Gynecology

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.

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.

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.

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.

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.

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.