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Polycystic ovary syndrome (PCOS) and non-alcoholic fatty liver disease (NAFLD) are two common non-infectious pathologies. Their frequency and medico-social significance have increased significantly over the past decades and reflect the effects of radical changes in human lifestyle on human health in a transgenerational aspect. Due to absence a complete understanding of the etiology and pathogenesis of PCOS and NAFLD, modern medicine still does not have etiopathogenetic methods of treating these frequent diseases. Considering epidemiological and pathogenetic data PCOS and NAFLD can be regarded as related pathologies, which creates the prospect of improving the effectiveness of their management if the joint approach to scientific research and implementation of their results in medical practice is applied. The purpose of the review is to summarize the current scientific data on the common pathophysiological and clinical relationships between PCOS and NAFLD, which can contribute to improving the effectiveness management of both diseases. Pathogenetic relationships between PCOS and NAFLD are bidirectional. According to current data, it seems possible to consider PCOS as a significant risk factor for the development of NAFLD in women of reproductive age both in the presence of excess weight and with normal body weight. As is known, that liver is involved in the clearance of androgens by the formation of sex steroid-binding globulin, as well as in the inactivation of insulin. Disruption of these metabolic processes due to liver pathology can lead to the development or strengthening of biochemical and clinical hyperandrogenism and the development of hyperinsulinemia and insulin resistance (IR). Conclusions. The presence of fatty liver and especially steatohepatitis deepens the hormonal disorders inherent in PCOS (primarily, an increase of free androgens, IR and ovulatory dysfunction), as well as potentiates and accelerates the development of cardiometabolic complications, including atherogenic dyslipidemia, dysglycemia, metabolic syndrome and cardiovascular complications. Early detection of NAFLD in women with PCOS, regardless of the presence of obesity, may improve the effectiveness of PCOS management and prevention of its cardiometabolic risks.

Endometriosis affects 10% of all women of reproductive age, i.e. 190 million patients. Ukraine currently does not gather statistics on the incidence of endometriosis, but, at a rough estimate, this number is approximately 280 thousand women and the real number may be higher. Endometriosis has known significant social, medical and economic impact. Therefore, Ukrainian leading specialists in obstetrics and gynecology focus on new treatments for endometriosis, given current scientific data and the needs of patients. The given resolution and algorithms for treatment for endometriosis are the common stand of leading specialists in gynecology in our country and were developed on the basis of modern domestic and foreign data and current clinical guidelines. This resolution aims to improve clinical approaches to the routine practice of treatment for endometriosis. The constant increase in the incidence of endometriosis and its management characteristics allows to conduct an extensive study of the effectiveness and safety profile of various progestogens. In recent years, a number of further evidence have appeared regarding dydrogesterone treatment for endometriosis. New data on the effectiveness of dydrogesterone offer another hormone-based treatment for endometriosis, which is extremely important given the need for long-term and individualized treatment for endometriosis. The Europ ean Society of Human Reproduction and Embryology (ESHRE) states that the degree of pain relief in endometriosis is the same for all hormone-based treatments, but the safety and tolerability profiles of different medicinal products differ, which must be considered. According to the obtained data on the effectiveness and metabolic safety profile of various progestogens and during the discussion, algorithms for dydrogesterone-based treatment for endometriosis were proposed.

Background. Postmenopausal osteoporosis (PMO), which is developed due the estrogen defi ciency in women after menopause, is the most common type of systemic osteoporosis. The latest Ukrainian recommendation for its management requires revision due to new data from high-quality research performed in recent years. The purpose was to develop a guideline on the diagnosis, prevention, and treatment of PMO based on an analytical analysis of modern literary sources in order to improve the awareness of the medical community of Ukraine. Methodology. To develop the guideline, an expert group of 13 leading Ukrainian scientists of various specialties was created who conducted a tho rough review of modern literature on this topic, assessed the level of existing evidence using the GRADE system, proposed and voted on 15 recommendations of the guideline. Results. The guideline contains chapters on diagnosis and diff erential diagnosis of PMO, assessment of the osteoporotic fracture risk, the role of bone turnover markers in the management of PMO, and modern strategies of antiosteoporotic treatment. Conclusions. The Ukrainian guideline on the diagnosis, prevention, and treatment of PMO, which contains 15 main recommendations, created on the basis of a tho rough analysis and synthesis of modern literature data, is an important tool for the management of PMO and is recommended by Ukrainian Association of Osteoporosis for use in Ukrainian me dical community.

A review of world literature and Ukrainian researches on the most common requests to gynecologists among military women, on the structure of pathology and treatment methods was made. Special attention is paid to the hormonal contraception, namely combined oral contraceptives (COCs) in the usual and continuous regime (avoiding the hormone-free interval) and the levonorgestrel-releasing intrauterine systems (LNG-IUDs). Cases of global practice of using COCs in extended regimen were considered, which showed that 47.2% of 1156 women chose a prolonged regimen of COCs, the main reason for this was the desire to avoid symptoms associated with menstruation. We consider this option very positive for military women, because some studies show that military women who took COCs in a continuous regimen were almost twice as favorable to their reception as those who used them in a regular mode. The positive aspects of the LNG-IUDs use in military women are presented, as a factor in the prevention of abnormal uterine bleeding, reducing the risk of iron deficiency in case of possible blood loss, and reducing the intensity of dysmenorrhea as a negative factor in the military conditions. Ways to increase compliance between a gynecologist and a military woman are also considered, using the example of global studies, which prove that insufficient awareness of patients about the possible ways and positive effects of using COCs in extended regimen reduced patients’ commitment to choosing new regimens. Conclusions. In today’s realities, the gynecological service in our country faces a number of new problems that require a strategic approach and solution. World practice and national studies prove that stress-induced hormonal disorders in military women, such as abnormal uterine bleeding, menstrual cycle disorders, dysmenorrhea, are negative factors in combat conditions, require the attention and resolution by doctors. One of the options for solving this problem can be the appointment of COCs according to the usual and extended scheme or appointment of LNG-IUDs.

