Vol 24, No 5 (2022)


Opportunities and clinical significance of preoperative diagnosis of infiltrative endometriosis

Podzolkova N.M., Kuznetsov R.E., Glazkova O.L., Gorozhanina A.A., Churayants V.V., Romanovskaya O.A., Sozaeva L.G., Cheporev L.A.


Aim. To optimize preoperative diagnosis of infiltrative forms of genital endometriosis.

Materials and methods. We analyzed the results of the preoperative examination and surgical treatment of 667 patients from 22 to 49 years old (31.4 [27.3; 34.2]) with external endometriosis presented with pelvic pain, dysmenorrhea, dyspareunia (n=580), and primary or secondary infertility (n=215). The duration of the disease ranged from 1 to 16 years. Seventy-eight (11.69%) patients had a history of surgery for external endometriosis. The serum concentration of the CA-125 tumor marker was measured by immunochemiluminescence assay. Colonoscopy was performed in 655 cases, and cystoscopy in 66 cases. In addition, pelvic ultrasound was performed for all patients. Pelvic magnetic resonance imaging (MRI) was performed with an intravenous bolus injection of a contrast agent.

Results. Patients with endometrioid ovarian cysts (n=564) and "minor" forms of endometriosis (n=44) predominated. Endometrioid infiltrates occurred in 59 (8.84%) patients. In the group of patients with infiltrates, 18.64% had a history of surgery for endometriosis; 5.7% had a recurrence. Patients with retrocervical endometriosis and endometriosis of uterosacral ligaments predominated among females with infiltrative forms. No statistically significant differences in CA-125 concentration between patients with and without infiltrates were observed. The infiltrate was revealed, and its topography was described in 49 (83.05%) patients using ultrasound and 56 (94.81%) patients using MRI. All patients with dysuria had ultrasound, MRI, colonoscopy and cystoscopy.

Conclusion. The combined use of pelvic ultrasound and MRI provides high accuracy in diagnosing infiltrative endometriosis.

Gynecology. 2022;24(5):342-347
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Virus-associated chronic endometritis: treatment options

Tapilskaya N.I., Tolibova G.K., Tral T.G., Savicheva A.M., Glushakov R.I., Sadikova G.A., Budilovskaya O.V., Krysanova A.A., Gzgzyan A.M., Bespalova O.N.


Aim. To evaluate the effectiveness of Alloferon (Allokin-alfa®) in the complex treatment of virus-associated chronic endometritis (CE) in patients with infertility, papillomavirus infection (PVI) persisting in the uterine cavity, and recurrent herpes-virus infection localized in the genital area.

Materials and methods. A prospective (n=33) open randomized (2:1) study was conducted to assess the efficacy of Alloferon (Allokin-alfa®) in the complex treatment of CE in patients with infertility, PVI, and recurrent herpes-virus infection, aged 25 to 37 years (median age 31 [29; 32.5] years). All patients received valacyclovir therapy at 500 mg once daily for 30 days from the day of randomization. Patients in the main group (n=21) simultaneously with the start of antiviral therapy received Allokin-alfa® as 9 subcutaneous injections once every two days (one injection every other day). The uterine cavity microbiota of the patients was assessed 3 months after treatment, and histological and immunohistochemical studies of endometrial biopsy specimens were performed.

Results. The microbiological data analysis showed HPV elimination in 71.4% vs 16.7% of patients in the alloferon and control groups, respectively (χ2 – 7.102, p=0.008). Also, in the main group, a significant decrease in the severity of CE (χ2 – 27.586, p<0.001) and p16ink4a protein expression levels (χ2 – 6.17, p=0.013) were observed.

Conclusion. In the treatment of virus-associated CE, the addition of alloferon to virus-suppressive therapy leads to higher rates of HPV elimination from the uterine cavity and significantly reduces the severity of CE.

