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Background. Abnormal uterine bleeding (AUB) in adolescence is one of the urgent problems of medicine nowadays. It is on the 2nd place among all the reasons for hospitalization in gynecological departments, and its incidence among girls during puberty is 50%. Clinical case description. This is the clinical case of 15-year-old girl admitted to the gynecology department with complaints on long-lasting bloody vaginal discharge, fatigue, dizziness. The diagnosis of «abnormal uterine bleeding in adolescence» burdened with iron deficiency anemia (IDA) was established according to laboratory and instrumental examinations. The patient underwent RBC-transfusion with specific buffy coat and was administered with hormonal hemostatic and anti-anemic therapy. Conclusion. We can conclude (with reference to this observation and the reviewed literature) not only that IDA is one of the most common complications of AUB in adolescence, but also what management should be used in such clinical cases.

The objective of the study was to evaluate the profile and diagnostic significance of serum autoantibodies in infertile patients with premature ovarian insufficiency (POI). The pilot study included 26 patients of reproductive age with POI and diminished ovarian reserve who received complex treatment using new surgical technologies (Group 1) and 18 patients without POI (Group 2). The profile of serum autoantibodies, including anti-ovarian antibodies, antibodies against thyroid peroxidase (TPO), steroidogenic enzymes, and steroid and gonadotropic hormones, was studied using modified ELISAs and human recombinant steroidogenic enzymes (CYP11A1, CYP19A1, CYP21A2). Patients in Group 1 had higher levels of IgG autoantibodies against steroidogenic enzymes, estradiol, progesterone, and TPO than those in Group 2. Tests for IgG antibodies against CYP11A1, CYP19A1, and CYP21A2 exhibited high sensitivity (65.4–76.9%), specificity (83.3–89.9%), and AUC values (0.842–0.910) for POI, the highest in the first test. Three-antibodies panel screening showed higher diagnostic accuracy (84.1% versus 75–79.6%). The levels of these antibodies correlated with menstrual irregularities and a decrease in the antral follicle count. Thus, antibodies against CYP11A1, CYP19A1, and CYP21A2 have a high diagnostic value for POI. Three-antibody panel screening may improve the accuracy of POI diagnosis and be useful for identifying high-risk groups, early stages of the disease, and predicting POI progression.

Energy metabolism plays a pivotal role in the pathogenesis of endometriosis. For the initial stages of the disease in adolescents, this aspect remains unexplored. The objective of this paper was to analyze the association of cellular and endosomal profiles of markers of glycolysis, mitochondrial biogenesis, apoptosis, autophagy and estrogen signaling in peritoneal endometriosis (PE) in adolescents. We included 60 girls aged 13–17 years in a case–control study: 45 with laparoscopically confirmed PE (main group) and 15 with paramesonephric cysts (comparison group). Samples of plasma and peritoneal fluid exosomes, endometrioid foci and non-affected peritoneum were tested for estrogen receptor (Erα/β), hexokinase (Hex2), pyruvate dehydrogenase kinase (PDK1), glucose transporter (Glut1), monocarboxylate transporters (MCT1 and MCT2), optic atrophy 1 (OPA1, mitochondrial fusion protein), dynamin-related protein 1 (DRP1, mitochondrial fission protein), Bax, Bcl2, Beclin1, Bnip3, P38 mitogen-activated protein kinase (MAPK), hypoxia-inducible factor 1 (Hif-1α), mitochondrial voltage-dependent anion channel (VDAC) and transforming growth factor (TGFβ) proteins as markers of estrogen signaling, glycolysis rates, mitochondrial biogenesis and damage, apoptosis and autophagy (Western-Blot and PCR). The analysis identified higher levels of molecules associated with proliferation (ERβ), glycolysis (MCT2, PDK1, Glut1, Hex2, TGFβ and Hif-1α), mitochondrial biogenesis (OPA1, DRP1) and autophagy (P38, Beclin1 and Bnip3) and decreased levels of apoptosis markers (Bcl2/Bax) in endometrioid foci compared to non-affected peritoneum and that in the comparison group (p < 0.05). Patients with PE had altered profiles of ERβ in plasma and peritoneal fluid exosomes and higher levels of Glut1, MCT2 and Bnip3 in plasma exosomes (p < 0.05). The results of the differential expression profiles indicate microenvironment modification, mitochondrial biogenesis, estrogen reception activation and glycolytic switch along with apoptosis suppression in peritoneal endometrioid foci already in adolescents.

Uterine leiomyomas are the most common benign tumors in women of childbearing age. They may lead to problems of conception or complications during the gestational period. The methods of treatment include surgical (myomectomy and hysterectomy, embolization of arteries) and therapeutic treatment (ulipristal acetate, leuprolide acetate, cetrorelix, goserelin, mifepristone). Both approaches are efficient but incompatible with pregnancy planning. Therefore, there is a call for medical practice to develop therapeutical means of preventing leiomyoma onset in patients planning on becoming pregnant. Based on the analysis of GWAS data on the search for mononucleotide polymorphisms associated with the risk of leiomyoma, in meta-transcriptomic and meta-methylomic studies, target proteins have been proposed. Prospective therapeutic treatments of leiomyoma may be based on chemical compounds, humanized recombinant antibodies, vaccines based on markers of the uterine leiomyoma cells that are absent in the adult organism, or DNA and RNA preparations. Three different nosological forms of the disease associated with driver mutations in the MED12, HMGA2, and FH genes should be considered when developing or prescribing drugs. For example, synthetic inhibitors and vaccines based on matrix metalloproteinases MMP11 and MMP16 are expected to be effective only for the prevention of the occurrence of MED12-dependent nodules.