Background. Vitamin D deficiency (VDD) is widespread in the world; its proportion varies considerably in different populations and depends on many causes. Up to now, there were no National recommendations for the diagnosis, prevention, and treatment of VDD in adults in Ukraine. Their creation became the purpose of this work. Methodology. Consensus was created using the Delphi method, voting was conducted using the SurveyMonkey® platform. After approval of the composition of the Consensus Group, agreement on the order of formation and structure of the Consensus, creation and correction of the main statements, and two voting rounds, the main Consensus statements were formed and were successfully voted on. The 15 authors of the article are 15 experts who participated in the voting. The final 14 Consensus statements are presented in this article. Each statement is preceded by a justification based on high-quality evidence available in the current literature. Results. Despite the reduction of VDD in the Ukrainian population in recent years, experts have recommen­ded increasing the awareness of the medical community and the Ukrainian population about the problem and ways to overcome it, with a screening of the total serum level of 25-hydroxyvitamin D (25(OH)D) in subjects from the groups of risk to achieve the target concentration of 30–50 ng/ml (75–125 nmol/l). To ensure it, we recommend the individual selection of a prophylactic dose of vitamin D (800–2000 IU/d for young healthy persons and 3000–5000 IU/d for patients with diseases and conditions that affect the metabolism of vitamin D). For the treatment of VDD, we recommend short-term intake of higher doses (4000–10,000 IU/d) of vitamin D with control of the 25(OH)D level after 4–12 weeks of treatment and subsequent use of maintenance doses. Also, we re­commend the determination of serum 25(OH)D level before the initiation of antiosteoporotic therapy in patients with osteoporosis and its complications to prevent its ineffectiveness and increase the safety profile.

Сталий розвиток суспільства будь-якої країни багато в чому визначається здоров’ям вагітних, яке визначає життєздатність і здоров’я потомства на всіх етапах онтогенезу. Мета - провести аналіз тенденцій змін та інтегральної оцінки (ІО) основних предикторів вагітності високого ризику (ВВР) в Україні у 2010-2021 рр. Матеріали та методи. Здійснено комплексний ретроспективний аналіз, загальну характеристику динаміки і регіональних особливостей ІО основних предикторів ВВР на основі даних Державної служби статистики України та ДЗ «Центр медичної статистики МОЗ України». Структуризовану за окремими компонентами ІО основних предикторів ВВР здійснено за загальноприйнятою методикою комплексної оцінки стану здоров’я населення на основі інтегральних показників. Інтерпретацію результатів ІО проведено з урахуванням того, що чим вищий інтегральний показник, тим більший ризик розвитку ВВР. Використано методи системного підходу, структурно-логічного, епідеміологічного аналізу, математичний метод і метод моделювання. Результати. Аналітичні дані показали, що останніми роками в Україні утримуються все ще високі при різноспрямованій тенденції рівні материнської та перинатальної захворюваності і смертності, значній частині яких можна було запобігти шляхом ідентифікації та мінімізації предикторів ВВР. Проведений аналіз стану основних предикторів розвитку ВВР виявив високі рівні частоти народжуваності юних (5,21‰) і старших (7,86‰) жінок зі збільшенням їхнього сумарного внеску в загальну народжуваність з 9,5% у 2010 р. до 16,29% у 2021 р., темп приросту - 71,5%, недостатнє при негативній тенденції охоплення вагітних диспансерним наглядом та оглядом терапевта (90,7% - у 2010 р., 87,82% - у 2021 р., темп убутку - 3,9%; та 90,83%, 89,51% і 9,9% відповідно). За цей період залишалася високою частота хвороб та ускладнень гестаційного періоду - анемії (26,4% - у 2010 р.; 24,75% - у 2021 р., темп приросту - 6,5%), хвороб системи кровообігу (6,2-6,34% та 2,3%), хвороб сечостатевої системи (14,05-14,03% та -2,4%), цукрового діабету (0,17-0,96% та 452,9%), хвороб щитоподібної залози (9,65-9,2% та 1,76%), прееклампсії та еклампсії (2,31-2,1% та -9,1%), гестозів (6,65-6,7% та 0,8%) і венозних ускладнень (2,84-4,98% та 69,0%). Комплексна ІО основних предикторів ВВР здійснена шляхом розподілу регіонів на три групи: І група з високим ризиком розвитку ВВР (ІО - 131,1-111,9%); ІІ група із середнім ризиком розвитку ВВР (106,5-92,0%); ІІІ група з нижчим за середній ризиком розвитку ВВР (89,6-60,3%). До І групи регіонів, що потребують детального вивчення і корекції детермінант ВВР, належать м. Київ, Вінницька, Полтавська, Дніпропетровська, Київська, Чернігівська та Чернівецька області, до ІІ групи регіонів із середнім ризиком розвитку ВВР, що потребують посилення окремих компонентів медико-соціальної допомоги вагітним, - Волинська, Миколаївська, Донецька, Рівненська, Харківська, Львівська, Житомирська, Черкаська, Хмельницька та Закарпатська області. Висновки. Розроблений інструментарій ІО основних детермінант ВВР дає змогу забезпечити об’єктивне оцінювання їх у цілому і за окремими компонентами в розрізі регіонів, своєчасно виявляти проблеми, які потребують втручання. Автори заявляють про відсутність конфлікту інтересів.