Gynecology. 2022;24(5):348-354
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A clinical and immunological rationale for ultrasonic cavitation use in the complex treatment of infertility in chronic endometritis

Sorokin Y.A., Gizinger O.A., Radzinsky V.E.


Aim.To prove the safety and efficacy of using the ultrasonic cavitation of saline to restore the endometrial receptivity, local immune balance, and antioxidant status in females with chronic endometritis (CE) and a history of reproductive losses.

Materials and methods. Fifty females aged 29.95±7.65 years (range 23–38 years) with histologically and immunohistochemically confirmed CE were examined. The control group included 45 female patients aged 28.98±9.9 years (range 23–38 years) with infertility of tubal-peritoneal genesis without histochemical studies confirming CE and with no history of reproductive losses. Transvaginal pelvic ultrasound was used in the study. All the patients had histological, immunohistochemical examination of endometrial scrapings, including quantification of CD138+, CD20+, CD56+, progesterone receptors (PR), and estrogen receptors (ER) in the stroma and glands. The following cytokines were measured in protein-free fractions of uterine cavity contents by ELISA: interleukin (IL)-2, IL-10, IL-8, tumor necrosis factor-α, IL-1β, interferon-γ, interferon-α. The activity of lipoperoxidation factors and antioxidant system enzymes (catalase, superoxide dismutase, glutathione peroxidase) was detected by spectrophotometry. As a part of the treatment, irrigation of the uterine cavity with sonicated 0.9% sodium chloride solution was applied twice in 6 sessions consecutively within three months.

Results. According to transvaginal pelvic ultrasound, the endometrial thickness before treatment was 6.54±1.2 mm. An increase in endometrial thickness up to 9.02 (7.62–10.42) mm in the luteal phase of the next cycle and up to 9.34 (8.12–10.56) mm in the two subsequent luteal phases was observed within three months after irrigation of the uterine cavity with sonicated normal saline. The normalization of the ЕR/PR ratio and decrease in CD138+, CD20+, and CD56+ cells in the endometrial stroma and glands were noted. Mature pinopods were revealed in 71.25 (67.29–74.46)% of patients, which is 2.95 times more than the respect value before the treatment, 24.55 (21.43–27.75)%. After treatment, a recovery of cytokine production was noted: IL-2, IL-10, tumor necrosis factor-α, IL-8, IL-1β, interferon-γ, interferon-α; concentration of primary, secondary and tertiary products of lipoperoxidation decreased; superoxide dismutase enzyme activity increased by 36.98 (32.88–41.18)%, catalase by 15.32 (14.13–16.51)%, glutathione peroxidase by 12.32 (11.12–14.2)%; р<0,005. Reduced colonization rate of Streptococcus spp, Enterococcus faecalis, Escherichia coli, elimination of Mycoplasma genitalium, Ureaplasma urealyticum, and increased of Lactobacillus spp. were reported.

Conclusion. Using the cavitated normal saline restores the endometrium structure, normalizes the ЕR/PR ratio, reduces the colonization by opportunistic and pathogenic microorganisms in the uterine cavity and normalizes the cytokine balance and the content of pro-oxidative and anti-oxidative factors. High clinical and immunological efficacy supports cavitated solutions in the complex treatment of infertility in females with CE.

Gynecology. 2022;24(5):355-361
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Management of patients with the atrophic variant of vulvar lichen sclerosus

Kolesnikova E.V., Zharov A.V., Penzhoyan G.A., Mingaleva N.V.


Aim.The objective is to optimize the diagnosis and management of the atrophic variant of the vulvar lichen sclerosus (LS).

