Vol 23, No 2 (2021)


Ovarian endometriosis and fertility preservation problem

Chernukha G.E., Dumanovskaya M.R., Ilina L.M.


Aim. To review the most recent literature regarding the modern management of women with ovarian endometriosis and no desire for immediate pregnancy but wanted fertility preservation in future.

Materials and methods. The analysis of latest publications on this topic has been carried out.

Results. Ovarian endometriosis is associated with infertility due to several factors including potential gonadotoxic effect per se and ovarian reserve decline after surgical treatment. Medical treatment is the first-line therapeutic option for patients with pelvic pain and no desire for immediate pregnancy in absence indications for the urgent surgery, for prevention disease progression. Postoperative long-term medical therapy has been effective in the prevention of endometrioma recurrence, repeated surgery, additional ovarian reserve decline and preserve fertility in future.

Conclusion. Ovarian endometriosis management should be individualized according to the patient’s intentions and priorities. Long-term progestins most appropriate therapy for fertility preservation in women prior to performing surgery or provide assisted reproductive technologies, if needed.

Gynecology. 2021;23(2):110-116
pages 110-116 views

Facets of the problem of infiltrative endometriosis: from pathogenesis to effective therapy

Radzinskii V.E., Orazov M.R., Mihaleva L.M., Bekulova M.A.


Endometriosis remains an unresolved problem in gynecology. The urgency of the fight against this disease is due to its high prevalence among women of reproductive age. Endometriosis, especially its infiltration forms, affects all aspects of the patient’s life, its clinical manifestations – pelvic pain, dyspareunia, dysmenorrhea, dyschezia, lead to social disadaptation, problems in personal life, depression and anxiety. The socio-economic burden of the disease motivates researchers to further study the pathogenesis of endometriosis and search for pathogenetically justified pharmacological solutions.

Gynecology. 2021;23(2):117-124
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Human papillomavirus vaccination: evidence base for efficacy and safety

Dobrokhotova Y.E., Borovkova E.I.


The article provides a literature review on the prevention of cervical cancer by human papillomavirus (HPV) vaccination. Currently, 3 vaccines are available: the 4-valent vaccine against HPV types 6, 11, 16 and 18, the 9-valent vaccine against HPV types 6, 11, 16, 18, 31, 33, 45, 52, 58 and the bivalent vaccine against HPV types 16 and 18. Vaccination provides protection for women and men against infection with HPV and further development of HPV-associated diseases. Following immunization, seroconversion develops in 93-100% of women and in 99-100% of men and is effective in preventing incident and persistent HPV infection as well as cervical intraepithelial neoplasia. HPV immunization is ineffective in treating an existing HPV infection, genital warts, or anogenital intraepithelial neoplasia. HPV vaccination status does not affect recommendations for cervical cancer screening.

Gynecology. 2021;23(2):125-130
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Diseases of the cervix – non-obvious consequences of pelvic floor muscle failure

Orazov M.R., Toktar L.R., Karimova G.A., Pak V., Li K.


The literature review presents domestic and foreign data on the relationship between pelvic floor dysfunction (PFD) and cervical diseases found in PubMed, Scopus, Embase and eLibrary systems over the past 10 years. This relationship is mainly realized due to alterations in vaginal biocenosis as the earliest clinical manifestation of PFD. The article describes PFD prevalence, classification, and risk factors for PFD. It also describes main methods of treatment and their side effects. The article provides data on changes in the vaginal biocenosis in PFD. Attention is paid to the risk for cervical intraepithelial neoplasia and cervical cancer in PFD.

Gynecology. 2021;23(2):131-136
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Modern approaches to the management of menopause

Artymuk N.V., Tachkova O.A., Marochko T.Y.


Aim. To conduct an analytical review of modern publications highlighting modern approaches to improving the quality and increasing life expectancy in postmenopausal women.

Materials and methods. The analysis of 47 foreign and domestic literature sources on this topic is carried out.

Results. Menopause is a time of significant change for women and a good time to assess and promote health. Patient counseling should include information on lifestyle, contraception, individual and family risks of cancer and osteoporosis. Hormonal, non-hormonal and complementary methods can be used to correct the symptoms of menopause. MHT is the most effective treatment for symptom relief and can be offered to most women. Topical vaginal oestrogen treatment is effective in relieving urogenital symptoms. Women should be able to make informed choices regarding the use of MHT, based on balanced and accurate information about its benefits and risks.

