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BACKGROUND: One of the most dangerous reproductive pathologies is primary ovarian insufficiency (POI). Except manifestation in the age AIM: To evaluate features of replicative (telomere length) and biochemical (metabolic syndrome) markers among females with primary ovarian insufficiency.MATERIALS AND METHODS. Research has been provided in collaboration between Endocrinology Research Centre of the Russian Ministry of Health and Lomonosov Moscow State University Medical Research and Educational Centre in the period since 10.01.2021 until 01.08.2022. Females with non-iatrogenic hypergonadotropic hypogonadism caused by primary ovarian insufficiency (n=33); healthy females of reproductive age (18–49 y.o.; n=24). Patients have undergone laboratory genetic (leucocyte telomere length), biochemical analyses. DNA extraction — with Qiagen DNA blood mini kit (Germany).Leukocyte telomere length — with real-time polymerase chain reaction PCR (Flow-fish). Soft program IBM SPSS Statistics (version 26,0 for Windows).RESULTS. Females with POI due to estrogenic deficiency have slightly shorter mean telomere length (10,0 [7,9–10,7] kB, than healthy females of reproductive age (10,8 [10,0–13,1] кБ, рCONCLUSIONS. Female with POI and receiving sex steroid replacement therapy have decrease of telomere length and increase of chances for carbohydrate metabolism disturbances in opposite to healthy reproductive females.

AIM. To reveal the peculiarities of steroidogenesis and arterial hypertension in «physiological» hyperandrogenism in men.MATERIALS AND METHODS. One-stage simultaneous study. The groups of men with hyperandrogenism caused by increased total testosterone (n=34) and those with hyperandrogenism caused by increased dihydrotestosterone (DHT) (n=66) were compared. In determining the type of hyperandrogenism and allocating patients to groups, DHT and total testosterone levels were determined by enhanced chemiluminescence. Subgroups of men with and without arterial hypertension were compared in the group of patients with hyperandrogenism due to an increase in total testosterone. Body mass index, waist circumference, systolic and diastolic blood pressure, pulse, and LH, SBHG, estradiol, blood multisteroid levels by isotope dilution liquid chromatography/tandem mass spectrometry, glucose, blood lipid spectrum, uric acid, creatinine, renin, potassium, sodium, and blood chloride were assessed in all patients. Patients with arterial hypertension additionally underwent daily BP monitoring, albuminuria assessment, electrocardiography, ocular fundus examination. The baseline threshold level of significance was pRESULTS. Statistically significant differences were found in the levels of 17-hydroxypregnenolone, 17-hydroxyprogesterone, and androstenedione, which were higher in men with elevated levels of total testosterone. No statistically significant differences in other laboratory parameters were found. No cases of increased blood pressure were detected in the group of men with elevated DHT. In the group of men with elevated total testosterone, 23,5% of men with arterial hypertension without targetorgan lesions were identified, while hyperandrogenism was associated with 17,6% of cases. Arterial hypertension associated with hyperandrogenism was characterized by a rise in blood pressure in the early morning hours. Estradiol levels, while remaining within normal limits, were statistically significantly lower in patients with arterial hypertension compared with men with elevated testosterone but without hypertension.CONCLUSION. No cases of arterial hypertension were observed in «physiological» hyperandrogenism due to elevated DHT levels, whereas its incidence in «physiological» hyperandrogenism due to elevated total testosterone was 23,5%. The features of steroidogenesis were increased production of 17-hydroxypregnenolone, 17-hydroxyprogesterone, and androstenedione in men with testosterone hyperandrogenism and decreased estradiol production in patients with arterial hypertension compared with patients without testosterone hyperandrogenism.

The article presents a draft of clinical recommendations for the diagnosis and treatment of primary hyperparathyroidism in adult patients, which provides a modern examination algorithm, discusses the basic principles of laboratory, instrumental diagnostics and treatment approaches.

Wide spectrum of surgical techniques and approaches is used nowadays for treatment of benign prostatic hyperplasia (BPH). Every method is chosen individually for every patient depending on clinical and anamnestic data, ratio risk/ratio and surgeon’s professional skills. Debits for treatment of benign prostatic hyperplasia have a trend for annual increasement in countries with demographic aging. Present article is dedicated to overview of financial and economic aspects of main surgical techniques: open simple prostatectomy, transurethral resection and laser enucleation.

