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Despite the widespread availability of highly effective methods of contraception, unintended pregnancy is common. Unplanned pregnancies have been linked to a range of health, social and economic consequences. Emergency contraception reduces risk of pregnancy after unprotected intercourse, and represents an opportunity to decrease number of unplanned pregnancies and abortions. Emergency contraception pills (ECP) prevent pregnancy by delaying or inhibiting ovulation, without interfering with post fertilization events. If pregnancy has already occurred, ECPs will not be effective, therefore ECPs are not abortificants. Ulipristal acetate (17alpha-acetoxy-11beta-(4N-N,N-dymethilaminophenyl)-19-norpregna--4,9-diene-3,20-dione) is the first drug that was specifically developed and licensed for use as an emergency contraceptive. It is an orally active, synthetic, selective progesterone modulator that acts by binding with high affinity to the human progesterone receptor where it has both antagonist and partial agonist effects. It is a new molecular entity and the first compound in a new pharmacological class defined by the pristal stem. Up on the superior clinical efficacy evidence, UPA has been quickly recognized as the most effective emergency contraceptive pill, and recently recommended as the first prescription choice for all women regardless of the age and timing after intercourse. This article provides literature review of UPA and its role in emergency contraception.

Obesity has a deteriorating impact on women with PCOS, although prevalence and the impact of specific traits of PCOS remain inconstant in different populations. Therefore, the aim of this study was to explore the differences in clinical, hormonal and metabolic features between obese and nonobese Croatian women diagnosed as having PCOS according to Rotterdam consensus criteria. The study included 74 obese and 208 nonobese women with PCOS. Clinical, biochemical and metabolic variables were compared among those PCOS subgroups. Obese subjects with PCOS had a higher risk of developing oligo-amenorrhea (OR 3.7; 95% CI, 1.1-12.5) and lower risk for developing hirsutism and acne (OR 0.2; 95% CI, 0.1-0.3 and OR 0.8; 95% CI 0.5-1.4, respectively). Obese PCOS subjects also had a higher risk of developing hyperandrogenemia (OR 2.5; CI 95% 0.9-6.7), insulin resistance (OR 4.5; CI 95%, 2.6-7.9), hypercholesterolemia (OR 5.0, CI 95% 2.5-10.2), hypertriglyceridemia (OR 5.2; 95% CI, 2.9-9.2) as well as elevated serum CRP levels (OR 4.1; 95% CI 1.4-12.2) compared to nonobese PCOS women. In conclusion, nonobese Croatian women with PCOS are more inclined to cosmetic problems associated with PCOS then metabolic ones. This is the first study to report the impact of obesity on acne and irregular menses as a study outcome. Obesity deteriorates menstrual regularity, insulin sensitivity and lipid profile in Croatian women with PCOS; therefore one of the fundamental treatment strategies of PCOS should be obesity prevention.

The aim of this study was to calculate the relative prevalence of all phenotypes of polycystic ovary syndrome (PCOS) and to compare them for anthropometrical, hormonal and metabolic differences according to the Rotterdam Criteria. A total of 300 women with PCOS aged 26.7 +/- 5.6 years (mean +/- SD) and 100 women aged 28.3 +/- 4.1 years (mean +/- SD) were included in a control group. Anthropometrical, hormonal and metabolic parameters were compared between the groups. The most prevalent phenotype in our population was the most severe, phenotype A (56.7%), followed by phenotype D (26.7%) and phenotype C (14.3%). Phenotype B was present in only 2.3% of patients. The four main phenotypes did not differ in age, BMI and WHR. Women with phenotypes A and C had increased levels of LH and an increased LH/FSH ratio along with elevated androgen levels compared to the other groups. Serum glucose levels did not differ between the groups studied, however, higher levels of insulin, GIR and HOMA-IR were found between phenotype A and the control group. Phenotype C PCOS or ovulatory PCOS have the same characteristics as classic PCOS, however in a more mild form, which represents a transition between the classic form and the control group. Compared to the control group, phenotype D had higher mean levels of serum testosterone (still within normal range) along with elevated LH levels and LH/FSH ratio, similar to classic PCOS. However, compared with women diagnosed with PCOS based on hyperandrogenism, oligo-ovulation and polycystic ovaries, these patients demonstrated milder endocrine and metabolic abnormalities. Therefore, from an endocrine point of view, our study supports the inclusion of a normoandrogenic anovulatory phenotype in PCOS diagnostic criteria.