Conclusion. Menopause is a time of change for women and provides an opportunity for health assessment and promotion. The decision to treat menopausal symptoms using hormonal, non-hormonal and complementary methods should be made on an individual basis depending on the presence of risk factors and the patient’s preferences.

Gynecology. 2021;23(2):137-143
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Psychic status in a woman with climacteric syndrome and cardiac complaints

Beliaeva E.N., Kostroma I.V., Kuznetsova L.V., Khazova E.L., Zazerskaia I.E.


Aim. To assess the features of psychoemotional status in women with climacteric syndrome, manifested by cardiac symptoms.

Materials and methods. The study included 28 women aged 44 to 56 years (M=53,8±0,7) with menopause-associated complaints, manifested mainly by cardiac symptoms. Modified Kupperman-Uvarova menopausal index was used to diagnose climacteric syndrome and assess its severity. To study the psychoemotional status the Tsung anxiety and depression self-assessment scales were used. Holter ECG monitoring and echocardiography were performed on the ASTEL LTD Cardio DM-3 apparatus for 72 hours.

Results. The most common cardiac complaints in menopausal syndrome were: increased blood pressure, palpitations, recurrent chest pain. Ventricular premature beats were the most common finding. Emotional-affective disorders were found in women of the study group. For women with a mild climacteric syndrome, signs of mood instability, increased emotional lability, irritability, and low levels of anxiety are characteristic. Women with moderate climacteric syndrome complained of anxiety, irritability, anger, and prolonged episodes of decreased mood. According to the anxiety and depression self-assessment scales, these women typically had emotional-affective disorders which manifested by high levels of anxiety, and 29% of them had mild levels of depression. Women with severe climacteric syndrome complained of prolonged episodes of decreased mood, sleep disturbances, and performance impairment; these women predominantly had high levels of anxiety and moderate levels of depressive disorder.

Conclusion. In women with climacteric syndrome, major symptoms are neurovegetative, with a predominance of complaints associated with ventricular rhythm disorders. For climacteric syndrome, affective spectrum disorders are characteristic. The more pronounced the climacteric syndrome, the more severe the anxiety-depressive disorder.

Gynecology. 2021;23(2):144-148
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Gynecological diseases as predictors of female sexual dysfunction

Stenyaeva N.N., Chritinin D.F., Chausov A.A.


Background. Female sexual dysfunction is extremely common and affects about half of the world’s women. Currently, the question of the relationship between gynecological morbidity in women and the characteristics of sexual activity and sexual functioning in a couple remains poorly understood.

Aim. To establish gynecological diseases associated with decreased sexual functioning, sexual health disorders in women on the basis of a screening assessment when visiting the clinic.

Materials and methods. We conducted a cross-sectional descriptive study of the sexual functioning of 1256 women who presented to outpatient appointments. Anamnestic and clinical methods were used, sexological testing using the Female Sexual Function Index questionnaire.

Results. Based on anamnestic data, screening assessment of sexual health and sexual functioning of 1235 women who applied for outpatient appointments to a gynecological clinic, a high gynecological and extragenital morbidity was established in patients (100%). The structure of gynecological diseases is represented by female infertility (48.3%), inflammatory diseases of the genital organs (38.5%; of which salpingo-oophoritis – 16.6% and vulvovaginitis – 15.9%), endometriosis (13.9%) , menstrual irregularities (8.3%), as well as pain disorders (8.1%). The incidence of infections, predominantly sexually transmitted, was revealed, among them papillomatous viral infection (8.3%), genital herpes (5.3%) and chlamydia (3.7%). It was found that in gynecological patients with diseases characterized by a chronic course, inflammation, pelvic pain, menstrual and reproductive disorders, sexual functioning significantly decreases (p=0.00) and sexual health is impaired. Sexual dysfunctions were detected in 21.6% of patients, their structure is represented by isolated (39.3%) and combined (60.7%) disorders of libido, orgasm, sexual anhedonia, failure of genital response, as well as dyspareunia, vaginismus. In 33.7% of patients, preclinical forms of sexual dysfunction were identified that did not meet the criteria for sexual dysfunction (did not cause distress, were short-lived), but confirmed by the analysis of patient complaints, as well as by the results of the Female Sexual Function Index questionnaire.

