REPRODUCTIVE ENDOCRINOLOGY

Postpartum depression: neurosteroid pathogenesis and pathogenesis-based treatment with micronized progesterone

2026-07-03T02:57:21+03:00

Background. Postpartum depression (PPD) affects 17.22% of women globally, representing a critical public health challenge with serious consequences for mother and child. Recent advances in neurosteroid research have demonstrated that the pathogenesis of postpartum depression is fundamentally associated with the abrupt postpartum decline in estrogen, progesterone, and its metabolite allopregnanolone levels.

Objective of the review: to analyze the neurobiological mechanisms of PPD, evaluate current diagnostic approaches, and investigate the evidence base regarding the use of micronized progesterone as a pathogenetically grounded therapeutic option, particularly in resource-limited settings.

Materials and methods. A literature search was conducted in the PubMed/MEDLINE, Cochrane Library, Embase, and Google Scholar databases for the period from 2014 to 2026. The search was performed using the keywords. Inclusion criteria comprised randomized controlled trials, systematic reviews, meta-analyses, clinical guidelines, as well as original studies investigating neurosteroid function and clinical trials of progesterone therapy for PPD. Epidemiological data regarding the prevalence of postpartum depression and diagnostic instruments, including the EPDS, PHQ-9, DSM-5, and the ICD-11, were also included in the analysis. A comparative analysis of treatment protocols was conducted taking into account international standards and the specific features of the Ukrainian healthcare system.

Literature analysis. Allopregnanolone, a potent modulator of GABA-A receptors, plays a central role in the etiology of PPD. Although rapidly acting neurosteroid medications, including brexanolone and zuranolone, demonstrate high efficacy, their limited accessibility due to cost necessitates alternative therapeutic approaches. Micronized bioidentical progesterone, as a substrate for endogenous allopregnanolone synthesis, demonstrates a significant reduction in symptoms, with the prevalence of depression decreasing from 86.7% to 23.3% (p < 0.05), while maintaining safety during lactation when administered vaginally.

Conclusions. Micronized progesterone represents a pathogenetically grounded, safe, and economically accessible treatment option for PPD, particularly relevant within the Ukrainian healthcare context. Improvement of PPD treatment outcomes requires the implementation of universal screening programs and the development of clear patient referral protocols.

Features of fertility indicators in women with autoimmune thyroiditis without thyroid dysfunction

2026-07-03T03:25:51+03:00

Background. Autoimmune thyroiditis (AIT) is one of the most common endocrine disorders in women of reproductive age and may affect fertility even under euthyroid conditions. The impact of thyroid autoimmunity on ovarian reserve remains insufficiently studied.

Objective of the study: to investigate the effect of autoimmune thyroiditis on ovarian reserve by analyzing the relationships between thyroid function parameters, thyroid antibody levels, and fertility markers.

Materials and methods. A two-center cross-sectional analytical study was conducted involving 107 women of reproductive age (18–40 years) with AIT (main group). The control group included 20 women without thyroid pathology. Serum levels of thyroid-stimulating hormone (TSH), free thyroxine, antibodies to thyroid peroxidase (TPOAb), antibodies to thyroglobulin (TgAb), anti-Müllerian hormone (AMH), and follicle-stimulating hormone (FSH) were measured. Antral follicle count (AFC) was assessed using transvaginal ultrasound.

Results. Patients with AIT demonstrated significantly higher levels of TSH, TPOAb, and TgAb compared to controls (p < 0.001), with no significant differences in free thyroxine levels. FSH levels were significantly higher (p < 0.005), and AFC was significantly lower (p < 0.001) in women with AIT, whereas AMH levels did not differ significantly between groups (p > 0.05). A correlation analysis revealed a significant inverse relationship between TSH and FSH (r = –0.50; p = 0.03), while no significant associations were found between other thyroid parameters, antibody levels, and ovarian reserve markers.

