Vol 25, No 3 (2023)

Aim. To assess the impact of new coronavirus infection (NCI) and COVID-19 vaccination on menstrual function in comparison with the frequency of depressive disorders during the COVID-19 pandemic among female students of a medical university.

Materials and methods. Data for a continuous transverse (cross-sectional) study were obtained using an online survey. The questions included demographics, characteristics of menstrual function, the history of COVID-19 and vaccinations against it, and the standard CES-D (Center for Epidemiologic Studies Depression Scale) questionnaire. The survey included 1.879 female medical students. The exclusion criteria were age under 18 and over 25 years, hormonal contraceptives, pregnancy, childbirth during the last year, and vaccination after COVID-19. After applying the exclusion criteria, three study groups were formed. Group 1 included female students with a history of NCI (n=140), group 2 included students with no history of NCI, who were initially vaccinated against COVID-19 (n=647), group 3 (control group) included unvaccinated students with no history of NCI (n=55).

Results. There were no differences in the prevalence of changes in menstrual function in female students after the NCI (49.3%) and after COVID-19 vaccination (39.6%) compared to the control group (43.6%); p=0.477. The rate of depression in the overall study cohort was 43.3%, without any significant differences between the study groups. Significant predictors of changes in menstrual function during the pandemic were marriage (odds ratio – OR 2.33 [1.51–3.61]), depression (OR 1.72 [1.28–2.3]), a history of menstrual dysfunction (OR 1.5 [0.12–1.99]), and later menarche (OR 1.76 [1.02–3.04]). Multivariate analysis did not show the significance of the history of NCI and vaccination as factors of menstrual dysfunction (OR 1.61 [0.89–2.90] and OR 0.91 [0.59–1.41], respectively).

Conclusion. During the COVID-19 pandemic, female medical students reported frequent changes in menstrual function and depressive disorders. During the pandemic, the most significant predictors of menstrual disorders in female students were depression, a history of menstrual dysfunction, and marriage. A multicenter prospective study is necessary to clarify the mechanisms of the pandemic's impact on menstrual function.

Aim. To assess the incidence and severity of new persistent symptoms in somatically healthy young women with and without a history of COVID-19.

Materials and methods. The main study group included patients who had PCR-confirmed COVID-19 in July–October 2021 (n=181); the comparison group included women without COVID-19 during this period (n=71). Inclusion criteria: female sex, age 18–35 years, no pregnancy, overweight/obesity, diabetes mellitus, chronic hypertension, premenstrual syndrome, and other somatic and/or chronic infectious diseases. Post-COVID syndrome (PCS) was diagnosed based on symptoms absent before COVID-19, appeared >4 weeks from the disease onset, and lasted at least 2 months, which could not be explained by alternative diagnoses. We used primary medical records and interviewed patients using a special questionnaire to develop a statistical database. The severity of symptoms was assessed using a 10-point scale.

Results. New persistent symptoms during the pandemic in young, initially somatically healthy women with and without COVID-19 were reported with similar frequency: 96.1 and 93.0%, respectively (odds ratio – OR 1.88, 95% confidence interval – CI 0.58–6.14; pχ²=0.327). Only patients with COVID-19 reported cough (43.6%), shortness of breath (26.5%), chest pain (18.2%), weight loss (18.8%), hair loss (60.8%); in the comparison group, these symptoms were not reported; pχ²<0.001. Patients with PCS were more likely to experience memory impairment – 49.2% vs 12.7% (OR 6.66, 95% CI 3.13–14.21; pχ²<0.001); headache – 43.1% vs 11.3% (OR 5.96, 95% CI 2.7–13.17; pχ²<0.001); depression – 19.9% vs 8.5% (OR 2.69, 95% CI 1.08–6.7; pχ²=0.029); myalgia – 31.5% vs 8.5% (OR 4.98, 95% CI 2.04–12.17; pχ²<0.001). Patients of both groups showed similar frequency of fatigue (69.0% vs 71.8%; pχ²=0.66), drowsiness (54.9% vs 43.6%; pχ²=0.11), palpitations (19.7% vs 29.8%; pχ²=0.1), menstrual cycle changes (22.5% vs 21.0%; pχ²=0.865), and skin manifestations (2.8% vs 6.6%; pχ²=0.24). COVID-19 survivors had a more pronounced memory impairment (4.0 vs 1.0 points; p<0.001), headache (5.0 vs 3.0 points; p=0.001), myalgia (5.0 vs 1.0 points; p<0.001) and less severe insomnia (3.0 vs 5.0 points; p=0.004).

Conclusion. The PCS symptoms are common in initially somatically healthy women of early reproductive age. Similar symptoms in women with no history of COVID-19 may be due to post-traumatic stress anxiety disorder. Further interdisciplinary research is needed to identify the pathophysiological mechanisms for the occurrence of new persistent symptoms in different age and social groups during the COVID-19 pandemic.

Aim. To evaluate the endometrial microbiota in patients with uterine scar defect after cesarean section.