Conclusion. Thus, chronic gynecological diseases with inflammatory manifestations, pelvic pain, menstrual and reproductive dysfunctions are associated with decreased sexual functioning, sexual dysfunctions, and preclinical forms of sexual dysfunctions.

Gynecology. 2021;23(2):149-154
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Cervical cancer: monitoring of the main indicators characterizing this pathology in Khabarovsk Krai (2009–2019)

Pestrikova T.Y., Ismaylova A.F., Kiselev S.N.


Aim. Conduct a comparative assessment of the main indicators of the incidence of cervical cancer in Khabarovsk Krai (2009–2019) аnd the prevalence of types of human papillomavirus among the female population.

Materials and methods. A comparative analysis of the data of the official statistics of the Ministry of Health of Khabarovsk Krai, using the Rosstat database for the period 2009–2019, taking into account the incidence, mortality, prevalence of types of human papillomavirus, was carried out. The dynamics trend was determined in the process of graphical analysis of the diagram and by modeling trends. The results of the studies were subjected to the methods of statistical information processing.

Results. The results revealed in our study indicate that the increase in the incidence of cervical cancer in Khabarovsk Krai from 2009 to 2019 was 44.4% (with an average annual growth rate of 4.5%). Most often, cervical cancer in Khabarovsk Krai is detected in urban residents. The share of urban women with this pathology in 2019 reached 77.2%. The proportion of stage I–II cancer detected exceeds the proportion of stage III–IV cancer by 2.5 times. Mortality in patients with cervical cancer in Khabarovsk Krai exceeds that in the Russian Federation. Of the 1617 residents of the city of Khabarovsk of reproductive age, 883 (54%) women had the presence of human papillomavirus. For our region, most often, women had highly oncogenic types of human papillomavirus 16, 56, 51.

Conclusion. Statistical analysis based on the results of diagnosing early and advanced stages of cervical cancer, mortality from this nosological form, and the spread of the human papillomavirus remain among the most important criteria. The data obtained make it possible to assess the effectiveness of the chosen tactics in the regions and take timely corrective measures aimed at both early detection of cervical cancer and a decrease in the persistence of the human papillomavirus in women with background cervical pathology.

Gynecology. 2021;23(2):155-160
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Blood bisphenol A concentration in patient with infertility affects in vitro fertilization outcomes

Syrkasheva A.G., Kindysheva S.V., Starodubtseva N.L., Frankevich V.E., Dolgushina N.V.


Aim. To analyze the relationship between bisphenol A levels in the blood of patients with infertility and in vitro fertilization (IVF) outcomes.

Materials and methods. Infertility treatment of 301 married couples was performed using IVF. The level of bisphenol A in the blood of patients was determined by gas chromatography-mass spectrometry. The influence of bisphenol A levels on parameters of early embryogenesis and outcomes of IVF programs was assessed.

Results. Bisphenol A was detected in 92.9% (277/298) blood samples of women and in 92.7% (141/154) blood samples of men. Bisphenol A levels in women had a statistically significant positive correlation with the level of bisphenol A in their spouses (r=0.533, p<0.0001). No differences were found in the main parameters of early embryogenesis and pregnancy rates in quartile bisphenol A subgroups in women and men. There was a trend towards an increase in the miscarriage rate with an increase in the level of bisphenol A. The threshold level of bisphenol A that increased the miscarriage rate was 0.9 ng/ml for women and 0.4 ng/ml for men. With an increase in the threshold level of bisphenol A in both spouses (men ≥0.4 ng/ml and women ≥0.9 ng/ml), the odds ratio for miscarriage after IVF 8.8 (95% confidence interval 0.88–113.08).

Conclusions. Bisphenol A was found in the majority of infertile patients. A significant positive correlation was noted between the level of bisphenol A in patients and their spouses. An increase in the level of bisphenol A in the blood is associated with an increased risk of early reproductive losses after IVF, which requires further research.

Gynecology. 2021;23(2):161-166
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Approaches to the realization of reproductive function in women with systemic lupus erythematosus and antiphospholipid syndrome

Vlasova G.A., Perminova S.G., Kosheleva N.M.


