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Uterine fibroids is an extremely common tumor of the female reproductive system, among whose manifestations are infertility, spontaneous abortions, incorrect fetal position, placenta previa, premature delivery, bleeding during and after delivery, and an increased risk of cesarean section. According to the literature, myomas are changing in size during pregnancy and in the postpartum period. Aim of the study. To assess the dynamics of uterine fibroid size change during pregnancy and the effect of an existing uterine fibroid on the course of pregnancy and labor. Materials and methods. Outpatient records of patients aged 24 to 45 years (mean age 33.36 ± 4.63 years) who were diagnosed with Pregnancy and uterine fibroids from 2016 to 2021 at Verum Medical Center were evaluated (n = 57). The size of the fibroids (volume and diameter) before, during (I or II prenatal screening) and after pregnancy (first pelvic ultrasound after delivery) was used for statistical analysis. Forty-one of the 57 patients had pelvic ultrasound before, during, and after pregnancy and were included in the statistical analysis of changes in uterine myoma size. Results. Among the patients included in the statistical analysis, uterine fibroids increased in volume by 194.38% ± 86.9 (40.98% ± 18.4 in diameter) during pregnancy, and decreased by 53.98% ± 14.93 in diameter and by 54.28% ± 29.62 of baseline in the postpartum period. A significant number of fibroids (39.47%) did undergo involutionary changes and were not visualized in the first postpartum ultrasound. The live birth rate was high at 90% (64% of deliveries were through natural childbirth and 26% through cesarean section). Conclusions. There was no effect of intramural, intramural-subserosal, and subserosal uterine fibroids with an average diameter of £20 mm on pregnancy and live birth in women. A great amount of uterine fibroids nearly triple in size during pregnancy, but after delivery they return to their original size and even halve in size. This can be regarded as a confirmation of the absence of a negative effect of pregnancy, or, possibly, a positive effect on uterine fibroid size, which requires further investigation.

The document was approved at an expanded meeting of the Ukrainian Society of Gynecological Endocrinology with the involvement of all board members and representatives of the Association of Obstetricians-Gynecologists of Ukraine, the Association of Pharmacologists of Ukraine, the Association of Anesthesiologists of Ukraine, as well during the Third Ukrainian School of Gynecological and Reproductive Endocrinology with international participation ISGE 19–20.03.21.The COVID-19 pandemic has significantly impacted medical practice, in terms of organizational and clinical practices, posing a number of complex and contradictory challenges for professionals.This document is the result of the systematization of scientific data available by March 2021 and recommendations of international medical and specialized professional societies on controversial clinical issues in gynecological practice caused by the COVID-19 pandemic, as well as certain issues of safety and ratio of using hormonal drugs. The involvement of experts from professional associations of the obstetric and gynecological field, pharmacology, anesthesiology and vascular surgery and phlebology in the working group made it possible to formulate clinically justified provisions of the position.The position includes three thematic sections: “On the use of estrogen-containing combined hormonal contraceptives (CHC) during the COVID-19 pandemic”; “On the use of menopausal hormone therapy (MHT) during the COVID-19 pandemic”; “On the issue of unregistered compounded bioidentical hormones”. At the beginning of each thematic section, the main conclusions of the consensus position of professional medical associations are presented. According to the data available by March 2021, there is no reason to limit the use of CHC or MHT in healthy women (currently not having COVID-19). The question of CHC or MHT discontinuing or switching to other forms by women with COVID-19 should be decided depending on the severity of the disease, the total set of risk factors for thromboembolic complications and other individual characteristics of the clinical situation. Further research will provide elaboration of more detailed algorithms. Physicians need to be vigilant about the safety of compounded Bioidentical Hormonal Therapy (cBHT) in any dosage form (including pellets), especially during the COVID-19 pandemic, given the unexplored systemic effects and therefore the potential risks. Preference should be given to officially licensed medicinal products with a well-studied safety profile and clinical effects, the use of which is authorized by doctor's prescription and supported by clinical protocols and guidelines.