Abnormal vaginal discharge (AVD) is a common syndrome. Its management is addressed in many evidence-based guidelines: International Union of Sexually Transmitted Infections (IUSTI) and WHO Guidelines for management of vaginal discharge (2018); American College of Obstetrics and Gynecology (ACOG) Practice Bulletin No. 215 «Vaginitis in non-pregnant patients» (2020); U.S. Centers for Disease Control and Prevention (CDC) Guidelines for the treatment of sexually transmitted diseases (2021) etc. In December 2022, the Ministry of Health of Ukraine approved an adapted Clinical Guidelines and Standards of Medical Care “Abnormal vaginal discharge”. A special aspect of AVD management is frequent recurrence. Among the many hypotheses of the etiology of the recurrent course of vaginal infections the clinical aspect of difficulties of identifying all pathogens in case of mixed forms deserves special attention. Thus, there is need to presume the possibility of a mixed etiology of AVD or an atypical course of mono-infection at the stage of clinical examination. This review focuses on the role of vaginal discharge pH measuring both in the clinical stage of diagnosing the causes of AVD and in the interpreting laboratory results. Vaginal pH testing is an important component of the clinical stage in diagnostics of the AVD causes. This feasible and quick study allows objectifying the vaginal dysbiosis with a decrease in lactoflora and lactic acid value, which requires further laboratory diagnostics during the examination. Also it is an integral part of the Amsel criteria in the diagnostics of bacterial vaginosis, and vaginal health index to assess the degree of vaginal atrophy in menopause. Vaginal pH testing improves the diagnosis of difficult-to-detect infections and rare causes of AVD. Also, this method is useful for telemedicine to prevent unnecessary medical examinations, laboratory tests and self-treatment, or vice versa, to confirm the need for a specialist consultation.

Research objectives: to evaluate the effect of vitamin D supplementation (Olidetrim) in the complex anti-relapse therapy of bacterial vaginosis (BV) in women of reproductive age. Materials and methods. The study included 63 women of reproductive age with BV and with a level of 25-hydroxyvitamin D below 75 nmol/l, who were divided into groups: the main group included 32 women who were prescribed standard therapy (metronidazole 500 mg twice a day for 7 days) and cholecalciferol (Olidetrim) 4000 IU/day with subsequent continuation of its intake in a dose 2000 IU/day for up to 6 months; the comparison group included 31 women, who were not intake vitamin D preparation during the standard therapy and during the next 6 months of observation. After treatment, women provided completed questionnaires and self-collected vaginal swabs 1, 3, and 6 months after beginning of the study or before BV relapse. Evaluation of Gram-stained smears was carried out by microscopy according to Hay/Ison criteria, where BV corresponded to type III. The level of 25-hydroxyvitamin D in blood serum was determined by the chemiluminescent immunoassay method before the start of the study and at 3 and 6 months of follow-up. The primary endpoint was BV recurrence at any post-treatment interval; the patients were offered a second treatment in this case. Results. Vitamin D deficiency at the beginning of the study was detected in 12 (37.5%) patients of the main group and in 13 (41.94%) women of the comparison group, an insufficient level – in 20 (62.5%) patients of the main group and in 58.06% women of the comparison group. Patients complained of pathological vaginal discharge, itching, burning and dyspareunia lasting from 1 week to 2 months. At the seven-day course of basic BV therapy all participants noted the normalization of discharge and the absence of vaginal discomfort. Positive dynamics were also observed according to the gynecological examination. One month after the treatment, 4 (12.5%) participants of the main and 6 (19.36%) women of the comparison group noted the recovery of symptoms. Absence of BV recurrence after 3 months was noted by 25 (78.12%) women of the main group and 16 (51.61%) women of the comparison group (p = 0.054), that was confirmed by the laboratory tests. At the same time, the level of 25-hydroxyvitamin D in the main group increased by 43.37% (p = 0.05), and in the comparison group it did not differ from the initial level. There were no complaints in 24 (75.0%) patients after 6 months, however, a laboratory-confirmed normal state of the vaginal microbiome was observed in 22 (70.96%) participants of the main group and in 14 (45.16%, p = 0.07) women of the comparison group. Continuation of vitamin D intake at a dose of 2000 IU/day for the next 3 months demonstrated maintenance of the 25-hydroxyvitamin D level within normal values (81.7 ± 6.23 nmol/l in the main group vs. 38.51 ± 5.43 nmol/l in comparison group, p = 0.05). Conclusions. A decrease in the frequency of BV recurrences in women during support a normal level of vitamin D was found, which allows recommending the inclusion of cholecalciferol supplementation (Olidetrim) in the standard treatment. In patients with recurrent BV a long-term monitoring of the serum level of vitamin D is advisable in order to timely prescribe supplementation.