Aim. To assess the safety and efficacy of assisted reproductive technology (ART) programs in patients with systemic lupus erythematosus (SLE) with/without comorbid antiphospholipid syndrome (APLS).

Materials and methods. The observational study included 26 patients with diagnosed SLE, of whom 7 women had comorbid APLS and disorders of reproductive function. The analysis of the causes of impaired fertility was based on history and comprehensive examination data, which, along with risk factors for possible complications, determined the choice of ART programs.

Results. In 23 of 26 patients, infertility (primary: 14, secondary: 9) was diagnosed, and 3 patients were diagnosed with repeated miscarriage. The main etiological factors of infertility were tubal (n=6), male (n=8) and their combination (n=3); in 9 cases the etiology of infertility remained unclear. 10 patients with a history of lupus nephritis had a reduced ovarian reserve. In total, 23 infertile patients underwent 33 in vitro fertilization programs. 11 (33%) clinical pregnancies were registered, of which 7 ended in live birth. There were no cases of severe exacerbation of SLE and thrombotic complications.

Conclusion. ART can be used in patients with SLE with / without APLS, if the underlying disease is compensated for and prevention for complications is used. The effectiveness of ART programs is comparable to that in the general population. Further research is needed to make a final judgment on the safety of various ART programs in SLE with/without APLS.

Gynecology. 2021;23(2):167-172
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The state of bone mineral density in the prolapse of the pelvic organs

Musin I.I., Minasov T.B., Naftulovich R.A., Popova E.M., Mingareeva K.N., Berg E.A., Molokanova A.R., Berg P.A.


Background. Plausible predictions of future mortality and disability are useful aids in making decisions about priorities for medical research. Recent advances in medicine have led to the fact that some countries, such as Japan, have the highest life expectancy in the world. Osteoporotic fractures make a significant contribution to the development of morbidity and mortality in the aging population. Despite an active study of the mechanisms of the development of pelvic organ prolapse and disorders of bone mineral density separately, the general background of these diseases has previously been little studied.

Aim. To study bone density according to densitometry data in peri- and postmenopausal women.

Materials and methods. To carry out this study, 2 groups of women were formed. The first (experimental) group included 76 women admitted for routine surgical treatment of genital prolapse, the second group (control) – 68 women without clinical manifestations of pelvic floor descent, who underwent a medical examination by a gynecologist on an outpatient basis.

Results. Analysis of extragenital diseases in women included in the study showed a high prevalence in the experimental group of hypertension (p=0.028), osteochondrosis (p=0.001), scoliosis (p=0.028), hemorrhoids (p=0.013). Also, women in this group more often noted stretch marks on the skin (p=0.002) and were more often operated on for other diseases (p=0.043), which indicates the association of genital prolapse with undifferentiated connective tissue dysplasia and hypertension. The diagnosed “severe osteoporosis” (according to 1 or more densitometry indicators, where the T-score is less than -2.5) had a direct correlation with the duration of menopause. For a detailed analysis of the factors influencing severe osteoporosis in peri- and postmenopausal women, logistic regression analysis and ROC analysis were performed. The independent variable was the presence of severe osteoporosis, and the dependent variables were: stage according to POP-Q, the presence of hypertension, the presence of diabetes mellitus in history.

Conclusion. This study confirms the presence of a comorbidity decrease in bone density according to densitometry and the presence of hypertension (p=0.028) and genital prolapse. According to the ROC analysis, an increase in the stage of genital prolapse according to the POP-Q classification increases the risk of developing severe osteoporosis.

Gynecology. 2021;23(2):173-176
pages 173-176 views

Vulvovaginitis and their correction in patients with cervical HPV-associated diseases in the light of the doctrine of pathomorphosis

Kononova I.N., Dobrokhotova Y.E., Kareva E.N., Semioshina O.E., Shmakova N.A.


Background. Biological pathomorphosis of the leading pathogens of the vaginal microecological system with the occurrence of vulvovaginitis in human papillomavirus (HPV)-associated cervical intraepithelial neoplasia (CIN) is a fundamental prerequisite for optimizing the complex treatment of this disease.

Aim. Optimization of treatment of vulvovaginitis based on the study of the pathomorphism of their pathogens in patients with HPV-associated CIN.

