ISSN (print): 2079-5696, ISSN (online): 2079-5831 Founder: Medicinskie izdaniya CJSC Editor-in-Chief: Vera N. Prilepskaya, Doctor of Sc., Professor Frequency / Access: 6 issues per year / Open Included in: White List (3rd level), Higher Attestation Commission List, RISC, Scopus
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All the Copyright statements for authors are present in the standart Publishing Agreement (Public Offer) to Publish an Article in an Academic Periodical 'GYNECOLOGY'. READ the details online (tap to see in details) Publishing Agreement (Public Offer) to Publish an Article in an Academic Periodical 'GYNECOLOGY' The editorial board of the 'GYNECOLOGY' (ISSN 2079-5696 (Print), ISSN 2079-5831 (Online), mass media registration certificate ПИ № ФС 77 - 63961 dated 18.12.2015) represented by editor-in-chief Vera N. 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Innovative contraception with estetrol and the mammary gland: A modern view of the problem of reducing mammologic risks. A literature review
Disruption of homeostasis of sex hormones, in particular estrogens, progestogens, and androgens, is associated with an increased risk of breast malignancies. Therefore, in clinical practice, drugs aimed at achieving euestrogenic status, which have a risk-reducing effect on endometrial cancer and ovarian cancer, are used. However, studies are ongoing on the risks of breast malignancies associated with the use of hormonal drugs for contraception. Given the controversial positions of the international medical community on the effect of combined hormonal contraceptives on breast tissue, the presented literature review of the most recent studies describes the effects of contraceptives from the standpoint of cancer alertness and cancer prophylaxis, as well as with an emphasis on the use of innovative drugs.
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Atypical hyperplasia and early endometrial cancer: controversial aspects of terminology, classification, diagnosis and treatment. A review
The incidence of endometrial atypical hyperplasia (EAH) and cancer (EC) shows a steady increase every year, which is associated with an increase in the prevalence of their risk factors, primarily the “nonsteroidal triad”: obesity, diabetes mellitus, and metabolic syndrome. In the context of the demographic crisis and the postponement of reproductive plans for the sake of self-realization, the issue of fertility preservation with a favorable prognosis in young patients with EAH and early stages of EC of the low-risk group becomes especially relevant. Significant advancements in classification approaches, with the isolation of EC molecular subtypes that determine prognosis, and in diagnostics, with the development of a new method of liquid-based cytology combined with ultrasound examination, help clearly stratify patients at the outpatient stage into a cohort suitable for organ-preserving therapy. A review of the results of systematic reviews and meta-analyses proves that to date, oral progestins or gonadotropin-releasing hormone agonists, the installation of a levonorgestrel-containing intrauterine system alone or in various combinations are justified alternatives to radical surgical treatment in patients with precancer and EC with minimal invasion of the myometrium according to expert-level ultrasound or magnetic resonance imaging, provided that complete drug pathomorphosis of foci is achieved with the prompt implementation of reproductive plans with the thorough monitoring by an obstetrician-gynecologist and a reproductive specialist.
Innovations in the diagnosis and treatment of endometriosis: from the current advancements to a future outlook: A review
The search for approaches to diagnosing and treating endometriosis remains a priority in modern gynecology. The extremely high prevalence of this condition and its detrimental effect on somatic and reproductive health and the quality of life of patients determine the need for long-term therapy. The article describes evidence-based, modern guidelines-regulated approaches to the clinical management of patients with endometriosis. Currently, the arsenal of a modern clinician includes several technologies for effective clinical management of such patients (pain management, infertility treatment, monitoring the progression and recurrence of the disease, and quality of life). One such approach is the use of the “gold standard” pharmacotherapy for endometriosis with progestogens, namely dienogest 2 mg, which has been proven not only to relieve symptoms but also to effectively control endometriosis progression and recurrence. The immediate and long-term prospects for the diagnosis and treatment of endometriosis, in particular, drugs with an anti-angiogenic mechanism of action that can potentially change the prognosis of patients with this disease, are also considered.