The aim of this study was to calculate the relative prevalence of all phenotypes of polycystic ovary syndrome (PCOS) and to compare them for anthropometrical, hormonal and metabolic differences according to the Rotterdam Criteria. A total of 300 women with PCOS aged 26.7±5.6 years (median±SD) and 100 women aged 28.3±4.1 years (median±SD) were included in a control group. Anthropometrical, hormonal and metabolic parameters were compared between the groups. The most prevalent phenotype in our population was the most severe, phenotype A (56.7%), followed by phenotype D (26.7%) and phenotype C (14.3%). Phenotype B was present in only 2.3% of patients. The four main phenotypes did not differ in age, BMI and WHR. Women with phenotypes A and C had increased levels of LH and an increased LH/FSH ratio along with elevated androgen levels compared to the other groups. Serum glucose levels did not differ between the groups studied, however, higher levels of insulin, GIR and HOMA-IR were found between phenotype A and the control group. Phenotype C PCOS or ovulatory PCOS have the same characteristics as classic PCOS, however in a more mild form, which represents a transition between the classic form and the control group. Compared to the control group, phenotype D had higher mean levels of serum testosterone (still within normal range) along with elevated LH levels and LH/FSH ratio, similar to classic PCOS. However, compared with women diagnosed with PCOS based on hyperandrogenism, oligo-ovulation and polycystic ovaries, these patients demonstrated milder endocrine and metabolic abnormalities. Therefore, from an endocrine point of view, our study supports the inclusion of a normoandrogenic anovulatory phenotype in PCOS diagnostic criteria.

Obesity has a deteriorating impact on women with PCOS, although prevalence and the impact of specific traits of PCOS remain inconstant in different populations. Therefore, the aim of this study was to explore the differences in clinical, hormonal and metabolic features between obese and nonobese Croatian women diagnosed as having PCOS according to Rotterdam consensus criteria. The study included 74 obese and 208 nonobese women with PCOS. Clinical, biochemical and metabolic variables were compared among those PCOS subgroups. Obese subjects with PCOS had a higher risk of developing oligo- amenorrhea (OR 3.7 ; 95% CI, 1.1-12.5) and lower risk for developing hirsutism and acne (OR 0.2 ; 95% CI, 0.1-0.3 and OR 0.8 ; 95% CI 0.5-1.4, respectively). Obese PCOS subjects also had a higher risk of developing hyperandrogenemia (OR 2.5 ; CI 95% 0.9-6.7), insulin resistance (OR 4.5 ; CI 95%, 2.6-7.9), hypercholesterolemia (OR 5.0, CI 95% 2.5-10.2), hypertriglyceridemia (OR 5.2 ; 95% CI, 2.9-9.2) as well as elevated serum CRP levels (OR 4.1 ; 95% CI 1.4-12.2) compared to nonobese PCOS women. In conclusion, nonobese Croatian women with PCOS are more inclined to cosmetic problems associated with PCOS then metabolic ones. This is the first study to report the impact of obesity on acne and irregular menses as a study outcome. Obesity deteriorates menstrual regularity, insulin sensitivity and lipid profile in Croatian women with PCOS ; therefore one of the fundamental treatment strategies of PCOS should be obesity prevention.

Polycystic ovary syndrome (PCOS) is a common endocrine condition affecting women of reproductive age. There are many typical signs and symptoms that allow for the diagnosis of PCOS depending on the criteria used. Interestingly, ethnicity influences the extent of these signs and symptoms; therefore, the frequency of symptoms varies between different countries and ethnic groups. The prevalence of this syndrome in Croatia is unknown, and it's clinical and biochemical characteristics have not yet been reported. During this study, we used the Rotterdam criteria to evaluate 365 Croatian women with PCOS, and compared them to 304 age matched controls to assess the clinical and biochemical abnormalities that occur in PCOS patients. The mean age of PCOS patients at presentation was 26.1 +/- 5.9 years and of controls were 28.0 +/- 4.2 years. Women with PCOS has significantly higher body mass index (BMI) than the control group, although in both groups most patients had normal weight (76.2% vs. 87.8%). Abdominal distribution of fat tissue was similar in both groups. Menstrual cycle abnormalities were observed in 90.7% of PCOS patients, and ultrasonographic appearance of polycystic ovaries was reported in 97.3% of PCOS cases. Nearly 75% of patients with PCOS had hirsutism and 49.6% had acne. We recorded significantly higher serum levels of luteinizing hormone (LH), total testosterone (TT), free testosterone (fT) and insulin, while the serum levels of sex hormone binding globuline (SHBG) and follicular stimulating hormone (FSH) were significantly lower than in the control group. Serum glucose values were not significantly different between the groups. In conclusion, chronic anovulation, hirsutism and ultrasound appearance of polycystic ovaries are the dominant features of PCOS in Croatian population. The majority of patients with PCOS had normal body weight. The incidence of insulin resistance in this group of patients is less than the previously described frequency in other populations of patients with PCOS and normal weight.