Materials and methods. We examined 58 female patients from 20 to 70 years old with the atrophic variant of the vulvar LS. The control group included 30 deemed healthy females 20–70 years old. The atrophic variant of LS was diagnosed based on symptoms (dryness and discomfort in the vulva, superficial vulvodynia and dyspareunia, mild itching) and signs (marked atrophy of the external genitalia tissue up to aplasia of the labia minora and clitoris, vaginal stenosis, minimal hypopigmentation, absence of sclerosis). In addition, the following cytokines were measured in the peripheral blood of patients: interleukin (IL)-20, 23, 10, tumor necrosis factor-α, and interferon-γ. The measurements were performed before and after immunotherapy with sodium deoxyribonucleate.

Results. In all patients, there was a rapid shrinkage of the labia minora and clitoris, thinning and easy traumatization of the dermis and epidermis, contributing to secondary infection and synechiae formation up to complete vaginal occlusion. An increase in IL-23 (19.01 [18.0; 38.5] vs. 16.6 [12.98; 20.71] in the control group), 2.7-fold (p<0.03) decrease in tumor necrosis factor-α, interferon-γ and IL-20 are common for the atrophic variant of LS. The immunomodulatory and clinical efficacy of sodium deoxyribonucleate was demonstrated. Severe vulvodynia before treatment was noted in 29 (50%) patients and no patient (0%) after therapy; 44 (75.8%) patients reported complete reversal of superficial vulvodynia after treatment, and there were no patients without vulvodynia before treatment (0%). Mild itching before treatment was noted by 20 (40%) patients and 2 (3.4%) patients after treatment. Considering the cytokine levels, topical glucocorticoids in atrophic LS are inappropriate and can lead to atrophy and immunosuppression aggravation, contributing to the secondary infection.

Conclusion. The observed differences in cytokine levels in patients with atrophic vulvar LS confirm the relevance of LS clinical classification by variants, support their use for LS diagnosis and immunotherapy efficacy control, and also suggest a differentiated approach to the treatment of different LS variants considering the effect of the drugs used on cytokine status.

Gynecology. 2022;24(5):362-368
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Comparative evaluation of functional constipation prevention methods in pregnant women

Rybakova T.N., Nazarova L.V., Kovalenko M.S., Tuzlukov I.I.


Aim. To perform a comparative evaluation of different methods for preventing functional constipation in pregnant women.

Materials and methods. The study included 150 pregnant women aged 18 to 42 years, 22 to 36 weeks of gestation, with functional constipation. Group 1 included 50 patients who received dietary fiber OptiFibre in addition to diet therapy; group 2 included 50 patients who received diet therapy in combination with lactulose; group 3, the control group, included 50 pregnant women who received corrective diet therapy only. The outcomes were evaluated on day 14 of observation.

Results. A diet only was not sufficiently effective in normalizing stools in pregnant women with a gestational age of 22–36 weeks. By day 14, stool frequency was restored in groups 1 and 2 patients. However, during lactulose use, gastrointestinal discomfort persisted more frequently; not all patients reported normal stools at the medium recommended dose, which required an increase of the dose. However, there were episodes of loose stool, which required discontinuation of the medicine. The best results were achieved with the combination of diet and partially hydrolyzed OptiFibre dietary fibers, both in terms of restoration of stool regularity, relief of associated gastrointestinal symptoms, and tolerance of the dietary fibers.

Conclusion. Soluble dietary fiber OptiFibre, combined with diet therapy, restores regular stools and resolves constipation in pregnant women. It is well tolerated and safe to use in obstetric practice. The findings suggest using OptiFibre for constipation in pregnant women.

Gynecology. 2022;24(5):369-373
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Incidence of premature ovarian failure and early menopause in carriers of BRCA1 pathogenic variants

Rshtuni S.D., Chernukha G.E., Donnikov A.E., Tabeeva G.I., Burmenskaya O.V., Marchenko L.A.


Aim. To determine the incidence of premature ovarian failure (POF) and early menopause with regard to reproductive status in carriers of the pathogenic variant of the BRCA1 gene.

Materials and methods. According to the inclusion and exclusion criteria, out of 90 carriers of pathogenic variants of the BRCA1 gene, 38 females were included in the study group, and 110 females without these pathogenic variants were included in the control group. The reproductive status, age of menopause onset, history of pelvic surgeries, and palliative care were evaluated in the study groups.

