REPRODUCTIVE ENDOCRINOLOGY

Impact on the links of the mastopathy pathogenesis: a view on the pathological cascade correction

V.V. Bobritska, V.S. Strakhovetsky, O.V. Golovina, T.O. Kozub — Fri, 15 Mar 2024 00:00:00 +0200

Background. Dyshormonal diseases of the breast (DDB) are a mirror of gynecological problems and pathological conditions of the thyroid gland (TG). The herbal non-hormonal drug Tazalok, which has hormone-regulating, anti-estrogenic, anti-proliferative, anti-inflammatory, sedative and tonic effects, was chosen as a drug for the treatment of various clinical and morphological forms of DDB.

Objectives of the study: to investigate the possibilities of optimizing the DDB treatment and to evaluate the effectiveness of phytoselective therapy with Tazalok on various pathogenic links of mastopathy, taking into account the role of the TG in the pathogenesis of DDB.

Materials and methods. The study included 140 women of reproductive age with DDB, who were divided into 4 groups depending on the morphological forms of DDB, 35 women in each: I group – fibrocystic mastopathy; group II – the predominance of the cystic component, solitary cysts of the breast; III group – predominance of the fibrous component, with expansion of the milk ducts; group IV – mastodynia without organic changes in the breast. Patients received Tazalok 45 drops twice a day for 3 months. The level of sex steroids and thyroid hormones was determined before and after treatment, an ultrasound of the breast and TG was performed, and the dynamics of the pain syndrome were evaluated using a color analog scale.

Results. A decrease in the level of estradiol to reference norms, an increase in follicle-stimulating and luteinizing hormones, progesterone, elimination of insufficiency of the luteal phase and restoration of ovulation were noted. The ratio of estradiol/progesterone in the study groups before the start of therapy was 1.6–4.5, after treatment it was 0.12–0.08, which indicates the disappearance of hyperestrogeny, as one of the main factors of DDB. The level of prolactin decreased from 1.6 to 2.0 times compare to the indicators before therapy. Thyroid function indicators improved, morphological signs of pathological changes in the TG and breast decreased, and the level of hormones normalized.

Conclusions. Monotherapy with Tazalok is a highly effective method of treating DDB, which results in functional and organic changes in the breast, TG, reduction of pain syndrome and echographic signs of the disease.

Vaginal microbiome and neoplasms of the female reproductive system: a marker or a factor of influence?

V.V. Artyomenko, N.M. Nastradina, V.O. Chikanchi, S.R. Iacoban — Fri, 15 Mar 2024 00:00:00 +0200

The study of the human microbiome is one of the most pertinent areas of science and medicine today. The impact of changes in the microbiome is widely discussed in the context of new approaches to the diagnosis, treatment and prevention of many diseases. At the same time, approaches to the management of patients with precancerous and cancerous diseases are changing along with the discovery of new approaches to the management of this category of patients. Scientists all over the world are studying changes in the vaginal microbiome and its role in the female oncological pathology. This article contains the latest information in this direction.

It is known that the vaginal microbiome is predominantly composed of anaerobic and facultative anaerobic flora. Normally, the dominant bacteria in the vagina are lactobacilli. A decrease in the number of lactobacilli facilitates the penetration of pathogenic bacteria and the development of sexually transmitted diseases and precancerous transformations. Studies on the effectiveness of chemotherapy have shown that interventions in the vaginal-cervical microbiome can improve patient response to platinum-based drugs and enhance the therapeutic effect of chemotherapy. Several studies have reported an increased prevalence of Sneаthia spp. in the vaginal microbiome of patients with high-risk human papillomaviruses, cervical intraepithelial neoplasia and invasive cervical carcinoma. Further research is needed on microbiome changes in vaginal and vulvar cancer.

The composition and functions of the vaginal microbiome have been shown to change in women with human papillomavirus. In future studies, it is necessary to conduct analyses in larger samples and more complex populations, taking into account differences in the clinical characteristics of women and focusing on dynamic changes in cancer occurrence, in order to understand the overall development of the disease and the general trend of microbiome changes in gynecological cancer. In addition, close attention should be paid to the development of individualized screening and treatment, and by studying differences in populations, screening and treatment plans can be more precisely formulated and have better results.