Unatoč brojnim, danas dostupnim metodama kontracepcije stopa neplaniranih trudnoća u Republici Hrvatskoj neprihvatljivo je visoka. Novi oblici hormonske kontracepcije ženama nude veći izbor, manje rizika i bolje podnošenje, što će, nadamo se, u konačnici rezultirati manjom stopom neželjenih trudnoća. Liječnici se moraju upoznati s novim dostignućima na polju hormonske kontracepcije kako bi mogli individualizirati izbor. U ovom se članku navode novi načini, režimi i oblici primjene hormonske kontracepcije.

Iako u Hrvatskoj do danas nije zabilježena smrt zbog ektopične trudnoće (ET), to je i dalje hitno stanje opasno po život, zahtijeva hospitalizaciju i adekvatno liječenje. Učestalost ET iznosi oko 2%, s tendencijom rasta zadnjih 30 godina. Zahvaljujući ranoj dijagnozi (pomoću beta-HCG-a i transvaginalnom ultrazvuku) moguće je rano i pravodobno laparoskopsko liječenje preko 90% ET u nerupturiranom stanju. Laparoskopski se može učiniti salpingektomiju, salpingotomiju, mužnju jajovoda i/ili instiliranje farmakološki aktivnih otopina. Prikazuju se načini izvođenja pojedinih metoda, prednosti, komplikacije i mane laparoskopskog liječenja ET. Trajanje zahvata, hospitalizacija i radna nesposobnost signifikantno su kraći nego u operiranih laparotomijom. Zaključno, laparoskopija je danas u dijagnostici i liječenju ET zlatan i obvezujući standard, pouzdana je, jednostavna i brza, postiže odlične rezultate, poboljšava željeno naknadno intrauterino zanošenje, kratke je hospitalizacije i radne nesposobnosti.

Primjenjivost terapijske punkcije i skelrozacije alkoholom cističnih lezija jajnika.

Prikazuje se analiza prospektivne, randomizirane studije primjene konzervativnih laparoskopskih postupaka zbog nerupturirane trudnoće u jajovodu. Korištene i promatrane su laparoskopske metode: instilacija hipertonične otopine glukoze, instilacija prostaglandina i salpingotomija. Po ispunjavanju ulaznih kriterija za primjenu terapijskog protokola, pacijentice su randomizirane u terapijske skupine. Dijagnoza TTr postavljena je vaginosonografski, određivanjima koncentracije β hCG u serumu i laparoskopijom. Postoperacijski je praćeno kliničko stanje i bitniji laboratorijski parametri. Tri do šest mjeseci nakon zahvata načinjena je histerosalpingografija zbog provjere prohodnosti jajovoda. Kriteriji uključenja u studiju: 1) koncentracije β hCG-a do 2.500 IJ/L, 2) nerupturirana TTr, 3) pismena suglasnost pacijentice po objašnjenju postupka, 4) iskazan interes za daljnjom reprodukcijom, 5) stabilno hemodinamsko stanje, 6) negativna srčana akcija embrija, 7) promjer zahvaćenog jajovoda do 4 cm, 8) mogućnost kontrole uspjeha. U KB “ Merkur” , Zajčeva 19, Zagreb, u periodu između 1992. i 2002. načinjeno je 525 intervencija zbog ETr (2, 7% na broj poroda). Od svih ektopičnih trudnoća, tubarnih je bilo 97%. Najčešće su bile ampularno lokalizirane (69%). Od toga je 94% operiranih, a kroz analizirani period laparoskopski operiranih 54, 8% (signifikantno više od laparotomiranih p