Results. The incidence of POF in the group of carriers of pathogenic variants of the BRCA1 gene was significantly higher compared to the control group (p<0.004), while the incidence of early menopause showed no significant differences in the studied groups (13.2% vs. 4.5%, respectively; p<0,069). No significant differences were found in the analysis of reproductive status.

Conclusions. Females with and without pathogenic variants of the BRCA1 gene did not differ significantly by the main indices of reproductive status. Carriers of pathogenic BRCA1 gene variants have a significantly higher incidence of POF vs. controls. Adverse effects of pathogenic BRCA gene variants on women's ovarian reserve and reproductive potential cannot be excluded. Healthy carriers of pathogenic variants of the BRCA1/2 gene are recommended to plan pregnancy in the early reproductive period.

Gynecology. 2022;24(5):374-379
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Hormonal parameters and embryological outcomes of in vitro fertilisation/intra cytoplasmic sperm injection cycles in women using dydrogesterone for the prevention of premature luteinizing hormone surge during ovarian stimulation

Korneeva I.E., Kovalchuk A.I., Nazarenko T.A., Mityurina E.V., Perminova S.G., Bachurin A.V., Ivanets T.Y.


Aim. To evaluate the hormonal parameters and embryological outcomes of an ovarian stimulation protocol using dydrogesterone to prevent the premature LH surge in IVF/ICSI programmes.

Materials and methods. A prospective study randomised, including 79 women with normal ovarian reserve undergoing ovarian stimulation for IVF/ICSI with recombinant FSH (rFSH) from Day 2 or 3 of the menstrual cycle. To prevent the premature LH surge, participants in Group 1 (n=38) received oral dydrogesterone 20 mg/day from the start of ovarian stimulation until the day of ovulation trigger administration. Participants in Group 2 (n=41) received a GnRH antagonist. We evaluated the starting and total dose of gonadotropins, duration of stimulation, serum levels of LH, oestradiol and progesterone on Day 1 and 6 of stimulation and the day of trigger administration, number of retrieved and mature oocytes, fertilization rate, and the number of blastocysts and cryopreserved embryos.

Results. There were no significant differences in most hormonal parameters, characteristics of the ovarian stimulation and embryological outcomes between the two groups. Serum levels of progesterone in the dydrogesterone arm were higher than in the GnRH antagonist arm (2.3 nmol/l [2.0–3.4] vs 1.5 [1.0–2.4] nmol/l; p=0.026), but without any impact on the embryological outcomes.

Conclusion. Prevention of premature LH surge in ovarian stimulation cycles using oral dydrogesterone may represent a convenient alternative to the conventional use of GnRH antagonists, reducing the number of required injections and potentially increasing the convenience in patients who are not planning a fresh embryo transfer.

Gynecology. 2022;24(5):380-385
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Uterine leiomyosarcoma and disseminated peritoneal leiomyomatosis in the surgical treatment of uterine myoma: a retrospective analysis

Seregin A.A., Kosova Y.A., Seregina P.A., Ponomareva Y.N., Nadezhdenskaia A.B., Kirilova E.V., Asaturova A.V., Tregubova A.V., Magnaeva A.S., Ishchuk M.P., Ovodenko D.L.


Aim. To analyze the incidence and types of adverse outcomes and complications of laparoscopic myomectomies.

Materials and methods. This work is a retrospective study based on data from the Kulakov National Medical Research Center for Obstetrics, Gynecology, and Perinatology. We analyzed 711 case histories of patients diagnosed with uterine myoma who received surgical treatment in the Department of Innovative Oncology and Gynecology from 2015 to 2019. The frequency of malignant neoplasms, verified by pathomorphological examination, and the characteristics of surgical interventions performed in these patients were comparatively evaluated.

