REPRODUCTIVE ENDOCRINOLOGY

Angiogenesis factors and hormonal changes in the first half of pregnancy in patients after controlled ovulation stimulation

2026-04-17T16:59:04+03:00

Objective of the study: to evaluate the dynamics of early pregnancy hormones and angiogenesis markers in pregnant women after controlled ovarian stimulation (COS).

Materials and methods. 156 patients were divided into 4 groups: Group I – 41 pregnant women who became pregnant after in vitro fertilization (IVF) in a natural cycle, Group II – 43 pregnant women after 1–2 cycles of COS, Group III – 42 pregnant women after 3 or more cycles of COS. 22 patients of subgroup IIA and 21 patients of subgroup IIIA did not receive additional treatment by COS, 21 pregnant women of subgroup IIB and 21 patients of subgroup IIIB were prescribed melatonin to achieve an antioxidant effect. 30 healthy pregnant women with spontaneous pregnancy formed the control group. In all pregnant women at 11–13 weeks, the serum levels of progesterone, estradiol, β-human chorionic gonadotropin (β-hCG), vascular endothelial growth factor A (VEGF-A), placental growth factor (PLGF), soluble fms-like tyrosine kinase receptor (sFlt-1) were determined.

Results. Patients in all groups had no differences in progesterone concentrations, which can be explained by the administration of progesterone as part of implantation support. The estradiol content at the end of the first trimester of pregnancy was lower in patients receiving COS cycles than in women with spontaneous pregnancy, and the β-hCG levels were significantly higher. Such hormonal changes are associated with a higher risk of pregnancy loss. VEGF-A at the transition between the first and second trimesters of pregnancy demonstrates an increase in pregnant women with 3 or more COS cycles, which indicates excessive antiangiogenic activity. PLGF, on the contrary, showed a reduced content in this subgroup of women, which may be the cause of incomplete trophoblast invasion and associated gestational complications. Patients who simultaneously with COS took an antioxidant drug, in terms of the concentration of early pregnancy hormones and angiogenic factors, did not differ from women with spontaneous pregnancy.

Conclusions. Patients who underwent COS within the IVF had signs of functional chorion insufficiency, namely reduced concentration of estradiol and increased content of β-hCG. Pregnant women with 3 or more cycles of COS at the end of the first trimester of pregnancy had a higher level of VEGF-A than women with spontaneous pregnancy, as well as a lower concentration of PLGF. The appointment of antioxidant therapy within the IVF leads to an increase in estradiol, a decrease in β-hCG. Antioxidant therapy in pregnant women with 3 or more cycles of IVF allows to reduce the level of VEGF-A and increase the PLGF content.

Features of assessing the condition of pregnant women with parathyroid adenoma

2026-04-17T17:14:32+03:00

The relevance of this topic lies in the lack of reliable statistical data in available literature regarding the incidence of parathyroid gland disorders in pregnant women and

the differences in diagnosis and therapy during pregnancy versus outside of pregnancy. A physician’s knowledge of the physiological changes that occur in a woman’s

body during pregnancy, including mineral metabolism and endocrine gland function, facilitates accurate and timely differential diagnosis between parathyroid tumors, physiological processes, and symptoms of gestational complications.

Differential diagnosis of parathyroid pathology from gestational processes at various stages of pregnancy is complex. Timely detection of parathyroid pathology is particularly important at the stage of pregnancy planning. Differential diagnosis of parathyroid adenoma is carried out in comparison with gestational processes, including gestational complications such as nausea and vomiting in pregnant women. Late diagnosis of clinical manifestations of parathyroid pathology in pregnancy can lead to severe consequences for both the mother and the fetus. For this reason, in clinical practice, timely detection of parathyroid pathology during the pregnancy planning stage is essential.

Examination of pregnant women and determination of therapeutic interventions should be multidisciplinary, personalized, and include measurement of blood levels of thyroid-stimulating hormone, vitamin D, calcium, magnesium, phosphorus, and parathyroid hormone.

Therapeutic options for hyperparathyroidism in pregnant women are limited. A personalized and multidisciplinary approach is essential in each individual case. Women with parathyroid tumors require individualized, qualified monitoring during both the early and late postpartum periods and during lactation, as there is always a risk of hypercalcemia. Administration of vitamin D should be carried out under laboratory control of its blood levels in pregnant women and should be personalized, taking into account the gestational age.

In newborns of mothers with parathyroid tumors, it is necessary to monitor calcium levels in both blood and urine.