Genitourinary syndrome of menopause: Important aspects of the pathogenesis, diagnosis, and treatment: A review
Genitourinary syndrome of menopause (GSM) is a significant medical and social problem of the menopausal period, involving 10–90% of women older than 50 years. The high prevalence of GSM underscores the necessity for practitioners to remain informed about its pathogenesis, diagnosis, and treatment. New data indicate the need for practical work with patients who have a high risk of developing GSM or who already show its manifestations. The review includes data from international and Russian scientific papers on this topic, published over the past 10 years. A systematic analysis of data on the pathogenesis of GSM was conducted, characterizing the variety of urinary and gynecological symptoms and specific features that should be considered in the differential diagnosis with other diseases. GSM therapy includes pathogenetic treatment (menopausal hormone therapy, topical application of estrogen-containing drugs), exercise, giving up bad habits, normalization of body weight, and other interventions. The use of topical formulations containing estriol and lactobacilli is pathogenetically justified and is the main direction in both the treatment and prevention of recurrent GSM episodes. Modern medicine can effectively eliminate the symptoms of GSM and develop preventive measures that will improve the quality of life of a woman during the postmenopausal period.
The role of comprehensive genetic testing in patients of early reproductive age with genital malformations: A retrospective study
Background. Congenital malformations of the genital organs exhibit numerous anatomical variants and are characterized by impaired function due to complete or partial obstruction of the organs. Uterine and/or vaginal abnormalities significantly impair reproductive outcomes and are often associated with abnormalities in other organs and systems. To date, the etiology of congenital malformations of the uterus and/or vagina remains controversial; the possible role of genetic predisposition and molecular genetic predictors for these conditions has not been clarified. Aim. To assess the occurrence of various reproductive system malformations among patients admitted at the federal center, to characterize the known genetic causes of congenital malformations of the female genital organs according to the literature, and to propose an algorithm for genetic testing of adolescent girls diagnosed with malformations of the uterus and/or vagina. Materials and methods. Retrospective analysis of data from 2160 medical records and discharge reports of patients with reproductive system malformations, admitted for examination and treatment to the Department of Gynecology of Children and Adolescents of the Kulakov National Medical Research Center for Obstetrics, Gynecology, and Perinatology from 2013 to 2023. During the analysis, special attention was paid to clinical, history, and instrumental data, as well as the results of genetic counseling and molecular genetic testing. Results. An in-depth genetic testing showed that of the 749 examined patients, 516 (68.9%) had uterine and vaginal aplasia, 107 (14.3%) had partial or total vaginal aplasia with a functioning uterus, and 126 (16.8%) had obstruction of one of the hemivaginas with doubling of the uterus. In all cases, the patients' karyotypes were normal female (46,XX). Conclusion. According to the study results, the main groups of anomalies of the internal reproductive organs (aplasia of the uterus and vagina – Mayer–Rokitansky–Küster–Hauser syndrome; vaginal aplasia with a functioning uterus; anomalies of Müllerian duct fusion – uterine doubling and OHVIRA syndrome) were identified, data on the known genetic mechanisms of the development of these malformations were described, the approach for molecular genetic search for genetic etiology in these groups of patients was proposed.
Medical and social characteristics of youth from the perspective of assessing reproductive potential: a multicentral study in the Far Eastern Federal District. A cross-sectional one-step study
Introduction. In the context of the demographic crisis in modern Russia, the focus of the state’s demographic policy is aimed at young people. The reproductive health (RH) and positive reproductive attitudes (RA) of young people, whose number is progressively declining, are especially important for ensuring population reproduction. Aim. To assess the RH and RA of the student-age population from the standpoint of demographic potential. Materials and methods. A cross-sectional study was conducted based on an anonymous online interview of young people using a specially created questionnaire. The statistical database was developed based on 2005 questionnaires completed by I–VI-year students and residents of medical universities of four subjects of the Far Eastern Federal District: Amur State Medical Academy (Amur Region), Chita State Medical Academy (Trans-Baikal Territory), Banzarov Buryat State University (Republic of Buryatia), Ammosov North-Eastern Federal University (Republic of Sakha, Yakutia). Mathematical analysis of the results was performed using the IBM SPSS Statistics version 25.0 software. Differences were considered significant at p < 0.05. Results. 