Results. Surgical interventions for uterine myoma are leading in gynecology due to the high prevalence of such disorders. Conservative myomectomy remains the "gold standard" in organ-sparing surgery. However, during surgeries for suspected benign neoplasms, there is a risk of morcellation of the malignant tumor, significantly worsening patient survival outcomes. In our study, the incidence of uterine leiomyosarcoma in suspected benign neoplasms was 0.98%. The probability of parasitic myomas or disseminated perineal leiomyomatosis after myomatous nodule morcellation is 0.19%.

Conclusion. No reliable information about the malignant potential of the tumor and its proliferative activity can be obtained until a definitive pathomorphological examination. The above considerations warrant the routine use of prophylactic measures to prevent tumor cell dissemination.

Gynecology. 2022;24(5):386-392
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Association of matrix metalloproteinase gene polymorphisms with different biological subtypes of breast cancer

Pavlova N.V., Ponomarenko I.V., Churnosov M.I.


Aim. To investigate the associations of matrix metalloproteinase (MMP) MMP3 (rs679620), MMP8 (rs1940475), and MMP9 (rs17576 and rs3787268) gene polymorphisms with different biological subtypes of breast cancer (BC).

Materials and methods. The study sample consisted of 285 patients with BC of various biological subtypes (luminal A and B [n=153], triple negative [n=108], and HER2 positive [HER2+, n=24]) and 746 females in the control group. Genotyping of four polymorphic sites of MMP3 (rs679620), MMP8 (rs1940475), and MMP9 (rs17576 and rs3787268) genes was performed in the study groups.

Results. The role of MMP gene polymorphisms in the BC development of various biological subtypes differs. The c.836 A>G MMP9 polymorphism (rs17576, the odds ratio is 0.67–0.71 for the G allele) has a protective effect on the development of luminal A- and B-subtypes of BC; susceptibility to triple-negative BC is associated with the polymorphic site c.1331-163 G>A MMP9 (rs3787268, OR 4.51 for genotype AA), and two polymorphisms of the MMP3 (c.133 T>C, rs679620, OR 0.46–0.49 for T allele) and MMP8 (c.259 T>C, rs1940475, OR 0.37–0.48 for T allele) genes are associated with HER2+ BC development. According to the in silico data, the above polymorphisms have pronounced functional effects in organs and tissues that are pathogenetically significant for the disease, including the target organ, the breast.

Conclusion. The c.836 A>G MMP9 (rs17576) polymorphism is associated with luminal A- and B-subtype of BC; c.1331-163 G>A MMP9 (rs3787268) is associated with triple negative BC, and c.133 T>C MMP3 (rs679620) and c.259 T>C MMP8 (rs1940475) are involved in HER2+ BC development.

Gynecology. 2022;24(5):393-398
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Options for overcoming implantation failures in infertility of uterine genesis due to chronic endometritis. A review

Krasnopolskaya K.V., Mikhaleva L.M., Orazov M.R., Dolgov E.D.


Chronic endometritis remains one of the most controversial issues of modern gynecology. The high relevance of research in this area is confirmed not only by the high prevalence but also by the extremely negative impact of this disease on the reproductive potential of patients. The complexity of the pathogenesis mechanism of the chronic inflammatory process of the endometrium stimulates the genuine interest of the world gynecological community to study the main patterns of endometrial receptor disorder, including implantation status and repeated reproductive failures. In this regard, it is essential to summarize the accumulated results of worldwide research to find the most optimal and effective diagnostic and therapeutic approaches.

Gynecology. 2022;24(5):400-407
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Vulvovaginal atrophy in the peri- and post-menopause: relevance and impact on quality of life

Orazov M.R., Silantyeva E.S., Radzinsky V.E., Mikhaleva L.M., Khripach E.A., Dolgov E.D.