Мета дослідження – вивчити особливості клінічного перебігу передраку і раку вульви у жінок пре- і постменопаузального віку. Матеріали та методи. Із 2017 до 2020 рр. у поліклінічному відділенні Національного інституту раку обстежено 160 хворих із дистрофічними захворюваннями, передраком і початковим раком вульви. Аналіз амбулаторних карт та історій хвороб усіх жінок дозволив нам додатково вивчити особливості клінічного перебігу патологічних процесів зовнішніх статевих органів залежно від віку. Вік хворих у дослідженні коливався від 49 до 70 років, у середньому (59,6±3,5) року. Менструальна функція була не змінена у 40 (25 %) зі 160 жінок. Вік менархе варіював від 11 до 18 років (середній вік – (14,5±0,3) року). Середня тривалість менструального циклу склала (30±0,4) дня. Більшість пацієнток неодноразово зверталася до гінекологів і дерматологів із приводу свербежу та дискомфорту в ділянці зовнішніх статевих органів. Лікар проводив консервативне лікування «лейкоплакії і краурозу» впродовж багатьох місяців, а іноді й років, без гістологічного уточнення діагнозу. Результати дослідження та їх обговорення. При дослідженні біоптатів вульви переважали хворі із діагнозом раку вульви I А стадії (34 %) порівняно з VIN (інтраепітеліальною неоплазією вульви) (12 %). При цьому VIN і початковий рак вульви були асоційовані з вірусом папіломи людини лише в 37,5 % випадків. Висновок. Однією з особливостей клінічного перебігу неоплазій вульви у жінок пре- і постменопаузального віку є те, що злоякісний процес частіше виявляється на стадії монофокальної інвазивної пухлини.

Сhaykivska E. F., Berezenko V. S., Tatarchuk T. F. Vitamine D supply in girls of puberty age with autoimmune hepatitis. Journal of Education, Health and Sport. 2020;10(5):366-379. eISSN 2391-8306. DOI http://dx.doi.org/10.12775/JEHS.2020.10.05.039 https://apcz.umk.pl/czasopisma/index.php/JEHS/article/view/JEHS.2020.10.05.039 https://zenodo.org/record/4445155 The journal has had 5 points in Ministry of Science and Higher Education parametric evaluation. § 8. 2) and § 12. 1. 2) 22.02.2019. © The Authors 2020; This article is published with open access at Licensee Open Journal Systems of Nicolaus Copernicus University in Torun, Poland Open Access. This article is distributed under the terms of the Creative Commons Attribution Noncommercial License which permits any noncommercial use, distribution, and reproduction in any medium, provided the original author (s) and source are credited. This is an open access article licensed under the terms of the Creative Commons Attribution Non commercial license Share alike. (http://creativecommons.org/licenses/by-nc-sa/4.0/) which permits unrestricted, non commercial use, distribution and reproduction in any medium, provided the work is properly cited. The authors declare that there is no conflict of interests regarding the publication of this paper. Received: 04.05.2020. Revised: 16.05.2020. Accepted: 29.05.2020. VITAMIN D supply IN GIRLS OF PUBERTY AGE WITH AUTOIMMUNE HEPATITIS 2E. F. Сhaykivska, 1V. S. Berezenko, 1T. F. Tatarchuk 1SI "Institute of Pediatrics, Obstetrics and Gynecology named Academic Elena M. Lukyanova National Academy of Medical Sciences of Ukraine”, Kyiv, Ukraine 2Danylo Halytsky Lviv National Medical University, Lviv, Ukraine Abstract Vitamin D undergoes important biotransformation and inactivation in the liver. Because vitamin D is metabolized in the liver, abnormal vitamin D metabolism can be expected to be associated with chronic liver disease, including autoimmune hepatitis (AIH). The prevalence of vitamin D deficiency in puberty was the justification for the objective of the study– to determine the characteristics of vitamin D supply in girls of puberty age with AIH with autoimmune hepatitis during this period. Materials and methods. To solve this goal, a comprehensive clinical and paraclinical examination of 66 girls withAIH and 180 relatively healthy girls of the control group aged 12-17 years. The complex included clinical and anamnestic data, biochemical study of liver function, determination of serum autoantibodies and markers of viral hepatitis, the level of 25- (OH) D in blood serum, ultrasound and elastography of the hepatobiliary system organs, liver biopsy. Results. The mean level of vitamin 25 (OH) D in the serum of girls with AIH of pubertal age was 17.14 ± 1.06 vs. 23.27 ± 0.53 ng / ml in the control (p 9 points, the share of patients with vitamin D deficiency was 79.41% compared with 53.13% of cases among girls with AIH, where the histological activity index was Key words: girls; puberty age; autoimmune hepatitis; vitamin D supply.