Miscarriage remains an important global problem: 23 million miscarriages are registered annually in the world, i.e. 44 pregnancy losses every minute, and the total risk of miscarriage is 15.3% of all pregnancies. Effective methods of pregnancy preservation (in case of idiopathic miscarriage and threatened miscarriage) include lifestyle modification and progestagen therapy. Progesterone is the main hormone necessary to maintain pregnancy. The effectiveness of progestogens among medical methods that increase the chances of pregnancy preservation has been proven by numerous studies. Effectiveness and safety of various types of progestogens during pregnancy have been studied. As a result, progesterone and dydrogesterone became the only progestogens approved for use in obstetrics – micronized progesterone and dydrogesterone reduce the frequency of miscarriage in women with clinical diagnoses of threatened miscarriage and idiopathic recurrent miscarriage. In addition, the progestogens safety has been carefully studied in modern randomized studies, prospective trials and meta-analyses and the same safety profile of dydrogesterone and micronized progesterone for pregnant women and the fetus has been proven. Studies have shown that oral dydrogesterone has relatively low antagonistic activity at glucocorticoid and mineralocorticoid receptors compared to progesterone and therefore well tolerated. Oral dydrogesterone due to the peculiarities of structure has improved bioavailability compared to progesterone, which allows a woman to avoid the inconvenience and discomfort associated with the intravaginal or intramuscular use of progesterone. In addition, dydrogesterone has a 1.5 times higher affinity for progesterone receptors compared to micronized progesterone and a pronounced anti-inflammatory and immunomodulation effect, which provides certain clinical advantages for patients after recurrent pregnancy losses. Thus, progestogens are indicated for all patients with recurrent pregnancy losses from the moment of receiving a positive pregnancy test, as they reduce the risk of miscarriage. It is important that the use of progestagen drugs during the first and second trimester of pregnancy is not associated with side effects

Objective: to evaluate the clinical tolerability, effectiveness and stability of the therapeutic result when using different regimens for the treatment of recurrent bacterial vaginosis (BV) in women of reproductive age. Materials and methods. 105 women of reproductive age with diagnosed recurrent symptomatic BV participated in the study. The participants were randomized into three comparable groups of 35 women each. A ten-day primary decontamination of the vaginal tract was carried out in all groups: intravaginal administration of the drug Tergynan for group 1 and Femiril suppositories in groups 2 and 3. After the initial treatment patients of group 3 received the vaginal probiotic suppositories Alactel Femi for 15 days, after that they used it twice a week No. 10. The effectiveness of BV therapy was evaluated immediately after the antibacterial course and after a 6-month follow-up period based on the results of clinical examination and determination of vaginal pH. Results. Subjective and objective signs of bacterial infection were not detected in all participants after the course of vaginal decontamination. The pH of vaginal secretion was within the normal range and did not differ statistically between the groups. After 6 month, according to the results of a gynecological examination and pH test, one recurrence of BV was confirmed in group 1 and 2. The patients of group 3 had no complaints about manifestations of reinfection, which, in combination with the data of pH-metry, allowed confirming the absence of BV recurrences in them. Additional use of a probiotic in a complex with lactic acid in group 3 was associated with a stable normalization of the acid-alkaline balance of the vaginal secretion: 4.43 ± 0.12 and 4.39 ± 0.14 in groups 1 and 2, respectively, against 4.02 ± 0 ,12 in the 3rd group (p < 0.05). Conclusions. Obtained results indicate a more stable anti-relapse effectiveness and safety of the local use of Femiril, followed by the restoration of the physiological parameters of the vaginal biotope with a complex of probiotics and lactic acid in the Alactel femi. The effectiveness of this approach consists in combining the antibacterial effect of phytoextracts with the successive restoration of vaginal immunity and metabolism through persistent colonization of the mucous membrane with living lactobacilli of eubiotic origin.

Clinical lecture is intended for general practitioners – family doctors who provide medical assistance to women with menopausal disorders and are based on the Unified clinical protocol of primary, secondary (specialized), tertiary (highly specialized) heath care “Menopausal disorders and other disorders in the perimenopause” approved by the order of the Ministry of Health of Ukraine dated June 17, 2022 No. 1039. Clinical lecture provides methods and algorithms for diagnosis and treatment of associated with menopause disorders, which will allow forming a comprehensive management strategy of women during menopause by a family doctor in Ukraine and will contribute to improving their health and quality of life. Today, there are no reliable signs that predict the severity and duration of menopausal disorders, so women should focus on a healthy lifestyle as a way to prevent severe menopausal disorders. To clarify the stages of reproductive aging, it is advisable to use the Stages of Reproductive Aging Workshop (STRAW+10). All women over 40 who come for a visit should be asked 6 questions to identify menopausal syndrome. The international Menopause Rating Scale is used to determine the severity of menopause symptoms. Women with symptoms of menopause should be referred to an obstetrician-gynecologist. Treatment of patients with menopausal disorders is carried out by a general practitioner – a family doctor and is carried out using non-medicinal methods and pharmacotherapy. The family doctor can prescribe non-hormonal drugs. Hormonal treatment of menopause symptoms is prescribed by an obstetrician-gynecologist. Treatment of accompanying pathology is prescribed by relevant specialists in accordance with current standards of medical care. Patients with perimenopausal and menopausal disorders need to be monitored by a general practitioner – a family doctor, who maintains the medical documentation and helps the patient comply with the recommendations of specialists.

