Vol 25, No 1 (2023)


Conservative treatment strategies for endometrioid ovarian cysts: A review

Makarenko T.A., Galkina D.E., Borisova E.A.


Endometriosis remains one of the most topical diseases in current gynecology and is a multifactorial condition with an overgrowth of tissue morphologically and functionally similar to the endometrium outside the uterine cavity. One of the most frequently diagnosed forms of endometriosis is endometrioid ovarian cysts. An important feature of the clinical course of ovarian endometriosis is its negative impact on reproductive function and the recurrent nature of the disease, which may require repeated surgeries with even greater damage to the ovarian tissue. Therefore, the development of a long-term drug treatment strategy for patients with a history of endometrioid cysts aimed at preventing recurrences is urgently needed. According to domestic and foreign clinical guidelines, progestagen hormone therapy is recommended as first-line therapy for such patients. One of the most clinically studied drugs with a favorable efficacy and safety profile proven in numerous studies is dienogest. The paper presents the experience of foreign and domestic authors in conservative therapy in patients with a history of endometrioid cysts using dienogest in terms of recurrence prophylaxis.

Gynecology. 2023;25(1):4-10
pages 4-10 views

Diagnostic features of polycystic ovary syndrome: A review

Kravchenko E.N., Khomutova E.Y., Engurazova E.N., Vorontsova M.S.


Currently, the diagnostic criteria for polycystic ovary syndrome (PCOS) are focused on the stratification of subtypes by metabolic features. Depending on the identified subtype, treatment options are revised following the management goal: improvement of the hyperandrogenism symptoms, menstruation regulation, and fertility recovery. The PCOS diagnostic features, including ultrasound pattern, are essential for the diagnosis. Future studies should focus on the health effects of postmenopausal women with PCOS.

Gynecology. 2023;25(1):11-16
pages 11-16 views

Human papillomavirus: etiology, pathogenesis, role, and importance in the development of cervical cancer: A review

Ziganshin A.M., Keidar S.V., Khalitova R.S., Mulyukov A.R., Muhamed'yarova E.N.


Human papillomavirus (HPV) is now considered the most common sexually transmitted infection. Since the discovery by Nobel laureate Harald zur Hausen (2008) of HPV as a virus with a high carcinogenic risk, the strategy for screening and prevention of this disease has changed dramatically. It has significantly increased the relevance of the study of this infection. Although HPV is not life-threatening, its highly oncogenic subtypes can lead to the development of cervical cancer with high mortality.

Gynecology. 2023;25(1):17-21
pages 17-21 views

The etiopathogenesis of uterine leiomyomas: A review

Alali O.M., Churnosov M.I.


Background. The most frequent female reproductive system tumors are uterine leiomyoma (UL). They are benign monoclonal tumors of uterine smooth muscle. They affect reproductive-age women with a lifetime prevalence of 30–70%. UL is a disease with complex etiology determined by many genetic and environmental factors. Despite the frequency of UL, there is no long-term, cost-effective or fertility-preserving therapy option for it.

Aim. To summarize the available literature data on the etiopathogenesis of uterine fibroids as well as the risk factors for the development of this disease.

Materials and methods. The PubMed, Scopus, and Web of science literature databases were searched for relevant articles using such keywords as uterine fibroids, UL, association, genetic and hormonal factors, gene, etiology in various combinations.

Results. Genetic disorders and hormonal and growth factors all have a part in the etiology of UL, and studies have resulted to the use of hormone therapy for fibroids, with varying results. Recent findings on the etiopathogenesis of UL, as well as the introduction of relevant genetically modified mouse models of UL, have rekindled interest in the disease. In this review, the basic features of fibroids are discussed, as well as the primary contributors to UL etiopathogenesis, including as genetic, hormonal, and growth causes. Besides the risk factors that contribute to the development of UL.

Conclusion. Many questions about the causes and mechanisms of development factors that predispose remain unanswered, necessitating the continuation of these studies in order to obtain new information. Prospective studies are needed to better understand the biology and epidemiological associations, both to better understand modifiable risk factors and to shed light on the etiopathogenesis of this disease.

Gynecology. 2023;25(1):22-30
pages 22-30 views

The effect of pelvic organ prolapse and various options for its correction on female sexual function: A review

Podzolkova N.M., Osadchev V.В., Glazkova O.L., Babkov K.V., Denisova Y.V.