Endometrial hyperplasia (EH) is a pathological condition characterized by proliferation of the endometrial glands with an increase in the glands/stroma ratio compared to normal proliferative endometrium. EH is a precursor to the development of one of the most common gynecological malignancies – endometrial cancer. There are EH without atypia and with atypia. Total hysterectomy with bilateral salpingo-oophorectomy is the method of choice in the treatment of atypical EH. It is important to eliminate risk factors – overweight patients should lose weight by adjusting diet, increase physical activity. Recently, aromatase inhibitors have also proven to be an effective treatment option for EH with atypia. Oral progestogens and the levonorgestrel-releasing intrauterine device are methods of choice for conservative treatment of premenopausal and postmenopausal women with atypical EH. However, not all patients can use progestins for a long time due to possible side effects. Failure of progestin treatment may depend on various factors, such as the patient’s age, health status, other conditions, and the degree or type of hyperplasia. So it is important to look for new methods of EH management and adjuvant drugs that will potentiate the effectiveness of basic treatment, as well as opportunities to reduce the risks of progesterone receptor resistance and potentiation of progestins. Cridanimod is a new small molecule that has been shown in studies to increase the progesterone receptors expression in the endometrium. It has been suggested that in combination with progestin therapy it increases the progesterone receptors expression and thus improves the effectiveness of treatment. Research results allows to consider the possibility of using cridanimod in complex EH therapy, especially against the background of viral infection. Cridanimod reduces the risk of resistance to progestogen therapy in EH, provides the best result after conservative treatment and reduces the number of relapses.

The effect of iron deficiency (ID) without anemia on the reproductive health of women in contrast to iron deficiency anemia is still insufficiently evaluated from a clinical point of view, despite a weighty theoretical basis and a large pool of clinical observations. The purpose of this review is to systematize the ID causes without anemia in women associated and not associated with reproductive disorders, the effects of ID without anemia on reproductive health, and modern approaches to the diagnosis and treatment of this pathology. ID without anemia affects most of the physiological processes in a woman's body, including hormonal regulation, immune processes and functions of the nervous system. The negative effect of ID without anemia on a woman's reproductive function is realized through hormone-mediated and immune mechanisms. ID without anemia is currently underestimated in terms of somatic and reproductive health of women, as well as quality of life. Сlinical manifestations of ID without anemia are mostly nonspecific, which is why clinicians, focusing only on hematological parameters are often explaining them by other reasons, which leads to late diagnosis. Assessment of hematological parameters alone is accompanied by significant underdiagnosis of ID without anemia. Diagnosis of ID without anemia should be carried out in women with risk factors (abnormal uterine bleeding, heavy menstrual bleeding, etc.), as well as with dyshormonal disorders, recurrent inflammatory processes in combination with ID symptoms by assessing the ferritin and transferrin saturation. To treat ID without anemia it is necessary to eliminate the etiological factor and carry out a sufficiently long-term supplementation with oral iron preparations with good tolerance and bioavailability. Iron bisglycinate is the form of iron intake that does not affect the mucous membrane of the gastrointestinal tract and is absorbed by the small intestine mucosa unchanged, which ensures its good tolerability and high efficiency for the correction of ID.