Objectives: to evaluate the benefits of delayed conservative myomectomy with the aim of reducing body weight and correcting hematological and metabolic parameters against the background of the use of gonadotropin-releasing hormone (GnRH) agonists and a combination of myo-inositol and D-chiro-inositol (Inofolic combi) in obese patients with metabolic syndrome by comparing this technique with immediate surgery. Materials and methods. The study included 72 patients with uterine fibroids and obesity who required conservative myomectomy. Patients were offered to postpone surgical intervention in order to correct body weight, metabolic and hematological indicators. As a preoperative preparation, patients were recommended to use GnRH agonists (goserelin), inositols, and iron preparations for anemia. Patients were divided into 2 groups: the first group (n = 31) followed all these recommendations, the second group (n = 41) refused to follow the recommendations and postponed surgical treatment. Group 1 underwent surgical treatment 3 months after the start of treatment, group 2 – after the initial consultation. Results. Patients of the first group lost an average of 7.3 ± 1.4 kg of body weight during preoperative preparation, their hemoglobin level increased by an average of 21.78%, and the volume of the largest myomatous node decreased by an average of 21.82%. The duration of the operation was significantly shorter in group 1 (75 ± 3.84 min) than in group 2 (118 ± 5.33 min). Laparotomy in the first group was not performed in any patient, in the second group it was performed in 9 patients (21.95%) (p < 0.05). There was a decrease in the severity of postoperative pain in group 1, (3.4 В± 1.25 points on the visual analog scale), which was significantly lower than in group 2 (5.1 В± 3.4 points). Conclusions. Body weight reduction against the background of the use of GnRH agonists (goserelin) and inositols (Inofolic combi) due to the improvement of the technical conditions of the operation, metabolic and hematological indicators allow to reduce the duration of surgical intervention and the frequency of laparotomies in patients with uterine fibroids against the background of obesity and metabolic syndrome.

Uterine fibroids (UF) is an extremely common benign tumor of the female reproductive system. This pathology is often associated with symptoms that significantly impair the quality of life of a woman and her working capacity, and can also affect the ability to conceive and gestation. Today, we have in the arsenal of operational, drug and minimally invasive methods of UF treatment. One of the most researched and at the same time rather controversial methods of UF treatment is uterine artery embolization (UAE). Literary sources were reviewed using the MEDLINE, PubMed and Web of Science databases for the period 2011–2021. The data related to the history of the technique development, its implementation, indications and contraindications for UAE, its effect on the UF symptoms and on fertility were systematized and presented in this review. UAE as an independent method for the treatment of benign uterine tumors has 20 years of experience in the world and in Ukraine. The indications for UAE are symptomatic UF: profuse and/or prolonged menstruation, dysmenorrhea, compression of the pelvic organs, dyspareunia, frequent urination or urinary retention. Absolute contraindications for UAE are genital tract infections, pregnancy, doubts about the diagnosis, as well as contraindications to the use of X-ray contrast agents. The effectiveness of UAE is assessed by the manifestations of UF symptoms and by the degree of fibroids size reduction. The average node reduction in the diameter is 2.2 cm. The clinical efficacy index is 81–96, 70–100 and 46–100% respectively in the treatment of abnormal uterine bleeding, pelvic pain and symptoms of compression of adjacent organs. There is a decrease in the node volume by 25–60% within 3–6 months. Conclusions. UAE today is an effective and safe minimally invasive operation, which is a worthy alternative to hysterectomy and expands the possibilities of organ-preserving technologies if there is UF.

Uterine fibroids is an extremely common tumor of the female reproductive system in the population. The problem of this pathology is the diversity of symptoms, mediated by the variety of sizes and locations of myomas, significant impact on reproductive function and frequent misunderstanding of the tumor nature, which leads to unwarranted hysterectomies, even among young women. Authors review the literature on the basis of modern guidelines, which reveals the potential of preserving methods of treatment of fibroids. It is also attempted to answer the most common questions about this pathology. The incidence of uterine fibroids increases with age. Fibroids are hormone dependent tumors, but the obvious cause has not yet been identified, although various risk factors are known, both modified (e.g., obesity, parity) and unmodified (race, age, etc.). Diagnosis of fibroids is simple – just an examination and ultrasound of the pelvis. Among the organ preservation methods of treatment are currently known medicinal (some of them can be used as mono-method or in combination with other methods), minimally invasive (among which stands out uterine artery embolization, as the most studied, effective and safe method) and surgical – conservative myomectomy, which can be performed by different approaches (laparoscopic, hysteroscopic or laparotomy) depending on the number and location of fibroids. This review considers the issues of fertility in uterine fibroids and after organ preservation technologies for its treatment. Differential diagnosis of uterine fibroids with leiomyosarcoma – a rare tumor and its diagnosis is quite difficult. The development of modern medical science, combining specialties with the formation of multidisciplinary teams (as in the case of collaboration with endovascular surgeons to perform uterine artery embolization) and use of an individual approach depending on the fibroids characteristics and patient needs helps reduce the proportion of hysterectomies for uterine fibroids, preservation of the organ and fertility.