Dynamics of C-reactive protein and albumin levels in women of late reproductive age during pregnancy induced in assisted reproductive technology programs

F.A. Khancha, O.M. Nosenko — Fri, 15 Mar 2024 00:00:00 +0200

Background. Pregnancy from a biological point of view is an inflammatory condition. Decreased fertility, especially when assisted reproductive technologies are required, as well as women’s late reproductive age is associated with increased inflammation.

Objective of the study: to determine the serum levels of C-reactive protein (CRP) and albumin in women of late reproductive age in the dynamics of pregnancy induced in assisted reproductive technologies programs.

Materials and methods. Under observation were 123 women with infertility cured in assisted reproductive technologies cycles: 65 were pregnant women of late reproductive age (group I), 58 were of active reproductive age (group II). Control group С consisted of 57 pregnant women of advanced reproductive age after the natural concept. The level of CRP was determined using the immunoturbidimetric method, albumin level – with a colorimetric analysis.

Results. It was found that, the CRP level in the blood serum increased over the course of the gestational process and was significantly lower in the first trimester compared to the second and third trimester in all studied groups of pregnant women. Pregnant women of group I had higher levels of serum CRP compared to women of group II and group C. The albumin level in the blood serum in the first trimester of pregnancy was statistically significantly higher compared to the second and third trimesters in all studied groups. Women in group I had lower levels of serum albumin compared to pregnant women in group II and group C.

Conclusions. Pregnancy induced in assisted reproductive technologies programs in women of late reproductive age is characterized by increased levels of CRP and decreased levels of albumin in peripheral blood serum, which requires the development of appropriate therapeutic and preventive correction during pregnancy.

Clinical and pathogenetic parallels of the hormonal profile and the qualitative composition of the intestinal microbiocenosis in pregnant women

V.G. Marichereda, I.O. Adonina, N.M. Rozhkovska — Fri, 15 Mar 2024 00:00:00 +0200

Objective of the study: assessment of clinical and pathogenetic parallels of changes in the hormonal profile and qualitative composition of intestinal microbiocenosis in pregnant women with different nutritional status at different stages of gestation.

Materials and methods. 96 pregnant women aged 25–35 with metabolic syndrome (group I), 37 women with obesity of the first degree (group II) and 30 women of the same age with normotrophic nutritional status and physiological course of pregnancy (control group) were examined. Average blood pressure was monitored, the hormonal profile (progesterone, estriol, leptin levels) and lipid profile was assessed, as well as the composition of the intestinal microbiocenosis at 17–20 and 35–37 weeks of gestation.

Results. In the period of 17–20 weeks the leptin level in the I group was 38.4 ± 0.7 μg/ml, in the II group – 37.7 ± 1.1 μg/ml, in the control group – 33.2 ± 1.3 μg/ml. In the period of 35–37 weeks its level decreased in all clinical groups, amounting to 112.7 ± 1.4 μg/ml in the I group, 118.3 ± 3.9 μg/ml in the II group, 237 5 ± 5.3 μg/ml in the control group.

Cases of the II degree of intestinal dysbiosis prevailed in groups I and II. 65 cases of I degree of dysbiosis and 32 cases of the II degree were found in the I group, 27 and 10 cases in the II group, respectively. 4 (13.3%) pregnant women had II degree of dysbiosis, 12 (40.0%) had I degree of dysbiosis in the control group. The frequency of dysbiosis was correlated with the body mass index (r = 0.82 p < 0.05), the blood content of estradiol (r = 0.49 p < 0.05), progesterone (r = -0.34 p < 0, 05) and leptin (r = 0.69 p < 0.05).

Conclusions. The presence of metabolic syndrome and obesity in pregnant women affects the qualitative composition of the intestinal microbiocenosis, which is manifested by an increase in the population of opportunistic microorganisms. The frequency of dysbiosis correlates with the body mass index, estradiol, progesterone and leptin concentrations.

Non-hormonal methods of correction of climacteric disorders in women

T.F. Tatarchuk, S.I. Reheda, N.V. Kosei, N.F. Zakharenko, K.D. Plaksiieva — Fri, 15 Mar 2024 00:00:00 +0200

Objective of the study: to optimize non-hormonal therapy of menopausal syndrome in perimenopausal women.