Conclusions. Autoimmune thyroiditis is associated with early functional and morphological changes in ovarian reserve even in euthyroid patients. A decrease in AFC combined with elevated FSH in the presence of preserved AMH may indicate early stages of ovarian reserve decline. The observed association between TSH and FSH suggests a potential interaction between thyroid and gonadotropic axes, whereas the lack of correlation with thyroid antibodies may indicate a limited direct impact of autoimmune activity on ovarian reserve. These findings highlight the importance of comprehensive evaluation of reproductive potential in women with AIT.

Optimization of rehabilitation management strategies for women with postoperative hematomas

2026-07-03T03:34:15+03:00

Objective of the study: to evaluate the clinical efficacy and safety of suppositories based on distrept enzymes H46A (streptokinase and streptodornase) in reducing the size of postoperative hematomas (POH), alleviating symptoms, and preventing chronicity in patients after hysterectomy.
Materials and methods. This prospective study included 69 women with POH following either transabdominal or transvaginal hysterectomy. Patients were randomized into two groups. The treatment group (group 1, n = 35) received a combined distrept enzymes H46A (streptokinase/streptodornase) preparation in the form of suppositories alongside standard antibacterial therapy for 12 days. The control group (group 2, n = 34) received only standard treatment. Clinical symptoms (pain intensity, hyperthermia), inflammation activity (C-reactive protein), and POH size based on ultrasound findings were evaluated at baseline (day 0), at the end of treatment (day 12), and after two weeks of follow-up (day 26).
Results. The treatment group demonstrated faster achievement of target body temperature levels, reduced inflammatory activity (as indicated by C-reactive protein levels of 8.9 ± 0.31 mg/L vs. 13.4 ± 0.41 mg/L in the control group, p < 0.001), and positive dynamics in pain syndrome across all POH localizations (p < 0.05). Ultrasound findings confirmed a more pronounced regression in POH size in the enzyme therapy group during the treatment and follow-up periods. Complete resorption of POH was observed in 46% of patients in group 1 immediately after the treatment course (day 12) and in 100% of cases at the end of the follow-up period. In group 2, target body temperature levels were achieved more slowly, and pain was more intense and prolonged. On days 12 and 26 of the study, POH persisted in 82% and 6% of patients in the control group, respectively (p < 0.05).
Conclusions. The use of local enzyme therapy with suppositories containing distrept enzymes H46A (streptokinase/streptodornase) in combination with standard antibacterial therapy demonstrated several advantages: reduced inflammatory activity, more pronounced regression of pain syndrome, increased rate of complete hematoma resorption, and a prolonged effect even after the treatment course was completed.

Clinical course of pregnancy in women undergoing assisted reproductive technologies

2026-07-03T01:34:36+03:00

Objective of the study: to investigate the course of pregnancy achieved after controlled ovarian stimulation (COS) cycles.
Materials and methods. The course of pregnancy and delivery was analyzed in 156 patients. A total of 126 patients who conceived using assisted reproductive technologies (ART) were divided into three groups: Group I included 41 women whose pregnancy was achieved by in vitro fertilization in a natural cycle; Group II included 43 patients after 1–2 COS cycles; Group III included 42 women after 3 or more COS cycles. The control group consisted of 30 patients with spontaneous pregnancies.
Depending on the pharmacological support of COS, the patients were additionally divided into subgroups: 22 patients in subgroup IIA and 21 women in subgroup IIIA did not receive additional antioxidant therapy during COS, whereas 21 women in subgroup IIB and 21 participants in subgroup IIIB received melatonin for antioxidant support.
The frequency of first-trimester complications (hemorrhagic discharge, retrochorionic hematoma, lower abdominal pain, vomiting), second-trimester complications (cervical insufficiency, threatened miscarriage), and third-trimester complications (preterm birth, preeclampsia, fetal growth restriction) was assessed in all participants.
Results. The first trimester of pregnancy after ART was characterized by a lower frequency of threatened miscarriage and retrochorionic hematoma compared with spontaneous pregnancy, which may be explained by standardized progesterone support. However, pregnancy following COS was associated with an increased frequency of hemorrhagic discharge during the first trimester, particularly after three or more COS cycles. In contrast, women after ART more frequently reported first-trimester vomiting; its incidence was higher in women after COS and increased further with multiple stimulation cycles.
Cervical insufficiency was the most common second-trimester complication, and its frequency increased with the number of COS cycles.
During the third trimester, women after ART more frequently experienced preterm delivery, with incidence increasing alongside the number of stimulation cycles. A tendency toward a higher frequency of fetal growth restriction was also observed in patients who underwent more than three COS cycles. Importantly, the administration of antioxidant therapy during COS significantly reduced the frequency of these complications.
Conclusions. Pregnancy after ART is more frequently associated with gestational complications, including early pregnancy vomiting and hemorrhagic discharge in the first trimester, cervical insufficiency in the second trimester, and preterm birth in the third trimester. The severity of these disorders increases with the number of COS cycles. The addition of antioxidant therapy to stimulation protocols was associated with a reduction in the frequency of observed obstetric complications.