Vulvovaginal atrophy (VVA) is detected in more than 50% of postmenopausal women, and at 40–49 years of age, 15-19% of women have relevant signs. Atrophic changes in the female urogenital system are associated with hypoestrogenism, which results in the defective synthesis of collagen and elastin due to reduced functional activity of fibroblasts. Although the symptoms of genitourinary syndrome of menopause significantly impair the quality of life, women rarely seek medical help for urogenital symptoms, considering them a normal condition for the period of aging. We searched Cochrane Library, PubMed, Science Direct, and ELibrary databases for the keywords vulvovaginal atrophy, genitourinary syndrome of menopause, quality of life, epidemiology, and postmenopausal age for 2012–2022. The literature review suggests that the prevalence of VVA is extremely high but underestimated due to the infrequent seeking of medical care by female patients with relevant symptoms. The genitourinary syndrome of menopause dramatically impacts patients' quality of life, but not all women eligible for treatment receive it. One of the reasons for refusing hormonal treatment is patients' fear of the systemic effects of hormonal drugs. There is an unmet need for alternative non-hormonal therapies. The objective is to analyze and systematize the scientific data accumulated over the past ten years on the epidemiology of VVA, its impact on patients' quality of life, and the challenges in diagnosing and treating the disease.

Gynecology. 2022;24(5):408-412
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Female genital tuberculosis: a clinical lecture

Kulchavenya E.V.


The problem of extrapulmonary tuberculosis (EPT) remains urgent since, along with a decrease in the incidence of the disease, there is an increase in the number of neglected, late diagnosed cases. Female genital tuberculosis (FGT) is a relatively rare disease difficult to diagnose, occurring on average in 0.5–2.0 cases per 100,000 population; in recent years, an increase of EPT in this localization has been observed. Tuberculosis can affect any organ of the female genital system, either single or in combination. The most frequently involved are the tubes (95–100%), endometrium (50–60%), ovaries (20–30%), cervix (5–15%), myometrium (2.5%) and vagina/vulva (1%). The most common symptom of FGT that makes patients seek medical advice is infertility. Other symptoms of FGT include menstrual irregularities (oligo-, hypo-, dis-, amenorrhoea as well as meno- and metrorrhagia), pelvic pain, and abnormal vaginal discharge. In postmenopausal women, FGT is characterized by symptoms resembling endometrial malignancy, such as postmenopausal bleeding, persistent leukorrhea, and pyometra. The diagnosis is based on a thorough history, clinical examination, and proper examination of the sample material obtained by endoscopy. Tuberculin test with intradermal injection of 2 TU of tuberculin (Mantoux test) was positive in 42.6% of patients with genital tuberculosis. Hysterosalpingography is an important method for diagnosing FGT, which assesses the internal structure of the female reproductive tract and the patency of the fallopian tubes. On ultrasound, the fallopian tubes may appear dilated, thickened, or filled with serous discharge (hydrosalpinx) or caseous mass (pyosalpinx). Laparoscopy and dye hydrotubation are reliable tools for the diagnosis of genital tuberculosis, especially for the involvement of the fallopian tubes, ovaries, and peritoneum. Microbiological examination of sampled material in FGT using solid media is low-informative; polymerase chain reaction and other molecular diagnostic methods should be used. It should be acknowledged that FGT is not a rare condition, but it is often overlooked. The two main reasons for late diagnosis are vague clinical signs and low alertness. Since infertility is a frequent complication of FGT, all infertile women should be screened for tuberculosis: tuberculin, ultrasound, hysterosalpingography, and in complicated cases, diagnostic laparoscopy with obligatory tissue sampling for pathomorphological and microbiological studies.

Gynecology. 2022;24(5):413-420
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Novel prospects in cervical incompetence treatment

Sinchikhin S.P., Stepanyan L.V., Kimaeva A.K., Sinchikhina E.S.


Background. A "Method of cervical incompetence treatment in pregnant women" (RF patent for invention №2746437, priority dated December 25, 2019) is presented. Method details are described.