Endometrial polyp is the most common structural abnormality of the mucous membrane of the uterus (endometrium) detected in unexplained infertility. Endometrial micropolyps are a hysteroscopic sign of chronic endometritis, detectable in 60% of women suffering from infertility. Both of the lesions provide an unfavorable environment for the endometrium receptivity and therefore may have common features in their etiopathogenesis. Study objective: to study the composition of microbiota in the vagina, the cervix and the uterine cavity in women of reproductive age diagnosed with endometrial polyps and micropolyps. Study design: the study involved 130 patients aged 18–35 years: 70 patients with endometrial polyps (group I), 30 patients with micropolyps (group II) and 30 patients of the control group (group III). Study methods: group I and II were diagnosed by hysteroscopy with histological confirmation, endometrial samples from healthy women were obtained by aspiration biopsy. Test system “Femoflor” was used to study the quantitative composition of vaginal microbiota, bacteriological examination of the cervix and the endometrium was performed by PCR and by cultivating aerobic and anaerobic microorganisms on special growth media. Study results: no statistically significant differences in the quantitative composition of vaginal microbiota have been identified in all study groups, the only changes recorded have been in the number of lactobacilli. The control group reported sufficient content of lactobacilli in 63% of women studied, the group I – 39%, the group II – from 23%. The cervical canal was sterile in 29% of women with polyps, 47% of women with micropolyps and 30% of healthy patients. The spectrum of pathogens isolated from the cervical canal was much narrower as opposed to the vagina and had no statistically significant differences between the groups. The frequency of the uterine cavity infection was 83% in women of group I, 73% in group II and 77% in group III. The endometrium of the patients from the control group has been seeded with noticeably more Enterococcus faecalis (43% vs. 11% in group I and 17% in group II). Endometrial samples of women from group I were characterized by significantly higher detection of Candida spp. – 21%, and herpes viruses type 1, 2, and 6 – 17%. The spectrum of microorganisms isolated from the endometrium of women with micropolyps did not significantly differ from that in the control group. Evaluation of concordance of the vaginal and endometrial biotope in all groups has not shown any significant differences but in Enterococcus faecalis in the I group (0 vs. 11%) and group III (0 to 43%). When comparing cervical and endometrial biotope the only significant difference has been detected in the group of women with endometrial polyps and concerned herpes virus type 6 (0 vs 11%) as well as the high-risk strains of HPV (31% vs. 6%). The limitations of this study: isolated endometrial pathogens were not correlated with the qualitative and quantitative composition of the gastrointestinal microbiota; further reliable data can be obtained from the detailed study of the nature of immune response in women with a variety of viral agents detected in the uterine cavity, as well as from classifying them according to the obtained results and building a more large-scale research. Conclusions: endometrial polyps and micropolyps – a pathology that results from dysbiotic changes in the vagina. The presence of microbial agents in the uterine cavity is not always indicative of the inflammatory processes. No convincing evidence of the etiologic role of any infection in the micropolyps formation has been obtained. Women with endometrial polyps demonstrated higher content of Candida spp. and viruses.

The goal of the work. Determine the level of manganese exposure in women withpolycystic ovary (PCOS) and analyze possible sources of exposure.Material and methods. The research was conducted in Kyiv. The first group (control)consisted of 38 women of reproductive age. The second group consisted of 52 women inwhom PCOS had been diagnosed. Using ICP-MS, a study of serum manganese in bothgroups of women was conducted. The study of environmental pollution with manganesewas carried out by processing data published in the open sources of information.Results. In women with PCOS, manganese values (median - 0.0095 mg/l, 95 percentile -0.13 mg/l) in serum were elevated, which significantly exceeded values from the controlgroup (median - 0.0035 mg/l, 95 -procetylene - 0.014 mg/l, p = 0.0012). Investigation ofpossible sources of exposure showed that drinking water could not be the cause ofexposure to manganese. Indicators of manganese in surface waters exceed the maximumpermissible values from 3,2 to 28 times. The level of air pollution by manganese inhundreds of times exceeded the safe levels for humans. Current article reviews differentpathogenic mechanisms of high concentration influence of manganese on PCOSoccurrence based on the type of exposure.Conclusion. High manganese concentrations in serum were found in women with PCOS.Sources of women's exposure are connected, probably, with high level of manganese insurface waters and air pollution. Both inhalatory and nutrient manganese exposurecreate pathogenic basis for PCOS.