Studies of recent decades show a steady increase in the average life expectancy of a person, and women in particular. The World Health Organization predicts a four-fold increase in the number of women over 70 by 2030, and many of them over the age of 45 may face menopausal problems. Menopause is a physiological state in a woman’s life, during which, against the background of age-related changes, there is a gradual decrease and shutdown of ovarian function and the cessation of estrogen production. Genitourinary syndrome occurs in every third woman in this period. Estriol is the main estrogen that specifically addresses problems associated with estrogen deficiency: dyspareunia, dryness and itching in the vagina and lower genitourinary tract, urinary incontinence, moderate urinary incontinence, and recurrent vulvovaginitis and cystitis. Vulvovaginal dystrophy in women of the older age group is a multidisciplinary problem at the intersection of gynecology, urology and dermatology, which can and should be solved to prevent more severe gynecological and urological pathologies.

According to present medical databases there many trials to provide in vivo researches in vivo to confirm/refute shortening process of telomeres among patients with Turner syndrome. Despite the successful clinical experience of providing such patients with Turner syndrome, a lot of omics (proteomic and metabolomic) aspects still stay unclear. Main disadvantages of most researches are small volume and minimized mathematical correlation with chronic disease (coronary heart disease, essential hypertension, cardiovascular malformations). Finally, organization of international prospective multi-centered researches in vivo including patients with mosaic cariotype and co-operation between physicians and biologists are optimal solutions for this present problem.

BACKGROUND: Melatonin is the main hormone of the pineal gland. By regulating circadian rhythms and being an immune regulator and antioxidant, this hormone takes part in the work of the ovaries: its high concentrations block apoptosis and neutralize reactive oxygen species involved in folliculogenesis, ovulation, egg maturation and corpus luteum formation.AIM: To study melatonin status and its relationship with menstrual dysfunction and sleep disorders in obese women of reproductive age.MATERIALS AND METHODS. In a one-stage comparative study, women 18-35 years old took part: 30 patients with obesity and menstrual disorders of an inorganic nature and 30 healthy women in the comparison group with normal weight and regular menstrual cycle. All participants underwent a questionnaire to identify somnological disorders, and the level of melatonin in saliva and 6-sulfatoxymelatonin in urine was also investigated.RESULTS: In the group of patients with obesity (n=30), various sleep disorders were encountered in 47% of cases (p=0.003), including more often obstructive sleep apnea syndrome was recorded (30% of cases), and a correlation was found between the indicators of the questionnaire survey of subjective sleep characteristics and body mass index of patients (r=0.450, p=0.030) compared with a group of healthy women with normal weight (n=30). In the main group, the level of melatonin in saliva was statistically significantly lower than in the control: median 12.6 pg / ml and 25.5 pg / ml, respectively (p=0.008), the same pattern was recorded for 6-sulfatoxymelatonin: 14, 72 pg / ml and 31.12 pg / ml, respectively.CONCLUSION: Patients with obesity and menstrual dysfunction are more likely to suffer from various sleep disorders and have lower levels of melatonin in saliva and 6-sulfatoxymelatonin in urine.

Congenital adrenal hyperplasia (CAH) is a group of autosomal recessive diseases characterized by a defect in one of the enzymes or transport proteins involved in the cortisol synthesis in the adrenal cortex. The most common form of CAH, which occurs in more than 90% of cases, is a 21-hydroxylase enzyme deficiency. The latter is subdivided into nonclassical and classic (salt-losing and virilizing) forms. The prevalence of classic forms of 21-hydroxylase deficiency ranges from 1: 14,000 to 1:18,000 live births worldwide. According to the data of neonatal screening in the Russian Federation, the prevalence of the disease in some regions ranges from 1: 5000 to 1: 12000, in the country as a whole - 1: 9638 live newborns. The non-classical form of CAH occurs more often - from 1: 500 to 1: 1000 among the general population. In second place is the hypertensive form of CAH - a deficiency of 11β-hydroxylase, which, according to the literature, occurs in about 1 per 100,000 newborns. These clinical guidelines were compiled by a professional community of narrow specialists, approved by the expert council of the Ministry of Health of the Russian Federation, and updated the previous version published in 2016. The clinical guidelines are based on systematic reviews, meta-analyses and original articles, and scientific work on this issue in the Russian Federation and other countries. The purpose of this document is to provide clinicians with the most up-to-date, evidence-based guidelines for the CAH diagnosis and treatment