Aim. To evaluate the efficacy and safety of the novel cervical incompetence (CI) treatment method in pregnant women.

Materials and methods. The study included 150 pregnant women divided into three groups, with 50 subjects in each group. Group 1 included pregnant women with CI who received the novel treatment method (narrowing of the dilated cervical canal with a flexible tape with a fixation lock); Group 2 included pregnant women who underwent surgical correction of CI (U-shaped sutures to the cervix); Group 3 included pregnant women with the initial stage of CI, in whom obstetric pessaries were used. Patients in the groups were comparable in age, reproductive behavior, somatic diseases, and obstetric and gynecological history.

Results. After CI correction, different early complications were observed in 20, 66, and 34% of pregnant women by groups, respectively. The novel method of narrowing the dilated cervical canal with a flexible loop with a fixation lock is technically a simpler manipulation than surgical suturing of the cervix with a prolapsed amniotic sac. Clinical signs of threatening miscarriage in subsequent gestational periods occurred in 22% of patients in Group 1, 64% of Group 2, and 28% of Group 3. Full-term delivery was reported in 88, 68, and 84%, respectively.

Conclusion. The novel method of CI correction is technically simple, clinically- and cost-effective. Furthermore, this method does not involve using medications that can affect the pregnant woman and the fetus.

Gynecology. 2022;24(5):421-426
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A review of international and national clinical guidelines for the management of patients with endometrial polyps

Orazov M.R., Mikhaleva L.M., Poymanova O.F., Mullina I.A.


Endometrial polyp (EP) is a common disease of the uterine mucosa in reproductive age, peri- and post-menopause. Hysteroscopy is the primary method of diagnosing EP, and polypectomy is the method of choice for treatment. Despite many years of research on EP, there are still gaps in the understanding of its pathogenesis; approaches to the diagnosis and therapy of EP are not standardized, which makes it difficult for gynecologists to make informed decisions about the management of patients with this disease. It determined the focus of our work. We reviewed clinical guidelines for EP diagnosis and treatment from the American Society of Gynecological Endoscopy, the Norwegian Society for Gynecology and Obstetrics, the draft clinical guidelines "Endometrial polyps" from the Russian Society for Obstetrics and Gynecology (as of July 28, 2022, not approved by the Russian Ministry of Health); as well as the Royal College of Obstetricians and Gynecologists guideline on the management of women with endometrial hyperplasia. The review has led to the conclusion that the recommendations in the current clinical guidelines for the management of women with EP are inconsistent and the diagnostic algorithm for suspected EP is not well-established; the indications for the wait-and-see, surgical treatment of EP are not defined; criteria of high oncological risk requiring surgical treatment of EP are not formulated. Clarifying these issues will help gynecologists make informed decisions about treatment options.

Gynecology. 2022;24(5):427-431
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Complete repeat cytoreduction under regional anesthesia in a patient with myasthenia gravis: a clinical case

Chukhnov S.A.


The article summarizes the published data on the prevalence, pathogenesis, features of clinical presentation, and treatment of myasthenia gravis and myasthenic crises. Particular attention is paid to the anesthesia method choice and perioperative management of patients with myasthenia gravis. A clinical case of successful combined spinal-epidural anesthesia for complete repeat cytoreductive surgery in a patient with moderate myasthenia gravis is presented.

Gynecology. 2022;24(5):432-435
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Decreased sexual desire in a patient with infertility: a clinical сase

Stenyaeva N.N., Chritinin D.F.


The article addresses the problem of decreased sexual desire in an infertile female with a decreased ovarian reserve who needs to use assisted reproductive technologies. Short-term psychotherapy as part of rational and cognitive-behavioral therapy was used; psychotherapeutic procedures with relaxing breathing techniques and a method of nonconscious audiovisual psychocorrection were described.

Gynecology. 2022;24(5):436-439
pages 436-439 views

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