Criminal and legal responses to violations of bioethical standards in medicine: challenges for legal policy in the 21st century

2026-04-18T04:51:32+03:00

Background. The article proves that the relevance of the topic is due to the rapid development of biomedicine, the introduction of the latest medical technologies, the expansion of clinical trials, transplantology, assisted reproductive technologies, and the use of artificial intelligence in medicine, which significantly complicates the task of ensuring an appropriate balance between scientific progress, the protection of human rights, and public interests. In such conditions, violations of bioethical standards acquire not only medical and legal significance, but also criminal significance.

Objective of the review: to provide a comprehensive scientific and legal analysis of the mechanisms of criminal law response to violations of bioethical standards in the field of medical practice, taking into account the current challenges and trends in the development of legal policy in the 21st century, as well as to develop theoretically sound and practically oriented recommendations for improving criminal legislation and law enforcement practices in this area.

Analysis of literary data. The materials of the study are based on a methodological foundation formed by an integrated system of general scientific, special legal and interdisciplinary methods of scientific knowledge, the use of which is determined by the complexity of the problems of criminal law response to violations of bioethical standards in the field of medical practice. Particular attention is paid to the analysis of criminal offenses related to illegal medical interventions, violations of the procedure for conducting clinical trials, organ and tissue transplantation, manipulation of reproductive material, as well as forced or uninformed medical procedures. The need for improving criminal legislation and law enforcement practices, taking into account bioethical approaches, international standards, and the modern challenges of the 21st century, is justified.

Conclusions. It is summarized that the effectiveness of criminal law response to violations of bioethical standards can be ensured only under the conditions of implementation of a comprehensive legal policy that provides for a combination of preventive tools, coherent regulatory frameworks, and guaranteed protection of the rights and legitimate interests of both patients and medical professionals.

Menopause, immunity, and autoimmune rheumatic diseases – pathogenetic intersections and clinical implications

2026-04-18T03:07:50+03:00

Menopause is a physiological stage in a woman’s life characterized by permanent ovarian failure and sustained estrogen deficiency, leading to systemic endocrine, metabolic, and immunological changes. Declining estrogen levels are associated with the development of a pro-inflammatory immune phenotype, immunosenescence, and disruption of the delicate balance between innate and adaptive immunity. These mechanisms are highly relevant to autoimmune and rheumatic diseases, as menopause may modify disease expression, clinical manifestations, and long-term complications rather than acting solely as a chronological event.

Estrogens play a central role in regulating macrophage function, T- and B-cell responses, cytokine production, and immune tolerance. Estrogen deficiency promotes a shift toward Th1- and Th17-driven immune responses, reduction of regulatory T cells, and enhanced activity of pro-inflammatory mediators. In parallel, age-related immune remodeling, including epigenetic alterations, may further amplify chronic inflammation and contribute to cumulative organ damage.

In patients with rheumatoid arthritis and systemic scleroderma, menopause is more often associated with poorer functional outcomes and an increased risk of vascular complications, whereas postmenopausal lupus erythematosus usually has a milder clinical course. Sjögren’s disease has a peak incidence in the perimenopause, indicating a significant role for estrogen deficiency in exocrine gland damage.

Menopause also has a profound impact on the musculoskeletal system, accelerating bone loss and increasing the risk of osteoporosis and fragility fractures, particularly in women with chronic inflammatory conditions. These effects result from the combined influence of estrogen deficiency, immune dysregulation, and persistent low-grade inflammation.

Menopausal hormone therapy may be considered in patients with rheumatic diseases to alleviate symptoms related to estrogen deficiency within an individualized risk–benefit framework. In particular, menopausal hormone therapy helps reduce musculoskeletal pain, improve a woman’s well-being and quality of life, alleviate urogenital symptoms in patients with Sjögren’s disease, and reduces the frequency of exacerbations and the risk of developing ACPA-positive rheumatoid arthritis.

Nutritional support for women’s health under chronic stress (micronutrient supplementation)

2026-04-18T04:07:30+03:00

Background. Women’s reproductive health is highly vulnerable to nutritional deficiencies, which are exacerbated under crisis conditions. Despite the evident role of nutrients, integrated strategies for personalized nutritional correction are still lacking in domestic gynecological practice.

Objective of the review: to substantiate the role of micronutrient status in maintaining the adaptive potential of women under chronic stress conditions and to identify strategies for personalized nutritional management.

Materials and methods. A systematic review of the literature (PubMed and Google Scholar databases) on the nutritional status of women published from March 2015 to March 2025 was conducted. A narrative review and comparative analysis of the biological value of foods were used.