Aim. To evaluate the results of treatment of patients with uterine fibroids and infertility with ineffective art programs in the anamnesis and to identify possible risk factors for repeated art failures. Materials and methods. 510 patients with uterine fibroids and infertility were examined and surgically treated prior to the ART program. Myomectomy was performed using various approaches: laparoscopic access in 250 patients, laparotomic access in 70 patients, hysteroscopic myomectomy in 100 patients, and combined access (laparoscopic and hysteroscopic) in 90 women. Results. Primary infertility was observed in 38.0%, secondary in 62.0% of patients. The average duration of infertility was 4.41.9 years. ART had in history 54.5% of patients. During the follow-up period up to 2 years, 24.3% of women had recurrent uterine fibroids. After carrying out of surgical treatment and the following ART pregnancy was achieved in 44.3% of patients. Pregnancies ended in childbirth in 58.8% of cases, which exceeded the total share (41.6%) of adverse pregnancy outcomes (ectopic pregnancy, abortions, spontaneous miscarriages at various times) by 1.4 times. Conclusion. Risk factors for repeated ART failures in patients who have undergone myomectomy are: age over 40 years; duration of infertility for more than 5 years and the presence of 3 or more ineffective IVF attempts in the history; the presence of previous surgical interventions such as uterine artery embolization and FUS-ablation; the presence of submucous fibroids, a dominant node located close to the uterine cavity and myoma with signs of blood supply disorders; the combination of uterine fibroids with external genital endometriosis and chronic endometritis.

In order to determine genetic loci associated with decreasing risk of uterine leiomyomata (UL), a genome-wide association study (GWAS) was performed. We analyzed a group of patients with a family history of UL and a control group consisting of patients without uterine fibroids and a family predisposition to this pathology. Six significant single nucleotide polymorphisms were selected for PCR-genotyping of a large data set of patients with UL. All investigated loci (rs3020434, rs11742635, rs124577644, rs12637801, rs2861221, and rs17677069) demonstrated the lower frequency of minor alleles within a group of women with UL, especially in a subgroup consisting of patients with UL and a familial history of leiomyomata. We also found that the minor allele frequencies of these SNPs in our control group were higher than those across the Caucasian population in all. Based on the obtained data, an evaluation of the common risk of UL was performed. Further work will pave the way to create a specific SNP-panel and allow us to estimate a genotype-based leiomyoma incidence risk. Subsequent studies of genetic variability in a group of patients with a familial predisposition to UL will allow us to make the prediction of the development and course of the disease more individualized, as well as to give our patients personalized recommendations about individual reproductive strategies.

Abstract Obtaining fast screening information on molecular composition of a tissue sample is of great importance for a disease biomarkers search and for online surgery control. In this study, high resolution mass spectrometry analysis of eutopic and ectopic endometrium tissues (90 samples) is done using direct tissue spray mass spectrometry in both positive and negative ion modes. The most abundant peaks in the both ion modes are those corresponding to lipids. Species of three lipid classes are observed, phosphatidylcholines (PC), sphingomyelins (SM) and phosphoethanolamines (PE). Direct tissue analysis gives mainly information on PC and SM lipids (29 species) in positive ion mode and PC, SM and PE lipids (50 species) in negative ion mode which gives complementary data for endometriosis foci differentiation. The biggest differences were found for phospholipids with polyunsaturated acyls and alkils. Although, tissue spray shows itself as appropriate tool for tissue investigation, caution should be paid to the interpretation of mass spectra because of their higher complexity with more possible adducts formation and multiple interferences must be taken into account. The present work extends the application of direct tissue analysis for the rapid differentiation between endometriotic tissues of different foci.

Background: Adenomyosis is a very real problem encountered in modern gynecology due to the increase in the incidence, severity of the disease, and absence of effective methods of conservative treatment. The aim of the study was to investigate the clinical and morphological features of the focal and diffuse forms of adenomyosis. Methods and Results: The study involved 70 women who applied to the Center with the diagnosis of ‘adenomyosis’. Examination included transvaginal sonography (TVS), magnetic resonance spectroscopy (MRS), and morphological study of the adenomyotic foci. With a probability of 99%, one can argue that focal adenomyosis (FA) in its clinical features is different from diffuse adenomyosis (DA) in all its major manifestations. Conclusion: FA has unique morphological characteristics and clinical features. The diagnosis of FA should be based on a complex of clinical and instrumental data in conjunction with morphological process verification. Besides, there are difficulties in the diagnosis of FA, which is a major reason for the incorrect determination of the treatment tactic for patients. However, the application of MRS allows the preoperative identification of the biochemical structure of the focus and determination of its borders, and in the postoperative period, selection of optimal treatment tactics based on the identified morphological features of the removed adenomyotic foci.