Materials and methods. 60 female patients aged 40–55 years with mild climacteric disorders were examined. Group I included 30 women who received a psychological consultation with recommendations on lifestyle and dietary correction, group II included 30 women who received Ayurvedic herbal drug Zintago 10 ml three times a day for three months a psychological consultation with recommendations on lifestyle and dietary correction. Patients were tested before treatment and 1 and 3 months after therapy according to the following scales: Spielberger-Hanin, PSM-25, MRS, and according to the SF-36 scale before treatment and 3 months after.

Results. 1 (31.4 ± 1.9 points) and 3 (27.8 ± 2.3 points) months after treatment in the II group there was a significant (p < 0.05) decrease in the indicator of personal anxiety according to the Spielberger scale in comparison with the initial level. There was a decrease in the index of situational anxiety from 36.4 ± 1.9 points before treatment to 26.2 ± 1.7 points (p < 0.05) in group II after 3 months of therapy. There were no significant clinical results in group I.

According to the PSM-25 scale, a clinically significant effect was in both groups after 3 months of treatment, but in group II it was achieved faster, after only one month – from 154.7 ± 9.6 to 122.6 ± 8.3 points (p < 0.05).

According to the SF-36 scale, a significant improvement in the quality of life in group I after 3 months of therapy was only in the indicators of social functioning (from 54.6 ± 7.1 points before treatment to 73.8 ± 5.8 after 3 months of therapy, p < 0.05) and role functioning due to emotional state (from 57.3 ± 6.6 to 74.8 ± 4.6 points, p < 0.05), while patients of group II demonstrated a significant improvement in all domains of the SF-36 scale.

The somato-vegetative component of the MRS scale in the II group before treatment was 3.7 ± 0.06, and after 1 and 3 months it decreased to 3.4 ± 0.04 and 2.6 ± 0.06 points, respectively, (р < 0 ,05).

Already after 3 months of treatment there was a significant decrease in the indicators of psycho-emotional changes in all women, which indicates the feasibility of using psychoprophylactic drugs in patients with mild menopausal syndrome.

Conclusions. Psychological counseling can be used in perimenopausal women to correct the manifestations of menopausal syndrome (somato-vegetative and psychological components) and such mental health indicators as social and role functioning. The ayurvedic herbal compositions can enhance the effect of psychological counseling in perimenopausal women with mild menopausal syndrome.

Uterine fibroid in the premenopause: experience of medication treatment

О.V. Kravchenko — Fri, 15 Mar 2024 00:00:00 +0200

Objectives of the study: to evaluate the effectiveness of the progestogens for the treatment of uterine fibroids (UF) in women in the premenopausal period.
Materials and methods. 42 patients aged 45–50 years with UF were examined. The diagnosis of UF was verified according to clinical and instrumental research methods. The effectiveness of the therapy was evaluated according to clinical and ultrasound examination data before and during the course of treatment. All patients with diagnosed symptomatic UF received progestogen dienogest 2 mg ones a day continuously for a year, with clinical and sonographic control every 3 months.
Results. UF was symptomatic in all examined patients. According to the International Federation of Gynecology and Obstetrics (FIGO) classification system for UF, 42.8% (18) of women had type III–IV nodes, 54.8% (23) had type II–V nodes, and 2.4% (1) of women had type VI nodes. In all patients were 2 or more nodes.
Already after 6 months of therapy, bleeding complaints decreased by more than 8 times, moderate pain syndrome and urination disorders were noted in only one (2.4%) patient. After 12 months, pelvic pain and bladder dysfunction were absent in 100% of cases. One (2.4%) patient had spotting bleeding for 2 days during the 8th month of treatment. After 6 and 12 months of treatment, the size of the endometrium decreased significantly to 3.6–7 and 3.2–4.6 mm, respectively. The total volume of the uterus also underwent positive changes: it decreased by 10–40% in each patient during the course of treatment.
Conclusions. It should be preferred progestogens in the treatment of UF in women aged 45–50 years who wish to preserve the uterus. Therapy with dienogest in a continuous long-term regimen showed high clinical effectiveness, confirmed the active antiproliferative, antiovulatory effect of the drug in the absence of estrogen deficiency symptoms, which is important for this age group of patients.