Analysis of literature data. Based on the literature review, it was found that 70–80% of women worldwide suffer from multiple vitamin deficiencies. Studies on iodine and selenium demonstrate their fundamental role not only in thyroid homeostasis but also in the prevention of estrogen-dependent breast diseases.

Under chronic stress conditions, adequate intake of magnesium and zinc is critical for modulation of the nervous and immune systems, as well as metabolic status. Even with a conscious approach to nutrition, modern women face the problem of the “phytate barrier” and low bioavailability of iron. Under conditions of internal displacement and economic instability, the diet often becomes monotonous (predominantly grain-based). This explains why iron deficiency anemia remains an epidemic problem despite the availability of food products. Stress closes a vicious circle: nutrient deficiencies lower the threshold of stress resilience, and each new stressful event further depletes micronutrient stores.

Conclusions. The implementation of integrated supplementation strategies using multivitamin and mineral complexes is a necessary step to preserve women’s reproductive and somatic health under chronic stress.

Cervical cancer screening from the perspective of a family doctor

2026-04-17T18:17:12+03:00

Objective of the review: to determine the role of the family physician in the prevention of cervical cancer and to assess potential barriers and prospects for this role; to examine the possibilities of integrating artificial intelligence into the evaluation of liquid-based cytology results; and to assess the potential effects of implementing innovative technologies in cervical screening methods.

Materials and methods. Bibliographic-semantic and analytical methods were applied. The search for relevant sources was conducted in international scientometric databases (PubMed, Scopus, Web of Science, DOAJ) covering publications from 2016 to 2026.

Analysis of literature data. Most women in target groups eligible for cervical screening have a general awareness of human papillomavirus but underestimate its leading role in the development of cervical cancer. As a result, they tend to avoid participation in screening programs for various reasons (logistical, communicational, financial, etc.). An additional factor is insufficient awareness and limited engagement of physicians regarding the possibilities of addressing these barriers. Among the competencies of the family physician (and primary care in general), proactive monitoring and organization of priority target groups are particularly important.

It is also worth noting that the possibility of patient self-sampling significantly facilitates the screening process and increases coverage. Another important aspect is the quality of laboratory diagnostics. There is evidence of a higher frequency of errors due to specialist fatigue resulting from a large volume of repetitive work. Given the rapid development of artificial intelligence, which has achieved a high level of accuracy in the analysis of typical visual patterns, it becomes possible to involve specialists primarily in ambiguous or complex cases, thereby improving the overall quality of diagnostics.

Conclusions. The development and implementation of an effective organizational and functional model of primary healthcare (especially involving general practitioners – family physicians) should be a priority under conditions of limited healthcare resources. This will make it possible to increase coverage, improve population adherence to preventive care, and enhance the credibility of healthcare professionals. This, however, will not be possible without adequate education (including training in communication and social interaction) of healthcare providers. The integration of artificial intelligence with liquid-based cytology reduces the risk of missing precancerous conditions, improves the quality of results, and builds trust in screening outcomes not only among women but also within the population as a whole.

Prevention of recurrence of uterine leiomyoma and endometriosis with coexisting disease in women of reproductive age after surgical treatment

2026-04-18T02:14:40+03:00

Objective of the study: to evaluate the effectiveness of a medication containing a gonadotropin-releasing hormone antagonist, estradiol, and norethisterone (Rieko) in the postoperative period after surgical treatment of women of reproductive age with comorbidity of uterine leiomyoma and endometriosis in order to prevent recurrence of the disease.

Materials and methods. The study included 49 women aged 26 to 45 years with a combination of uterine leiomyoma and endometriosis. 21 patients received the medication Rieko in the postoperative period starting from the first day of the menstrual cycle for the prevention of recurrence during three menstrual cycles (the main group). 28 patients in the postoperative period did not receive treatment with hormonal medications (comparison group). All patients underwent surgical laparoscopy or laparotomy via the Pfannenstiel approach under endotracheal anesthesia. Conservative myomectomy, removal of ovarian endometriomas, and/or vaporization or excision of endometrioid heterotopias on the pelvic organs were performed during laparoscopy or laparotomy.

Results. Examination of patients after treatment showed that severe and moderate pain was observed only in 4.8% of women in the main group, which was almost three times less than in the comparison group and almost 19 times less than before surgical treatment. Dysmenorrhea was reported three times less frequently by patients in the main group. Abnormal uterine bleeding and significant blood loss ceased in the main group, in the comparison group they were observed in 17.9% of women (p < 0.05). Assessment of the psychoemotional state of the participants three months after treatment indicated an increase in the overall level of indicators in 95.2% of patients who received hormonal therapy.

