kazan State Medical University” MoH RF, and maternity unit and prenatal clinic of the Volzhskaya Central City Hospital in the Mari El Republic. First-trimester biochemical screening results and uterine artery PI were the basis for the formation of FGR risk groups. Pregnancy and delivery outcomes in 156 pregnant women with a risk for the development of FGR and in 25 healthy controls were evaluated. In order to improve the placental blood flow based on the proven safety profile, all women with FGR received dipyridamole in the II trimester of pregnancy for at least 3 weeks.

Conclusion: concomitant decrease in PAPP-A MoM and increase in uterine artery PI provide the most valuable information for forecasting FGR. Administration of dipyridamole by women with FGR helps to improve placental blood flow, prevents degenerative changes in the placenta, and promotes live births even in III degree FGR. 

The aim of the study was to compare the efficacy and safety of tocolytic agents - atosiban and hexoprenaline.

Patients and methods: The study included 119 pregnant women with threatening preterm labour between 28 to 34 weeks of gestation. Sixty two pregnant received 62 tocolysis by hexoprenaline and fifty seven - atosiban. There were no differences in the clinical condition of pregnant women and features of preterm labour among groups before start of the tocolysis.

The degree of effectiveness is determined by the duration of the pregnancy prolongation (48 hours, 7 days, more than 14 days).

Results: 9 women of 62 that received hexoprenaline tocolysis (22,6%), and 2 – atosiban (3.5%) failed to prolong the pregnancy for more than 48 hours (p < 0,05). Additionally, 5 women of the hexoprenaline group had premature labour within the first week from the treatment start and eight within 7-14 days. In the group of women with an effective atosiban tocolysis all births took place in a range of more than 7 days from the beginning of tocolysis. Four woman in hexoprenaline group received one repeated course of therapy with this drug (without a loading dose) for 24 hours. In atosiban group full repeated course was conducted in the two cases. Full-term gestation births occurred in 14 women (22.6%) after hexoprenaline tocolysis and in 19 (33.3%) – atosiban (p > 0,05%). On average, atosiban tocolysis allowed to prolong pregnancy by 6.5 days longer than hexoprenaline (p < 0,05).

Conclusion: The results of study has shown that atosiban is more effective than hexoprenaline in pregnancy prolongation for more than 48 hours in threatening preterm labor. 

Urogenital infections (UGI) remain one of the urgent problems of obstetrics and gynecology. In the period of gestation, the UGI may cause such complications as chorioamnionitis, intrauterine growth retardation and intrauterine and intrapartum infection of the fetus, spontaneous abortions, premature birth, purulent-septic complications in the postpartum period. According to the literature, UGI in pregnant women have a high prevalence and often occur in a latent form, complicating timely diagnosis and subsequent treatment.

Increased interest to the vaginal microecosystems is largely due to the fact that the role of evolutionary formed microbial populations in this habitat lies not only in the maintenance of vaginal colonization resistance, but also in formation of microecological health of newborns, and consequently, the human population in general.

The formation of the qualitative and quantitative composition of microflora is regulated by a complex mechanism of microbial interactions inside each of microecosystems and is controlled by physiological factors of the host organism in the dynamics of his life. 

The article analyzes the global and national research on the resistance of Candida yeasts to fluconazole. The studies demonstrate that the formation of resistance is determined by many factors: type of yeast, choice of the antimycotic medication, geographical location, etc. In addition, one can not disregard the socio-economic and even political causes. The frequency of detection of drug-resistant strains of different species of Candida yeast to fluconazole varies across different regions, between countries of the same region, and may vary from year to year within a country. In other words, the formation of yeast resistance/ susceptibility to fluconazole, and to other antifungals alike, is dynamic and may be reversible.

Therefore, both global and national studies conducted over the past decades and devoted to the formation of resistance of Candida yeast to azoles, in particular, fluconazole, have shown that it is still the medication of choice for the treatment of candidiasis, including acute vulvovaginal candidiasis, as well as for relief and prevention of exacerbations of recurrent vulvovaginal candidiasis. C. krusei was and remains one of the most fluconazole-resistant yeast species. Other species, such as C. inconspicua and C. norvegensis, the number and incidence of which is too low for the moment to make any statistically valid conclusions, may in the future be added to the list. 