Sindrom policističnih jajnika (PCOS) je jedan od najčešćih endokrinih poremećaja i vodeći uzrok neplodnosti žena reproduktivne dobi. Primarni ishod liječenja neplodnosti kod PCOS je rođenje zdravog djeteta, preduvjet je osigurati ovulaciju. Ispitanice i metode: Ovo prospektivno longitudinalno kohortno istraživanje uključilo je 96 neplodnih žena sa sindromom policističnih jajnika rezistentnih na klomifen citrat. Ispitanice su bili podijeljene u dvije skupine, jedna skupina podvrgnuta je laparoskopskom bušenju samo desnog jajnika (ULOD), dok su oba jajnika bila tretirana u drugoj skupini (BLOD). ULOD skupina (n = 49) primila je toplinske doze prilagođene volumenu desnog jajnika (60 J/cm3), a BLOD skupina (n = 47) fiksne doze od 600 J po jajniku, bez obzira na volumen. Obje skupine podudarale su se u broju ispitanica, dobi i osnovnim parametrima. Nakon operacije, skupine su praćene 6 mjeseci da bi se ocijenio ovulacijski odgovor. Rezultati: Stopa ovulacije tijekom prvog menstrualnog ciklusa nakon LOD bila je značajno viša u ULOD skupini nego u BLOD (73 % vs 49 %; smanjenje apsolutnog rizika (ARR), -0,25; 95 % interval pouzdanosti (CI), -0,44 do -0.03; P = 0,014). ULOD na desnom jajniku značajno povećava šanse za ovulaciju u ispitanica s većim desnim jajnikom u odnosu na one s manjim desnim jajnikom (100 % vs 36 %; ARR, -0,64; 95 % CI, -0,84 do -0,37; P = 0,004). Zanimljivo je da su šanse za ovulaciju također značajno veće u ispitanica BLOD skupine s većim desnim u odnosu na one s manjim desnim jajnikom(88 % vs 33 %; ARR, -0,55; 95 % CI, -0,73 do - 0,28; P = 0,002). Stopa trudnoće također je značajno veća u ispitanica s većim desnim jajnikom u odnosu na one s manjim desnim jajnikom, bez obzira na tretman. Mjesec dana nakon operacije, AMH je bio značajno niži u BLOD nego u ULOD skupini [srednja razlika (MD): -0,6 ng / ml], dok je pad testosterona (T) i slobodnog androgenog indeksa (FAI) bio je značajno veći u ULOD nego u BLOD skupini (MD 0,2 nmol / L za T; 1.1 za FAI). Pad AMH bio je izraženiji u BLOD i u prvom mjesecu (P = 0,018) i u šestom mjesecu (P = 70 0,023). Nasuprot tome, u šestom mjesecu ULOD skupina pokazala je značajno veći porast AFC [ULOD vs BLOD, P < 0,001] i volumena jajnika [ULOD vs BLOD, P = 0,013]. Zaključak: Unilateralna dijatermija toplinskom energijom prilagođenom volumenu jajnika učinkovitija je od bilateralne dijatermije fiksnim dozama. Šanse za ovulaciju su veće u ispitanica s većim desnim jajnikom bez obzira koja se laparoskopska tehnika koristi. Dijatermija prvenstveno smanjuje razine androgena i za razliku od AMH, T i FAI su konzistentni pokazatelji ovulacije nakon ULOD. Unilateralna dijatermija s prilagođenim termalnim dozama nije samo učinkovitija u smislu ovulacijske reakcije, već manje oštećuje i pričuvu jajnika od bilateralne dijatermije.