The sexual activity of patients before and after the treatment of pelvic organ prolapse (POP) largely determines their quality of life and satisfaction with the intervention. This review analyzes current data on the nature of changes in sexual function in various pelvic organ prolapse correction methods. Particular attention is paid to a comparative assessment of the effect of available surgical techniques with abdominal and vaginal access on the risk of de novo dyspareunia. Based on the results of clinical studies and systematic reviews, the most optimal ways of correcting POP have been established; tools for assessing their effectiveness in routine clinical practice have been proposed; the importance of an interdisciplinary approach to the treatment of POP with the involvement of medical psychologists has been noted due to the significant role of emotional and behavioral factors in sexual dysfunction.

Gynecology. 2023;25(1):31-38
pages 31-38 views

Pathogenesis of dyspareunia associated with pelvic floor dysfunction: A review

Silantyeva E.S., Orazov M.R., Khamoshina M.B., Astafeva E.K.


Dyspareunia is a condition associated with a wide range of disorders. Pelvic floor dysfunction, manifesting as a myofascial syndrome or pelvic floor muscle hypertonia, may predict dyspareunia in women in different age groups. The review addresses the current view on the dyspareunia pathogenesis associated with pelvic floor muscle dysfunction.

Gynecology. 2023;25(1):39-42
pages 39-42 views


The incidence of HPV infection of high carcinogenic risk in women of the Kemerovo region

Artymuk N.V., Breus A.V., Artymuk D.A.


Aim. Toassess the prevalence of various types of human papillomavirus (HPV) of high carcinogenic risk (HCR) and the rate of abnormal findings of cytological examination in HPV-positive and HPV-negative women of the Kemerovo region.

Materials and methods. A continuous cross-sectional study was conducted. The study included 675 women aged 21 to 65 (mean age 40.5±10.6 years) residing in the Kemerovo region. Patients were sampled from the cervical canal for semi-quantitative HPV-typing and cytological examination with Papanicolaou staining (PAP-test) using a liquid-based cytology method. For HPV-positive patients, an HPV typing with the quantification of 14 HCR HPV types was performed by polymerase chain reaction with real-time detection. Statistical data processing was performed using the StatSoft Statistica 6.1 software bundle.

Results. The mean rate of HCR HPV detection in women of the Kemerovo region in the age group of 21–65 years is 17.8% and decreases with age. HPV type 16 prevailed and was detected in 31.6% of women. In 19.2% of women, the HPV subtype 31 was diagnosed; in 18.3%, the subtype 35; in 16.7%, the subtype 33. The HPV subtypes 39, 56, and 66 were the rarest. One subtype of HCR HPV was detected in 26.7% of women, two subtypes in 6.7%, and three or more subtypes in 66.6% of women. According to the cytological examination, CIN 1, 2, and 3 rates were 3.3, 0.8, and 0.7%, respectively. HSIL (CIN 2–3) was detected in 1.5% of cases, LSIL (CIN 1) in 3.3%. The rate of CIN 1 in HPV(+) women was higher: 13.3% vs 1.0% in HPV(-) (χ2=43.197; p<0.001). CIN 2 and CIN 3 were reported in HPV(+) patients only. HSIL+ was diagnosed in 7.9% of HPV(+) females (χ2=39.778; p<0.001).

Conclusion. Thus, the study results showed that the mean infection rate of HCR HPV in women of the Kemerovo region at the age of 21–65 years is 17.8% and decreases with age. HPV subtype 16 is predominant; subtypes 31, 35, and 33 were less common. In HPV-positive women, abnormal findings of cytological examination were significantly more common.

Gynecology. 2023;25(1):44-48
pages 44-48 views

Prediction of adenomyosis in patients with uterine fibroids

Shramko S.V., Zorina V.N., Vlasenko A.E., Sabantsev M.A.


Aim. To determine the clinical, anamnestic, and immunological predictors of adenomyosis by developing a prognostic model of uterine fibroids with concomitant adenomyosis.

Materials and methods. A retrospective single-center study was conducted at Kurbatov Novokuznetsk City Clinical Hospital №1, from 2012 to 2019. The model included 284 women with histologically confirmed uterine fibroids, of which 34.9% (99/284) were fibroids with adenomyosis and 65.1% (185/284) were “isolated” uterine fibroids. Logistic regression was used to develop the mathematical model.