Clinical guidelines have long been one of the working tools of the modern doctor, helping him quickly navigate the most effective proven methods of treatment and prevention of various diseases, and also to adapt these methods to the specific tasks of their patients and to achieve maximum personalization of treatment. Clinical practice guidelines are drawn up by professional non-profit associations and are approved by the Scientific Council of the Ministry of Health of the Russian Federation, while often one recommendation is prepared by two or even three associations. The peculiarity of the recommendations offered to your attention is that not only endocrinologists, but also therapists, cardiologists, gynecologists, gastroenterologists, and experts of many other specialties are involved in the prevention and treatment of obesity. The Multidisciplinary Working Group presents this a project in a multidisciplinary journal to bring together the efforts of several professional associations that associated with the need to pay attention not only to obesity itself but also to comorbid conditions. We are looking forward to constructive criticism and a comprehensive discussion of the problem on the pages of our journal.

BACKGROUND. COVID-19 is a disease that has a negative systemic effect on the human body, including the male gonads. Therefore, the androgenic status in men with COVID-19 needs to be studied.AIM. To evaluate the levels of total testosterone, sex hormone binding globulin (SHBG) and free testosterone in men in the acute phase of COVID-19 and during convalescence.MATERIALS AND METHODS. A continuous dynamic prospective study of 70 men with moderate to severe COVID-19 at the age of 50[44; 64] years. During the study, the levels of total testosterone, SHBG were determined with further calculation of the level of free testosterone by Vermeullen. The data were collected twice — at the patient’s hospitalization and at his discharge. The differences between the groups were considered statistically significant at p RESULTS. At the time of hospitalization for COVID-19, hypogonadism syndrome was observed in 61 people — 87%. Patients with hypogonadism did not statistically significant differ in age and severity of COVID-19 disease compared to men without hypogonadism. Inpatient treatment lasting 12[10;14] days resulted in a statistically significant increase in the levels of total testosterone from 4,7[2,96;8,48] to 12,85[8,62;19,2] nmol/l, pCONCLUSION. COVID-19 has a pronounced negative effect on the production of testosterone in men, leading to the development of laboratoric hypogonadism, which is potentially reversible. The reversibility of laboratoric hypogonadism is typical for younger patients.

Present worldwide healthcare researches prove that female patients are more sensitive to the population aging. Menopause or climacteria (climax) — is not as ageing itself, but a physiological unstoppable process. The main task for a physician is to improve life quality for female despite of ageing problems. Menopausal hormone therapy (MHT) due to the estrogen component has an anti-inflammatory, antioxidant effect and promotes the expression of telomerase, which together changes the homeostasis and integrity of telomeres. The use of MHT for five years or more can not only significantly change the quality of life, but also increase its duration. Literature search was carried out in national (eLibrary, CyberLeninka.ru) and international (PubMed, Cochrane Library) databases in Russian and English. The priority was free access to the full text of articles. The choice of sources was prioritized for the period from 2019 to 2021. However, taking into account the insufficient knowledge of the chosen topic, the choice of sources dates back to 1989.

Polycystic ovary syndrome (PCOS) is a polygenic endocrine disorder caused by both genetic and epigenetic factors. Depending on the period of a woman’s life, the clinical picture, diagnosis, and treatment tactics of the disease are different. PCOS has a complex of reproductive, metabolic and psychological characteristics. The target audience of these clinical recommendations are obstetrician-gynecologists, endocrinologists, general practitioners, general practitioners. In these clinical guidelines, all information is ranked according to the level of persuasiveness of recommendations and the reliability of evidence, depending on the number and quality of studies on this issue.