Conclusions. Timely administration of the medication Rieko in the postoperative period in women of reproductive age with comorbidity of uterine leiomyoma and endometriosis improves the psychoemotional state, reduces clinical manifestations of the disease, and prevents recurrence.

Resolution of the VII International Forum of Experts on Menopausal Hormone Therapy

2026-04-17T15:39:42+03:00

The VII International Forum of Experts on Menopausal Hormone Therapy (MHT) was held in Kyiv on November 18, 2025. The modern approach to the MHT prescription is not to resolve the issue of its appropriateness, but to choose the optimal form for a particular woman. Different routes of hormone administration have different pharmacokinetic properties and effects on metabolism, the coagulation system, and women’s somatic health. The recommendations of the European Menopause and Andropause Society emphasize the appropriateness of using combined MHT to improve the glycemic profile and delay the development of diabetes mellitus, with a preference for metabolically neutral progestogens – progesterone and dydrogesterone.
Transdermal estrogens enter the systemic circulation directly, minimizing the effect on the liver and coagulation, which makes them the method of choice for women with an increased risk of venous thrombosis, obesity, or hypertriglyceridemia. At the same time, the effectiveness of transdermal MHT is characterized by significant interindividual variability.
MHT is an effective antiresorptive method for the prevention of osteoporosis and fractures. Clinical studies demonstrate a significant increase in bone mineral density and a reduction in the risk of fractures with the use of MHT, particularly the combination of estradiol and dydrogesterone. Timely initiated MHT (within the first 10 years after menopause) is also associated with a decrease in all-cause mortality, cardiovascular complications, and neurodegenerative diseases. The individual choice of the form of MHT is a key factor in its safety and clinical efficacy.
Particular attention should be paid to oncological safety, particularly the risk of breast cancer, when selecting MHT in patients using a levonorgestrel-releasing intrauterine system. Data from systematic reviews and meta-analyses indicate that the use of estrogens does not increase this risk, while it largely depends on the type of progestogen. Progesterone and dydrogesterone have the most favorable safety profile for the breast compared with synthetic gestagens, which is confirmed by the results of large-scale studies.
Psychoemotional and sexual disorders (anxiety, depression, sleep disorders, and decreased libido) are common in perimenopause and are largely due to systemic estrogen deficiency, which affects neurometabolic, vascular, and neuroendocrine homeostasis. The high frequency of these disorders justifies the need for comprehensive diagnostic assessment and individualized MHT in perimenopausal women.

Endometriosis and menopausal health: аn European Menopause and Andropause Society clinical guide – 2025

2026-04-18T05:24:08+03:00

Introduction. Endometriosis is a common gynecological condition, and problems may persist or develop after the menopause. Endometriosis or its treatment in premenopausal women may lead to premature or early menopause. Thus, it is imperative that healthcare providers are appropriately trained in management of endometriosis at the menopause and beyond.

Aim: to provide an evidence-based clinical guide for the assessment and management of menopausal health in women with a history of endometriosis.

Materials and methods. Review of the literature and consensus of expert opinion.

Summary recommendations. Surgery is the preferred option for managing symptomatic endometriosis after the menopause, as it should reduce pain, ensure an accurate diagnosis, and decrease risk of malignancy. Women with endometriosis may experience a spontaneous early menopause or surgically induced menopause. Endometriosis is also associated with an increased risk of cardiovascular disease, ovarian, breast, and thyroid cancers, as well as osteoporosis.

Menopausal hormone therapy (MHT) is indicated for managing vasomotor and genitourinary symptoms and maintaining bone health. Continuous combined MHT may be safer than other forms in both hysterectomized and non-hysterectomized women with endometriosis as the risk of recurrence and malignant transformation of residual endometriosis may be reduced. Estrogen-only MHT should be avoided, even for women who have had a hysterectomy. For women not using MHT, alternative pharmacological treatments, such as neurokinin-3 receptor antagonists, should be considered for managing vasomotor symptoms. Additionally, antiresorptive and anabolic therapies, along with calcium and vitamin D supplementation, should be provided as indicated to ensure skeletal protection. If endometriosis recurs during MHT use and the patient is symptomatic, several management strategies may be employed: altering the regimen, discontinuation, and use of non-hormonal strategies. Herbal preparations should be avoided as their efficacy is uncertain and some may contain estrogenic compounds.