Results. Predictors of adenomyosis in patients with uterine fibroids have been established: age 43 years and older, concomitant endometrial hyperplasia, chronic inflammatory diseases of the cervix, menometrorrhagia, history of childbirth, history of endometrial disorders, varicose veins of the lower extremities, history of appendectomy, blood serum lactoferrin of more than 1.8 mg/L, interleukin-6 levels more than 2.8 pg/mL. The model has an accuracy of 91%, a sensitivity of 90%, a specificity of 92%, a positive predictive value of 85%, and a negative predictive value of 94%.

Conclusion. The established predictors of adenomyosis allow for predicting the risk of adenomyosis in patients with uterine fibroids, facilitating effective treatment choices.

Gynecology. 2023;25(1):49-54
pages 49-54 views

Flucovag: efficacy and safety in patients with vulvovaginal candidiasis: a prospective, multicenter, open-label, randomized, comparative clinical study

Kutueva F.R., Glushakov R.I., Tapilskaya N.I., Nikolaeva A.E., Poromov A.A., Pustotina O.A.


Design. A prospective, multicenter, open-label, randomized, comparative clinical study.

Objective. To compare the efficacy and safety of Flucovag (sertaconazole) vaginal suppositories, 300 mg (OTCPharm JSC, Russia; manufactured by Altpharm LLC, Russia) and the brand-name drug Zalain® (sertaconazole), 300 mg (Egis Pharmaceuticals PLC, Hungary) in the treatment of vulvovaginal candidiasis.

Materials and methods. The study included female patients (18–55 years old) with uncomplicated vulvovaginal candidiasis treated in outpatient settings. In total, 220 patients were randomized into two groups: group 1 (n=110) received a single dose of Flucovag vaginal suppositories, and group 2 (n=110) received a single dose of Zalain® vaginal suppositories. Seven days after the treatment, its clinical efficacy was evaluated. In case of incomplete clinical improvement after 7 days, patients received an additional dose of Flucovag (n=4) or Zalain (n=5) suppositories, respectively.

Results. At the end of therapy in the study groups, the clinical cure rates (99.1% vs. 96.3%, p≥0.05), microscopic, and culture results were comparable. No serious adverse events were reported in both groups throughout the study.

Conclusion. The study results demonstrate a favorable safety profile and high antifungal activity of sertaconazole.

Gynecology. 2023;25(1):55-61
pages 55-61 views


A pilot study of the intrauterine non-ablative erbium laser effectiveness in the endometrium preparation for cryopreserved embryo transfer in women with a history of implantation failures

Pustotina O.A., Gashenko A.A., Ustinova E.I., Lishova E.A., Lopatina A.V., Techiieva Z.S., Vizintin Z.


Background. Embryo implantation failure remains an urgent issue of assisted reproductive technologies (ART).

Aim. To determine the effect of intrauterine irradiation with a non-ablative erbium laser on the endometrium state using the histological and immunohistochemical examination and to evaluate its effectiveness in ART cryo-protocols.

Materials and methods. The study enrolled 25 women aged 26–45 with 1 to 5 failed implantations who were planning a pregnancy in a cryopreserved embryo transfer protocol. On days 6–10 of the menstrual cycle, all patients underwent a single procedure of intrauterine irradiation of the endometrium and cervical canal mucosa with an erbium laser in a non-ablative mode using Fotona SP Dynamis laser system (Slovenia). The histological and immunohistochemical data of the endometrium before and 1–2 months after the procedure and the pregnancy rate with subsequent transfer of the cryopreserved embryo were assessed.

Results. Intrauterine irradiation with a non-ablative erbium laser increased the proliferative activity of the endometrium (p=0.029), the expression of vascular endothelial growth factor (p=0.029), reduced the sclerosis lesions in the spiral arteries and endometrial stroma, increased the expression of progesterone and estrogen receptors, thus significantly increasing the effectiveness of the ART cryo-protocols (p=0.013).

Gynecology. 2023;25(1):62-71
pages 62-71 views

Anemia in women of reproductive age in current clinical practice and effectiveness of iron fumarate combined with folate

Sturov V.G., Melchenko N.I., Balysheva A.S.


Iron deficiency anemia (IDA) and latent iron deficiency are common. The article describes the mechanisms of development, diagnostic criteria, the clinical presentation of the IDA. The current options for treating anemia with oral iron supplements and their indications, effectiveness and safety criteria.