Polycystic ovary syndrome (PCOS) is an exceedingly complex endocrine, reproductive and metabolic disorder of a diverse and still unclear pathogenesis. PCOS affects approximately 10% of women of reproductive age and is considered one of the most common endocrine and reproductive disturbances in its group (1)(2). The syndrome is clinically characterised by oligo/anovulation and infertility, hirsutism and abdominal obesity (3). However, the absence of clearly defined causative factors and mechanisms has historically made research and collaboration regarding PCOS difficult. Nevertheless, recently, European and American communities have come to a consensus regarding the definition of PCOS. The current requirement for diagnosis of PCOS necessitates that at least two of the following criteria are present: ultrasound evidence of polycystic ovaries, oligo/anovulation and/or biochemical evidence of hyperandrogenism after the exclusion of other conditions which cause the same features (4)(2). In addition to the reproductive abnormalities, most women diagnosed with PCOS are predisposed to obesity and insulin resistance as well as dyslipidemia and hypertension (5). In other words, there is a high incidence of metabolic syndrome in patients with PCOS. This encompasses the development of type 2 diabetes and cardiovascular disease. Clearly it is the high incidence as well as the yet unknown mechanisms linking PCOS to metabolic and vascular abnormalities which make PCOS of high socioeconomic importance. Additionally, the amelioration of these metabolic and vascular abnormalities has been shown to improve hyperandrogenism and fertility and subsequently requires more scientific elucidation (5). Recent studies have focused on the role of obesity, or more specifically the role of various adipocytes in PCOS. It has been shown that adipocytes are secretory cells that produce a number of proteins with hormonal type functions, collectively referred to as adipokines. In this review we see that a number of studies have shown that the secretion of various adipokines is disrupted in PCOS (6)(7) and that it is considered that this disruption of adipokine secretion could be a significant predictor of metabolic and vascular disease in patients with PCOS (8)(5)(9). Current research is aimed at further elucidating this connection because the early detection of these associated diseases would allow preventative treatment and subsequently result in improved clinical outcome, and improved quality of life for patients with PCOS.

Oralna hormonska kontracepcija više je od 50 godina u upotrebi i danas se smatra najpouzdanijom reverzibilnom kontracepcijskom metodom. Od početka primjene, uzimalo ju je oko 300 milijuna žena, a procjenjuje se da danas u svijetu oralnu hormonsku kontracepciju uzima između 70 i 80 milijuna žena. Zbog dugog perioda korištenja i velikog broja žena koje su uzimale ove preparate, oralna hormonska kontracepcija smatra se vjerojatno najispitivanijim preparatom u povijesti medicine. OHK ima kontracepcijske i nekontracepcijske učinke. Upravo nekontracepcijski učinci djeluju protektivno na zdravlje žene te govore u prilog korištenja OHK. Mnoge studije potvrdile su da preparati OHK smanjuju rizik pojavnosti izvanmaternične trudnoće, funkcionalnih cista jajnika, benignih bolesti dojke, upalnih bolesti u zdjelici, osteoporoze te reumatoidnog artritisa. Također reduciraju rizik od pojave vrlo zloćudnih bolesti, kao što su rak jajnika i endometrija te rak debelog crijeva. Preparati OHK također se primjenjuju za regulaciju menstruacijskog ciklusa, a koriste se i za liječenje endometrioze, mioma te hiperandrogenizma i Sindroma policističnih jajnika, danas najčešće endokrinopatije u žena. Iako često krivo percipirano u javnosti, prednosti korištenja OHK premašuju njene nedostatke te se danas preparati OHK smatraju čuvarem ženskog reproduktivnog zdravlja., Oral hormonal contraception (OHC) has been in use for over 50 years and today it is considered the most reliable reversible contraceptive method. Since the start of its application approximately 300 million women have been using the method and today it is estimated that between 70 and 80 million women are using this method. Oral hormonal contraception is considered the most tested compound in the history of medicine because of the long period of usage and the large number of women using it. OHC has both contraceptive and non-contraceptive effects. The non-contraceptive effects are exactly what acts protectively on women's health and adds to the benefits of using OHC. Many studies have confirmed that OHC compounds decrease the risk of extrauterine pregnancies, functional ovary cysts, benign breast diseases, inflammatory pelvic diseases, osteoporosis and rheumatoid arthritis. They also reduce the occurrence risk of very malignant diseases such as ovarian and endometrial cancer and colon cancer. OHC compounds are also applied for menstrual cycle regulation and are also used to treat endometriosis, myomas and hypergonadism as well as polycystic ovarian syndrome, the most common endocrinopathy in women today. Even though it is often misinterpreted in the public, the advantages of using OHC surpass their deficiencies, so today OHC compounds are considered as a guardian of female reproductive health.