An update to the American Cancer Society cervical cancer screening guideline – 2025

2026-04-18T05:29:44+03:00

This update expands the 2020 American Cancer Society (ACS) cervical cancer screening guideline for average-risk women and individuals with a cervix who are at average risk, to include self-collection for human papillomavirus (HPV) testing and revised guidance for exiting cervical cancer screening.

Self-collected vaginal specimens, a method of primary HPV testing, align with the ACS cervical cancer screening guideline. When clinician-collected cervical specimens are used for HPV testing, repeat screening is recommended every 5 years for those with a negative test.

For self-collected vaginal specimens, the ACS endorses the following recommendations:

Primary HPV screening using clinician-collected cervical specimens is preferred, and self-collected vaginal specimens are acceptable for average-risk individuals aged 25–65 years;
Repeat testing in 3 years is recommended after a negative result on a self-collected HPV screening test.

These recommendations apply only to combinations of collection devices and HPV assays approved by the US Food and Drug Administration for HPV testing in a clinical setting or at home. The rationale notes that the use of self-collected vaginal specimens can overcome barriers to screening for many patients, but most patients who test HPV-positive will require extra follow-up steps, and data on long-term, real-world effectiveness are limited. For certain high-risk individuals, clinician-collected samples are still recommended.

Furthermore, in response to high rates of cervical cancer among individuals older than 65 years and with poor implementation of current exiting screening criteria, ACS has amended the 2020 guideline to recommend HPV testing at ages 60 and 65 years, with the last HPV test at an age no younger than 65 years as a requisite to exiting screening.

The revised recommendation states: To qualify for discontinuation of screening, the ACS recommends an average-risk woman with a cervix at average risk have negative primary HPV tests (preferred) or negative co-testing using HPV tests and cytology (acceptable) at ages 60 and 65 years. If primary HPV tests or co-testing are not available, three consecutive negative cytology (Papanicolaou) tests at the recommended screening interval with the last test at age 65 years are acceptable. If self-collected vaginal specimens are used for HPV testing, the 3-year testing interval should be followed. Additional screening exit stipulations relate to women at higher risk because of prior abnormal test results or current immune suppression.

Preconception preparation of women with removed fallopian tubes due to hydrosalpinx long before initiation of cycles of assisted reproductive technologies

2026-04-17T18:03:59+03:00

Background. Some women with hydrosalpinx undergo isolated salpingectomy at a stage when they have not yet started a family and are not planning pregnancy in the near future. When such patients are referred for assisted reproductive technologies (ART) a long time after surgery, changes in the cervicovaginal microbiota, imbalance of reproductive hormones, signs of oxidative stress and chronic endometritis are often detected.

Objective of the study: to evaluate the effectiveness of the proposed comprehensive preconception preparation in women who underwent salpingectomy for hydrosalpinx long before the initiation of ART cycles.

Materials and methods. A total of 128 women with isolated salpingectomy for hydrosalpinx long before the start of ART programs were examined. The main group underwent preconception preparation according to the author’s method, and the comparison group received preparation according to standard protocols. The control group consisted of 34 healthy women who entered ART cycles due to male-factor infertility of non-inflammatory origin.

The proposed preconception preparation included: extended diagnostics of the state of the cervicovaginal microbiota; assessment of free radical oxidation and antioxidant defense; immunohistochemical determination of CD138+ expression in endometrial samples; and a complex of therapeutic and preventive measures, which included restoration of the cervicovaginal microbiota, cyclic hormone therapy, the use of combined antioxidant-vitamin and nutraceutical agents, as well as targeted treatment of chronic endometritis.

Results. The use of comprehensive preconception preparation according to the author’s method contributed to the normalization of gonadotropic regulation and an increase in the levels of major steroid hormones. At the same time, a decrease in the intensity of free radical oxidation, an improvement in the state of antioxidant defense, regression of inflammatory changes in the endometrium, as well as a significant increase in the cumulative pregnancy rate and live birth rate were noted.

Conclusions. Personalized preconception preparation is appropriate and effective in women with removed fallopian tubes due to hydrosalpinx, even if salpingectomy was performed long before the initiation of ART cycles.

Abnormal uterine bleeding and hypermenstrual syndrome: new clinical horizons

2026-04-17T17:30:19+03:00

Objective of the study: to evaluate the clinical effectiveness of combined non-hormonal therapy in women of reproductive age with heavy menstrual bleeding (hypermenstrual syndrome), specifically assessing the impact of adding the herbal medicinal product Tazalok to symptomatic treatment with tranexamic acid on menstrual blood loss volume, bleeding duration, iron metabolism parameters, neurovegetative status, and quality of life.