11.4% of female and 1.1% of male respondents had chronic diseases of the reproductive system. Reproductive diseases accounted for 82.8% of gynecological pathology: 54.2% of polycystic ovary syndrome, 11.3% of pelvic inflammatory disease, 8.9% of external endometriosis, 5.4% of menstrual disorders, 3% of female infertility [pχ2 < 0.001, odds ratio 22.97 (95% confidence interval 13.05–40.46)]. In 32.7% of respondents, sexual debut occurred before the age of 18. The majority of respondents (67.8%) do not consider early onset of sexual activity to be a risk factor for RH (pχ2 < 0.001), and 68.2% received information about the contraception method for the first time in their lives from unreliable sources of information (friends/relatives, Internet resources), and only 31.8% from healthcare professionals. Contraceptive methods currently used include condoms (88.2%), oral contraceptives (20.5%), withdrawal (18.8%), rhythm method (8.6%), and intrauterine contraceptives (1.2%). 5.8% of respondents have children, 94.2% are childless, of which 6% are childfree. In the future, 94% of respondents plan to have children at 20–24 years (11.8%), 25–29 years (62.7%), 30–34 years (15.7%), 35 years and older (3.8%). Causes of delayed childbearing and voluntary childlessness include getting an education (77.7%; pχ2 = 0.019), fear of financial difficulties (56.8%; pχ2 = 0.619), career priority (47.7%; pχ2 = 0.680), common law marriage (46.8%; pχ2 = 0.103), not sure about the future (33.0%; pχ2 = 0.620), relationship problems within a couple (27.0%; pχ2 < 0.001), do not want to be responsible (22.4%; pχ2 < 0.001). In general, 70.5% of respondents consider the state policy aimed at supporting motherhood to be effective; 29.5% do not or rather do not consider it effective (pχ2 < 0.001). The majority of respondents considered the improvement of housing conditions to be the most effective measure for deciding on the birth of a child in a young family [66.2%; pχ2 < 0.001, odds ratio 1.29 (95% confidence interval 1.13–1.48)]. The desired number of children was 2.05 ± 0.9 [0; 4], and in case of adequate living, material, and financial conditions available, it was 2.37 ± 1.0 [0; 4] (p > 0.05). Conclusion. The state of RH and RA in modern youth can have a negative impact on the quality of the demographic potential of the population. Active cross-departmental work with young people on education in the field of RH and the fostering of commitment to its protection, education of family-oriented values, and positive RA is necessary.
The use of oral probiotics in pregnant women as a new paradigm for healthy motherhood: A prospective study
Background. There is currently a growing interest in the benefits of taking probiotics during pregnancy, but evidence supporting their positive impact remains scarce. The study evaluated the effect of probiotics on the incidence of urogenital infections and bacterial vaginosis in pregnant women, pregnancy complications, and delivery outcomes. Aim. To evaluate the effect of an oral probiotic on the course and outcomes of pregnancy. Materials and methods. A prospective study included 60 pregnant women divided into three groups. All patients underwent pH-metry of the vaginal contents at registration. Group 1 included 15 pregnant women with a pH level of 3.8–4.5 (control group). Forty-five pregnant women with a pH > 4.5 without growth of opportunistic flora, who underwent a study of the vaginal microflora using the Femoflor-16 test were divided into two subgroups: Group 2 (n = 25) received the synbiotic Enterolactis Duo, containing lyophilized live Lacticaseibacillus paracasei DG, or DSM 34154, as well as inulin at a dose of 4 g and Group 3 (n = 20) patients did not receive the probiotic. Before the start of therapy and 2 months after the therapy, the change of the symptoms, the level of vaginal pH, as well as the course of pregnancy, and delivery outcomes were evaluated. In addition, as part of a comprehensive assessment of intestinal function, the frequency and consistency of stool were analyzed. Results. In 15 (60.0%) patients with increased vaginal pH who took a probiotic (Group 2), normalization of the microflora was observed after 21 days, characterized by an increase in Lactobacillus spp. and a decrease in pH to < 4.5. Symptoms, such as vaginal dryness and discomfort, did not differ significantly between the groups, except for a decrease in the severity of itching in the group taking the probiotic. There were no significant differences in the incidence of delivery complications (preeclampsia, premature rupture of membranes, chorioamnionitis, etc.) between the groups, probably due to a small sample. In Group 2, statistically significant (p < 0.05) clinical signs of improvement were observed: stool frequency normalized to 5–6 times a week, constipation relieved, and normal stool (types 3–4 according to the Bristol Stool Form Scale [BSFS]) prevailed. Conclusion. The study suggests that oral probiotics may help normalize vaginal microbiota in pregnant women with elevated vaginal pH. In addition, the data indicate their potential to improve intestinal motor function. The observed decrease in constipation among patients taking a probiotic underscores its positive effect on stool regulation. However, more studies in a larger sample are needed to confirm the effect of probiotics on the incidence of labor complications and other pregnancy outcomes and the persistence of the effect on stool normalization. The results of this study emphasize the importance of further research on the role of probiotics in obstetrics and gynecology.