BACKGROUND: The cocaine-amphetamine regulated transcript has been discovered long time ago (circa over 25 years ago) but still stays not enough investigated. Just during last five years scientist’s society started providing interest to the genomic, proteomic and metabolic essence of the cocaine-amphetamine regulated transcript.AIM: The evaluation of historical pathway and perspectives of the cocaine-amphetamine regulated transcript medical investigations.MATERIALS AND METHODS: The literature search has been provided via Russian (eLibrary, CyberLeninka.ru) and international (PubMed, Cochrane Library) databases and among articles on Russian and English languages. The main criteria for article selection was free access and 2019–2021 years of publishing. Although the introduction is based on the articles published in 1989. The present article was created according to the federal project «Central and peripheral pathophysiological mechanisms of adipose tissue diseases and their clinical and hormonal manifestations» (2020–2022)RESULTS AND CONCLUISON: It is necessary to keep on investigating genomic, proteomic and metabolomic markers because they contain important clues for successful resistance against human diseases. The 21st century is the era of transformation from simple clinical medicine to personalized science. For example, researches in the area of cocaine-amphetamine regulated transcript may result in invention of genetic medicine against dangerous metabolic diseases.

The paper describes a case of a perinatal lethal Gaucher disease in a 29-week-old fetus with non-immune hydrops, facial dysmorphia, hepatosplenomegaly, and hypoplasia of cerebellum and pons. Gaucher cells were found in the lymph nodes, spleen, lungs, thymus, cerebellum, and bone marrow. No storage cells have been detected in the placenta. There was a significant placental weight increase due to swelling. The diagnosis of Gaucher disease was confirmed by biochemical analysis (deficiency of glucocerebrosidase activity and sharply increased hexanoylsphingosine concentration) and molecular genetic techniques (the presence of two mutations of theОписано наблюдение перинатального летального варианта болезни Гоше у 29-недельного плода с неиммунной водянкой, признаками лицевой дизморфии, гепатоспленомегалией, гипоплазией мозжечка и моста. Клетки Гоше обнаружены в лимфатических узлах, селезенке, легких, тимусе, мозжечке и костном мозге. В плаценте клеток накопления не выявлено, отмечено значительное повышение ее массы за счет отека. Диагноз болезни Гоше подтвержден биохимическими (снижением активности глюкоцереброзидазы и резким повышением концентрации гексаноилсфингозина) и молекулярно-генетическими (наличие двух мутаций гена

Objective. To evaluate the ovarian reserve function in female patients with obesity in comparison with women without obesity. Materials and methods. This study evaluated 500 caucasian women, age 20-30 years, 250 with obesity (body mass index, BMI ≥30 kg/m2) and 250 without obesity (BMI

BACKGROUND: It has been proven that vitamin D plays an important role in pregnancy. Deficiency of this element may be associated with the risk of developing gestational diabetes mellitus, preeclampsia, placentar insufficiency, low birth weight and premature birth.AIMS: To conduct an epidemiological analysis of vitamin D supply in women at different stages of pregnancy, living in Russia.MATERIALS AND METHODS: We included 1198 pregnant women living in 3 regions of Russia in the observational, multicenter, cross-sectional, continuous study. All pregnant women were tested for serum 25(OH)D levels. We collected biomaterial from August 2018 to December 2019. The end point of the study was the indicator of vitamin D supply in pregnant women and its level depending on the trimester of pregnancy and region of Russia. Statistical analysis included counting and grouping according to vitamin D levels, and calculating the median vitamin D concentration in each region.RESULTS: We confirmed vitamin D deficiency in all regions. The optimum level of this element is present in less than 7% of women. Insufficiency of this element is present in 20,62% of all women. The largest percentage of them is in a deficit of this element — 46,66%. We found that the lowest rates are in Smolensk, where the median was 12,75 ng/ml. In addition, we found changes in vitamin D concentration: with an increase in gestational age revealed a decrease in its level.CONCLUSIONS: In our study, we confirmed the presence of a 25(OH)D deficiency in most of the examined pregnant women, which is consistent with international epidemiological data. We should remember about these both at the stage of pre-gravid preparation and at the stage of pregnancy itself in order to achieve the optimal level of vitamin D.

