Gynecology

Background. Genitourinary syndrome of menopause (GSM) significantly reduces the quality of life (QoL) of women, causing pain during sexual activity, worsening sexual function and relationships with a partner, and reducing self-esteem. Nearly 75% of women with GSM report a negative impact of symptoms on intimacy, and about half of them on overall life satisfaction.

Aim. To assess the clinical efficacy and impact on vaginal microbiocenosis of a topical vaginal product containing Lactobacillus acidophilus and estriol in postmenopausal women with GSM.

Materials and methods. The study included 34 patients diagnosed with GSM. The follow-up algorithm for these patients included several visits for examination, verification of diagnosis, and prescribing adequate therapy, followed by an assessment of the cure rate. At the first visit, patients' complaints and gynecological history were reviewed, gynecological status was assessed, samples were collected for smear microscopy and polymerase chain reaction (PCR) testing, and cytological examination and colposcopy were performed. At the second visit (after 10 days), according to the clinical and laboratory diagnostic study, all patients were diagnosed with N95.2, "Postmenopausal atrophic vaginitis" and prescribed therapy with a drug containing Lactobacillus acidophilus (lyophilisate) 50.00 mg and estriol 0.03 mg per vaginal tablet (Gynoflor E). The drug was used intravaginally in the evening at bedtime, for 12 days, then the maintenance dose was 1 vaginal tablet 2 times a week. The third and fourth visits were performed 15 and 30 days after the start of treatment, respectively (gynecological examination, microscopy, pH-metry, and cytological examination). The fifth visit of the patient was 3 months after the end of the main course of treatment during the maintenance therapy (gynecological examination, microscopy, pH-metry, PCR, cytological examination, and colposcopy). Treatment effectiveness was assessed using subjective and objective criteria, including the vaginal health index (VHI) and quantitative characteristics of the vaginal biotope, as determined by the FEMOFLOR®II test results.

Results. Changes in clinical symptoms during treatment with Gynoflor E showed a statistically significant improvement in 8 subjective symptoms (complaints) and 7 objective parameters. The number of complaints (0.85) per patient decreased by 8.2 times. The VHI at the fifth visit showed no signs of severe atrophy. The severity of atrophy was moderate (47.06%) or mild (52.94%) (p < 0.001), compared with the first visit, when 100.0% of patients had severe vulvovaginal atrophy. At the fifth visit, a comparative analysis of QoL using the D. Bаrlоw scale showed that GSM symptoms had become mild, i.e., did not affect daily life (100.0%), whereas at the first visit, their severity negatively affected daily life in all patients (p < 0.001). The study of the vaginal biotope at the fifth visit showed that the pool of Lactobacillus spp. (lg, gEq/mL) expanded, the total proportion of which in 52.94% of patients was 61.0–100.0%. Comparative analysis of the results of vaginal biotope assessment at the first and fifth visits showed a statistically significant difference (p < 0.001), indicating a reduction in the pool of opportunistic microbiota in the total vaginal biotope during topical therapy with a drug containing Lactobacillus acidophilus and estriol.

Conclusion. The use of the main and maintenance courses of local therapy with a combination drug containing Lactobacillus acidophilus and estriol in patients with GSM for 3 months resulted in improvement and increased QoL on the D. Barlow. GSM symptoms became mild and had no negative impact on daily life in 100.0% of the patients.

Background. Cervical stenosis (CS) is a result of the cervical canal scarring, which leads to its narrowing or complete occlusion with obliteration of the external os. Currently, the treatment of cervical stenosis and stricture is not standardized in clinical practice, and this issue is also not addressed in Russian and international clinical guidelines. Since cervical cancer is an important obstetric-gynecological and oncological problem, it requires the search for adequate therapies available in outpatient settings. Promising are biomedical agents derived from collagen-containing gels – extracellular matrix biomimetics used in tissue engineering and regenerative medicine. Recent research shows they can model cell differentiation.