Chronic non-specific cervicitis: Clinical significance, microbiocenosis, and diagnostic pitfalls (2016–2020 retrospective analysis)
Background. Chronic non-specific cervicitis (CNC) remains one of the most common inflammatory diseases of the cervix; however, its clinical and morphological criteria and diagnostic significance remain poorly defined, especially with negative test results for human papillomavirus (HPV) and common sexually transmitted infections (STIs). Aim. To characterize the clinical, morphological, and microbiological features of CNC in women of reproductive age, with the strict exclusion of HPV-associated and specific infectious diseases of the cervix. Materials and methods. A retrospective analysis of data from 152 women aged 18–49 was conducted: 131 patients with histologically confirmed CNCs and 21 healthy women. Clinical and history data, extended colposcopy, liquid-based cytology, diagnosis of HPV and STIs using polymerase chain reaction, the state of vaginal biocenosis according to the “Femoflor-16” panel, and the histological data of biopsy specimens were evaluated. Statistical analysis included the Mann–Whitney U test, the Fisher test, and calculation of the odds ratio with a 95% confidence interval. Results. CNC was associated with an earlier age of onset of sexual activity (p = 0.03), a high incidence of chronic salpingo-oophoritis (45.8%), and dysbiosis episodes (41.2%). Histologically, CNC was characterized by almost universal lymphoplasmacytic infiltration (97.7%) and variable reactive epithelial changes. In patients with CNC, anaerobic-associated dysbiosis with Lactobacillus spp. deficiency was much more common. Colposcopic and cytological changes often mimicked low-grade squamous intraepithelial lesions, leading to diagnostic challenges. Conclusion. CNC is an independent, microbiota-dependent inflammatory cervix phenotype that complicates the interpretation of screening tests. Morphological verification and assessment of the microbiocenosis are key components of diagnosing and differentiating CNCs from intraepithelial lesions.
Multicomponent verification of diagnosis in premature ovarian failure: A retrospective study
Introduction. Premature ovarian failure (POF) is a loss of ovarian function in women under the age of 40 years. Aim. To describe the multicomponent manifestations when verifying the diagnosis of POF using the assessment of the vaginal component in patients. Materials and methods. We conducted a retrospective analysis of medical records from patients aged 35–40 years receiving outpatient care, divided into two groups. The test group included 38 patients with an irregular menstrual cycle (MC) with its duration more than 38 days (or the frequency of menstruation is less than 10 per year), followed by the absence of menstruation for 3 months (amenorrhea). The comparison group included 38 patients with regular MC who attended an outpatient preconception examination. Results. Patients with POF, in addition to vasomotor symptoms and psycho-emotional disorders, have manifestations of hypoestrogenism, including symptoms of genitourinary syndrome/vulvovaginal atrophy. The concentration of Lactobacilli in the vaginal biotope in patients with POF was below the reference values (p < 0.001). In contrast, the concentration of facultative anaerobic (p < 0.001) and obligate anaerobic (p < 0.001) microorganisms, yeast-like fungi (p < 0.001), and representatives of the Mollicutes class (p < 0.001) exceeded the reference range. Therefore, the prevalence of the vagina, cervix, and vulva diseases (aerobic vaginitis, bacterial vaginosis, vulvovaginal candidiasis), for which patients with POF had 2 to 3 outpatient visits per year, was significantly higher than in patients with normal MC (p < 0.001; p < 0.001; p < 0.01). The relative risks in patients with POF were 4.3 for aerobic vaginitis, 12.1 for bacterial vaginosis, and 2.3 for vulvovaginal candidiasis. Conclusion. The study highlights that gynecologists should recognize patients with POF may experience symptoms of genitourinary syndrome/vulvovaginal atrophy, not just vasomotor symptoms and psycho-emotional disorders, even if active vaginal symptoms are absent.
Changes in mucosal status, microcirculation parameters, and immunological parameters in response to combined non-hormonal therapy for vulvovaginal atrophy: A prospective study
Background. The relevance of age-related diseases stems from the ongoing aging of the population; in Russia, the share of women over 45 is 57.3%. The typical presentation of age-related changes includes vulvovaginal atrophy (VVA), which has extensive symptoms. The intimate nature of the problem often prevents women from discussing it openly. Hormone therapy is a traditional treatment option for VVA and its symptoms; however, it has some limitations. Aim. To compare the clinical effect of a combination therapy with hyaluronic acid and a phytoestrogen complex, as well as antimicrobial peptides and cytokines, with traditional local hormonal therapy. Materials and methods. The study included 68 female patients with VVA symptoms and 72 females without VVA manifestations. VVA patients were divided into two groups: in the test group, women received combined trophic therapy, and in the control group, subjects received traditional local hormone therapy. To assess the effectiveness of treatment at baseline and at 1 and 3 months after the end of therapy, analyses of cytological tests, ultrasound examinations, and enzyme immunoassays were performed, and a vaginal health index was calculated. Results. The overall treatment effectiveness in the test group was not inferior to that of local hormone therapy, as indicated by laboratory and instrumental parameters. Two therapeutic approaches had different effects on immunological parameters: in the test group, the level of interleukin-6 in vaginal swabs of patients receiving a combination of a protein-peptide complex, cytokines, hyaluronic acid, and phytoestrogens significantly decreased and differed significantly from that in the comparison group. Conclusion. The described non-hormonal approach to the treatment of VVA manifestations has significantly fewer limitations for use than hormonal agents, a pronounced positive effect on local immunity, and is well tolerated by patients. Therefore, the combination of hyaluronic acid and a phytoestrogen complex, as well as antimicrobial peptides and cytokines, is effective and safe and can become an alternative to traditional hormonal treatment.