Open prospective study to evaluate the efficacy of a new vaginal pessary containing 300mg tinidazole, 200mg tioconazole and 100mg lidocaine with a 3-day regime (Gynomax XL®) in the treatment of vaginal infections due to bacterial vaginosis, candidiasis an

P.A. Regidor, M. Sailer — Fri, 15 Mar 2024 00:00:00 +0200

Introduction. The management of infections of the vulva and vagina depend on the selection and administration of effective specific therapies that allow a fast treatment, enhancing the compliance of the patients.

Objective of the study: the efficacy and safety of a new medicinal product containing 300mg tinidazole/200mg tioconazole/100mg lidocaine for the treatment against vaginal candida albicans, bacterial vaginosis and combined infections was evaluated upon 69 patients.

Materials and methods. Clinical controls, pH, 10% KOH probe, microscopical and microbiological analysis were performed at day 1, day 4, day 10 and at day 30 of the study. Success was defined as follows: 0 points = no symptoms, 1 point = mild symptoms, 2 points = moderate symptoms, 3 points = severe symptoms.

Results. A complete clinical recovery at day 10 was observed in 54 (80.6%) patients. A clinical improvement in 12 (17.9%) and a failure in 1 patient (1,5%). At day 30 a clinical complete recovery was observed in 58 (86.6%) patients, a clinical improvement in 7 (10.4%) and a failure in 2 patients (3%).

Conclusions. This formulation (GynomaxXL), a vaginal suppository given at 3 consecutive days, is a highly effective and safe combination in the therapy of vulvovaginal candidiasis and bacterial vaginosis.

Features of steroid hormone levels in girls with menstrual cycle disorders and mental health disorders

Fri, 15 Mar 2024 00:00:00 +0200

Objectives of the study: to investigate the peculiarities of the steroid hormone status in girls with menstrual function disorders, depending on comorbid psychopathology.
Materials and methods. A total of 174 girls with menstrual function disorders (78 with abnormal uterine bleedings (AUB) and 96 with oligomenorrhea (OM)) were examined. The diagnosis of psychopathology was determined based on the clinical presentation at the time of examination. The comparison group consisted of 35 girls with a normal menstrual cycle.
The laboratory examination included the assessment of estradiol, testosterone, cortisol (C), and dehydroepiandrosterone sulfate (DHEA-S) levels. The C/DHEA-S ratio was calculated using the unprocessed raw values.
Results. Menstrual function disorders are often associated with hypoestrogenemia, a prevalent phenomenon. It was observed in almost a third of patients with AUB, whereas in girls with OM this number was significantly higher. Significant reduced values are found in girls with accompanying depressive states, especially in cases of AUB and OM. In instances of AUB and OM, the number of individuals with elevated levels of testosterone increased by 1.97–2.2 times in the presence of psychopathology. DHEA-S in patients with AUB was reduced in more than half of the girls, while in patients with OM it varies evenly in both directions, regardless of the presence or absence of psychopathology. A C level were more often reduced than increased, and achieves statistical significance when OM combined with neurotic disorders and AUB combined with depressive states. The C/DHEA-S ratio, as a stress indicator, was statistically significantly elevated in patients with AUB. This may suggest more pronounced manifestations of stress in patients with AUB than in girls with OM and a higher adaptability of the girls’ bodies with OM.
Conclusions. Thus, the understanding of the role of reproductive steroids in the development of menstrual function disorders during adolescence has been deepened. Distinctive features of their interrelations in the presence of psychopathology have been identified. The impact of cortisol and DHEA-S, as well as C/DHEA-S ratio, on mental well-being in endocrine-related gynecological disorders in girls has been established

Chronic endometritis and endometriosis: what do they have in common?