Menopause is the final cessation of menstrual cycles due to loss of follicular activity of the ovaries. According to the results of a meta-analysis of 36 studies performed in 35 countries, the average age of menopause onset is 48.8 years (95% CI 48,3 – 49,2) with significant fluctuations of this indicator depending on the geographical region of residence of women: lower in Africa, Latin America and middle East countries (47,2–48.4 years) and later in Europe and Australia (50,5–51,2 year) [1]. The number of women in peri- and postmenopausal phase in connection with the increase in life expectancy is increasing. In Russia it is currently more than 21 million. The average age of the menopause onset in Russia ranges from 49 to 51 years, at the same time women live in conditions of estrogen deficit for 1/3 of their life [2, 3].

Vasomotor symptoms are the most common symptoms of menopause, requiring treatment with estrogen and/or progestogen. Recent international guidelines recognize the need to use the lowest effective dose of hormone replacement therapy. Drospirenone (DR) in combination with 17β-estradiol (E2) is used as hormone therapy (HT) for relief the symptoms and prevention of postmenopausal osteoporosis.

The review presents data of 2 large randomized controlled studies that evaluated the lowest effective dose combination DRSP/ E2, the safety of this dose for endometrium, identified features of its pharmacodynamics and pharmacokinetics, depending on various factors. The minimum effective dose for the relief of hot flushes without causing any significant impact on the endometrium is DRSP of 0,25 mg/E2 of 0,5 mg. According to the results of the pharmacokinetic study a correlation between effectiveness of low dose DRSP/E2 with DRSP and E2 exposure levels was showed, and smoking reduces the effectiveness of hormonal therapy. This drug not only copes with moderate to severe hot flushes, but also reduces the incidence of symptoms of vulvovaginal atrophy, improving quality of life. 

Despite the proven effect of menopausal hormone therapy on menopausal syndrome, a number of factors prevent perimenopausal women from receiving the treatment. The article is a review of literature on the possibility of non-hormonal treatment with tofisopam for neuro-vegetative and psycho-emotional disorders associated with climacteric syndrome. The article tells about the efficacy and safety of the drug taking into account its pharmacodynamic properties.

A number of studies have shown that menopausal hormone therapy (MHT), consisting of 1 mg 17ß-estradiol and 5 mg dydrogesterone, is effective to reduce the severity of menopausal symptoms and increases bone mineral density in postmenopausal women [1] and at the same time has a favorable safety indicators for the endometrium and the pattern of bleeding [2, 3]. Nevertheless, current guidelines recommend the use for the treatment of menopausal symptoms of the lowest effective dose of estrogen [4–6]. In this regard, we developed a new combined mode of MHT with continuous use of ultra-low doses of hormones – 0.5 mg 17ß-estradiol and 2.5 mg of dydrogesterone. The use of ultra-low doses of estrogen protects the endometrium by lower doses of progestogen. Similar combinations of low doses of MHT can reduce the incidence of adverse events, such as the sensitivity of the mammary glands, uterine bleeding, cardiovascular disease, ischemic stroke and venous thromboembolic complications, and at the same time, to maintain effectiveness against menopausal symptoms [7–11]. The appearance of in the arsenal of gynecologists of ultra-low dose MHT is likely to improve the patient’s adherence to this treatment regime. In addition, a low dose of estrogen is particularly useful for older women (>59 years).

The article presents the basic definitions related to the treatment of postmenopausal osteoporosis, and certain sections from the guidelines of the Russian Association on Osteoporosis (2016) dedicated to the prescription of active vitamin D metabolites (alfacalcidol).

Premenstrual syndrome (PMS) is a complex, cyclical, polyethiological, multifactorial combination of physical and mental disorders that occur in some women of reproductive age in the second - luteal - phase of the menstrual cycle and negatively affect the woman’s usual lifestyle.

Premenstrual dysphoric disorder (PMDD) is a severe form of PMS in which psychoneurological symptoms prevail. For the diagnosis of PMDD, the specific DSM-5 criteria were developed by the American Psychiatric Association according to which the the diagnosis is confirmed by the presence of five or more symptoms in women during the week prior to menstruation and their disappearance a few days after the onset of menstruation. These symptoms are observed for at least two cycles.

Treatment of women with PMS/PMDD, first of all, should start with the lifestyle adjustment, inclusion of regular mode rate physical activity into daily activities. The effectiveness of vitamins B6, E and calcium has not been confirmed in studies. First-line drug therapy includes SSRIs or combined oral contraceptives containing drospirenone are prescribed first, then agonists of gonadotropin-releasing hormone.