Neplodnost je bolest reprodukcijskog sustava. Svjetska zdravstvena organizacija je definirala neplodnost kao izostanak trudnoće nakon 12 mjeseci redovitih nezaštićenih odnosa. Uzroci neplodnosti mogu biti u muškom, ženskom ili u oba partnera. Postoje slučajevi kada se uzrok ne može prepoznati te se govori o idiopatskoj neplodnosti. Kada se sumnja na neplodnost oba partnera se moraju podvrgnuti nizu pretraga koji će otkriti uzrok neplodnosti i uputiti na najbolje metode liječenja. Ovisno o uzroku neplodnosti različite su metode liječenja. Za korektivne operacije oštećenog reprodukcijskog sustava danas se primjenjuju endoskopske kirurške tehnike, laparoskopija i histeroskopija. Unatoč snažnom napretku endoskopske kirurgije danas će više od 70% neplodnih parova neplodnost liječiti metodama medicinski potpomognute oplodnje (MPO), posebno postupcima izvantjelesne oplodnje (IVF). Izvantjelesna oplodnja je metoda medicinski potpomognute oplodnje kojom se liječe teži oblici muške neplodnosti, te neplodnosti žena zbog oštećenih ili nepostojećih jajovoda, ali i neplodnost kojoj može biti uzrok endometrioza ili nepoznati uzrok, tzv. idiopatska neplodnost. Postupak izvantjelesne oplodnje može se raditi s jajnim stanicama dobivenim u prirodnom ili stimuliranom ciklusu. Prirodni ciklus može biti čisti prirodni ili modificirani prirodni ciklus. Stimulirani ciklus za IVF može biti blago stimulirani ili se mogu koristiti konvencionalni ili standardni protokoli stimulacije ovulacije. Premda su prve trudnoće pomoću oplodnje izvan tijela bile iz prirodnih ciklusa, zbog poboljšanja rezultata IVF-a tijekom povijesti više su korišteni konvencionalni protokoli ovarijske stimulacije s višim dozama gonadotropina, poput tzv. dugog protokola.Zbog učestalog ovarijskog hiperstimulacijskog sindroma, te učestalih višeplodnih trudnoća u takvim protokolima stimulacije ovulacije, danas se više koriste blaži protokoli.Danas je moguće prije ulaska u postupak in vitro fertilizacije procijeniti rezerve jajnika u pacijentice i izabrati za nju najprikladniji protokol stimulacije ovulacije. Stoga danas možemo govoriti o potpunoj individualizaciji stimulacije ovulacije u žena koje liječe neplodnost oplodnjom izvan tijela., Infertility is a disease of the reproductive tract. World health organization has defined infertilty as an unability to concieve after 12 months of regular unprotected relations. The reasons of infertility can be in the male, female partner or both. Also there are some cases when the cause of infertility remains unknown and then it is referred to as idiopathic infertility. Whenever there is doubt of infertilty or a couple is struggling to concieve both partners need to undergo series of test that will reveal the reason of infertilty and point to the best treatment. Depending on the reason of inferitilty there are different ways of treating. The treatment always begins from the less invasive methods. Despite the strong development of endoscopic surgery, 70% of couples with infertilty will be treated with medically induced conception, especially n vitro fertilization. IVF is a medical method to treat severe cases of male infertility, and female infertilty caused by damaged or unexisting fallopian tubes, but also infertilty cause by edomethrioisis or idiopathic infertilty. In vitro fertilzation is divided into two basic groups: natural cycli and stimulated cycli. If a stimulation drug is used early in the menstrual cyclus then that cyclus is stimulated. Throught the history doctors gave advantage to protocols with high dosage of stimulation drugs which resulted in higher number of oocytes for implantation. However high doses of hormones can have bad outcome on the women, worst of which is hyperstimulation sydrome. That is why today in vitro fertilization is developing in a way that patients are treated with lower dosed of hormones that still enable an adequate number and quality of oocytes. The choice of protocol to be used is still very individual and depends on the characteristics of the patient.