Materials and methods. A prospective comparative clinical study included 100 women of reproductive age diagnosed with abnormal uterine bleeding of the heavy menstrual bleeding type. Participants were divided into two equal groups (n = 50 each). Group I received tranexamic acid during menstruation. Group II received tranexamic acid according to the same regimen combined with the Tazalok. Assessments were performed at baseline and after 1, 2, and 3 months of therapy. Menstrual blood loss was quantified using the Pictorial Blood Loss Assessment Chart (PBAC), and bleeding duration was recorded in days. Laboratory evaluation included hemoglobin, ferritin, follicle-stimulating hormone, luteinizing hormone, estradiol, progesterone, prolactin and cortisol levels. Neurovegetative and psychoemotional symptoms (headache, sleep disturbances, emotional lability, anxiety, tearfulness, fatigue) were assessed before and after treatment.

Results. During the three-month follow-up, both groups demonstrated a significant reduction in menstrual blood loss and bleeding duration compared with baseline (p < 0.05). After three months, mean blood loss decreased to 86.3 ± 7.7 mL in Group I and 63.4 ± 5.1 mL in Group II, with significantly lower values in the combined therapy group (p = 0.017). Bleeding duration shortened to 6.3 ± 0.25 days and 5.2 ± 0.21 days, respectively, with between-group differences becoming significant from the first month of treatment (p = 0.0045) and persisting thereafter (p = 0.0014). In Group II, the rate of complete symptom resolution was higher for hypermenorrhea (54% vs 36%), metrorrhagia (48% vs 40%), and intermenstrual bleeding (40% vs 32%), while the proportion of cases without clinical improvement was lower (4–6% vs 10.0–14% in Group I).

Improvement in iron metabolism accompanied the reduction in blood loss: hemoglobin and ferritin levels increased. The combined therapy group also demonstrated more pronounced favorable hormonal changes, including increased progesterone levels and decreased prolactin and cortisol concentrations (p < 0.05), along with a greater reduction in neurovegetative and psychoemotional symptoms.

Conclusions. Combined non-hormonal therapy with the addition of the herbal medicinal product Tazalok to tranexamic acid provides faster and more pronounced control of heavy menstrual bleeding, better restoration of hemoglobin and ferritin levels, favorable neuroendocrine modulation, and greater improvements in neurovegetative and psychoemotional symptoms compared with symptomatic therapy alone.

Modern approaches to the treatment of endometrial polyps considering age-related and morphological-functional aspects

2026-04-17T17:56:52+03:00

Objective of the study: to evaluate the effectiveness of treatment of endometrial polyps (EP) in women taking into account age-related and morphological and functional aspects.

Materials and methods. A total of 116 women with EP were under our observation and were divided into two groups. Group I included 54 women of late reproductive age (35–45 years); Group II consisted of 62 patients of perimenopausal age (45–55 years). The diagnosis of EP was verified according to the data of clinical, instrumental, and morphological methods of investigation. For the prevention of EP recurrence, patients with glandular and glandular–fibrous polyps received dienogest at a dose of 2 mg per day for 6 months in a continuous regimen. The effectiveness of the therapy was evaluated on the basis of clinical and instrumental data and the results of pipelle biopsy after 6 months and twice during follow-up at three-month intervals.

Results and discussion. All women underwent hysteroresectoscopy with pathomorphological examination of the obtained material to verify the diagnosis. In women of reproductive age, glandular and glandular-fibrous polyps prevailed (87.0%). In perimenopausal patients, fibrous and glandular-fibrous polyps were dominant (56.4%). Adenomatous polyps were more common in perimenopausal patients – 12.9% and 9.2%, respectively.

Evaluation of the effectiveness of progestogen therapy after 6 months showed that, according to ultrasound examination, EP were not detected in any woman in either group. During further follow-up three and 6 months after treatment, EP were detected by ultrasound examination in three patients (6.3%) of late reproductive age and in one woman (3.3%) of perimenopausal age. The diagnosis was confirmed by repeat hysteroscopic resection and histological examination.

Conclusions. Long-term continuous anti-relapse therapy with dienogest in a group of women of late reproductive and in a group of perimenopausal age demonstrated high efficacy and reduced the recurrence rate of EP to 6.3% and 3.3% of cases, respectively.