Menopausal hormone therapy (MHT) remains the most effective treatment for vasomotor symptoms and genitourinary syndrome of menopause. MHT, initiated in women during the “therapeutic window” to relieve symptoms of estrogens deficiency and prevent or treat osteoporosis, is the only intervention that reduces the risk of cardiovascular diseases and diabetes in healthy middle-aged women. MHT must be individualized and adapted; that is, a differentiated selection of therapy should be carried out, considering the woman’s health status and her comorbidities, as well as the MHT regimen (type, dose, route of administration and possible side effects). The article reflects the algorithms for prescribing MHT in different periods of menopause, which allow applying an individualized approach to patients who need MHT.

Obesity is a common problem among women of reproductive age. There are data from clinical and experimental studies indicating the role of hyperprolactinemia in the development of metabolic syndrome, as well as the metabolic benefits of treating hyperprolactinemia. Research objective: to evaluate the clinical efficacy of Vitex Agnus Castus standardized extract on hormonal and metabolic status in women with menstrual cycle disorders and obesity. Materials and methods. 60 women aged 19 to 35 years with obesity and menstrual cycle disorders with laboratory-confirmed insulin resistance and prolactin near the upper limit of the reference values or was slight increase were examined. All the patients were given recommendations for lifestyle modification. 30 of them, who formed the main group, received Cyclodynon. 30 patients of the control group were not prescribed Cyclodynon therapy. Results. At the end of the treatment, the menstrual cycle was normalized in 93.3% patients of the main group, and in 66.3% patients of the control group (p < 0.05). Ovulation signs were detected in 86.67% women of the main group and only in 30.0% women of the control group (p < 0.05). The mean prolactin value and the HOMA index were significantly lower in the main group; prolactin level did not exceed the physiological values in 86.67% women in the main group after 6 months, and in 40.0% of the control group, p < 0.05. There was a decrease in body mass index and waist/hip circumference ratio in patients of the studied groups; the dynamics was slightly higher in the main group but did not differ significantly. Conclusions. Cyclodynon is effective for the treatment of menstrual cycle disorders and metabolic disorders in women with obesity and metabolic syndrome. Good tolerability, absence of side effects, and sufficient efficacy of Cyclodynon allow it to be recommended as the drug of choice in patients with prolactin levels near the upper limit of the reference values or a slight increase of it and in patients with intolerance to synthetic dopamine agonists.

Today, the prevalence of overweight and obesity is pandemic. This disorder is defined as “a complex chronic disease in which abnormal or excess body fat impairs health, increases the risk of long-term medical complications, and decreases life expectancy”. This article presents evidence-based clinical guidelines for the management of obese patients, as well as excerpts comments on pharmacological treatment. Treatment approaches for overweight and obese patients include behavioral interventions, lifestyle adjustments, etc. One of the methods is pharmacological therapy, based on the following principles: therapy for weight loss can be used starting already at a body mass index ≥ 27 kg/m2 or ≥ 30 kg/m2 with complications associated with excess body fat. As drugs can be used liraglutide, combination of naltrexone + bupropion, orlistat. Pharmacotherapy must be accompanied by lifestyle modification, including if necessary therapeutic diet, increased physical activity on ongoing basis with its mandatory control, and behavioral or cognitive-behavioral therapy. Pharmacotherapy can be used to support the weight loss achieved through lifestyle modifications and to prevent weight gain. It is forbidden to use over-the-counter drugs unless they are approved for weight control. Patients with metabolic obesity should be consulted by specialists to assess the feasibility of bariatric surgery, followed by treatment with this specialist. Every clinician must have sufficient knowledge to diagnose obesity and offer their patients an individualized, long-term, evidence-based weight loss regimen. The success of obesity treatment depends on the patient's trust the doctor and on the doctor's knowledge in this area.

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.