R.A. Ruda — Fri, 15 Mar 2024 00:00:00 +0200

Background. Chronic endometritis and endometriosis are difficult illnesses to diagnose, due to their non-specific manifestations, but at the same time they are quite common and often result in impaired fertility. Both endometritis and endometriosis are chronic inflammatory diseases that could affect the receptivity of the endometrium, precisely it affects the implantation process, as well as it contributes to early pregnancy losses, which makes a challenge for reproductive specialists. In addition, these diseases negatively affect the social and psychological aspects of a modern woman’s life due to the fact that such common symptoms as pelvic pain, dyspareunia, abnormal uterine bleeding exhaust and deprive the woman at her usual activity and lead to a deterioration of her psycho-emotional state, that requires modern approaches in diagnosis and treatment.
Objectives of the study: to identify and investigate the relationship between chronic endometritis and endometriosis.
Materials and methods. Endometrial samples taken during pipelle biopsy from 105 women were studied, among them 45 patients without endometriosis and 60 with endometriosis. All women were of reproductive age, had not taken oral contraceptives, progestins, or antibiotics in the past 6 months, and had no neoplastic pathology.
A pathohistological examination of the obtained material was performed in all cases. Logistic regression analysis was performed on variables such as age, body mass index, parity, presence of uterine fibroids, and endometriosis.
Results. Chronic endometritis was confirmed in 86.7% of patients with endometriosis and in 44.4% of women without signs of endometriosis. Considering these data, it can be argued that chronic endometritis is more common among women with endometriosis compared to women without this pathology. It was also established histologically that the frequency of chronic endometritis in adenomyosis is 2.6 times higher than in other pathologies without endometriosis (52 confirmed cases versus 20).
Conclusions. The results of this study indicate a strong connection betISSN 2309-4117ween chronic endometritis and endometriosis.

Comparative analysis of the frequency of postoperative intrauterine adhesions with classical and modified hysteroscopic metroplasty

Y.L. Kalitsynska, I.Z. Gladchuk, D.O. Hryhurko — Fri, 15 Mar 2024 00:00:00 +0200

Background. Treatment of women with RPL-syndrome (recurrent pregnancy loss), which is caused by intrauterine septum, involves hysteroscopic metroplasty. However, the main drawback of these methods is the risk of formation of the intrauterine adhesions in 35–50% of patients in the postoperative period. Modern methods of preventing the formation of postoperative intrauterine adhesions are not always effective.
Objectives. To conduct a comparative analysis of the postoperative intrauterine adhesions frequency after proposed and traditional electrosurgical hysteroscopic metroplasty.
Materials and methods. 138 patients with primary miscarriage (RPL-syndrome) and/or premature birth who had intrauterine septum and were operated on between 2016 and 2021 participated in the study. The main group consisted of 88 patients aged 27.52 ± 1.59 years who were performed hysteroscopic metroplasty according to the proposed modified technique. The comparative group consisted of 50 patients at the age of 28.21 ± 1.65 years that get surgical treatment according to the classical method of hysteroscopic metroplasty. The effectiveness of operations was evaluated using the «Menstrual blood loss assessment» scale (order of the Ministry of Health of Ukraine No. 353 dated 04/13/2016), the 2D/3D ultrasound method, and second-look hysteroscopy data.
Results. In the main group, unlike the comparison group, postoperative hypomenorrhea was 3 times less frequent and ultrasound signs of adhesions were 2.2 times less frequent; intrauterine adhesions were detected 25% less often according to second-look hysteroscopy (p < 0.05).
Conclusions. The modified technique of hysteroscopic metroplasty in comparison with the traditional technique of surgery in women with RPL-syndrome helps to reduce the frequency of postoperative intrauterine adhesions by 25%. The obtained results are preliminary and require further research.

V International expert forum on menopausal hormone therapy

Fri, 15 Mar 2024 00:00:00 +0200

On November 23, 2023, the V International Forum of Experts on Menopausal Hormone Therapy (MHT) was held. The Expert Council’s working group included leading experts in the field of endocrine gynaecology and related areas from Azerbaijan, Armenia, Georgia, Kazakhstan, Moldova, Uzbekistan, and Ukraine.
The Forum experts noted the importance of dialogue and understanding between doctor and patient, the need for interdisciplinary integration between doctors of those specialties that deal with women’s health issues. Close cooperation with related specialists who provide care to women is necessary, as they are often the ones who encounter the first manifestations of menopause in patients and can therefore refer them to an obstetrician-gynaecologist in a timely manner.
The experts reviewed the issue of cardiovascular risk and MHT and determined the following benefit/risk ratio for the cardiovascular effects of MHT:
• MHT is not recommended for women at high cardiovascular risk or with previous cardiovascular disease;
• MHT may reduce the risk of CVD-related all-cause death in women < 60 years of age and with menopause of up to 10 years;
• timely initiation of MHT (in women under 60 years of age or within 10 years of menopause) has the greatest cardiovascular health benefits.
The forum updated the Algorithm for prescribing MHT in premature and early menopause and addressed the management of women with polycystic ovary syndrome
in menopause. Since the majority of women with this syndrome are overweight and obese, they should use the most metabolically neutral drugs, i.e. those containing didrogesterone or progesterone, for MHT. MHT with didrogesterone has a favourable safety profile in relation to the most common risks of MHT: does not increase the risk of breast cancer and venous thromboembolism, has a favourable safety profile with respect to the endometrium, and does not affect metabolism.