Aim. To analyze and prove the effectiveness of iron fumarate combined with folate for treating and preventing iron deficiency in women of reproductive age.

Materials and methods. Sixty women aged 18–47 with mild to moderate iron deficiency were examined. All patients received of iron fumarate (equivalent to 150 mg of elemental iron) combined with 1500 mcg of folic acid for 21–42 days. Hemoglobin, ferritin, serum iron, and erythrocyte indices were measured.

Results. In most patients, recovery from anemia was observed: an increase in hemoglobin by 27–32% and ferritin by a mean of 35%, i.e., 1.67 times compared with alternative iron therapy (iron sulfate and gluconate). The rate of side effects was less than 4%.

Conclusion. Co-administration of iron fumarate with folic acid has been shown to increase the therapeutic efficacy and has a high safety profile in patients with IDA (especially in pregnant women requiring additional folate supplements).

Gynecology. 2023;25(1):72-76
pages 72-76 views

Historical aspects and current view for device-based endometrial destruction

Sinchikhin S.P., Kostenko E.V., Stepanyan L.V., Sinchikhina E.S.


A historical perspective on the issue of device-based endometrial destruction is presented. The article describes in detail various current methods of thermal coagulation of the uterine mucosa for its destruction. A comparative analysis of hysteroscopic and non-hysteroscopic methods of endometrial destruction in terms of treatment effectiveness, complications, and recurrence prevention is presented. The ways of technological development of instrumental treatment methods of intrauterine disorders are highlighted.

Gynecology. 2023;25(1):77-83
pages 77-83 views

Extrapelvic endometriosis: the mystery of the "black square" or "quintessential classics"?

Orazov M.R., Radzinsky V.E., Dolgov E.D., Abramashvili Y.G.


Endometriosis is still one of the most mysterious and urgent gynecological diseases. The prevalence of endometriosis is steadily increasing, despite the development of innovative methods of diagnosis and treatment. Endometriosis is the presence of a heterotopic endometrium outside the uterine cavity and most often affects the pelvic organs. However, more and more often, the world medical community actualizes the study of extrapelvic endometriosis as a unique clinical entity with specific pathogenetic patterns, approaches to verification, and therapeutic concepts. The article summarizes and systematizes the current scientific data on pathogenesis, clinical phenotypes, and therapy of extrapelvic endometriosis.

Gynecology. 2023;25(1):85-90
pages 85-90 views

Laparoscopic correction of pelvic organ prolapse and stress urinary incontinence: a current view of the problem

Dobrohotova Y.E., Taranov V. ., Lapina I.A., Tyan A.G., Chirvon T.G., Glebov N.V., Kaykova O. ., Malakhova A.A.


Pelvic organ prolapse refers to a group of multidisciplinary disorders with various etiological components involved in its pathogenesis, destabilizing the ligamentous and musculofascial apparatus. In most cases, pelvic floor dysfunction requires surgical treatment, eliminating existing defects and clinical symptoms and improving patients' quality of life. Corrective surgery for genital prolapse by laparoscopic approach is highly effective and is associated with a low risk of adverse clinical outcomes. However, despite the significant progress and improvement of surgical treatment options, choosing the optimal treatment method based on a personalized approach remains an urgent issue. This literature review reviews traditional and alternative methods of laparoscopic correction of pelvic organ prolapse.

Gynecology. 2023;25(1):91-94
pages 91-94 views

Sexual dysfunction: an interdisciplinary problem of classical gynecology

Podzolkova N.M., Sumyatina L.V.


Sexual dysfunction in women is a complex interdisciplinary medical problem that remains beyond the attention of an obstetrician-gynecologist and negatively affects a woman's quality of life and well-being. The article presents data on prospects for using herbal agents based on the chasteberry fruit extract (Vitex agnus-castus, chaste tree) in women with sexual dysfunction.

Gynecology. 2023;25(1):95-101
pages 95-101 views

Effect of an estetrol/drospirenone contraceptive on sexual function in women of reproductive age

Orazov M.R., Ermakov V.V., Novginov D.S.