Research objective: to examine the incidence of asymptomatic and recurrent bacterial vaginosis (BV) in Ukrainian women and to evaluate diagnostic and treatment strategies for the disease control. Materials and methods. This study lasted from January to March 2021 and included 277 doctors of women's clinics, gynecological hospitals and oncology centers from all regions of Ukraine. Information was provided on 12 896 patients between of 18 and 59 ages with BV. Results. Analysis of data from 12 896 questionnaires allowed us to determine that women from 18 to 35 years of age (62.6%) were the most frequently consulted about BV. Only 58.72% patients with BV reported about abnormal vaginal discharge as the reason for visit, while 41.24% of the respondents reported other reasons. Questionnaire analysis of patients with vaginal discharge revealed scant symptoms of the disease: only 62.67% complained about the change of discharge character; 38.49% and 36.35% of examinees pointed to the vaginal itching and unpleasant odor, respectively; 19.89% of patients were troubled by dysuric symptoms and 15.10% of patients mentioned dyspareunia. In the list of submitted questionnaires, 59.92% of patients indicated an additional examination to identify the causes of vaginitis by the PCR method (urogenital scraping). According to its results, Gardnerella vaginalis was detected in diagnostically significant concentrations in 71.49% of patients, Atopobium vaginae was found in 11.32% of cases, Mobiluncus spp. was detected in 19.96% of patients and Trichomonas vaginalis was found in 13.12% of patients. Candida colonization was diagnosed in 62.07%, with Candida albicans in 48,52% cases and non-albicans forms in 13,55% of patients. In the treatment of BV priority was given to the vaginal forms of the most compliant therapy regimens: 2 times a day for 3 days or once a day for 7 days, depending on the clinical situation. Some patients opted for a long course of treatment for recurrent infections, choosing the combination metronidazole 750 mg / miconazole 200 mg 1 suppository once a day for 5 days for 12 months. Conclusion. Diagnosis of BV in Ukraine continues to be based on clinical conditions and requires a unified algorithm that will be based on current clinical guidelines and dictated by national protocols for management. High mycotic colonization (62,07%) in BV makes it expedient to use combined agents (metronidazole 750 mg / miconazole 200 mg tioconazole/tinidazole) both as etiotropic and empirical therapy and especially if there are clinical conditions that may can cause BV (before surgical interventions, after antibiotic therapy, in endocrine pathology, etc.).

Dysmenorrhoea and intermenstrual pelvic pain are the most common symptoms of clinical manifestations of adenomyosis, which significantly impair the quality of women’s life. Adequate and long-term pain correction and alternative therapeutic approaches became extremely important for patients with adenomyosis during the COVID-19 pandemic. Research objective: to examine the clinical efficacy of nitric oxide donor (L-arginine) in the complex treatment of pelvic pain syndrome associated with adenomyosis. Materials and methods. The study included 63 women diagnosed with adenomyosis. Patients were divided into 2 groups by simple randomization: I (D) group (n = 31) received dydrogesterone 30 mg from 5 to 25 days of the menstrual cycle, II (D+T) group (n = 32) in addition to dydrogesterone received a nitric oxide donor L-arginine (Тivortin) according to the scheme. Pelvic pain was assessed before treatment with a Visual Analogue Scale and a McGill Pain Questionnaire, and an assessment of the overall pain impact on women's well-being was based on the SF-36 Health Status Survey. The effectiveness of pelvic pain therapy was assessed after the first and third months of treatment, as well as three months after the end of therapy with the above methods. Results. Researchers achieved a therapeutic effect in the treatment of chronic pelvic pain in both study groups, but in group II (D + T) after 3 months of treatment there was a significant reduction in pelvic pain, while patients of the standard therapy group have prolonged progestogen intake. There was a further improvement in the clinical condition in group I (D) after 6 months of follow-up, as well as no recurrence of pain in group II (D + T). Conclusions. The results of study demonstrate a significant effect of Tivortin as part of complex therapy on the rate of achievement and duration of therapeutic effect in the treatment of pelvic pain associated with adenomyosis.

Purpose of the study: to examine the morphological and immunohistochemical features of the endometrium in postmenopausal women with uterine bleeding, depending on body weight and metabolic syndrome. Materials and methods. The study included 114 women with postmenopausal uterine bleeding. Women were divided into 3 groups. Group I included 41 patients with overweight and obesity class I–II, group II – 43 women with metabolic syndrome, group III (control) consisted of 30 patients with normal body weight. Hysteroscopy with morphological analysis of biopsied material was performed for all patients of groups I and III and 41 patients of group II. Pathohistological and immunohistochemical analysis were used to diagnose endometrial pathology. The level of cell proliferation in the endometrium was assessed by immunohistochemical analysis using monoclonal antibodies for Ki-67 expression; antiapoptotic activity was determined by the Bcl-2 and COX-2 expression. Results. Endometrial pathology was diagnosed in 94.74% of women. Endometrial polyps in the structure of the identified pathologyprevailed in group I and control group III (82.93% and 83.33%, respectively), while endometrial polyps were detected in 25.59% of women in the group II. Endometrial hyperplasia was diagnosed in the vast majority (69.76%) in group II, hyperplasia without atypia was detected in 51.16% and endometrial hyperplasia with atypia in 18.60%. Conclusions. Endometrial hyperplasia value was higher in postmenopausal women with metabolic syndrome compared to patients with normal weight, overweight and obesity. There was an increase of Ki-67, Bcl-2 and COX-2 expression in the endometrial glands in women with metabolic syndrome in comparison to patients with normal weight and obesity, for which only increased Bcl-2 expression in the stroma was observed. This confirms the existing data on the predominance of the apoptosis inhibition over proliferation in the formation of endometrial diseases in the postmenopausal period and confirms the combination of hyperproliferative processes and apoptosis inhibition if there is metabolic syndrome.

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.