Resolution of the II Ukrainian forum of experts on abnormal uterine bleeding

Fri, 15 Mar 2024 00:00:00 +0200

Approaches to the diagnosis and treatment of abnormal uterine bleeding (AUB) are constantly updated due to the new results of clinical studies and in the process of revising international clinical guidelines. These updates need to be implemented in clinical practice. Therefore, on October 20, 2023, the II Ukrainian Forum of experts on AUB was held, the key provisions of which are outlined in this resolution.
A new multi-level three-component classification system «HyPO-P + GAIN-FIT-PIE» developed by the International Federation of Gynecology and Obstetrics (FIGO) in 2022 was presented at the Forum. FIGO experts anatomically grouped the causes of ovulation disorders into 4 groups: I – hypothalamic, II – pituitary, III – ovarian, IV – polycystic ovary syndrome (first level HyPO-P). Also, this classification system includes the second level GAIN-FIT-PIE (genetic, autoimmune, iatrogenic, neoplastic; functional, infectious, inflammatory, traumatic, vascular; physiological, idiopathic, endocrine) and the third level with examples of specific conditions within the subgroups of the second level. Correct classification of ovulation disorders is important for the AUB diagnosis and management, since ovulation disorders are associated with disorders of the menstrual cycle characteristics, which leads to the development of functional AUB.
In order to optimize the treatment of patients with AUB, the experts of the Forum developed an algorithm for the AUB management taking into account the individual approach and characteristics of the patient, which is based on the current FIGO classifications – PALM-COEIN (2018) and HyPO-P + GAIN-FIT-PIE (2022). According to
this algorithm, patient management tactics depend on the type of disorders (structural, functional), the patient’s reproductive stage (adolescence, active reproductive age, perimenopause) and the need for contraception. Hormonal drugs (combined oral contraceptives and progestogens) are main direction of pharmacotherapy of functional AUB. The high efficiency of dydrogesterone among the progestogens has been proven, starting from the first cycle of therapy.

Melatonin exchange in infertile women with repeated implantation failures

O.M. Nosenko, R.Y. Demydchyk — Fri, 15 Mar 2024 00:00:00 +0200

Background. Repeated implantation failure occurs in approximately 10–15% of women undergoing in vitro fertilization and embryo transfer (IVF-ET) cycles. One of the important factors is the changed morpho-functional state of the endometrium and chronodestruction in the woman’s body.

Objective of the study: to determine the characteristics of melatonin (MT) metabolism in infertile women with repeated implantation failures in IVF-ET cycles.

Material and methods. 103 women of reproductive age with infertility and repeated implantation failures who were treated in IVF-ET cycles were observed. Depending on the onset of pregnancy in the current IVF-ET cycle, women were divided into 2 groups: group A – 35 women with the onset of pregnancy, group B – 68 patients without the onset of pregnancy. The control group (group C) included 32 healthy fertile women. The MT level in blood serum and 6-sulfatoxymelatonin (aMT6s) in urine was determined.

Results. The initial levels of MT in patients of group A (11.38 ± 0.38 pg/ml) and in group B (9.55 ± 0.27 pg/ml) were lower than in group C (13.67 ± 0.65 pg/ml) in 1.20 (p < 0.01) and 1.43 (p < 0.01) times, respectively. At the same time, the level of MT in women of group A was 1.19 times higher than in the group B (p < 0.03). Excretion of aMT6s in urine in group A (5.09 ± 0.19 ng/ml Cr) and in group B (3.03 ± 0.09 ng/ml Cr) were lower than in group C (6.12 ± 0.21 ng/ml Cr) respectively in 1.20 (p < 0.01) and 2.02 (p < 0.01) times. The aMT6s concentration in urine in patients of group A was 1.68 times higher than in group B (p < 0.01). A direct relationship was established between the levels of serum MT and urinary aMT6s, which was most adequately approximated by a polynomial dependence: y = 0.0139x2 – 0.1127x + 3.2978, R² = 0.2994, r = 0.51, p < 0.01.