The article presents data on new possible mechanisms of pathogenesis of polycystic ovary syndrome. In the past years there have been a lot of studies on the effect of vitamin D on the development of insulin resistance and hyperandrogenism. The amount of evidence for of the correlation between vitamin D deficiency and obesity is growing. The search for genetic markers predisposing to polycystic ovary syndrome among vitamin D receptor gene polymorphisms seems quite premising. Considering of detected connections, therapy with vitamin D may be an effective treatment for this disease. In addition to the influence on reproductive function vitamin D is involved in the regulation of circadian rhythm, and it’s disturbance may lead to the development of anovulation. Another important factor in control of sleep and wakefulness cycles is melatonin. It’s participation in development and maturation of follicles by inhibiting of oxidative stress was proved, and the use of melatonin in women as a treatment for infertility helped to improve reproductive function. Thus, further studies of the role of vitamin D and melatonin may allow developing principally new approaches and medical guidelines for clinical practice.

It is well known that GADD45 overexpression in the nervous system leads to the increased longevity in Drosophila. In this study, we performed an approximation of survivorship curves in Drosophila with GADD45 overexpression using the Gompertz distribution. We showed that the life span prolongation is caused by the alteration of R parameter, reflecting the mortality rate at the beginning of adult life, and not by the alteration of another Gompertz distribution parameter, α, reflecting the exponentially growing mortality rate. In addition, we analyzed the survivorship curves in the case of radiation hormesis (the phenomenon of life span extension under the exposure to low doses of radiation) and confirmed the regularity stated above. On the basis of this regularity, we concluded it promising to search for geroprotectors among the substances decreasing the R parameter, which is easier to assess than the full survivorship curve.

Hexagrammidae are endemics of the northern Pacific widely spread in marginal seas and coastal parts of the Pacific Ocean from the East China Sea in the west and California in the east to the Bering Strait in the north (Rass, 1962; Rutenberg, 1962; Shinohara, 1994). Almost all greenlings are nearbottom fish inhabiting coastal areas, and only lingood Ophiodon elongatus and Atka mackerels of the genus Pleuro� grammus lead a semipelagic mode of life and perform migrations to considerable distances into open waters (Gorbunova, 1962; Rutenberg, 1962). Hexagrammi� dae spawn in coastal areas in shallow water where incubation of bottom eggs takes place. The hatched out larvae are carried out by currents into open waters, sometimes to considerable distances from the coast, and they pass the first several months of life in the pelagial. Despite rather considerable number of publi� cations on the biology and ecology of greenling, the early stages of ontogenesis of these fish have not been adequately covered in literature, and were most com� prehensively considered in the paper of Gorbunova (1962) according to material of the 1950s. The distri� bution of juveniles of arabesque greenling Pleurogram� mus azonus and Atka mackerel P. monopterygius in the epipelagial of far eastern seas and the northern part of the Pacific Ocean is described in papers of Mel'nikov et al. (1996a, 1996b); Mel'nikov and Efimkin (2003); Mel'nikov and Loboda (2003). In the suggested paper, the occurrence in ichthy� oplankton and distribution of Hexagrammidae at early stages of ontogenesis in the northwestern part of the Pacific Ocean are considered.

Specific urogenital tract symptoms in women with diabetes mellitus are shown to directly correlate with the quality of compensation of carbohydrate metabolism while atrophic vulvovaginitis is both a consequence and an early marker of its decompensation. It is concluded that combined patogenetically sound treatment of acute and chronic "atrophic diabetic vulvitis" in patients presenting with disturbances of carbohydrate metabolism in the peri- and postmenopausal period should include Estrocard therapy, apart from thorough compensation of carbohydrate metabolism, in order to normalize the vaginal health index and the quality of life of the patients.

Pregnancy is a complex metabolic state, which includes dramatic changes in hormone secretion, amid growing demand for energy-rich compounds necessary for growth and development of the fetus. Women with diagnosed diabetes is always a greater risk of obstetric complications, which can be prevented by knowing the risk factors for diabetes, the criteria for early diagnosis, an algorithm of pregnancy, careful management of the postpartum period.