Materials and methods. A two-stage examination of 211 patients with HPV-associated CIN I was carried out from 2013 to 2020. To study the pathomorphosis of the disease, the patients were divided into 2 groups, the 1st group was examined in 2013–2016, the 2nd – in 2017–2020. The study of microbiocenosis was carried out by RT-PCR using Femoflor-16 reagents. At the second stage, a study of the clinical efficacy of treatment of vulvovaginitis with the complex drug nifuratel 500 mg + nystatin 200 thousand IU (Macmiror Complex) in comparison with metronidazole 500 mg.

Results and discussion. It was revealed that patients with HPV-associated CIN I over the last 8 years have a pathomorphosis of pathogens. In particular, the change in the dominance of anaerobic dysbiosis with the highest bacterial replication of Gardnerella vaginalis in association with Clostridium, Megasphaera spp. and Fusobacterium on the mixed nature of microflora, manifested in the form of vulvaginitis with the dominance of Atopobium vaginae in association with G. vaginalis, Ureaplasma (urealyticum + parvum) and the addition of the intestinal group Enterobacteriaceae spp. and Escherichia coli. The use of the complex drug nifuratel 500 mg + nystatin 200 thousand IU (Macmiror Complex) demonstrated a higher (4 times) clinical efficacy, a 12-fold decrease in the recurrence of the inflammatory process compared with metronidazole in the treatment of vulvovaginitis in patients with CIN I.

Conclusions. 1. The structure of the cervico-vaginal microbiota in HPV-associated CIN I degree is characterized by dysbiotic disorders in 68.3% of cases. During the last 8 years, there was a pathomorphosis of the microecological status from the dominant anaerobic (in 74.2% of cases, χ²=9.39 at p=0.001) to the dominant mixed (in 60.8% of cases, χ²=8.54 at p=0.001 ) with the addition of the intestinal group Enterobacteriaceae spp. and E. coli in 60.8% of patients (χ²=9.59 at p=0.001), which indicated a change in the dominant causative agents of vulvovaginitis in CIN I. 2. Comparative analysis of the clinical efficacy of complex drugs has demonstrated an increase in clinical efficacy when using the drug nifuratel 500 mg + nystatin 200 thousand IU by 4 times, a decrease in the recurrence of the inflammatory process by 12 times, compared with standard therapy with metronidazole, which allows us to recommend inclusion of the drug nifuratel 500 mg + nystatin 200 thousand IU in the therapy of vulvovaginitis in patients with CIN I.

Gynecology. 2021;23(2):177-183
pages 177-183 views

Incidence rate and structure of external genital endometriosis in hospital patients

Gerasimov A.M., Malyshkina A.I., Kuligina M.V., Krasilnikova A.K., Polumiskov D.M., Abdullaeva L.K., Fadeeva E.V., Dvoinova I.Y.


Aim. To assess the frequency of genital endometriosis and its various forms based on the analysis of hospitalized morbidity.

Materials and methods. Analysis of the medical data base of the gynecological clinic of the Gorodkov Ivanovo Research Institute of Maternity and Childhood for the period 2000–2019. The unit of observation is a case of endometriosis in a patient who left the gynecological clinic of a 24-hour hospital. The clinical characteristics of the prevalence of genital endometriosis are given based on the analysis of 9.378 surgery protocols for the period 2000–2019. The stages of spread of the endometrioid process were assessed according to the 1985 R-AFS classification.

Results. The total number of patients diagnosed with endometriosis was 17% of the total number of gynecological patients. The proportion of hospitalized with endometriosis in 2000–2019 increased by 2 times – from 4.5 to 9.2%. Over 20 years, the proportion of patients with endometriosis of the uterus (N80.0) – from 36.2 to 9.0% (p<0.001), with endometriosis of the rectovaginal septum and vagina (N80.4) decreased from 2.6 to 0% (p<0.01). The proportion of patients with ovarian endometriosis (N80.1) increased from 12.1 to 34.6% (p<0.001), pelvic peritoneal endometriosis (N80.3) – from 16.5 to 51.1% (p<0.001). The proportion of patients with endometriosis of two or more localizations increased from 1.6 to 40.2% (p<0.001). Over the 20-year period, there was a decrease in the average age of patients with endometriosis – from 37.8±0.43 years in 2000 to 36.2±0.34 years in 2009 and 33.8±0.29 years in 2019 (p<0.001). The range of fluctuations in age characteristics ranged from 13 to 55 years. The overwhelming majority of observations are “minor” forms (I and II stages of the disease) – 57.6%. Retrocervical endometriosis was diagnosed in 20.1%. Endometrioid ovarian cysts were in 11.7% of cases. In most cases, endometriotic lesions were combined with adhesions of the small pelvis.

