Maria A. Kepsha

Allergic reactions of the lower genital tract in women cause significant chronic vulvovaginal discomfort and require active diagnosis and treatment. Modern approaches to therapy, which combine allergen elimination and anti-inflammatory therapy, can achieve improvement or cure in most cases. Obstetricians-gynecologists are recommended to involve dermatovenerologists and allergists for joint management of patients in case of non-standard cases of vaginitis. From a scientific point of view, further studies of immune mechanisms in the genital tract and the development of new methods of specific therapy and prevention remain relevant. In the future, the results of such studies will help to develop more accurate clinical guidelines and improve the effectiveness of care for these patients. Successful treatment of allergic diseases of the vulva and vagina significantly improves the quality of life, restores a woman's confidence and comfort in everyday and intimate life. Developing an interdisciplinary approach, education, and a thoughtful method for addressing symptoms can help overcome many difficulties in diagnosing and treating this condition. The identified unresolved issues will serve as the starting point for new research and progress in this field of medicine.

Background. Chronic non-specific cervicitis (CNC) remains one of the most common inflammatory diseases of the cervix; however, its clinical and morphological criteria and diagnostic significance remain poorly defined, especially with negative test results for human papillomavirus (HPV) and common sexually transmitted infections (STIs). Aim. To characterize the clinical, morphological, and microbiological features of CNC in women of reproductive age, with the strict exclusion of HPV-associated and specific infectious diseases of the cervix. Materials and methods. A retrospective analysis of data from 152 women aged 18–49 was conducted: 131 patients with histologically confirmed CNCs and 21 healthy women. Clinical and history data, extended colposcopy, liquid-based cytology, diagnosis of HPV and STIs using polymerase chain reaction, the state of vaginal biocenosis according to the “Femoflor-16” panel, and the histological data of biopsy specimens were evaluated. Statistical analysis included the Mann–Whitney U test, the Fisher test, and calculation of the odds ratio with a 95% confidence interval. Results. CNC was associated with an earlier age of onset of sexual activity (p = 0.03), a high incidence of chronic salpingo-oophoritis (45.8%), and dysbiosis episodes (41.2%). Histologically, CNC was characterized by almost universal lymphoplasmacytic infiltration (97.7%) and variable reactive epithelial changes. In patients with CNC, anaerobic-associated dysbiosis with Lactobacillus spp. deficiency was much more common. Colposcopic and cytological changes often mimicked low-grade squamous intraepithelial lesions, leading to diagnostic challenges. Conclusion. CNC is an independent, microbiota-dependent inflammatory cervix phenotype that complicates the interpretation of screening tests. Morphological verification and assessment of the microbiocenosis are key components of diagnosing and differentiating CNCs from intraepithelial lesions.

В обзоре рассмотрены актуальные аспекты хронических и рецидивирующих вульвовагинитов (ВВ) и бактериального вагиноза (БВ) у женщин различных возрастных групп. Высокая распространенность и склонность к рецидивам обусловлены особенностями возбудителей, биопленочной персистенцией, нарушениями местного и системного иммунитета. Выраженность патогенетических механизмов, включая дефицит факторов врожденного иммунитета, варьирует в зависимости от возраста. Активация NOD2-зависимых путей с использованием глюкозаминилмурамилдипептида (ГМДП) патогенетически обоснована, а его интеграция в этиотропную терапию ассоциируется с уменьшением частоты рецидивов и формированием более стойкой ремиссии. Применение препарата «Ликопид®» как источника ГМДП в комплексном, возрастно-ориентированном подходе к ведению рецидивирующих ВВ/БВ у женщин старше 18 лет представляется целесообразным. Перспективными направлениями являются разработка унифицированных критериев рецидива и проведение возрастно-стратифицированных клинических исследований.

енитоуринарный менопаузальный синдром (ГУМС) представляет собой совокупность симптомов, обусловленных дефицитом эстрогенов в постменопаузе и затрагивающих слизистые оболочки нижних мочевых путей и гениталий. Несмотря на эффективность локальной эстрогенотерапии, существует потребность в альтернативных негормональных средствах, особенно у женщин с противопоказаниями к гормональному лечению. Цель исследования — оценка клинической эффективности и влияния на микробиоценоз влагалища негормонального крема Триофемин®, содержащего гиалуронат натрия, пантенол, лактобациллы двух живых штаммов и фитокомпоненты, у женщин с ГУМС. Установлено, что Триофемин® является эффективным и безопасным негормональным средством для лечения ГУМС, обеспечивая улучшение клинических симптомов, восстановление слизистой влагалища и нормализацию микробиоты. Средство представляет собой перспективную альтернативу гормональной терапии для женщин в постменопаузе.