The goal of the work. To determine the level of nickel exposure of women with polycysticovary syndrome (PCOS) and analyze the possible sources of exposure and pathogeneticmechanisms.Material and methods. The control group consisted of 38 women of reproductive agewho live in Kyiv, Ukraine. The second group consisted of 52 women who had beendiagnosed PCOS. In both groups of women, the determination of nickel in serum wasdone by the ICP MS method. The study of environmental pollution by nickel was carriedout by processing data published in open sources of information.Results. In women with PCOS, elevated levels of nickel were detected (median-0.036 mg/l, 95 percentile-0.194 mg/l), which significantly exceeded the control group (median-0.001 mg/l, 95 percentile-0.097 mg/l, p=0.0012). The study of possible sources of exposure showed that drinking and surface water could not be the cause of exposure tonickel. The lands used in agriculture are nickel-polluted. Controversial data on airpollution do not give possibility to make a clear conclusion. The work considerspathogenetic mechanisms of the possible influence of high concentrations of nickel onthe occurrence of PCOS.Conclusion. In women with PCOS high concentrations of nickel in serum were detected.There is a certain risk of nickel entering foods grown on contaminated lands. The elevated level of exposure to nickel has pathogenetic foundations for the occurrence ofPCOS.

The study of the level of knowledge about hygiene of girls with recurrent adhesions in their mothers was performed. The study included 463 mothers at Central (Kiev), Western (Lviv), East (Donetsk) regions of Ukraine: 290 mothers of girls aged 2 to 8 years with recurrent adhesions of the labia minora (2 or more); the control group consisted of 173 mothers who have girls (age 8 years) with a history of adhesions.Women were questioned about knowledge about intimate hygiene, where do they get this information and how this knowledge is being implemented in practice; and it was made the following conclusions:1. Violation of the rules of intimate hygiene at girls plays defi nite role in the development of labial adhesions and can be a risk factor for recurrence of labial adhesions.2. The level of knowledge of mother about the rules of girl intimate hygiene is one of the most important factors in the prevention of disorders of reproductive health at girls.3. Educative work of pediatrician and child gynecologist may have a decisive role in reducing the occurrence of relapse of adhesions of the labia minora in girls.4. The highest percentage of relapses occurs within 3 months after treatment - up to 45%.5. Long-term follow-up (not less than 1 year after the treatment) of the girl with every 3-months visit to the doctor should be implemented to the daily practice ofpediatricians and child gynecologist., Было выполнено исследование уровня знаний о гигиене ребенка у матерей девочек с рецидивирующими синехиями. В исследование вошли 463 матери с центрального (Киев), западного (Львов), восточного (Донецк) регионов Украины: 290 мам девочек в возрасте от 2 до 8 лет с рецидивирующими синехиями малых половых губ (2 и более раз); группу контроля составили 173 мамы, у которых девочки (возраст 8 лет) не имели в анамнезе синехий.Женщинам проводили опрос о качестве их знаний об интимной гигиене, откуда они получают эту информацию и насколько эти знания выполняются на практике. В итоге авторы сделали следующие выводы:1. Самый высокий процент рецидивов происходит через 3 месяца после лечения – до 45%.2. Нарушение правил интимной гигиены у девочек играет определенную роль в развитии синехий и является фактором риска рецидива.3. Большое значение в профилактике нарушений репродуктивного здоровья девочек играет уровень знаний мамы о правилах интимной гигиены.4. Просветительская работа педиатра и детского гинеколога может оказать решающую роль в снижении возникновения и рецидива синехий малых половых губ у девочек.5. Необходимо длительное (не менее 1 года) диспансерное наблюдение девочки после лечения с визитом к доктору 1 раз в 3 месяца.