Protection of patients’ rights to confidentiality and informed consent in reproductive health

2026-07-03T12:45:19+03:00

Objective of the review: to conduct a comprehensive analysis of the legal and ethical foundations for protecting patients’ rights to confidentiality and informed consent in the field of reproductive health; to identify the specific features of the legal regulation of personal medical data processing; and to examine the mechanisms ensuring the patient’s right to autonomous decision-making regarding medical interventions in the context of modern reproductive technologies and international human rights standards.

Methodology. The study employed a set of general scientific and special legal research methods, including formal legal, systemic and structural, comparative-legal, and legal analysis methods. The source base comprised the regulatory legal acts of Ukraine, international human rights and healthcare instruments, scholarly works of domestic and foreign researchers, as well as materials of law enforcement and judicial practice concerning the protection of medical confidentiality and informed consent in the field of reproductive health.

Analysis of the literature. The legal regulation of reproductive health in Ukraine and international practice establishes clear requirements for healthcare institutions and medical personnel regarding the collection, processing, storage, and protection of patients’ personal data, as well as ensuring an adequate level of informed consent. Failure to comply with these requirements may result in legal liability, adverse social consequences, and a decline in public trust in the healthcare system. This underscores the necessity of developing a comprehensive system for the protection of patients’ rights based on the integration of legislative provisions, medical protocols, ethical standards, and public policy measures aimed at enhancing the safety of medical services, increasing public legal awareness, and ensuring effective personal data protection.

Conclusions. The study of this issue made it possible to outline legal mechanisms for ensuring a balance between state interests in the healthcare sector and the personal rights of patients, as well as to identify directions for improving the regulatory framework and practical approaches to the protection of patients’ rights. This confirms the relevance of the topic for contemporary Ukrainian legislation and public policy, given its interdisciplinary nature, which combines medical law, human rights, and state regulatory practices in the field of reproductive health. The findings also highlight the need for further scholarly research, legislative activity, and the development of effective mechanisms for ensuring and protecting patients’ rights.

Manifestations of autonomic dysfunction in girls aged 6–17 years with consideration of the features of their sexual development

2026-07-03T12:06:21+03:00

Objective of the study: to investigate the manifestations of autonomic dysfunction in girls aged 6 to 17 years with physiological or disordered pubertal development.
Materials and methods. A total of 550 girls aged 6–17 years were examined. The participants were divided into three groups: Group I – 6–7 years, Group II – 8–12 years, Group III – 13–17 years. Clinical assessment of pubertal development was performed using the Tanner scale. The presence of pubertal development disorders and clinical signs of somatoform autonomic dysfunction, as well as their combinations, were analyzed.
Results. The prevalence of manifestations of somatoform autonomic dysfunction across different age groups was 72.2%. It was found that the prevalence of autonomic disorders increased with age: 3.5% in the 6–7 years group, 32.5% in the 8–12 years group, and 64% in the 13–17 years group. A considerable number of girls demonstrated a combination of symptoms forming different autonomic symptom complexes. The prevalence of autonomic dysfunction manifestations was higher in the 8–12 years group (87.4%) and the 13–17 years group (95.7%) compared to the 6–7 years group (31.1%), i.e., among girls who are already in the pubertal period, which confirms the relationship between the autonomic nervous system and the endocrine system. In girls aged 6–7 years, only one autonomic dysfunction syndrome was identified. In the 8–12 years group, 27 (20.9%) patients had a combination of two syndromes, and 12 (9.3%) had three syndromes; in the 13–17 years group, 110 (43.3%) patients had a combination of two syndromes, and 16 (6.3%) had three syndromes.
Conclusions. Іn girls with impaired timing or sequence of the appearance of secondary sexual characteristics, autonomic disorders were more frequent (90.3%) in the 8–12 years group compared to girls in the 6–7 years group, which may be associated with the synergistic regulation of the autonomic and endocrine systems and activation of the hypothalamic-pituitary-ovarian axis in girls older than 8 years. This indicates that this age period represents a risk period for the development of autonomic disorders. The overlap syndrome, in which different autonomic disorders coexist, emerges during puberty and its prevalence increases with age.