Introduction. Pregnancy planning is one of the leading areas in the population reproductive health care, in particular preventing and reducing the number of abortions.Aim. To evaluate the uterine bleeding profile and other adverse events associated with the use of an etonogestrel subcutaneous contraceptive implant (Implanon NXT®). Materials and methods. We analysed medical records of female patients (n = 153) who used Implanon NXT® in the period from 2013 to 2023, records of adverse events, uterine bleeding, bleeding management techniques and reasons given by women for discontinuing the use of implants.Results. The median duration of uterine bleeding episodes ranged from 7 to 13 days within a three-year period of use of Implanon NXT®. During the first 3 months, the proportion of women with prolonged bleeding was higher as compared to all other observation periods and gradually decreased during the first year of use of the drug from 41.2 to 15.8%. 40 patients with complaints of unsatisfactory uterine bleeding patterns required adjustment of drug dosages; 14 women continued to use Implanon NXT® after adjustment of drug dosages and repeated visits. 17.0% (n = 26) of patients required early removal of the implant. Due to pregnancy planning, the implant was removed early in 13% (n = 20) of patients. The most common adverse events included functional ovarian cysts, mastalgia, increased appetite, decreased libido, dizziness, acne; most of them were transient and did not require any management, and were not considered the reason for implant removal.Conclusion. The number of uterine bleeding episodes in patients using the etonogestrel implant was comparable to the normal menstrual cycle. Some women had changes in the uterine bleeding patterns, such as amenorrhea, frequent and prolonged bleeding, which reduced the duration of use of this contraception method. At the same time, combined oral contraceptives were the most effective as compared to other drugs used in correction regimens.

Individual sexual and reproductive life management has been сonfirmed by medical and state communities since 1990s. Every citizen officially received rights for access to appropriate goods and services. Such international agreements as 1994 International Conference on Population and Development (ICPD, Cairo, Egypt) and 2004 WHO Reproductive health strategy, estimated reproductive health and family planning as priorities. Worldwide agreement on the 2005 summit declares achieving of female reproductive health before year 2015 as worldwide progress.WHO created complex of international eligibility criteria for male and female contraception with the aim of medical aid improvement. According to WHO plan, those criteria should be used by countries considering policy, needs, priorities and resources of national healthcare programs. For example, USA, United Kingdom, Russia etc. have successfully adopted medical eligibility criteria for contraception on the national level.The present review is summary product created by interdisciplinary expert group including representers of federal and regional healthcare establishments, medical universities, and international medical organizations.

Introduction. During pregnancy, the body’s need for most micronutrients increases, and therefore timely detection and adequate correction of deficient conditions are justified, starting from the stage of pre-gravidar preparation.Objective. The purpose of the study is to present literature data on the role of magnesium in homeostasis and own experience of the effectiveness of the use of magnesium preparation.Materials and methods. A review of the literature for 2021–2023 in the databases was conducted in the databases PubMed (the National Library of Medicine), The Cochrane Library, as well as in scientific citation databases (Scopus, Web of Science) The experience of own application of the preparation containing magnesium lactate dihydrate (470 mg) is also presented + pyridoxine hydrochloride (5 mg).Result and discussion. The intake of magnesium into the human body with food is insufficient. Exogenous magnesium replenishment is clinically justified in isolated or associated with other conditions of established deficiency, primarily with intense emotional and physical exertion, sleep deprivation, as well as with emotional lability, palpitations, muscle fasciculations, with magnesium elimination due to iatrogenic exposure or increased demand, for example, gestational-conditioned. Regular use of Magne B6® has demonstrated its effectiveness in the treatment of symptoms of psychological daily stress (fatigue, irritability, deterioration of sleep quality) in women planning pregnancy.Conclusions. The results obtained appear to be important in terms of reducing the risks of clinical progression of somatic symptoms and potential gestational complications, as well as improving the quality of life of childbearing age women who are actively planning to implement their reproductive function.

В статье проведен обзор отечественных и зарубежных источников, посвященных диагностической ценности иммуноцитохимического исследования в диагностике интраэпителиальных неоплазий шейки матки.

Currently, cervicitis of nonspecific etiology is one of the urgent problems of modern gynecology due to the extremely high frequency of their occurrence, a tendency to a chronic relapsing course, a negative impact on reproductive health, and the risk of developing a number of complications. The role of violations of vaginal microbiocenosis and local immune status in the development of CNC has been convincingly shown. The replacement of lactobacilli with predominantly anaerobic microorganisms (Ureaplasma, Mycoplasma, Gardnerella vaginalis, Prevotella, Peptostreptococcus spp. and Bacteroides spp.), characteristic of bacterial vaginosis, is extremely often detected in patients with CNC. Of particular importance from the point of view of clarifying the pathophysiological mechanisms of development and the development of new diagnostic and prognostic markers, as well as the personalization of CNC therapy, is the study of the cytokine status. Cervicitis and other inflammatory diseases of the lower genital tract are characterized by an increase in the expression of pro-inflammatory cytokines with simultaneous inhibition of the formation of anti-inflammatory cytokines. Significant multidirectional changes in the balance of pro- and anti-inflammatory cytokines were revealed in active and chronic sluggish cervicitis. It should be noted that, despite the variety of proposed approaches to CNC therapy, this problem is still far from being solved to date. One of the promising directions is the personalization of CNC therapy based on molecular genetic markers (polymorphisms of cytokine genes, Toll-like receptors, genes of the detoxification system). The use of such a personalized approach can significantly increase the effectiveness of CNC treatment and reduce the risk of disease recurrence.

Новые национальные медицинские критерии приемлемости методов контрацепции (2022): вклад в охрану репродуктивного здоровья женщин