Conclusions. Women with repeated implantation failures are characterized by a decrease in the level of MT in blood serum and its main metabolite aMT6s in urine, which may be one of the key factors of implantation failure.

Clinical features of hypertension in patients with normal weight and overweight

V.I. Bulda, I.O. Berdnyk, O.V. Barabanchyk, I.O. Rodionova — Fri, 15 Mar 2024 00:00:00 +0200

Objective of the study: То determine the clinical features of arterial hypertension in overweight patients.

Materials and methods. There were 170 patients included in the study and depending on body weight were divided into two groups: group I – 86 patients with normal body weight and group II – 84 patients with overweight. In our work we calculated the proportion of patients with abdominal obesity and also analyzed concomitant pathology according to the available medical documentation and anamnesis.

Results. There were slightly more women in the two groups. Comparing the data of office measurement of systolic and diastolic blood pressure in patients with hypertension with normal weight and overweight didn’t show significant differences. The most significant association was observed between patients with overweight and nonalcoholic fatty liver disease (objective data (OD) 3.25; 95% confidence interval (CI) 1.55–5.13) and with impaired glucose tolerance (OR 3.54; 95% CI 1.12–5.68). The percentage of patients with dyscholesterolemia was also statistically higher, although slightly lower than in previous cases (OD 2.61; 95% CI 1.05–3.87) and with gastroesophageal reflux disease (OD 3.14; 95% CI 1.56–5.99). A direct correlation was found between patients with abdominal obesity and the presence of gastroesophageal reflux disease (r = 0.56, p < 0.01), dyscholesterolemia (r = 0.53, p < 0.05) and with diabetes (r = 0.45, p < 0.05). In addition, patients who smoked significantly more often had coronary heart disease (p = 0.044).

Conclusions. The article summarizes information on the clinical features of arterial hypertension in overweight patients. The prevalence of hypertension among the adult population is 30-45%, with overweight and obesity continuing to occupy leading positions among young and mature people in the developed world and in middle-income countries. Determining the features of the course, duration of the disease, the distribution between stage and degree in this category of patients will help to develop optimal algorithms for patient management.

Domestic violence and reproductive health: problems of update of state legal policy

M.M. Blikhar, I.Р. Andrusіak, O.L. Khytra, I.L. Hula, V.М. Pasternak — Fri, 15 Mar 2024 00:00:00 +0200

Objective of the study: to study the problem of updating the legal policy of the state within the scope of domestic violence and women’s reproductive health.

Materials and methods. The study was carried out from 2021 to 2023 in 4 regional centers of Ukraine: Lviv, Uzhgorod, Chernihiv and Kyiv. A survey of 712 people was conducted using structured questions, which were aimed at studying various aspects of social perception of legal policy regarding domestic violence and its manifestations during a woman’s pregnancy. Two focus groups were subject to analysis: the first group included 580 pregnant and non-pregnant women of various ages, the second group included 132 students of senior years of medical universities.

Results. The results of the survey proved that pregnant women also become victims of domestic violence, especially from their intimate partner, but the level of physical and sexual violence is reduced during this period. The number of births significantly affects the frequency of domestic violence: respondents stated that the fourth or more births significantly increased the risk of becoming a victim of violence. The need to update the legal policy in the field of medical education is substantiated. However, the lack of education of health workers regarding violence emphasizes the need for updating approaches. Therefore, emphasis is placed on the core task of medical personnel - to cooperate with law enforcement agencies and other services including social to ensure the safety of victims and provide them with the necessary support.

Conclusions. Based on statistical indicators, scientific doctrine in the field of medicine and law (Australia, Great Britain, USA, Iran, Norway, Latin America), it can be summarized that violence during pregnancy has primary (somatic) and long-term (psychological) consequences. Although these problems largely depend on socio-mental factors and the legal policy of the state, they still remain a serious threat to women’s health and reproductive function.