Secondary amenorrhea in adolescent girls during the war in Ukraine: a priority issue and the effectiveness of Vitex agnus-castus therapy

2026-07-03T12:38:15+03:00

Objective of the study: to determine the dynamics of menstrual function disorders in adolescent girls over the past three years of the war in Ukraine (March 2022 – March 2025), to identify secondary amenorrhea as the predominant disorder, and to evaluate the effectiveness of Vitex agnus-castus (BNO1095) monotherapy in patients with functional disorders and borderline elevated prolactin levels.
Materials and methods. A single-center prospective non-interventional observational study was conducted involving adolescent girls over the past three years (March 2022 – March 2025), with a retrospective comparative analysis of the pre-war period (2019–2021). The analysis included 358 adolescents aged 14–17 years who sought medical care for menstrual function disorders. The frequency of secondary amenorrhea and the effectiveness of Vitex agnus-castus (BNO1095) monotherapy administered for 3–6 months were analyzed separately.
In the examined girls, prolactin levels in most cases were at the upper limit of the reference range (22–23 ng/mL), which was interpreted as borderline hyperprolactinemia without signs of organic pathology, with further division into two groups - the main and control (n =179 in each). The main group was selected to evaluate the effectiveness of Vitex agnus-castus (BNO1095) as a therapeutic option for prolactin-dependent menstrual disorders.
Results. Over the three years of the war, secondary amenorrhea became the leading menstrual disorder (43.2% of cases), with a statistically significant predominance over dysmenorrhea and oligomenorrhea (p < 0.05). Vitex agnus-castus (BNO1095) monotherapy resulted in restoration of menstruation in 82.5% of cases compared to 39.6% in the control group.
Conclusions. Secondary amenorrhea has become a leading reproductive health issue among adolescents during the war. Effective restoration of menstrual function and reduction of prolactin levels can be achieved with Vitex agnus-castus (BNO1095) monotherapy, even when used off-label in adolescents; however, this approach requires confirmation in randomized controlled trials.

Non-hormonal prevention and treatment of genitourinary syndrome of menopause

2026-07-03T02:42:22+03:00

Objective of the review: to evaluate the clinical efficacy of hyaluronic acid and polycarbophil in the treatment of genitourinary syndrome of menopause (GSM).

Materials and methods. A structured literature review was conducted in accordance with the PRISMA 2020 guidelines. The search was performed in MEDLINE (PubMed), EMBASE, and Cochrane Library databases for the period 2000–2025.

Analysis of the literature. The analysis demonstrated that both hyaluronic acid and polycarbophil showed statistically significant improvement in GSM symptoms. Most studies reported a reduction in vaginal dryness and dyspareunia intensity (p < 0.001), improvement in quality of life and sexual function scores (p < 0.001), and an increase in vaginal health index values. Comparative studies did not reveal statistically significant differences between hyaluronic acid and polycarbophil, indicating their clinical equivalence in symptomatic management. At the same time, vaginal estrogen therapy demonstrates a more pronounced and sustained effect.