Резюме. Синдром поликистозных яичников (СПЯ) - заболевание, характеризующееся хронической ановуляцией, наличием клинических или биохимических проявлений гиперандрогении и мелкокитозными изменениями яичников. Одним из наи- более значимых этапов в изучении патогенеза СПЯ стало открытие взаимосвязи между овариальной гиперандрогенией и нарушением чувствительности к инсулину. С целью сравнительного изучения влияния инсулинорезистентности на стероидную активность цитохрома Р450с17α авторы провели динамическое, активное, проспективное исследование 60 женщин раннего репродуктивного возраста, страдающих СПЯ, средний возраст которых составил 25,2±5,8 (М-25,0). Пациенткам были проведены функциональные пробы с блокатором гонадолиберина (ГнРГ) и адренокортикотропным гормоном (АКТГ). После этого в течение 3 мес. проводилась терапия сенситайзером к инсулину. В результате проведенного лечения при повторном проведении проб изучалась динамика некоторых показателей овариального и надпочечникового стероидогенеза. Авторы делают выводы, что компенсаторная гиперинсулинемия и ИР являются причиной гиперандрогении, лечение метформином приводит к значительному снижению продукции андрогенов яичниками, в том числе и за счет снижения ЛГ-зависимого стероидогенеза в овариальной ткани, а значительное снижение уровня 17-ОН-Р у больных с СПЯ и ИР на фоне 3 мес. лечения метформином может свидетельствовать о воздействии препарата на ферментативную активность Р450с17α. Resume. Polycystic ovary syndrome (PCOS) - the disease characterised by chronic anovulation, presence of clinical or biochemical manifestations of hyperandrogenism and polycystic ovary changes. One of the most significant stages in studying pathogenesis of PCOS was the discovery of the interrelation between ovarian hyperandrogenism and decreased sensitivity to insulin. For the purpose of comparative studying of influence of the insulin resistance on steroid activity of cytochrome Р450с17α authors undertook a dynamic, active, prospective research in 60 women of the early reproductive age with PCOS, with middle age 25,2+5,8 (М-25,0). In this group of patients we performed functional tests with a blocker of gonadotropin-releasing hormone and adrenocorticotropic hormone analogfollowed by 3 months therapy with insulin sensitizer (metformin) with repeat of the functional tests at the end of treatment period to assess the indicators of ovarian and adrenal sex hormones secretion. Authors conclude that hyperinsulinemia and insulin resistance are the cause of hyperandrogenism, and treatment with insulin sensitizers leads to considerable decrease in production of ovarian androgens including at the expense of decrease luteinizing hormone-dependent sex steroid sinthesis in ovarian tissue, and considerable decrease in level 17-hydroxyprogesterone in patients with PCOS and insulin resistance after 3 month treatment with insulin sensitizer can testify the metformin's influence on enzymatic activity of Р450с17α.

Ichthyoplankton of the Sea of Okhotsk from October to December 2007 comprised larvae and fry of eight fish species belonging to five families. The larvae of lord Hemilepidotus gilberti, white-spotted greenling Hexagrammos stelleri, and Atka mackerel Pleurogrammus monopterygius were the most widespread and numerous in the study period. Fish larvae from October to December 2007 were seined over the vast water area of the Sea of Okhotsk, maximum catches were made in waters of western Kamchatka. The food spectrum of larvae of five fish species (H. gilberti, Hexagrammos octogrammus, H. stelleri, P. monopterygius, and Bathymaster signatus) included approximately 20 plankters. Irrespective of species belonging, copepods Pseudocalanus minutus and Oithona similis, eggs and nauplii of copepods, as well as juveniles of pteropods were common food items for all fish. Larvae of all considered fish species in the Sea of Okhotsk fed mainly during the light hours of the day.

The review gives updates on the pathogenesis of background, precancer, and cancer of the cervix uteri. Epidemiological and molecular biological studies have established that human papillomavirus infection is the most important factor of carcinogenesis of the cervix uteri. The impact of reproductive dysfunction on the development of cervical pathology has been assessed and a possible mechanism of involvement of sex steroids in carcinogenesis assumed.В обзоре представлены современные данные о патогенезе фоновых, предраковых заболеваний и рака шейки матки. В результате эпидемиологических и молекулярно-биологических исследований установлено, что важнейшим фактором канцерогенеза шейки матки является инфицирование женщин вирусом папилломы человека. Проводится оценка степени влияния функциональных нарушений репродуктивной системы на развитие патологии шейки матки, а также предполагается возможный механизм участия половых стероидов в канцерогенезе.