Aim. To evaluate the effectiveness of extracellular matrix biomimetics, a heterogeneous implantable gel formulation, Sphero®GEL, produced in Russia, for the treatment of CS of various origins.

Materials and methods. The study included 15 patients with CS and a mean age of 40.5 ± 11.9 years. Most patients (73.3%) had cervical intraepithelial neoplasias of varying severity, for which cervical conization was performed. Due to the stricture of the cervical canal, 12/12 (100%) of patients of reproductive age had dysmenorrhea symptoms; the mean pain severity according to the Visual Analog Scale was 4.38 ± 2.29. All patients received two 2.0 mL intracervical injections of the drug with an interval of 28 days. Method of use for Sphero®GEL MEDIUM: punctual injections of 0.5 mL in the cervix stroma at a depth of 3 mm pointwise along the circumference of the external os at 3, 6, 9, 12 o’clock positions and 1.5 mL multipositionally along the entire circumference and length of the cervical canal at a depth of 25 mm at 3, 6, 9, 12 o’clock positions. Two injections were performed with an interval of 28 days; the mean interval was 31.1 ± 5.8 days. The median follow-up of patients was 8 months.

Results. After 3 months of treatment, the cervical canal patency was restored in 10/15 (66.7%) patients (the mean Hegar’s diameter was 3.67 ± 1.37 mm); after 6 months, it was restored in 14/15 (93.3%) patients (the mean diameter was 4.78 ± 0.85 mm). The mean pain severity on the Visual Analog Scale at 6 months was 0.91 ± 1.59, which was statistically significantly lower than before treatment (p = 0.005). No adverse events were reported during the treatment. High treatment adherence was observed: 4 points on the Morisky–Green scale in 14/15 (93.3%), while the prolonged interval between doses (31.1 ± 5.8 days instead of 28 days) was not statistically significant (p > 0.05) and was due to the onset of the menstrual period.

Conclusion. Intracervical injections of a heterogeneous, implantable gel formulation, Sphero®GEL, are an effective method of non-surgical treatment for CS of various origins.

Functional hypothalamic amenorrhea (FHA) is a condition that occurs as a result of a malfunction of the hypothalamic-pituitary-ovarian axis in women of reproductive age due to effects of environmental factors, many of which are widely known. However, the factors that determine the individual predisposition to this condition, as well as the duration and severity of its course, remain unexplored. Epigenetic modifications that alter gene activity without altering DNA structure are among the most promising markers of many diseases, including those involving the hypothalamus-pituitary system. The pathogenetic role of one of the key epigenetic regulators in the genesis of these diseases – non-coding RNAs – is actively being studied. Also, the potential of using non-coding RNAs as therapeutic agents in some conditions is being investigated. The purpose of the review was to systematize the literature data on the potential role of microRNAs as one of the most actively studied epigenetic regulators in the pathogenesis of FHA. The main types of epigenetic modifications and current data on their role in the development of diseases involving the hypothalamus-pituitary system, as well as conditions associated with FHA, are described. The study of epigenetic regulators whose activity is altered by external factors in FHA development is highly promising. Moreover, further studies are needed to evaluate the potential of epigenetic regulators as therapeutic agents in patients with FHA to improve treatment effectiveness and minimize the adverse consequences of the disease on reproductive and somatic health.

The mixture of ozone and oxygen (O₃–O₂, 5:95) is called "medical ozone." Ozone therapy, which uses an ozone-oxygen mixture, is applied for a wide range of diseases, including certain cervical diseases. It is also used in other branches of medicine, such as the treatment of purulent wounds, inflammatory-degenerative diseases, and circulatory disorders. In cervical diseases, low concentrations of ozone used therapeutically do not cause toxic effects and exhibit immunomodulatory, anti-inflammatory, bactericidal, antiviral, fungicidal, antihypoxic, reparative, and related effects. Ozone therapy has shown efficacy in the treatment of benign cervical diseases, including those associated with HPV, which justifies its further research. For severe dysplasia, ozone therapy may be considered an adjunctive method of rehabilitation, rather than a substitute for surgical treatment.