Vol 23, No 3 (2021)

Physiological loss of ovarian function during the menopausal transition often leads to the development of unfavorable symptoms associated with vulvovaginal atrophy, recurrent urinary tract infections and dyspareunia. Currently, the scientific community is actively discussing the risks and benefits of prescribing menopausal hormone therapy to relieve the consequences of estrogen deficiency. The study of vaginal microbiota in dynamics made it possible to take a deeper look at the development of genitourinary menopausal syndrome and associate several microorganisms with specific undesirable manifestations. The link between recurrent urinary tract infections during menopause and physiological replacement of microbiota by opportunistic flora with the development of unpleasant symptoms resolves doctors to resort to irrational courses of antibiotic therapy. The review is devoted to the generalization of information on microbiological changes in the vagina during perimenopause, the possibilities of choosing the optimal hormone therapy for the correction of symptoms, the use of new promising methods, including management by modulating the vaginal microbiota.

The article presents an overview of the physiological role of anti-Mullerian hormone (AMH) during person’s lifetime, the fluctuations of its values from birth to the reproductive period in women, the significance of its determination in the diagnosis and prognosis of treatment outcomes for many gynecological diseases. AMH is produced mainly by preantral and early antral follicles and decreases during the final maturation and luteinization. AMH plays a potential role in preserving the ovarian reserve by performing dual actions. AMH inhibits the initial recruitment of follicles, preventing the influence of stimulating growth factors for recruitment (KIT-ligand, the main fibroblast growth factor). From the moment of puberty, AMH reduces the sensitivity of primary follicles to the follicle-stimulating hormone, reducing the likelihood of their cyclic recruitment. The systematic review data presented the characteristics of the ovarian reserve in a healthy female population aged 0 to 19 years. At birth, very low AMH values were noted with an increase in its level in the first 3 months of life, followed by a monthly increase of 31%. A significant increase in AMH secretion was revealed by the beginning of puberty, then most authors noted a constant level of serum AMH in the adolescent period. The level of AMH in the blood serum decreases with an increase in chronological age by 6–8% annually and varies during the menstrual cycle. AMH is an important diagnostic tool in pediatric practice when differentiating various causes of puberty disorders, virilization and menstrual cycle disorders in girls.

Background. The prevalence of pelvic floor dysfunction (PFD) is soaring steadily. The protrusion of the cervix beyond vaginal opening when exposed to environmental factors can lead to the development of dystrophic, sclerotic and neoplastic processes of the cervix, which are mediated by changes in the pH, biocenosis of the vagina and environmental factors.

Aim. To study the pathogenesis of cervical diseases in patients with PFD.

Materials and methods. The study design is an open-label prospective observational study. The study included 40 patients of reproductive age: 26 patients with cervical disease with PFD (PFD group), 14 patients without cervical disease and PFD made up the second group.

Results. The patients included in the study were comparable in terms of age and body mass index. Pap smear analysis revealed that the average number of leukocytes is significantly higher in patients with PFD compared to patients in the group without PFD – 5.5 (1.5–20.0) and 1.5 (1.5–6.5) respectively (p=0.040). In PFD group, a high prevalence of the following conditions was observed: cervical leukoplakia (15%), CIN1 (38.5%), CIN2 (8%), chronic cervicitis (38.5%). Onco-cytological test results reviewed where the high prevalence of parakeratosis and hyperkeratosis (15%), ASCUS (15%), LSIL (23%) and HSIL (8%) were also noteworthy. It was observed that human papillomavirus type 16 was predominant in PFD patient group.

Conclusion. The data obtained indicates an increased risk of developing cervical diseases in patients with PFD.

Aim. To increase the effectiveness of complex treatment of women with intrauterine synechiae (IS) through intrauterine administration of platelet-rich plasma (PRP).

Materials and methods. The authors studied the complex treatment results of 60 women with second and third degree intrauterine synechiae: 20 patients in the active treatment group, after hysteroscopic destruction of intrauterine synechiae, underwent intraoperative subendometrial administration of PRP followed by irrigating the uterine cavity with PRP on the 2nd and 3rd days after the operation, along with complex postoperative treatment (antibacteria and cyclic hormone therapy, physiotherapy); 40 patients in the comparison group underwent only complex postoperative treatment without PRP administration. The authors conducted comparative assessments of menstrual function, endometrial thickness and uterine cavity during check-up hysteroscopy procedure.

Results. Two months after the treatment, a statistically more significant increase in the thickness of endometrial tissue was found with the use of PRP compared with patients treated without PRP (p=0.03 and 0.04). Statistically more significant changes in the state of the uterine cavity were revealed when using PRP in the group of patients with the second-degree process severity (p=0.00005), while in patients with the third-degree process severity there were no statistically significant differences identified depending on the method of treatment used. The authors confirm high safety and reliability of the method as well as no adverse reactions to parenteral and intracavitary administration of autologous PRP.

Conclusion. The study confirmed applicability and prospects of using PRP as a stage in complex treatment of IS patients.

Background. Genital prolapse (GP) and stress urinary incontinence (SUI) are characterized by a failure of connective tissue skeleton of the pelvic floor structures, and there are many risk factors in their pathogenesis. Metabolic syndrome (MS), which includes obesity and abnormalities in the lipid and carbohydrate profile, contributes to the initiation of pelvic organ prolapse (POP) due to increased intra-abdominal pressure and the presence of comorbidities. Endothelial dysfunction associated with MS aggravates the existing metabolic disorders, resulting in the formation of a vicious circle and an increase in the likelihood of recurrence of genital prolapse symptoms and НМ during tension in the postoperative period.

Aim. The search for rational algorithms for the comprehensive management of patients with POP and MS.

Materials and methods. A comparative analysis of effectiveness of treatment with the use of surgical method or drugs which affect the metabolic profile in patients with GP and SUI was carried out.

Results. Drugs which contribute the restoration of lipid and carbohydrate profiles, and microcirculatory vasculature normalization, attenuate negative effects of MS components on the integrity of pelvic floor structures. Comprehensive management of patients with POP and MS with surgical correction of GP and SUI, as well as the use of drugs affecting metabolism, is highly effective and predictive in regard to POP severity and the risk of recurrence of clinical symptoms in the postoperative period.

Conclusion. Adequate restoration of the endothelial layer in patients with pelvic floor muscle incompetence and endothelial dysfunction reduces the likelihood of developing mesh-associated complications after the surgical stage of treatment.

Primary dysmenorrhea is one of the most common causes of pelvic pain in women. It can reduce quality of life and interfere with daily activities. The use of combined oral contraceptives in young women with primary dysmenorrhea is an effective and safe treatment option. The article presents a clinical case of the effective use of combined oral contraceptives containing drospirenone in a young woman with primary dysmenorrhea and severe pain syndrome, which is not relieved by analgesics and antispasmodics and significantly reduces the patient's quality of life.

This article presents a clinical case in a woman with a full two-legged uterus. This pathology in the patient was revealed by ultrasound examination in 2013. There is one spontaneous miscarriage in the anamnesis; later, the patient did not become pregnant with regular sexual activity without contraception. A comprehensive examination of the patient was carried out. It was decided to conduct a hysteroscopy, during which one cervical canal was identified, in the area of the internal pharynx, a division into two hemipolostas was visualized. In the future, the patient underwent Strassmann’s reconstructive plastic surgery, which is the “gold standard” for this pathology. Laparatomic metroplasty is a safe and effective procedure for women with a bicornuate uterine malformation. The postoperative period was uneventful. A year later, the patient became pregnant in the natural cycle. Pregnancy proceeded without complications, culminating in the birth of a healthy child.