Materials and methods. The study included 80 women of reproductive age. The main group included 50 patients with a uterus scar defect due to cesarean section; the comparison group included 30 women with a competent uterus scar due to cesarean section. Patients underwent a Pipelle endometrial biopsy on days 20–22 of the menstrual cycle using a double-lumen catheter that excludes sample contamination with vaginal and cervical microflora. A molecular genetic study of the endometrium was performed by real-time polymerase chain reaction using the Femoflor 16 reagent kit (DNA-Technology

Moscow). The DNA content in the specimen was measured using software and expressed in genome equivalent (GE) proportional to the number of microorganisms. The statistical data were processed using the Exсel software package and SPSS Statistics 22.0.

Results. The study showed the following statistically significant differences: lower count of Lactobacillus spp. – 2.600 (1.430–3.600) GE/mL vs 3.550 (2.800–4.700) GE/mL in patients of the comparison group (p=0.02); higher count of Streptococcus and Staphylococcus spp. – 3.270 (3.000–3.700) GE/mL and 3.450 (3.200–3.600) GE/mL vs 1.030 (0.760–1.700) GE/mL and 0.560 (0.120–1.200) GE/mL in the comparison group, respectively (p<0.00001); higher count of Enterobacteriaceae – 2.700 (1.700–3.300) GE/mL vs 0.950 (0.660–1.120) GE/mL in the comparison group (p<0.00001); higher count of Gardnerella/Prevotellabivia/Porphyromonas spp. – 2.310 (0.930–3.480) GE/mL vs 1.000 (0.000–1.860) GE/mL (p=0.003); higher count of Peptostreptococcus spp. – 0.195 (0.000–1.560) GE/mL vs 0.000 (0.000-0.000) GE/mL (p=0.032); Eubacterium spp. – 1.355 (0.100–2.460) GE/mL vs 0.000 (0.000–1.560) GE/mL (p=0.040).

Conclusion. Endometrial dysbiosis in patients with a uterus scar defect after cesarean section due to the possible effects of microorganisms can be considered one of the leading causes of the formation of a uterus scar defect in the postoperative period.

The analytical review presents data from the world literature, which discusses the relevance of vulvar intraepithelial neoplasia associated with human papillomavirus (uVIN). The incidence of uVIN is steadily increasing, especially in young women, and 10–11.2% of cases can progress to vulvar carcinoma. More than 50% of uVIN cases are associated with anogenital diseases associated with the human papillomavirus, which determines the need for a comprehensive assessment and proper treatment of uVIN patients.

Breast diseases (BD) are among the most urgent issues of modern reproductive medicine. This organ is an integral part of the female reproductive system and undergoes cyclic changes during the menstrual cycle. The modern "nosological trio" of BD is mastodynia, benign dysplasia, and breast cancer. These diseases have an extremely high prevalence, and breast cancer, in turn, ranks 1st in the structure of mortality from malignant neoplasms of the female reproductive system. All these aspects warrant the research of the key pathogenetic mechanisms of these conditions. However, one of the most relevant topics in modern gynecology is the counseling on the selection of contraceptive methods in these patients. Therefore, it is necessary to address the safety of hormonal contraceptive methods and to analyze innovations in hormonal contraceptives, which may have several protective and risk-reducing properties for BD.

Currently, endometriosis is one of the most common and relevant gynecological conditions. It is characterized by a wide range of symptoms, with highly heterogeneous pain being one of the most typical. The unifying concept of the algological patterns of endometriosis is chronic pelvic pain, which contributes to a pronounced decrease in patients' quality of life. Therefore, it is necessary to analyze the key pathogenetic mechanisms of pelvic pain associated with endometriosis and to determine a personalized therapeutic approach based on them.

The data on managing patients with vulvovaginal atrophy and abnormal cytological results are provided for obstetrician-gynecologists.

Aim. To identify risk factors for in vitro fertilization (IVF) failures in women with adenomyosis-associated infertility.

Materials and methods. The study included 83 patients of reproductive age with adenomyosis. Women were divided into two groups: the main group (n=53) included patients with adenomyosis and a history of 1 or more unsuccessful attempts at embryo transfer, and the comparison group (n=30) included women with adenomyosis without impaired fertile function. The mean age of the patients was 36±4.0 years.

Results. Gynecological conditions such as cervical dysplasia, noninflammatory vaginal diseases, and a history of sexually transmitted infections (STIs) were significantly (5-fold) more common in patients with a history of IVF failures (p<0.05). A high prevalence of endocrine and digestive system disorders (27.7 and 7.7 times, respectively) was found in infertile women with adenomyosis (p<0.05). Coagulation disorders were identified 4.8 times more often in women with adenomyosis-associated infertility and IVF failures. Inflammatory and proliferative endometrial diseases (hyperplasia, intrauterine synechia, and chronic endometritis) were significantly more common in patients in the main group than in patients with adenomyosis without impaired fertility (p<0.05).

Conclusion. Risk factors for IVF failure in women with adenomyosis-associated infertility are other specified coagulation defects [D68.8] (antiphospholipid syndrome), odds ratio (OR) 4.8, 95% confidence interval (CI) 1.1–20.9; dysplasia of cervix uteri, unspecified [N87.9] (OR 10.2, 95% CI 1.2–92.4), other noninflammatory disorders of vagina [N89.7] (OR 10.2, 95% CI 1.2–92.4), STIs (OR 12.7, 95% CI 1.4–112.5), endocrine system disorders (OR 27.7, 95% CI 1.5–516.5), and digestive system disorders (OR 7.8, 95% CI 2.2–27.8).