Trombocitopenija pogađa 6 do 10% trudnoća i druga je po učestalosti hematoloških bolesti u trudnoći. Trombocitopenija označava broj trombocita u krvi manji od 150 x 109/L. Postoji mnogo potencijalnih uzročnika trombocitopenije u trudnoći od kojih su neki specifični za trudnoću, a ostali imaju povećanu incidenciju za vrijeme trudnoće. Trombocitopenija se u trudnoći može pojaviti kao izolirani poremećaj ili u sklopu nekih drugih bolesti. Najčešći izolirani oblik trombocitopenije u trudnoći je gestacijska trombocitopenija s udjelom od najmanje 75%, čiji klinički simptomi nestaju, a laboratorijski nalazi se normaliziraju dovršenjem trudnoće. Trombocitopenija se također može pojaviti u sklopu preeklampsije, HELLP sindroma, trombotičke trombocitopenijske purpure, hemolitičko-uremičkog sindroma, a može biti i sekundarna pri sistemskom eritematoznom lupusu ili antifosfolipidnom sindromu. Kao oblik izolirane trombocitopenije javlja se imuna trombocitopenija. Neki trombocitopenični poremećaji ne utječu na ishod trudnoće, dok se drugi povezuju s visokim majčinskim i neonatalnim morbiditetom i mortalitetom. Zbog toga je bitno otkriti uzrok trombocitopenije u trudnoći kako bi se spriječile i na vrijeme počele liječiti moguće komplikacije i posljedice., Thrombocytopenia affects 6-10 % of pregnancies and is the second most common hematologic disease in pregnancy. Thrombocytopenia occur when the number of platelets in the blood is less than 150 x 109/L. There are many potential causes of thrombocytopenia in pregnancy, some of which are specific to pregnancy, while others have an increased incidence during pregnancy. Thrombocytopenia in pregnancy can occur as an isolated disorder or as part of other disease. The most common form of isolated thrombocytopenia in pregnancy is gestational thrombocytopenia with a share of at least 75 %, with clinical symptoms that disappear after pregnancy, and laboratory findings normalized after termination of pregnancy. Thrombocytopenia can occur as part of pre-eclampsia, HELLP syndrome, thrombotic thrombocytopenic purpura, hemolytic-uremic syndrome, and may be secondary to the systemic lupus erythematosus and antiphospholipid syndrome. Immune thrombocytopenia occurs as a form of isolated thrombocytopenia. Some thrombocytopenic disorders do not affect the outcome of pregnancy, while others are associated with high maternal and neonatal morbidity and mortality. Therefore, it is important to detect pathological causes of thrombocytopenia in pregnancy so that possible complications and consequences can be predicted and managed.

Ovarijska rezerva je konačan broj jajnih stanica prisutnih u ovariju koje su dostupne za folikulogenezu. Procjena ovarijske rezerve bitna je u evaluaciji i liječenju neplodnosti, te u predviđanju ishoda metoda medicinske oplodnje. Kako nijedan test danas dostupan ne mjeri direktno ukupan broj oocita, procjena se vrši posredno mjerenjem ovarijskih hormona i poznavanjem fiziološke osnove reprodukcije. Testove za mjerenje ovarijske rezerve možemo podijeliti na pasivne i dinamičke. Pasivni uključuju mjerenje serumskih koncentracija FSH, estradiola, AMH, inhibina-B, mjerenje broja antralnih folikula, te određivanje volumena i vaskularizacije ovarija. U dinamičke testove ubrajamo provokacijski test klomifen citratom, egzogeni FSH test te provokacijski test gonadotropinima. Kako niti jedna od ovih metoda nije idealna, najbolji uvid u ovarijsku rezervu dobivamo kombinacijom nekoliko njih. Endometriom je benigna, o estrogenu ovisna ovarijska cista, koja je usko povezana s neplodnošću i sa smanjenom ovarijskom rezervom. Pretpostavljenih mehanizama te povezanosti ima nekoliko među kojima su najznačajniji oštećenje jajnika samom prisutnošću endometrioma i smanjenje ovarijske rezerve tijekom operacije uslijed uklanjanja zdravog tkiva ovarija koje se nalazi u okolini ciste. Mnogo je dijagnostičkih metoda pomoću kojih možemo utvrditi prisutnost endometrioma s velikom vjerojatno, ali jedina sigurna dijagnoza je patohistološki nalaz. Nema konsenzusa po pitanju načina liječenja endometrioma, iako se danas u pravilu najčešće pristupa laparoskopskoj operaciji. Mnoge studije su pokazale kako je ovarijska rezerva neupitno smanjena nakon operacije endometrioma iako prema dosadašnjim saznanjima to ne utječe drastično na stopu zanošenja pošto funkcija kontralateralnog jajnika ostaje normalna., Ovarian reserve is defined as the number of oocytes in the ovary that are available for folliculogenesis. Determining ovarian reserve is important in evaluating and treating infertility, as well as in predicting the outcomes of assisting reproduction methods. There is no test available today that could directly measure number of oocytes. Therefore, in order to estimate the ovarian reserve different tests are being used, including measuring levels of hormones and knowing the physiological grounds for reproduction. Test used in determining the ovarian reserve can be divided in two groups, passive and dynamic. Passive tests include measuring serume levels of FSH, oestradiol, AMH, inhibin-B as well as measuring AFC, ovarian volume and ovarian vascularisation. Dynamic tests are clomiphene citrate challenge test, egsogeneous FSH test and gonadotrophins challenge test. As neither one of this methods is considered to be ideal, the best way to determine ovarian reserve is to combine them. Endometrioma is a benigb, oestrogen dependant cyst, which is strongly related to infertility and to diminished ovarian reserve. There are several suggested mechanisms to explain that correlation, the most significant being damage of the ovary caused by the presence of the endometrioma itself and removal of healthy ovarian tissue during surgery. Many diagnostic methods are being used to determine the presence of endomerioma, but the only confirmation is the pathohistological one. No consensus has been reached regarding endometrioma treatment. However, laparoscopic surgery is the most common way to treat endometiroma. Many studies have shown that the ovarian reserve is undoubtedly diminished following endometrioma surgery. However, studies have also shown that pregnancy rates in such patients do not seem to be significantly lower which is mostly atributed to the normal fucntion of the contralateral ovary.