Purpose of the study: to determine the regional characteristics of the health indicators of pregnant women on the basis of integral assessment of extragenital pathology, complications and adverse consequences of pregnancy. Materials and methods. A comprehensive retrospective analysis of regional characteristics and dynamics of the main indicators of pregnant women’s health in Ukraine for the period 2010–2019 was carried out. According to the Center for Medical Statistics of Ukraine integral assessment (IA) of pregnant women’s health was carried out according to the generally accepted calculation method using integral indicators of the extragenital pathology frequency, pregnancy complications and its adverse consequences. Results. Health of pregnant women remains unsatisfactory with multidirectional trends in the frequency of individual pathologies in recent years. Simultaneously with a downward trend against the background of a high level of anemia and genitourinary system diseases (24.73 and 14.38 per 100 pregnant women in 2019, the rate of decline was 6.29% and 1.74%), gestosis, preeclampsia and eclampsia (6.57, 2.11 and 1.2%, 9.48%), not carrying a pregnancy, delivering a dead fetus (5.84, 0.43 and 15.92%, 9.3%), the incidence of circulatory system diseases and thyroid gland dysfunctions (7.61, 9.88, growth rate 18.7%, 2.33%) is increasing. Incidence of diabetes in pregnant women in Ukraine rapid increases in 10.4 times (0.17 per 100 pregnant women in 2010 and 0.77 in 2019). High regional differences in the frequency of different pathologies of pregnant women were revealed. The difference between the highest and lowest rates of circulatory system diseases in 2019 was 23.9 times, diabetes mellitus – 12.6 times, thyroid diseases – 5.4 times, genitourinary system diseases – 4.3 times, anemia in pregnant women – 3.4 times, and complications and adverse effects of pregnancy – 2.4–4.7 times. The analysis of the IA of the health status of pregnant women according in 2019 revealed that the level of health was higher than the average in Ukraine in Ivano-Frankivsk (65.5%), Zaporizhzhya (72.82%), Odesa (75.5%), Zakarpattia (76.5%), Lviv (81.1%), Sumy (81.3%), Luhansk (84.3%) and Ternopil (84.4%) regions, and low than the average level in Dnipropetrovsk (132.35%), Poltava (123.1%), Chernivtsi (118.0%), Chernihiv (111.7%) regions and Kyiv (117.1%). Conclusions. Developed toolkit for the IA of pregnant women’s health makes it possible to provide an objective assessment of pregnant women’s health in general and for individual components in the context of regions as a means of timely identification of problems that require intervention and effective management decisions to minimize risk factors that cause impaired health in pregnant women.

Modern literature information on the etiopathogenetic prevalence of lichen sclerosus has been presented by the authors; clinical manifestations and classification of the disease have been outlined; diagnosis and treatment issues have been discussed in the article. 3 clinical cases of genital lesions in the form of lichen sclerosus in patients with limited scleroderma have been described. In our opinion, lichen sclerosus is one of the forms of limited scleroderma. Purpose. To investigate the conditions for the diagnosis and treatment of genital lesions in the form of lichen sclerosus in patients with limited scleroderma. Methods. The first line of therapy for lichen sclerosus is the use of super-powerful topical glucocorticoids. Clobetasol propionate 0.05% is to be used for 3 months (1 month daily, then every other day for a month, then 2 times a week for a month). After 3 months of treatment, if a positive effect is declared, maintenance therapy is recommended once a week. Topical calcineurin inhibitors are recommended as a second-line therapy. Effective and safe excipients are emollients that moisturize the skin and mucous membranes, prevent transdermal fluid loss, and reduce subclinical inflammation. The possibility of using triamcinolone (1-2 mg) onto pathologically altered tissue in women with lichen sclerosus where there are hyperkeratotic sites resistant to GCS can be considered after exclusion of intraepithelial neoplasia or malignant transformation. The effectiveness of physiotherapeutic methods, such as low-intensity helium-neon laser radiation in the red or infrared range, treatment with sunlight and radiation generated by medical equipment, photodynamic therapy has been described. Results. One of the important measures is the elimination of irritating factors, as well as careful care of the vulva and the treatment of secondary infection. It consists in adherence to a diet (exclusion of spicy, salty, sweet foods, caffeine-containing products, alcohol) and intimate hygiene rules (limitation / exclusion of soap-containing products, deodorants, synthetic underwear, pads, tampons). The underwear should not be very tight. In addition, patients should exclude mechanical irritation of the affected area, including shaving. With extreme manifestation of itching, it is recommended to prescribe desensitizing therapy and sedatives. Conclusions. Clinical cases of practical interest in connection with the clinical manifestations of limited scleroderma on the skin and genitals have been considered. Frequent lesions of the genital organs in the form of a typical clinic of lichen sclerosus in women suffering from limited scleroderma, the similarity of their clinic, histological picture and pathogenesis have been noted. All this gives a reason to consider lichen sclerosus as a manifestation of limited scleroderma.

The pathology of the thyroid gland is quite common, especially in iodine deficiency regions, which include Ukraine. The probability of finding violations of the functional state of the thyroid gland in pregnant women is high, which increases the risks that burden pregnancy or make it impossible. The American Thyroid Association published new approaches to the management of pregnant women in 2017. Diagnostic and therapeutic approaches to such women are specified in them. It is noted that the normal range of thyroid-stimulating hormone (TSH) concentration in them differs from those in non-pregnant individuals and depends on the trimester of pregnancy. The detection of TSH level of more than 2.5–3.0 mIU/L is critical, indicates that women have hypothyroidism, which requires immediate replacement hormone therapy with L-thyroxine. Each pregnant woman should supplement her diet with additional intake of potassium iodide preparations at a dose of 150–200 μg daily throughout pregnancy and infant feeding.