Endometrial polyps and chronic endometritis are two most common causes of unexplained infertility in women of reproductive age.The aim of our study was to conduct a comparative analysis of the hormonal homeostasis and the state of the receptor apparatus of the endometrium in women of reproductive age with endometrial polyps and micropolyps.For a research 4 groups of women were chosen: 34 women with endometrial polyps (IA group), 36 patients with endometrial polyps and micropolyps (IB group), 30 women with micropolyps (IІ group) and 30 healthy women (ІІІ group). In all groups of women the content in blood serum for 3–5 day of a menstrual cycle of gonadotropic hormones (follicle-stimulating hormone, luteinizing hormone) and sex steroid hormones (estradiol, prolactin) was studied, for 21 days of a cycle estimated the content of progesterone. Level of an expression of receptors of progesterone and estrogen estimated in endometrium and at endometrial polyps, also in І a cycle phase.The conducted research revealed reliable decrease in level of progesterone at women with endometrial polyps against the background of lack of significant changes in the receptor device. At patients with micropolyps the tendency to a hypoprogesteronemia was also observed, but changes in an expression of steroid receptors it was not also revealed.The authors conclusion is the low concentration of progesterone initiate non-hormonal pathophysiological mechanisms of development of endometrial polyps which should be considered at purpose of antirecurrent therapy.Thus, in case of progesteron deficit perverse mechanisms literally overlap in an attempt to start the process of tumor. Inflammation is an important component of the physiological menstrual cycle, during prolonged hypoprogesteronemia it becomes pathological. It is directly involved in the formation of such a microenvironment for endometrium in which the mechanisms of fibrosis fully realize their potential, cell proliferation and angiogenesis, creating a strong foundation for the subsequent formation and growth of endometrial polyps. To date, it is proved that an imbalance in estrogen-progesterone system actually increases the risk of developing endometrial polyps, but not always through steroid receptors.

Polycystic ovary syndrome (PCOS) is the most common endocrinopathies in women of reproductive age. The aim of the study was to determine the concentrations of some essential macro- and microelements in the body of women with PCOS. Taking into account the frequent combination of PCOS with inflammatory processes of genitals, it was decided to examine trace elements concentration in this category of women. Study includes 3 groups of women: 30 women with PCOS against the background of inflammatory diseases of pelvic organs (I group), 22 patients with PCOS without inflammatory processes of pelvic organs (II group) and 25 healthy women (III group). In all groups it was studies macro- and microelements concentration in blood: magnesium (Mg), copper (Cu), manganese (Mn), nickel (Ni), zinc (Zn), chromium (Cr), selenium (Se), vanadium (V). The study revealed increase zinc and nickel level, decrease manganese level in women with PCOS, that give grounds suppose their participation in the infringement of folliculogenesis and ovulation due to their properties to intensification of the lipids peroxide oxidation and reduction activity of antioxidant system, injuries cell membranes and mitochondria, gap DNA molecules and to disturb transcription processes. More high zinc and nickel concentrations in patients with PCOS in the background of inflammatory process indicates on possible inflammation role in disorders development, because proinflammatory cytokines (IL-1, IL-6, IL-18, TNF-α) leads to the zinc accumulation and elevated nickel concentrations can induce inflammation and inhibit the functional activity of macrophages and natural killer cells, setting the conditions for chronic inflammation. Level study of trace elements (zinc, nickel and manganese) may be recommended for women with PCOS and with inflammatory diseases of pelvic organs and control their administration in complex multivitamin preparations.

The National consensus on management patients with endometriosis includes the main issues of epidemiology, clinical manifestations, and diagnostics of this disease. The document also contained evidence-based recommendations on treatment tactics of endometriosis (medical and surgical treatment), secondary prevention of endometriosis.