A key finding was the high placebo effect observed in studies of vaginal moisturizers, which complicates data interpretation and highlights the need for larger and more standardized studies. Non-hormonal therapies (hyaluronic acid and polycarbophil) provide clinically meaningful relief of GSM symptoms; however, their effect is predominantly symptomatic and is not associated with restoration of the morphological structure of the vaginal epithelium. A major limitation of current research is the discrepancy between subjective and objective outcome measures, which restricts comprehensive evaluation of therapeutic efficacy.

Conclusions. Hyaluronic acid and polycarbophil are effective non-hormonal options for the treatment of mild to moderate GSM, improving symptoms and quality of life. Although vaginal estrogen therapy remains the most effective treatment due to its impact on both symptoms and morphological changes, hyaluronic acid and polycarbophil may be considered first-line therapy in mild to moderate cases, in patients with contraindications to hormones, and in combination regimens to enhance treatment efficacy and adherence.

Adolescent pregnancy in wartime: current challenges and multidisciplinary approaches to management

2026-07-03T01:22:57+03:00

Background. Adolescent pregnancy remains one of the most complex medical and social problems in modern perinatology and reproductive health, developing against the background of biological immaturity, psychoemotional vulnerability, and social determinants of health. In the context of military conflict, this issue acquires new characteristics, as traditional risk factors are compounded by chronic stress, disrupted access to medical care, forced population displacement, and increasing social instability.
Objective of the review: to summarize current scientific data regarding the epidemiology of adolescent pregnancy, its biological and social determinants, the specific features of its course under wartime conditions, and to provide a critical analysis of approaches to the management of this category of patients.
Materials and methods. A narrative literature review was conducted using international scientometric databases (MEDLINE, PubMed, Scopus, and Web of Science), as well as materials from the World Health Organization, the United Nations Children’s Fund, the United Nations Population Fund and national guidelines. Original studies, systematic reviews, and meta-analyses were included in the analysis.
Analysis of the literature. Adolescent pregnancy is associated with an increased risk of obstetric and perinatal complications, including anemia, preeclampsia, preterm birth, and fetal growth restriction. At the same time, contemporary studies demonstrate heterogeneity of findings and indicate that a substantial proportion of these risks are determined not only by maternal age, but also by social conditions, access to healthcare, and behavioral factors. Under wartime conditions, psychoemotional mechanisms, particularly activation of the hypothalamic-pituitary-adrenal axis, as well as disruption of healthcare system functioning, play a key role.
Conclusions. Adolescent pregnancy during wartime is a complex multifactorial problem that requires reconsideration of traditional management approaches. Shifting the focus from an age-based risk model to a biopsychosocial paradigm, integrating multidisciplinary support, developing youth-friendly services, and implementing trauma-informed care principles are key directions for optimizing medical care.

Polyendocrine metabolic ovarian syndrome, the new name for polycystic ovary syndrome: a multistep global consensus process

2026-07-03T14:45:09+03:00

Polyendocrine metabolic ovarian syndrome (PMOS), previously named polycystic ovary syndrome (PCOS), affects one in eight women. However, the term PCOS is inaccurate, implying pathological ovarian cysts, obscuring diverse endocrine and metabolic features, and contributing to delayed diagnosis, fragmented care, and stigma, while curtailing research and policy framing. Building on an international mandate for change, we outline an unprecedented, rigorous, multistep global consensus process for the name change. Funding and governance were established with engagement of 56 leading academic, clinical, and patient organisations. Using iterative global surveys (with responses from 14 360 people with PCOS and multidisciplinary health professionals from all world regions), modified Delphi methods, nominal group technique workshops, and marketing and implementation analyses, we identified principles prioritising scientific accuracy, clarity, stigma avoidance, cultural appropriateness, and implementation feasibility. An accurate new name was prioritised over retaining the PCOS acronym or a generic name. Implementation approaches prioritised evolution rather than transformation. Preferred terms were polyendocrine, metabolic, and ovarian, reflecting the condition’s multisystem pathophysiology, and polyendocrine metabolic ovarian syndrome was the consensus new name. Accuracy was improved by omitting cysts and by capturing endocrine, metabolic, and ovarian dysfunction. A co-designed global implementation strategy, including a transition period, education, and alignment with health systems and disease classification, is under way.