Vol 19, No 2 (2017)

The article presents data on reproductive health problems in women of late reproductive and perimenorausal age. The indications and optimal methods of contraception in this age period have been refined. It was noted that the individual approach and correctly selected COCs in the late reproductive and perimenopausal periods provide reliable contraception and have a curative effect in endometrial hyperplasia, dysmenorrhea, AMC, hyperandrogenism and PMS. Contraceptive and therapeutic aspects of the use of Lindineth 20 are considered. The use of COC with age, gynecological and extragenital diseases reduces the frequency of the formation of functional ovarian cysts and benign breast diseases and the risks of development of ovarian, endometrial and colorectal cancer in the future.

The aim of the study - to analyze the nutritional status, fat content and leptin in patients with functional hypothalamic amenorrhea (FHA). Subjects and methods. Clinical and laboratory methods were performed to examine 48 patients with FHA (age 25.8±5.43 years, BMI 19.7±2.01 kg/m2), including an assessment of the nutrient intake, eating behavior, lipid profile, leptin level and body composition by using dual-energy X-ray absorptiometry. Results. Body weight loss was observed in 29.2% of patients, body fat deficiency - in 100% of patients with low and in 58.8% with normal BMI respectively. Hypoleptinemia was detected in 77.1% of patients, hypercholesterolemia without increasin go fatherogenic index in 68.8% of patients. The analysis of the EDI-2 questionnaires showed that 54.2% of patients had drive for thinness, 22.9% of patients had body dissatisfaction. Nutritional examination showed a decrease of caloric intake in 50% of patients, daily carbohydrate intake - in 91.7%, increase protein intake in 70.8%, fats in 62.5% of patients. The ratio of nutrient consumption (proteins, fats, carbohydrates) was 1:1:0.3. Conclusion. The revealed features of the metabolic and nutritional status of patients with FHA point to the need for multidisciplinary interaction of the gynecologist, nutritionist and psychotherapist to normalize eating behavior, energy balance, total body fat percentage and menstrual status.

The article provides statistical information on the syndrome of polycystic ovaries (PCOS) in the morbidity pattern of patients of the SCDC "Juventa" from 2010 to 2015. The complexity of diagnosis of the syndrome in adolescents is indicated. Based on information on the pathogenesis of PCOS, the risk groups for the formation of the syndrome and methods for possible prevention were discussed. The principles of choosing hormonal drugs for conducting corrective hormonal therapy are discussed.The experience of using drugs containing chloromadinone acetate and drospirenone is presented in adolescents.

The results of a clinical-psychological prospective examination of 131 patients with cervical cancer, the uterus body and ovaries of stage I-III according to FIGO, reproductive age in total hysterovectomy and radiation suppression of ovaries isolated in three clinical groups are presented: group I - patients after combined and complex special treatment; Group II - patients after combined radiation treatment and group III - patients after combined and complex treatment, therapy of postovariochemical manifestations of which was carried out by traditional therapy. Identification of personal resources of stress-resistance was carried out using the copy-test of R.Lazarus. The intensity of oxidative processes in blood plasma was judged by the content of their carbonyl derivatives, revealed in the reaction with 2,4-dinitrophenylhydrazine. Results and discussion. For patients in the state of total hysterovarioectomy (groups I and III), the hyperactivity of the strategy "Confrontation" (76.8% and 76.4%, respectively) and "Positive revaluation" (67.8% and 72.6%) are a common phenomenon. "Constructive strategies"; "Distant" (73.8%) and "Acceptance of responsibility" (82.5%) are typical for patients of the II group who are in drug and radiation suppression. In the blood of all patients, increased oxidative potential was determined. Significant changes were demonstrated in the analysis of the intensity of induced (metal-catalyzed) OMB: at λ 370 nm and λ 530 nm in group I and group III (p<0.01): the level of oxidation products was significantly lower in the group II patients after SLT. Changes were demonstrated in the analysis of the intensity of induced (metal-catalyzed) OMB. The level of carbonyl groups was significantly lower in the group of patients II after SLT (p<0.01). After the therapy with allogeneic hydrolyzate of the placenta (AHP) with Melsmon of the APEC for 14 weeks, an objective orientation toward a decrease in the oxidative potential in the blood of patients was manifested. The serum level of the end products of OMB had an active decrease in comparison with the similar values in group I at λ 370 nm (1.3 times) and λ 430 nm (1.5 times); p<0.01. At λ 530 nm - groups I decrease by 1.4 times and II decrease by 1.6 times, p<0.01. The level of OMB in induced oxidation demonstrated a pronounced active decrease, especially at λ 530 (p<0.01). The study of induced AMB in the serum of Group III patients with gynecological cancer, the treatment of which was carried out by traditional methods in the PES did not show any statistical differences. In group I patients, the activity of non-constructive strategies is significantly reduced: confrontation (from 76.8% to 54.2%); flight/avoidance (from 64.2% to 38.6%). More actively, patients began to apply resources to constructive distancing strategies (activity increased from 42.4% to 68.3%); planning of problem solving (from 42.8% to 72.4%). The active decrease in the level of the carbonyl products of protein oxidation correlated with the improvement and stabilization of the psychological status in the form of non-constructive coping strategies "Confrontation", "Escape-avoidance" in patients of group I (r=0.379, r=0.437, p<0.001) and group II (r=0.439, r=0.376, p<0.001). Conclusions. 1. In gynecological cancer cases examined in the PES state , there is an intensification of the processes of free radical oxidation of biomolecules. However, in patients with preserved ovaries, the oxidative processes are somewhat reduced. 2. Decrease in the levels of carbonyl oxidation products against the background of Melsmon therapy in patients with gynecological cancer in the state of PES testifies to the possibility of participation of the drug components in antiradical protection. 3. Evaluation of the results of sonographic monitoring of the abdominal and pelvic organs in patients included in the study did not reveal a worsening of the prognosis of the underlying disease against the background of allogeneic placental therapy. 4. Allogeneic placental therapy with Melsmon helps to improve the psychological status of gynecological cancer patients in the form of stress-overcoming.

The results of treatment of 65 patients with uterine leiomyoma (LM) of various sizes received with abundant uterine bleeding are analyzed. All patients underwent endovascular haemostasis by performing uterine artery embolization (EMA). The clinical features of the course of the disease after performing EMA at different tumor sizes were studied. The insufficiently high efficiency of EMA at combined defeat of uterus LM and adenomyosis is noted.

The literary review presents modern views on the problem of habitual loss of pregnancy. Questions of terminology, causes and risk factors, strategic directions of pre-survey examination and per-conceptual management of patients with this pathology are discussed. The causes of habitual loss of pregnancy are extremely diverse and, as a rule, are interrelated. These are genetic causes (chromosomal abnormalities of the embryo or one or both parents), endocrine disorders (the endpoint of which is a violation of the functional and structural state of the endometrium), immunological factors (realized at the level of local disruption of the production of various cytokines, normally providing implantation and placentation processes) and hemotaziologic disorders (the most studied of which is AFS). An important role of pre-gestational detection and correction of risk factors for pregnancy loss in a married couple is shown.

This publication is devoted to one of the most relevant areas of gynecological practice - the use of combined oral contraceptives (COCs), taking into account their positive non-contraceptive properties. The issue of how to use COCs with the benefit of reproductive health of women, with what to combine them and how to prevent the risks associated with taking hormonal drugs, is reflected in detail. The information is presented in the form of an analytical review of international studies on the benefits and risks of using COCs.