Conclusion. Thus, genital endometriosis is a common gynecological pathology, which is often the reason for hospitalization for surgical intervention in women of different age groups. However in most cases affects in most important period in a woman’s life – reproductive. The given data emphasize the need to study and develop therapeutic measures to improve the system of organizing medical care, to find the most optimal and effective forms of diagnosis, approaches to the treatment and rehabilitation of women with endometrisis, which would significantly reduce the volume of surgical interventions, thus reducing financial costs, including overcoming infertility.

Gynecology. 2021;23(2):184-189
pages 184-189 views


Detection of oncological diseases in patients with pelvic organ prolapse. Case report

Baibuz D.V., Molchanov O.L., Glushchenko Z.V., Lebedeva Y.A., Utkin S.V., Kravtsov A.A., Shakhaliev R.A., Baibuz P.D.


Pelvic organ prolapse is a common benign disease among women that is characterized by an isolated or combined descent of the anterior, posterior vaginal wall, uterus, and vaginal dome after hysterectomy. Given the fact that most of the operations are performed among middle-aged and elderly patients, the probability of detecting previously undiagnosed tumor of the abdominal cavity and pelvic region increases, which may be due to the limited volume of basic preoperative diagnosis. The purpose of our report is to draw the attention of clinicians to the problem of insufficient examination of women when planning treatment of pelvic organ prolapse on the example of our experience in managing a patient with this pathology in combination with pelvic tumor.

Gynecology. 2021;23(2):193-197
pages 193-197 views


Infiltrative endometriosis and adhesions: is there a cause-and-effect relationship?

Orazov M.R., Mihaleva L.M., Bekulova M.A.


Endometriosis is a chronic inflammation condition which is associated with adhesive processes in the small pelvis and pelvic pain syndrome. The pathogenesis of adhesions has similar components to the mechanism of endometrioid heterotopia. A comprehensive approach to the treatment of infiltrative endometriosis proves its effectiveness and is the most rational for this cohort of patients. The use of proteolytic enzymes, which has long been included in clinical practice, is a pathogenetically reasonable addition to the pharmacological strategy in obstetrician-gynecologist practice.

Gynecology. 2021;23(2):198-204
pages 198-204 views

Post-abortion contraception: how to make the right choice?

Dobrokhotova Y.E., Narimanova M.R., Khlynova S.A., Saprykina L.V., Il’ina I.I.


More than 600 thousands abortions are performed annually in Russia. Women presenting for abortion care are often motivated by the pregnancy to use effective contraception; they are also at high risk for repeat unintended pregnancy. Contraceptive counseling and the supply of contraceptive methods are part of post-abortion care and positively influence the subsequent use of contraceptive methods. Oral contraceptives (OCs) following induced abortion offer a reliable method to avoid repeated abortion. Immediate administration of combined OCs after abortion may reduce vaginal bleeding time and amount, shorten the menstruation recovery period, and reduce the risk of complications and unintended pregnancies. Сombination of ethinylestradiol 30 µg + drospirenone 3 mg demonstrates the advantages of a low estrogen dose with the antimineralocorticoid activity of drospirenone that is responsible for the drug’s significant antiandrogenic and antimineralocorticoid effects, reflected clinically in lower rates of adverse events including less fluid retention. Сombination of ethinylestradiol 30 µg + drospirenone 3 mg and Metafolin has similar contraceptive efficacy, side effect, safety and benefits profile to other drospirenone-containing contraceptives. The article presents the results of the latest studies about using of combined OCs (ethinylestradiol 30 µg + drosperinone 3 mg and Metafolin) after abortion.

Gynecology. 2021;23(2):205-209
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Use of desogestrel-containing three-phase peroral contraceptives. Resolution of the meeting of the expert council


The meeting of the expert council on the rational use of desogestrel-containing three-phase oral contraceptives was held on August 20, 2020.

Gynecology. 2021;23(2):190-192
pages 190-192 views

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