The article is devoted to the subject of topical interest to women of reproductive age. Affecting not only the health of women, but also various aspects of their life, dysmenorrhea is a medical and social problem. The use of nonsteroidal anti-inflammatory agents in this condition is an effective means of pathogenetic therapy that significantly improves the quality of life of women.

Because of the conducted microbiological research cervic-vaginal zone with carriers of human papilloma virus identified local factors homeostasis that contribute to the progression of the process with a cervical lesion as cervical intraepithelial neoplasia. The comparative analysis of prophylactic use of eubiotiks and acid glycyrrhizinic drug for the prevention of HPV-associated lesions of the cervix.

Overactive bladder (OAB) is a serious urination disorder which affects at least 17% of the population above 40 years old, of which 56% are women and 44% are men. M-cholinoblockers are the first line therapy and the main treatment for OAB. However, their side effects, along with low efficacy, force women to stop taking the drugs. Activation of beta-3-adrenergic receptors is known toreduce the tone of detrusor muscle in the bladder. This resulted in the invention of mirabegron (Mirabegron, Betmiga, Astellas Pharma Europe, Netherlands), the first drug of a new pharmacologic group (beta-3 adrenergic agonists) for the treatment of OAB. A selective beta-3 agonist, mirabegron has no side effects such as dry mouth, increased intraocular pressure or constipation. Numerous clinical studies demonstrated a reduction in the number of episodes of urinary incontinence and frequent urination in the mirabegron group compared to the placebo group.

Epidemiological studies showed that overactive bladder (OAB) syndrome is among the ten most common diseases, ahead of diabetes, gastric ulcer and duodenal ulcer. In addition, the number of patients with OAB is steadily growing every year. Prevalence of OAB ranges from 12 to 22%, and despite a significant decline in the quality of life, only 4–6,2% of patients seek the help of professionals.

Estrogen deficiencies manifested by vasomotor symptoms, psychological and emotional disorders, urogenital disorders and other complications may be initiated by age-related (physiological) ovarian failure, or a sharp decline in the production of sex steroids in women treated for breast cancer. That results in a significant reduction in the quality of life of women, including general population, and requires treatment. The article tells about the current principles of menopausal hormone therapy based on the provisions of the global consensus, the potential and advancements in herbal medicine, and highlights debatable topics in the management of menopause.

Purpose of the study: evaluation of the quality of life of patients with symptomatic uterine myoma up to 12 weeks of gestation against a background of mifepristone 50 mg daily continuously for 3 months.

Material and methods. The prospective study involved 141 patients with uterine myoma who received treatment with mifepristone (Gynestril®) 50 mg continuously for 3 months. In order to evaluate changes in the volume of uterine bleeding, each patient kept a diary where she registered the number of sanitary napkins used. Sonographic examination was used to evaluate the size of the uterus and fibroids. The Visual Analogue Scale (10-point VAS scale) was used to assess the pain intensity. Quality of life of patients and their satisfaction with the therapy was also evaluated by a 10-point VAS scale. The complaints, physical examination data and results of sonographic studies were recorded before and immediately after the end of treatment (1st and 2nd visits).

Study results. Drug therapy with Gynestril® (mifepristone 50 mg) for patients with uterine myoma for 3 months helped to obtain a statistically significant (p < 0.001) improvement across all the evaluated parameters: in a large majority of patients, control of menstrual blood loss was achieved (decreased duration and volume of bleeding), while 85 patients (60.3%) achieved reversible drug-induced amenorrhea, and 43 patients (30.5%) - oligomenorrhea; a large majority of patients achieved reduction of pain severity according to VAS, while in 118 (83.7%) patients the parameter was estimated as “slight pain/no pain” after the end of treatment. According to the ultrasound results, a statistically significant decrease was achieved in the number of displayable fibroids (from 2.1 to 1.9 at an average), the volume of the dominant myoma node (on average by 65% from 37.34 to 13.27 cm3) and of the uterus (an average of 35% from 182.71 to 118.09 cm3). In addition, a vast majority of patients - 99.9% - evaluated the quality of life and satisfaction with treatment as high.

Conclusions. Therefore, the results of the study demonstrate that Gynestril® is highly effective, safe and promising in the pharmaceutical treatment of uterine fibroids. 

At the end of the second decade of the twenty-first century, venous thromboembolic complications continue to be one of the most critical issues, affecting the professional interests of doctors in various clinical fields. This is primarily due to the high potential risk for the health and life (less frequently) of patients [1, 2].