Hormonsko nadomjesno liječenje se koristi kod žena s nedostatkom estrogena. Simptomi i znaci nedostatka estrogena koji dovode do smanjenja kvalitete života primarno se očituju kod žena reprodukcijske dobi s hipoestrogenim amenorejama, onih s prijevremenom menopauzom, te kod žena u klimakteriju i postmenopauzi. HNL se preporučuje u liječenju vazomotornih tegoba, urogenitalne atrofije, te u prevenciji osteoporotičnih prijeloma. Primjena hormonskog nadomjesnog liječenja je vremenski ograničena zbog povećanog rizika od venske tromboembolije i karcinoma dojke. Liječenje treba provoditi najnižom učinkovitom dozom, kroz najkraće moguće vrijeme. Treba ga individualizirati sukladno potrebama i rizicima svake pacijentice. HNL ne treba provoditi dulje od 5 godina. Rizik karcinoma dojke ovisan je o trajanju korištenja, i putu primjene, a ne o dozi hormona, te se prestankom terapije vraća na početne vrijednosti. Rizik je veći ako se uz estrogene koristi i progestagen. HNL nema učinak primarne ili sekundarne prevencije ishemične bolesti srca ili moždanog udara. Povećava rizik tromboemboličkih incidenata, te se ne provodi u žena s tromboemboličkim incidentom u anamnezi. Žene žive gotovo trećinu života u postmenopauzi, te u Hrvatskoj slično zapadnim zemljama, 18% cijele populacije su žene u postmenopauzi. To nam govori koliko je hormonsko nadomjesno liječenje važan čimbenik u očuvanju zdravlja i kvalitete života žena tijekom procesa starenja. Cilj ovog rada je dati pregled o najnovijim spoznajama, te dobrobitima i rizicima hormonskog nadomjesnog liječenja., Hormone replacement therapy is used in women with estrogen deficiency. Patients in reproductive age with hypoestrogenemic amenorrhea and premature menopause as well as women in climacterium and postmenopause have numerous symptoms and signs of estrogen lack, which may result in decreased quality of life. HRT is recommended for the treatment of vasomotor symptoms, urogenital atrophy, and the prevention of osteoporosis-related fractures. Use of hormone replacement therapy is time limited due to an increased risk of venous thromboembolism and breast cancer. Treatment should be started with lowest effective dose for the shortest possible time. It should be individualized according to the needs and risks of each patient. HRT should not be taken for a period longer then five years. The risk of breast cancer varies with the treatment duration, route of administration, and it doesn’t depend on the dosage of hormones. The risk is greater if used with estrogen and progestin. HRT is not indicated for primary or secondary prevention of cardiovascular disease. Also, it increases the risk for tromboembolic episodes and is not recommended in patients with history of thromboembolism. Women live almost one third of their life in postmenopause, and in Croatia 18% of entire population are post-menopausal women. This leads to conclusion how hormone replacement therapy plays an important role in maintaining the health and quality of life of postmenopausal women. The aim of my thesis is to give the review of the latest findings in the area of benefits and risks of hormone replacement therapy.