Sexual function in women with genital prolapse: A prospective comparative study
Background. Pelvic organ prolapse (POP) significantly reduces quality of life, including sexual function. Despite the high prevalence (up to 50% of women over 40 years of age), the effect of POP on intimate health has not been sufficiently studied. Aim. To assess sexual function in women with genital prolapse using a validated FSFI questionnaire. Materials and methods. A prospective comparative study was conducted with 170 females; however, 53% (n = 90) refused to complete the FSFI questionnaire and did not sign the informed consent form. The test group included 40 patients with POP; the control group included 40 females without POP (groups were comparable in age; p > 0.05). The prospective sample study is ongoing, and this paper presents interim results. Sexual function was assessed using the FSFI self-administered questionnaire (19 questions, 6 domains). Statistical analysis was performed using SPSS 26.0 and R 4.2.0 (t-test, p < 0.05). Results. Total FSFI score in the test group was lower by 11.35 points [19.05 vs. 30.4; 95% confidence interval (CI) (-12.94; -9.76); p < 0.05]. Key domain deficits included orgasm (53% decrease [Δ = -2.77, 95% CI (-3.25; -2.29); p < 0.05]); pain (44% increase in symptoms [Δ = -2.26; 95% CI (-2.68; -1.84); p < 0.05]); lubrication (45% decrease [Δ = -2.19, 95% CI (-2.55; -1.83); p < 0.05]), and arousal (48% decrease [Δ = -1.76; 95% CI (-2.10; -1.42); p < 0.05]). The following barriers were observed during the study: 68.3% of women with POP refused to be surveyed (the “stigma paradox”). Conclusion. POP is associated with critical impairment of sexual function, especially in the domains of orgasm, pain, arousal, and lubrication. The results of the study justify the need to include the assessment of sexual function in the standard of POP diagnostics, the development of rehabilitation programs that combine surgical correction and restoration of intimate health, and the introduction of anonymous questionnaire methods with the participation of psychologists to overcome stigma.
Surgical considerations in the management of deep endometriosis across different age groups: A retrospective study
Aim. To assess the age, clinical, medical history, and surgical characteristics of patients with deep infiltrative endometriosis (DIE), depending on the presence of ovarian endometrioid cysts (EC) and the localization of infiltrates. Materials and methods. A cross-sectional retrospective study of 265 patients aged 19–49 with DIE was conducted. The patients were divided into the following groups: DIE without EC (n = 161) and DIE combined with EC (n = 104). Within the groups, age-specific subgroups were identified based on the localization of the endometrioid infiltrate: colorectal endometriosis, urinary tract endometriosis, and endometriosis of other localizations. Menstrual and reproductive functions, clinical symptoms, surgical history, and extension and type of surgical procedures were assessed. The t-test and Fisher's exact test were used. Results. The mean age of patients was 35.5 ± 6.0 years, while DIE was statistically significantly more likely to be detected at the age of 30–39 years. The leading symptoms were chronic pelvic pain, dysmenorrhea, and intestinal symptoms. 38.1% (n = 101) of women had a history of surgery for endometriosis, and they constituted a higher proportion in the DIE without EC group (44.1% vs 28.9%; p = 0.01). In this group, ovarian resections, excision, and coagulation of external genital, retrocervical, and uterosacral endometriosis, as well as urinary tract surgery and segmental bowel resections, were performed more often. Conclusion. Deep endometriosis predominantly affects women of reproductive age and is associated with repeated and traumatic surgeries. Surgery in patients with DIE due to the technical difficulty should be performed by a multidisciplinary team, and is associated with severe complications caused by damage to organs and anatomical structures. The data obtained emphasize the need to use comprehensive programs to prevent adhesion formation in such patients, including the use of bovhyaluronidase azoximer.