This article assesses the problem of obesity as a risk factor for development of severe metabolic complications and different disorders of reproductive function in women of childbearing age. It is pointed that obesity is associated with high prevalence of hyperandrogenemic and hyperplastic disorders, polycystic ovary syndrome, infertility, complications of pregnancy and childbirth. Article discusses the questions of integrated treatment approach of this category of patients, which include non-drug interventions (rational nutrition, lifestyle modification) as well as the use of medications which lower the insulin resistance and hyperinsulinemia to restore ovary function and the possible use of combined oral contraceptives for correction of anovulation.

Согласно современным представлениям главным фактором, определяющим перинатальную смертность, развитие акушерских и гинекологических осложнений, а также прогрессирование сосудистых осложнений сахарного диабета (СД) у матери является степень компенсации углеводного обмена с первых дней беременности. Надежная контрацепция для женщин с СД типа 1 является единственным реальным путем снижения риска как для самой матери, так и для ее будущего потомства, а также позволяет избежать абортов, более половины которых сопровождается развитием различных осложнений и ведет к декомпенсации основного заболевания. При выборе метода контрацепции у женщин с СД, кроме надежной профилактики незапланированной беременности, встает вопрос, как избежать влияния используемых методов коррекции фертильности на углеводный, липидный обмен, систему гемостаза, физиологические возрастные изменения, происходящие в организме женщины, на фоне высокой чувствительности органов-мишеней к экзогенно вводимым половым стероидам. Цель исследования – оценить влияние и эффективность современных контрацептивных средств с пероральным и парентеральным путем введения, с разными дозами эстрогенового и прогестагенового компонента, в различных режимах на углеводный обмен у женщин с СД типа 1 в репродуктивном периоде, провести анализ приемлемости (контроль менструального цикла) пролонгированных режимов использования вагинальной рилизинг-системы «НоваРинг» (режим сравнения – стандартный 21/7).

В настоящее время основным и наиболее значимым фактором, определяющим перинатальную смертность, частоту акушерских и гинекологических осложнений, а также скорость прогрессирования сосудистых осложнений у беременных с сахарным диабетом (СД), является степень компенсации углеводного обмена с первых дней беременности. Проспективное кооперированное исследование DCCT (Diabetes Control and Complication Trial) показало, что беременность у женщин с СД типа I значительно повышает риск развития и прогрессирования микрососудистых осложнений основного заболевания (ретинопатия, нефропатия) [1, 2]. Женщины с СД нуждаются в тщательном планировании беременности с использованием современных высокоэффективных методов контрацепции, к которым относятся гормональные и внутриматочные методы контроля фертильности.Цель исследования – оценить влияние и эффективность современных низкодозированных контрацептивных средств с разными дозами эстрогенового компонента и разными прогестагеновыми компонентами, а также внутриматочных контрацептивных средств на углеводный и липидный обмен у женщин с СД типа I в репродуктивном периоде.

Актуальность контрацепции у женщин с сахарным диабетом (СД) в позднем репродуктивном периоде и перименопаузе обусловлена широкой распространенностью данного заболевания, а также достижениями в диабетологии, позволившими максимально отдалить сроки появления и прогрессирования микро- и макрососудистых осложнений, тем самым увеличивая продолжительность детородного периода у женщин с нарушениями углеводного обмена. Беременность у больных данной категории связана с высоким риском развития осложнений, характерных и для женщин без нарушений углеводного обмена, и прогрессированием необратимых микро- и макрососудистых осложнений [1—3].Несмотря на снижение фертильности в старшем возрасте, случаи рождения детей у женщин старше 36 лет нередки. по статистике стран Западной Европы, 30% женщин в возрасте 45—54 лет имеют регулярный менструальный цикл и способны к зачатию. Фертильность женщин с СД при компенсации и субкомпенсации углеводного обмена не отличается от таковой у их сверстниц без СД [1, 4]. Согласно рекомендациям ВОЗ, контрацепция необходима женщинам и после наступления менопаузы в течение одного года [5]. Предупредить беременность у женщин с СД в данном возрастном периоде можно с помощью различных методов контрацепции. Однако влияние контрацептивов на углеводный и жировой обмен или систему гемостаза могут ограничивать их выбор [1, 4, 6].