The use of hormonal contraception is widespread worldwide. Over the years of use, it has been possible to study its contraceptive effectiveness and its effect on carbohydrate metabolism, blood coagulation, lipid profile, liver function tests, and other systems and organs. However, the effect on sexual function has not been sufficiently studied. For a long time, ethinylestradiol remained the main estrogen in combined oral contraceptives; however, the desire to improve safety led to the development of a new drug containing natural, highly selective estrogen estetrol and the well-known progestogen drospirenone. Therefore, it is relevant to study the effect of the new combined oral contraceptive on sexual function.

Gynecology. 2023;25(1):102-105
pages 102-105 views

Evaluation of the effectiveness of an antimicrobial peptide-cytokine product in the complex treatment of pregnant women with asymptomatic bacteriuria

Sinchikhin S.P., Salov I.A., Proskurina E.V., Sinchikhina E.S.


Background. Asymptomatic bacteriuria in pregnant women can contribute to urological and gestational complications. Antibiotic therapy is recommended in patients with 105 CFU/mL and above in the urine. However, choosing antimicrobial therapy is challenging for those with 103–104 CFU/mL.

Aim. To assess the effectiveness of Superlymph® combined with phytotherapy in pregnant women with asymptomatic bacteriuria.

Materials and methods. Pregnant women aged 21 to 38 with asymptomatic bacteriuria (bacterial count of 103–104 CFU/mL), comparable in age, reproductive history, and extragenital comorbidities, were divided into three groups. In group 1 (32 subjects), Superlymph® and a herbal medicine containing centaury, lovage root, and rosemary leaves were used. In group 2 (33 subjects), only the herbal medicinal product was used. In group 3 (35 subjects), the above drug products were not used. The patients received the herbal medicinal product containing centaury, lovage root, and rosemary leaves 2 tablets TID for 14 days. Superlymph® was administered intravaginally (1 suppository [10 units] BID for 10 days). A follow-up urine culture for groups 1 and 2 was taken 2–3 weeks after the completion of therapy, and for patients of group 3, 2–3 weeks after the previous culture. A routine general clinical assessment of pregnant women was performed. Statistical analysis was carried out using the Statistica 12.0 software.

Results. Patients of the main group that received the peptide-cytokine and herbal medicinal products had the most significant improvement compared with pregnant women of other groups, as shown by complete eradication from the urinary tract of Escherichia coli, improved urinary laboratory tests, cytology, and fewer gestational complications. Premature onset of labor was significantly less common (6-fold) in patients of the main group versus controls, who refused the proposed therapy for asymptomatic (moderate) bacteriuria.

Conclusion. The addition of peptide-cytokine agent Superlymph® increases the treatment effectiveness in pregnant women with asymptomatic bacteriuria.

Gynecology. 2023;25(1):106-111
pages 106-111 views


Endometriosis of the surgical scar of the anterior abdominal wall. Case report

Baklygina E.A., Pchelintsev V.V., Pristupa E.M., Markin A.V.


Endometriosis is the presence of tissue with morphological and functional features similar to endometrium outside the uterine cavity. Endometriosis affects approximately 10% of women worldwide, mostly of reproductive age. The rate of extragenital endometriosis is 0.3–3.5%. Diagnosis of endometriosis of the anterior abdominal wall is complex and includes analysis of clinical and medical history data, ultrasound, magnetic resonance imaging, and histological examination of the removed tissues. The article presents a clinical case of a large lesion of extragenital endometriosis localized in the subcutaneous fat of the anterior abdominal wall in a patient with a history of cesarean section. The main clinical manifestations of this disorder were cyclic pain during menstruation and an enlargement of the existing mass in the subcutaneous fat.

Gynecology. 2023;25(1):112-115
pages 112-115 views

Terlipressin in obstetric and gynecological practice: a case of a missed miscarriage in late pregnancy complicated by bleeding. Case report

Tskhay V.B., Yametov P.K., Raspopin Y.S., Yametova N.M., Polstyanaya G.N., Ryabinin D.A.


A few randomized multicenter studies indicate that prophylactic vasopressin in obstetric and gynecological surgeries is mainly safe and associated with a significant reduction in intraoperative blood loss. This article reviews recent scientific papers describing the use of vasopressin in obstetric and gynecological practice with an assessment of its effectiveness depending on the dose and route of administration. We present a clinical case demonstrating that drugs with a vasopressor effect, in particular terlipressin, in a patient with uterine bleeding after a late induced miscarriage allowed to obtain an excellent hemostatic effect and avoid the need for additional methods of surgical hemostasis.

Gynecology. 2023;25(1):116-120
pages 116-120 views

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