Vol 26, No 4 (2024)

The article addresses studies of estetrol (E4) use as part of combined oral contraceptives (COCs) and its various effects on the body. Despite the rapid recovery of fertility after discontinuation of COCs, their popularity is declining due to adverse side effects such as weight gain, mood changes, poor menstrual control, and mastalgia. Therefore, the potential of the natural fetal estrogen E4, with high bioavailability and low risk of metabolic sequelae, is being studied. The data analyzed suggest that E4 may reduce the risk of breast cancer, as it induces less breast cell proliferation compared to other estrogens. During E4 therapy, the risk of venous thromboembolism is minimized, and there is less impact on hepatic enzymes, which improves the quality of sexual life and opens up the opportunities of prescribing COCs with E4 to women who are continuously receiving other drugs – statins, antiretroviral agents, or anticonvulsants. The article highlights promising results from clinical studies that confirm the efficacy of E4-based COCs, showing high levels of patient satisfaction. Clinical use of COCs with E4 can improve quality of life by eliminating the adverse effects associated with sexual function and providing high control over the menstrual cycle. Further research is needed on the impact of COCs with E4 on the psycho-emotional state and quality of women's sexual life, as well as the possible therapeutic effects of E4-based COCs, which will individualize the approach to contraception and provide women with safer and more effective options.

Pelvic inflammatory disease in women is one of the most important public health problems worldwide. The diagnosis is made based on clinical criteria. Empirical antibiotic therapy is the cornerstone of standard treatment. Antibiotic resistance and associated failures of standard therapy require the search for additional measures beyond those recommended in the clinical guidelines. Systemic enzyme therapy appears to be the most appropriate treatment for improving pelvic inflammatory disease outcomes.

Background. The literature shows that up to 75% of women of reproductive age suffer at least one episode of acute candidal vulvovaginitis (CVV) in life, up to 45% report 2 cases or more, up to 20% experience recurrent (often complicated) course of this disease. Recurrent CVV requires a non-standard approach and the use of other treatment methods in addition to antimycotic agents.

Aim. To evaluate the effectiveness of the peptide-cytokine agent Superlymph in the complex therapy of recurrent CVV.

Materials and methods. The study included 90 patients which were divided into three groups. All patients underwent all stages of diagnosis and treatment. Group 1 (n=30) received standard of care with antimycotics + Superlymph 10 units twice a day vaginally for 10 days. Then without interruption, Superlymph 10 units once daily was administered vaginally for 10 days. Group 2 (n=30) included patients who received antifungal treatment with Superlymph 10 units twice a day vaginally for 10 days. Group 3 (n=30) included females who received standard antimycotic therapy without other drugs.

Results. Ten days after the start of therapy, the symptoms were completely relieved in 100% of patients in Groups 1 and 2, and 2 (6.7%) patients from Group 3 reported CVV recurrence. None of the patients in the study groups discontinued therapy due to adverse events, and all patients reported good or excellent tolerability. Six months after the end of therapy, the percent of Lactobacilli in the urogenital scraping according to the Femoflor-16 test was high in Groups 1 and 2 – 96.7% in patients of both groups. In Group 3, it was 83.3%. A high abundance of Candida spp. was not found in any of the patients in Groups 1 and 2, while in Group 3, it was found in 16.7% of patients.

Conclusion. The addition of Superlymph 10 units to the standard antimycotic systemic therapy during the exacerbation of CVV can significantly reduce the number of relapses in women within 6 months after the end of treatment. Complex therapy with Superlymph can be an alternative to fluconazole monotherapy in patients with recurrent CVV, particularly in women planning pregnancy. Superlymph can be used during pregnancy after consulting a doctor and following the prescribing information.

Background. Ovarian endometriomas are one of the most common ovarian neoplasms. There are specific ultrasound criteria for this type of endometriosis; however, in some cases, differential diagnosis from other ovarian tumors is challenging.

Aim. To compare the levels of complement system components (C3 and C4) in women with endometriomas and other benign ovarian lesions and to determine the possibilities of using these indicators for differential diagnosis.

Materials and methods. A comparative cohort study of 100 women who underwent surgical treatment of ovarian neoplasms (laparoscopic, cystectomy) was performed. Group 1 included 60 women diagnosed with ovarian endometriomas, and Group 2 included 40 women with other benign ovarian masses (mature teratomas, corpus luteum cysts, ovarian cystadenomas). The C3 and C4 complement components were measured before surgery and 12 months after surgical treatment.

Results. C3 and C4 complement system components before and after surgery were significantly higher in women with ovarian endometriomas (compared with other ovarian masses); p<0.001. Surgical treatment led to a significant decrease in C3 and C4 in both groups; however, the magnitude of this effect was greater in Group 1, i.e., in patients with endometriomas, surgical removal of the mass contributes to a more significant decrease in the complement system components than in other benign masses. It may indicate that surgical treatment of endometrioma affects the overall immunological phenotype.

Conclusion. C3 and C4 levels in women with ovarian endometriomas are higher compared to those in patients with other benign ovarian masses. After surgical treatment of endometrioma, the levels of C3 and C4 decrease but remain higher than in women after surgery due to other ovarian neoplasms.

Aim. To improve reproductive health and quality of life of patients with genital prolapse combined with elongation, cicatricial deformation of the cervix.

Materials and methods. The study included 43 patients with genital prolapse of grades I–II according to the POP-Q classification in combination with elongation and cicatricial deformation of the cervix. All of them underwent surgery – plastic surgery of the cervix using the Yeltsov–Strelkov stratification method in combination with reconstruction of levels II and III of pelvic floor support according to DeLancey.

Results. The results of surgical treatment were assessed after 1–6 years. Overactive bladder was diagnosed before surgery in 4 (9.3%) people, after – in 2 (4.7%); p<0.05. In this case, an increase in the maximum flow rate and a decrease in the volume of residual urine were observed (p>0.05). In 41 (95.3%) patients, improvements were found in all parts of the vagina in the postoperative period. They were satisfied with the treatment according to the results of the PFDI-20 questionnaire. Recurrence of genital prolapse in the form of prolapse of the posterior vaginal wall was detected in 2 (4.6%) women. Pregnancy occurred in 8 people: in 3 (7.0%), it ended in timely delivery by cesarean section according to the sum of relative indications; in 2 (4.6%), medical terminations of pregnancy were performed; in 1 (2.3%) – surgical abortion. The remaining 36 (83.7%) protected themselves from pregnancy throughout the observation period.

Conclusion. Surgical treatment in the volume of plastic surgery of the cervix by the method of stratification and reconstruction of II and III levels of pelvic floor support according to DeLancey in case of genital prolapse of I–II degree according to the POP-Q classification in combination with cicatricial deformation and elongation of the cervix made it possible to restore the topography of the pelvic organs and their functions. This method of surgical treatment makes it possible to recreate the anatomy of the cervix with native tissues without its amputation. It has no unfavorable obstetric outcomes and can be used in women interested in reproductive function.

Childhood asymmetry labium majus enlargement (CALME) is a rare, benign disease of pre-pubertal age characterized by non-neoplastic unilateral proliferation of the soft tissues of the vulva without a peripheral capsule. The pathogenesis of CALME is not completely clear. Generally, the only treatment method is surgery because it is necessary to verify the diagnosis and exclude the neoplastic process. Most studies indicate the benign nature of CALME and the importance of a non-surgical approach if specific diagnostic criteria are met. The article presents clinical observations of CALME syndrome in girls, taking into account the modern differentiated approach to the management of patients with this disorder.